[Multiple aortocoronary bypass without artificial circulation]
Insights
Direct myocardial revascularization without cardiopulmonary bypass is effective for severe coronary artery disease. This beating heart surgery offers reliable results, making it suitable for most patients needing bypass procedures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Interventional Cardiology
Context:
- Presents results from 145 surgeries for direct myocardial revascularization (off-pump coronary artery bypass grafting).
- Patients predominantly had severe angina (FC III-IV, 80.6%), acute coronary syndrome (6.5%), and prior myocardial infarction (63.8%).
- Significant proportion had reduced left ventricular ejection fraction (<40% in 28.8%) and complex coronary artery disease (multi-vessel, left main stenosis).
Purpose:
- To evaluate the efficacy and safety of off-pump myocardial revascularization in patients with complex coronary artery disease.
- To assess immediate and late postoperative outcomes, including complications and graft patency.
- To determine the suitability of off-pump coronary artery bypass grafting (CABG) for a broad range of patients.
Summary:
- Off-pump CABG demonstrated excellent results with no perioperative myocardial infarction, stroke, or organ insufficiency.
- Low rates of postoperative complications: 0.9% required resternotomy for hemorrhage, 1.2% for suppurative issues.
- High frequency of complete autoarterial revascularization (42.7%) using sequential and composite grafts.
Impact:
- Establishes off-pump myocardial revascularization as an efficacious and reliable surgical method with good short- and long-term outcomes.
- Highlights the critical role of surgical experience in managing complex coronary artery disease and comorbidities.
- Suggests that off-pump CABG is a viable option for nearly all patients requiring bypass surgery, irrespective of coronary anatomy.
Abstract:
Results of 145 surgeries for direct myocardial revascularization without artificial circulation are presented. FC III and IV angina of effort was diagnosed in 80.6% and 13.5% of the patients respectively, acute coronary syndrome in 6.5%, past myocardial infarction in 63.8%. Mean left ventricular ejection fraction (EF) prior to surgery was 48.7 +/- 5.1%; it was below 40% in 28.8% of the patients. Three- and two-vessel coronary disease was documented in 54.7% and 35.3% of the patients respectively; 10% of them presented with the affected anterior interventricular branch, 14% with the stenotic trunk of the left coronary artery. Mean revascularization index increased from 22 to 76. The frequency of complete autoarterial revascularization amounted to 42.7%. Sequential and composite grafts were used in 93 and 257 cases respectively. No patient experienced perioperative myocardial infarction, acute disturbance of cerebral circulation, acute renal or cardiac insufficiency. Immediate postoperative hemorrhage requiring resternotomy developed in 0.9% of the patients, 1.2% with suppurative complications needed additional surgical treatment. It is concluded that myocardial revascularization on a beating heart is an efficacious and reliable method ensuring good results in the immediate and late postoperative period. Its success first and foremost depends on the previously gained experience that permits to operate patients with severe multi-vessel coronary artery disease and various concomitant disorders and thereby correct combined pathological conditions. The available data give reason to consider each patients in need of aortocoronary bypass as a candidate for myocardial revascularization on a beating heart regardless of the character and extent of coronary lesions and anatomical feature of the coronary bed.
