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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Emergency Off-Pump Coronary Artery Bypass Graft Surgery for Patients on Preoperative Intraaortic Balloon Pump
Hisato Ito1, Toru Mizumoto1, Hironori Tempaku1
1Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi.
Insights
Emergency off-pump coronary artery bypass graft surgery is a viable option for patients needing intraaortic balloon pump support. This procedure demonstrates good long-term survival and reduced adverse events, especially with complete revascularization.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Interventional Cardiology
Background:
- Patients with acute coronary syndrome often require intraaortic balloon pump (IABP) support.
- Evaluating outcomes for IABP-supported patients undergoing emergency coronary artery bypass graft (CABG) surgery is crucial.
Purpose of the Study:
- To assess early and long-term outcomes of emergency off-pump CABG (OPCAB) in patients requiring preoperative IABP support.
- To identify predictors of mortality and adverse events in this high-risk patient group.
Main Methods:
- A retrospective evaluation of 115 patients who underwent emergency OPCAB with preoperative IABP support.
- Analysis included patient demographics, preoperative conditions (acute myocardial infarction, unstable angina, left main/triple-vessel disease), surgical details, and long-term follow-up.
- Cox multivariate analysis was used to identify prognostic predictors.
Main Results:
- Perioperative mortality was low (3 deaths).
- Complete surgical revascularization was achieved in 71.3% of patients, with high use of internal thoracic artery grafts (83.5%).
- Five-year outcomes included 83.3% survival, 73.5% freedom from major adverse cardiac and cerebrovascular events (MACCE), and 84.2% freedom from repeat revascularization.
- Preoperative renal impairment and low ejection fraction predicted mortality. Renal impairment and peripheral vascular disease predicted MACCE, while complete revascularization was protective.
- Previous percutaneous coronary intervention increased repeat revascularization risk, whereas complete revascularization was protective.
Conclusions:
- Emergency off-pump CABG surgery is a feasible and effective option for patients requiring preoperative IABP support.
- Complete revascularization is a key factor in improving outcomes and reducing adverse events in this population.
Background:
The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery.
Methods:
One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87). Acute myocardial infarction and unstable angina were present in 54 patients (47.0%) and 61 patients (53.0%), respectively. Left main disease and triple-vessel disease without left main involvement were present in 74 patients (64.3%) and 33 patients (28.7%), respectively.
Results:
There were 3 perioperative deaths. Complete surgical revascularization was accomplished in 82 patients (71.3%), and in situ internal thoracic artery graft was used in 96 (83.5%). Late survival, freedom from major adverse cardiac and cerebrovascular events, and freedom from repeat revascularization rates at 5 years were 83.3%, 73.5%, and 84.2%, respectively. The Cox multivariate prognostic predictors of total mortality were preoperative renal impairment (hazard ratio [HR] 7.90; 95% confidence interval [CI]: 3.06 to 20.4) and low ejection fraction (HR 0.94, 95% CI: 0.88 to 0.99). The multivariate risk predictors of major adverse cardiac and cerebrovascular events were preoperative renal impairment (HR 2.68, 95% CI: 1.00 to 7.19) and peripheral vascular disease (HR 2.81, 95% CI: 1.05 to 7.51), and complete revascularization was protective (HR 0.39, 95% CI: 0.19 to 0.81). The multivariate risk factor of repeat revascularization was previous percutaneous coronary intervention (HR 3.26, 95% CI: 1.14 to 9.33), and complete surgical revascularization was also protective (HR 0.30, 95% CI: 0.11 to 0.85).
Conclusions:
Off-pump coronary artery bypass graft surgery is a feasible option for patients requiring preoperative intraaortic balloon pump support.
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