title: [Integrated coronary artery bypass strategy prevents urgent pump conversion during off-pump coronary artery bypass grafting].
abstract: Urgent pump conversion during off-pump coronary artery bypass (OPCAB) results in high morbidity and mortality. We retrospectively evaluated if the peri-operative integrated strategy prevents this lethal event in our 400 consecutive OPCAB operations. The patients with preoperative cardiogenic shock and/or ventricular arrhythmias underwent on-pump coronary artery bypass grafting (CABG). All other patients (99% of total CABG) were scheduled to undergo OPCAB (n=400). Prophylactic intraaortic balloon pumping (IABP) was applied to the patients with critical (>95%) left main trunk stenosis or low (<0.35) left ventricular ejection fraction. All the patients received the deep pericardial suture, apex-traction device, suction-type stabilizer, test-clamp of target coronary arteries by micro bulldog clamp, and intra-coronary shunts. Intra-operative IABP was applied in the case of sustained ST-segment change and/or elevated pulmonary artery pressure. Pump conversion was indicated for the patients with ventricular fibrillation and/or cardiogenic shock. Two patients (0.5%) had pump conversion due to ventricular arrhythmia and sustained hypotension, respectively. These pump conversion did not result in hospital mortality. Three hospital deaths (0.7%) occurred due to non-cardiac causes. The integrated strategy using prophylactic or intra-operative IABP in OPCAB produce a low pump conversion rate even during an early period of surgeon's learning curve.
authors.affiliation: Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yokoyama
authors.forename: S
authors.initials: S
authors.lastname: Takase
authors.forename: Y
authors.initials: Y
authors.lastname: Misawa
authors.forename: K
authors.initials: K
authors.lastname: Hagiwara
authors.forename: M
authors.initials: M
authors.lastname: Tanji
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.forename: M
authors.initials: M
authors.lastname: Watanabe
authors.forename: S
authors.initials: S
authors.lastname: Kondo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged