Left main coronary disease: improved early outcomes after off-pump coronary artery bypass grafting in high-risk patients
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Ugursay Kiziltepe1, Murat Kurtoglu, Gokhan Ozerdem
1Diskapi Yildirim Beyazit E. A. Hospital. ukiziltepe@gmail.com.
Insights
Off-pump coronary artery bypass grafting (CABG) is safe for high-risk patients with left main coronary artery (LMCA) stenosis. This technique improves early postoperative outcomes compared to on-pump CABG.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Surgery
Background:
- Left main coronary artery (LMCA) stenosis poses risks during coronary artery bypass grafting (CABG).
- Off-pump CABG (OPCAB) offers improved outcomes but is often contraindicated for LMCA disease.
- This study evaluates OPCAB versus conventional on-pump CABG in high-risk LMCA patients.
Purpose of the Study:
- To document the safety and feasibility of off-pump CABG in patients with LMCA disease.
- To compare early postoperative outcomes between off-pump and on-pump CABG in high-risk LMCA patients.
Main Methods:
- A comparative study of 199 high-risk patients (EuroScore ≥ 5) with LMCA disease between 2007-2010.
- 100 patients underwent off-pump CABG (Group I), and 99 underwent on-pump CABG (Group II).
- Perioperative variables and outcomes within the first six months were analyzed.
Main Results:
- Group I (off-pump) had higher mean age and EuroScore but lower hospital mortality (1% vs. 6.1%).
- Off-pump CABG showed significantly reduced need for postoperative inotropic support (9% vs. 48.4%), blood loss, and transfusions.
- Hospital stay was also shorter in the off-pump group (6.57 vs. 7.68 days).
Conclusions:
- Off-pump CABG is a safe and feasible option for high-risk patients with LMCA disease.
- The off-pump technique leads to improved early postoperative outcomes.
- This approach challenges the perception of LMCA stenosis as an absolute contraindication for OPCAB.
Background:
Left main coronary artery (LMCA) stenosis is a risk factor in coronary artery bypass grafting (CABG). Although improved outcomes of off-pump CABG have been well documented, LMCA stenosis is often perceived as a contraindicationfor off-pump CABG. In this study, we compared on-pump and off-pump techniques in high-risk patients with LMCA disease.
Aim:
Documentation of safety and feasibility of off-pump CABG in patients with LMCA disease.
Methods:
One hundred ninty nine patients with LMCA disease and a EuroScore ≥ 5 were operated upon between 2007 and 2010. One hundred patients (Group I) were operated upon using off-pump techniques, while 99 (Group II) were operated upon using conventional on-pump techniques. Perioperative variables and outcomes at first six months were compared.
Results:
Despite higher mean age and EuroScore (70.9 ± 4.8 vs. 65.6 ± 7.9, p < 0.001, and 6.09 ± 0.8 vs. 5.31 ± 0.68,p < 0.001, respectively), and lower ejection fraction (41.4 ± 7.3 vs. 49.0 ± 6.2, p < 0.001), hospital mortality (1% vs. 6.1%,p = 0.065), postoperative inotropic support (9% vs. 48.4%, p < 0.001), blood loss (680.6 ± 265.0 vs. 847.2 ± 382, p < 0.001) and transfusions of blood (0.57 ± 0.79 U vs. 1.49 ± 0.82 U, p < 0.001), and hospital stay (6.57 ± 2.04 vs. 7.68 ± 3.44,p = 0.006) were lower in Group I. In both groups, mean number of distal anastomoses and completeness of revascularisation were similar.
Conclusions:
Using the off-pump technique is safe and improves postoperative early outcomes in high-risk patients with LMCA disease.
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