Abstract
Background
Beating heart surgery has now become the commonest technique of doing Coronary Artery Bypass Graft Surgery (CABG) in our country. It is being used even in such high risk situations like diffuse coronary disease and Critical Left Main stem Stenosis (LMCS) with good results. The aim of this study is to retrospectively review our results in Off-Pump Coronary Artery Bypass Surgery (OPCAB) in patients with critical left main stem stenosis.
Methods
This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery. During the period from April 2003 to September 2005 a total of 64 patients underwent OPCAB procedure for critical LMCS. During the same period 10 patients underwent CABG on Cardio Pulmonary Bypass (CPB). The age range was 36–77yrs. The sex distribution was M: F 53∶10. Ten patients were done as emergency. 2 of them were on Intra Aortic Balloon Pump (IABP) support preoperatively. 10 patients were high risk with a Euro score of ≥5.
Results
Left Internal Mammary Artery (LIMA) was used in 78% of cases. Average grafts per patient was 2.96. The median ventilation time was 5.91 hrs. New IABP insertion in postoperative period was required in 1 patient. One patient was reexplored for bleeding. There was one perioperative myocardial infarction. 57% of patients did not need any blood transfusion. There was no conversion to CPB. There was no operative mortality. Inotropes were used in ten cases.
Conclusions
OPCAB is a safe method of revascularization in patients with critical LMCS. Preoperative IABP is useful in patients with cardiogenic shock. However, there is a place for CPB in patients needing additional procedures like Mitral Valve repair (MV repair) or Dor's procedure or when the vessels are very diffusely diseased. Those patients who are unstable despite IABP support may be managed by Beating heart On Pump (BHOP) technique.
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References
Kolesov VI. Mammary artery-coronary artery anastomosis as a method of treatment for angina pectoris. J Thorac Cardiovasc Surg 1967; 54: 535–44.
Buffolo E, Andrade JC, Branco JN, Aguiar LF, Ribeiro EF, Jantene AD. Myocardial revascularization without extracorporeal circulation. Seven year experience in 593 cases. Eur J Cardiothorac Surg 1990; 4: 504–08.
Bennetti F, Naselli G, Wood M, et al. Direct myocardial revascularization without extracorporeal circulation: experience in 700 patients. Chest 1991; 100: 312–16.
Cartier R, BrannCartier R, Brann S, Martineau R, Couturier A. Left main coronary artery stenosis and revascularization in the beating heart. Short- and long-term experience. Ann Chir 1999; 53: 701–05.
Dewey TM, Magee MJ, Edgerton JR, Mathison M, Tennison D, Mack MJ. Off-pump bypass grafting is safe in patients with left main coronary disease. Ann Thorac Surg 2001; 72: 788–92.
Yeatman M, Caputo M, Ascione R, Ciulli F, Angelini GD. Off-pump coronary artery bypass surgery for critical left main stem disease safety, efficacy, and outcome. Eur J Cardiothorac Surg 2001; 19: 239–44.
Louagie YA, Gonzalez ME, Schroder E. Off-pump myocardial revascularization for left main stem disease in a high-risk patient. Acta Chir Belg 1999; 99: 309–11.
Nashef SAM, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16: 9–13.
Lu JCY, Grayson AD, Pullan DM. On-Pump versus Off-Pump surgical revascularization for left main stem stenosis: Risk Adjusted Outcomes. Ann Thorac Surg 2005; 80: 136–43.
Guyton RA, Thourani VH, Puskas JD, Shanewise JS, Steele MA, Palmer-Steele CL, Johansen JV. Perfusion-assisted coronary artery bypass: selective graft perfusion in off-pump cases. Ann Thorac Surg 2000; 69: 171–75.
Vassiliades TA, Nielsen JL, Lonquist JL. Coronary perfusion methods during off-pump coronary artery bypass: results of a randomized clinical trial. Ann Thorac Surg 2002; 74: S1383–89.
Calafiore AM, Di Mauro M, Teodori G, et al. Impact of aortic manipulation on incidence of cerebrovascular accidents after surgical myocardial revascularization. Ann Thorac Surg 2002; 73: 1387–93.
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Raghuram, A.R., Kumar, S., Balamurugan, K. et al. Off pump coronary artery bypass (OPCAB) in critical left mainstem stenosis—Our experience. Indian J Thorac Cardiovasc Surg 22, 178–181 (2006). https://doi.org/10.1007/s12055-006-0754-y
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DOI: https://doi.org/10.1007/s12055-006-0754-y