Rastelli Operation with a Custom-made “Valved Conduit” in an ACHD Case

Abstract

Short Communication Objectives: Surgical revascularization in patients with multi-vessel coronary artery disease still raises many questions. The aim of the study was retrospective analysis of the single center immediate and mid-term results of off-pump Coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease. Materials and Methods: This retrospective study includes 564 patients with IHD operated in the department of cardiac surgery in the Republican Research Center of Emergency Medicine in 2013-2017. Four hundred and seventy-three patients (84%) were male and 91(16%) were female, the average age was 56.2±0.9 years. Results: In the early postoperative period, 18 patients died, hospital mortality was 3.19%. Among the causes of mortality, there were perioperative myocardial infarctioneight (1.4%) and acute heart failure-eight (1.4%). In two cases (0.35%), the cause of death was septic complications. In a single-factor analysis, we observed that an unstable state on admission and emergent conversion to on-pump can be considered reliable risk factors for the development of the lethal outcome in the early postoperative period. During the follow-up period (2-40 months on average 24.1±0.34), 9 (2.4%) patients died, and the main causes of death were acute heart failure due to myocardial infarction in four (1.1%) and gastrointestinal bleeding in three (0.8%) patients. Freedom from the combined endpoint of cardiac death and myocardial infarction was 97.1% at 40 months; freedom from recurrent angina was 90.4% and freedom from repeated revascularization was 99.1%. Conclusion: Patients with multivessel coronary disease and unstable angina in most cases can undergo off-pump CABG with favorable early results. Hemodynamical problems can force surgeon to turn on-pump. Emergent on pump conversion following hemodynamical instability can be a significant factor for mortality. In our series, CABG showed favorable immediate and mid-term results.