Triple coronary artery revascularization on the stabilized beating heart: initial experience.

Abstract

OBJECTIVE: To decrease health costs and morbidity related to extracorporeal circulation, surgeons have modified the coronary artery bypass (CAB) technique so that it can be completed without the use of extracorporeal circulation. This study summarizes initial experience with direct coronary artery revascularization on the beating heart using a coronary stabilizer. DESIGN: A case series. SETTING: The Montreal Heart Institute, a university-affiliated centre, specializing in the treatment of cardiac illnesses. PATIENTS: Ten patients underwent CAB by this technique. They presented with double or triple coronary artery disease with no intramyocardial, heavily calcified, diffused atheromatous coronary vessels, or left main coronary disease. INTERVENTION: CAB grafting in the beating heart. The anterior wall was grafted in all patients, the inferior wall in 7 and the posterior wall in 7. MAIN OUTCOME MEASURES: Patient survival and graft patency. RESULTS: One patient died of multiple organ failure not related to the grafting technique itself, and 1 patient suffered a non-Q myocardial infarction. Early coronary angiography performed on 8 patients showed 100% graft patency, most with excellent distal runoff (21/22 grafts). CONCLUSION: In patients with adequate anatomy, performance of CAB without extracorporeal circulation can achieve excellent early results provided there is appropriate mechanical stabilization of the beating heart.