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Coronary reoperations without the use of cardiopulmonary bypass
H Z Iscan1, O Kandemir, M K Gol
1Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Insights
Off-pump coronary artery bypass reoperations significantly reduce postoperative complications and hospitalization compared to traditional cardiopulmonary bypass methods. This off-pump strategy offers improved outcomes and economic benefits for patients undergoing repeat cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Coronary artery bypass reoperations traditionally have higher mortality and morbidity rates than primary procedures.
- Off-pump coronary artery bypass (OPCAB) surgery is a strategy to mitigate these risks.
Purpose of the Study:
- To compare the outcomes of coronary artery reoperations performed with and without cardiopulmonary bypass (CPB).
Main Methods:
- A retrospective study of 113 patients undergoing coronary artery revascularization between 1978 and 2000.
- 32 patients (Group II) underwent off-pump surgery on a beating heart, while 81 patients (Group I) had surgery with CPB and cardioplegic arrest.
Main Results:
- Off-pump surgery (Group II) showed significantly better early postoperative outcomes, including lower rates of low cardiac output, postoperative myocardial infarction, and shorter hospital stays.
- Operative mortality was 13.5% (11/81) for the CPB group and 3.1% (1/32) for the off-pump group, though this difference was not statistically significant.
- Off-pump reoperations were associated with fewer manipulations and less time compared to CPB procedures.
Conclusions:
- Coronary artery reoperations without CPB are more economic and less time-consuming.
- When performed with refined techniques and appropriate indications, off-pump coronary reoperations demonstrate significant mortality and morbidity advantages over CPB-assisted procedures.
- The off-pump strategy should be a standard consideration in the surgeon's armamentarium for coronary reoperations.
Background:
Reoperations of coronary artery surgery still carry a higher mortality and morbidity rate, compared to primary revascularization procedures. Coronary artery bypass reoperations without the use of cardiopulmonary bypass (CPB) is a potential strategy that has been developed to decrease mortality and morbidity.
Materials And Methods:
Between 1978 and 2000, 113 patients were reoperated for coronary artery revascularization, 32 (28.3%) cases on beating heart without the use of CPB (Group II) and 81 (71.7%) cases under CPB and cardioplegic arrest (Group I). Mean age of Groups I and II were 61.3+/-5 and 57.4+/-7.3 years, respectively.
Results:
Statistically significant difference was found between the two groups, favoring off pump surgery in the early postoperative findings with respect to low cardiac output, postoperative myocardial infarction and postoperative hospitalization duration until discharge. Operative mortality was not statistically different between groups and these figures for cardiopulmonary and off pump groups were 11/81 (13.5%), 1/32 (3.1%), respectively.
Conclusion:
Reoperations of coronary artery revascularization surgery without the use of CPB is more economic, necessitating less manipulations, free of side effects of CPB, less time consuming surgical procedure compared to reoperations performed under standard techniques. When performed with a refined technique and true indications, off pump coronary reoperations have mortality and morbidity advantages over the surgery performed under CPB, improvements in techniques and instruments off pump strategy must be in the surgeons armamentarium in coronary reoperations.