Left main coronary artery stenosis: Early experience with surgical revascularization without cardiopulmonary bypass

Background. To determine the safety of surgical revascularization without cardiopulmonary bypass (CPB) in left main stem (LMS) coronary stenosis. Methods and results. Between October 1996 and April 1998, 67 consecutive patients with a greater than or equal to 50% LMS stenosis underwent coronary revascularization without bypass CBH) and were compared to a contemporary group of 160 patients revascularized with conventional bypass (CPB). Mean ages in both groups were similar: 63.1 and 64.5 years in BH and CPB groups respectively (p = 0.91). Significant triple vessel disease occurred in 40 (80%) and 75 (47.5%) patients in BH and CPB groups respectively (p = NS), Average grafts per patient was numbered 3.1 in BH group and 2.9 in CPB group (p = NS). The perioperative infarction rate (defined arbitrarily as a CKMB >100 U/l) was 4% (2 patients, excluding 1 preoperative infarct) and 3.1% (5 patients, excluding 2 preoperative infarcts) in groups BH and CPB respectively (p = 0.28). Postoperative blood transfusion requirements were less in BH group (19 patients, 38%) compared to CPB group (103 patients, 64.4%), (p = 0.04), Postoperative inotropic requirements were similar in both groups; BH group (15 patients, 30%) and CPB group (72 patients, 45%). Mean hospital stay was 6.4 and 7.6 days in BH and CPB groups respectively (p = 0.49), The hospital mortality rate was 0% and 3.8% (6 patients) in BH and CPB groups respectively (p = NS). Conclusions. Our early experience suggests that non-CPB surgical revascularization in LMS stenosis is a feasible and safe alternative to convectional cardiopulmonary bypass.