Early Clinical Results of On-Pump Beating-Heart versus Off-Pump Coronary Artery Bypass Grafting in Patients with Acute Coronary Syndrome

Abstract Background Emergency coronary artery bypass grafting (CABG) in the setting of acute coronary syndrome (ACS) has been associated with increased morbidity and mortality. Avoiding cardiopulmonary bypass might be advantageous, but the role of off-pump CABG (OPCAB) remains controversial, as it has been associated with incomplete revascularization in several studies. The objective of this study was to evaluate the feasibility, efficacy, and outcome of OPCAB surgery in ACS patients. Methods We performed a retrospective review of ACS patients who underwent on-pump CABG (ONCAB) or OPCAB, either emergently or delayed, at our institution. Results Between January 2015 and December 2016, a total of 205 consecutive ACS patients underwent either ONCAB (109 patients, 53.2%) or OPCAB surgery (96 patients, 46.8%). EuroSCORE II levels (5.6 ± 7.2 vs 4.9 ± 6.5, p = 0.226) and demography were comparable between groups.A trend towards lower postoperative mortality was observed in OPCAB patients (2.1 vs 5.5%). The incidence of postoperative stroke and low cardiac output syndrome, as well as the duration of inotropic support and the need for re-sternotomy, was significantly lower in the OPCAB group (p < 0.05).CABG performed instantly in an emergency situation was not associated with increased mortality or morbidity when compared with delayed procedures, and OPCAB surgery in emergency patients was associated with lower postoperative morbidity and shorter stays in the intensive care unit (p < 0.05).There were no differences in completeness of revascularization between groups (median 1 [1–1.33;0.33–1.67] OPCAB versus median 1 (1–1.33;0.67–2) ONCAB, p = 0.617), even in the emergency setting. Conclusion OPCAB surgery is safe and effective in ACS and may be considered in hemodynamically stable patients in the emergency setting.

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A new beating-heart off-pump coronary artery bypass grafting training model

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivu321 ◽

2014 ◽

Vol 20 (1) ◽

pp. 7-9 ◽

Cited By ~ 8

Author(s):

Wobbe Bouma ◽

Michiel Kuijpers ◽

Aanke Bijleveld ◽

Gijs E. De Maat ◽

Bart M. Koene ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Training Model ◽

Beating Heart ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Off Pump ◽

Pump Coronary Artery Bypass

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Regional experience of acute coronary syndrome surgical treatment

Kazan medical journal ◽

10.17750/kmj2015-330 ◽

2015 ◽

Vol 96 (3) ◽

pp. 330-334 ◽

Cited By ~ 1

Author(s):

I R Yagafarov ◽

N G Sibagatullin ◽

I R Zakirov ◽

E V Tenin ◽

Z Sh Ishmuratova ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Adverse Events ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Off Pump ◽

Coronary Syndrome ◽

Pump Coronary Artery Bypass

Aim. To summarize the experience of surgical myocardial revascularization in acute coronary syndrome.Methods. The study included 72 patients with acute coronary syndrome who underwent coronary artery bypass grafting in the department of cardiac surgery. All patients were allocated to 3 groups depending on the urgency and the risk of intervention: first group - emergency coronary artery bypass grafting; second group - urgent coronary artery bypass grafting in patients at high risk of adverse events; third group - delayed coronary artery bypass grafting in patients at low risk of adverse events.Results. On-pump coronary artery bypass grafting was performed in 2 (25%) patients, off-pump coronary artery bypass grafting - in 6 (75%) patients, including 3 patients who were operated using parallel off-pump coronary artery bypass grafting technique. Positive clinical results were achieved in all patients. Patients with high risk for adverse events (n=55) underwent surgery in a period of 1 to 10 days from onset of disease (average delay was 4.3±2.6 days). Surgeries using extracorporeal circulation were performed in 39 (71%), including off-pump coronary artery bypass grafting - in 16 (29%), of whom 9 patients underwent parallel off-pump coronary artery bypass grafting. Intra-aortic balloon pump was used in 4 patients. Unfavorable outcome in this group was registered in 10 (13.8%) cases. Patients with a low risk of adverse events (n=9) underwent coronary artery bypass grafting after 10 days from the onset of the disease. All patients were operated using extracorporeal circulation. Unfavorable outcomes were not registered in that group.Conclusions. A decision to perform coronary artery bypass grafting in patients with acute coronary syndrome with ST elevation is made when it is impossible to perform coronary angioplasty due to the isolated and combined stenosis of left main coronary artery and other arteries of the heart. Coronary artery bypass grafting in patients with acute coronary syndrome associated with a high risk for adverse events should be performed as an emergency intervention using intra-aortic balloon pump. Off-pump coronary artery bypass grafting is associated with a lower risk of adverse events, require little or no blood transfusion, and reduce hospital stay.

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