Left main coronary artery stenosis and revascularization in the beating heart. Short- and long-term experience

OBJECT: To determine the safety of surgical revascularization without cardiopulmonary bypass in left main coronary artery stenosis. METHODS: Between October 1996 and October 1998, 67 patients with a left main stem stenosis (LMS) (> 50%) underwent revascularization on beating heart surgery (BHS) and were compared to a cohort of 192 patients with LMS disease that were operated on under cardiopulmonary bypass (CPB) during 1996. RESULTS: Mean age and sex distribution and prevalence of preoperative risk factors were the same in both groups as well as the average number of grafts per patient was 3.1 +/- 0.7 and 2.9 +/- 0.7 in BHS and CPB groups respectively. Perioperative infarction rate (defined arbitrarily as a CK-MB > 100 IUL) was 2.9% in BHS group and 3.1% in CPB group. Postoperative blood transfusion requirements were less in BHS group (38%) compared to CPB group (64%), p < 0.05. Inotropic requirements postoperatively were similar in both groups. Hospital stay was shorter in BHS group (6.8 days) compared to CPB group (7.6 days) although not significant. There was no operative mortality in BHS group whereas 4.7% died postoperatively in CPB group. CONCLUSION: Our experience suggests that non-bypass surgical revascularization is a feasible and safe alternative to conventional cardiopulmonary bypass.