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Patient selection in off-cardiopulmonary bypass revascularization
Ricardo de Carvalho Lima1, Mozart Escobar, José Glauco Lobo Filho
1Division of Cardiothoracic Surgery, Department of Surgery, Oswaldo Cruz University Hospital, Faculty of Medical Sciences, Pernambuco State University, Recife, Pernambuco, Brazil. rclima@elogica.com.br
Background:
The last few years have been marked by striking advances in off-pump coronary artery bypass grafting (OPCABG), thanks mainly to developments in instrumentation and technical progress in the revascularization of the posterior arteries of the heart. In 2001, OPCABG was performed on approximately 20% of patients who underwent surgical myocardial revascularization in the United States. This retrospective study aims to evaluate our experience with this procedure over the past 10 years, emphasizing the rapid and increasing progress of the method, indications, contraindications, and results.
Methods:
Between August 1991 and December 2001, 2,759 patients suffering from angina pectoris underwent OPCABG. The patients' ages ranged from 13 to 93 years with a mean of 63 years +/- 12 years. The over 80-year-old group accounted for 3.5% of the patients. Males represented 58% of the patients.
Results:
Intraoperative mortality in OPCABG was low. In the intraoperative period 0.4% of patients died, and the figure for the postoperative period was 2.5%. It was noted that 7.9% of the patients presented serious, nonfatal complications.
Conclusions:
OPCABG is a reproducible procedure with results similar to those obtained in revascularization of the myocardium using extracorporeal circulation (ECC). We believe that over 90% of patients can be operated upon without the aid of extracorporeal circulation (ECC). In our experience, all patients are potential candidates for myocardial revascularization surgery without ECC.