Myocardial revascularization without extracorporeal circulation *1Seven-year experience in 593 cases

Abstract

The authors present the results of 593 consecutive and non-selectedpatients who underwent direct myocardial revascularization withoutextracorporeal circulation in the period September 1981 to December 1988.The results are compared with 3086 patients who underwent conventionalbypass surgery over the same period of time. The ages varied from 33 to 80years (mean = 56) with 40 patients older than 70. The overall mortality inthe group without cardiopulmonary bypass (CPB) was 1.7% (10/593) comparedwith 3.8% for conventional revascularization. Our mortality in the last 3years has been 0.5% and 0% in the last 203 patients revascularized withoutCPB. The number of grafts varied from 1 to 5 (average 1.6). The treatedarteries were: anterior descending (557), right (282) marginal (5) andcircumflex marginal (4). Immediate postoperative complications were fewerand hospital discharge was earlier in the group treated without CPB. Theauthors conclude that this tactical alternative has the advantages of:lower morbidity and mortality, lower cost and no need for bloodtransfusion. Drawbacks are the need for greater technical expertise and itseems to be possible in about 19% of all patients who undergo myocardialrevascularization.