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Primary coronary artery bypass grafting without cardiopulmonary bypass in impaired left ventricular function
Y Moshkovitz1, L Sternik, Y Paz
1Department of Cardiac Surgery and The Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Coronary artery bypass grafting without cardiopulmonary bypass offers a safe alternative for patients with severe left ventricular dysfunction. This technique demonstrates reduced mortality and morbidity, making it suitable for high-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) is associated with significant mortality and morbidity in patients with left ventricular dysfunction.
- Patients with reduced ejection fraction present a higher surgical risk for traditional CABG procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump coronary artery bypass grafting (OPCABG) in patients with severely impaired left ventricular function.
- To compare outcomes of OPCABG versus conventional CABG in a high-risk surgical population.
Main Methods:
- A cohort of 75 patients with ejection fraction ≤ 0.35 underwent primary OPCABG between December 1991 and December 1994.
- The study included patients with congestive heart failure, recent myocardial infarction, and those requiring emergency operations, including cases of cardiogenic shock.
Main Results:
- The mean number of grafts per patient was 1.9, with internal mammary artery use in 85% of cases.
- Perioperative mortality was 2.7%, with a 1.3% stroke rate. At a mean follow-up of 28 months, 1- and 4-year actuarial survival rates were 96% and 73%, respectively.
- Late angina recurrence was observed in 10.5% of patients.
Conclusions:
- Off-pump coronary artery bypass grafting (OPCABG) is a feasible and safe alternative to conventional CABG for patients with extreme left ventricular dysfunction.
- OPCABG is particularly beneficial for patients with coexisting risk factors, including acute myocardial infarction and cardiogenic shock, offering improved outcomes.
Background:
Conventional coronary artery bypass grafting using cardiopulmonary bypass carries relatively high mortality and morbidity for patients with left ventricular dysfunction.
Methods:
Seventy-five patients with ejection fraction less than or equal to 0.35 underwent primary coronary artery bypass grafting without cardiopulmonary bypass between December 1991 and December 1994. Thirty-two patients (43%) had congestive heart failure, 11 (15%) were referred for operation within the first 24 hours of evolving myocardial infarction, and 21 (28%) up to 1 week after acute myocardial infarction. Eighteen patients (24%), 6 of whom were in cardiogenic shock, underwent emergency operations.
Results:
Mean number of grafts/patient was 1.9 (range, 1 to 4), and internal mammary artery was used in 66 patients (85%). Only 17 patients (23%) received a graft to a circumflex marginal artery. Two patients (2.7%) died perioperatively, and 1 (1.3%) sustained stroke. At mean follow-up of 28 months, 13 patients had died, and angina had returned in 7 (10.5%). One- and four-year actuarial survival was 96% and 73%, respectively.
Conclusions:
Coronary artery bypass grafting without cardiopulmonary bypass is a viable alternative to conventional coronary artery bypass grafting particularly for patients with extreme left ventricular dysfunction or those with coexisting risk factors, such as acute myocardial infarction and cardiogenic shock.