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Reoperative coronary surgery with and without cardiopulmonary bypass
G Teodori1, A L Iacò, M Di Mauro
1Department of Cardiac Surgery, G. D'Annunzio University, Chieti, Italy.
Insights
Reoperative coronary surgery without cardiopulmonary bypass (CPB) is feasible for select patients, offering similar outcomes to on-pump procedures. Careful patient selection based on graft complexity is key to successful redo coronary artery bypass grafting (CABG).
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Reoperative coronary artery bypass grafting (CABG) presents unique challenges.
- Evaluating the safety and efficacy of performing CABG without cardiopulmonary bypass (CPB) is crucial for improving patient outcomes.
- This study analyzes the technical aspects and benefits of off-pump reoperative coronary surgery.
Purpose of the Study:
- To assess the technical feasibility and outcomes of reoperative coronary surgery performed without cardiopulmonary bypass (CPB).
- To compare the results of off-pump versus on-pump reoperative CABG in terms of patient complexity and clinical endpoints.
- To identify factors influencing the success of redo CABG, particularly the role of CPB utilization.
Main Methods:
- A retrospective analysis of 166 patients undergoing reoperative coronary surgery between November 1994 and May 1999.
- Patients were divided into two groups: Group A (112 patients) with CPB and Group B (54 patients) without CPB.
- Surgical approaches included median sternotomy, limited access sternotomy (LAST), and posterolateral thoracotomy.
Main Results:
- The number of anastomoses per patient was significantly higher in Group A (2.4 ± 0.8) compared to Group B (1.1 ± 0.4) (p < 0.001).
- Off-pump CABG (Group B) was predominantly used for single grafts (82.8%) and single territory revascularization (76.6%).
- Overall mortality (3.6%), cerebrovascular accident (CVA) incidence (0.6%), and acute myocardial infarction (AMI) incidence (1.8%) were similar between groups, with no significant difference in early major adverse events.
Conclusions:
- While primary endpoints like mortality and major adverse events were comparable, patients undergoing off-pump reoperative CABG (Group B) experienced fewer complications.
- Significant differences in patient technical profiles existed between the on-pump and off-pump groups.
- Tailoring surgical strategy based on the territory to be grafted can optimize results in redo coronary surgery, potentially achieving outcomes similar to the primary operation.
Background:
Reoperative coronary surgery without cardiopulmonary bypass (CPB) was analyzed to evaluate the technical profile of the patients studied and the benefit from this technique.
Material And Methods:
From November 21, 1994 to May 20, 1999, 166 patients had reoperative coronary surgery, 112 patients (Group A) with and 54 patients (Group B) without CPB. Median sternotomy was used in all the patients in Group A and in 13 patients in Group B. The remaining had a LAST (37 patients) or a posterolateral thoracotomy (4 patients).
Results:
Anastomoses per patient were 2.4 +/- 0.8 in Group A and 1.1 +/- 0.4 in Group B (p < 0.001). When a single graft was needed, CPB was not used in 82.8% of the cases. However, when more than one graft was required, CPB was not used in only 5.6% of the cases. When a single territory had to be grafted, CPB was not used in 76.6% of the patients. If two territories were grafted, only 6.8% of the patients were in Group B, whereas no patient who needed a graft in all the three territories was in Group B. Overall mortality was 3.6% cerebrovascular accident (CVA) and acute myocardial infarction (AMI) incidence were 0.6% and 1.8%, respectively, and were similar in both groups. Incidence of early major events (overall 8.4%) was not different between groups.
Conclusions:
The primary endpoints (mortality, CVA rate, and AMI) were similar in both groups, but patients in Group B were less complicated. However, patients in the two groups were not the same, as the technical profile was quite different. As our results were similar to those obtained in the first operation, we think that consideration of different surgical possibilities, depending on territory to be grafted, will improve the results of redo coronary surgery, making them similar to those obtained in the first operation.
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