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J Thorac Cardiovasc Surg 2000;119:221-229
© 2000 Mosby, Inc.
SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE |
From the Departments of Cardiac Surgery,a Anesthesiology,c and Biostatistics,d Montreal Heart Institute, and the Department of Cardiac Surgery,b University of Montreal, Montreal, Quebec, Canada.
Address for reprints: Raymond Cartier, MD, Montreal Heart Institute, Research Center, 5000 Belanger St E, Montreal, Quebec, Canada H1T 1C8 (E-mail: cartierr{at}icm.umontreal.ca) .
Objective: We sought to report our recent experience with off-pump coronary artery revascularization in multivessel disease.
Methods: Between October 1996 and December 1998, 300 off-pump beating heart operations were performed at the Montreal Heart Institute by a single surgeon, representing 94% of all procedures undertaken during this same time frame (97% for 1998). This cohort of patients was compared with 1870 patients operated on with cardiopulmonary bypass from 1995 to 1996.
Results: Mean age, sex distribution, and preoperative risk factors were comparable for the two groups. On average, 2.92 ± 0.8 and 2.84 ± 0.6 grafts per patient were completed in the beating heart and cardiopulmonary bypass groups, respectively. A majority of patients (70%) had either a triple or quadruple bypass. Coronary anastomoses were achieved with myocardial mechanical stabilization and heart "verticalization." Ischemic time was shorter in the beating heart group (29.8 ± 0.9 vs 45 ± 0.4 minutes, P < .05). Similarly, the need for transfusion was significantly less in the beating heart group (beating heart operations, 34%; cardiopulmonary bypass, 66%; P < .005). Reduced use of postoperative intra-aortic counterpulsation, as well as a lower rise in creatine kinase MB isoenzyme, was observed in the beating heart group. Operative mortality rates (beating heart operations, 1.3%; cardiopulmonary bypass, 2%) and perioperative myocardial infarction (beating heart operations, 3.6%; cardiopulmonary bypass, 4.2%) were comparable for the two groups.
Conclusion: In a majority of patients, off-pump complete coronary artery revascularization is an acceptable alternative to conventional operations, yielding good results given progressive experience, rigorous technique, and adequate coronary artery stabilization.
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