Off-pump coronary artery bypass grafting in a low-volume center

The advantages of off-pump coronary artery bypass grafting (OPCAB) are well documented; however, the conversion of OPCAB to cardiopulmonary bypass (CPB) is associated with higher morbidity and mortality. This issue is of particular concern in low-volume centers or centers that are beginning to use OPCAB. We present an OPCAB methodology that uses a maximum number of arterial grafts.

We routinely use OPCAB in every patient unless there is another associated condition. We used the following methods to improve the safety of OPCAB: (1) maintaining normothermia, (2) routine use of a pulmonary artery catheter, (3) routine use of a femoral arterial line, (4) routine use of a cell saver, and (5) complete revascularization.

We included 173 consecutive patients in the study. All patients underwent OPCAB without any conversion to CPB. Hemodynamic compromise in 5 patients (2.89%) required insertion of an intra-aortic balloon pump (IABP). OPCAB was completed in all 5 patients after IABP insertion. Blood transfusions (BTs) were avoided in 55 patients (31.8%), and 68 patients (39.3%) required ≤2 units of blood.

The OPCAB technique is still evolving. Low-volume centers have higher rates of conversion to CPB. Hypotension due to an impaired left ventricular function can be successfully treated by using an IABP. Although blood loss can be managed with BTs, use of a cell saver helps to reduce the number of BTs. We conclude that our technique of total arterial OPCAB using a cell saver can be safely performed in a low-volume center.