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Published on: September 15, 2023
[Integrated coronary artery bypass strategy prevents urgent pump conversion during off-pump coronary artery bypass
H Yokoyama1, S Takase, Y Misawa
1Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan.
Insights
An integrated strategy using prophylactic or intra-operative intra-aortic balloon pumping (IABP) significantly reduces urgent pump conversion during off-pump coronary artery bypass (OPCAB) surgery, minimizing associated mortality.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Surgical Outcomes
Context:
- Off-pump coronary artery bypass (OPCAB) surgery aims to reduce complications associated with cardiopulmonary bypass.
- Urgent pump conversion during OPCAB is associated with increased morbidity and mortality.
- Implementing a comprehensive peri-operative strategy is crucial for managing high-risk patients during OPCAB.
Purpose:
- To evaluate the effectiveness of a peri-operative integrated strategy in preventing urgent pump conversion during OPCAB surgery.
- To assess the impact of prophylactic and intra-operative intra-aortic balloon pumping (IABP) on pump conversion rates.
- To determine the safety and efficacy of the integrated strategy in a large cohort of OPCAB patients.
Summary:
- A retrospective analysis of 400 OPCAB operations was conducted.
- Patients received prophylactic or intra-operative intra-aortic balloon pumping (IABP) based on specific criteria.
- The integrated strategy included specialized surgical techniques and devices, alongside IABP management.
Impact:
- The integrated strategy resulted in a very low pump conversion rate (0.5%) with no associated hospital mortality.
- Non-cardiac causes accounted for the few hospital deaths (0.7%).
- This approach demonstrates feasibility and safety, even during the early learning curve for OPCAB surgery.
Abstract:
Urgent pump conversion during off-pump coronary artery bypass (OPCAB) results in high morbidity and mortality. We retrospectively evaluated if the peri-operative integrated strategy prevents this lethal event in our 400 consecutive OPCAB operations. The patients with preoperative cardiogenic shock and/or ventricular arrhythmias underwent on-pump coronary artery bypass grafting (CABG). All other patients (99% of total CABG) were scheduled to undergo OPCAB (n=400). Prophylactic intraaortic balloon pumping (IABP) was applied to the patients with critical (>95%) left main trunk stenosis or low (<0.35) left ventricular ejection fraction. All the patients received the deep pericardial suture, apex-traction device, suction-type stabilizer, test-clamp of target coronary arteries by micro bulldog clamp, and intra-coronary shunts. Intra-operative IABP was applied in the case of sustained ST-segment change and/or elevated pulmonary artery pressure. Pump conversion was indicated for the patients with ventricular fibrillation and/or cardiogenic shock. Two patients (0.5%) had pump conversion due to ventricular arrhythmia and sustained hypotension, respectively. These pump conversion did not result in hospital mortality. Three hospital deaths (0.7%) occurred due to non-cardiac causes. The integrated strategy using prophylactic or intra-operative IABP in OPCAB produce a low pump conversion rate even during an early period of surgeon's learning curve.
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