Beta-blockade in 200 coronary bypass grafting procedures

Area of Science:

• Cardiology
• Cardiac Surgery
• Pharmacology

Background:

• Continuous perfusion with high-dose beta-blocker (esmolol)-enriched blood is an alternative for myocardial protection during coronary artery bypass grafting (CABG).
• This study reports on the application of this technique in 200 unselected consecutive cases.

Purpose of the Study:

• To evaluate the safety and efficacy of continuous high-dose esmolol perfusion for myocardial protection during CABG.
• To assess outcomes in a large cohort of unselected patients undergoing CABG with this technique.

Main Methods:

• 200 patients undergoing CABG with continuous esmolol infusion.
• Induction of a slow hypocontractile beating heart using esmolol (788 +/- 20 mg per operation).
• Normothermic cardiopulmonary bypass with an aortic cross-clamp time of 52 +/- 1.2 min and 2.9 +/- 0.1 distal anastomoses performed.

Main Results:

• Postoperative ventilation: 25 +/- 5.1 hours; ICU stay: 2.3 +/- 0.3 days.
• Postoperative myocardial infarction rate: 4%.
• Hospital stay: 11.2 +/- 0.4 days; 30-day mortality: 2.5%; 3-month mortality: 3%.

Conclusions:

• High-dose beta-blockade via continuous esmolol perfusion is a safe and effective strategy in CABG.
• This technique demonstrates particular advantages for high-risk patient populations undergoing CABG.