General Thoracic and Cardiovascular Surgery

, Volume 62, Issue 6, pp 357–363

Optimal coronary artery bypass grafting strategy for acute coronary syndrome

  • Hiroyuki Nishi
  • Taichi Sakaguchi
  • Shigeru Miyagawa
  • Yasushi Yoshikawa
  • Satsuki Fukushima
  • Daisuke Yoshioka
  • Tetsuya Saito
  • Koichi Toda
  • Yoshiki Sawa
Original Article

DOI: 10.1007/s11748-013-0358-6

Cite this article as:
Nishi, H., Sakaguchi, T., Miyagawa, S. et al. Gen Thorac Cardiovasc Surg (2014) 62: 357. doi:10.1007/s11748-013-0358-6

Abstract

Objective

Conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass and cardiac arrest is associated with higher mortality and morbidity rates in acute coronary syndrome (ACS) patients undergoing surgery. Although off-pump CABG (OPCAB) is beneficial for high-risk patients, its efficacy for ACS is unknown, with on-pump beating CABG an adjunctive method. We investigated the effects of OPCAB and on-pump beating CABG for ACS.

Methods

We evaluated 121 consecutive patients with ACS (91 males, 30 females; mean age 69.5 ± 10.3 years) who underwent CABG since 2000. Seventy-five had unstable angina (UA) and 46 acute myocardial infarction (AMI) [non-ST elevation (NSTEMI): 22, ST elevation (STEMI): 24]. We assessed CABG for acute coronary syndrome under our primary OPCAB strategy, and compared perioperative status between UA and AMI patients.

Results

(1) Sixty-five (87 %) with UA underwent OPCAB, 8 on-pump beating CABG, and 2 conventional CABG. Conversion from OPCAB was seen in 4 patients. In-hospital mortality was 1.3 %. (2) All UA patients who had intra-aortic balloon pumping (IABP) underwent OPCAB. No patients with preoperative IABP experienced conversion from OPCAB. (3) In AMI patients, hospital mortality was higher (8.9 %) and the ratios for OPCAB, on-pump beating CABG, and conventional CABG were 39, 57, and 4 %, respectively. Mortality was exclusively seen in patients with STEMI who underwent conventional CABG.

Conclusions

OPCAB might have beneficial effects for ACS patients with UA, while IABP was found essential for completing OPCAB. In AMI patients, on-pump beating CABG might be reasonable for avoiding conversion from OPCAB and ischemic perfusion injury.

Keywords

Acute coronary syndrome Coronary artery bypass grafting Myocardial infarction Beating heart surgery 

Copyright information

© The Japanese Association for Thoracic Surgery 2013

Authors and Affiliations

  • Hiroyuki Nishi
    • 1
  • Taichi Sakaguchi
    • 1
  • Shigeru Miyagawa
    • 1
  • Yasushi Yoshikawa
    • 1
  • Satsuki Fukushima
    • 1
  • Daisuke Yoshioka
    • 1
  • Tetsuya Saito
    • 1
  • Koichi Toda
    • 1
  • Yoshiki Sawa
    • 1
  1. 1.Department of Cardiovascular SurgeryOsaka University Graduate School of MedicineSuitaJapan