Related Experiment Video
Updated: Jul 4, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass
Enrico Ferrari1, Nicolas Stalder, Ludwig K von Segesser
1Department of Cardiovascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland. enricoferrari@bluewin.ch
Insights
On-pump beating heart surgery offers a safer alternative for high-risk patients with life-threatening coronary syndrome needing emergency bypass surgery. This technique reduced mortality and morbidity in selected patients compared to standard methods.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Interventional Cardiology
Background:
- Standard myocardial revascularization uses cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest.
- High-risk patients with acute coronary syndrome or cardiac decompensation undergoing emergency revascularization often face poor outcomes.
- The on-pump beating heart technique is explored as a method to reduce mortality and morbidity in this specific patient group.
Purpose of the Study:
- To evaluate the clinical experience and outcomes of the on-pump beating heart technique.
- To assess the feasibility and effectiveness of this approach in high-risk patients requiring emergency coronary artery bypass grafting (CABG).
Main Methods:
- Twenty-five high-risk patients (mean age 69 years, LVEF 27%) with life-threatening coronary syndrome underwent emergency on-pump beating heart surgery.
- These patients predominantly had multi-vessel disease (88%) and some had left main disease (24%) or severe cardiac failure (35%).
- Pre-operative EuroScore was high (≥8 in 73% of patients).
Main Results:
- All patients completed the on-pump beating heart coronary revascularization with a mean of 2.9 grafts per patient.
- Mortality was low (2/25 deaths in ICU), with no postoperative myocardial infarctions in survivors.
- Complications included transient renal failure (8 patients) and one sternal wound infection; mean hospital stay was 12 days.
Conclusions:
- On-pump beating heart myocardial revascularization is a viable alternative for selected high-risk patients with life-threatening coronary syndrome requiring emergency multi-vessel CABG.
- This technique appears to offer reduced mortality and morbidity compared to standard on-pump arrested heart surgery in emergency settings.
Background:
Cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience.
Methods:
Out of 290 patients operated for CABG from January 2005 to January 2006, 25 (8.6%) selected high-risk patients suffering from life threatening coronary syndrome (mean age 69 +/- 7 years) and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction (LVEF) was 27 +/- 8%. The majority of them (88%) suffered of tri-vessel coronary disease and 6 (24%) had a left main stump disease. Nine patients (35%) were on severe cardiac failure and seven among them (28%) received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients (73%).
Results:
All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.9 +/- 0.6 and the internal mammary artery was used in 23 patients (92%). The mean CPB time was 84 +/- 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 +/- 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 +/- 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an implantable cardiac defibrillator. One year after surgery they all had a standard trans-thoracic echocardiogram showing a mean LVEF rate of 36 +/- 11.8%.
Conclusion:
Standard on-pump arrested heart coronary surgery has higher mortality and morbidity in emergencies. The on-pump beating heart myocardial revascularization seems to be a valid alternative for the restricted and selected cohort of patients suffering from life threatening coronary syndrome and requiring multiple emergency CABG.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
Published on: April 24, 2017
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Introduction Cardiac Emergencies
01:30Cardiomyopathy II: Dilated Cardiomyopathy