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Related Experiment Videos

Conversions in off-pump coronary surgery.

Emir Mujanovic1, Emir Kabil, Mehdin Hadziselimovic

  • 1Cardiovascular Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina. emirm@mail.com

The Heart Surgery Forum
|June 25, 2003
PubMed
Summary

Conversions from off-pump to on-pump coronary artery bypass grafting (CABG) due to severe instability caused significant ischemic complications. However, mild instability or graft issues during conversion did not negatively impact outcomes, highlighting the importance of timing.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Minimally Invasive Cardiac Procedures

Background:

  • Off-pump coronary artery bypass (OPCAB) surgery is increasingly utilized.
  • Understanding conversion rates and outcomes from OPCAB to on-pump coronary artery bypass (ONCAB) is crucial for patient safety.
  • A new center in Bosnia and Herzegovina trained its team in OPCAB procedures.

Purpose of the Study:

  • To analyze the outcomes of patients converted from OPCAB to ONCAB during coronary artery bypass grafting (CABG).
  • To identify factors influencing adverse outcomes in converted OPCAB patients.
  • To evaluate the impact of conversion timing and cause on patient results.

Main Methods:

  • Retrospective analysis of 784 coronary artery bypass grafting (CABG) procedures.

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  • Categorization of surgeries into on-pump coronary artery bypass (ONCAB), off-pump coronary artery bypass (OPCAB), and converted OPCAB to ONCAB groups.
  • Detailed review of reasons for conversion and associated patient outcomes, including ischemic complications.

    • Main Results:

    • Of 784 CABG procedures, 357 (45.5%) were OPCAB, and 36 (4.6%) were converted from OPCAB to ONCAB.
    • Common conversion reasons included hemodynamic instability (21), graft revision difficulty (8), ventricular fibrillation (5), and poor native vessel (2).
    • Conversions due to mild instability or graft issues (n=27) showed no adverse ischemic effects, while severe instability/arrest (n=9) led to complications in 66.6% of patients.

    Conclusions:

    • Aggressive monitoring and management of myocardial ischemia are vital in OPCAB surgery.
    • Conversion from OPCAB to ONCAB in cases of mild hemodynamic instability does not adversely affect outcomes.
    • Severe hemodynamic compromise or cardiac arrest during OPCAB necessitating conversion is associated with significant cerebral and myocardial ischemic complications, underscoring the critical role of appropriate conversion timing.