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[Myocardial revascularization without extracorporeal circulation in patients with multivessel coronary disease]
Giovanni Troise1, Federico Brunelli, Marco Cirillo
1Unità Funzionale di Cardiochirurgia, Ospedale Poliambulanza, Via Bissolati, 57 25124 Brescia. cch-segreteria.poli@poliambulanza.it
Insights
Off-pump coronary artery bypass grafting (CABG) is feasible for multivessel coronary disease, achieving complete revascularization. This technique demonstrates favorable early and intermediate-term outcomes, including low mortality and complication rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Context:
- Criticisms of off-pump coronary artery bypass grafting (CABG) have focused on achieving complete revascularization in patients with multivessel coronary disease.
- The study addresses concerns regarding the systematic application of off-pump CABG while ensuring comprehensive myocardial revascularization.
- A significant shift towards off-pump procedures is noted, with over 90% of eligible patients undergoing surgery without cardiopulmonary bypass since September 2000.
Purpose:
- To evaluate the feasibility and outcomes of off-pump CABG in patients with multivessel coronary disease.
- To assess the completeness of revascularization achieved with the off-pump technique.
- To report early and intermediate-term results, including mortality, morbidity, and long-term survival.
Summary:
- A total of 868 patients with multivessel coronary disease underwent off-pump CABG between September 1997 and April 2003.
- An average of 2.5 anastomoses per patient were completed, with bilateral internal mammary artery use in 66% and total arterial revascularization in 55.2%.
- The in-hospital mortality rate was 0.6%, with a 3.5% incidence of major non-fatal complications. Mean postoperative hospital stay was 4.8 days. Long-term survival rates at 1, 3, and 5 years were 97.3%, 93.7%, and 86.7%, respectively. Freedom from revascularization at these time points was 98.7%, 96.6%, and 96.6%.
Impact:
- The findings demonstrate that off-pump CABG is a feasible option for achieving complete myocardial revascularization in patients with multivessel coronary disease.
- The study provides evidence of favorable early and intermediate-term clinical outcomes, supporting the safety and efficacy of the off-pump technique.
- Results indicate good long-term survival and freedom from repeat revascularization procedures, suggesting sustained benefits of off-pump CABG.
Background:
Some criticisms have been addressed to off-pump coronary surgery technique concerning the possibility of its systematic use with the respect of the completeness of revascularization. We report our experience with off-pump revascularization in patients with multivessel coronary disease.
Methods:
Between September 1997 and April 2003, 868 patients with multivessel coronary disease were scheduled for off-pump surgical revascularization. From September 2000, the percentage of patients operated on without cardiopulmonary bypass has been stably > 90%. Fifteen patients (1.7%) had a conversion to cardiopulmonary bypass for anatomical reasons (n = 6) or clinical instability (n = 9).
Results:
An average of 2.5 +/- 0.8 (range 1-5) anastomoses per patient were completed. Bilateral mammary artery was used in 573 patients (66%); totally arterial revascularization was accomplished in 479 patients (55.2%). In-hospital mortality rate was 0.6% (5 patients). Total incidence of non-fatal postoperative complications (bleeding requiring re-exploration, perioperative myocardial infarction, stroke, new onset of acute renal failure) was 3.5%. Mean postoperative hospital stay was 4.8 +/- 3.8 days. At a mean follow-up of 21.6 +/- 15.6 months (range 1-65 months), the postoperative actuarial survival rates were 97.3, 93.7 and 86.7% at 1, 3 and 5 years postoperatively. Actuarial freedom rates from new revascularization were 98.7, 96.6 and 96.6% at 1, 3 and 5 years postoperatively.
Conclusions:
Early- and intermediate-term results of this study demonstrate the feasibility of off-pump revascularization in all patients with multivessel coronary disease, respecting the criterion of complete myocardial revascularization.
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