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Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results

^a Department of Cardiac Surgery and Anesthesiology, Hôpital Cardiologique du Haut-Levêque, 33600 Pessac, France
^b CEPTA Centre d'Exploration, de Prévention et de Traitement de l'Athérosclérose. Hôpital Cardiologique du Haut-Levêque, 33600 Pessac, France
^c University of Bordeaux 2, 33000 Bordeaux, France

*Corresponding author. Cardiovascular Surgery Department, Haut-Lévêque Hospital, Avenue de Magellan, 33600 Pessac, France. Tel.: +33 5 57 65 65 65; fax: +33 5 57 65 34 31.

E-mail address: laurent.barandon{at}chu-bordeaux.fr (L. Barandon).

Left ventricle dysfunction and comorbidities are responsible for a large number of complications after CABG. OPCAB could be an interesting alternative for very high-risk patients. Patients were included if EuroSCORE >9, or with at least two of the following criteria, severe LV dysfunction, recent myocardial infarction (MI), terminal renal failure, lung dysfunction, PVD, BMI>30. Patients were operated using the Octopus^® (Medtronic) system. One hundred and twenty patients, mean age 68±10 years, 72% male, were operated. Mean EuroSCORE was 10.2±5.3, LV function 36.79±11.3%, recent MI 57%, renal failure 52%, COPD 44%, PVD 52%, obesity 34%. Mean graft per patient was 2.1±0.8. Three patients underwent secondary PTCA treatment for incomplete revascularization. Combined surgery was required for 20%. Early mortality was 3%. Intensive care unit stay was 2.7 days. Early complications were: low output syndrome 3%, MI 0.8%, stroke 0.8%, kidney support 7%. Graft patency was systematically analyzed with MCTA or angiocardiography. OPCAB strategy seems to be safe and secure in this population of very high-risk patients reducing multi-organ failure. However, long-term results are needed to confirm this strategy.

Key Words: Coronary artery bypass graft; Off-pump; High-risk surgery