[Myocarcial revascularisation without extracorporeal circulation: current indications, surgical technique and results].
BACKGROUND
This study was undertaken to assess our experience of the evolution, over time, of beating heart surgery in the Cardiologic Center Foundation Monzino.


METHODS
From March 1995 to June 2000, 506 patients underwent myocardial revascularization on beating heart: 313 until May 1999, and 193 between June 1999 and June 2000, after the advent of coronary artery stabilizers and shunts, to keep the surgical field bloodless, with minimal motion and continuous myocardial perfusion. Surgical accesss was via a median sternotomy for 408 cases and via a left anterior thoracotomy for 98 cases.


RESULTS
The indications by choice increased, from I to II period, from 61% to 83% with special situations in which patients had three-vessel coronary artery disease raised from 33% to 50%, concerning also bypass grafts performed on circumflex artery and right coronary increased. Postoperative mortality in hospital decreased from 1.3% to 0.5% and perioperative IMA (acute myocardial infarction) from 3.8% to 0.5% in patients undertaken to median thoracotomy. Hospital stay decreased from 8 to 7 days about [no significant differences with patients who underwent CPB (cardiopulmonary bypass)]; in patients who underwent to MTS (left anterior minithoracotomy) there was no deaths, IMA decreased from 3.9% to 0% and hospital stay from 6 to 5 days. Grafts patency increased from 92.3% to 100%.


CONCLUSIONS
To perform completed revascularisations is possible now even on the beating heart, and also to make precise anastomosis as on pump CABG, in a reproducible and easy way. The beating heart procedure, that is also more economical, might be expanded to all patients, not only high risk patients.
Zanobini
M
M
Servizio di Chirurgia Cardiaca, Centro Cardiologico Fondazione I. Monzino, Università degli Studi, Milan, Italy. zanobini@lycosmail.com
Mantovani
A
A
Cannata
A
A
Pompilio
G
G
Polvani
G L
GL
Parolari
A
A
Alamanni
F
F
Agrifoglio
M
M
Biglioli
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000706:statistics & numerical data
La rivascolarizzazione coronarica senza circolazione extracorporea. Indicazioni attuali, tecnica chirurgica e risultati.