On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting.

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_3E562FE590C8
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting.
Périodique
Journal of Cardiothoracic Surgery
Auteur(s)
Ferrari E., Stalder N., von Segesser L.K.
ISSN
1749-8090
Statut éditorial
Publié
Date de publication
2008
Peer-reviewed
Oui
Volume
3
Numéro
38
Pages
1-6
Langue
anglais
Résumé
BACKGROUND: Cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience. METHODS: Out of 290 patients operated for CABG from January 2005 to January 2006, 25 (8.6%) selected high-risk patients suffering from life threatening coronary syndrome (mean age 69 +/- 7 years) and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction (LVEF) was 27 +/- 8%. The majority of them (88%) suffered of tri-vessel coronary disease and 6 (24%) had a left main stump disease. Nine patients (35%) were on severe cardiac failure and seven among them (28%) received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients (73%). RESULTS: All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.9 +/- 0.6 and the internal mammary artery was used in 23 patients (92%). The mean CPB time was 84 +/- 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 +/- 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 +/- 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an implantable cardiac defibrillator. One year after surgery they all had a standard trans-thoracic echocardiogram showing a mean LVEF rate of 36 +/- 11.8%. CONCLUSION: Standard on-pump arrested heart coronary surgery has higher mortality and morbidity in emergencies. The on-pump beating heart myocardial revascularization seems to be a valid alternative for the restricted and selected cohort of patients suffering from life threatening coronary syndrome and requiring multiple emergency CABG.
Mots-clé
Aged, Coronary Artery Bypass, Off-Pump, Echocardiography, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Morbidity, Myocardial Ischemia, Retrospective Studies, Risk Factors, Severity of Illness Index, Stroke Volume, Survival Rate, Switzerland, Time Factors, Treatment Outcome
Pubmed
Web of science
Open Access
Oui
Création de la notice
22/01/2009 12:16
Dernière modification de la notice
20/08/2019 13:35
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