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Ann Thorac Surg 2001;71:165-169
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass

Martin Czerny, MDa, Harald Baumer, MDa, Juliane Kilo, MDa, Andreas Zuckermann, MDa, Georg Grubhofer, MDb, Orest Chevtchik, MDa, Ernst Wolner, MDa, Michael Grimm, MDa

a Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
b Department of Cardiothoracic and Vascular Anesthesia, University of Vienna Medical School, Vienna, Austria

Accepted for publication July 19, 2000.

Address reprint requests to Dr Grimm, Währinger Gürtel 18-20, A-1090 Vienna, Austria
e-mail: michael.grimm{at}akh-wien.ac.at

Background. The feasibility of complete revascularization on the beating heart without cardiopulmonary bypass (CPB) as compared with the standard operation with CPB in elective low-risk patients with multivessel disease has not been clearly demonstrated in a prospective trial.

Methods. Eighty selected low-risk patients were enrolled. In preoperative study with coronary angiography, the decision was made whether complete revascularization without CPB could be performed. Patients were randomly assigned to receive CABG either with (n = 40) or without CPB (n = 40). Randomization criteria were age, sex, and left ventricular ejection fraction. Completeness of revascularization as well as short- and mid-term clinical outcome in a 13.4 ± 6.5 month follow-up period were monitored.

Results. Twenty-six of 40 (65%) patients undergoing CABG without CPB underwent complete revascularization. In 5 of these patients (12.5%) suitable vessels were discarded for technical reasons and 9 patients (22.5%) were switched to CABG with CPB owing to the deeply intramyocardial course of target vessels (n = 5) or to hemodynamic instability (n = 4). In the group of patients operated on with CPB, 34 of 40 patients (85%) received complete revascularization. In 6 patients (15%) suitable vessels were discarded for technical reasons. Mean number of bypass grafts was 3.1 ± 0.8 with CPB and 2.6 ± 0.5 without CPB (p = 0.043). Clinical outcome and hospital stay were comparable in both groups. No patient died during the study period. No myocardial infarction was observed. Three patients undergoing CABG without CPB underwent successful PTCA 3 months after surgery.

Conclusions. CABG without the use of CPB is effective for complete revascularization in the majority of selected low-risk patients. Nevertheless, it has to be stated that the rate of incomplete revascularization in this early series of CABG without CPB is higher, and compromises the basic principle of complete revascularization.




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