Clinical Practice of On-pump Beating-heart Coronary Artery Bypass Grafting at Tri-Service General Hospital

Background: Current cardioplegic techniques cannot consistently avoid myocardial ischemic damage in high-risk patients undergoing coronary artery bypass grafting. Alternatively, revascularization without cardiopulmonary bypass is not always technically feasible. Beating-heart surgery with cardiopulmonary bypass support but without aortic cross-clamping may be an acceptable alternative. Methods: From April 2005 to August 2006, 70 patients underwent coronary artery bypass grafting through pump-supported, noncross-clamped beating-heart surgery. Among the patients, 74.3% were men and 25.7% were women. The mean age was 68±11.4 years. Preoperative left ventricular ejection fraction was 50.0%±15.5%. Results: Revascularization of 204 distal anastomoses (2.87 grafts/patient) was completed; 11.4% involved quadruple bypass, 68.6% involved triple bypass, and 20% involved double bypass. The mean operation time was 278±62 minutes, and the mean bypass time was 61.0±26.3 minutes. The hospital mortality rate was 1.4%. The median postoperative ventilation time was 48±30 hours, the median intensive care unit stay was 4.1±2.3 days, and the mean total hospital stay was 12.8±4.7 days. Postoperative complications included acute renal failure (2.8%; all recovered after medical treatment), cerebrovascular events (1.4%), and reoperation for hemostasis (5.7%). One patient died during the hospital stay because of severe low cardiac output with multiple organ failure. Conclusions: On-pump beating-heart coronary artery bypass grafting may eliminate intraoperative global myocardial ischemia and may be an acceptable surgical option. This procedure avoids the myocardial injury associated with aortic cross-clamping and allows safe and complete coronary revascularization.