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Multivessel off-pump revascularization in patients with significant left main coronary artery stenosis: early and
Robert B Beauford1, Craig R Saunders, Troy Adam Lunceford
1Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, NJ 07112, USA.
Insights
Off-pump coronary artery bypass (OPCAB) is safe and effective for severe left main stenosis, offering a survival benefit over conventional bypass grafting. This approach reduces complications and mortality in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Significant left main stenosis (> or =50%) traditionally posed challenges for off-pump coronary artery bypass (OPCAB) due to hemodynamic concerns.
- Patient selection and surgical techniques for OPCAB in critical left main stenosis (LMS) require careful evaluation.
- Assessing the safety and feasibility of OPCAB in patients with LMS is crucial for expanding treatment options.
Purpose of the Study:
- To evaluate the safety and feasibility of off-pump coronary artery bypass (OPCAB) in patients with critical left main stenosis (LMS).
- To compare outcomes between OPCAB and conventional on-pump coronary artery bypass (CABG) in patients with severe LMS.
Main Methods:
- Retrospective review of a prospectively updated database.
- Inclusion of patients with severe left main disease undergoing isolated coronary revascularization between January 1, 1999, and May 31, 2002.
- Comparison of 234 on-pump coronary artery bypass (CABG) patients with 420 off-pump coronary artery bypass (OPCAB) patients.
Main Results:
- Groups were well-matched for key clinical characteristics, though the CABG group was younger.
- Off-pump coronary artery bypass (OPCAB) was associated with significantly lower mortality (1.9% vs. 6.4%) and reduced need for intra-aortic balloon pump and postoperative renal failure compared to conventional coronary artery bypass (CABG).
- Intermediate-term survival analysis demonstrated a significant survival benefit for patients undergoing OPCAB.
Conclusions:
- Multivessel off-pump coronary artery bypass (OPCAB) is a safe and effective alternative for patients with severe left main disease.
- Eliminating cardiopulmonary bypass (CPB) in this patient subgroup conveys a significant survival advantage.
- OPCAB should be considered a viable option for revascularization in select patients with critical left main stenosis.
Background:
The presence of significant left main stenosis (> or =50%) has been considered a relative contraindication to the use of off-pump coronary artery bypass (OPCAB) stemming from well-documented hemodynamic perturbations during the displacement of the heart. We examined our experience with patients with critical left main stenosis (LMS) to assess the safety and feasibility of OPCAB in this subgroup.
Methods:
Our prospectively updated database was queried to identify all patients with severe left main disease who underwent isolated coronary revascularization between January 1, 1999 and May 31, 2002. This query yielded 234 on-pump and 420 off-pump patients with significant LMS whose clinical information was retrospectively reviewed.
Results:
The groups were well matched with regard to gender, left ventricular function, surgical priority, and severity of angina. The conventional coronary artery bypass (CABG) group was significantly younger than the OPCAB group and had a higher incidence of a previous myocardial infarction. Patients in the CABG cohort were more likely than OPCAB patients to remain ventilated after 24 hours, require placement of intraoperative or postoperative intraaortic balloon pump, or suffer from postoperative renal failure. There was a decrease in mortality (6.4% vs. 1.9%; p = 0.006) when CPB was eliminated. Intermediate term survival analysis revealed a significant survival benefit in the off-pump group (p = 0.007).
Conclusions:
Multivessel off-pump revascularization in patients with severe left main disease is a safe and effective alternative to conventional bypass grafting and conveys a survival benefit.
