Coronary bypass grafting without cardiopulmonary bypass - Technical considerations, clinical results, and follow-up

Background: Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB). We present our early 'off pump' coronary bypass surgery experience in combination with a minithoracotomy or sternotomy. Methods: Between 11/1996 and 12/1997 312 patients were included in a prospective study, 223 (Group A) underwent an antero-lateral minithoracotomy (MIDCAB) and 89 (Group B) had a full sternotomy (OPCAB). ITA harvesting and anastomosis was performed under direct vision in all cases. Different devices for local mechanical immobilization were used to perform the anastomosis. Results: In 212 patients of group A revascularization was by a single ITA graft and in 11 patients by a double graft using the radial artery as a T graft. Conversion to sternotomy and cardiopulmonary bypass was necessary in 12 (5.3%) patients. Intraoperative myocardial infarction was observed in 5 patients (2.2%). Early-postoperative reoperation due to graft failure was necessary in 5 patients (2.2%). Mortality was 0.4% (one patient). The early postoperative graft patency rate was 97.1% as confirmed by angiography. In group B, 25 patients had single graft and 64 patients multiple graft revascularization. Intraoperative conversion to CPB was necessary in 10 patients (11.2%). Intraoperative myocardial infarction occurred in 1 patient (1.1%), postoperative low output syndrome in 2 patients (2.2%). Early postoperative reoperation due to graft failure was necessary in 1 patient (1.1%). Mortality was 1.1%. Angiographic control of 48 patients after 6 months confirmed a patency rate of 92.6%. Conclusion: Coronary bypass surgery without using cardiopulmonary bypass is safe to achieve good early and mid-term results. MIDCAB is a minimally invasive technique. Experienced surgeons should be ready to compete with PTCA techniques.