On-pump beating-heart coronary artery bypass grafting for acute myocardial infarction.
The early results of emergent coronary artery bypass grafting by conventional operative method for acute myocardial infarction are reported to be poor. The purpose of this study is to evaluate on-pump beating-heart coronary artery bypass grafting for acute myocardial infarction. Thirty-one patients with acute myocardial infarction underwent emergent surgery between January 1998 and June 2004 at Nayoro City General Hospital. In 16 patients, on-pump surgery was performed on the arrested heart, and in the other 15, on-pump surgery was performed on the beating heart. Early results were compared between the two groups. Preoperative and perioperative patient characteristics revealed no significant differences between the two groups. Although there was no statistically difference between the two groups, the early mortality rates of on-pump arrested-heart coronary bypass grafting (31.3%) was higher than that of on-pump beating-heart coronary bypass grafting (13.3%). Postoperatively, the creatine kinase myocardial band value for the on-pump beating-heart group was significantly lower than that for the on-pump arrested-heart group (221 +/- 200 IU/L versus 666 +/- 540 IU/L, p = 0.008). The incidence of postoperative acute renal failure was significantly higher in the on-pump arrested-heart group than in the on-pump beating-heart group (p = 0.034). The durations of ventilator use and inotropic agent use were longer in the on-pump arrested-heart group than in the on-pump beating-heart group, though the differences were not statistically different (p = 0.152, p = 0.223). On-pump beating-heart coronary artery bypass grafting has the possibility to eliminate intraoperative global myocardial ischemia and to be an acceptable surgical option for acute myocardial infarction associated with lower postoperative mortality and morbidity.