Li Ruzheng | PubMed Health

PubMed2005

Systematic off-pump coronary artery bypass.

PURPOSE: We assessed the feasibility of systematic off-pump coronary artery bypass (OPCAB) and identified risk factors for on-pump conversion. METHODS: Between July 1, 2002 and December 31, 2003, OPCAB was attempted for all patients who required isolated coronary artery bypass in our institution. The perioperative results of patients were prospectively entered into a structured database, the results were analyzed to identify the risks of requirement of cardiopulmonary bypass. RESULTS: OPCAB was performed in all but 4 patients, giving an OPCAB success rate of 98.3% (229/233). The reason for cardiopulmonary bypass was hemodynamic instability occurring during reoperative surgery in 3, and cardiogenic shock in 1. The isolated risk factor for on-pump conversion was reoperation (relative risk 11.6). Mean number of distal anastomoses performed under OPCAB was 3.7+/-1.2, and the complete revascularization rate was 92.1% (211/229). There was one hospital death (0.4%). During a mean follow-up period of 1.0+/-0.4 years, two patients developed angina, which were treated with catheter intervention; otherwise, there was no death, or other cardiac events observed. CONCLUSION: Systematic OPCAB was feasible except in patients undergoing reoperative surgery or patients with on-going deep cardiogenic shock. Systematic OPCAB provided successful complete revascularization and its short term results were acceptable.

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Routine reoperative off-pump coronary artery bypass grafting via midline sternotomy: is it feasible?

Multivessel off-pump coronary artery bypass (OPCAB) has been conducted safely; however, the clinical outcomes of reoperative OPCAB have not been reported clearly. Currently OPCAB is being performed systematically in this institution including reoperative surgeries. Between September 1, 1999, and December 31, 2003, reoperative OPCAB via midline sternotomy was planned for nonemergent patients with normal left ventricular function without valvular disease. The perioperative results of patients who underwent reoperative OPCAB were analyzed. Thirty-five patients were scheduled for OPCAB. Of these, OPCAB was performed in 27 patients, giving OPCAB success rate of 77.1%. Failure of OPCAB was due to graft injury in 2, ischemic EKG change in 1, and dense adhesion and difficulty of dissection in 5 patients. The mean number of grafts with completed OPCAB was 3.0 +/- 1.5. There were no hospital deaths, strokes, or respiratory or renal failures. One patient (3.7%) developed perioperative myocardial infarction. Postoperative angiography was obtained in 12 patients (26 distal anastomoses), and all anastomoses were perfect except for 1 distal anastomosis stenosis, giving an overall stenosis-free patency rate of 95.1%. During a follow-up period (mean 2.5 +/- 0.6 years), all patients survived without cardiac event, except 1 patient who underwent catheter intervention. Cardiopulmonary bypass may be required during cardiac dissection to decompress the heart and to facilitate dissection. However, once lysis of the adhesion is completed, reoperative OPCAB can be performed without increasing surgical risks. Midterm results were satisfactory.

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