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Recent advances in multivessel coronary grafting without cardiopulmonary bypass.
Heart Surg Forum. 1998; 1(1):20-5.HS

Abstract

BACKGROUND

Coronary artery bypass grafting (CABG) without the heart lung machine has been possible for easily accessible targets such as the anterior descending or proximal right coronary. Until now technical difficulty in reaching lateral and inferior wall targets imposed significant barriers to multivessel off-pump grafting. To expand the potential for off-pump CABG the authors have devised new exposure and stabilization techniques suitable for all target vessels. In this report we relate our experience with these new techniques and demonstrate that multivessel coronary bypass can be safely performed without cardiopulmonary bypass (CPB).

METHODS

From February 8, 1993 to December 16, 1997 a total of 280 patients underwent myocardial revascularization on the beating heart via median sternotomy. Until May 20, 1997 only patients with high preoperative risk factors for CPB were considered for this approach (Group A; N = 122). After this date any patients with favorable anatomy were included (Group B; N = 158) and were subsequently compared with patients operated on using CPB during the same time interval (Group C; N = 114). In Group B patients lateral and/or inferior wall targets were exposed by means of 4 cloth slings (2 through the transverse sinus and 2 behind the inferior vena cava) and by positioning the patients in Trendelenburg with rightward rotation of the table. Regional stabilization of the target artery was obtained with a commercial stabilizing foot plate.

RESULTS

Thirty day hospital mortality was only 2 patients (1.6%) in Group A, 3 patients (1.9%) in Group B, and 3 patients (2.6%) in Group C (NS). Postoperative complications were low in both Group A and B. When Group B was compared with a similar cohort in whom CPB was used (Group C), there were statistically significant improvements in ICU and hospital stay demonstrated when CPB was not used (16.8+/-10.7 vs 26.3+/-38.6 hours respectively; p = 0.007, and 4.1+/-1.5 vs 5.5+/-2.4 days respectively, p<0.001). Angiographic followup was available for 78 patients in Groups A and B with a global patency rate (all grafts) of 98.6%, including a patency rate of 96.7% for 60 grafts to obtuse marginal branches of the circumflex).

CONCLUSIONS

Multivessel CABG without CPB is possible with results similar to those obtained with pump-oxygenator support using simple exposure and stabilization techniques.

Authors+Show Affiliations

Department of Cardiac Surgery, G. D'Annunzio University, San Camillo de' Lellis Hospital, Via C. Forlanini 50, 66100 Chieti, Italy. Calafiore@unich.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

11276435

Citation

Calafiore, A M., et al. "Recent Advances in Multivessel Coronary Grafting Without Cardiopulmonary Bypass." The Heart Surgery Forum, vol. 1, no. 1, 1998, pp. 20-5.
Calafiore AM, Di Giammarco G, Teodori G, et al. Recent advances in multivessel coronary grafting without cardiopulmonary bypass. Heart Surg Forum. 1998;1(1):20-5.
Calafiore, A. M., Di Giammarco, G., Teodori, G., Mazzei, V., & Vitolla, G. (1998). Recent advances in multivessel coronary grafting without cardiopulmonary bypass. The Heart Surgery Forum, 1(1), 20-5.
Calafiore AM, et al. Recent Advances in Multivessel Coronary Grafting Without Cardiopulmonary Bypass. Heart Surg Forum. 1998;1(1):20-5. PubMed PMID: 11276435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recent advances in multivessel coronary grafting without cardiopulmonary bypass. AU - Calafiore,A M, AU - Di Giammarco,G, AU - Teodori,G, AU - Mazzei,V, AU - Vitolla,G, PY - 1998/05/20/accepted PY - 2001/3/29/pubmed PY - 2001/5/22/medline PY - 2001/3/29/entrez SP - 20 EP - 5 JF - The heart surgery forum JO - Heart Surg Forum VL - 1 IS - 1 N2 - BACKGROUND: Coronary artery bypass grafting (CABG) without the heart lung machine has been possible for easily accessible targets such as the anterior descending or proximal right coronary. Until now technical difficulty in reaching lateral and inferior wall targets imposed significant barriers to multivessel off-pump grafting. To expand the potential for off-pump CABG the authors have devised new exposure and stabilization techniques suitable for all target vessels. In this report we relate our experience with these new techniques and demonstrate that multivessel coronary bypass can be safely performed without cardiopulmonary bypass (CPB). METHODS: From February 8, 1993 to December 16, 1997 a total of 280 patients underwent myocardial revascularization on the beating heart via median sternotomy. Until May 20, 1997 only patients with high preoperative risk factors for CPB were considered for this approach (Group A; N = 122). After this date any patients with favorable anatomy were included (Group B; N = 158) and were subsequently compared with patients operated on using CPB during the same time interval (Group C; N = 114). In Group B patients lateral and/or inferior wall targets were exposed by means of 4 cloth slings (2 through the transverse sinus and 2 behind the inferior vena cava) and by positioning the patients in Trendelenburg with rightward rotation of the table. Regional stabilization of the target artery was obtained with a commercial stabilizing foot plate. RESULTS: Thirty day hospital mortality was only 2 patients (1.6%) in Group A, 3 patients (1.9%) in Group B, and 3 patients (2.6%) in Group C (NS). Postoperative complications were low in both Group A and B. When Group B was compared with a similar cohort in whom CPB was used (Group C), there were statistically significant improvements in ICU and hospital stay demonstrated when CPB was not used (16.8+/-10.7 vs 26.3+/-38.6 hours respectively; p = 0.007, and 4.1+/-1.5 vs 5.5+/-2.4 days respectively, p<0.001). Angiographic followup was available for 78 patients in Groups A and B with a global patency rate (all grafts) of 98.6%, including a patency rate of 96.7% for 60 grafts to obtuse marginal branches of the circumflex). CONCLUSIONS: Multivessel CABG without CPB is possible with results similar to those obtained with pump-oxygenator support using simple exposure and stabilization techniques. SN - 1098-3511 UR - https://www.unboundmedicine.com/medline/citation/11276435/Recent_advances_in_multivessel_coronary_grafting_without_cardiopulmonary_bypass_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -