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[Coronary artery bypass grafting under beating heart without cardiopulmonary bypass]
K Takahashi1, S Takahashi, S Suzuki
1Department of Cardiovascular Surgery, Aomori Rousai Hospital, Hachinohe Japan.
Insights
Beating heart coronary artery bypass grafting without cardiopulmonary bypass is safe and effective, especially for patients with chronic kidney disease. This minimally invasive approach offers reduced blood loss and cost compared to traditional surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Off-Pump Coronary Artery Bypass Grafting
Context:
- Standard coronary artery bypass grafting (CABG) involves cardiopulmonary bypass, carrying significant risks for high-risk patients.
- Beating heart surgery without cardiopulmonary bypass has emerged as a safer alternative.
- This study evaluates the outcomes of off-pump CABG in a specific patient cohort.
Purpose:
- To assess the safety, efficacy, and cost-effectiveness of off-pump coronary artery bypass grafting (OPCABG).
- To evaluate the procedure's suitability for patients with major risk factors and comorbidities.
- To compare OPCABG outcomes with standard CABG surgery.
Summary:
- The study involved 40 patients undergoing OPCABG between October 1995 and October 1997, including 11 reoperative procedures.
- Patients had various risk factors including chronic hemodialysis, poor renal/lung function, and advanced age.
- Graft utilization included internal thoracic artery (42), gastroepiploic artery (7), and saphenous vein (4).
- Different surgical approaches were employed, including median sternotomy and thoracotomy.
Impact:
- OPCABG demonstrated safety, cost-effectiveness, and reduced blood loss compared to standard CABG.
- The procedure was particularly effective for patients with chronic hemodialysis.
- Minimally invasive approaches like left thoracotomy and laparotomy with diaphragm approach showed effectiveness in reoperative cases, preserving graft patency.
Abstract:
Recently coronary artery bypass grafting under beating heart without cardiopulmonary bypass has been widely accepted for patients with associated risks of standard bypass surgery. Between October 1995 and October 1997, we performed this procedure on 40 (11 reoperative procedures). There were 26 single-vessel (9 reoperative procedures), 12 double-vessel (2 reoperative procedures) and 2 triple-vessel bypass procedures. Major risk factors and concomitant disorders were as follows: chronic hemodialysis, 3; poor renal function, 5; poor lung function, 6; reoperative procedure, 11; elder patient (age > or = 75 y), 4. Twenty-five patients were operated through a mediansternotomy, 11 through left thoracotomy (small thoracotomy 7), 1 through a small right thoracotomy, 3 through a laparotomy with the diaphragm approach, 1 through both a left thoracotomy and a laparotomy with the diaphragm approach. Fifty-three grafts were used during this course (internal thoracic artery [ITA] = 42, gastroepiploic artery [GEA] = 7, saphenous vein [SV] = 4) and the sequential bypass was performed with 2 LITA grafts. In selected patients this procedure is very safe, cost-effective and required less blood loss compared to standard bypass surgery. This procedure was considered to be very effective for patient with chronic hemodialysis. Also, left thoracotomy (a small thoracotomy) and laparotomy with the diaphragm approach showed particular effectiveness to reoperative procedures in order to preserve the patent grafts.