Does The Current Cabg Operations Deserve A Title Upgrade Like The Coronary Stents? The Results Of Our 3rd Generation Cabg Operations
Rares Eniu, Christoph Huber, Tornike Sologashvili, Mathieu Van Steenberghe, Marc-Joseph Licker, Karim Bendjelid, Mustafa Cikirikcioglu.
Hopitaux Universitaires de Geneve, Geneve, Switzerland.
BACKGROUND: Owing to the evolution of anaesthesia, cardiopulmonary bypass, surgical techniques-materials and the usage of more arterial-grafts; current CABG operations deserve to be entitled as upgraded, taking after the nomenclature of coronary-stents. The aim of this study is to assess the results of 3rd generation CABG operations performed in our institution and to launch an updated terminology to compete with current percutaneous treatment methods in front of scientific and public platforms. METHODS: We retrospectively examined a cohort of 139 patients who underwent CABG between 2016-2020 in our institution.By looking at the evolution of CABG operations since 1960s (see Figure below), we define the 3rd generation CABG as fulfilling the following criteria: • patients with coronary diseases presented at the weekly HeartTeam • usage of modernized CPB with low volume cardioplegic solutions, • use of higher number of arterial than venous grafts and Doppler flow measurement before weaning from CPB • perioperative anaesthetic and intensive care management using protocolized fast-tracking approach. Pre-, per-, and post-operative data were collected for each patient from the hospital digital computer system. The study end point was 1 year rate of MACCE.
RESULTS: The most common intervention was a triple bypass (63/139). 324 bypass grafts were used of which 77.1% (250) were arterial and 22.8% (74) were venous grafts. 98% (n=317) bypass grafts were of adequate flow verified by using transit time flow measurement and pulsatility index. Mean aortic clamping time and MECC time was 1:00H and 1:23H respectively. There was no mortality. The postoperative rate of MACCE is 3.6% (5/139).CONCLUSIONS: Currently used CABG operations which incorporates all the newest techniques and technologies in order to improve the outcome for the patient deserve to be entitled as 3rd generation like their competitive percutaneous alternatives. 3rd generation CABG is a safe and good technique on carefully selected patients. 
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