Outcome of non-elective coronary artery bypass grafting without cardio-pulmonary bypass
D Varghese1, M H Yacoub, R Trimlett
1Department of Cardiothoracic Surgery, Harefield Hospital, London, UK.
Insights
Beating heart coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is a safe and feasible option for urgent and emergency cases. This technique demonstrates acceptable outcomes in high-risk patients requiring non-elective procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Off-Pump Coronary Artery Bypass Grafting
Background:
- Limited data exists on the application of beating heart coronary artery bypass grafting (CABG) in emergency and urgent settings.
- Non-elective cardiac surgery presents unique challenges and risks.
- Assessing the safety and efficacy of off-pump CABG in these critical situations is crucial.
Purpose of the Study:
- To retrospectively evaluate the safety and efficacy of beating heart coronary artery bypass grafting (CABG) in non-elective (urgent and emergency) cases.
- To determine the feasibility of performing CABG without cardiopulmonary bypass (CPB) in high-risk patients.
- To analyze postoperative outcomes and complications associated with this approach.
Main Methods:
- Retrospective review of urgent and emergency coronary artery bypass grafting (CABG) cases performed without cardiopulmonary bypass (CPB) between July 1999 and February 2000.
- Analysis of patient demographics, preoperative risk factors (e.g., Canadian Cardiovascular Society grade 4 angina, triple vessel disease, preoperative IABP), and surgical details (e.g., number of anastomoses, arterial grafts).
- Evaluation of postoperative complications, intensive care unit (ICU) stay, hospital stay, and mortality rates.
Main Results:
- 35 patients underwent non-elective off-pump CABG, with 62.9% classified as urgent and 37.1% as emergencies.
- The average number of anastomoses was 2.8, with 68.6% of patients receiving triple or quadruple vessel grafting. All patients received at least one arterial graft.
- Postoperative complications included supraventricular arrhythmias (22.9%) and low cardiac output (20%). No conversions to cardiopulmonary bypass were required. The mortality rate was 2.9%.
Conclusions:
- Non-elective coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is a feasible and safe surgical option.
- Modern cardiac stabilization devices facilitate successful outcomes in urgent and emergency CABG procedures.
- Off-pump CABG can be safely performed in high-risk, non-elective patient populations with acceptable morbidity and mortality.
Objectives:
There is limited experience in the use of beating heart coronary artery bypass grafting (CABG) in emergency and urgent cases. The aim of this study was to retrospectively assess the safety and efficacy of this technique when used in a non-elective setting.
Methods:
We retrospectively reviewed all urgent and emergency cases of coronary artery bypass grafting performed without cardiopulmonary bypass (CPB) from July 1999 to February 2000. There were 35 patients in total. The mean age was 64.8+/-11.9. Twenty-six (74.3%) patients had Canadian Cardiovascular Society grade 4 angina. Twenty-six patients (74.3%) had triple vessel disease. Eleven patients (31.4%) were on preoperative IV nitrates and nine patients (25.7%) had a preoperative IABP (intra aortic balloon pump). Three patients (8.6%) had suffered a preoperative cardiac arrest during coronary angiography. Other associated significant risk factors were smoking (60%), hypertension (40%), hypercholesterolemia (57.1%) and previous Q wave myocardial infarction (31.4%).
Results:
Twenty-two patients (62.9%) were classified as being urgent and 13 patients (37.1%) were classified as emergencies. The mean number of anastomoses performed were 2.8+/-0.8 (range 1-4) with 68.6% of patients under going triple or quadruple vessel grafting. All patients (100%) received at least one arterial graft. There was no conversion to cardiopulmonary bypass. The main postoperative complications were--supraventricular arrhythmias eight (22.9%), low cardiac output seven (20%) and postoperative HF/dialysis two (5.7%). The median postoperative intensive care unit (ICU) stay was 27.5 h. The mean postoperative hospital stay was 8.3+/-3.1 days. One patient died (2.9%) at the eighth day after surgery due to postoperative myocardial infarction, multi-organ failure secondary to the septicaemia and ventricular arrest.
Conclusion:
Non-elective CABG without CPB is feasible and safe with modern cardiac stabilization devices.
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