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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Redo coronary artery bypass grafting: on-pump and off-pump coronary artery bypass grafting revascularization
Insights
Redo coronary artery bypass grafting (CABG) is safe and effective. Off-pump CABG (OPCAB) showed better short-term outcomes, including shorter operation times and hospital stays, making it suitable for high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Redo coronary artery bypass grafting (CABG) is a complex procedure for patients with previously treated coronary artery disease.
- Evaluating short-term outcomes of on-pump versus off-pump techniques in redo CABG is crucial for optimizing patient care.
Purpose of the Study:
- To compare the short-term clinical outcomes of on-pump versus off-pump techniques in redo coronary artery bypass grafting (CABG).
- To identify potential advantages of off-pump coronary artery bypass grafting (OPCAB) in a redo setting.
Main Methods:
- A non-randomized study of 80 patients undergoing redo CABG between January 2003 and August 2013.
- Patients were divided into two groups: 40 undergoing on-pump CABG (redo-ONCAB) and 40 undergoing off-pump CABG (redo-OPCAB).
- Data collected included operation time, graft number, revascularization completeness, postoperative ventilation, and complications.
Main Results:
- The redo-OPCAB group experienced significantly shorter operation times, reduced postoperative ventilation, and shorter intensive care unit stays compared to the redo-ONCAB group.
- Fewer platelet and blood transfusions were required in the redo-OPCAB group.
- Higher rates of incomplete revascularization and use of transmyocardial laser revascularization were observed in the redo-OPCAB group, with no significant differences in perioperative stroke, low output syndrome, or in-hospital mortality.
Conclusions:
- Redo CABG is a safe and effective surgical intervention.
- The off-pump CABG technique demonstrates superior short-term outcomes and is recommended, particularly for high-risk patients undergoing redo procedures.
Objective:
To analyze the short-term outcomes of redo coronary artery bypass grafting (CABG) using on-pump and off-pump CABG techniques.
Methods:
From January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique (redo-ONCAB group) and 40 underwent off-pump CABG technique (redo-OPCAB group). Furthermore, transmyocardial laser revascularization was performed in high-risk patients who were not suitable to conventional grafting. Clinical data of the two groups were recorded and analyzed including operation time, coronary grafts, incomplete revascularization, postoperative ventilation, perioperative stroke, and low output syndrome, etc.
Results:
There were no significantly differences in age, gender distribution, incidences of hypertension, stroke, and other clinical characteristics between redo-OPCAB group and redo-ONCAB group (all P>0.05), except for incidences of renal dysfunction and pulmonary disease (all P<0.05). The number of grafting vessels in the redo-ONCAB and redo-OPCAB groups was 2.1 ± 0.74 and 1.4 ±0.52 respectively. There was significant difference between the two groups (P=0.0243). Compared with the redo-ONCAB group, there was shorter operation time (P=0.0045), postoperative ventilation (P=0.0211) and intensive care unit stay (P=0.0400), as well as fewer use of platelet (P=0.0338) and blood transfusion (P=0.0034) in the redo-OPCAB group. The incidence of incomplete revascularization (P=0.0253) and the use of transmyocardial laser revascularization (P=0.0052) were higher in the redo-OPCAB group than those in the redo-ONCAB group (all P<0.05). However, no significant differences were showed for the incidence of the use of intra aortic balloon pump and continuous renal replacement therapy, perioperative stroke, low output syndrome, and in-hospital mortality between the two groups (all P>0.05).
Conclusion:
Redo CABG is the safety and efficacy surgical procedure, and redo-OPCAB technique with better outcomes is commended especially in high-risk patients.
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