Coronary artery surgery without cardiopulmonary bypass

Necessity of further improvement of surgical techniques used for myocardial revascularization is stressed in the paper. Cardiopulmonary bypass remains traumatic for the patient because it results in disturbed regulation of circulation and hypoxia of internal organs. Critical stenosis is an indication for surgery. It allows to clamp an artery distal to the stenosis thus providing up to 20 min for creation of distal anastomosis. Critical stenosis is defined as narrowing of an artery over 75% with subsequent fall in blood flow the minimal level of which is maintained due to existent collaterals. Since December 1997 the author performs mammary coronary anastomosis via minimally invasive approach through the 4-th intercostal space with the use of endoscope for isolation of the internal mammary artery. Intraoperative balloon dilatation through incision of vascular wall as an auxiliary measure for decreasing coronary artery stenosis prior to creation of distal anastomosis. Comparison of similar groups of patients operated upon with and without cardiopulmonary bypass shows decreased mortality and better postoperative course in the former group. It is emphasized that renaissance of operations without cardiopulmonary bypass signifies a step ahead in development of coronary surgery leading to lessening of invasivness of interventions.