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Published on: September 15, 2023
Left Ventricular Venting during On-Pump Beating-Heart Coronary Artery Bypass Grafting for Advanced Ischemic
Tomo Yoshizumi1, Tomonari Uemura1, Yasunari Hayashi1
1Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.
Insights
This study introduces a surgical approach combining on-pump beating-heart coronary artery bypass grafting (OPBH CABG) with left ventricular (LV) venting. This method aids complete revascularization in high-risk patients with severe heart dysfunction.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Cardiac Surgery
Background:
- Advanced ischemic cardiomyopathy (ICM) presents challenges in surgical revascularization due to severe left ventricular (LV) dysfunction and dilation.
- Traditional methods may struggle to achieve complete revascularization in these complex cases.
Purpose of the Study:
- To describe a novel surgical strategy integrating on-pump beating-heart coronary artery bypass grafting (OPBH CABG) with left ventricular (LV) venting.
- To evaluate the feasibility and outcomes of this combined approach in patients with advanced ICM and severe LV impairment.
Main Methods:
- A cohort of 7 patients with advanced ICM and severe LV dysfunction underwent OPBH CABG with LV venting.
- The surgical technique focused on LV decompression, reduced myocardial workload, and enhanced surgical exposure for coronary anastomosis.
Main Results:
- Complete revascularization was successfully achieved in all 7 patients.
- No in-hospital deaths or postoperative complications were reported.
- The median LV ejection fraction was 21.7% and median LV end-diastolic diameter was 61.6 mm.
Conclusions:
- The combination of OPBH CABG and LV venting is a viable strategy for selected high-risk patients with advanced ICM.
- This approach facilitates complete revascularization and offers myocardial unloading benefits.
Abstract:
We describe a surgical strategy combining on-pump beating-heart coronary artery bypass grafting (OPBH CABG) with left ventricular (LV) venting for patients with advanced ischemic cardiomyopathy (ICM) with severe LV dysfunction and marked LV dilation. This strategy provides LV decompression, reduces myocardial workload, and improves surgical exposure during coronary anastomosis, facilitating complete revascularization. Between January 2013 and September 2024, 7 patients underwent OPBH CABG with LV venting. Six patients had chronic ICM with dilated ventricles and severe systolic dysfunction, and 1 presented with acute coronary syndrome and impaired LV function. The median age was 65 years (interquartile range [IQR], 61-80). The median left ventricular ejection fraction was 21.7% (IQR, 19.2-27.9), and the median left ventricular end-diastolic diameter was 61.6 mm (IQR, 58.7-69.3). Complete revascularization was achieved in all patients without additional mechanical circulatory support. There were no in-hospital deaths or postoperative complications. This strategy may enable complete revascularization in selected high-risk patients while contributing to myocardial unloading.
