Off-pump CABG surgery in left main coronary artery disease: a single-center prospective registry
Ajeet Bana1, Anuj Sangal2,3, Navneet Mehta4
1Eternal Heart Care Centre & Research Institute, Jawahar Nagar, Jaipur, 302017 India.
Insights
Off-pump coronary artery bypass grafting (CABG) is a safe and effective treatment for left main (LM) coronary artery disease (CAD). This study found low in-hospital mortality and major adverse cardiovascular events (MACE) with favorable 3-year outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Left main (LM) coronary artery disease (CAD) treatment involves complex decisions, with concerns about incomplete revascularization and survival rates in off-pump (OPCAB) versus on-pump (ONCAB) surgery.
- Evaluating outcomes in high-risk LM CAD patients undergoing OPCAB is crucial.
Purpose of the Study:
- To assess the safety and efficacy of off-pump coronary artery bypass grafting (OPCAB) in patients with significant left main (LM) coronary artery disease (CAD).
Main Methods:
- A prospective, registry-based study involving 1323 high-risk patients with LM triple-vessel CAD undergoing OPCAB surgery between January 2013 and June 2019.
- Data collected included clinical features, extent of CAD, operative details, in-hospital outcomes, and 3-year follow-up.
- Descriptive statistics were used to analyze the data.
Main Results:
- The study cohort (n=1323) had a mean age of 63 years, with 88.4% males. Common comorbidities included diabetes (45.2%) and previous myocardial infarction (35.0%).
- All patients had LM disease (100%) with triple-vessel disease in 99.4%.
- In-hospital major adverse cardiovascular events (MACE) were low at 1.6% (n=21). At 3-year follow-up (n=1041), MACE rates were 8.1% (n=84), with cardiovascular deaths at 2.7% (n=28).
Conclusions:
- Off-pump CABG surgery demonstrates safety in patients with left main coronary artery disease.
- Low in-hospital mortality and MACE rates were observed.
- Three-year outcomes for OPCAB in LM CAD patients are comparable to published data for on-pump CABG.
Background And Objective:
The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Patients with left main multi-vessel coronary artery disease (LM CAD) have concerns regarding incomplete revascularization and reduced survival with off-pump (OPCAB) when compared with on-pump (ONCAB) coronary bypass surgery. To evaluate outcomes among high-risk LM CAD patients undergoing OPCAB, we performed a registry-based prospective study.
Methods:
We performed 4868 coronary artery bypass graft (CABG) surgeries from Jan 2013 to Jun 2019 with 4662 (95.8%) OPCAB. In OPCAB cohort, we had 1323 patients (28.4%) with significant LM (> 50%) triple vessel CAD. Data regarding clinical features, extent of CAD, operative details, in-hospital outcomes, and 3-year follow-up were obtained. Descriptive statistics are reported.
Results:
The study cohort (n = 1323) was aged 63 ± 9 years with men 88.4%. Tobacco use was in 328 (24.8%), diabetes 598 (45.2%), previous myocardial infarction 463 (35.0%), previous coronary intervention 40 (3.0%), and congestive heart failure in 54 (4.1%). All patients had LM (100.0%) with triple vessel disease in 99.4% (LAD, left anterior descending 100.0%; LCX, left circumflex 99.4%; RCA, right coronary artery 78.7%). Vessels bypassed/patient were 2.7 ± 0.4 with 3.2 ± 0.7 total grafts and 2.1 ± 0.8 venous grafts. In total, 1278 (96.5%) patients received left internal mammary artery (LIMA), 63(4.7%) bilateral internal mammary artery (BIMA), and 74 (5.6%) radial artery grafts. There was no patient with conversion from OPCAB to ONCAB. In-hospital major adverse cardiovascular events (MACE: all-cause deaths, myocardial infarction, and stroke) were in 21 (1.6%). At 3-year follow-up (n = 1041), MACE rates were in 84 (8.1%) and cardiovascular deaths in 28 (2.7%).
Conclusions:
This study shows that off-pump CABG surgery is safe in patients with LM CAD. There is low in-hospital mortality and MACE and 3-year outcomes are similar to the published data of LM CAD patients who undergo on-pump CABG.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s12055-023-01526-3.
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