How to Avoid Problems in Redo Coronary Artery Bypass

ABSTRACT Background: Redo cardiac surgery still carries higher mortality and increased morbidity as compared with primary coronary revascularizations. Various steps can be taken to decrease the incidences of adverse outcomes. From our experience, we have accumulated safe steps to be taken during the surgical procedure to reach a positive outcome. Methods: We reviewed our own experience of redo coronary artery bypass surgery (CABG) at two institutions during the last 4 years. Though the surgeons were the same at both institutions, because of institutional variability of patient referrals, operative equipment, anesthesia management, and preoperative care, we kept the data separate. Five surgeons performed CABG with almost similar myocardial preservation techniques; however, the surgical skill varied slightly depending on the seniority and clinical experience. We performed 433 redo coronary artery revascularizations at one institution and 201 in the second institution. Fifteen percent of these patients also had additional procedures, such as valve repair, valve replacement, or aneurysm resection. In this patient group, 160 patients underwent either urgent or emergent CABG. Urgent surgery was defined as patient revascularization during the same admission as cardiac catheterization, and emergency surgery was defined as a patient undergoing surgery on the same day as the catheterization, especially when hemodynamic instability was present. The total mortality was 7%, while the elective redo CABG mortality was 3%. The length of stay ranged from 8.5 to 12.6 days. The morbidity included perioperative stroke in 18 patients and nonfatal perioperative myocardial infarction (MI) in 19 patients. Major factors contributing to the mortality were stroke, perioperative bleeding and exploration, renal failure, respiratory failure, and malnutrition. Conclusion: We outlined the precautions and safe surgical approaches to be undertaken during redo CABG for a successful outcome.     

How to avoid problems in redo coronary artery bypass

BACKGROUND: Redo cardiac surgery still carries higher mortality and increased morbidity as compared with primary coronary revascularizations. Various steps can be taken to decrease the incidences of adverse outcomes. From our experience, we have accumulated safe steps to be taken during the surgical procedure to reach a positive outcome. METHODS: We reviewed our own experience of redo coronary artery bypass surgery (CABG) at two institutions during the last 4 years. Though the surgeons were the same at both institutions, because of institutional variability of patient referrals, operative equipment, anesthesia management, and preoperative care, we kept the data separate. Five surgeons performed CABG with almost similar myocardial preservation techniques; however, the surgical skill varied slightly depending on the seniority and clinical experience. We performed 433 redo coronary artery revascularizations at one institution and 201 in the second institution. Fifteen percent of these patients also had additional procedures, such as valve repair, valve replacement, or aneurysm resection. In this patient group, 160 patients underwent either urgent or emergent CABG. Urgent surgery was defined as patient revascularization during the same admission as cardiac catheterization, and emergency surgery was defined as a patient undergoing surgery on the same day as the catheterization, especially when hemodynamic instability was present. The total mortality was 7%, while the elective redo CABG mortality was 3%. The length of stay ranged from 8.5 to 12.6 days. The morbidity included perioperative stroke in 18 patients and nonfatal perioperative myocardial infarction (MI) in 19 patients. Major factors contributing to the mortality were stroke, perioperative bleeding and exploration, renal failure, respiratory failure, and malnutrition. CONCLUSION: We outlined the precautions and safe surgical approaches to be undertaken during redo CABG for a successful outcome.     

Surgical revascularization for acute coronary syndrome: comparative surgical and long-term results.

OBJECTIVE: The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). METHODS: In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed. A total of 67 patients with ACS underwent CABG, comprised of 33 patients receiving an emergency CABG (emergent group: E-G) and 34 patients receiving an urgent CABG (urgent group: U-G). The early and long-term results were evaluated retrospectively. RESULTS: Preoperatively, the incidences of acute myocardial infarction and cardiogenic shock were significantly higher in E-G. No significant differences were found in the intraoperative factors except for the number of distal anastomoses (2.5 in E-G vs. 3.1 in U-G, p=0.01). The hospital mortality was 9.1% in E-G, and 2.9% in U-G, with no significant difference between the groups. Moreover, no patient in U-G necessitated emergency CABG while waiting for surgery. The patency rate of the grafts was 100% in E-G, and 96.2% in U-G. The 5-year survival rate excluding in-hospital death was 80.3% in E-G, and 78% in U-G (p>0.05). The 5-year cardiac event-free rate was 80.3% in E-G, and 80.9% in U-G (p>0.05). CONCLUSION: An emergency CABG can be reserved for ACS patients when symptoms and hemodynamic state are stabilized with medical therapies. Improvements in long-term results can be expected after high quality and complete surgical revascularization.     

Surgical revascularization for acute coronary syndrome

Objective: The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). Methods: In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed. A total of 67 patients with ACS underwent CABG, comprised of 33 patients receiving an emergency CABG (emergent group: E-G) and 34 patients receiving an urgent CABG (urgent group: U-G). The early and long-term results were evaluated retrospectively. Results: Preoperatively, the incidences of acute myocardial infarction and cardiogenic shock were significantly higher in E-G. No significant differences were found in the intraoperative factors except for the number of distal anastomoses (2.5 in E-G vs. 3.1 in U-G, p=0.01). The hospital mortality was 9.1% in E-G, and 2.9% in U-G, with no significant difference between the groups. Moreover, no patient in U-G necessitated emergency CABG while waiting for surgery. The patency rate of the grafts was 100% in E-G, and 96.2% in U-G. The 5-year survival rate excluding in-hospital death was 80.3% in E-G, and 78% in U-G (p>0.05). The 5-year cardiac event-free rate was 80.3% in E-G, and 80.9% in U-G (p>0.05). Conclusion: An emergency CABG can be reserved for ACS patients when symptoms and hemodynamic state are stabilized with medical therapies. Improvements in long-term results can be expected after high quality and complete surgical revascularization.     

Changes in left ventricular performance related to perioperative myocardial infarction in coronary artery bypass graft surgery

Strict electrocardiographic, enzymatic, scintigraphic, and hemodynamic criteria for perioperative myocardial infarction (MI) were defined and related to serial assessments of left ventricular performance during rest and exercise in patients seen early and late after coronary artery bypass graft operation. Global left ventricular performance was determined by radionuclide ventriculography from which changes in the pattern of serial postoperative ejection fractions (EF) were obtained. Patients were divided into two groups based on the presence or absence of perioperative MI, and were matched in pairs on the basis of preoperative EF and extent as well as location of coronary artery obstructions. The results indicate that neither short- nor long-term depression in resting EF occurred subsequent to perioperative MI. However, an exercise-related increase in EF eight months postoperatively was depressed in patients who had perioperative MI compared with those who did not. Patients with new Q waves and abnormal postoperative elevation in serum levels of the myocardial isoenzyme of creatine kinase (CK-MB) had a greater early decrease in EF compared with patients without evidence of perioperative MI. However, seven days after operation, the EF in both groups returned to preoperative levels. Patients with abnormal technetium 99m-pyrophosphate scintigrams had changes in perioperative EF similar to those in patients without MI. The presence of low cardiac output syndrome immediately after operation was associated with immediate and short-term decreases in EF, which were not seen in any of the other patient subgroups.     

Serial assessment of left ventricular performance following coronary artery bypass grafting. Early postoperative results with myocardial protection afforded by multidose hypothermic potassium crystalloid cardioplegia

Forty patients who recently underwent coronary artery bypass graft (CABG) operations had serial hemodynamic and scintigraphic studies. Multidose hypothermic potassium crystalloid cardioplegia was used for myocardial protection and newer techniques in anesthetic management and perioperative patient care were also employed. The method of equilibrium cardiac gated blood pool (GBP) scintigraphy was used to obtain perioperative changes in global ejection fraction (EF) and regional wall motion (RWM). Ninety percent of patients displayed a decrease in EF 2 hours postoperatively when compared to their preoperative values. This change was also associated with a fall in cardiac index (CI) and left ventricular stroke work index (LVSWI). Twenty-four hours postoperatively, EF and CI recovered to preoperative levels, but LVSWI remained depressed. Seven days postoperatively, global EF had improved to a value greater than the preoperative one (50% +/- 3% versus 57% +/- 4%, p < 0.05). Perioperative changes in RWM followed the same pattern as EF, but recovery in this index of regional contractility was faster than EF, since maximal improvement was observed 24 hours postoperatively. Thus transient left ventricular dysfunction is common immediately after CABG, but recent advances in myocardial protection and perioperative management are associated with short-term increases in regional and global left ventricular function documented by noninvasive GBP imaging.     

Perioperative myocardial ischemia in patients undergoing sternectomy shortly after coronary artery bypass grafting

Coronary revascularization reduces cardiac complications associated with noncardiac surgery in patients with severe coronary disease. However, patients undergoing emergency noncardiac surgery soon after coronary bypass operations may still be vulnerable to ischemic myocardial events. We prospectively evaluated the incidence of myocardial ischemia in 82 consecutive patents scheduled for sternectomy in the first (Group 1; 35 patients) or second (Group 2; 47 patients) week after coronary artery bypass graft (CABG) surgery. The interval between CABG surgery and sternectomy in Groups 1 and 2 was 6 days (range, 4-7 days) and 11 days (range, 8-14 days), respectively. Electrocardiographic (ECG) changes consistent with myocardial ischemia were assessed with a two-channel Holter system for 48 h. There were no between-group differences in updated Acute Physiology and Chronic Health Evaluation score, use of beta-blockers, or perioperative hemodynamic changes. The incidence of ECG changes consistent with myocardial ischemia was fivefold more frequent in Group 1 (22.85% versus 4.25%; P < 0.05). Of the ischemic patients in Group 1, 25% experienced a perioperative acute myocardial infarction (one was fatal). There were no infarcts in Group 2. Thus, patients appear to be prone to coronary events during sternectomy performed early after CABG surgery. Although the incidence of ischemia did not differ from that previously reported after CABG surgery alone, further investigation is required to determine whether the findings obtained in this high-risk population are generalizable to patients undergoing noncardiac surgery soon after uneventful CABG surgery. IMPLICATIONS: This study demonstrates an increased incidence of myocardial ischemia when sternectomy for mediastinitis is performed within one week of coronary artery bypass graft surgery, and this ischemia is associated with a 25% incidence of myocardial infarction.     

Perioperative myocardial infarction and risk of death with and without preoperative beta blockers

This study compares patients who have had a myocardial infarction in the perioperative period who were on perioperative beta blockers with those who had a myocardial infarction and were not on perioperative beta blockers. The charts of 68 patients were reviewed retrospectively. The timing and diagnosis of the myocardial infarction, gender, age, type of surgery, type of anesthesia, diabetics, preoperative medical clearance, and deaths were recorded. A subgroup of patients who had significant bleeding perioperatively or postoperatively were compared with patients with no bleeding problems. From 1998 through 2006, there were 46,003 patients who had surgery and 68 perioperative infarcts. Of the 68 patients, 25 received perioperative beta blockers and 11 died. Of the 43 patients who did not receive beta blockers, 22 died. There was no statistically significant difference when the patients were analyzed for concomitant bleeding or nonbleeding with regards to survival and beta blockers.     

On- and off-pump coronary surgery and perioperative myocardial infarction: an issue between incomplete and extensive revascularization.

OBJECTIVE: Complete myocardial revascularization is the standard for coronary artery bypass grafting. It has been shown, however, that off-pump coronary bypass surgery (OPCAB) may reduce completeness of revascularization without affecting perioperative myocardial infarction rates. We evaluated the influence of OPCAB on major postoperative events in a large consecutive cohort of patients, with special emphasis on risk factors for perioperative myocardial infarction. METHODS: From 1995 to 2004, 5935 patients underwent isolated coronary bypass surgery; of these, 4623 (77.9%) and 1312 (22.1%) underwent on-pump coronary surgery (CABG) and OPCAB, respectively. Patients undergoing OPCAB were matched to patients undergoing CABG by propensity score; logistic regression analysis models were used to study predictors of perioperative myocardial infarction. RESULTS: In matched pairs, postoperative mortality, myocardial infarction, stroke, and atrial fibrillation were similar between groups, while reoperation for bleeding, time on ventilator and red blood cell use were lower in patients undergoing OPCAB. The number of distal anastomoses was lower in patients undergoing OPCAB (2.2+/-0.80 in OPCAB vs 2.9+/-0.86 in CABG, p<0.001), as well as complete revascularization rates (61.9% in OPCAB vs 90.0% in CABG, p<0.001). Multivariate analyses, performed on preoperative and intraoperative variables, showed that both incomplete revascularization and increasing numbers of distal anastomoses (even when controlling for completeness of revascularization) were significant predictors of perioperative myocardial infarction, while CABG/OPCAB strategy did not influence it. CONCLUSIONS: The choice of surgical technique did not influence the occurrence of major perioperative complications and of myocardial infarction, which is negatively affected by incomplete or too extensive revascularization strategies.     

Safety of peripheral vascular surgery after recent acute myocardial infarction

We have treated 30 patients requiring urgent or emergent vascular procedures in the first 6 weeks after a myocardial infarction (median 11 days) from 1977 through 1989. Forty operations were performed, including 28 lower extremity revascularizations, 10 major amputations and revisions, and two carotid endarterectomies. There were four postoperative deaths (three cardiac related) and two nonfatal reinfarctions. Cardiac complications did not correlate with age, interval from myocardial infarction to surgery within the initial 6 weeks, type of anesthesia, or complexity of operation. Twenty of 24 patients survived attempts at leg revascularization, with ultimate limb salvage in 16. Our cardiac complication rate of 17% (5/30 patients) was reasonably close to that predicted by the Goldman risk scale for classes II and III and significantly better than class IV and also better than that predicted by the Cooperman risk scale for vascular surgery, despite the more recent preoperative myocardial infarctions in our patients. We attribute our low morbidity and mortality to the extracavitary nature of the procedures and possibly to improvements in anesthetic and perioperative management. Patients requiring urgent revascularization for limb salvage should not be denied surgery on the basis of a recent myocardial infarction.     

Increased risk of urgent revascularization

To determine the risk factors for operative mortality and morbidity, we performed a prospective analysis of 1,980 patients undergoing isolated coronary artery bypass operations between 1982 and 1984. The operative mortality was 3.5%, and the incidence of perioperative myocardial infarction was 8.6% and low output syndrome, 12.0%. Stepwise logistic regression identified sex, preoperative left ventricular ejection fraction, and the urgency of operation as independent risk factors for postoperative mortality. Urgent revascularization was performed in patients with unstable angina refractory to maximal medical therapy. In these patients the operative mortality was 8.5%. Independent risk factors of postoperative morbidity, in addition to sex, ejection fraction, and urgent revascularization, included a previous bypass procedure, age, and New York Heart Association functional class. Unstable angina unresponsive to medical therapy contributed significantly to the operative risk. Interventions to reduce perioperative ischemic injury, such as improved methods of myocardial protection, may improve the results in high-risk patients.     

Nitroglycerine-induced volume loading

Fifty-five patients who underwent elective aortic aneurysmorrhaphy were studied intraoperatively to assess ventricular function responses to volume loading and nitroglycerine/inotrope mini-infusions. Assessments of preoperative cardiac reserve and risk of perioperative myocardial infarction were based on ejection fraction (EF); an algorithm was developed to direct differential preanesthetic loading to maximize ventricular performance in normal (EF, greater than 60%), moderate-risk (EF, 35% to 60%), and high-risk (EF, less than 35%) patients. Sixty percent of the patients in the series were at significant risk of myocardial infarction, including 25 with an EF from 35% to 60% and seven with an EF less than 35%; the perioperative myocardial infarction rate was zero. Nitroglycerine-induced volume loading in this series allowed aortic aneurysmorrhaphy without any decrease in ventricular function at the critical points of anesthetic induction, aortic cross clamping, or declamping; such optimization of myocardial performance appears to prevent perioperative myocardial infarction, even in high-risk patients.     

冠状动脉旁路移植术患者术后早期运动耐量改善的影响因素

目的　探讨冠状动脉旁路移植术 (CABG)患者术后早期运动耐量改善的影响因素 ,以提高手术疗效。方法　随机选择 30例行 CABG患者 ,术前和术后 1～ 3个月进行平板运动试验 (TET) ,以手术前后运动功量的差值为应变量 ,各项临床指标与手术情况为自变量 ,进行 L ogistic多元回归分析。　结果　无手术死亡。术后运动功量等运动耐量指标及心肌缺血指标有明显改善 (P<0 .0 0 1) ,术前左心功能、心肌梗死史、心绞痛、高血压和乳内动脉 (IMA)移植是影响手术疗效的主要因素。　结论　 CABG能显著提高运动耐量 ,改善心肌缺血 ,了解并重视这些影响因素将有助于更好地选择手术病例 ,预测手术疗效。     

Effects of clopidogrel on perioperative blood loss in off pump elective coronary artery bypass surgery. A prospective single blinded observational study

Background  

Concern about possible hemorrhagic complications arising from use of oral antiplatelet agents in immediate proximity to CABG surgery leads many physicians to avoid or discontinue these agents preoperatively exposing these patients to risk of perioperative myocardial infarction, stroke and vascular event. So we aimed to study the effect of clopidogrel on perioperative blood loss in patients who stopped the drug before surgery with variable time periods. The study was designed to evaluate the effect of preoperative clopidogrel on Coronary Artery Bypass Grafting (CABG) surgery outcome in terms of perioperative blood loss.     

围术期心肌缺血和心肌梗死研究进展

背景 围术期多种因素可能导致心肌缺血和心肌梗死,了解其发生机制,有效预防,可降低围术期心脏事件发生率.目的 探讨围术期心肌缺血和心肌梗死的发生机制及有效预防措施.内窖冠状动脉粥样硬化后冠脉内皮对交感神经、副交感神经兴奋的反应性发生改变以及围术期特殊的病理生理状态是围术期心肌缺血和心肌梗死发生的主要机制.对于冠心病患者加强围术期心肌缺血和心肌梗死的监测与诊断,加强围术期药物治疗维持斑块稳定性、维持氧供需平衡,并完善术后镇痛、加强保温、避免血糖过高可减少围术期心肌缺血和心肌梗死的发生.趋向 冠心病患者非心脏手术前常规预防性药物的治疗时间与获益的关系以及术前冠脉重建的价值尚需进一步探讨.     

围术期心肌缺血和心肌梗死研究进展

背景 围术期多种因素可能导致心肌缺血和心肌梗死,了解其发生机制,有效预防,可降低围术期心脏事件发生率.目的 探讨围术期心肌缺血和心肌梗死的发生机制及有效预防措施.内窖冠状动脉粥样硬化后冠脉内皮对交感神经、副交感神经兴奋的反应性发生改变以及围术期特殊的病理生理状态是围术期心肌缺血和心肌梗死发生的主要机制.对于冠心病患者加...     

Nonrandomized Matched Pair Analysis of Intermittent Ischemic Arrest versus Potassium Crystalloid Cardioplegia during Myocardial Revascularization

The quest for the ideal method of myocardial preservation during coronary artery bypass graft (CABG) surgery continues at a rapid pace. Nevertheless, in the present clinical practice of cardiac surgery, the choice is chiefly between hypothermic intermittent ischemic arrest and hypothermic potassium cardioplegia. This study applies newer techniques in radionuclear cardiology, as well as more conventional enzymatic, electrocardiographic, and hemodynamic determinations, to the evaluation of the effectiveness of the previously mentioned modes of myocardial protection. Serial assessments are made preoperatively as well as during the first ten days postoperatively. We find that the perioperative incidence of myocardial damage and changes in left ventricular performance are almost identical using either method in patients with relatively normal preoperative left ventricular performance who do not have severe preoperative refractory ischemia or necrosis.     

Clinical characteristics and current management of medically refractory unstable angina.

Of 531 patients admitted to the Duke Coronary Care Unit with unstable angina (UA) from June 1981 to September 1982, 100 had persistent angina despite optimal medical therapy of nitrates, propranolol, and nifedipine. At catheterization, 70% of the refractory patients had left main (LM) or three-vessel disease (TVD), 68% had left ventricular end-diastolic pressures of greater than 12 mmHg, and 24% had ejection fractions (EF) of less than 0.40. Twenty-four patients were greater than 65 years of age, and 53 had associated major diseases. Forty-eight patients (Group I) had no evidence of myocardial infarction in the 30 days before catheterization, whereas 52 patients had an infarction precipitating the unstable angina within the preceding 30 days (Group II). Emergent coronary artery bypass grafting was performed in all 100 patients irrespective of ventricular function, hemodynamic status, or coronary anatomy. Management protocols included prompt surgical intervention, preoperative stabilization with the balloon pump in LM or TVD, meticulous myocardial protection, and complete coronary revascularization. An average of 3.6 grafts were placed in each patient. There were two hospital deaths in Group I, and two in Group II. Two-year survival was 90% in Group I and 88% in Group II, and 81% of surviving patients were NYHA Class I or II. Thus, refractory UA denotes particularly severe coronary disease with a high incidence of LM, TVD, and depressed EF. Baseline clinical characteristics, criteria for operation, and expected results in the postinfarction group seem to be similar to the unstable angina group in general. Cardiac anatomic and functional variables no longer constitute operative contraindications. Aggressive operative management is safe, and the current risk may be less dependent on coronary anatomy and ventricular function than previously appreciated.     

Impact of simultaneous myocardial revascularization on operative risk, functional result, and survival following mitral valve replacement

A cohort of 282 patients who underwent mitral valve replacement with a xenograft bioprosthesis was strictly segregated according to etiology of mitral dysfunction and analyzed regarding the impact of arteriographic coronary artery disease (CAD) and concomitant coronary artery bypass grafting (CABG) on operative risk, functional result, and survival. CAD was present in 21% of the 122 patients with predominant mitral stenosis (MS) and 59% of the 155 patients with mitral regurgitation (MR); moreover, discordance between the presence of angina and anatomic CAD was found in 27% (33 of 122) of the MS subgroup and 36% (56 of 155) of the MR subgroup.Etiology of the valvular dysfunction was rheumatic in 148 patients, myxomatous degeneration in 83, and ischemic in 32. Within these subgroups, 41 patients (27%), 40 patients (48%), and 32 patients (100%), respectively, had CAD. Of those patients with CAD, 85% of the rheumatic subgroup, 90% of the degenerative subgroup, and 81% of the ischemic subgroup underwent concomitant CABG at the time of valve replacement. Within each subgroup no statistically significant (P greater than 0.05) differences in operative mortality rate, perioperative myocardial infarction rate, incidence of late angina or late infarction, or late actuarial survival were evident when compared on the basis of CAD, and/or CABG, with one exception. The exception was the 10% incidence of perioperative myocardial infarction in the rheumatic subgrohp with coronary disease versus 2% in the rheumatic subgroup without coronary disease (P = 0.05). Within the time constraints of this study (mean follow-up = 2.3 years; maximum follow-up = 5.9 years), these results support simultaneous MVR and CABG when hemodynamically appreciable CAD is found. Moreover, the overall 43% incidence of arteriographic CAD warrants routine coronary angiography in most adults undergoing preoperative catheterization for mitral valvular disease.     

Outcome of non-elective coronary artery bypass grafting without cardio-pulmonary bypass.

OBJECTIVES: There is limited experience in the use of beating heart coronary artery bypass grafting (CABG) in emergency and urgent cases. The aim of this study was to retrospectively assess the safety and efficacy of this technique when used in a non-elective setting. METHODS: We retrospectively reviewed all urgent and emergency cases of coronary artery bypass grafting performed without cardiopulmonary bypass (CPB) from July 1999 to February 2000. There were 35 patients in total. The mean age was 64.8+/-11.9. Twenty-six (74.3%) patients had Canadian Cardiovascular Society grade 4 angina. Twenty-six patients (74.3%) had triple vessel disease. Eleven patients (31.4%) were on preoperative IV nitrates and nine patients (25.7%) had a preoperative IABP (intra aortic balloon pump). Three patients (8.6%) had suffered a preoperative cardiac arrest during coronary angiography. Other associated significant risk factors were smoking (60%), hypertension (40%), hypercholesterolemia (57.1%) and previous Q wave myocardial infarction (31.4%). RESULTS: Twenty-two patients (62.9%) were classified as being urgent and 13 patients (37.1%) were classified as emergencies. The mean number of anastomoses performed were 2.8+/-0.8 (range 1-4) with 68.6% of patients under going triple or quadruple vessel grafting. All patients (100%) received at least one arterial graft. There was no conversion to cardiopulmonary bypass. The main postoperative complications were--supraventricular arrhythmias eight (22.9%), low cardiac output seven (20%) and postoperative HF/dialysis two (5.7%). The median postoperative intensive care unit (ICU) stay was 27.5 h. The mean postoperative hospital stay was 8.3+/-3.1 days.One patient died (2.9%) at the eighth day after surgery due to postoperative myocardial infarction, multi-organ failure secondary to the septicaemia and ventricular arrest. CONCLUSION: Non-elective CABG without CPB is feasible and safe with modern cardiac stabilization devices.