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Systematic Off-pump Coronary Artery Bypass: Risk Factor for On-pump Conversion FREE TO VIEW

Hitoshi Hirose, MD*; Atsushi Amano, MD; Ruzheng Li
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Juntendo University Hospital, Tokyo, Japan


Chest. 2004;126(4_MeetingAbstracts):828S-b-829S. doi:10.1378/chest.126.4_MeetingAbstracts.828S-b
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PURPOSE:  We assessed the feasibility of systematic off-pump coronary artery bypass (OPCAB) and identified the risk factors for on-pump conversion.

METHODS:  Between 07/01/2002 and 12/31/2003, OPCAB was attempted for all patients who required isolated coronary artery bypass grafting (CABG) in our institution. The perioperative results of patients were prospectively entered structured database and the results were analyzed to identify the risk of requirement of cardiopulmonary bypass.

RESULTS:  OPCAB was performed in all but 4 patients, giving OPCAB success rate of 98.3% (229/233). The reason for cardiopulmonary bypass was hemodynamic instability occurred during the reoperative surgery in 3 (3/14, 21.4%), and cardiogenic shock developed after induction of general anesthesia in 1 (1/1, 100%). OPCAB success rate was 99.5% (218/219) in primary CABG and 78.6% (11/14) in reoperative CABG, p<0.001. The risk factor for on-pump conversion was reoperation (relative risk 11.6, 95% confident level 5.7-619.1). Mean number of distal anastomosis by OPCAB was 3.7 ± 1.2, and complete revascularization rate was 92.1% (211/229). There was one hospital death (0.4%, 1/233) due to perioperative myocardial infarction. Other postoperative complications included stroke in 2, mediastinitis in 2, respiratory failure in 2, postoperative bleeding in 1, and ventricular tachycardia in 1. During a mean follow-up period of 1.0 ± 0.4 years, two patients developed angina, which were treated with catheter intervention; otherwise, no death, or other cardiac events were observed.

CONCLUSION:  Systematic OPCAB feasible except for the patients who are undergoing reoperative surgery or the patients who are experiencing on-going cardiogenic shock. Systematic OPCAB provided successful complete revascularization and its short term results were acceptable.

CLINICAL IMPLICATIONS:  Systematic OPCAB provided successful complete revascularization and its short term results were acceptable.

DISCLOSURE:  H. Hirose, None.

Wednesday, October 27, 2004

12:30 PM - 2:00 PM




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