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[Coronary revascularization on beating heart]
Insights
Off-pump coronary artery bypass grafting (CABG) using normothermic techniques offers a less invasive approach. This method resulted in low mortality, reduced complications, and shorter intensive care unit stays.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
Context:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- Minimally invasive techniques are increasingly preferred to reduce patient morbidity.
- On-pump CABG (using cardiopulmonary bypass, ECC) has been the traditional standard.
Purpose:
- To evaluate the outcomes of off-pump CABG (OPCAB) performed using normothermic techniques.
- To assess the safety and efficacy of OPCAB compared to traditional on-pump CABG.
- To determine if OPCAB compromises the completeness of revascularization.
Summary:
- A total of 134 OPCAB procedures were performed by a single surgical team using normothermia.
- 98 procedures were performed without extracorporeal circulation (ECC) support, and 36 with ECC support.
- The study reported a low postoperative mortality rate of 2.2%, minimal myocardial infarction (CK-MB release), reduced bleeding, and a mean ICU stay of 19 hours.
- Arterial revascularization was achieved in 94% of patients, with an average of 2.7 bypasses per patient.
- Conversion to cardiac arrest was not required in any case.
Impact:
- OPCAB performed under normothermia is a less invasive surgical option for coronary revascularization.
- This technique can decrease postoperative complications and shorten intensive care unit stays.
- The principle of complete revascularization is maintained with this approach, even in patients with significant preoperative myocardial infarction.
Abstract:
At authors clinic 563 coronary artery bypass graft procedures were done from 1. January 1998 to 15. September 1999. 134 coronary revascularizations were performed from the same surgical team on beating heart using the same surgical technic at normothermia. Out of them, 98 operations were done with and 36 without ECC support respectively. Patients were operated on with this sophisticated technic exclusively during this period. Conversion to cardiac arrest was not necessary in any case. Male/female ratio was 76/58, 84% of the patients suffered from one or more preoperative myocardial infarction. The average bypass number was 2.7/patient. Arterial revascularization was performed in 94%. Postoperative mortality was 2.2% (3 pts). The postoperative inotropic demand, myocardial infarction rate (CK-MB release) and the amount of bleeding was very low. Mean postoperative stay in the ICU decreased to the average of 19 hrs. Patients normally left hospital on the 7th postoperative day. This operative technique--performed by an experienced surgeon--is less invasive for the heart and other organ systems, the incidence of complications can be decreased and the principle of complete revascularization is not compromised.