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Current results in off pump surgery
1Department of Cardiac Surgery, University G. D'Annunzio, Chieti, Italy.
Insights
Myocardial revascularization without cardiopulmonary bypass (CPB) offers comparable early and mid-term outcomes to traditional CPB surgery. Patients undergoing off-pump procedures experienced faster recovery and fewer complications.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Techniques
- Minimally Invasive Cardiac Surgery
Background:
- Traditional myocardial revascularization often utilizes cardiopulmonary bypass (CPB).
- Assessing alternative techniques like off-pump surgery is crucial for patient outcomes.
Purpose of the Study:
- To compare early and mid-term results of myocardial revascularization performed with and without cardiopulmonary bypass (CPB).
- To evaluate the safety and efficacy of off-pump coronary artery bypass grafting.
Main Methods:
- A comparative study of 747 patients undergoing isolated myocardial revascularization: 480 off-pump (Group A) and 267 on-pump (Group B).
- Specific surgical techniques for vessel exposure and anastomosis in off-pump procedures were detailed.
- Key outcomes including mortality, cerebrovascular accident, myocardial infarction, and recovery parameters were analyzed.
Main Results:
- Crude and risk-adjusted mortality and incidence of cerebrovascular accident and acute myocardial infarction were similar between groups.
- Off-pump patients (Group A) showed significantly improved recovery: earlier waking, reduced inotrope use, lower peak CK-MB, less bleeding, fewer transfusions, and shorter ICU and hospital stays.
- Graft patency rates were high (98.5% patent, 97.0% patent and non-restrictive) for checked anastomoses.
Conclusions:
- Myocardial revascularization without CPB yields favorable early and mid-term results in selected patients.
- Primary endpoints (death, acute myocardial infarction) were comparable regardless of technique.
- While some secondary endpoints favored off-pump surgery, the benefit for high-risk patients with comorbidities remains an area for further scientific investigation.
Objective:
We reviewed our experience with myocardial revascularization without cardiopulmonary by-pass (CPB) to evaluate early- and mid-term results compared with those obtained using CPB.
Methods:
From May 21, 1997 to November 1998, 747 patients had isolated myocardial revascularization, 480 without CPB (Group A) and 267 with CPB (Group B). Exposure of the target vessels was obtained with four slings (two passed through the transverse sinus and two behind the inferior vena cava) and four deep pericardial sutures on the mobile pericardium around the left atrium (Lima stitches). The number of anastomoses/patient (when two or more conduits were used) was higher in Group B (3.1 +/- 1.0 vs 2.6 +/- 0.7, P < 0.001). More marginal branches were grafted in Group A (258 vs 239), but the percentage was higher in Group B (P < 0.001). Crude and risk adjusted mortality was similar in both groups, as well as cerebrovascular accident (CVA) and acute myocardial infarction incidences. Patients in Group A woke earlier, had less inotropes, lower creatinkinase myocardial band (CK-MB) peak, lower bleeding and less transfusion, shorter Intensive Care Unit (ICU) and postoperative stay in hospital than patients in Group B. 266 anastomoses were checked; of these 98.5% were patent and 97.0% were patent and not restrictive.
Conclusions:
Myocardial revascularization without CPB can provide good early- and mid-term results in selected patients. Primary endpoints (death and acute myocardial infarction) were similarly independent from the technique used. Some of the secondary endpoints were favorable in Group A: however their importance is minor. Even if we feel that some high risk patients with severe comorbidities can benefit from CPB surgery; this aspect is difficult to demonstrate scientifically.