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Coronary artery bypass without cardiopulmonary bypass for patients with acute myocardial infarction
R Mohr1, Y Moshkovitch, I Shapira
1Department of Thoracic and Cardiovascular Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
Coronary artery bypass grafting without cardiopulmonary bypass is a safe and effective treatment for acute myocardial infarction patients with suitable anatomy. This high-risk group experienced low operative mortality and good long-term survival rates.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Acute myocardial infarction (AMI) necessitates timely intervention.
- Coronary artery bypass grafting (CABG) is a standard treatment for AMI.
- Off-pump CABG (OPCAB) offers an alternative to conventional CABG, potentially reducing complications.
Purpose of the Study:
- To evaluate the surgical outcomes of high-risk patients undergoing off-pump CABG for acute myocardial infarction.
- To assess the safety and efficacy of OPCAB in patients with coronary anatomy suitable for this technique.
Main Methods:
- A cohort of 57 patients with acute myocardial infarction underwent OPCAB between January 1992 and December 1994.
- Patients had coronary anatomy suitable for OPCAB within one week of infarction.
- Surgical data, including graft numbers, artery utilization, and preoperative conditions (cardiogenic shock, intra-aortic balloon pump), were recorded.
Main Results:
- Operative mortality was low at 1.7% (1 patient).
- Mean postoperative hospital stay was 6.8 days.
- One- and 5-year actuarial survival rates were 94.7% and 82.3%, respectively.
- Renal failure and preoperative cardiogenic shock predicted mortality; older myocardial infarction and early operation predicted unfavorable outcomes.
Conclusions:
- Off-pump CABG is a relatively low-risk procedure for selected acute myocardial infarction patients.
- The technique demonstrates favorable short-term and long-term survival.
- Careful patient selection is crucial for optimal outcomes in OPCAB for AMI.
Objective:
Between January 1992 and December 1994, 57 patients having an acute myocardial infarction with coronary anatomy suitable for coronary artery bypass grafting without cardiopulmonary bypass underwent this procedure within 1 week of the infarction. We describe the surgical results of these high-risk patients.
Methods:
The study population included 43 male patients (75%) and 14 female patients (25%) whose mean age was 58.5 +/- 10.4 years. Thirty-two patients (56%) underwent emergency bypass grafting within 48 hours of an acute myocardial infarction, 4 of them (12.5%) as a bailout procedure after complicated percutaneous transluminal coronary angioplasty. Of these 32 patients, 7 patients (22%) were in cardiogenic shock, and 10 patients (31%) required preoperative intra-aortic balloon pump. Twenty-five patients (44%) underwent coronary bypass grafting 2 to 7 days after an acute myocardial infarction. The mean number of grafts per patient was 1.8 (range, 1-4), and the internal thoracic artery was used in 47 patients (82%). Only 7 patients (12%) received grafts to a circumflex marginal branch.
Results:
Operative mortality was 1.7% (1 patient), and the mean postoperative hospital stay was 6.8 +/- 3 days. One- and 5-year actuarial survivals were 94.7% and 82.3%, respectively. Angina returned in 7 patients (12%), 1 of whom underwent reoperation. Multivariate analysis revealed renal failure and preoperative cardiogenic shock to be independent predictors of overall mortality. Old myocardial infarction and operation within the first 48 hours were independent predictors of overall unfavorable outcome events.
Conclusions:
These results suggest that coronary artery bypass grafting without cardiopulmonary bypass is a relatively low-risk procedure for patients having an infarction with coronary anatomy suitable for this technique.