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Complete myocardial revascularization on the beating heart
Insights
Off-pump coronary artery bypass grafting (CABG) allows complete myocardial revascularization without cardiopulmonary bypass (CPB). This technique is safe and effective, even in patients with comorbidities.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Innovation
- Minimally Invasive Cardiac Procedures
Background:
- Complete myocardial revascularization is achievable on a beating heart.
- Excellent visualization, exposure, and stabilization are key for off-pump surgery.
- Cardiopulmonary bypass (CPB) is not always necessary for successful coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump CABG.
- To demonstrate complete revascularization without CPB.
- To assess outcomes in a large patient cohort undergoing off-pump procedures.
Main Methods:
- 300 patients underwent total revascularization via median sternotomy using myocardial stabilization.
- The CardioThoracic System was employed for stabilization.
- Off-pump coronary artery bypass grafting (CABG) was performed using sequential coronary occlusion and multiple arterial grafts.
Main Results:
- An average of 3.4 grafts were placed per patient.
- Conversion to CPB was required in 6% of cases.
- Low unadjusted mortality (2.3%) and stroke rate (0.7%) were observed, with comorbidities like diabetes (48%) and prior myocardial infarction (28%) not being limiting factors.
Conclusions:
- Complete revascularization can be safely accomplished without cardiopulmonary bypass.
- Off-pump CABG is a viable and safe alternative to traditional bypass surgery.
- The technique is effective across a range of patient comorbidities.
Background:
Complete myocardial revascularization with excellent visualization, exposure, and stabilization can be accomplished on the beating heart without cardiopulmonary bypass (CPB).
Methods:
Three hundred patients were totally revascularized via median sternotomy with myocardial stabilization using the CardioThoracic System. All patients who underwent coronary artery bypass grafting were considered for the off-pump procedure. Pericardial sutures were placed at the level of the left atrial appendage and were pulled upwards to the right. The stabilizer was applied sequentially from circumflex, obtuse marginal, intermediate, diagonal, left anterior descending, and right coronary artery. Coronaries were occluded using the Calafiore technique, and multiple arterial grafts were inserted.
Results:
The average number of grafts was 3.4 per patient. Six percent had to be converted to standard CPB. Comorbidity was not a limiting factor with 8% redos, 48% having diabetes, and acute myocardial infarctions in 28%. The unadjusted mortality was 2.3%, and stroke rate was 0.7%.
Conclusions:
These results indicate that complete revascularization can safely be accomplished without CPB.