title: Coronary artery bypass surgery without cardioplegia: hospital results in 8515 patients†.
abstract: OBJECTIVE
  Cardioplegic myocardial protection is used in most cardiac surgical procedures. However, other alternatives have proved useful. We analysed the perioperative results in a large series of patients undergoing coronary artery bypass (CABG) using cardiopulmonary bypass (CPB) and non-cardioplegic methods.
  
  
  METHODS
  From January 1992 to October 2013, 8515 consecutive patients underwent isolated CABG with CPB without cardioplegia, under hypothermic ventricular fibrillation and/or an empty beating heart. The mean age was 61.9 ± 9.5 years, 12.4% were women, 26.3% diabetic, 64% hypertensive; and 9.6% had peripheral vascular disease, 7.8% cerebrovascular disease and 54.3% previous acute myocardial infarction (AMI). One-third of patients were in Canadian Cardiovascular Society Class III/IV. Three-vessel disease was present in 76.5% of the cases and 10.9% had moderate/severe left ventricle (LV) dysfunction (ejection fraction <40%). A multivariate analysis was made of risk factors associated to in-hospital mortality and three major morbidity complications [cerebrovascular accident, mediastinitis and acute kidney injury (AKI)], as well as for prolonged hospital stay.
  
  
  RESULTS
  The mean CPB time was 58.2 ± 20.7 min. The mean number of grafts per patient was 2.7 ± 0.8 (arterial: 1.2 ± 0.5). The left internal thoracic artery (ITA) was used in 99.4% of patients and both ITAs in 23.1%. The in-hospital mortality rate was 0.7% (61 patients), inotropic support was required in 6.6% and mechanical support in 0.8, and 2.0% were re-explored for bleeding and 1.3% for sternal complications (mediastinitis, 0.8%). AKI, the majority transient, occurred in 1595 patients (18.9%). The incidence rates of stroke/transient ischemic attack (TIA) and acute myocardial infarction (AMI) were 2.6 and 2.5%, respectively, and atrial fibrillation/flutter occurred in 22.6% of cases. Age, LV dysfunction, non-elective surgery, previous cardiac surgery, peripheral vascular disease and CPB time were independent risk factors for mortality and major morbidity. The mean hospital stay was 7.2 ± 5.7 days.
  
  
  CONCLUSIONS
  Isolated CABG with CPB using non-cardioplegic methods proved very safe, with low mortality and morbidity. These methods are simple and expeditious and remain as very useful alternative techniques of myocardial preservation.
authors.affiliation: Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal.
authors.forename: Pedro E
authors.initials: PE
authors.lastname: Antunes
authors.affiliation: Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Ferrão de Oliveira
authors.affiliation: Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal.
authors.forename: David
authors.initials: D
authors.lastname: Prieto
authors.affiliation: Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal.
authors.forename: Gonçalo F
authors.initials: GF
authors.lastname: Coutinho
authors.affiliation: Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Correia
authors.affiliation: Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Branco
authors.affiliation: Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine of Coimbra, Coimbra, Portugal antunes.cct.chuc@sapo.pt.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Antunes
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Hypothermic ventricular fibrillation; Myocardial protection; Non-cardioplegic techniques; On-pump heart beating; Outcomes