Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies
Leonidas V Athanasopoulos1, Thanos Athanasiou1
1Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
Insights
Off-pump surgery for left main stem disease offers comparable or better outcomes than traditional bypass. This approach is safe and feasible, showing reduced complications like stroke and shorter hospital stays.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Surgery
Background:
- Left main stem (LMS) disease is a critical condition associated with high morbidity and mortality.
- Conventional treatment involves bypass surgery for hemodynamic stability.
- Evidence on off-pump (OFP) surgery for LMS disease requires comprehensive review.
Approach:
- Systematic literature search for studies comparing OFP surgery to conventional approaches for LMS disease.
- Focus on postoperative outcomes, including mortality, stroke rates, blood transfusions, and inotropic use.
- Analysis of concerns and controversies surrounding OFP surgery for LMS disease.
Key Points:
- Most studies indicate favorable or equal outcomes for OFP surgery compared to conventional methods.
- OFP surgery demonstrated equal or lower mortality rates in several studies.
- Reduced rates of stroke, blood transfusions, and inotropic agent use were observed with OFP surgery.
Conclusions:
- Off-pump surgery is a feasible and safe option for treating left main stem disease.
- Despite concerns regarding hemodynamic instability and complete revascularization, OFP surgery shows promising results.
- Further research may clarify controversies surrounding graft numbers and stroke rates in OFP surgery.
Abstract:
Left main stem (LMS) disease is known to be a poor prognostic factor in terms of morbidity or mortality. Traditionally, it has been treated with constitution of bypass to provide required haemodynamic stability. We searched the literature for evidence on off-pump (OFP) surgery for treating this high-risk group of patients focusing in our review on postoperative outcomes, concerns and controversies. The majority of the studies identified showed favourable or equal outcomes of OFP when compared to conventional approach. All of the studies, apart from two, which showed lower incidence of postoperative deaths, demonstrated equal mortality rates. Stroke rates were found less in three studies. Less blood transfusions, inotropic use and length of study has been also demonstrated. The main concerns of OFP surgery are: haemodynamic instability and less complete revascularization. Main controversies are: same or favourable outcomes despite lower number of grafts with OFP surgery and less stroke rates despite manipulation of aorta with side-clamping. Despite these concerns and controversies OFP surgery has been proven to be feasible and safe as demonstrated by results from numerous studies.
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