Surgical myocardial revascularization (CABG) in patients with pulmonary disease: beating heart versus cardiopulmonary bypass.
BACKGROUND
Adverse effects on the respiratory system can be severe in many instances after coronarv artery bypass grafting (CABG) with cardiopulmonary bypass (CPBP). Recently, operative techniques without CPBP have gained widespread consent, thanks to the newly developed retractors that allow satisfactory immobilisation of the surgical field.


METHODS
Thirty-seven patients operated upon in our Institution between April 1997 and April 1998 showed an obstructive and/or restrictive pulmonary disease. Twenty-one patients were operated on without CBPB (group A), while 16 patients were operated using CPBP (group B, control). The allocation in each group had been randomised.


RESULTS
The length of the operation in group A was less than in group B (196+/-35 minutes vs 235+/-60 minutes), (p=0.014). A significant difference was found in postoperative bleeding: 562+/-381 ml vs 776+/-378 (p=0.046), in postoperative red cell count, hemoglobin level and Hct. Permanence on the ventilator was 19.1+/-13 hours in group B and 13.1+/-6.1 hours in group A (p=0.03). The length of stay in ICU was significantly different: 33.8+/-16.2 hours for group A vs 53.6+/-29.3 hours for group B (p=0.01). No respiratory failure occurred in group A; two patients experienced slow weaning from ventilation assistance and one died from that complication in group B.


CONCLUSIONS
Myocardial revascularization without CPBP allows a better postoperative clinical course in patients with advanced pulmonary disease.
Covino
E
E
Department of Cardiac Surgery, Medical School, University Federico II, Naples, Italy.
Santise
G
G
Di Lello
F
F
De Amicis
V
V
Bonifazi
R
R
Bellino
I
I
Spampinato
N
N
D016063:Blood Loss, Surgical; D002245:Carbon Dioxide / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000150:complications; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications; D012121:Respiration, Artificial; D012140:Respiratory Tract Diseases / Q000097:blood / Q000150:complications / Q000628:therapy; D013997:Time Factors
D006454:Hemoglobins; D002245:Carbon Dioxide; D010100:Oxygen