How much myocardial revascularization can we do without extracorporeal circulation?

The main goal of this study is to present a technical alternative that allows myocardial revascularization to be performed on the marginal branches of the circumflex coronary artery without the use of extracorporeal circulation (ECC). The technique for exposing the coronary vessels is performed by placing a stitch in the posterior pericardium. The surgeon lifts the heart using his or her left hand with the aim of exposing the posterior pericardium. A single polypropylene "O" stitch on a #4 needle is threaded into a cardiac ribbon folded back on itself and run twice through the region between the inferior pulmonary vein and the inferior vena cava. The suture thread is run along a tourniquet-type rubber tube and the latter is then directed down to the pericardium, bringing the cardiac ribbon with it. Handling the thread by means of such a tourniquet and the two parts of the ribbon makes it possible to maneuver the heart into different positions in order to expose the coronary arteries: anterior interventricular, diagonal, circumflex, and right coronary. In the present study, the position exposing the coronary arteries was adopted. The circumflex artery was exposed by separating the two legs of the ribbon and pulling one of them +/- 90 degrees to the right and the other +/- 90 degrees to the left of the patient's main axis, with the polypropylene thread being pulled in the direction of the patient's main axis and fixed in the inferior angle of the surgical wound. From August 1981 to June 1999, 609 patients had their arteries revascularized without the use of ECC. Among this group, 147 patients (24.14%) had the circumflex artery revascularized. Of the 609 patients, 48 (7.88%) presented serious complications and 21 (3.44%) died. It was possible to modify the anatomical position of the heart by exposing the circumflex artery with its marginal obtuse branches and performing anastomosis in a simple manner with no loss of quality or hemodynamic involvement, permitting a complete revascularization without the aid of extracorporeal circulation.