Coronary artery bypass without extra corporeal circulation

240 patients underwent coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC). Mean grafts per patient was 1.9 (range 1-5). The internal mammary artery (IMA) was used in 210 cases (87%), but in only 53 (22%) were there grafts to the circumflex marginals. Unfavorable results included an operative mortality of 7 cases (2.9%), nonfatal perioperative myocardial infarction (MI) (2.5%), stroke (0.4%), and sternal infection (1.7%). There were 2 deaths among 17 patients (12%) with calcified aorta, and 4 among 40 (10%) who underwent emergency operation. Multivariate analysis showed these 2 risk factors to be the only predictors of early mortality: emergency operation odds ratio 9.8, and calcified aorta odds ratio 8.0. Perioperative risk factors that were not major predictors of early mortality or unfavorable outcome included left ventricular dysfunction (EF < 35%: 52 patients, 22%), congestive heart failure (53, 22%), cardiogenic shock (8, 3%), acute MI (67, 28%), age > 70 years (64, 27%), renal failure (22, 9%), and stroke or carotid disease (12, 5%). Followup ranged from 1-31 months (mean 12). There were 9 late deaths (4 cardiac), and 18 cases (7.5%) of early return of angina. 1-year actuarial survival was 92%; 192 patients (80%) had uneventful outcomes and are doing well. Calcified aorta, nonuse of the IMA, reoperation, and diabetes mellitus were independent predictors of unfavorable events. We conclude that CABG without ECC can be performed with relatively low operative mortality, but there seems to be increased risk of early return of angina. It should therefore be considered for those patients with appropriate coronary anatomy in whom ECC poses a very high risk. However, it is still a hazardous procedure when used as as an emergency operation, and for cases with calcified aorta.