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[Systemic coronary surgery in the beating heart. Experience in 250 cases]
R Cartier1, D Bouchard, R Martineau
1Département de Chirurgie Cardiaque (chirurgien cardiovasculaire, Institut de Cardiologie de Montréal, Québec, Canada.
Annales De Chirurgie
|December 10, 1999
Summary
Off-pump coronary artery revascularization is a safe and effective alternative to conventional bypass surgery for multi-vessel disease. This technique offers comparable outcomes with reduced complications, making it suitable for most patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Coronary Artery Disease Management
Background:
- Coronary artery bypass grafting (CABG) traditionally utilizes cardiopulmonary bypass (CPB).
- Off-pump CABG (OPCAB) has emerged as an alternative, aiming to reduce CPB-related complications.
- Multi-vessel disease presents complex revascularization challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump coronary artery revascularization (OPCAB) in patients with multi-vessel coronary artery disease.
- To compare OPCAB outcomes with conventional on-pump CABG (ONCAB).
Main Methods:
- A retrospective comparison of 250 OPCAB patients (1996-1998) with 1870 ONCAB patients (1995-1996) at the Montreal Heart Institute.
- Patients underwent OPCAB using myocardial mechanical stabilization and heart verticalization techniques.
- Demographic and perioperative data were analyzed for both groups.
Main Results:
- Both groups had comparable baseline characteristics and mean graft numbers (2.89 in OPCAB vs. 2.84 in ONCAB).
- OPCAB demonstrated significantly shorter ischemic times (29.8 min vs. 45 min) and reduced transfusion rates (34% vs. 66%).
- Operative mortality (1.6% vs. 2%) and perioperative myocardial infarction rates (3.6% vs. 4.2%) were similar between groups.
Conclusions:
- Off-pump complete coronary artery revascularization is a viable alternative for the majority of patients with multi-vessel disease.
- Successful OPCAB requires progressive experience, rigorous technique, and effective myocardial stabilization.
- OPCAB can achieve good clinical results comparable to conventional surgery.