Coronary artery bypass grafting without cardiopulmonary bypass-An attractive alternative in high risk patients

Abstract

OBJECTIVE: This study compares preoperative risk factors, estimated,observed, and risk adjusted mortality, and postoperative complications inpatients undergoing coronary artery bypass grafting. Patients were dividedin two groups depending on operative method: Group A patients had coronaryartery bypass grafting using cardiopulmonary bypass. In group Bcardiopulmonary bypass was not utilized. Patients operated on betweenJanuary 1 1995 and August 31 1996 were compared. Group A consisted of 1829patients and Group B 172. METHODS: Patients were selected to undergocoronary artery bypass grafting without the use of cardiopulmonary bypasseither because the surgeon felt that there were contraindications to--or noneed for the heart-lung machine. The decision to avoid the use ofcardiopulmonary bypass was taken pre- operatively by the individualsurgeon. Median sternotomy, formal left thoracotomy or left anterior smallthoracotomy were used. The data was collected and validated by thehospital's professional data collectors. Data-analysis was performed usingthe NY-state database. RESULTS: Previous heart surgery and extensivelycalcified ascending aorta were significantly more common in Group B as wasestimated and observed mortality. This resulted in identical risk-adjustedmortality of 2.8%. When reoperations were reviewed separately risk adjustedmortality was lower in Group B (2.1 versus 3.1%) but this difference wasnot statistically significant. Cardiovascular-and other-complications werehigher in group A patients. In reoperative patients this difference wassignificant (P = 0.05). The need for postoperative mechanical assistancewas also reduced (Group A: 14.9% versus Group B: 1.3% P = 0.01).CONCLUSION: We conclude that coronary artery bypass surgery can be donesafely in selected patients without cardiopulmonary bypass. Mortality isunchanged and complications are less frequent. Cost and hospitalutilization are decreased. The greatest benefit is observed inreoperations.