Direct myocardial revascularization without cardiopulmonary bypass

Abstract

The authors present their experience with 160 patients who underwent coronary artery saphenous vein bypass revascularization without cardiopulmonary bypass. The distal sutures were performed with interruption of the coronary flow without any devices for perfusion of the coronary artery: the proximal sutures were made with tangential clamping of the aorta. Vessels most frequently revascularized were the anterior descending and the distal right coronary artery. Out of 597 patients who underwent bypass surgery in this period, this technique could be employed in 160 cases (26.8%). Hospital mortality was 3.1% (5/160) and perioperative myocardial infarction as determined by daily EKGs and CKMB occurred in 4 patients (2.5%). Control hemodynamic studies were performed in 41 of the 160 patients (25.6%) with a patency rate of 83.9% in the 62 grafts restudied. We conclude that direct myocardial revascularization can be performed safely without major difficulties and with efficient anastomoses. The main advantages of the technique are that it does not require the use of extracorporeal circulation and, consequently, the use of any blood, as well as its low cost due to shorter hospitalization periods.