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Coronary surgery: which method to use?

Miguel Sousa Uva1, Vanessa Rodrigues, Nuno Monteiro

  • 1Departamento da Circulação Hospital da Cruz Vermelha, Lisboa. uvamiguel@hotmail.com

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|July 1, 2004
PubMed
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Comparing four coronary artery bypass grafting (CABG) methods, this study found no significant differences in mortality or morbidity. However, off-pump, beating heart, and cardioplegia methods offered better myocardial protection than ventricular fibrillation during CABG.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Surgical Outcomes

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
  • Myocardial protection strategies during CABG significantly influence patient outcomes.
  • Comparing different myocardial protection techniques is crucial for optimizing surgical results.

Purpose of the Study:

  • To compare four myocardial protection methods during CABG: off-pump (OFF), cardiopulmonary bypass with cardioplegia (CARD), cardiopulmonary bypass with beating heart (BEAT), and cardiopulmonary bypass with ventricular fibrillation (FIBR).
  • To evaluate these methods based on markers of myocardial ischemia, mortality, morbidity, and mid-term results.

Main Methods:

  • A retrospective study of 241 patients undergoing isolated CABG.

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  • Patients were divided into four groups based on the myocardial protection method used: OFF (n=108), CARD (n=66), BEAT (n=47), and FIBR (n=20).
  • Myocardial ischemia was assessed by measuring CK-MB and troponin T levels preoperatively and at 1, 6, 12, and 24 hours postoperatively.

    • Main Results:

    • No significant differences were found in in-hospital mortality (2.5%), atrial fibrillation, stroke/TIA, blood transfusion rates, or length of stay between the groups.
    • The number of distal anastomoses was highest in the BEAT group (3.27) and lowest in the OFF group (2.55).
    • Myocardial markers (CK-MB and troponin T) were significantly higher in the FIBR group at 12 and 24 hours postoperatively compared to CARD and OFF groups, indicating less myocardial protection.

    Conclusions:

    • None of the four revascularization methods demonstrated superiority in terms of mortality, morbidity, or length of stay.
    • Off-pump, beating heart, and cardioplegia methods provided better myocardial protection compared to ventricular fibrillation, as evidenced by lower myocardial ischemia markers.
    • Mid-term survival and angina relief were comparable across all studied groups.