ABSTRACT 27

Complete myocardial revascularization without cardiopulmonary bypass: Intent to bypass versus performed coronary grafts

Dimitri Novitzky MD, Jimmy Sung MD and Reginald Peniston MD
VA Medical Center and the University of South Florida Tampa, Florida, USA

Introduction: Myocardial revascularization without cardiopulmonary bypass (Off CPB) has been criticized for incomplete revascularization.  

Objectives: Upon pre-operative review of the coronary angiogram, coronary arteries were assigned to undergo bypass graft with intent to treat (projected) were compared to actually performed (performed).

Methods: Data were collected on 73 consecutive patients. The LAD territory was involved in 72 pts. the RCA in 62 and the CFX in 63. 

The surgical technique consists of three deep pericardial sutures, cardiac herniation into the right pleural cavity and the use of intermittent hypotensive anesthesia.

Results: The projected and performed grafts for each coronary artery territory are shown.  An average of 2 grafts/Pt were performed in patients with 1 VD, 3.12 for 2 VD and 3.88 for 3 VD.

Conclusions: Using the combination of deep pericardial sutures, right cardiac herniation and intermittent hypotensive anesthesia, complete myocardial revascularization can be fully achieved.  Angiographically underfilled and undersized coronaries may be graftable at the time of surgery, thus expanding the number of performed grafts.