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Emergency off-pump coronary artery surgery.
Shahzad G Raja1, Zulfiqar Haider, Haider Zaman
1Department of Cardiac Surgery, Alder Hey Hospital, Liverpool L12 2AP, United Kingdom. drrajashahzad@hotmail.com
Chinese Medical Journal
|June 17, 2004
Summary
Emergency off-pump coronary artery bypass grafting is a feasible option for acute coronary syndromes, demonstrating low morbidity and mortality. This technique offers excellent early results for complete revascularization in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Off-pump coronary artery bypass grafting (OPCAB) is increasingly preferred for elective revascularization in high-risk patients with multi-vessel coronary artery disease.
- The efficacy of OPCAB for emergency revascularization in acute coronary syndromes (ACS) requires further validation.
Purpose of the Study:
- To evaluate the feasibility and outcomes of emergency off-pump coronary artery bypass grafting (OPCAB) in patients with acute coronary syndromes (ACS).
Main Methods:
- A prospective study involving 66 patients with ACS undergoing emergency OPCAB between April 2001 and September 2003.
- Patients presented with ACS, with 38 on platelet glycoprotein IIb/IIIa receptor antagonists; all underwent sternotomy for complete coronary revascularization without cardiopulmonary bypass (CPB).
Main Results:
- An average of 2.9 grafts per patient were performed, with 83.3% achieving revascularization of the posterior descending and marginal arteries.
- Four patients (6%) experienced intraoperative instability requiring conversion to CPB.
- The mortality rate was 3% (2/66), with postoperative stroke in 2 patients and acute renal failure requiring hemofiltration in 3 patients.
Conclusions:
- Emergency OPCAB with complete revascularization is a feasible and safe strategy for patients with ACS.
- The procedure is associated with low morbidity and mortality, and excellent early angiographic results.