Aortocoronary bypass without extracorporeal circulation: why and when?

Abstract

Thirty patients have been operated on since July 1986. The mean age was55 years (range 32-68). Twenty-three simple and 7 double bypasses wereperformed. The internal mammary artery and 1 prosthetic conduit were usedfor the 29 left anterior descending (LAD) anastomoses and saphenous veinfor the others [5 right coronary artery (RCA), 3 diagonal]. The use of animplantable Doppler probe for continuous monitoring during the 1stpostoperative week confirmed patency and gave an estimated flow (mean:79.23 ml/min, range 43.4). There were no deaths and no cases of infarctionor ischaemia, but stress test performance improved. The main advantage ofthis rapid and safe technique was avoidance of morbidity of extracorporealcirculation (ECC) and limited operative myocardial ischaemia. Criteria ofselection were unstable, permanent angina (14); unsuccessful PTCA (8) PTCAand failure (5 emergency cases), redo surgery (4); poor LV function (EFless than 20%) (3); fibrinolytic treatment or severe coagulopathy (2). Theideal patient has severe stenosis with or without retrograde filling of LADwith either RCA or circumflex (which require a lateral thoracotomy).