A 63-year-old man with unstable angina and idiopathic thrombocytopenic purpura (ITP) underwent off-pump coronary artery bypass grafting after being admitted to our hospital because of angina pectoris. Coronary angiography performed on admission showed 90% stenosis of the left main coronary artery. High dose transvenous γ globulin therapy was performed for 3 days before surgery. The number of platelets, which was 2.3×10⁴/mm³ on admission increased to 4.1×10⁴/mm³ before surgery. Ten units of platelets were transfused intraoperatively, with little perioperative hemorrhage and no increased incidence of bleeding complications. The postoperative course was uneventful. High dose transvenous γ globulin therapy and operation without cardiopulmonary bypass were useful in facilitating the treatment of this ITP coronary artery bypass patient.

The use of transapical aortic cannulation for arterial inflow during surgical repair of type A acute aortic dissection was evaluated. Thirty-six patients who underwent repair of type A aortic dissection were divided into 2 groups: those who underwent repair with transapical aortic cannulation (group A; 19 patients) and those who underwent repair with axillary and/or femoral artery cannulation (group C; 17 patients). Preoperative condition, estimated blood loss, transfusion requirements, and duration of the tube drainage and postoperative hospital stay did not differ in the 2 groups. Cannulations were successful in all patients, and none of the attempted inflow sites required moving to alternate sites in either group. The time to initiation of extracorporeal circulation (74.2±16.2min versus 88.8±12.5min, p=0.005) and the extracorporeal circulation time (175.2±55.5min versus 216.6±58.1min, p=0.036) was shorter in group A than in group C. However, the total operation time did not differ between the groups (309.3±112.5min in group A versus 363.4±130.9min in group C, p=0.198). All patients survived the operation, and there were no complications directly related to transapical aortic cannulation. Postoperative stroke tended to be lower in group A than in group C (5.3% versus 29.4%; p=0.081). There was 1 operative death in group A (5.3%) and 4 operative deaths in group C (23.5%) (p=0.167). These data demonstrate that the use of transapical aortic cannulation yielded more favorable results than other cannulation techniques for induction of extracorporeal circulation and for minimization of extracorporeal circulation time and postoperative morbidity. We conclude that transapical aortic cannulation represents a safe, effective and less invasive means of providing arterial inflow during cardiopulmonary bypass for patients undergoing surgical correction of type A aortic dissection.