Objective : In a retrospective study, we compared 2 groups of 100 consecutive patients (Jan – May 2000), operated for coronary artery disease with the use of extracorporeal circulation (group A) or on the beating heart using the Octopus II+ device (group B).
Methods : There were no significant preoperative differences between groups in sex, age, coronary artery disease, previous PTCA, preoperative IABP, old and recent infarctions, diabetes and peripheral vascular disease. Group B comprised more patients with a compromised left ventricular function. Carotid artery disease, atheromatosis of the ascending aorta and obstructive lung disease, were statistically significant more prevalent (respectively p=0,006 - 0,013 - 0,001) in the beating heart group.
Results : All patients were operated through midline sternotomy. Significant more distal anastomoses were performed in group A (3,7 per patient (range 2-6)) with regard to group B (2,95 per patient (range 1-5) p=0.001). Mean aortic cross-clamp time was 40,4 minutes (range 20 – 80 min), mean occlusion time of the coronary vessels in group B varies from 6 to 7,5 minutes (range 4 – 25 min). Postoperative evolution was quite similar. A significant lower incidence of atrial fibrillation was diagnosed in the beating heart group (13% versus 26%). There was a tendency for higher early mortality (p=0.056) and morbidity (stroke, wound healing, revision for bleeding) in group A. More patients were in need for transfusion in group A. Length of hospital stay was shorter in group B.
Comment : In our experience is beating heart surgery a safe alternative for conventional coronary surgery. We actually prefer this technique for elderly patients, patients with an important vascular history or higher co-morbidity. A prospective, randomized study comparing both groups has been started.