Advantages of Beating Heart Bypass Surgery Without Use of Heart-Lung Machine in Baghdad

Abstract

The location of the coronary arteries in the sub epicardium was one among other factors that stimulated cardiac surgeons to attempt revascularization without cardiopulmonary bypass (CPB). This study summarizes the experience with 163 patients who had coronary artery bypass grafting (CABG) without extra corporeal circulation (CPB) in Iraqi Center for Heart Diseases from September 1999 to July 2005. CABG on beating heart accounted for about 20% of the total number of coronary operations performed in the center at that time. 83.5% of patients were males and 16.5% were females. Age range was 31-78 years with a mean of 60 years. Majority of patients (70%) were presented with advanced functional class (FC) III and IV. Overall, 60% of patients had myocardial infarction and 8% had previous PTCA. Thirty six percent of patients had EF% below 50% with higher incidence in the elderly patients (high-risk group). All the  patients were primary CABG and were done through median sternotomy. A total of 316 grafts were placed with a mean of 1.9 grafts/patient, (3 - 4) grafts per patient were placed in 21.5% of patients (substantially complete revascularization). Conversions to CPB were needed in four patients (2%), there were three mortalities (1.8%) after per-operative myocardial infarction (MI), and prolonged
low cardiac output state. Mean 1CU stay was 24 hours and mean hospital stay was 5.5 days. Seventy two percent of patients reported complete relief of symptoms. Twenty two percent developed atypical chest pain with negative treadmill test and 5 patients (3.0%) had positive treadmill test in the follow- up period, which was 2-3 months after surgery. Post-operative complications were reported in 26% of patients, most commonly post-operative hypertensive crisis (6%) and low cardiac output (LCO) syndrome (4%).