Off-pump Coronary Artery Bypass is a Safe Option in Patients Presenting as Emergency

Abstract

Introduction: The applicability of off-pump coronary-artery bypass (OPCAB) in patients who present as emergency remains controversial. Herein, we explore the efficacy and safety of OPCAB in patients who were indicated for emergency surgery. Materials and Methods: Between 2002 and 2007, a total of 282 patients underwent OPCAB, of which 68 were presented as emergency. This cohort (group A) was compared to 68 patients who had traditional on-pump coronary artery bypass grafting (CABG, group B) under emergency indications during the same period of time. Baseline demographics, intraoperative data and postoperative outcomes were analysed. Results: Preoperative demographics were comparable in both groups. Mortality during the first 30 days was comparable in both groups and no stroke occurred in the whole series. Patients in group A had significantly less pulmonary complications (4.4% vs 14.7%, P= 0.04), less ventilation time (30.3 ± 33.6 hours vs 41.5 ± 55.4 hours, P = 0.18) and were less likely to have prolonged ventilation, (19.1% vs 35.3%, P = 0.03). Similarly, OPCAB patients had less postoperative renal-failure/dysfunction (5.9% vs 8.8%, P = 0.51) and required less inotropic support (66.2% vs 88.2%, P = 0.002), bloodtransfusions (23% vs 86.8%, P <0.0001), and atrial- (17.6% vs 35.3%, P = 0.02) or ventricular-pacing (17.6% vs 41.2%, P = 0.002). Although the number of diseased vessels was comparable in both groups, patients in group A received less distal anastomoses. (2.78 ± 1.19 vs 3.41 ± 0.89, P = 0.002). Similarly, complete revascularisation was achieved less frequently in group A (76.5% vs 94.1%, P = 0.004). Conclusion: OPCAB strategy is a safe and efficient in emergency patients with reasonable good short-term postoperative outcomes. Keywords: Cardiac surgery, Coronary artery disease, Off-pump coronary-artery bypass

Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction

“…The mortality of this revascularization surgery is linked to various preoperative factors also highlighted in the literature. Increased mortality in patients operated on soon (<48 h) after MI seems to be linked to multiple risk factors such as age > 65 years old [ 6 , 7 , 8 ], poor LVEF [ 6 , 9 , 13 ], acute renal failure [ 9 ] or anaemia [ 16 ]. Left ventricle failure is one of the major complications of ischemia that must be strongly considered before STEMI revascularization surgery.…”

“…Multiple retrospective studies have aimed to assess the timing of surgery as a predictive factor of survival [ 5 , 6 , 7 , 8 ]. However, discrepancies in patient characteristics, surgical techniques (off or on pump) and cut-offs for timing prevented strong recommendations [ 8 , 9 ].…”