[Evaluation of value of coronary artery bypass grafting without cardiopulmonary bypass for emergency or subemergency case].
From August 1999 through September 2000, emergency (operation within 24 hours after hospitalization) or subemergency (within 48 hours) coronary artery bypass grafting without cardiopulmonary bypass (OPCAB) was performed in 16 patients (EM group) with a mean age 71.9 years old (range: 47-85). The patients were divided into 3 groups of which were acute myocardial infarction (AMI) group, chronic heart failure (CHF) group and unstable angina (u-AP) group, and compared preoperative hemodynamics, the number of graft, target arteries, bypass patency and hospitalization period after surgery with 26 patients performed the elective OPCAB in the same duration (EL group). All patients in EM group were used intra-aortic balloon pumping (IABP) assist before operation. In EL group, 16 patients (61.5%) were required IABP (p < 0.05). Ejection fraction and cardiac index in CHF group were significantly lower than those of EL group (47.8 +/- 1.1 vs. 63.3 +/- 2.4, 2.8 +/- 0.2 vs. 1.9 +/- 0.2: p < 0.05). Pulmonary capillary wedge pressure in AMI group and CHF group was significantly higher than that of EL group (16.7 +/- 5.9, 20.8 +/- 5.4 vs. 7.2 +/- 0.8: p < 0.01). There was a significant difference in the mean number of bypass in EM group compared with that of EL group (1.8 +/- 0.2 vs. 2.7 +/- 0.2: p < 0.05). In AMI group and CHF group, the grafting rate to the major vessel in the anterior wall was occupied in more than 70% of all bypasses per patient, however that was less than 50% in EL group. The arterial graft was actively used for revascularization. The hospitalization period in AMI group and CHF group was longer than that in u-AP group and EL group (28.5 +/- 9.8, 38.8 +/- 7.4 vs. 15.7 +/- 1.5, 13.0 +/- 0.7: p < 0.01). There was no difference in bypass patency between EM group and EL group (96.6 vs. 97.2). During the follow-up period, any death and complications were not recognized in both groups. These results suggested that OPCAB would be one of the valuable procedures in the emergent coronary artery bypass grafting.
Nakano
H
H
Department of Cardiovascular Surgery, Tokyo Medical University Kasumigaura Hospital, Ibaraki, Japan.
Daimon
M
M
Hayashi
K
K
Okamura
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000601:surgery; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D004630:Emergencies; D004632:Emergency Medical Services; D006333:Heart Failure / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009203:Myocardial Infarction / Q000601:surgery; D014654:Vascular Patency