[Systemic coronary surgery in the beating heart. Experience in 250 cases].
OBJECTIVE
To report our recent experience with off-pump coronary artery revascularization in multi-vessel disease.


METHODS
Between October 1996 and August 1998, 250 off-pump (OP) procedures were completed at the Montreal Heart Institute, representing more than 90% of all procedures done during the same time frame (97% for 1998). These patients have been compared to 1870 patients operated upon under cardiopulmonary bypass during the years 1995-1996 (CPB).


RESULTS
Mean age, sexe distribution, and preoperative risk factors were comparable for both groups. On average 2.89 +/- 0.8 and 2.84 +/- 0.6 grafts/patient were completed in OP and CPB groups respectively. A majority (70%) of patients had either a triple or quadruple bypass. Coronary anastomoses were achieved with myocardial mechanical stabilization and heart "verticalization". Ischemic time was shorter in the OP group (29.8 +/- 0.9 vs 45 +/- 0.4 min, p < 0.05). Similarly, need for transfusion was significantly less (OP: 34 vs CPB: 66%, p < 0.005). Use of postoperative intra-aortic counterpulsation as well as the raise of CK-MB were lesser in the OP group. Operative mortality (OP: 1.6%, vs CPB: 2%, p = ns) and perioperative myocardial infarction rate (OP: 3.6% vs CPB: 4.2) were comparable for both groups.


CONCLUSIONS
Off-pump complete coronary artery revascularization is an acceptable alternative to conventional surgery in a majority of patients with good results given progressive experience, rigorous technique, and adequate coronary artery stabilization.
Cartier
R
R
Département de Chirurgie Cardiaque (chirurgien cardiovasculaire, Institut de Cardiologie de Montréal, Québec, Canada.
Bouchard
D
D
Martineau
R
R
Couturier
A
A
D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D003250:Constriction; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000097:blood / Q000201:enzymology / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D017678:Sex Distribution; D013997:Time Factors; D016896:Treatment Outcome
D007527:Isoenzymes; D003402:Creatine Kinase
La chirurgie coronarienne systématique à coeur battant. Expérience de 250 cas.