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Coronary artery bypass grafting without cardiopulmonary bypass for high-risk patients
1Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Jyounanku, Fukuoka, Japan.
Insights
Coronary artery bypass grafting without cardiopulmonary bypass was performed on 23 high-risk patients. This off-pump technique showed an 89% graft patency rate, suggesting improved outcomes for these patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
Background:
- High-risk patients often present with multiple comorbidities, increasing surgical risks.
- Traditional cardiopulmonary bypass can be associated with complications in elderly and comorbid patients.
Purpose of the Study:
- To evaluate the feasibility and outcomes of coronary artery bypass grafting performed without cardiopulmonary bypass in high-risk patients.
- To assess graft patency and early postoperative results of off-pump coronary artery bypass grafting.
Main Methods:
- Retrospective analysis of 23 patients undergoing off-pump coronary artery bypass grafting between January 1991 and June 1993.
- Distal anastomoses were performed under temporary coronary flow interruption.
- Angiography was used to assess graft patency postoperatively.
Main Results:
- The study included patients with significant risk factors such as advanced age, poor left ventricular function, and renal failure.
- A total of 37 distal anastomoses were performed, with 24 utilizing internal thoracic arteries.
- The hospital mortality rate was 4.3% (1 death), and postoperative angiography revealed an 89% graft patency rate.
Conclusions:
- Coronary artery bypass grafting without cardiopulmonary bypass is a viable option for high-risk patients.
- The off-pump technique may lead to improved postoperative outcomes in this patient population.
- Further research is warranted to confirm the long-term benefits of this approach.
Abstract:
Between January 1991 and June 1993, coronary artery bypass grafting was performed without either cardiopulmonary bypass or cardiac arrest in 23 patients. Most patients had several surgical risk factors, including age > or = 70 years, poor left ventricular function, left main coronary artery stenosis, chronic renal failure, and aortic aneurysm. Distal anastomoses were made under temporary interruption of coronary flow. A total of 37 distal anastomoses to the left anterior descending coronary artery and/or right coronary artery (mean 1.6 per patient) were made, 24 of which were internal thoracic arteries. The coronary occlusion time ranged from 7-14 min (mean 9.8 min). Combined cardiac or vascular operations were carried out in six patients (abdominal aortic aneurysm repair, thoracic aortic aneurysm repair, carotid endarterectomy, and coronary endarterectomy). There was one hospital death. Postoperative angiography was performed in 22 patients and showed a patency rate of 89%. In summary, coronary artery bypass grafting without cardiopulmonary bypass may improve the postoperative outcome of high-risk patients.