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Hemodynamic collapse during off-pump coronary artery bypass grafting
Thomas A Vassiliades1, James L Nielsen, James L Lonquist
1Pensacola Heart Institute, Florida, USA.
Insights
Hemodynamic collapse during off-pump coronary artery bypass (OPCAB) is rare but serious. Identifying ischemic or mechanical causes can improve surgical outcomes and patient safety in these critical cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Thoracic Surgery
Background:
- Hemodynamic collapse during off-pump coronary artery bypass (OPCAB) is not well understood.
- This study analyzes 23 cases of sustained hemodynamic collapse during elective OPCAB.
Purpose of the Study:
- To define the causes of hemodynamic collapse during elective OPCAB.
- To identify potential improvements in surgical technique and patient management.
Main Methods:
- Retrospective review of 23 patients who experienced intraoperative hemodynamic collapse during 1420 elective OPCAB procedures.
- Analysis of preoperative characteristics, intraoperative data, and postoperative outcomes.
Main Results:
- Hemodynamic collapse occurred in 1.6% of elective OPCAB procedures.
- Most patients (20/23) had an uneventful postoperative course after requiring cardiopulmonary bypass.
- Two deaths occurred among the three patients with an unstable postoperative course.
Conclusions:
- Causes of hemodynamic collapse were primarily ischemic, mechanical, or a combination.
- Retrospective analysis identified opportunities for improving intraoperative technique and judgment.
- Experience suggests strategies to enhance the safety and success of OPCAB surgery.
Background:
The causes of hemodynamic collapse during off-pump coronary artery bypass (OPCAB) remain scarcely defined. We present an analysis of 23 cases of sustained hemodynamic collapse during elective off-pump CABG.
Methods:
During a 54-month period, we performed 1420 elective OPCAB procedures through a sternotomy, constituting 71.2% of the total CABG procedures performed. Twenty-three patients (1.6%) experienced hemodynamic collapse intra-operatively requiring immediate cardiopulmonary bypass. Preoperative characteristics, intraoperative data, and postoperative outcome were retrospectively reviewed in each patient.
Results:
In all cases, improvements in intra-operative technique and/or judgment could be made retrospectively. Twenty (20/23) of these patients had an uneventful postoperative course and three (3/23) patients had an unstable course with two deaths.
Conclusions:
The causes of hemodynamic collapse during elective OPCAB were ischemic, mechanical, or a combination of both. A detailed review of our five and a half year experience has revealed a number of suggestions for improving the conduct of the operation.