[Coronary artery bypass grafting on the beating heart in patients with severe cardiac dysfunction; on the necessity of cardiopulmonary bypass].

Six patients with severe cardiac dysfunction due to acute myocardial infarction underwent coronary artery bypass grafting on beating hearts, because we were afraid of difficulty in weaning from the cardiopulmonary bypass (CPB). The first two operations were performed without use of CPB (group A) and the following cases were done with CPB (group B). All patients received emergent operations except one, and three patients needed intra-aortic balloon pumping support perioperatively. Although all patients had three vessel disease, the number of the graft was one or two. Anesthesia was maintained by fentanyl, midazolam, sevoflurane and nitrous oxide. All patients in group B could be weaned from the CPB easily. In a patient of group A, hypotension persisted during cardiac procedure. In a patient of group B, ventricular fibrillation occurred when the coronary artery was occluded by snares. In another patient of group B, we discontinued inotropic agents and used verapamil during CPB for a easy cardiac procedure and myocardial protection. We conclude that coronary artery bypass grafting on the beating heart in the patients with severe cardiac dysfunction due to acute myocardial infarction should be performed with CPB to maintain systemic hemodynamics, to protect myocardium during occlusion of the coronary artery, and to make the surgical procedure easy.