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Systematic off-pump coronary artery bypass.

Hitoshi Hirose1, Atsushi Amano, Li Ruzheng

  • 1Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|July 21, 2005
PubMed
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Systematic off-pump coronary artery bypass (OPCAB) is feasible, with a 98.3% success rate. Reoperation is the main risk factor for needing cardiopulmonary bypass during OPCAB surgery.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Minimally Invasive Cardiac Surgery

Background:

  • Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
  • Off-pump coronary artery bypass (OPCAB) surgery aims to avoid cardiopulmonary bypass, potentially reducing complications.
  • Assessing the feasibility and risks of systematic OPCAB is crucial for surgical practice.

Purpose of the Study:

  • To evaluate the feasibility of performing coronary artery bypass grafting systematically off-pump (OPCAB).
  • To identify specific risk factors associated with the need for conversion to on-pump procedures during OPCAB.
  • To analyze the perioperative outcomes and short-term results of systematic OPCAB.

Main Methods:

  • Prospective data collection of isolated coronary artery bypass procedures between July 2002 and December 2003.

Related Experiment Videos

  • Analysis of a structured database to identify patients requiring conversion to cardiopulmonary bypass.
  • Statistical analysis to determine risk factors for on-pump conversion.

    • Main Results:

    • OPCAB was successfully performed in 98.3% (229/233) of attempted cases.
    • Reoperation was the isolated significant risk factor for on-pump conversion (relative risk 11.6).
    • A mean of 3.7 distal anastomoses were performed, with a 92.1% complete revascularization rate and one hospital death (0.4%).

    Conclusions:

    • Systematic OPCAB is feasible, particularly for primary surgeries.
    • Patients undergoing reoperative surgery or those in deep cardiogenic shock are at higher risk for on-pump conversion.
    • Systematic OPCAB achieves successful complete revascularization with acceptable short-term outcomes.