Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results.
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. One hundred and twenty 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.
Barandon
Laurent
L
Department of Cardiac Surgery and Anesthesiology, Hôpital Cardiologique du Haut-Levêque, 33600 Pessac, France. laurent.barandon@chu-bordeaux.fr
Richebé
Philippe
P
Munos
Emmanuel
E
Calderon
Joachim
J
Lafitte
Marianne
M
Lafitte
Stéphane
S
Couffinhal
Thierry
T
Roques
Xavier
X
D000368:Aged; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D009765:Obesity / Q000150:complications; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000150:complications; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D018487:Ventricular Dysfunction, Left / Q000150:complications