Coronary artery bypass without cardiopulmonary bypass for patients with acute myocardial infarction

Mohr, R Moshkovitch, Y Shapira, I Amir, G Hod, H Gurevitch, J

R. Mohr et al., Coronary artery bypass without cardiopulmonary bypass for patients with acute myocardial infarction, J THOR SURG, 118(1), 1999, pp. 50-56

30

INGLESE

Article

Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY

0022-5223 → ACNP

118

1

1999

50 - 56

ISI

0022-5223(199907)118:1<50:CABWCB>2.0.ZU;2-Z

Objective: Between January 1992 and December 1994, 57 patients having an ac ute myocardial infarction,vith coronary anatomy suitable for coronary arter y bypass grafting without cardiopulmonary bypass underwent this procedure w ithin 1 week of the infarction, We describe the surgical results of these h igh-risk patients. Methods: The study population included 43 male patients (75%) and 14 female patients (25%) whose mean age was 58.5 +/- 10.4 years. Thirty-two patients (56%) underwent emergency bypass grafting within 48 hou rs of an acute myocardial infarction, 4 of them (12.5%) as a bailout proced ure after complicated percutaneous transluminal coronary angioplasty, Of th ese 32 patients, 7 patients (22%) were in cardiogenic shock, and 10 patient s (31%) required preoperative intra-aortic balloon pump. Twenty-five patien ts (44%) underwent coronary bypass grafting 2 to 7 days after an acute myoc ardial infarction. The mean number of grafts per patient was 1.8 (range, 1- 4), and the internal thoracic artery was used in 47 patients (82%), Only 7 patients (12%) received grafts to a circumflex marginal branch. Results: Op erative mortality was 1.7% (1 patient), and the mean postoperative hospital stay was 6.8 +/- 3 days, One- and 5-year actuarial survivals were 94.7% an d 82.3%, respectively. Angina returned in 7 patients (12%), 1 of whom under went reoperation, Multivariate analysis revealed renal failure and preopera tive cardiogenic shock to be independent predictors of overall mortality, O ld myocardial infarction and operation within the first 48 hours were indep endent predictors of overall unfavorable outcome events, Conclusions: These results suggest that coronary artery bypass grafting without cardiopulmona ry bypass is a relatively low-risk procedure for patients having an infarct ion with coronary anatomy suitable for this technique.