Total arterial revascularization for multiple vessel coronary artery disease: with or without cardiopulmonary bypass
Marek A Deja1, Kazimierz Widenka, Piotr Duraj
12nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland. narizol@slam.katowice.pl
Insights
Off-pump coronary artery bypass grafting using arterial conduits is safe for complex procedures. This technique shows a trend towards a smoother postoperative recovery with less need for inotropic support and blood products.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Assessing the utility of off-pump coronary artery bypass (CABG) grafting.
- Evaluating the off-pump technique for complex CABG procedures using only arterial grafts.
Purpose of the Study:
- To determine the safety and efficacy of off-pump total arterial revascularization for multi-vessel coronary artery disease.
- To compare perioperative outcomes between on-pump and off-pump CABG using arterial conduits.
Main Methods:
- Analysis of perioperative data from 324 patients undergoing total arterial revascularization for multi-vessel coronary artery disease.
- Comparison of 181 on-pump CABG cases with 143 off-pump CABG cases.
- Evaluation of graft numbers, anastomosis types, proximal anastomosis sites, and graft routing.
Main Results:
- No significant differences in mortality, perioperative myocardial infarction, stroke, or atrial fibrillation between groups.
- Off-pump patients required less inotropic support and blood product usage.
- Aorta used for proximal anastomosis in 58% of on-pump vs. 40% of off-pump cases (P=.002).
Conclusions:
- Total arterial revascularization for multi-vessel coronary artery disease can be safely performed off-pump.
- The off-pump technique demonstrated a trend towards a smoother postoperative course.
- Off-pump CABG may offer advantages in terms of reduced resource utilization.
Background:
To assess the usefulness of off-pump technique for more technically demanding coronary artery bypass procedures using exclusively arterial conduits.
Methods:
Analysis of perioperative data of 324 consecutive patients in whom total arterial revascularization for multiple- vessel coronary artery disease was performed--181 cases on-pump and 143 cases off-pump.
Results:
On average in the on-pump group 2.7 +/- 0.8 (range, 2-5) grafts per patient were constructed versus 2.4 +/- 0.7 (range, 2-4) grafts per patient in the off-pump group (P < .001). Of the total number of 490 anastomoses performed on-pump, 83 (17%) were side-to-side and of 349 anastomoses performed off-pump, 51(15%) were side-to-side, a nonsignificant difference (P = .4). The aorta was used as a site for proximal anastomosis of 1 or more arterial conduits in 105 patients (58%) who underwent on-pump surgery and in 57 patients (40%) who underwent off-pump surgery (P = .002). In the off-pump group, the right internal thoracic artery (RITA) was rarely (12%) routed through the transverse sinus to circumflex branches compared with the on-pump group (34%) (P = .017). RITA in off-pump patients was more often used to revascularize the anterior wall (47% versus 29%; P = .08). We observed no difference in mortality (1.7% versus 0%; P = .3), incidence of perioperative myocardial infarction (8.8% versus 7.7%; P = .8), stroke (1.7% versus 1.4%; P = .8), or atrial fibrillation (24% versus 19%; P = .3). We observed less inotropic support and less blood-product use in off-pump patients.
Conclusion:
Total arterial revascularization for multiple-vessel coronary artery disease may be safely performed off-pump. We observed tendency to somewhat smoother postoperative course in the off-pump group.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care