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Surgical myocardial revascularization without cardiopulmonary bypass
A Bhan1, S K Choudhary, A Mathur
1Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi. shivmeet@medinst.ernet.in
Insights
Coronary artery bypass grafting without cardiopulmonary bypass demonstrated high graft patency (95%) and safety in selected patients. This off-pump technique is a reproducible and effective surgical option.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) without cardiopulmonary bypass is increasingly performed.
- Safety, reproducibility, and efficacy of off-pump CABG require further validation through comprehensive follow-up.
- This study prospectively evaluates 96 patients undergoing off-pump CABG with 100% angiographic follow-up.
Purpose of the Study:
- To assess the safety, reproducibility, and efficacy of coronary artery bypass grafting (CABG) without cardiopulmonary bypass.
- To evaluate graft patency rates using comprehensive angiographic follow-up.
- To determine the clinical outcomes of off-pump CABG in a selected patient cohort.
Main Methods:
- Prospective study of 96 consecutive patients undergoing off-pump CABG via midsternotomy.
- Utilized pharmacological and mechanical methods to minimize cardiac movement during anastomosis.
- All patients received pre-discharge coronary angiography and clinical follow-up ranging from 4 to 17 months.
Main Results:
- A total of 160 grafts were placed, with an average of 1.7 grafts per patient.
- Overall angiographic graft patency was 95.0%, with left internal mammary artery (LIMA) grafts showing 97.9% patency.
- Operative mortality was 1.0%, with a mean hospital stay of 5.7 days. Two patients required reoperation for bleeding.
Conclusions:
- Off-pump coronary artery bypass grafting (CABG) is a safe, reproducible, and effective option for selected patients.
- Careful patient selection and surgical approach are crucial for successful outcomes.
- High graft patency rates support the long-term efficacy of this technique.
Background:
Though coronary artery bypass grafting (CABG) without cardiopulmonary bypass is being performed with increasing frequency, in the absence of adequate angiographic follow-up, safety, reproducibility, and efficacy of the procedure remain doubtful. In this prospective study, we report the results obtained by 100% angiographic follow-up of 96 consecutive patients.
Methods:
A total of 96 patients (age range 33 to 76 years) underwent CABG without cardiopulmonary bypass. Single vessel disease was present in 46 (47.9%) patients, double vessel disease in 31 (32.3%), and triple vessel disease in 19 (19.8%) patients. All patients were operated through a standard midsternotomy and an optimal combination of pharmacological and mechanical methods were used to restrict cardiac movements during anastomosis. All patients underwent coronary angiography before discharge from the hospital.
Results:
A total of 160 grafts were placed (range 1 to 4 grafts per patient, average 1.7+/-0.3 grafts per patient). A single graft was placed in 46 patients, double grafts in 38, triple grafts in 10, and quadruple grafts in 2 patients. Various grafts included pedicled left internal mammary artery (LIMA) (n = 95), free LIMA (n = 1), right internal mammary artery (n = 14), radial artery (n = 24), right gastroepiploic artery (n = 5), and saphenous vein grafts (n = 21). Operative mortality was 1.0% (1 of 96). Two patients required reoperation for excessive bleeding. Mean hospital stay was 5.7+/-1.2 days. Overall angiographic patency was 95.0% with LIMA patency of 97.9% (93 of 95). One patient with block in midsegment of LIMA was reoperated using cardiopulmonary bypass. Follow-up ranged from 4 to 17 months (mean 8.2+/-3.1 months). Two patients (one with narrowed LIMA to left anterior descending artery anastomosis, and one with patent anastomosis) had residual angina.
Conclusions:
Coronary artery bypass grafting without cardiopulmonary bypass is a reproducible, effective, and safe option in selected group of patients. A conscientious approach in patient selection and route of operation is required.
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