Coronary Reoperations Without the Use of Cardiopulmonary Bypass

Background

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.Materials and methods: 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.

Results

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.

Conclusions

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.