Role of Cardiopulmonary Bypass in Single Vessel Coronary Revascularization: Implications for MID-CABG

(#1998-76290 ... June 1, 1998)

Ranjit John, M.D.¹, Asim F. Choudhri, B.S.¹, Windsor Ting, M.D.¹, Craig R. Smith, M.D.¹, Mehmet C. Oz, M.D.²

¹Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA.
²Irving Fellow, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA.

ABSTRACT

Background: Minimally invasive direct coronary artery bypass grafting (MID-CABG) is being utilized for the treatment of coronary artery disease in selected patients. This innovative procedure has generated numerous technical issues relating to coronary revascularization, including whether to perform the revascularization with or without cardiopulmonary bypass (CPB).

Methods: We addressed this issue indirectly by analyzing the 1995 New York State CABG registry, comparing patients who had single vessel bypass without CPB (Non-CPB Group) to a similar cohort of patients who had CABG performed on CPB (CPB Group). The database showed stratification of patients selected for bypass grafting without CPB to a significantly higher risk group, as shown by increased age, higher incidence of reoperation, transmural MI, congestive heart failure, carotid/cerebrovascular disease, and peripheral vascular disease.

Results: Patients in the Non-CPB Group had a higher incidence of postoperative malignant ventricular arrhythmias and heart block requiring pacemaker insertion. Otherwise, the incidence of postoperative complications was similar between the two groups.

Conclusions: There were no statistical differences in the hospital mortality or the length of hospitalization between the two groups. In conclusion, the data showed a definite trend toward doing higher risk cases off CPB. These cases had an acceptable early morbidity and mortality outcome. The results were comparable to a group of lower risk patients with single vessel CABG done on cardiopulmonary bypass. However, further follow-up are required to evaluate long-term outcomes and confirm the utility of this surgical option.

AUTHOR/ARTICLE INFORMATION

Reprint requests to: Asim Choudhri, c/o Mehmet C. Oz, M.D., Division of Cardiothoracic Surgery, Milstein Pavilion, Rm 7-435 177, Fort Washington Avenue New York, NY 10032, Office Telephone: (212) 305-4434, Office FAX (212) 305-2439, E-Mail: mco2@columbia.edu, chouasi@cucis.cis.columbia.edu

Submitted on: May 15, 1998

Keywords: Coronary artery bypass grafting, Minimally invasive direct coronary artery bypass grafting, Cardiopulmonary bypass, ischemic heart disease