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Coronary artery bypass surgery in high-risk patients

Alper Sami Kunt1, Osman Tansel Darcin, Mehmet Halit Andac

  • 1Department of Cardiovascular Surgery, Harran University Research Hospital, Sanliurfa, Turkey. dralper@msn.com

Current Controlled Trials in Cardiovascular Medicine
|August 30, 2005
PubMed

Insights

Off-pump coronary artery bypass graft (CABG) surgery does not offer clear benefits for all high-risk patients. However, it may be a viable option for those with severe left ventricular dysfunction and high Euroscore values.

Area of Science:

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

Background:

  • Debate persists regarding optimal surgical strategy for high-risk coronary artery bypass patients: off-pump versus on-pump.
  • Comparison of perioperative mortality and morbidity between off-pump and on-pump techniques is crucial.

Purpose of the Study:

  • To describe the experience with high-risk coronary artery patients undergoing myocardial revascularization.
  • To compare outcomes of on-pump versus off-pump surgical strategies in this patient cohort.

Main Methods:

  • Prospective study of 86 high-risk patients (EuroSCOREs > 5) from March 2002 to July 2004.
  • Patients assigned to off-pump (40) or on-pump (46) surgery based on coronary anatomy and revascularization feasibility.
  • Myocardial revascularization performed with or without cardiopulmonary bypass.

Main Results:

  • Off-pump group had significantly poorer left ventricular function (28.6% vs. 40.5%, p < 0.05) and higher Euroscores (7.26 vs. 12.1, p < 0.05).
  • No significant differences observed in graft number, surgical/anesthesia/OR times, ICU length of stay, or postoperative atrial fibrillation rates.

Conclusions:

  • Off-pump coronary artery bypass graft (CABG) does not provide universal clinical advantages for all high-risk patients.
  • Off-pump coronary revascularization may be a suitable alternative for patients with Euroscore ≥ 10 and left ventricular function ≤ 30%.
Abstract

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