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Indications and problems of coronary artery bypass grafting without cardiopulmonary bypass
K Kondo1, S Minohara, Y Sawada
1Department of Thoracic Surgery, Osaka Medical College, Japan.
Insights
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) offers a safe alternative for selected patients with complex conditions. This off-pump CABG technique demonstrates good outcomes and is a viable option for treating coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) traditionally involves cardiopulmonary bypass (CPB), which carries inherent risks.
- Alternative myocardial protection strategies are sought to mitigate these risks, especially in patients with comorbidities.
Purpose of the Study:
- To evaluate the safety and efficacy of performing CABG without CPB (off-pump CABG) in carefully selected patients.
- To assess the feasibility of this technique in patients with concomitant diseases.
Main Methods:
- A retrospective review of 5 patients who underwent off-pump CABG between January 1995 and the report date.
- Patients were selected based on specific criteria, including the presence of comorbidities like lung cancer, calcified aorta, and myocardial infarction.
- Key perioperative data, including ischemia time, cardiac enzyme levels, and recovery parameters, were analyzed.
Main Results:
- The study included 5 patients (1 male, 4 female; age 68-80 years) with complex conditions.
- Mean ischemia time per anastomosis was 15.3 ± 5.3 minutes, with maximum CPK-MB levels below 14 U/L.
- All patients had short recovery periods, with no need for prolonged ventilation and early oral intake. Postoperative angiography confirmed graft patency without ischemic symptoms.
Conclusions:
- Off-pump CABG is a useful alternative treatment for coronary artery disease in selected patients, particularly those with concomitant diseases.
- This technique provides myocardial protection while avoiding the risks associated with cardiopulmonary bypass.
- The study supports the continued use of off-pump CABG as a viable option in complex cardiovascular surgical cases.
Abstract:
As an alternative method of myocardial protection and to obviate the inherent risks of cardiopulmonary bypass (CPB), we have been performing coronary artery bypass grafting (CABG) without CPB in carefully selected patients. Since the first such operation was successfully performed in January 1995 on a patient with angina pectoris and lung cancer, four other patients have subsequently undergone this technique. This series of 5 patients, being 1 man and 4 women ranging in age from 68 to 80 years, is presented in this report. The reasons for the selection of this procedure were concomitant diseases including lung cancer, a calcified aorta, and myocardial infarction. The mean time of ischemia for each anastomosis was 15.3 +/- 5.3 min, and the maximum cardiac muscle creatine phosphokinase (CPK-MB) was less than 14 unit/l postoperatively. None of the patients required ventilatory support for longer than 24 h postoperatively, and oral intake was started within 24 h after extubation in all patients. Postoperative angiography confirmed graft patency and none of the patients developed any ischemic symptoms. All the patients were discharged between 1 and 2 months postoperatively. Thus, the off-pump technique is useful when concomitant diseases are present and will become an alternative method of treatment for coronary artery disease in selected patients.