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Conversion to off-pump coronary bypass without increased morbidity or change in practice
Ani C Anyanwu1, Sharif Al-Ruzzeh, Shane J George
1Harefield Hospital, Uxbridge, Middlesex, United Kingdom.
The Annals of Thoracic Surgery
|March 20, 2002
Summary
Complete conversion to off-pump coronary bypass surgery is feasible. This approach shows comparable short-term safety and efficacy to conventional methods, with a low conversion rate. Long-term outcomes require further study.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Techniques
- Minimally Invasive Cardiac Surgery
Background:
- Conventional coronary artery bypass grafting (CABG) often involves cardiopulmonary bypass (CPB).
- Off-pump coronary artery bypass (OPCAB) surgery aims to avoid CPB.
- Evaluating the transition to routine OPCAB is crucial for surgical practice.
Purpose of the Study:
- To assess the feasibility of a complete conversion from conventional CABG to routine OPCAB.
- To evaluate the learning curve and outcomes during this transition.
- To compare OPCAB outcomes with historical conventional CABG data.
Main Methods:
- Prospective analysis of 285 consecutive OPCAB procedures using the Octopus system over 16 months.
- Inclusion of all nonselected patients with at least two-vessel disease.
- Data collection on graft types, revascularization, CPB use, and complications.
Main Results:
- 807 grafts performed (mean 2.8/patient), with 84% arterial grafts (mean 2.3/patient).
- 179 patients (63%) received total arterial revascularization.
- Only 8 patients required CPB; low complication rates (mortality 1.5%, renal failure 8%, stroke <1%, AF 21%) comparable to conventional CABG.
Conclusions:
- Complete conversion to routine OPCAB is achievable with a low conversion rate.
- OPCAB demonstrates comparable short-term safety and efficacy without increased morbidity.
- Further long-term outcome studies are needed to define the definitive role of OPCAB in myocardial revascularization.