ABSTRACT 78

OFF PUMP CORONARY SURGERY IN PATIENTS WITH LEFT MAIN STENOSIS AND/OR IMPAIRED LEFT VENTRICULAR FUNCTION:  USE OF GENZYME* IMMOBILIZER AND BALLON COUNTERPULSATION

Gerard Babatasi, Massimo Massetti, Oliver Le Page, PierGiorgio Bruno, Andre Khayat, Cardiovascular and Thoracic Surgery, University Hospital, Caen, France

Coronary bypass surgery can be performed less invasively without CPB.  Multivessel off pump CABG (OPCAB) is challenging in patients with critical left main and/or severe ventricular dysfunction.

Method:  In a consecutive 10 months period, 23 patients with these characteristics underwent OPCAB with the Genzyme immobilizer system.

Results:  Out of 69 OPCAB, 23 (33 %) were performed on patients with those criteria.  Mean age was 69 +/- 4 years, emergency surgery was indicated in 35 %, unstable angina in 46 % and severe left main in 39 % (9 cases).  Mean ejection fraction was 44.7 % (+/- 3.2 %).  16 patients (70 %) had intra-aortic balloon pump (IABP) preoperatively.  Mean number of grafts/patients was 2.25 and LIMA was used in all cases.  Obtuse marginal branches were grafted in 64 % of cases.  1 patient required re-exploration for bleeding.  30 day mortality was 0 % (predicted 5.3 %, p<0.10), at a follow-up of 3.2 +/- 1.5 months.  No patients required conversion to CPB.

Conclusion:  We believe that the use of Genzyme stabilizer system and preoperative IABP can successfully be proposed for patients with critical left main, left ventricular dysfunction and yield satisfactory results.  Longer follow-up is warranted.