Coronary artery bypass surgery in high-risk patients

Mehmet Halit Andac,Alper Sami Kunt,Osman Tansel Darcın

doi:10.1186/1468-6708-6-13

Mehmet Halit Andac, Alper Sami Kunt

Open Access

https://doi.org/10.1186/1468-6708-6-13

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Abstract

BackgroundIn high-risk coronary artery bypass patients; off-pump versus on-pump surgical strategies still remain a matter of debate, regarding which method results in a lower incidence of perioperative mortality and morbidity. We describe our experience in the treatment of high-risk coronary artery patients and compare patients assigned to on-pump and off-pump surgery.MethodsFrom March 2002 to July 2004, 86 patients with EuroSCOREs > 5 underwent myocardial revascularization with or without cardiopulmonary bypass. Patients were assigned to off-pump surgery (40) or on-pump surgery (46) based on coronary anatomy coupled with the likelihood of achieving complete revascularization.ResultsThose patients undergoing off-pump surgery had significantly poorer left ventricular function than those undergoing on-pump surgery (28.6 ± 5.8% vs. 40.5 ± 7.4%, respectively, p < 0.05) and also had higher Euroscore values (7.26 ± 1.4 vs. 12.1 ± 1.8, respectively, p < 0.05). Differences between the two groups were nonsignificant with regard to number of grafts per patient, mean duration of surgery, anesthesia and operating room time, length of stay intensive care unit (ICU) and rate of postoperative atrial fibrillationConclusionUtilization of off-pump coronary artery bypass graft (CABG) does not confer significant clinical advantages in all high-risk patients. This review suggest that off-pump coronary revascularization may represent an alternative approach for treatment of patients with Euroscore ≥ 10 and left ventricular function ≤ 30%.

Highlights

Mortality and morbidity represent clinical outcomes that have been used in many research models examining patients undergoing coronary artery bypass graft (CABG) surgery [1,2,3,4,5,6]
Coronary artery disease patients with reduced left ventricular function appear to benefit more from CABG than from medical therapy [14]
We describe our experience in the treatment of high-risk coronary artery disease (CAD) patients undergoing onpump versus off-pump surgery

Summary

Introduction

Mortality and morbidity represent clinical outcomes that have been used in many research models examining patients undergoing coronary artery bypass graft (CABG) surgery [1,2,3,4,5,6]. Studies utilizing these endpoints have provided valuable information for determining the indications for surgery, estimating the need for various resources and implementing quality control monitoring of surgeons and institutions. In high-risk coronary artery bypass patients; off-pump versus on-pump surgical strategies still remain a matter of debate, regarding which method results in a lower incidence of perioperative mortality and morbidity. We describe our experience in the treatment of high-risk coronary artery patients and compare patients assigned to on-pump and off-pump surgery

Methods

Results

Conclusion