Beating Heart versus Conventional Coronary Bypass Surgery: Our Experience

Abstract

Background: Off-pump Coronary Artery Bypass (OPCAB) has become the standard surgical treatment of Coronary Artery Disease in most centres in India. It is clear from the current evidence that, in certain patients, OPCAB olTers advantages over conventional Coronary Artery Bypass Grafting (CABG). Experience of this procedure in the Armed Forces is highligbted. Methods: Retrospective analysis of 200 nonrandomized consecutive patients taken up for OPCAB and 200 conventional CABG between Jan 2005 and Dec 2007 was done. The European system for cardiac operative risk evaluation (euroSCORE) was used in all patients. Perioperative morbidity and mortality was compared in the two groups. Result: OPCAB was possible in 192 (96 %) out of200 patients taken up for this procedure. Eigbt patients required cardiopulmonary bypass (CPB) to complete the revascularization. Incidence ofreoperation for bleeding was 2.5% in OPCAB and 6% in CABG In the CABG group 2 % patients developed severe bleeding complications, 3 % required ventilation for more than 24 hour, 1 % required renal replacement therapy, 1 % had acute respiratory distress syndrome and 3.5 % had neuro-psychiatric manifestations. Incidence of these complications in OPCAB patients was lower or NIL. Overall mortality in the OPCAB group was 1.5 % and 2 % in the CABG group. However only one patient out of 192 (0.5 %) who underwent successful OPCAB died, while two patients out of eigbt who required conversion to CPB in this group died. Incidence of stroke, deep sternal infection and mortality was similar in both groups. Conclusion: OPCAB is safe, effective and can be offered to more than 90 % patients as the primary strategy for surgical myocardial revascularization. It has lower overall morbidity than conventional CABG Its main limitations are hemodynamic instability and inability to lind a deeply embedded target vessel. Both these factors offect the outcome adversely making conventional CABG a better option in these situations. MJAFI 2010; 66 : 357-361

Robotic coronary artery surgery: Outcomes and pitfalls

“…11 Although on-pump cardiac surgery provides the surgeon with better control and precision, there exists an increased risk of postoperative morbidities the complications arising from CPB still pose a serious challenge. 12 In the last decade, advancements in the field of cardiovascular surgery has led to the advent of off-pump coronary artery bypass grafting (OPCAB). 8 This procedure does not require the establishment of CPB and can be performed on the beating heart, thus in theory reducing the complications associated with CPB.…”