Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results
Laurent Barandon 1*,
Philippe Richebe 1,
Emmanuel Munos 1,
Joachim Calderon 1,
Marianne Lafitte 1,
Stephane Lafitte 1,
Thierry Couffinhal 1,
Xavier Roques 1
1 Haut-Leveque Hospital, Pessac, France
* To whom correspondence should be addressed. E-mail: lesbarandon{at}wanadoo.fr.
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Abstract |
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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. 120 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. Keywords: Coronary artery bypass graft; Off-pump; High-risk surgery
