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Published on: March 26, 2018
Total arterial revascularization on beating heart: experience in 803 cases
Sushil Kumar Singh1, Surya Kumar Mishra, Deepak Kumar
1Department of Cardiology & Cardiothoracic Surgery, Batra Hospital & Medical Research Centre, M.B. Road, New Delhi 110 0062, India.
Insights
Total arterial revascularization on the beating heart is a safe and effective procedure for coronary artery bypass grafting. This study of 803 patients shows excellent graft patency and minimal morbidity, avoiding cardiopulmonary bypass complications.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Background:
- Cardiopulmonary bypass can lead to adverse effects.
- Total arterial revascularization aims to mitigate these risks.
- Beating heart surgery offers an alternative approach.
Purpose of the Study:
- To evaluate the safety and efficacy of total arterial revascularization on the beating heart.
- To assess short-term outcomes, including graft patency and morbidity.
- To determine the reproducibility of the procedure in a large, unselected patient cohort.
Main Methods:
- Prospective study of 803 patients undergoing total arterial revascularization on a beating heart.
- Utilized an Octopus stabilizer for myocardial stabilization.
- Included various arterial grafts: internal mammary and radial arteries.
- Assessed outcomes including operative mortality, stroke, renal impairment, blood transfusion rates, hospital stay, and angiographic patency.
Main Results:
- Operative mortality was low at 0.5%.
- No postoperative strokes and minimal renal impairment were observed.
- 558 patients (69%) did not require blood transfusions.
- Mean hospital stay was 5.6 days.
- Overall angiographic graft patency was high at 98.6%.
Conclusions:
- Total arterial revascularization on the beating heart is a safe, effective, and reproducible technique.
- The procedure demonstrates excellent short-term graft patency and minimal patient morbidity.
- This approach is suitable for a wide range of patients, including those with complex coronary artery disease and reduced ejection fraction.
Abstract:
To avoid the deleterious effects of cardiopulmonary bypass, total arterial revascularization was performed on the beating heart, using an Octopus stabilizer, in this prospective study of 803 patients without selection bias. Single-vessel disease was present in 71 (9%) patients, double-vessel disease in 204 (25%), and triple-vessel disease in 528 (66%). An ejection fraction < 30% was found in 127 (16%) cases. Angiography was carried out before discharge in 204 (25%) patients. Grafts included left and right internal mammary arteries and the radial artery. There were 2,661 grafts placed with a mean of 3.31 grafts per patient (range, 1 to 6). Operative mortality was 0.5%. There was no postoperative stroke and few incidences of renal impairment, even in patients with chronic renal failure. Blood transfusion was not required in 558 (69%) patients. Mean hospital stay was 5.6 days. Overall angiographic patency was 98.6%. Total arterial revascularization on the beating heart was found to be safe, effective, and reproducible in almost all patients, with excellent short-term patency rates and minimal morbidity.
