Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study

Off-pump surgery for the poor ventricle?

“…A standardized OPCAB approach in high-risk patients does not come at a price of less complete revascularization. This is an important aspect that has been highlighted to be a crucial predictor for the long-term outcome [7,8], but has also been reported to be a major argument against OPCAB [11,24,25]. Our findings are supported by Puskas et al [8] who demonstrated feasibility of complete revascularization using OPCAB.…”

“…Current reports suggest OPCAB to be superior for high-risk patients [9]. For patients with severe ventricular dysfunction, only few reports are available [10][11][12][13].…”

Effects of the Presence of Left Main Coronary Artery Disease on the Results of Off-pump Coronary Artery Bypass Grafting Surgery

“…(5)(6)(7)(8) During the same period, the first reports on the results of OPCABG in high-risk patients appeared. (9) The milestone work was published by J.Puskas et al, (10) which convincingly demonstrated the advantages of OPCABG over on-pump CABG in high-risk patients. For the first time, the advantages of OPCABG operations in a highrisk group were demonstrated when comparison of patients by preoperative risk index was attempted.…”

A cirurgia de revascularização do miocárdio sem circulação extracorpórea minimiza o sangramento pós-operatório e a necessidade transfusional

“…Technological development, especially the use of stabilizers 19 , in addition to surgical experience 20 , allowed the safe treatment of the posterior arteries of the heart 21 , spreading the acceptance of the technique among surgeons and cardiologists. Recently, due to the suggestion that myocardial revascularization without extracorporeal circulation reduces morbidity in the surgical treatment of coronary artery disease, its indications expanded to the following patients: those with multivessel disease 22 , high-risk patients 23 , patients with chronic renal diseases 24 , the elderly 25 , and those with ventricular dysfunction 26 . Although most authors support the hypothesis that myocardial revascularization without extracorporeal circulation is associated with lower morbidity, this is still controversial 27,28 .…”

“…Comparative studies at the end of the 1990s 23 showed that patients referred for myocardial revascularization with extracorporeal circulation were traditionally more severely ill in regard to the number of risk factors and extension of coronary and systemic atherosclerosis, were older, more symptomatic, and more prone to urgent operations. The current scenario has changed drastically, and our case series reflects this tendency very well.…”