Authors
Borzov E.A., Latypov R.S., Vasiliev V.P., Shiryaev A.A.
National Medical Research Centre Of Cardiology Named After Academician E.I.Chazov, Moscow
Abstract
Introduction: Diffuse coronary artery disease (CAD) limits coronary artery bypass surgery (CABG) and requires complex coronary artery reconstruction (CAR). On-pump CABG with using CAR demonstrates satisfactory in these patients. Possibilities for off-pump CABG with using CAR are little-studied
Aim: Evaluation of clinical outcomes after on-pump and off-pump CABG in patients with diffuse CAD
Methods: 146 patients were included in the study, which divided into 2 groups: the first group formed by patients who underwent off-pump CABG (group 1 – off-pump, n=82); the second group formed by patients who underwent on-pump CABG (group 1 – on-pump, n=540). Propensity score matching was done to get comparable groups. The comparative analysis of hospital outcomes (angina recurrence, repeat revascularization, myocardial infarction, all-cause mortality) was performed.
Results: Most of patients were men (n=76.8%), the mean age was 64.5±7.9. The rate of 30-day mortality was 0% in both groups. Major cardiovascular events were analyzed; one patient from each group was suffered from perioperative myocardial infarction (1.2%). Acute renal failure was diagnosed in 2 patients from group 2 (2.4%), perioperative stroke was registered in 1 patient in the same group (1.2%). Resternotomy for excessive bleeding was performed in 1 patient from the 1 group (1.2%) and 3 patients from the 2 group (3.6%).
Conclusion: Off-pump CABG in patients with diffuse CAD is safe and associated with comparable effectiveness that rivals to on-pump surgery.
Keywords: coronary artery bypass grafting, off-pump surgery, diffuse coronary artery disease.
References
1. Song Y, Xu F, Du J, et al. Coronary endarterectomy with coronary artery bypass graft decreases graft patency compared with isolated coronary artery bypass graft: a meta-analysis. Interact Cardiovasc Thorac Surg. 2017; 25(1): 30-6. doi/10.1093/icvts/ivx045.
2. Li D, Guo P, Chen L, et al. Outcomes of Surgical Patch Angioplasty of the Coronary Artery for Diffuse Coronary Artery Disease. Brazilian J Cardiovasc Surg. 2020; 35(5): 706-12.
3. Gao L, Taha R, Gauvin D, et al. Postoperative Cognitive Dysfunction After Cardiac Surgery. Chest. 2005; 128(5): 3664-70.
4. Auer J, Weber T, Berent R, et al. Risk Factors of Postoperative Atrial Fibrillation After Cardiac Surgery. J Card Surg. 2005; 20(5): 425-31. doi/10.1111/j.1540-8191.2005.2004123.x.
5. Lamy A, Devereaux PJ, Prabhakaran D, et al. Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. N Engl J Med. 2016; 375(24): 2359-68. doi/10.1056/NEJMoa1601564.
6. Soylu E, Harling L, Ashrafian H, et al. Adjunct coronary endarterectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg. 2014; 19(3): 462-73.
7. Vettath M, Vellachamy K, Ganagadharan N, et al. Revascularisation Strategies in OPCAB (Off Pump Coronary Artery Bypass). В: Cardiac Surgery Procedures. IntechOpen; 2020.
8. Sianos G, Morel M-A, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005; 1(2): 219-27.
9. Cheng DC, Bainbridge D, Martin JE, Novick RJ. Does Off-pump Coronary Artery Bypass Reduce Mortality, Morbidity, and Resource Utilization When Compared with Conventional Coronary Artery Bypass? A Meta-analysis of Randomized Trials. Anesthesiology. 2005; 102(1): 188-203.
10. Hannan EL, Wu C, Smith CR, et al. Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery. Circulation. 2007; 116(10): 1145-52. doi/10.1161/CIRCULATIONAHA.106.675595.
11. Bakaeen FG, Chu D, Kelly RF, et al. Perioperative Outcomes after On- and Off-Pump Coronary Artery Bypass Grafting. Texas Hear Inst J. 2014; 41(2): 144-51.
12. Lemma MG, Coscioni E, Tritto FP, et al. On-pump versus off-pump coronary artery bypass surgery in high-risk patients: Operative results of a prospective randomized trial (on-off study). J Thorac Cardiovasc Surg. 2012; 143(3): 625-31.
13. Lamy A, Devereaux PJ, Prabhakaran D, et al. Off-Pump or On-Pump Coronary-Artery Bypass Grafting at 30 Days. N Engl J Med. 2012; 366(16): 1489-97. doi/10.1056/NEJMoa1200388.
14. Shroyer AL, Grover FL, Hattler B, et al. On-Pump versus Off-Pump Coronary-Artery Bypass Surgery. N Engl J Med. 2009; 361(19): 1827-37. doi/abs/10.1056/NEJMoa0902905.
15. Akchurin RS, Shiryaev AA, Vasiliev VP, et al. Modern trends in coronary surgery. Patologiya Krovoobrashcheniya I Kardiokhirurgiya. 2011; 21(3S): 34-44. (In Russ.)
16. Horev NG, Ermolin PA, Sukmanova IA, et al. Clinical trial of myocardial revascularization of the beating heart. Bjulleten' medicinskoj nauki 2021; 23(3): 19-27. (In Russ.)
17. Kurbanov SK, Vlasova EE, Salichkin DV, et al. In-hospital and one-year outcomes after coronary artery bypass grafting in patients with diffuse coronary artery disease. Kardiologicheskij vestnik. 2019; 1: 60-66. (In Russ.)
18. Nishigawa K, Fukui T, Takaki J, Takanashi S. Coronary endarterectomy for diffusely diseased coronary artery: An ace in the hole in coronary artery surgery. JTCVS Tech. 2021; 10: 133-7.
19. Takahashi M, Gohil S, Tong B, Lento P, Filsoufi F, Reddy RC. Early and mid-term results of off-pump endarterectomy of the left anterior descending artery. Interact Cardiovasc Thorac Surg. 2013; 16(3): 301-5. doi/10.1093/icvts/ivs482.
20. Shen J, Xia L, Song K, Wang Y, Yang Y, DIng W, et al. Off-pump onlay-patch grafting using the left internal mammary artery for a diffusely diseased left anterior descending artery: In-hospital and mid-term outcomes. Coron Artery Dis. 2019; 30(5): 354-9.
