R Cartier1. 1. Department of Cardiac Surgery, Montreal Heart Institute, Quebec, Canada. cartierr@icm.umontreal.ca
Abstract
BACKGROUND: The author reports his short-term experience with systematic off-pump coronary artery revascularization in multivessel disease. METHODS: Between September 1996 and October 1998, 275 off-pump revascularizations (83% of case load during this period; 97% since January 1998) were performed by a single surgeon (R.C.). The patient base of 216 men/59 women averaged 63 +/- 10 years. Main indication was unstable angina (60%). All surgeries were performed through a median sternotomy, with mechanical stabilization, and a heart "verticalizing" technique to enable access to the circumflex territory. RESULTS: An average of 2.91 +/- 0.83 (range 1 to 5) grafts/patient was achieved, with 70% of cases being triple or quadruple bypasses. Single or double internal thoracic arteries was utilized in 95% of cases. Complete revascularization was attained in 93% of surgeries. Total ischemic time averaged 28 +/- 10 (range 8 to 65) minutes. Myocardial infarction incidence was 4%, with only 1 patient requiring postoperative aortic counter-pulsation assistance. One early percutaneous transluminal coronary angioplasty was needed to restore an occluded posterior descending artery. Three operative deaths resulted. One conversion to cardiopulmonary bypass was required. A transfusion rate of 32% was observed, half the rate of conventional coronary artery bypass grafting at our institute. CONCLUSIONS: With gradual experience, proper operative technique, and surgical apparatus, beating heart bypass surgery may be used systematically as a suitable, safe alternative to conventional on-pump coronary artery bypass grafting, permitting complete revascularization in a majority of patients with excellent short-term results.
BACKGROUND: The author reports his short-term experience with systematic off-pump coronary artery revascularization in multivessel disease. METHODS: Between September 1996 and October 1998, 275 off-pump revascularizations (83% of case load during this period; 97% since January 1998) were performed by a single surgeon (R.C.). The patient base of 216 men/59 women averaged 63 +/- 10 years. Main indication was unstable angina (60%). All surgeries were performed through a median sternotomy, with mechanical stabilization, and a heart "verticalizing" technique to enable access to the circumflex territory. RESULTS: An average of 2.91 +/- 0.83 (range 1 to 5) grafts/patient was achieved, with 70% of cases being triple or quadruple bypasses. Single or double internal thoracic arteries was utilized in 95% of cases. Complete revascularization was attained in 93% of surgeries. Total ischemic time averaged 28 +/- 10 (range 8 to 65) minutes. Myocardial infarction incidence was 4%, with only 1 patient requiring postoperative aortic counter-pulsation assistance. One early percutaneous transluminal coronary angioplasty was needed to restore an occluded posterior descending artery. Three operative deaths resulted. One conversion to cardiopulmonary bypass was required. A transfusion rate of 32% was observed, half the rate of conventional coronary artery bypass grafting at our institute. CONCLUSIONS: With gradual experience, proper operative technique, and surgical apparatus, beating heart bypass surgery may be used systematically as a suitable, safe alternative to conventional on-pump coronary artery bypass grafting, permitting complete revascularization in a majority of patients with excellent short-term results.