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Off pump coronary surgery in Argentina.

Federico Benetti1

  • 1Benetti Foundation, Buenos Aires, Argentina.

Seminars in Thoracic and Cardiovascular Surgery
|March 26, 2003
PubMed
Summary

Ambulatory off-pump coronary artery bypass (OPCAB) surgery using a novel xiphoid approach allows for early patient discharge. This minimally invasive technique shows promising results for coronary revascularization, potentially expanding same-day discharge possibilities.

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Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Surgery
  • Cardiac Anesthesia

Background:

  • Off-pump coronary artery bypass (OPCAB) surgery has been refined for various clinical scenarios, including acute myocardial infarction.
  • Traditional OPCAB involves a full sternotomy, potentially leading to longer recovery times.
  • The concept of ambulatory cardiac surgery aims to reduce hospital stays and healthcare costs.

Purpose of the Study:

  • To evaluate the feasibility and initial outcomes of ambulatory off-pump coronary artery bypass (OPCAB) surgery using a xiphoid (lower sternotomy) approach.
  • To assess the safety and efficacy of this minimally invasive technique in terms of mortality, morbidity, and graft patency.
  • To explore the potential for early patient discharge (within 24 hours) after this procedure.

Main Methods:

  • A cohort of 78 patients underwent OPCAB surgery utilizing a xiphoid (lower sternotomy) approach between October 1997 and December 2001.
  • Patients included those with a mean age of 64.2 years, 70% male, and Canadian Cardiovascular Society class 3-4 severity.
  • Graft patency was assessed in 16 restudied patients, and early discharge outcomes were specifically analyzed.

Main Results:

  • The overall cohort experienced low rates of mortality (1%), conversion to complete sternotomy (1%), and perioperative infarction (1%).
  • In a subgroup of 6 patients discharged within 24 hours, there was 0% mortality and 0% perioperative infarction.
  • Immediate restudy of 16 patients showed 100% patency for all grafts (G A anastomosis).

Conclusions:

  • The xiphoid (lower sternotomy) approach for OPCAB surgery demonstrates a promising initial experience for achieving ambulatory status with early discharge.
  • This minimally invasive technique is safe and effective, with excellent graft patency and low complication rates.
  • The findings suggest the potential to expand the concept of ambulatory coronary artery surgery, including multiple arterial grafts, using existing technology.

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