Off-pump coronary artery bypass for emergency myocardial revascularization.
Emergency coronary artery bypass is associated with increased operative mortality. The objective of this study was to evaluate the efficiency and safety of off-pump emergency coronary artery bypass, and to compare the outcome with that of the conventional on-pump procedure. Data of 79 patients who underwent emergency isolated coronary artery bypass were reviewed retrospectively; 45 had off-pump coronary bypass and 34 had conventional surgery. In the off-pump group, mean ejection fraction was significantly lower (28% +/- 9% vs. 39% +/- 10%), and there were fewer grafts per patient (1.8 +/- 0.7 vs. 3.2 +/- 0.8). Early mortality was higher in the conventional surgery group (14.7% vs. 8.9%), but late mortality was similar in both groups. Patients who had on-pump surgery had lower rates of recurrent angina (16% vs. 34%) and symptoms of heart failure (20% vs. 51%). Re-hospitalization was more common in off-pump patients, but cardiac re-interventions were similar. There was no significant difference in 5-year survival rates. The results of off-pump coronary bypass were better than the preoperative predicted EuroSCORE, thus it was concluded that patients treated on an emergency basis should have an off-pump revascularization procedure.
Darwazah
Ahmad K
AK
Department of Cardiac Surgery, Makassed Hospital, Jerusalem, PO Box 19482, Israel. darwaz30@hotmail.com
Sham'a
Raed A H Abu
RA
Isleem
Ismail
I
Hanbali
Basel
B
Jaber
Bashar
B
D000328:Adult; D000787:Angina Pectoris / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D023921:Coronary Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome