To evaluate off-pump coronary artery bypass (OPCAB) grafting as therapy for coronary artery disease (CAD) with associated mitral regurgitation (MR) of uncertain etiology.
Retrospective analysis of all coronary artery bypass procedures from October 2002 to April 2003
Sixty-four consecutive cases, 59 elective and 5 emergent, were reviewed. Sixty-two patients underwent OPCAB and two underwent conventional, on-pump, bypass procedures. All had intra-operative transesophageal echocardiography (ITEE) performed. Ten patients (15.6%) had MR > of 2+. Nine of 10 had immediate resolution or improvement (to < 1+) of MR upon opening bypass grafts using OPCAB techniques. One did not, and underwent subsequent Mitral Valve Repair.CONCLUSIONS: OPCAB technique combined with ITEE provides immediate information on the impact of bypass grafting on co-existent MR. This technique is superior to previous techniques which require on-pump grafting, weaning from cardiopulmonary bypass (CPB), evaluation of MR in the context of recently arrested and stunned myocardium with bypass cannulae in place and a re-establishment of CPB and re-arresting of the heart if the MR require surgical correction.
OPCAB as a surgical technique visits less physiologic insult on patients, demonstrated by lower complication rates, fewer neurologic events and shorter hospital stays. Combination of OPCAB with ITEE in patients with CAD/MR provides immediate information on the ischemic component of the MR, eliminating guesswork in treatment and avoiding physiologically expensive bypass time and potentially unnecessary mitral valve procedures.
R. Adams, None.