Coronary artery by-pass without cardiopulmonary by-pass for patients with severe left ventricular dysfunction

Objectives. To evaluate results of coronary artery bypass grafting (CABG) without cardiopulmonary by-pass (CPB) for patients with severe left ventricular dysfunction. Materials and methods. Fifty-three patients with severe LV dysfunction (EF < 35%) underwent CABG without cardiopulmonary by-pass (CPB) between December 1991 and December 1993. They comprise 22% of 242 patients operated on without CPB by one of the authors (RM) in this period. There were 45 (85%) males and eight (15%) females. Twelve (23%) patients were over 70 years. Nine (17%) were re-do CABG. Ten (19%) were referred for operation within the first 24 hours of evolving MI, and 13 (25%) up to two weeks after acute MI. Nine (17%) had preoperative EF < 20%, and six patients (11%) were in cardiogenic shock. Mean number of grafts/pt was 1.8 and IMA was used in 41 (77%). Only 14 patients (26%) received a graft to a circumflex marginal artery. Ischemic time was 8 ± 4 minigraft (mean ± SD) when anastomosed to the LAD or RCA, and 14 ± 7 min/graft when anastomosed to a marginal branch. Results. One patient (1.9%) died perioperatively, and two (3.7%) suffered a non-fatal MI. At two-year followup there were three late deaths, one of them from cancer. Three patients had return of angina, two of them were reoperated upon. Conclusions. These results suggest that CABG without CPB may be advantageous for patients with severe LV dysfunction.