Coronary reoperations without the use of cardiopulmonary bypass

• Published in: Cardiovascular surgery (London, England) Vol. 11; no. 2; p. 155
• Main Authors: Iscan, H Z, Kandemir, O, Gol, M K, Saritas, A, Tasdemir, O
• Format: Journal Article
• Language: English
• Published: England 01-04-2003
• Subjects: Adult; Aged; Cardiopulmonary Bypass - adverse effects; Coronary Artery Bypass - methods; Female; Humans; Male; Middle Aged; Postoperative Complications; Prognosis; Reoperation - methods; Retrospective Studies; Risk Factors; Survival Analysis; Treatment Outcome
• ISSN: 0967-2109
• DOI: 10.1016/S0967-2109(02)00105-9

Reoperations of coronary artery surgery still carry a higher mortality and morbidity rate, compared to primary revascularization procedures. Coronary artery bypass reoperations without the use of cardiopulmonary bypass (CPB) is a potential strategy that has been developed to decrease mortality and morbidity.
Between 1978 and 2000, 113 patients were reoperated for coronary artery revascularization, 32 (28.3%) cases on beating heart without the use of CPB (Group II) and 81 (71.7%) cases under CPB and cardioplegic arrest (Group I). Mean age of Groups I and II were 61.3+/-5 and 57.4+/-7.3 years, respectively.
Statistically significant difference was found between the two groups, favoring off pump surgery in the early postoperative findings with respect to low cardiac output, postoperative myocardial infarction and postoperative hospitalization duration until discharge. Operative mortality was not statistically different between groups and these figures for cardiopulmonary and off pump groups were 11/81 (13.5%), 1/32 (3.1%), respectively.
Reoperations of coronary artery revascularization surgery without the use of CPB is more economic, necessitating less manipulations, free of side effects of CPB, less time consuming surgical procedure compared to reoperations performed under standard techniques. When performed with a refined technique and true indications, off pump coronary reoperations have mortality and morbidity advantages over the surgery performed under CPB, improvements in techniques and instruments off pump strategy must be in the surgeons armamentarium in coronary reoperations.