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European Journal of Cardio-Thoracic Surgery, Vol 11, 123-128, Copyright © 1997 by European Association for Cardio-thoracic Surgery

ARTICLES

Comparison of myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular dysfunction

L Sternik, Y Moshkovitz, H Hod and R Mohr
The Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Israel.

OBJECTIVE: To compare myocardial revascularization without cardiopulmonary bypass to standard open heart technique in patients with left ventricular (LV) dysfunction. METHODS: 117 patients with LV dysfunction (ejection fraction (EF) < 35%) underwent coronary artery bypass surgery between January 1991 and July 1994. Sixty-four (group A) were operated on without a cardiopulmonary bypass, and 53 (group B) with one. Prevalence of EF < 20% (17 vs. 6%) and emergency operations (22 vs. 7%, P = 0.03) was higher in group A. The average number of grafts was 1.9 +/- 0.8/pt in group A and 3.5 +/- 0.9/pt in group B (P < 0.01), and the internal mammary artery was used in 54 (84%) and 42 (79%) patients, respectively. Only 16 patients (25%) in group A received a graft to a circumflex marginal artery compared to 51 (96%) in group B (P < 0.0001). RESULTS: Two patients (3.1%) died perioperatively in group A compared to 7 (13%) in group B (P = NS). In two patients from group A (3.1%) and in four (7.5%) from group B intra- aortic balloon pump was inserted postoperatively (P = NS). One year actuarial survival was 91 and 79% (P = 0.03) and 2-year survival was 86 and 65% (P = 0.04), respectively. Return of angina occurred in five (8%) and three (6%) patients (P = NS). CONCLUSIONS: These results show a trend for lower operative risk resulting in better overall survival in selected patients with LV dysfunction undergoing coronary artery bypass surgery without cardiopulmonary bypass.

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