On-pump coronary artery bypass surgery—Is it outdated?

Abstract

Background: Coronary artery bypass surgery (CABG) for Acute Myocardial Infarction (AM1) is associated with increased mortality compared with CABG in nonAM1 patients. Mortality in intensive care units (lCU) among patients with AMl is around 10-20%. Moreover, the mortality rate at one year may reach 15%, and 25-40% has recurrent angina. In this report we present our experience with surgical revascularization after AMI .Methods: From Dec. 2004 to Oct. 2005 among 161 patients underwent CABG, 35 consecutive patients were operated on for recent AMI< 30 days). During first 6hrs, 16 (45.71 %) patients were operated, during 2days 2 patients (5.7 %), within 7days 4 patients (10.4%) and within 1 month 13 patients (37.14 %) were operated. ]8 patients (51.42%) had severe left ventricular dysfunction. 7 patients (20%) had significant left main disease. Most of the patients had multivessel disease (Triple vessel Disease 33). 13 patients (37.28%) had preoperative renal dysfunction. 4 patients reqired preoperative Intraaortic Balloon pump (IABP) for stablization. 23 (65.71%) were operated off cardiopulmonary bypass (CPB) and 12 (34.28%) were underwent CABG on CPB.The mean number of grafts per patient was 3.4 and Left Internal Mammary Artery was used in 31 patients (88.57%). 4 patients needed perioperative IABP during weaning from CPB. 21 patients (60%) needed longer ionotropic support. Average ventilation time was 17.06±8.5 hrs and average ICU stay was 5.5±3.2 days. Postoperative arrythmias was recorded in 5 patients (14.28%) responded well to Cordarone. 4 patients (10.4%) had loveConclusions: CABG in patients with recent AMI is a safe option with acceptable mortality and morbidity. Independent predictors for outcome are age > 70 yrs., severe Ventricular dysfunction, need for IABP, Q Ml and congestive heart failure.