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Off-pump coronary artery bypass grafting: the Zurich experience
R Tavakoli1, O Reuthebuch, C Hofer
1Department of Cardiac Surgery, City Hospital Zurich, Zurich, Switzerland. reza.tavakoli@triemli.stzh.ch
Insights
Off-pump coronary artery bypass grafting (OPCAB) offers a solution to rising costs and patient risk in multi-vessel coronary artery disease. This technique successfully reduces perioperative morbidity and healthcare expenses.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is standard for multi-vessel coronary artery disease.
- Increasing patient risk and healthcare costs necessitate innovative surgical strategies.
- Eliminating cardiopulmonary bypass is a key approach to address these challenges.
Purpose of the Study:
- To present the development and successful implementation of off-pump coronary artery bypass grafting (OPCAB) for isolated CABG.
- To detail the critical technical elements and perioperative management strategies for successful OPCAB.
Main Methods:
- OPCAB procedure developed for isolated CABG, focusing on specific surgical techniques.
- Key elements include: order of myocardial revascularization (anterior, inferior, lateral), intracoronary shunt use, no-touch aortic anastomosis, and endoscopic vein harvesting.
- Emphasis on perioperative management: anesthesiologist collaboration, early anti-platelet therapy, and temperature control.
Main Results:
- OPCAB procedure successfully offered to over 90% of eligible patients.
- Significant reduction in perioperative morbidity observed.
- Global costs associated with the procedure were reduced.
Conclusions:
- OPCAB is a viable and effective alternative to conventional CABG for selected patients.
- The described techniques and management strategies are crucial for successful OPCAB outcomes.
- OPCAB contributes to maintaining quality of care while reducing healthcare costs.
Abstract:
Coronary artery bypass grafting (CABG) is the surgical procedure of choice for treatment of multi-vessel coronary artery disease. The rising risk profile of the patients requiring isolated CABG and the economic pressure have prompted us to devise new operative strategies to treat these patients. Elimination of the cardiopulmonary bypass is one possible answer to the dilemma of maintaining the quality of care and reducing the exploding costs of our health system. Therefore, we developed the off-pump coronary artery bypass grafting (OPCAB) for patients requiring isolated CABG. In our experience the key to successful OPCAB relies on the order of revascularization of the myocardial walls (anterior, inferior, lateral), use of intracoronary shunt, no-touch technique for the proximal aortic anastomosis with heart string â (Guidant, IN, USA), close collaboration with the anesthesiologists, early and aggressive administration of anti-platelet therapy, endoscopic vein harvest by perfusionists, and improved body temperature control. Following these concepts, we have been able to offer the OPCAB procedure to over 90% of our patients and to reduce perioperative morbidity and global costs.
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