Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Coronary Artery Bypass Grafting (CABG) is associated with significant complications, particularly in patients with left ventricle dysfunction and comorbidities.
• Off-Pump Coronary Artery Bypass (OPCAB) surgery presents a potential alternative for managing high-risk surgical candidates.

Purpose of the Study:

• To evaluate the safety and efficacy of OPCAB surgery in a cohort of very high-risk patients.
• To assess early outcomes, including mortality, complications, and graft patency, in this patient population.

Main Methods:

• A prospective study included 120 very high-risk patients (EuroSCORE >9 or multiple comorbidities) undergoing OPCAB surgery using the Octopus system.
• Data collected included patient demographics, comorbidities, surgical details, and early postoperative outcomes.
• Graft patency was assessed using MCTA or angiocardiography.

Main Results:

• The study involved 120 patients (mean age 68 years, 72% male) with a mean EuroSCORE of 10.2.
• Early mortality was 3%, with low rates of major complications such as myocardial infarction (0.8%) and stroke (0.8%).
• The OPCAB strategy demonstrated a reduction in multi-organ failure, with an intensive care unit stay of 2.7 days.

Conclusions:

• OPCAB surgery appears to be a safe and secure strategy for very high-risk patients undergoing coronary artery bypass.
• The procedure may help reduce the incidence of multi-organ failure in this vulnerable population.
• Further long-term studies are necessary to fully validate the sustained benefits of OPCAB in high-risk individuals.