[Coronary artery bypass grafting under beating heart without cardiopulmonary bypass].

Recently coronary artery bypass grafting under beating heart without cardiopulmonary bypass has been widely accepted for patients with associated risks of standard bypass surgery. Between October 1995 and October 1997, we performed this procedure on 40 (11 reoperative procedures). There were 26 single-vessel (9 reoperative procedures), 12 double-vessel (2 reoperative procedures) and 2 triple-vessel bypass procedures. Major risk factors and concomitant disorders were as follows: chronic hemodialysis, 3; poor renal function, 5; poor lung function, 6; reoperative procedure, 11; elder patient (age > or = 75 y), 4. Twenty-five patients were operated through a mediansternotomy, 11 through left thoracotomy (small thoracotomy 7), 1 through a small right thoracotomy, 3 through a laparotomy with the diaphragm approach, 1 through both a left thoracotomy and a laparotomy with the diaphragm approach. Fifty-three grafts were used during this course (internal thoracic artery [ITA] = 42, gastroepiploic artery [GEA] = 7, saphenous vein [SV] = 4) and the sequential bypass was performed with 2 LITA grafts. In selected patients this procedure is very safe, cost-effective and required less blood loss compared to standard bypass surgery. This procedure was considered to be very effective for patient with chronic hemodialysis. Also, left thoracotomy (a small thoracotomy) and laparotomy with the diaphragm approach showed particular effectiveness to reoperative procedures in order to preserve the patent grafts.