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Multimodality targeted approach in redo off-pump coronary artery bypass surgery
Yugal K Mishra1, Harpreet Wasir, Surendra N Khanna
1Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, New Delhi, India. dryugal@mantramail.com
Asian Cardiovascular & Thoracic Annals
|April 15, 2003
Summary
Off-pump redo coronary artery bypass surgery using a multimodality approach is a safe and less invasive option. This method resulted in fewer complications and shorter hospital stays for patients needing repeat bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Redo coronary artery bypass grafting (CABG) is complex.
- Off-pump techniques aim to reduce complications associated with cardiopulmonary bypass.
Purpose of the Study:
- To evaluate the safety and efficacy of a multimodality, off-pump approach for redo coronary revascularization.
- To assess outcomes including mortality, complications, and resource utilization.
Main Methods:
- Retrospective analysis of 86 patients undergoing off-pump redo CABG from December 1997 to December 2000.
- Utilized various surgical approaches including median sternotomy, anterolateral thoracotomy, and posterolateral thoracotomy.
- Targeted specific coronary artery targets based on anatomical considerations.
Main Results:
- The study included 86 patients with a mean age of 61.82 years.
- Operative mortality was low at 2.3% (2 patients).
- Complications were minimal, including 4 perioperative myocardial infarctions and 1 reexploration for bleeding. Blood transfusion was required in 12 patients, and the mean hospital stay was 5 days.
Conclusions:
- A multimodality, off-pump redo CABG strategy is a safe and effective alternative.
- This approach is associated with decreased complications, reduced blood product requirements, and shorter hospital stays.
- It represents a less invasive option for myocardial revascularization in patients requiring repeat bypass surgery.