Off-Pump Coronary Artery Bypass Grafting in Acute Coronary Syndrome: Focus on Safety and Completeness of Revascularization

Abstract

Background Emergency coronary artery bypass grafting (CABG) in the setting of acute coronary syndrome (ACS) has been associated with increased morbidity and mortality. Avoiding cardiopulmonary bypass might be advantageous, but the role of off-pump CABG (OPCAB) remains controversial, as it has been associated with incomplete revascularization in several studies. The objective of this study was to evaluate the feasibility, efficacy, and outcome of OPCAB surgery in ACS patients. Methods We performed a retrospective review of ACS patients who underwent on-pump CABG (ONCAB) or OPCAB, either emergently or delayed, at our institution. Results Between January 2015 and December 2016, a total of 205 consecutive ACS patients underwent either ONCAB (109 patients, 53.2%) or OPCAB surgery (96 patients, 46.8%). EuroSCORE II levels (5.6 ± 7.2 vs 4.9 ± 6.5, p = 0.226) and demography were comparable between groups.A trend towards lower postoperative mortality was observed in OPCAB patients (2.1 vs 5.5%). The incidence of postoperative stroke and low cardiac output syndrome, as well as the duration of inotropic support and the need for re-sternotomy, was significantly lower in the OPCAB group (p < 0.05).CABG performed instantly in an emergency situation was not associated with increased mortality or morbidity when compared with delayed procedures, and OPCAB surgery in emergency patients was associated with lower postoperative morbidity and shorter stays in the intensive care unit (p < 0.05).There were no differences in completeness of revascularization between groups (median 1 [1–1.33;0.33–1.67] OPCAB versus median 1 (1–1.33;0.67–2) ONCAB, p = 0.617), even in the emergency setting. Conclusion OPCAB surgery is safe and effective in ACS and may be considered in hemodynamically stable patients in the emergency setting.

Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery

“…The causes of ICR include an invisible target vessel, hemodynamic instability precluding positioning of the heart. The CR rate in this group of patients undergoing MICS CABG was not inferior to that of patients undergoing OPCAB or on‐pump CABG in other studies 19,20 . This finding proves that MICS CABG can attain a good CR rate similar to that attained by conventional procedures.…”

Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery

“…One patient underwent complementary PCI for CR of the myocardium. The CR rate in this group of patients undergoing MICS CABG was not inferior to that of patients undergoing OPCAB or on-pump CABG in other studies 18,19 . This finding proves that MICS CABG can attain a good CR rate similiar to that attained by conventional procedures.…”

Long-Term Follow-Up of Device-Assisted Clampless Off-Pump Coronary Artery Bypass Grafting Compared with Conventional On-Pump Technique

“…Difficulty in target vessel exposure, and mechanical or electrical instability during heart manipulation and positioning are assumed to be the main causes of decreased technical accuracy or induction to give up a difficult anastomosis [ 20 ]. Subsequently, disappointing long-term results, as decreased survival and ischemic recurrence, are easily expectable unless the attending surgeon is trained enough to afford critical situations with no detrimental effects on the procedure [ 21 , 22 , 23 ]. Therefore, only experienced surgeons are considered to be justified in performing OPCAB [ 24 ].…”