The feasibility and safety of off-pump coronary bypass surgery in emergency revascularization

Abstract

Background:The efficacy and safety of off-pump coronary artery bypass grafting (OPCAB) in emergency revascularization remains controversial despite its widespread use. The aim of our study was to examine the applicability and safety of OPCAB in patients who were indicated for emergency surgery.Methods: This single-center study reviewed the indication, operative data, and early and long-term outcomes of 113 patients (mean age, 67.2±9.0 years; logistic EuroSCORE, 14.3±13.5) who underwent emergency OPCAB from January 2003 to December 2014 and were followed up (94.6% completion rate) for a mean 51.1±40.3 (range, 1-135) months. Results: Emergency OPCAB was associated with favorable surgical outcomes (number of distal anastomoses per patient, 3.04±0.87; internal thoracic artery (IMA) use, 98.2%; complete revascularization, 79.6%) and in-hospital outcomes (mortality, 5.3%; low cardiac output syndrome, 5.3%; stroke, 2.7%; pulmonary complications, 8.8%; renal failure, 11.5%). Only five patients (4.4%) required on-pump conversion. The 10-year outcomes were also acceptable (survival, 75.4%±5.6%; major cerebral and cardiovascular events, 52.1%±1.8%). The multivariate risk factors for late mortality were peripheral vascular disease (HR 2.95, 95% CI: 1.11-11.83), cardiogenic shock (HR 3.67,, and incomplete revascularization (HR 3.41,. When patients were separated by whether the procedure was performed early (<2010) or late (≥2010) in the study period, the late period cohort had better outcomes despite containing higher-risk patients. Conclusions: Our study suggests that emergency OPCAB can be performed safely and effectively with good hospital outcomes and adequate long-term results. OPCAB strategy can be considered as a good option in emergency revascularization.Keywords: Emergency; off-pump coronary artery bypass grafting (OPCAB) Submitted Nov 20, 2017. Accepted for publication Mar 22, 2018Mar 22, . doi: 10.21037/jtd.2018 View this article at: http://dx.doi.org/10. 21037/jtd.2018.03.190 2269 Journal of Thoracic Disease, Vol 10, No 4 April 2018 © Journal of Thoracic Disease. All rights reserved.J Thorac Dis 2018;10(4):2268-2278 jtd.amegroups.com purportedly by avoiding the inflammatory reactions and ischemic injury associated with cardiopulmonary bypass (CPB) (8)(9)(10)(11). However, OPCAB use in patients with critical preoperative conditions remains debatable because heart manipulation and displacement might result in compromised hemodynamics and cardiac decompensation. The feasibility and safety of OPCAB in patients meeting indications for emergency surgery was therefore assessed in this review of a 10-year single-center experience. Methods PatientsOf the 2,825 patients who underwent isolated OPCAB at our institution from January 2003 to April 2015, 113 (4%) underwent an emergency OPCAB according to the following indications: cardiogenic shock with complex anatomy not suitable for percutaneous coronary intervention (PCI) (41, 36.3%); ongoing ischemia despite optimal pharmacotherapy in patients with primary CABG indic...

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

“…In the literature and modern periodical publications, we can note an active discussion about how and which method is preferred. A number of authors indicate a low efficiency of off-pump CABG associated with the risk of incomplete revascularization, and as a consequence of perioperative myocardial infarction and late graft failure (4,5) . Other authors emphasize the absence of statistically significant differences in the mortality rate, postoperative complications, infarction and stroke in the postoperative period, as well as other advantages and disadvantages when comparing both methods, emphasizes the same duration of functioning of shunts in the long-term follow-up period.…”