Peri-operative benefits of beating-heart coronary revascularization in patients with triple vessel disease

OBJECTIVES: To compare the perioperative benefits of the offpump coronary artery surgery to conventional surgery with cardiopulmonary bypass (CPB) assistance. METHOD: Retrospective study comparing 50 consecutive patients with triple vessel disease (TVD) operated upon with CPB assistance to 50 consecutive patients with TVD operated on beating heart (BH) by the same surgeon between January 1996 and August 1997 at the Montreal Heart Institute. Matching criteria between the 2 groups were: first time operation, normal left ventricular ejection function (LVEF), and coronary TVD. RESULTS: Demographic data and risk factors were comparable in both groups. Unstable angina was the most common surgical indication (CBP: 72%, BH: 62%). The average number of grafts were comparable in both groups (CBP: 3.5 vs 0.6 vs BH: 3.3 +/- 0.4, p = 0.06) as well as the preoperative LVEF (CEC: 60 +/- 1% vs CB: 62 +/- 1.2%, p = 0.38). Arterial lactate count was lower in the BH group during the perioperative period (3.0 +/- 1.0 vs 3.9 +/- 1.7 mM) as well as the maximal CK-MB level (BH: 20 +/- 6.4 vs CBP: 40 +/- 3.5 IU/L, p = 0.003), transfusional needs (CB: 34% vs CEC: 66%, p = 0.003), and postoperative creatinin level (BH: 100 +/- 4.2 vs CBP: 120 +/- 7.1 mM, p = 0.001). Postoperative HB level was also higher in the BH group (110 +/- 14 vs 104 +/- 12, p = 0.001). CONCLUSION: Our data confirm potential benefits from BH surgery on patients affected with triple vessel disease relatively to transfusional needs, and myocardial as well as renal protection.