Document Detail

Off-pump strategy in high-risk coronary artery bypass reoperations.
MedLine Citation:
PMID:  17493423     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the role of off-pump coronary artery bypass grafting in the treatment of patients with severe recurrent angina after coronary artery bypass grafting who are not suitable for percutaneous coronary intervention and are considered too high risk for conventional on-pump revascularization.
PATIENTS AND METHODS: All patients who needed single- or double-vessel revascularization at reoperation with a predicted operative mortality of 10% or higher between March 4, 1994, and December 31, 2002, were studied. Risk stratification was performed using both the Parsonnet risk scoring system and the European System for Cardiac Operative Risk Evaluation. Active follow-up by questionnaire investigated major adverse cardiac events.
RESULTS: This study consisted of 84 patients with a median age of 69 years (interquartile range, 62-75 years); 14 (17%) were female. All patients had class III/IV symptoms. Previous operations included multiple coronary artery bypass grafts (15 patients [18%]) and heart transplantation (1 patient [1%]). Internal thoracic artery graft from a previous operation was patent in 43 patients (51%). Perioperative hemodynamic support with inotropes (35%) and intra-aortic balloon pump (14%) or ventricular assist device (2%) was common. The surgical approach varied for each patient. One operative death (1%) occurred. Estimated survival at 5 and 7 years was 77% and 67%, respectively. Late major adverse cardiac events observed during follow-up were cardiac death (n=66), nonoperative reintervention (n=8), and nonfatal myocardial infarction (n=5).
CONCLUSION: Off-pump coronary artery bypass grafting can mitigate reoperative risk in patients with an estimated risk of 10% or higher who are undergoing single- or double-vessel revascularization with satisfactory long-term outcome.
Dumbor L Ngaage; Kenton J Zehr; Richard C Daly; Thoralf M Sundt; Charles J Mullany; Joseph A Dearani; Thomas A Orszulak; Hartzell V Schaff
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  82     ISSN:  0025-6196     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-11     Completed Date:  2007-06-27     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  567-71     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Angina Pectoris / surgery*
Cardiotonic Agents / therapeutic use
Coronary Artery Bypass, Off-Pump* / adverse effects
Heart-Assist Devices
Intra-Aortic Balloon Pumping
Middle Aged
Retrospective Studies
Reg. No./Substance:
0/Cardiotonic Agents

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