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Coronary artery revascularisation without extracorporeal circulation. Indications and results
T A Folliguet1, F Laborde, J Temkine
1Institut Mutualiste Montsouris, Paris, France.
Insights
Off-pump coronary artery bypass grafting offers a safe option for selected patients, demonstrating low mortality and reduced costs. This technique is effective for single bypass procedures and can be combined with angioplasty for high-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) traditionally utilizes extracorporeal circulation.
- Off-pump CABG (OPCAB) presents an alternative for specific patient populations.
- Assessing the safety and efficacy of OPCAB is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the outcomes of coronary artery revascularization performed without extracorporeal circulation.
- To identify predictors of perioperative mortality in OPCAB procedures.
- To compare outcomes between low-risk and high-risk patient groups undergoing OPCAB.
Main Methods:
- A consecutive series of 210 patients underwent OPCAB.
- Preoperative risk factors and Parsonnet score were analyzed to predict mortality.
- Patients were stratified into low-risk (Parsonnet score < 15) and high-risk (Parsonnet score > 15) groups.
Main Results:
- The overall mortality rate was 3.3% (7 deaths).
- Older age, higher NYHA class, and lower ejection fraction were predictors of mortality.
- Low-risk patients had a 1.2% mortality rate, while high-risk patients had a 9% mortality rate.
- Reduced length of stay, operating room time, and medical costs were observed.
Conclusions:
- OPCAB can be performed with low operative mortality and minimal morbidity, particularly for single bypass revascularization.
- A multiple revascularization strategy combining OPCAB with angioplasty is feasible for high-risk patients.
- OPCAB demonstrates significant benefits in terms of resource utilization and patient outcomes.
Objective:
Coronary artery revascularisation without extracorporeal circulation is a technique which can be performed in selected patients in need of a coronary artery bypass graft.
Methods:
Consecutive patients (210) underwent coronary artery bypass graft without extracorporeal circulation. Indications were high risk patients, or single coronary artery lesion. To predict perioperative mortality, preoperative risk factors were reviewed, and Parsonnet score was calculated.
Results:
There were seven deaths (3.3%), and univariate analysis revealed greater age, NYHA, and poor ejection fraction to be the only predictors of early mortality. Perioperative myocardial infarction included 15 patients (7.1%), most of them seen in the multiple bypass group (10/39, 26%). Patients were divided into low risk (Parsonnet score < 15) 155 patients with two deaths (1.2%), and high risk (Parsonnet score > 15) 55 patients with five deaths (9%). Complete revascularisation was performed in the low risk group, while in the high risk only the symptomatic vessel was bypassed and other angiographic lesions treated with postoperative angioplasty (10 patients). A total of 12 patients developed early postoperative angina (5.7%), 9 presented an anastomosis dysfunction which was treated by angioplasty (5) and surgery (4), and 188 patients (85.7%) did not receive transfusions while 190 patients (90.4%) did not need postoperative inotropes. Length of stay, operating room time, and medical costs were all significantly reduced.
Conclusions:
Myocardial revascularisation without extracorporeal circulation can be performed with a low operative mortality, and minimal morbidity only in patients undergoing single bypass revascularisation. It can also be performed as part of a multiple revascularisation strategy in association with angioplasty in high risks patients.