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On-pump beating-heart coronary artery bypass grafting for acute myocardial infarction
Yuichi Izumi1, Katsuaki Magishi, Noriyuki Ishikawa
1Department of Thoracic and Cardiovascular Surgery, Nayoro City General Hospital, Nayoro, Hokkaido, Japan. yi398ngh@seagreen.ocn.ne.jp
Insights
On-pump beating-heart coronary artery bypass grafting shows promise for acute myocardial infarction, reducing early mortality and postoperative complications compared to arrested-heart surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Acute Myocardial Infarction Treatment
Background:
- Emergent coronary artery bypass grafting for acute myocardial infarction (AMI) using conventional methods has shown poor early results.
- On-pump beating-heart surgery is explored as an alternative approach for AMI.
Purpose of the Study:
- To evaluate the efficacy and outcomes of on-pump beating-heart coronary artery bypass grafting (CABG) in patients with acute myocardial infarction.
- Compare early results between on-pump arrested-heart and on-pump beating-heart CABG for AMI.
Main Methods:
- A retrospective study of 31 patients with AMI undergoing emergent on-pump CABG between January 1998 and June 2004.
- Patients were divided into two groups: 16 undergoing arrested-heart surgery and 15 undergoing beating-heart surgery.
- Early surgical outcomes were compared between the two groups.
Main Results:
- While no statistically significant differences in patient characteristics were observed, the on-pump arrested-heart group had higher early mortality (31.3%) than the beating-heart group (13.3%).
- The beating-heart group showed significantly lower postoperative creatine kinase myocardial band levels (221 vs. 666 IU/L) and reduced incidence of acute renal failure (p=0.034).
- Longer durations of ventilator and inotropic agent use were noted in the arrested-heart group, though not statistically significant.
Conclusions:
- On-pump beating-heart CABG can potentially eliminate intraoperative global myocardial ischemia.
- This technique presents an acceptable surgical option for acute myocardial infarction, associated with reduced postoperative mortality and morbidity.
Background:
The early results of emergent coronary artery bypass grafting by conventional operative method for acute myocardial infarction are reported to be poor. The purpose of this study is to evaluate on-pump beating-heart coronary artery bypass grafting for acute myocardial infarction.
Methods:
Thirty-one patients with acute myocardial infarction underwent emergent surgery between January 1998 and June 2004 at Nayoro City General Hospital. In 16 patients, on-pump surgery was performed on the arrested heart, and in the other 15, on-pump surgery was performed on the beating heart. Early results were compared between the two groups.
Results:
Preoperative and perioperative patient characteristics revealed no significant differences between the two groups. Although there was no statistically difference between the two groups, the early mortality rates of on-pump arrested-heart coronary bypass grafting (31.3%) was higher than that of on-pump beating-heart coronary bypass grafting (13.3%). Postoperatively, the creatine kinase myocardial band value for the on-pump beating-heart group was significantly lower than that for the on-pump arrested-heart group (221 +/- 200 IU/L versus 666 +/- 540 IU/L, p = 0.008). The incidence of postoperative acute renal failure was significantly higher in the on-pump arrested-heart group than in the on-pump beating-heart group (p = 0.034). The durations of ventilator use and inotropic agent use were longer in the on-pump arrested-heart group than in the on-pump beating-heart group, though the differences were not statistically different (p = 0.152, p = 0.223).
Conclusions:
On-pump beating-heart coronary artery bypass grafting has the possibility to eliminate intraoperative global myocardial ischemia and to be an acceptable surgical option for acute myocardial infarction associated with lower postoperative mortality and morbidity.
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