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Off-pump coronary artery bypass grafting. The 1st Medical Faculty of Charles University study
M Semrád1, P Bodlák, M Stríteský
1Dept. of Cardiovasc. Surg., Charles University Teaching Hospital, 1st Medical Faculty, U nemocnice 2, 12800, Prague 2, Czech Republic, semrad@post.cz
Insights
Off-pump coronary artery bypass grafting (CABG) using less invasive techniques through a median sternotomy demonstrated reduced postoperative complications and operative mortality. This approach shows promising short-term graft patency and mid-term clinical outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease.
- Evaluating less invasive techniques is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the surgical technique, anesthetic management, and outcomes of off-pump CABG (OPCAB) via median sternotomy.
- To compare OPCAB with conventional CABG using cardiopulmonary bypass (CPB).
Main Methods:
- 144 patients underwent OPCAB through median sternotomy from 1998-1999.
- A control group of 234 patients underwent CABG with CPB.
- Angiographic assessment of graft patency was performed in 100 patients (50 per group).
Main Results:
- The OPCAB group showed significantly lower rates of postoperative myocardial infarction, atrial fibrillation, renal, and respiratory complications.
- Operative mortality and low cardiac output syndrome were also lower in the OPCAB group.
- Angiography revealed excellent graft patency in both groups, with no occluded arterial grafts and acceptable vein graft patency.
Conclusions:
- Off-pump CABG via median sternotomy is associated with reduced postoperative complications and operative mortality.
- The technique, including novel stabilization devices, is effective.
- OPCAB demonstrates sufficient short-term graft patency and favorable mid-term clinical outcomes.
Objectives:
To explore the surgical technique, anaesthesiological management, immediate and mid-term results, graft patency and effectiveness of less invasive coronary artery bypass grafting through a median sternotomy.
Methods:
From January 1998 through December 1999, 144 patients had coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) done by one surgeon through a median sternotomy. The cohort of 107 men and 37 women averaged 60.8 years, mean ejection fraction (EF) was 51.8%. An average of 2.7 (range 1 to 5) grafts/patients was achieved. Results are compared with a CPB subgroup of patients operated on through a median sternotomy in the same time (N = 234). In a random subgroup of 100 patients (50 per group) an angiographic control of graft patency was done.
Results:
A non-CPB group showed less postoperative acute myocardial infarction (0.7% vs. 3.8%, p < 0.05) and atrial fibrillation (14.6% vs. 26%, p < 0.05), lower incidence of renal (2.8% vs. 5.1%, p < 0.05) and respiratory complications (2.0% vs. 3.8%, NS). We observed lower operative mortality (0.7% vs. 3.4%, p < 0.05), as well as the occurrence of low cardiac output syndrome (0.7% vs. 5.6%, p < 0.05) in the off-pump group. The follow-up is 36 +/- 12 months and the number of patients with recurrent angina, late AMI and late death is acceptable. We did not find an inordinate number of vein grafts occlusions (0.7% vs. 1.8%, NS) and stenoses (6.6% vs. 6.7%, NS) at anastomotic sites. None of the arterial grafts in both groups were occluded.
Conclusions:
There was little known about the efficacy of the less invasive coronary artery bypass grafting at the beginning of our study. Starting with pioneering the operative technique, we have discovered and proposed three types of a heart verticalization and a reusable stabilizing device. We detected lower incidence of postoperative complications and decreased operative mortality in a non-CPB group. Angiographic assessment displayed an excellent run-off in both groups of patients. Off-pump coronary bypass grafting is associated with sufficient short-term graft patency and mid-term clinical outcomes.