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J Thorac Cardiovasc Surg 1999;118:50-56
© 1999 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

CORONARY ARTERY BYPASS WITHOUT CARDIOPULMONARY BYPASS FOR PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

From The Department of Thoracic and Cardiovascular Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv,^a and The Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer,^b affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Address for reprints: Rephael Mohr, MD, The Department of Thoracic and Cardiovascular Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv 64239, Israel.

Objective: Between January 1992 and December 1994, 57 patients having an acute myocardial infarction with coronary anatomy suitable for coronary artery bypass grafting without cardiopulmonary bypass underwent this procedure within 1 week of the infarction. We describe the surgical results of these high-risk patients.
Methods: The study population included 43 male patients (75%) and 14 female patients (25%) whose mean age was 58.5 ± 10.4 years. Thirty-two patients (56%) underwent emergency bypass grafting within 48 hours of an acute myocardial infarction, 4 of them (12.5%) as a bailout procedure after complicated percutaneous transluminal coronary angioplasty. Of these 32 patients, 7 patients (22%) were in cardiogenic shock, and 10 patients (31%) required preoperative intra-aortic balloon pump. Twenty-five patients (44%) underwent coronary bypass grafting 2 to 7 days after an acute myocardial infarction. The mean number of grafts per patient was 1.8 (range, 1-4), and the internal thoracic artery was used in 47 patients (82%). Only 7 patients (12%) received grafts to a circumflex marginal branch.
Results: Operative mortality was 1.7% (1 patient), and the mean postoperative hospital stay was 6.8 ± 3 days. One- and 5-year actuarial survivals were 94.7% and 82.3%, respectively. Angina returned in 7 patients (12%), 1 of whom underwent reoperation. Multivariate analysis revealed renal failure and preoperative cardiogenic shock to be independent predictors of overall mortality. Old myocardial infarction and operation within the first 48 hours were independent predictors of overall unfavorable outcome events.
Conclusions: These results suggest that coronary artery bypass grafting without cardiopulmonary bypass is a relatively low-risk procedure for patients having an infarction with coronary anatomy suitable for this technique.

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