Revascularization of severe hibernating myocardium in the beating heart: early hemodynamic and metabolic features

Background. We investigated the effects of coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) in selected patients with severe hibernating myocardium. Methods. Twelve patients (EF = 25% ± 0.7%) with reversible ventricular dysfunction (from 2.0 ± 0.06 to 1.6 ± 0.05 left ventricular score index by echo-dobutamine, p < 0.01) in the territory of the left anterior descending artery (LAD) have been studied. Revascularization was achieved by anastomosing the left internal mammary artery to the LAD. The ischemic time of LAD was 9.0 ± 0.4 minutes. Results. Left ventricular function increased 6 hours and 48 hours after revascularization (left ventricular stroke work index from 32 ± 1.8 to 42 ± 1.5 and 40 ± 0.6 gxm/m2, respectively: p = 0.0001). During the surgical procedure, the heart did not release lactate or creatine phosphokinase. There were no perioperative deaths or severe complications. Conclusions. Early hemodynamic and metabolic features of CABG without CPB in patients with hibernating myocardium suggest that this procedure is safe and results in a significant improvement of cardiac function without affecting myocardial metabolism.