[Hemodynamic collapse during off-pump coronary artery bypass grafting and optimization]

Area of Science:

• Cardiovascular Surgery
• Surgical Outcomes
• Minimally Invasive Procedures

Context:

• Off-pump coronary artery bypass grafting (OPCAB) is an alternative to traditional bypass surgery.
• Minimizing hemodynamic instability during OPCAB is crucial for patient safety.
• The learning curve associated with OPCAB may influence procedural outcomes.

Purpose:

• To investigate the incidence of unpredicted hemodynamic collapse during OPCAB.
• To evaluate the effectiveness of specific strategies in preventing adverse hemodynamic events.
• To analyze the impact of surgical experience on complication rates in OPCAB.

Summary:

• This study analyzed 114 OPCAB procedures, dividing patients into early (60) and later (50) phases to assess the learning curve.
• Complications included ventricular fibrillation (12), conversion to cardiopulmonary support (6), and bradycardia (19).
• Conversion to percutaneous cardiopulmonary support (PCPS) decreased from 8% in the early phase to 1.8% in the later phase, indicating improved outcomes with experience.

Impact:

• Proactive management, including coronary perfusion, prophylactic intra-aortic balloon pumping (IABP), and specialized heart positioning, effectively prevented hemodynamic collapse.
• The findings suggest that OPCAB can be performed with a high success rate and low complication incidence, even without preoperative hemodynamic compromise.
• Successful OPCAB procedures with minimal support and full patient discharge highlight the technique's viability and safety.