[Coronary artery bypass grafting without cardiopulmonary bypass]

Abstract

From October 1995 until April 1996. CABG (coronary artery bypass grafting) was performed under the beating heart without CPB (cardiopulmonary bypass) in nine cases. They consisted of 7 males and 2 females ranging in age from 31 to 79 years old (mean 64.7 years). Single bypass grafting was performed in 6 cases, and double bypass grafting was done in 3 cases, involving 2 re-do cases. With regard to the major associated diseases, two patients had required chronic hemodialysis three time a week, four patients were administered with insulin for diabetes mellitus. There were other three patients with renal dysfunction not requiring hemodialysis, two patients had pulmonary problems, and one patient had Parkinson's disease. Further more two patients were older than 75th years in age. Graft anastomosis to the coronary artery was performed with 7-0 polypropylene. In one case, left thoracotomy was done to approach the heart for the anastomosis to intermediate artery, and in the other eight cases, median sternotomy was done. The grafts used in the nine cases were 4 right internal thoracic arteries, 6 left internal thoracic arteries, one gastroepiploic artery and one saphenous vein, 12 grafts in total. Subtotal gastrectomy for gastric cancer and cholecystectomy for cholecystitis was done in one patient for each. Heterologous blood transfusion was required two cases (22.2%). The postoperative course was very good in all cases. Eleven grafts in postoperative angiographed 8 cases were all patent, although presenting the string sign in one case, and angina pectoris disappeared in all cases. CABG under the beating heart without CPB was considered to be useful for the patients with considerable other diseases from the point of view of safety and ease of postoperative managements. We think that this procedure should be considered particularly for patients on chronic hemodialysis who required CABG.