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Myocardial revascularization of the beating heart in high-risk patients

G D'Ancona1, H Karamanoukian, A T Kawaguchi

  • 1State University of New York at Buffalo and Kaleida Health, Buffalo General Hospital, USA.

Journal of Cardiac Surgery
|January 5, 2002
PubMed

Insights

Off-pump coronary artery bypass grafting (CABG) is a safe alternative for high-risk patients. This approach significantly reduces perioperative complications compared to conventional CABG with cardiopulmonary bypass (CPB).

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia

Background:

  • Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) poses risks for high-risk patients.
  • Off-pump CABG (OPCAB) has emerged as a potential alternative to mitigate these risks.

Purpose of the Study:

  • To evaluate the benefits and safety of myocardial revascularization performed without CPB (OPCAB).
  • To compare perioperative outcomes of OPCAB versus conventional CABG (ONCAB) in high-risk patient subgroups.

Main Methods:

  • Retrospective analysis of OPCAB and ONCAB procedures from January 1995 to December 1999.
  • Patients categorized into high-risk groups: age >80 years, reoperative CABG, or left ventricular ejection fraction <40%.
  • Comparison of perioperative results and complications between OPCAB and ONCAB groups within these subgroups.

Main Results:

  • No significant differences in preoperative comorbidities between OPCAB and ONCAB groups.
  • More extensive coronary artery disease was noted in ONCAB patients.
  • OPCAB demonstrated a trend towards fewer perioperative complications, with significantly higher freedom from overall complications (p < 0.005).
  • Mortality rates were comparable between OPCAB and ONCAB groups (p = NS).

Conclusions:

  • Coronary artery bypass grafting can be safely performed without CPB in high-risk individuals.
  • The OPCAB technique is associated with markedly higher freedom from perioperative complications.
Abstract

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