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Objectives : Emergency Bypass System(EBS, Terumo^®, Japan) can be used in case of unstable hemodynamic condition during coronary artery bypass grafting(CABG) instead of conventional cardiopulmonary bypass(CPB). Major advantages of EBS are short priming time less than five minutes and no need of additional heparin administration. This study attempts to elucidate the efficacy of EBS and CPB in risky patients who cannot be performed safely with off-pump strategy only.
Methods :From May, 2008 to August, 2011, fifty-two patients who were predicted some morbidity with off pump coronary artery bypass grafting(OPCAB) underwent elective beating heart CABG with mechanical devices. Among them, nineteen patients were supported by EBS (EBS-CABG) and thirty three by CPB (ONCAB). We compared surgical outcomes between two groups retrospectively.
Results :They showed 8.2±7.8% of logistic Euroscore and EBS-CABG group showed a higher value than ONCAB without statistical meaning (EBS-CABG vs ONCAB ; 8.7±6.7% vs 7.9±8.4%, p=0.724). Two mortalities had occurred in ONCAB group (0.0% vs 6.1%, p=0.398). The number of distal anastomosis was higher in ONCAB group (3.1±0.5 vs 3.5±0.8, p=0.034), but complete revascularization rate was similar between groups (78.9% vs 75.8%, p=0.538). The mean time for support in EBS-CABG was shorter than that of ONCAB (85.6±35.3minutes vs 115.1±57.3, p=0.048). Intraoperative intra-aortic balloon pump support was needed in three patients (5.3% vs 6.1%, p=0.701). Morbidities such as cerebrovascular accident, bleeding reoperation, acute renal failure, mediastinitis, perioperative myocardial infarction, and respiratory complication showed superiority for EBS-CABG without statistical difference. Intensive care unit stay and hospital stay showed the same result. However, mean postoperative peak CK-MB level of EBS-CABG was lower than that of ONCAB (18.8±18.6ng/mL vs 33.8±30.1, p=0.030).
Conclusion : EBS assisted CABG showed more favorable outcomes than on-pump beating CABG in risky patients. In patients who have worse preoperative risk factors, EBS assisted CABG can be another option instead of OPCAB.