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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
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Beating heart myocardial revascularization on extracorporeal circulation in patients with end-stage coronary artery

E Prifti1, M Bonacchi, G Frati

  • 1Divisione di Cardiochirurgia, Policlinico di Careggi, Firenze, Italy.

Cardiovascular Surgery (London, England)
|October 18, 2001
PubMed

Insights

On-pump/beating-heart coronary artery bypass grafting (CABG) in patients with end-stage coronary artery disease (ESCAD) shows improved survival and reduced complications compared to conventional CABG. This technique offers better myocardial and renal protection.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Vascular Surgery

Background:

  • End-stage coronary artery disease (ESCAD) patients often have compromised left ventricular (LV) function and may not tolerate cardioplegic arrest well.
  • Conventional coronary artery bypass grafting (CABG) involves aortic cross-clamping and cardioplegia, which can be detrimental in high-risk patients.

Purpose of the Study:

  • To compare the outcomes of on-pump/beating-heart CABG versus conventional CABG in ESCAD patients.
  • To evaluate early and mid-term survival, morbidity, and left ventricular (LV) function improvement.

Main Methods:

  • A cohort of 78 ESCAD patients underwent on-pump/beating-heart CABG (Group I) between 1993-2000.
  • A control group of 78 ESCAD patients underwent conventional CABG (Group II), matched for age, sex, and LV ejection fraction (LVEF).
  • Outcomes including mortality, morbidity, and LV function were assessed postoperatively and at 6 months.

Main Results:

  • Postoperative mortality was similar (7.7% vs 11.5%, P>0.1).
  • Group II experienced significantly higher rates of perioperative myocardial infarction (P=0.039), low cardiac output syndrome (P=0.002), and bleeding >1000 ml (P=0.029).
  • At 6 months, Group I showed significant improvement in LVEF (27.2% vs 25%, P=0.001) and reduced LV end-diastolic pressure and diameter.

Conclusions:

  • On-pump/beating-heart CABG is a viable alternative for ESCAD patients, associated with lower postoperative morbidity.
  • This technique provides better myocardial and renal protection, reducing complications related to intraoperative hypoperfusion.
  • On-pump/beating-heart CABG may lead to better LV function recovery in ESCAD patients.
Abstract

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