Abstract

Study comparing the results of Coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB) in the treatment of left main stenosis (LMS) has not yet been made in Bosina and Herzegovina. The main aim of this study was to compare result of CABG performed by these methods in LMS group of patients in the early and late postoperative period. The study was divided in two parts. In the first part early postoperative period (30 days after the surgery) have been analysed, which consider results of CABG in 92 patients revascularisied without CPB (OPCAB) method (Group A), and 84 patients with LMS revascularisied with CPB method (ONCAB, CCAB) (Group B). In the second part late postoperative period (one year after surgery) have been analysed. Patients from both groups have been contacted and interviewed. Total number (276 versus 278) same as average number of grafts per patients (3.0 }1.45 versus 3,31 }0.86, p=0.096) was insignificantly higher in group B. Perioperative and postoperative results revealed significant differences between two groups with in the meaning of reduced mechanical ventilation time (2.9 versus 7.3 hours, p=0.039), less blood transfusion requirement (200.3 versus 419.9 ml, p=0.035) and postoperative length of stay (7.4 versus 8.3 days). Inotropic support requirement was significantly higher in group B during the surgery (14.1% versus 29.8%, p=0.019) and postoperative period longer than 12 hours (7.6 versus 22.6%; p=0.009). The most frequent postoperative complication was rhythm disturbance within the definition of atrial fibrillation (23.9 versus 32.1, p=0.295). There was significant difference in mortality in early postoperative period in group A ( 0.0 versus 5.95%, p=0.023). Recurrent angina was among the most frequent postoperative complications and side effect after coronary artery bypass grafting. Significant differences haven’t been revealed between two groups for total appearance of recurrent angina pectoris (25.0 versus 31.2%, p=0.479), for any of additional procedure (7.9 versus 7.8, p=0.802), for the major complications (8.0 versus 9.1%; p=0.985), for mortality (7.9 versus 5.2%; p=0.692). Patients’ survival after CABG for period of 12, 24, 36 and 48 months after surgery was not statistically significant (97.0 versus 96.1%, p= 0.802; 95.5 versus 96.1%, p=0.857; 93.2 versus 94.8%, p=0.913; 92.0 versus 94.8%, p= 0.692). In conclusion, CABG without CABG in treatment of LMS have several advantages compared to conventional method: reduced mechanical ventilation time, less blood transfusion requirement, less inotropic support requirement, shortened postoperative length of stay, reduced mortality in early postoperative period. In the late postoperative period no statistically significant difference was noticed within the mean of recurrent angina, additional procedures, major complications and mortality. Survival rate after CABG was not statistically different in patients operated with or without CPB.

Key words: coronary artery bypass grafting, LMS, early results of coronary artery bypass grafting, late results of coronary artery bypass grafting