Beating heart myocardial revascularization on extracorporeal circulation in patients with end-stage coronary artery disease
- PMID: 11604346
- DOI: 10.1016/s0967-2109(01)00092-8
Beating heart myocardial revascularization on extracorporeal circulation in patients with end-stage coronary artery disease
Abstract
Objectives: To evaluate in a cohort of ESCAD patients (pts) the effects of on-pump/beating-heart versus conventional CABG in terms of early and mid-term survival and morbidity and LV function improvement.
Methods: Between January 1993 and December 2000, 78 (Group I) ESCAD pts underwent on-pump/beating-heart surgery. Mean age in Group I was 66.2+/-6 (58-79), NYHA and CCS class were 3.2+/-0.6 and 3.3+/-0.4 respectively, Myocardial viability index 0.69+/-0.1 (%), LVEF (%) 24.8+/-4, LVEDP (mmHg) 28.1+/-5.8 and LVEDD(mm) 69.5+/-6. Group II consisted in 78 ESCAD patients undergoing conventional CABG selected in a randomized fashion from an age, sex, and LVEF corrected group of patients. Mean age in Group II was 65.7+/-5 (57-78), NYHA 3.1+/-0.7, CCS 3.4+/-0.8, LVEF(%) 25+/-5, LVEDP(mmHg) 27.9+/-4.4 and LVEDD(mm) 69.2+/-7.2.
Results: Postoperatively, 5(7.7%) patients died in Group I versus 7(11.5%) patients in Group II (P>0.1). CPB time resulted to be in Group II patients (P=0.001) and the mean distal anastomoses per patient was similar between groups (P=Ns). Perioperative AMI (P=0.039), LCOS (P=0.002), necessity for ultrafiltration (P=0.018) and bleeding>1000 ml (P=0.029) were significantly higher in Group II. None of the Group I patients underwent surgical revision for bleeding versus 8(10.3%) patients in Group II (P=0.011). At 6 months after surgery, the LV function improved significantly in Group I patients, demonstrated by an increased LVEF=27.2+/-4(%)(P=0.001), lower LVEDP=26.4+/-3(mmHg)(P=0.029) and LVEDD=67+/-4(mm) (P=0.004) instead of a lower LVEDD=66.8+/-6(mm)(P=0.032) versus the preoperative data in Group II. The actuarial survival at 1, 3 and 5 yr were 90, 82 and 71% in Group I and 89, 83 and 74% in Group II (P=Ns).
Conclusion: In ESCAD patients who may poorly tolerate cardioplegic arrest, on-pump/beating-heart CABG may be an acceptable alternative associated with lower postoperative mortality and morbidity. Such a technique offers a better myocardial and renal protection associated with lower postoperative complications due to intraoperative hypoperfusion.
Similar articles
-
Does on-pump/beating-heart coronary artery bypass grafting offer better outcome in end-stage coronary artery disease patients?J Card Surg. 2000 Nov-Dec;15(6):403-10. doi: 10.1111/j.1540-8191.2000.tb01300.x. J Card Surg. 2000. PMID: 11678463
-
Should mild-to-moderate and moderate ischemic mitral regurgitation be corrected in patients with impaired left ventricular function undergoing simultaneous coronary revascularization?J Card Surg. 2001 Nov-Dec;16(6):473-83. doi: 10.1111/j.1540-8191.2001.tb00552.x. J Card Surg. 2001. PMID: 11925028
-
Beating heart ischemic mitral valve repair and coronary revascularization in patients with impaired left ventricular function.J Card Surg. 2003 Sep-Oct;18(5):375-83. doi: 10.1046/j.1540-8191.2003.t01-1-02044.x. J Card Surg. 2003. PMID: 12974921 Clinical Trial.
-
Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center.J Cardiothorac Surg. 2017 Feb 23;12(1):11. doi: 10.1186/s13019-017-0572-x. J Cardiothorac Surg. 2017. PMID: 28231841 Free PMC article.
-
Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time.Heart Surg Forum. 2002;5(2):182-6. Heart Surg Forum. 2002. PMID: 12125670
Cited by
-
Surgery for chronic total occlusion of the left main coronary artery.Ann Saudi Med. 2012 Mar-Apr;32(2):156-61. doi: 10.5144/0256-4947.2012.156. Ann Saudi Med. 2012. PMID: 22366829 Free PMC article.
-
Interventions for protecting renal function in the perioperative period.Cochrane Database Syst Rev. 2013 Sep 11;2013(9):CD003590. doi: 10.1002/14651858.CD003590.pub4. Cochrane Database Syst Rev. 2013. PMID: 24027097 Free PMC article.
-
Definitions of low cardiac output syndrome after cardiac surgery and their effect on the incidence of intraoperative LCOS: A literature review and cohort study.Front Cardiovasc Med. 2022 Sep 29;9:926957. doi: 10.3389/fcvm.2022.926957. eCollection 2022. Front Cardiovasc Med. 2022. PMID: 36247457 Free PMC article.
-
On-pump beating heart versus conventional on-pump coronary artery bypass grafting on clinical outcomes: a meta-analysis.J Thorac Dis. 2021 Jul;13(7):4169-4184. doi: 10.21037/jtd-21-568. J Thorac Dis. 2021. PMID: 34422346 Free PMC article.
-
On-pump beating heart coronary revascularization: Is it valid for emergency revascularization?Ann Saudi Med. 2015 Mar-Apr;35(2):133-7. doi: 10.5144/0256-4947.2015.133. Ann Saudi Med. 2015. PMID: 26336019 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous