Efficacy of the direct myocardial revascularization performed on the beating heart or performed with the use of extra corporal circulation - comparison by means of myocardial perfusion SPECT

Introduction. In the recent years, new techniques of direct myocardial revascularization: OPCAB - off pump coronary artery bypass and MIDCAB - minimal invasive coronary artery bypass were developed. Aim of this study was to compare the efficacy of these methods with that of CABG performed with the use of extracorporal circulation. Material and methods. 20 patients operated on the beating heart (group 1; 16 men and 4 women; aged 40 to 65 years; mean 53,0 ±8,6 years) and 36 patients operated in the extracorporal circulation (group 2; 33 men and 3 women; aged 34 to 69 years, mean 52,5 ±8,6 years). In all the patients myocardial SPECT using 99mTc-MIBI at rest and after stimulation with dipyridamole (0,56 mg/kg) was performed twice: before and 4-7 months after revascularization. Myocardial perfusion was evaluated in 9 segments using following scale: from 1 (normal) to 5 points (no uptake). The average score in all nine segments constituted a perfusion index (PI). The differences of PI before and after operation, both at rest and after dipyridamole were compared. Results. In none of the patients of group 1 a perioperational ischemia was found by ECG or enzymatic (CK-MB) measurements. In a part of group 2 signs of transient ischemia were found. Global evaluation of perfusion in SPECT is presented. PI were similar in both groups, both at rest and after dipyridamole. Conclusion: Efficacy of the direct myocardial revascularization performed on the beating heart is similar to that of the CABG operations performed with the use of extracorporal circulation. The OPCAB and MIDCAM operations are less traumatizing