Off-pump coronary artery bypass grafting. Excellent results in a group of selected high-risk patients

H. B. Bittner, M. A. Savitt, Peter Mckeown, J. C. Lucke

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background. Off-pump coronary artery bypass grafting (OPCABG) has assumed an increasing role in many surgical practices. The ideal candidate has not been defined, but high-risk patients seem to benefit most when cardiopulmonary bypass (CPB), aortic cross clamping and cardioplegic arrest are avoided. Methods. Fourteen high-risk patients (age 52 to 81 years, 1 female, EF 44% ±8, Parsonnet score 23±4) were studied. They presented with acute coronary syndroms on platelet glycoprotein IIb/IIIa antagonists, acute myocardial infarction, worsening renal failure, decompensating ischemic cardiomyopathy, religious beliefs and denial of blood transfusion, and severe peripheral/cerebrovascular disease (total bilateral internal carotid artery occlusion and/or >90% stenosis). These patients underwent OPCABG via sternotomy with the intention of complete coronary revascularization. Results. An average of 2.3 grafts/patient were performed and the posterior descending artery (PDA) and marginal branches of the circumflex artery (LCX) were grafted in 79% of the patients. There were 3 events of intraoperative cardiac arrest precipitated by occlusion of right coronary artery (RCA) or positioning a cardiomegaly heart leading to immediate intra-vascular shunting (2) and/or conversion to CPB (1). One patient was converted to CPB and graft revision (intraoperative ultrasound and probing). The mortality rate was 0% and one stroke was observed on post-operative day 1. Coronary angiography (n=6) showed no significant stenosis. Conclusions. OPCABG complete revascularization is feasible in high-risk patients with low morbidity and mortality and excellent early results. OPCABG may be indicated in patients on platelet receptor antagonists preventing bleeding complications. Cardiomegaly can cause difficult off-pump LCX and PDA exposure and stabilization. RCA grafting off-pump is less tolerated and PDA grafting is preferred. High-risk patients for CPB are the ones who may benefit the most from OPCABG.

Original languageEnglish (US)
Pages (from-to)451-456
Number of pages6
JournalJournal of Cardiovascular Surgery
Volume42
Issue number4
StatePublished - Nov 1 2001
Externally publishedYes

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Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Cardiopulmonary Bypass
Arteries
Cardiomegaly
Coronary Vessels
Pathologic Constriction
Peptide Elongation Factor 1
Integrin beta3
Transplants
Cerebrovascular Disorders
Platelet Glycoprotein GPIIb-IIIa Complex
Sternotomy
Mortality
Platelet Aggregation Inhibitors
Religion
Internal Carotid Artery
Heart Arrest
Coronary Angiography
Cardiomyopathies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Off-pump coronary artery bypass grafting. Excellent results in a group of selected high-risk patients. / Bittner, H. B.; Savitt, M. A.; Mckeown, Peter; Lucke, J. C.

In: Journal of Cardiovascular Surgery, Vol. 42, No. 4, 01.11.2001, p. 451-456.

Research output: Contribution to journalArticle

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abstract = "Background. Off-pump coronary artery bypass grafting (OPCABG) has assumed an increasing role in many surgical practices. The ideal candidate has not been defined, but high-risk patients seem to benefit most when cardiopulmonary bypass (CPB), aortic cross clamping and cardioplegic arrest are avoided. Methods. Fourteen high-risk patients (age 52 to 81 years, 1 female, EF 44{\%} ±8, Parsonnet score 23±4) were studied. They presented with acute coronary syndroms on platelet glycoprotein IIb/IIIa antagonists, acute myocardial infarction, worsening renal failure, decompensating ischemic cardiomyopathy, religious beliefs and denial of blood transfusion, and severe peripheral/cerebrovascular disease (total bilateral internal carotid artery occlusion and/or >90{\%} stenosis). These patients underwent OPCABG via sternotomy with the intention of complete coronary revascularization. Results. An average of 2.3 grafts/patient were performed and the posterior descending artery (PDA) and marginal branches of the circumflex artery (LCX) were grafted in 79{\%} of the patients. There were 3 events of intraoperative cardiac arrest precipitated by occlusion of right coronary artery (RCA) or positioning a cardiomegaly heart leading to immediate intra-vascular shunting (2) and/or conversion to CPB (1). One patient was converted to CPB and graft revision (intraoperative ultrasound and probing). The mortality rate was 0{\%} and one stroke was observed on post-operative day 1. Coronary angiography (n=6) showed no significant stenosis. Conclusions. OPCABG complete revascularization is feasible in high-risk patients with low morbidity and mortality and excellent early results. OPCABG may be indicated in patients on platelet receptor antagonists preventing bleeding complications. Cardiomegaly can cause difficult off-pump LCX and PDA exposure and stabilization. RCA grafting off-pump is less tolerated and PDA grafting is preferred. High-risk patients for CPB are the ones who may benefit the most from OPCABG.",
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