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Coronary bypass grafting without cardiopulmonary bypass--technical considerations, clinical results, and follow-up
1University of Leipzig, Heart Center, Department of Cardiac Surgery, Germany. diea@server3.medizin.uni-leipzig.de
Insights
Off-pump coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) offers safe, minimally invasive options. This study shows good early and mid-term results for both minithoracotomy and sternotomy approaches.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Vascular Surgery
Background:
- Coronary bypass surgery can be performed with or without cardiopulmonary bypass (CPB).
- This study presents early experience with off-pump coronary artery bypass (OPCAB) surgery using minimally invasive techniques.
- The procedures involved either a minithoracotomy (MIDCAB) or a full sternotomy approach.
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump coronary bypass surgery.
- To compare outcomes between minimally invasive direct coronary artery bypass (MIDCAB) and sternotomy OPCAB.
- To assess early and mid-term graft patency rates.
Main Methods:
- A prospective study included 312 patients between November 1996 and December 1997.
- Group A (223 patients) underwent antero-lateral minithoracotomy (MIDCAB).
- Group B (89 patients) underwent full sternotomy (OPCAB). Internal thoracic artery (ITA) harvesting and anastomosis were performed under direct vision with mechanical immobilization devices.
Main Results:
- In Group A, 5.3% required conversion to CPB; 2.2% had intraoperative myocardial infarction; 2.2% needed reoperation for graft failure. Mortality was 0.4%. Early graft patency was 97.1%.
- In Group B, 11.2% required conversion to CPB; 1.1% had intraoperative myocardial infarction; 1.1% needed reoperation for graft failure. Mortality was 1.1%. 6-month patency was 92.6% in a subgroup.
- Overall, off-pump CABG demonstrated low complication rates and high graft patency.
Conclusions:
- Off-pump coronary bypass surgery is safe and yields good early and mid-term results.
- Minimally invasive direct coronary artery bypass (MIDCAB) is an effective minimally invasive technique.
- Surgeons performing these procedures should be prepared to compete with percutaneous coronary intervention (PCI) techniques.
Background:
Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB). We present our early 'off pump' coronary bypass surgery experience in combination with a minithoracotomy or sternotomy.
Methods:
Between 11/1996 and 12/1997 312 patients were included in a prospective study, 223 (Group A) underwent an antero-lateral minithoracotomy (MIDCAB) and 89 (Group B) had a full sternotomy (OPCAB). ITA harvesting and anastomosis was performed under direct vision in all cases. Different devices for local mechanical immobilization were used to perform the anastomosis.
Results:
In 212 patients of group A revascularization was by a single ITA graft and in 11 patients by a double graft using the radial artery as a T graft. Conversion to sternotomy and cardiopulmonary bypass was necessary in 12 (5.3%) patients. Intraoperative myocardial infarction was observed in 5 patients (2.2%). Early-postoperative reoperation due to graft failure was necessary in 5 patients (2.2%). Mortality was 0.4% (one patient). The early postoperative graft patency rate was 97.1% as confirmed by angiography. In group B, 25 patients had single graft and 64 patients multiple graft revascularization. Intraoperative conversion to CPB was necessary in 10 patients (11.2%). Intraoperative myocardial infarction occurred in 1 patient (1.1%), postoperative low output syndrome in 2 patients (2.2%). Early postoperative reoperation due to graft failure was necessary in 1 patient (1.1%). Mortality was 1.1%. Angiographic control of 48 patients after 6 months confirmed a patency rate of 92.6%.
Conclusion:
Coronary bypass surgery without using cardiopulmonary bypass is safe to achieve good early and mid-term results. MIDCAB is a minimally invasive technique. Experienced surgeons should be ready to compete with PTCA techniques.