Complete myocardial revascularization on the beating heart

BACKGROUND: Complete myocardial revascularization with excellent visualization, exposure, and stabilization can be accomplished on the beating heart without cardiopulmonary bypass (CPB). METHODS: Three hundred patients were totally revascularized via median sternotomy with myocardial stabilization using the CardioThoracic System. All patients who underwent coronary artery bypass grafting were considered for the off-pump procedure. Pericardial sutures were placed at the level of the left atrial appendage and were pulled upwards to the right. The stabilizer was applied sequentially from circumflex, obtuse marginal, intermediate, diagonal, left anterior descending, and right coronary artery. Coronaries were occluded using the Calafiore technique, and multiple arterial grafts were inserted. RESULTS: The average number of grafts was 3.4 per patient. Six percent had to be converted to standard CPB. Comorbidity was not a limiting factor with 8% redos, 48% having diabetes, and acute myocardial infarctions in 28%. The unadjusted mortality was 2.3%, and stroke rate was 0.7%. CONCLUSIONS: These results indicate that complete revascularization can safely be accomplished without CPB.