Gundry S R, Romano M A, Shattuck O H, Razzouk A J, Bailey L L
Loma Linda University Medical Center, Calif 92354, USA.
J Thorac Cardiovasc Surg. 1998 Jun;115(6):1273-7; discussion 1277-8. doi: 10.1016/S0022-5223(98)70209-0.
There has been resurgent interest in coronary revascularization performed on the beating heart. Heretofore, there has been no long-term comparison of this technique to traditional coronary artery bypass with cardioplegia.
The purpose of this study was to provide a comparison of long-term survival and intervention-free outcome between patient groups subjected to coronary bypass accomplished with or without the use of cardiopulmonary bypass.
From June 1989 to July 1990, all patients treated for coronary revascularization by three surgeons were considered for coronary revascularization with the heart beating: 107 patients underwent coronary bypass on the beating heart, and 112 patients underwent revascularization with the aid of bypass with cardioplegia. Mean ages (65 +/- 10 years) and risk factors were identical. Patients operated on with the heart beating had 2.4 +/- 0.9 grafts versus 3.2 +/- 1.1 grafts for patients having cardiopulmonary bypass with cardioplegia.
At 7-year follow-up, 86 of 107 (80%) patients operated on with the heart beating were alive versus 88 of 112 (79%) patients in whom cardiopulmonary bypass with cardioplegia was used. Cardiac deaths occurred in 13 of 107 (12%) patients in the former group versus 10 of 112 (9%) patients in the latter group. However, 32 of 107 patients operated on with the heart beating (30%) needed catheterization for their symptoms versus 18 of 112 (16%) patients in the bypass with cardioplegia group (p = 0.01). This results in 21 of 107 (20%) patients in the beating heart group needing angioplasty or a second coronary bypass versus only 8 of 112 (7%) patients in the bypass with cardioplegia group. No patient in the bypass with cardioplegia group required reoperation. Most of the reinterventions for the beating heart group were percutaneous transluminal coronary angioplasty (15 of 21 [71%] patients).
Despite one less graft per patient, survival and cardiac death rates were similar for the two groups. However, twice as many patients in the beating heart group required recatheterization (30% versus 16%), and 20% needed a second intervention. Only 7% of the bypass with cardioplegia group required reintervention. Limited revascularization of the beating heart provides long-term results comparable to full revascularization with cardiopulmonary bypass, but at the cost of a threefold increase in reinterventions.
