Surgical revascularization of posterior coronary arteries without cardiopulomonary bypass

Abstract

Objective -, the use of myocardial revascularization (MR) without cardiopulmonary bypass (CPB) has increased. Median sternotomy is the preferred approach, but other authors are performing the revascularization of the anterior descending coronary artery through a small incision in the anterolateral region of the left hemithorax 5,6 . These authors use the left internal thoracic artery (LITA) as the conduit of choice.In view of the difficulty in performing the revascularization of the posterior coronary arteries (PCA), there is a constant search for techniques to improve the surgical approach to these arteries. Beginning in January 1995, we developed a technique in the UNITORAX-PE clinic located in the Northeastern region of Brazil, allowing us to perform the revascularization of most PCAs. We consider PCAs the following arteries: diagonalis artery (DIA), marginal branches of the circumflex artery (MCX), posterior ventricular artery (PVA), and posterior descending artery (PDA). MethodsBetween January 1995 and June 1998, 673 patients underwent MR in our clinic. Of these 673 surgeries, 607 (90.2%) were performed without CPB. Of the total number of MR surgeries, 298 (44.27%) involved grafts for one or more PCAs and 280 (93.95%) of these procedures were performed without CPB (tab. I). Considering this specific group of patients who received PCA grafting without CPB, a total of 309 grafts for PCA were performed. Age ranged from 37 to 88 years (mean, 61 years). There was a preponderance of the male gender, with 198 (70.7%) men. The surgical approach was always made through median sternotomy. Three catgut # 0 threads were inserted in the posteroinferior area of the pericardium, to the left, between the left inferior pulmonary