Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies

Abstract

Left main stem (LMS) disease is known to be a poor prognostic factor in terms of morbidity or mortality. Traditionally, it has been treated with constitution of bypass to provide required haemodynamic stability. We searched the literature for evidence on off-pump (OFP) surgery for treating this high-risk group of patients focusing in our review on postoperative outcomes, concerns and controversies. The majority of the studies identified showed favourable or equal outcomes of OFP when compared to conventional approach. All of the studies, apart from two, which showed lower incidence of postoperative deaths, demonstrated equal mortality rates. Stroke rates were found less in three studies. Less blood transfusions, inotropic use and length of study has been also demonstrated. The main concerns of OFP surgery are: haemodynamic instability and less complete revascularization. Main controversies are: same or favourable outcomes despite lower number of grafts with OFP surgery and less stroke rates despite manipulation of aorta with side-clamping. Despite these concerns and controversies OFP surgery has been proven to be feasible and safe as demonstrated by results from numerous studies.

On- or Off-pump Coronary Artery Bypass Surgery. Is the Debate Settling Down?

“…OPCAB, despite a lower number of grafts, was found to provide similar or superior outcomes in LMCAD compared to on-pump CABG, and smaller stroke rates, even employing manipulation of aorta with side-clamping [21] .…”

Алгоритм Прийняття Рішень Під Час Коронарного Шунтування На Працюючому Серці

“…Протягом останніх років як в Україні, так і в світі відбувається значне збільшення кількості операцій коронарного шунтування (КШ) без використання штучного кровообігу [1]. На відміну від коронарного шунтування із застосуванням штучного кровообігу, оперативні втручання, виконані за методикою «працюючого серця», мають такі переваги: не відбувається активації протеолітичних ферментів та системної запальної відповіді, відсутній негативний вплив штучного кровообігу на імунну систему, не виникає споживання факторів згортання та тромбоцитів [2,3,4].…”

Left Main Coronary Artery Disease: Current Treatment Options

“…With evolving experience, some centers began to use off-pump technique in their routine daily practice and emerging number of reports in the literature have proven this method as a safe alternative to CPB. In a review article searching for studies comparing the results of on-pump CABG and off-pump CABG in patients with LMCAD, the outcomes, concerns and controversies were evaluated [46]. The majority of the studies identified showed favorable or equal outcomes of OFP when compared to conventional approach.…”