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Coronary artery bypass grafting without cardiopulmonary bypass through sternotomy and minimally invasive procedure
1Department of Cardiovascular Surgery, Paulista School of Medicine, Federal University of São Paulo, Brazil.
Insights
Coronary artery bypass grafting without cardiopulmonary bypass (CPB) offers a safe and cost-effective alternative for selected patients. This beating heart surgery demonstrates lower complication rates and acceptable mortality for myocardial revascularization.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting without cardiopulmonary bypass (CPB) is an established technique for specific patient groups.
- Conventional myocardial revascularization is a widely used method.
Purpose of the Study:
- To present the long-term experience with off-pump coronary artery bypass grafting (OPCAB).
- To evaluate the safety, efficacy, and cost-effectiveness of OPCAB compared to conventional CABG.
Main Methods:
- Retrospective analysis of 1761 OPCAB cases performed between September 1981 and April 1997.
- Comparison with 9164 patients who underwent conventional CABG during the same period.
- Inclusion of minimally invasive surgery in 3% of OPCAB cases.
Main Results:
- Overall applicability of OPCAB was 19.2%.
- Most commonly grafted arteries included the left anterior descending (LAD), right coronary artery (RCA), and diagonal branches.
- Acceptable mortality rate of 2.3% for OPCAB.
- Significantly lower incidence of major postoperative complications in the OPCAB group.
- Reduced costs associated with OPCAB due to the absence of extracorporeal circulation equipment.
Conclusions:
- Off-pump myocardial revascularization is a justified, safe, and effective surgical treatment for selected patients with coronary insufficiency.
- The technique offers a viable alternative with improved outcomes and cost benefits.
Abstract:
Coronary artery bypass grafting without cardiopulmonary bypass (CPB) is now an accepted technique of myocardial revascularization in a special subset of patients. This paper presents our total experience in 1761 cases operated on since September 1981 until April 1997 out of a total of 9164 patients revascularized with the conventional technique during this period of time. Among the 1761 patients, 53 (3%) were operated on by minimally invasive surgery. The overall applicability was 19.2% and the most common grafted arteries were left anterior descending artery (LAD), right coronary artery (RCA), and diagonal. Results indicate that the operation can be performed with an acceptable mortality (2.3%) and that all types of arterial conduits can be used. The incidence of major postoperative complications were significantly lower in this group of patients when compared with our patients receiving conventional myocardial revascularization. Most importantly there was decrease cost when the procedure was used because no extracorporeal circulation cardioplegia sets or other cannulas were used. We conclude based on in this fifteen years experience that the technique of myocardial revascularization in a beating heart is justified, safe and can offer to selected patients the best option of coronary insufficiency surgical treatment.