Reoperative coronary artery bypass grafting without cardiopulmonary bypass

Abstract

Between June 1979 and January 1992, 46 men and 13 women aged 35 to 81 years (mean, 58 years) underwent reoperative coronary artery bypass grafting without cardiopulmonary bypass. Isolated reoperative circumflex bypass was performed through a left thoracotomy, and reoperative bypass to the right coronary artery and left anterior descending coronary systems was through a median sternotomy. Complete revascularization was the goal in all patients. Saphenous vein grafts were placed to the right coronary artery (n = 21), circumflex artery (n = 11), and left anterior descending artery (n = 24), and 14 internal thoracic artery to left anterior descending artery bypass grafts were performed. The overall mortality rate was 3.4% (2 deaths). Postoperative morbidity included myocardial infarction in 1 patient and pleuropulmonary complications in 6. No patient was reexplored for hemorrhage, and 19 patients required no blood products. Twenty patients underwent repeat coronary angiography, and 18 of 20 grafts placed without cardiopulmonary bypass were patent. At a mean follow-up interval of 42.2 months 35 of 50 evaluable patients were in functional class I or II. In selected patients, reoperative coronary artery bypass grafting can be performed without cardiopulmonary bypass with a low perioperative morbidity and mortality rate, satisfactory graft patency rates, and good long-term symptomatic improvement.