Coronary artery bypass in the ambulatory patient

Abstract

In past decades, multiple organ dysfunctions 1 provoked by cardiopulmonary bypass (CPB) have been studied. The short-and long-term results and higher cost of CPB changed the scientific focus, causing less harm to the patient and giving more emphasis to off-pump and minimally invasive surgery. Many articles appeared. Benetti 2 and Karagoz and associates 3 contributed to the progress of minimally invasive direct coronary artery bypass (MIDCAB).With further investigation, we believe in the possibility of performing a MIDCAB in the ambulatory patient. We therefore operated on a series of selected patients who were totally awake and without orotracheal intubation. They were discharged from the hospital within 24 hours after the operation. MethodsBetween January 2000 and May 2001, 20 patients were subjected to coronary artery bypass while fully awake, without the use of CPB or an orotracheal tube. All patients had a lesion in the left anterior descending artery, and none had important chronic pulmonary disease. Ages varied between 41 and 75 years, and the predominant sex was male. All patients were subjected to preoperative psychologic preparation.From the Departments of Cardiothoracic Surgery, a Anesthesiology, b and Cardiology, c the Hospital Sa ˜o Jose ´do Avaı ´, Itaperuna/RJ, Brazil.