Document Detail


Coronary artery bypass grafting without cardiopulmonary bypass: a five-year experience.
MedLine Citation:
PMID:  12802377     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The current drive to practice less invasive surgery is changing surgical practice towards safer and simpler procedures. The practice of coronary artery bypass grafting (CABG) on a beating heart without cardiopulmonary bypass (CPB), off-pump CABG or OPCAB, has been gaining great attention as an alternative approach to conventional CABG. Since the first adoption of OPCAB in 1997 at our department, 181 patients have undergone OPCAB. OPCAB was indicated for patients who were possibly at risk for CPB, i.e., those who were elderly, who had a history of cerebrovascular disease, whose ascending aorta was severely atherosclerotic with calcification, whose respiratory function was compromised, or whose renal function was compromised. A patient with a concomitant malignant neoplastic disorder was also a candidate for OPCAB because of the possible deleterious effect of CPB on the immune system. More recently, when the coronary anatomy was suitable for OPCAB, even in younger or less risky patients, OPCAB was indicated. The OPCAB procedure was performed through a median sternotomy in 146 patients (80.6%), a left thoracotomy in 27 (14.9%), a subxiphoid approach in 6 and a combined one in 2. One hundred and eleven patients (61.3%) received 1 or 2 grafts (Group I) and 70 (38.7%) received 3 or more grafts (Group II). The number of grafted vessels in Group II patients was 3 to 5 with a mean of 3.44. The mean operative time was 163 minutes in Group I and 209.5 minutes in Group II. The frequency of the use of arterial grafts such as LITA, RITA and RA was significantly higher in Group II than in Group I. Death occurred in 3 patients with acute coronary syndrome who had to undergo urgent surgery. Angiographic examination was performed within 3 months, postoperatively, in 98 patients (54.1%) revealing the overall patency rate of each graft: LITA82/83 (98.8%), RITA 33/33 (100%), GEA 15/16 (93.8%), RA 20/20 (100%), and SVG 15/16 (93.8%). We conclude that, in light of our 5-year experience, off-pump CABG on a beating heart can be safely and effectively performed, with acceptable angiographic results even in patients with multi-vessel coronary disease requiring multiple revascularization. This procedure enables us to perform successful coronary bypass surgery for those who otherwise would not have been candidates for conventional CABG.
Authors:
Masami Ochi; Nobuo Hatori; Shigeto Kanno; Kenichi Yamada; Yoshiaki Saji; Shigeo Tanaka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of Nippon Medical School = Nippon Ika Daigaku zasshi     Volume:  70     ISSN:  1345-4676     ISO Abbreviation:  J Nippon Med Sch     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-06-12     Completed Date:  2003-07-18     Revised Date:  2012-09-25    
Medline Journal Info:
Nlm Unique ID:  100935589     Medline TA:  J Nippon Med Sch     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  157-64     Citation Subset:  IM    
Affiliation:
Department of Surgery II, Division of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan. m-ochi@nms.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass / methods*
Female
Humans
Male

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