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

Abstract

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

Myocardial revascularization without cardiopulmonary bypass

“…The feasibility and safety of this alternative of myocardial revascularization was later confirmed by others [13][14][15][16]. Technical maneuvers were described in order to facilitate construction of the distal anastomoses, such anesthesia expertise, pharmacological "stabilizers" to reduce heart rate and position of the operating table.…”

Resultados a largo plazo de la cirugía coronaria sin circulación extra corpórea en pacientes con lesión de tres vasos y/o tronco coronario izquierdo

“…La técnica de revascularización miocárdica sin CEC fue desarrollada en la década de los 80s por algunos grupos en el mundo, entre los que destacan los del Dr. Federico Benetti, en Argentina y el Dr. Enio Buffolo, en Brasil. [2][3][4] La idea era intentar disminuir las complicaciones asociadas al uso de CEC. Los resultados publicados por estos autores alentaron a otros grupos quirúrgicos a iniciar su uso.…”

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“…Subsequently, Kolesov performed the first internal mammary artery-coronary artery anastomosis on a beating heart in 1964 (14). With the widespread utilization of the cardiopulmonary bypass machine, there was a marked decrease in OPCAB procedures until the early 1990s, when a significant number of reports describing coronary artery anastomoses without utilizing CPB appeared (15)(16)(17)(18). Since the 1990s there has been a rapid increase in OPCAB worldwide.…”