Methods: Between January 2014 and December 2014, a total of 48 patients (37 males; 11 females; mean age 62±10 years; range, 41 to 82 years) who underwent complete revascularization on beating heart with a diagnosis of acute coronary syndrome were retrospectively analyzed. Initial procedure consisted of the left internal thoracic artery-left anterior descending artery grafting in all patients. Following the revascularization of the left anterior descending artery, remaining anastomoses were performed. Postoperative intensive care unit parameters, 30-day mortality rate, and altered left ventricle systolic function were recorded.

Results: The mean number of bypass graft anastomoses were 2.7±1.2 (range, 1 to 5) during a mean time of 49.2±2 (range, 10 to 122) min. The mean time from the onset of angina symptoms to surgery was 32.3±40 (range, 1 to 216) hours. One-third of the patients did not require any inotropic support postoperatively, while three patients required intraaortic balloon pump support. Two patients requiring intensive inotropic support and IABP during the immediate postoperative period died on postoperative Days 1 and 3, respectively. Another patient died due to complications associated with prolonged intensive care unit stay on postoperative Day 27. The mean time to discharge was 8.4±3.8 (range, 3 to 27) days in the remaining patients.

Conclusion: Our study results suggest that complete revascularization on a beating heart can be safely applied in the first-line setting in experienced centers for the surgical management of acute coronary syndrome, as it reduces systemic inflammatory response which may, otherwise, result from cardiopulmonary bypass, prevents global ischemia, and enables rapid reperfusion.