Off-Pump Beating Heart Coronary Artery Bypass Surgery in Low-Risk Patients: Does it Really Enhance Early Recovery?

Abstract

M Fouda, Off-Pump Beating Heart Coronary Artery Bypass Surgery in Low-Risk Patients: Does it Really EnhanceEarly Recovery?. 2001; 21(5-6): [347][348] Off-pump coronary artery bypass (OPCAB) surgery is an established mode of revascularization in many cardiac centers. The avoidance of cardiopulmonary bypass surgery has obvious advantages in high-risk patients. In patients with poor left ventricular function, our recent study, 1 like others, has documented the superiority of this technique over conventional bypass surgery. The aim of this retrospective analysis was to identify the benefits of this OPCAB surgery in a low-risk group of patients in comparison to conventional coronary artery bypass technique in a similar group of patients, with regards to intensive care unit (ICU) length of stay and total hospitalization time. In the comparison of the two techniques, the study showed a marginal superiority of the off-pump technique, though no significant statistical differences were reached. Materials and MethodsDuring a 32-month period ending in December 2000, a total of 282 patients underwent coronary artery bypass surgery using the off-pump technique. Of the total number, 200 were classified as low-risk, identified as patients with reasonable ventricular ejection fraction, good target vessels, and with no other comorbid factors. The total number of coronary artery bypass surgery cases during this period was 430.The criteria for on-pump surgery in our institution over the last three years have changed as the center has gained more experience in OPCAB surgery. As of now, absolute contraindications to off-pump surgery in our center are diffusely diseased vessels, emergency surgery and oversized hearts with poor function needing posterior revascularization.The off-pump cases were mainly done by our surgeon. The approach was a standard median sternotomy with full heparinization. Mechanical stabilization was achieved by using the Octopus II and Octopus III (Medtronic) system. Exposure of the back of the heart was achieved by using a double-armed sling fixed in its midpoint to the posterior pericardium between the right and left inferior pulmonary veins. Temporary occlusion of the vessel was achieved by-using a 4/0 prolene suture. For the right coronary artery, an intra-arterial shunt was used if the vessel was big and the stenosis was less than 80%, as temporary occlusion of such a vessel can cause serious arrhythmias. No pharmacological stabilization was used, but a small dose of dopamine was needed in a few cases. ResultsThere were 650 grafts using the off-pump technique, and these were predominantly in male patients. The demographic comparison between off-pump and the control group and the total number of grafts in each group are as shown in Tables 1 and 2. Although grafting of posterior vessels was extremely difficult initially in the off-pump group, with new techniques and instruments to visualize those vessels without hemodynamic compromise, the number of posterior vessels grafted in the group was comparable to the ...