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Ann Thorac Surg 1999;67:450-456
© 1999 The Society of Thoracic Surgeons

Original Articles

Multiple arterial conduits without cardiopulmonary bypass: early angiographic results

Antonio M. Calafiore, MDa,b, Giovanni Teodori, MDa,b, Gabriele Di Giammarco, MDa,b, Giuseppe Vitolla, MDa,b, Nicola Maddestra, MDa,b, Leonardo Paloscia, MDa,b, Marco Zimarino, MDa,b, Valerio Mazzei, MDa,b

a Division of Cardiac Surgery, University G. D Annunzio, Chieti, Italy
b Division of Cardiology, Hospital of Pescara, Pescara, Italy

Accepted for publication July 8, 1998.

Address reprint requests to Dr Calafiore, Department of Cardiac Surgery, "G. D’Annunzio" University, "San Camillo de’ Lellis" Hospital, Via C Forlanini 50, 66100 Chieti, Italy
e-mail: calafiore{at}unich.it

Background. Lack of angiographic results and technical difficulty in grafting the vessels in the lateral and posterior walls have reduced interest in myocardial revascularization without cardiopulmonary bypass (CPB). We describe our experience to demonstrate the feasibility of coronary surgical intervention without CPB in multivessel disease.

Methods. From May 21, 1997, through February 1998, 227 patients underwent revascularization with two or more arterial conduits as the first operation: 122 without CPB (group A) and 105 with CPB (group B). Group A included a greater number of high-risk patients.

Results. Mean ± SD anastomoses per patient were 2.5 ± 0.6 in group A and 2.8 ± 0.8 in group B (p = NS). No patient died in group A, whereas 1 patient (0.9%) died in group B. The postoperative complication rate was low in both groups, but intensive care unit and in-hospital stays were shorter in group A than in group B (14.1 ± 7.1 versus 27.3 ± 36 hours, p < 0.001, and 4.1 ± 1.6 versus 5.4 ± 2.4 days, p < 0.001, respectively [group A versus group B]). Sixty-seven patients in Group A (54.9%) underwent postoperative angiography 33 ± 35 days after operation. The patency rate was 98.9% (98.2% for the marginal branches).

Conclusions. Arterial revascularization of the coronary arteries without CPB is feasible, with results similar to those obtained with CPB. The two techniques, in our opinion, are complementary, not antagonistic.




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