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Coronary Artery Bypass Surgery Without Pump: Renewed Interest

Cardiothoracic Division, Department of Surgery Siriraj Hospital Prannok Road Bangkok 10700, Thailand

Minimally invasive coronary artery bypass graft (CABG) surgery has brought back the technique of myocardial revascularization without extracorporeal circulation. In 1972, Ankeney reported on 143 cases of CABG performed without extracorporeal circulation at a meeting of The Society of Thoracic Surgeons in Aberdeen, Scotland. He reported in 1975 that the midterm results compared favorably with the results reported by others using cardiopulmonary bypass.¹ Trapp and Bisarya² in 1975, reported a series of 63 patients who underwent CABG without a pump but with the addition of a method of perfusing the distal coronary artery, with no mortality. Benetti and colleagues³ in 1991 and Buffolo's group⁴ in 1996, reported two large series of CABG without a pump but the long-term patency of the grafts was not mentioned. We followed Ankeney's technique in performing the first CABG in Thailand in January 1974 at Siriraj Hospital. The patient was a 55-year-old male who was admitted with crescendo angina. The coronary arteriogram revealed total occlusion of the right coronary artery with 90% narrowing of the mid left anterior descending coronary artery. The patient underwent CABG using saphenous vein grafts to the left anterior descending and right coronary arteries, which relieved his angina. An angio-graphic study 4 years later revealed occlusion of the left vein graft but the right vein graft was widely open to the right coronary artery with retrograde filling of the left anterior descending coronary artery. The patient died 5 years later from intracerebral hemorrhage. After 2 subsequent operations without a pump, we switched to the cardiopulmonary bypass technique. Up to December 1998, we have performed 1885 cases of CABG and have not gone back to the original method. There is no doubt that CABG can be performed safely without using cardiopulmonary bypass to give a good immediate result. It remains unknown whether the long-term patency of the graft is the same as that using cardiopulmonary bypass. Until this information is available, CABG without a pump should remain in the armamentarium of cardiac surgeons, to be used only in selected patients.

References

1. Ankeney JL. To use or not to use the pump oxygenator in coronary bypass operation [editorial]. Ann Thorac Surg 1975;19:108–9.[Medline]

2. Trapp WS, Bisarya R. Placement of coronary artery bypass grafts without pump oxygenator. Ann Thorac Surg 1975;19:1–9.[Medline]

3. Benetti FJ, Naselli G, Wood M, Geffner L. Direct myocardial revascularization without extracorporeal circulation, experience in 700 patients. Chest 1991;100:312–6.[Abstract/Free Full Text]

4. Buffolo E, Silva de Andrade JC, Branco JNR, Teles CA, Aguiar LF, Gomes WJ. Coronary bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 1996;61:63–6.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Prinya Sakiyalak Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sakiyalak, P. Search for Related Content PubMed Articles by Sakiyalak, P.