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Off-pump surgery and alternatives to standard operation in redo coronary surgery.
J Card Surg. 2004 Jul-Aug; 19(4):313-9.JC

Abstract

BACKGROUND

Reoperative coronary artery bypass grafting (CABG) has been associated with higher mortality and morbidity than first-time CABG. Off-pump surgery has been introduced in an effort to reduce morbidity associated with traditional on-pump CABG. However, these techniques present unique challenges in the reoperative setting. A review of our experience was undertaken to determine safety, efficacy, and technical challenges in beating heart reoperative CABG.

METHODS

From January 1999 through April 2003 reoperative CABG procedures performed by a single surgeon were treated on an "intention to treat" basis without cardiopulmonary bypass. A standardized operative technique employing suction stabilization and exposure devices were used for sternotomy procedures with stabilization devices employed for limited access single-vessel revascularization.

RESULTS

Eighty-six of eighty-seven (99%) consecutive patients undergoing reoperative CABG had the procedure initiated off-pump. There were 24 of 62 females/males (28%/72%) with a mean age of 64.3 (34 to 92). Eighty-one of eighty-six (94.2%) procedures were successfully completed off-pump. Five (5.8%) conversions were due to hemodynamic instability, inability to dissect dense adhesions (2), inability to locate an intramyocardial LAD (1). The procedures were performed via a median sternotomy in 67 patients (78%) and by limited anterior or lateral thoracotomy in 19 patients (22%). The operative mortality was 2 of 86, predicted risk 6.7%. There was no mortality in the converted patients. Postoperative length of stay was 5.5 days. There were no strokes or perioperative myocardial infarctions. Complications included reoperation for bleeding in 2.2%. Sixty-one of sixty-six (92.4%) patients were able to be extubated in the operating room. The rate of transfusion was 23 in 86 patients (26.5%), and atrial fibrillation was 5 in 86 patients (5.8%).

CONCLUSION

Off-pump CABG can technically be performed safely in most patients presenting for reoperative CABG. Outcomes appear to be improved compared with published outcomes of reoperative on-pump CABG surgery.

Authors+Show Affiliations

Cardiopulmonary Research Science and Technology Institute, Dallas, Texas 75230, USA. smullins@csant.com

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15245460

Citation

Mack, Michael J.. "Off-pump Surgery and Alternatives to Standard Operation in Redo Coronary Surgery." Journal of Cardiac Surgery, vol. 19, no. 4, 2004, pp. 313-9.
Mack MJ. Off-pump surgery and alternatives to standard operation in redo coronary surgery. J Card Surg. 2004;19(4):313-9.
Mack, M. J. (2004). Off-pump surgery and alternatives to standard operation in redo coronary surgery. Journal of Cardiac Surgery, 19(4), 313-9.
Mack MJ. Off-pump Surgery and Alternatives to Standard Operation in Redo Coronary Surgery. J Card Surg. 2004 Jul-Aug;19(4):313-9. PubMed PMID: 15245460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-pump surgery and alternatives to standard operation in redo coronary surgery. A1 - Mack,Michael J, PY - 2004/7/13/pubmed PY - 2004/12/16/medline PY - 2004/7/13/entrez SP - 313 EP - 9 JF - Journal of cardiac surgery JO - J Card Surg VL - 19 IS - 4 N2 - BACKGROUND: Reoperative coronary artery bypass grafting (CABG) has been associated with higher mortality and morbidity than first-time CABG. Off-pump surgery has been introduced in an effort to reduce morbidity associated with traditional on-pump CABG. However, these techniques present unique challenges in the reoperative setting. A review of our experience was undertaken to determine safety, efficacy, and technical challenges in beating heart reoperative CABG. METHODS: From January 1999 through April 2003 reoperative CABG procedures performed by a single surgeon were treated on an "intention to treat" basis without cardiopulmonary bypass. A standardized operative technique employing suction stabilization and exposure devices were used for sternotomy procedures with stabilization devices employed for limited access single-vessel revascularization. RESULTS: Eighty-six of eighty-seven (99%) consecutive patients undergoing reoperative CABG had the procedure initiated off-pump. There were 24 of 62 females/males (28%/72%) with a mean age of 64.3 (34 to 92). Eighty-one of eighty-six (94.2%) procedures were successfully completed off-pump. Five (5.8%) conversions were due to hemodynamic instability, inability to dissect dense adhesions (2), inability to locate an intramyocardial LAD (1). The procedures were performed via a median sternotomy in 67 patients (78%) and by limited anterior or lateral thoracotomy in 19 patients (22%). The operative mortality was 2 of 86, predicted risk 6.7%. There was no mortality in the converted patients. Postoperative length of stay was 5.5 days. There were no strokes or perioperative myocardial infarctions. Complications included reoperation for bleeding in 2.2%. Sixty-one of sixty-six (92.4%) patients were able to be extubated in the operating room. The rate of transfusion was 23 in 86 patients (26.5%), and atrial fibrillation was 5 in 86 patients (5.8%). CONCLUSION: Off-pump CABG can technically be performed safely in most patients presenting for reoperative CABG. Outcomes appear to be improved compared with published outcomes of reoperative on-pump CABG surgery. SN - 0886-0440 UR - https://www.unboundmedicine.com/medline/citation/15245460/Off_pump_surgery_and_alternatives_to_standard_operation_in_redo_coronary_surgery_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0886-0440&date=2004&volume=19&issue=4&spage=313 DB - PRIME DP - Unbound Medicine ER -