Abstract: Poster Presentations |

Off-Pump Coronary Artery Bypass (OPCAB) Is the Procedure of Choice for Patients With Coronary Artery Disease and Associated Mitral Regurgitation FREE TO VIEW

R. Douglas Adams, MD, FACS, ABTS; Doug Vito, RDCS
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Lake Cumberland Regional Hospital, Somerset, KY


Chest. 2003;124(4_MeetingAbstracts):158S. doi:10.1378/chest.124.4_MeetingAbstracts.158S-a
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PURPOSE:  To evaluate off-pump coronary artery bypass (OPCAB) grafting as therapy for coronary artery disease (CAD) with associated mitral regurgitation (MR) of uncertain etiology.

METHODS:  Retrospective analysis of all coronary artery bypass procedures from October 2002 to April 2003

RESULTS:  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.

CLINICAL IMPLICATIONS:  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.

DISCLOSURE:  R. Adams, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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