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On-pump beating coronary artery bypass in high risk coronary patients
Abbas Afrasiabirad1, Naser Safaie1, Hosein Montazergaem1
1Department of Cardiac Surgery, Madani Heart Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
On-pump beating Coronary Artery Bypass Grafting (OPBCABG) is effective for high-risk patients, significantly reducing mortality and complications compared to conventional methods. This approach offers a safer alternative for complex cardiac surgeries.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Thoracic Surgery
Background:
- Conflicting results exist for Conventional Coronary Artery Bypass Grafts (CCABG) in high-risk patients.
- Off-pump CABG may present serious complications in these individuals.
- Evaluating on-pump beating CABG (OPBCABG) efficacy is crucial for high-risk coronary patients.
Purpose of the Study:
- To assess the efficacy of on-pump beating CABG (OPBCABG) in high-risk coronary patients.
- To compare OPBCABG outcomes against conventional CABG methods.
- To determine if OPBCABG reduces mortality and perioperative complications.
Main Methods:
- Prospective study comparing 157 OPBCABG patients with 157 CCABG patients (historical controls).
- Inclusion criteria for OPBCABG: severe left main stenosis, post-MI chest pain, unstable angina, ventricular arrhythmia, complicated intervention, or LV dysfunction.
- Patients underwent surgery between June 2003 and December 2011 (OPBCABG) versus pre-2003 (CCABG).
Main Results:
- Hospital mortality was significantly lower in the OPBCABG group (3.2%) compared to CCABG (9%) (P<0.001).
- OPBCABG patients experienced fewer instances of preoperative myocardial infarction, inotropic agent use, intraaortic balloon pump use, renal dysfunction, and prolonged ventilation.
- No significant preoperative differences were noted between the groups.
Conclusions:
- OPBCABG demonstrates effectiveness in high-risk coronary patients.
- This technique significantly reduces mortality and major perioperative complications.
- OPBCABG offers a superior alternative to conventional methods for selected high-risk individuals.
Background:
There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG) with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG) in coronary high-risk patients in comparison with the conventional methods.
Methods:
In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003.
Results:
Preoperative patient characteristics revealed no significant differences between the two groups. The patients' mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001). Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group.
Conclusion:
Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications.
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