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Coronary artery bypass surgery on the beating heart
1Department of Cardiovascular Surgery, Haynal Imre University of Health Sciences, Budapest, Hungary.
Insights
Coronary artery bypass surgery without cardiopulmonary bypass is feasible for select patients with ischemic heart disease. This approach reduced intensive care unit stays and improved patient quality of life without complications.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Ischemic heart disease (IHD) management often involves coronary artery bypass surgery (CABS).
- Cardiopulmonary bypass (CPB) carries potential risks, particularly for patients with comorbidities.
- Off-pump coronary artery bypass (OPCAB) surgery offers an alternative to traditional CABS with CPB.
Purpose of the Study:
- To report experiences and outcomes of OPCAB surgery.
- To evaluate the safety and efficacy of OPCAB in a selected patient cohort.
- To compare perioperative outcomes of OPCAB versus CABS with CPB.
Main Methods:
- Retrospective analysis of 151 IHD patients operated between January 1993 and June 1995.
- Seven patients underwent OPCAB surgery based on specific inclusion criteria.
- Perioperative data were compared between OPCAB and CABS with CPB groups.
Main Results:
- No blood transfusions were required for OPCAB patients.
- No perioperative myocardial necrosis was observed in the OPCAB group.
- OPCAB patients had a significantly shorter intensive care unit (ICU) stay (24 hours).
Conclusions:
- OPCAB surgery is a safe and effective option for carefully selected IHD patients.
- OPCAB can lead to improved patient outcomes, including reduced ICU stay and enhanced quality of life.
- This technique avoids complications associated with cardiopulmonary bypass, particularly in high-risk individuals.
Abstract:
Authors report their experiences with coronary artery bypass surgery without cardiopulmonary bypass. Between January 1993 and June 1995, 151 patients were operated upon by the same surgeon for ischaemic heart disease (IHD); 7 were of them without extracorporeal circulation (ECC). Patients were selected for the procedure on the following criteria: (1) symptomatic patient with proximally occluded, anteriorly located, major subepicardial artery(ies) unsuitable for, or after failed, PTCA; (2) presence of associated disease (like hypertension, diabetes mellitus, chronic obstructive pulmonary disease) enhancing a possible deleterious effect of cardiopulmonary bypass; (3) favourable response to beta-blocking agent pretreatment without side effects. Seven patients' perioperative data (white cell count, platelet count, whole plasma protein level, chest drainage, CK-MB release--incidence of perioperative myocardial mess loss--and days spent in the intensive care unit /ICU/) are compared to the corresponding data of patients with comparable pathology operated on with ECC. No blood transfusion was required, nor perioperative myocardial necrosis occurred. The patients operated on without ECC spent only 24 hours in the ICU, and the clinical check-up after 1-24 months revealed conditions free from angina pectoris. The patient's quality of life improved.