Views: 1,387 | Downloads:
27
| Responses: 0
| XML | Respond to this article | Alert & updates | Request permissions | Email to a friend |
Original ArticleOpen Access
Off-Pump Coronary Bypass Surgery and All Arterial Conduits: Learning Experience at Bangkok Heart Institute
Visudharom K 
,
Jotisakulratana MV ,
Pitiguagool V ,
Banyatpiyaphod S ,
Pamornsing P ,
Cumpeeravut P
,
Jotisakulratana MV ,
Pitiguagool V ,
Banyatpiyaphod S ,
Pamornsing P ,
Cumpeeravut P VIBUL JOTISAKULRATANA, MD*,
SUJIT BANYATPIYAPHOD, MD*,
PRANOM CUMPEERA VUT, MD*
Off-pump coronary artery bypass technique or bypass graft surgery without the use of a heart-
lung machine has been introduced in the last six years, and now comprises approximately 25 per cent
of all coronary artery bypass surgery being done in the world. One of the goals of beating heart surgery
is to eliminate the complications associated with the use of cardiopulmonary bypass. The use of all
arterial conduits for coronary artery bypass graft has become more acceptable after experiences gained
and reports of better long-term results.
From January 2001 to December 21 2002 the authors performed 251 off-pump procedures.
One hundred and nine of these cases were done utilizing all arterial conduits
The data was stratified using the US National Society of Thoracic Surgeons Cardiac Surgery
Database pre-operative risk module and divided into 3 groups as suggested: Low risk group with a
predicted mortality of 0-1 per cent (2 patients); Medium risk group with a predicted mortality of 2-9
per cent (87 patients), and High risk group with a predicted mortality of 10+ per cent (10 patients). The
predicted mortality of the entire group was 4.5 per cent.
There were 90 males and 19 females with a mean age of 60.2
เธ‘
10.7 years, with 15.6 per cent
of them older than 70 years. Pre-operative co-morbidities included 1
/
4
of the patients who had ejection
fraction (EF) of equal to or less than 0.4, 4.5 per cent had unstable angina, 1.6 per cent had urgent/
emergent status, 26.6 per cent underwent re-operative procedure, I per cent had pre-operative serum
creatinine more than 2 mg per cent, 4.8 per cent had a history of stroke, 20.2 per cent had a history of
congestive heart failure, 45.2 per cent had a history of previous myocardial infarction, 10.7 per cent
had a history of chronic obstructive pulmonary disease, 46.9 per cent had a history of diabetes, 62 per
cent had hypertension, and 20 patients (18.3%) required intra aortic balloon pump.
Intra-operative parameters revealed 3.7
เธ‘
1.3 grafts/patient. The left internal mammary artery
(LIMA) was used to the left anterior descending (LAD) in 6.4 per cent, or sequential with the diagonals
93.6 per cent. The 30 days mortality was 3.6 per cent (4 cases). Further analysis revealed that pre-
operatively, none of these 4 cases was in the low predicted (predicted mortality of 0-1%) risk group, 2
of them were in the medium (predicted mortality of 2-9%) and the other 2 were in the high predicted
risk (predicted mortality of 10+%) group. The skin-to-skin time was 4.1 hours and there were two con-
versions to on-pump in this group.
S18
SUJIT BANYATPIYAPHOD, MD*,
PRANOM CUMPEERA VUT, MD*
Off-pump coronary artery bypass technique or bypass graft surgery without the use of a heart-
lung machine has been introduced in the last six years, and now comprises approximately 25 per cent
of all coronary artery bypass surgery being done in the world. One of the goals of beating heart surgery
is to eliminate the complications associated with the use of cardiopulmonary bypass. The use of all
arterial conduits for coronary artery bypass graft has become more acceptable after experiences gained
and reports of better long-term results.
From January 2001 to December 21 2002 the authors performed 251 off-pump procedures.
One hundred and nine of these cases were done utilizing all arterial conduits
The data was stratified using the US National Society of Thoracic Surgeons Cardiac Surgery
Database pre-operative risk module and divided into 3 groups as suggested: Low risk group with a
predicted mortality of 0-1 per cent (2 patients); Medium risk group with a predicted mortality of 2-9
per cent (87 patients), and High risk group with a predicted mortality of 10+ per cent (10 patients). The
predicted mortality of the entire group was 4.5 per cent.
There were 90 males and 19 females with a mean age of 60.2
เธ‘
10.7 years, with 15.6 per cent
of them older than 70 years. Pre-operative co-morbidities included 1
/
4
of the patients who had ejection
fraction (EF) of equal to or less than 0.4, 4.5 per cent had unstable angina, 1.6 per cent had urgent/
emergent status, 26.6 per cent underwent re-operative procedure, I per cent had pre-operative serum
creatinine more than 2 mg per cent, 4.8 per cent had a history of stroke, 20.2 per cent had a history of
congestive heart failure, 45.2 per cent had a history of previous myocardial infarction, 10.7 per cent
had a history of chronic obstructive pulmonary disease, 46.9 per cent had a history of diabetes, 62 per
cent had hypertension, and 20 patients (18.3%) required intra aortic balloon pump.
Intra-operative parameters revealed 3.7
เธ‘
1.3 grafts/patient. The left internal mammary artery
(LIMA) was used to the left anterior descending (LAD) in 6.4 per cent, or sequential with the diagonals
93.6 per cent. The 30 days mortality was 3.6 per cent (4 cases). Further analysis revealed that pre-
operatively, none of these 4 cases was in the low predicted (predicted mortality of 0-1%) risk group, 2
of them were in the medium (predicted mortality of 2-9%) and the other 2 were in the high predicted
risk (predicted mortality of 10+%) group. The skin-to-skin time was 4.1 hours and there were two con-
versions to on-pump in this group.
S18
Download:
PDF