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Off-pump coronary artery bypass grafting with use of the octopus 2 stabilization system.
Heart Surg Forum. 2000; 3(4):282-6.HS

Abstract

BACKGROUND

The treatment of coronary artery disease has evolved rapidly over the last two decades. The gold standard of surgical revascularization, the on-pump coronary artery bypass graft, has been challenged by the development of percutaneous transluminal coronary angioplasty. Our experience with the alternative of the off-pump ("beating heart") coronary artery bypass (OPCAB) technique during a period of 18 months suggests that OPCAB avoids the complications of cardiopulmonary bypass and offers patients the benefit of long-term graft patency that greatly exceeds that of current endovascular technologies.

METHODS

The early results of 126 OPCAB procedures performed through a medial sternotomy incision during a period of 18 months were evaluated. There were 80 male and 46 female patients, with a mean age of 69 +/- 4.3 years. Emergency cases and reoperations were not included. A total of 268 anastomoses were performed, with a mean number of 2.12 anastomoses per patient. Conduits used, with their percentage of use, were: left internal thoracic artery (LITA) (100%), right internal thoracic artery (11.1%), greater saphenous vein (84%), and radial artery (31%). In 72% of the cases, off-pump surgery was chosen because of patient risk factors such as atherosclerotic aortic disease, previous cerebrovascular accident or carotid artery disease, renal dysfunction, malignancy or poor left ventricular function.

RESULTS

There was no operative mortality. One-month postoperative mortality was three patients (2.3%). Two died because of mesenteric ischemia, and the other death was due to cardiac failure. Seventy-one patients had a control angiogram before discharge. The patency of LITA anastomosis was 100% while overall patency rate was 95%. In 43 patients for whom an angiogram could not be performed, a Thallum 201 stress test was performed three months postoperatively. Thirty-eight patients had a normal test while five patients showed signs of ischemia. These patients had a control angiogram: in four patients anastomoses were patent, but in one patient there was a severe narrowing of a venous anastomosis to the distal right coronary artery (RCA) which was corrected with angioplasty. In the whole series eight patients (6.3%) refused to have any control examination.

CONCLUSIONS

Our early results suggest that off-pump CABG with Octopus 2 (Medtronic, Inc., Minneapolis, MN) can be a good alternative in high risk patients who need multiple vessel revascularization.

Authors+Show Affiliations

Kadir Has University Medical Faculty, Florence Nightingale Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey. belh@turk.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11178288

Citation

Akpinar, B, et al. "Off-pump Coronary Artery Bypass Grafting With Use of the Octopus 2 Stabilization System." The Heart Surgery Forum, vol. 3, no. 4, 2000, pp. 282-6.
Akpinar B, Güden M, Sagbas E, et al. Off-pump coronary artery bypass grafting with use of the octopus 2 stabilization system. Heart Surg Forum. 2000;3(4):282-6.
Akpinar, B., Güden, M., Sagbas, E., Sanisoglu, I., Aytekin, V., & Bayindir, O. (2000). Off-pump coronary artery bypass grafting with use of the octopus 2 stabilization system. The Heart Surgery Forum, 3(4), 282-6.
Akpinar B, et al. Off-pump Coronary Artery Bypass Grafting With Use of the Octopus 2 Stabilization System. Heart Surg Forum. 2000;3(4):282-6. PubMed PMID: 11178288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-pump coronary artery bypass grafting with use of the octopus 2 stabilization system. AU - Akpinar,B, AU - Güden,M, AU - Sagbas,E, AU - Sanisoglu,I, AU - Aytekin,V, AU - Bayindir,O, PY - 2000/06/08/accepted PY - 2001/2/15/pubmed PY - 2001/5/22/medline PY - 2001/2/15/entrez SP - 282 EP - 6 JF - The heart surgery forum JO - Heart Surg Forum VL - 3 IS - 4 N2 - BACKGROUND: The treatment of coronary artery disease has evolved rapidly over the last two decades. The gold standard of surgical revascularization, the on-pump coronary artery bypass graft, has been challenged by the development of percutaneous transluminal coronary angioplasty. Our experience with the alternative of the off-pump ("beating heart") coronary artery bypass (OPCAB) technique during a period of 18 months suggests that OPCAB avoids the complications of cardiopulmonary bypass and offers patients the benefit of long-term graft patency that greatly exceeds that of current endovascular technologies. METHODS: The early results of 126 OPCAB procedures performed through a medial sternotomy incision during a period of 18 months were evaluated. There were 80 male and 46 female patients, with a mean age of 69 +/- 4.3 years. Emergency cases and reoperations were not included. A total of 268 anastomoses were performed, with a mean number of 2.12 anastomoses per patient. Conduits used, with their percentage of use, were: left internal thoracic artery (LITA) (100%), right internal thoracic artery (11.1%), greater saphenous vein (84%), and radial artery (31%). In 72% of the cases, off-pump surgery was chosen because of patient risk factors such as atherosclerotic aortic disease, previous cerebrovascular accident or carotid artery disease, renal dysfunction, malignancy or poor left ventricular function. RESULTS: There was no operative mortality. One-month postoperative mortality was three patients (2.3%). Two died because of mesenteric ischemia, and the other death was due to cardiac failure. Seventy-one patients had a control angiogram before discharge. The patency of LITA anastomosis was 100% while overall patency rate was 95%. In 43 patients for whom an angiogram could not be performed, a Thallum 201 stress test was performed three months postoperatively. Thirty-eight patients had a normal test while five patients showed signs of ischemia. These patients had a control angiogram: in four patients anastomoses were patent, but in one patient there was a severe narrowing of a venous anastomosis to the distal right coronary artery (RCA) which was corrected with angioplasty. In the whole series eight patients (6.3%) refused to have any control examination. CONCLUSIONS: Our early results suggest that off-pump CABG with Octopus 2 (Medtronic, Inc., Minneapolis, MN) can be a good alternative in high risk patients who need multiple vessel revascularization. SN - 1098-3511 UR - https://www.unboundmedicine.com/medline/citation/11178288/Off_pump_coronary_artery_bypass_grafting_with_use_of_the_octopus_2_stabilization_system_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -