S Brann1, R Martineau, R Cartier. 1. Department of Cardiac Surgery, Montreal Heart Institute, Quebec, Canada.
Abstract
BACKGROUND: To determine the safety of surgical revascularization without cardiopulmonary bypass (CPB) in left main stem (LMS) coronary stenosis. METHODS AND RESULTS: Between October 1996 and April 1998, 67 consecutive patients with a > or =50% LMS stenosis underwent coronary revascularization without bypass (BH) and were compared to a contemporary group of 160 patients revascularized with conventional bypass (CPB). Mean ages in both groups were similar: 63.1 and 64.5 years in BH and CPB groups respectively (p=0.91). Significant triple vessel disease occurred in 40 (80%) and 75 (47.5%) patients in BH and CPB groups respectively (p=NS). Average grafts per patient was numbered 3.1 in BH group and 2.9 in CPB group (p=NS). The perioperative infarction rate (defined arbitrarily as a CK-MB >100 U/l) was 4% (2 patients, excluding 1 preoperative infarct) and 3.1% (5 patients, excluding 2 preoperative infarcts) in groups BH and CPB respectively (p=0.28). Postoperative blood transfusion requirements were less in BH group (19 patients, 38%) compared to CPB group (103 patients, 64.4%), (p=0.04). Postoperative inotropic requirements were similar in both groups; BH group (15 patients, 30%) and CPB group (72 patients, 45%). Mean hospital stay was 6.4 and 7.6 days in BH and CPB groups respectively (p=0.49). The hospital mortality rate was 0% and 3.8% (6 patients) in BH and CPB groups respectively (p=NS). CONCLUSIONS: Our early experience suggests that non-CPB surgical revascularization in LMS stenosis is a feasible and safe alternative to conventional cardiopulmonary bypass.
BACKGROUND: To determine the safety of surgical revascularization without cardiopulmonary bypass (CPB) in left main stem (LMS) coronary stenosis. METHODS AND RESULTS: Between October 1996 and April 1998, 67 consecutive patients with a > or =50% LMS stenosis underwent coronary revascularization without bypass (BH) and were compared to a contemporary group of 160 patients revascularized with conventional bypass (CPB). Mean ages in both groups were similar: 63.1 and 64.5 years in BH and CPB groups respectively (p=0.91). Significant triple vessel disease occurred in 40 (80%) and 75 (47.5%) patients in BH and CPB groups respectively (p=NS). Average grafts per patient was numbered 3.1 in BH group and 2.9 in CPB group (p=NS). The perioperative infarction rate (defined arbitrarily as a CK-MB >100 U/l) was 4% (2 patients, excluding 1 preoperative infarct) and 3.1% (5 patients, excluding 2 preoperative infarcts) in groups BH and CPB respectively (p=0.28). Postoperative blood transfusion requirements were less in BH group (19 patients, 38%) compared to CPB group (103 patients, 64.4%), (p=0.04). Postoperative inotropic requirements were similar in both groups; BH group (15 patients, 30%) and CPB group (72 patients, 45%). Mean hospital stay was 6.4 and 7.6 days in BH and CPB groups respectively (p=0.49). The hospital mortality rate was 0% and 3.8% (6 patients) in BH and CPB groups respectively (p=NS). CONCLUSIONS: Our early experience suggests that non-CPB surgical revascularization in LMS stenosis is a feasible and safe alternative to conventional cardiopulmonary bypass.