An Eclectic Approach To The Conduct Of The Coronary Bypass Operation
Alex Zapolanski, MD, Mariano Brizzio, MD, Juan B. Grau, MD, Richard E. Shaw, PhD.
The Valley Hospital, Ridgewood, NJ, USA.
Background: The best technical approach to coronary artery surgery has been an ongoing source of contention. Our objective was to identify the best surgical technique for specific groups of patients undergoing coronary bypass (CAB).
Methods: From November of 2005 to May of 2016, 2127 patients underwent isolated CAB at out Institution. Patients were entered into the STS national data registry and were coded using standard STS definitions. Observed to expected mortality was calculated (O/E). No patients were excluded. The mean age was 68 years (30-93). Seventy-six percent were male. Seventy-nine percent of patients (1679) underwent off-pump surgery, 16.2% had an on-pump arrested operation (346) and 4.8% had an on-pump beating heart procedure (102). Complete revascularization and use of both mammary arteries were never compromised (see table). Angiographic and intraoperative anatomic criteria for each specific approach will be discussed.
Results: The overall mortality was 0.7%. The expected mortality was 2.1% (O/E = 0.33%). In the off-pump group the mortality was 0.6% with an expected of 2.0% (O/E = 0.3%). The mortality in the on-pump arrested group was 1.1% with an expected of 2.0% (O/E = 0.6%). In the on-pump beating the mortality was 1.0% with an expected of 5.2% (O/E = 0.18%). Overall incidence of stroke was 0.89%, re-operations for bleeding 1.6% and atrial fibrillation 21%. Blood transfusion was lower in the off-pump group 25% vs. 45% in the on-pump groups. Prolonged ventilation, requirement for dialysis and incidence of stroke were lower in the off-pump group, but not statistically significant. There were only six conversions from off-pump to on-pump (0.3%) with no mortality.
Conclusion: Avoidance of cardiopulmonary bypass is a favorable approach to coronary surgery and our team’s first preference. The quality of the revascularization in terms of completeness and conduit selection was never compromised. Flexible intra-operative decision making to conduct the operation on-pump beating or arrested virtually eliminates the need for emergency conversion while allowing consistency of results in this more challenging group of patients.
|Grafts per pt||BIMA use|
|ALL PTS 2127||3.58||25.1%|
|OFF PUMP 1679 PTS||3.54||25.1|
|ON PUMP ARRESTED 346 PTS||3.79||25%|
|ON PUMP BEATING 102 PTS||3.59||10.8%|
Back to 2017 Display Posters