Optimizing off-pump coronary artery bypass graft: technical and metabolic aspects

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Procedures

Background:

• Coronary artery bypass graft (CABG) surgery traditionally involves cardiopulmonary bypass.
• Off-pump techniques aim to reduce complications associated with bypass.
• Metabolic support protocols can enhance cardiac function during surgery.

Purpose of the Study:

• To evaluate the feasibility of complete revascularization in the majority of coronary artery bypass graft (CABG) patients without using cardiopulmonary bypass.
• To assess the efficacy of the Octopus stabilizer device and a metabolic protocol for off-pump CABG.

Main Methods:

• A prospective study involving 285 consecutive patients undergoing off-pump CABG using the Medtronic Octopus stabilizer and a metabolic protocol.
• Median sternotomy was performed, with cardiogenic shock being a relative contraindication.
• The metabolic protocol was implemented to support cardiac function during the procedure.

Main Results:

• Successful complete revascularization was achieved in 96% of attempted off-pump CABG procedures (285/298 patients).
• The average number of grafts per patient was 3.3, with a mean patient age of 69.5 years.
• Low rates of perioperative myocardial infarction (0.7%) and operative mortality (2.8%) were observed, alongside significant cost savings from reduced blood product use and bypass supplies.

Conclusions:

• Complete revascularization is achievable in the majority of CABG patients without cardiopulmonary bypass.
• The combination of the Octopus off-bypass technique and metabolic support facilitates beating heart surgery with favorable outcomes.
• This approach leads to a low incidence of postoperative complications and considerable cost savings.