Results of Off-Pump Coronary Artery Bypass Surgery in Patients with EuroSCORE≥5

ORIGINAL ARTICLE
Islamjan M. Sharipov, Shavkat I. Karimov, Ravshanbek D. Kurbanov

 
International Journal of Biomedicine. 2019;9(1):13-18.
DOI: 10.21103/Article9(1)_OA1
Originally published March 15, 2019

Abstract: 

Background: The lack of reliable data on the possibility, safety and results of OPCABG in patients with high surgical risk hinders the further wide introduction into clinical practice of such operations. In this regard, conducting a comparative evaluation of the results of OPCABG in patients with low and high surgical risk seems to us a worthwhile project.
Materials and Methods: During the period between 2015 and 2017, 310 OPCABG operations were performed. Patients were divided into 2 groups depending on the EuroSCORE risk calculator value. Group 1 consisted of 130(41.9%) patients with a high surgical risk (EuroSCORE≥5), and Group 2 consisted of 180(58.1%) patients with a low surgical risk (EuroSCORE<5).
Results: We could not find between the two groups significant differences in the number of mean grafts per patients (3.12 in Group 1 and 3.13 in Group 2), in operation times, or in the level of morbidity and mortality (1.5% in Group 1 and 1.2% in Group 2).  All intraoperative conversions to on-pump CABG (5 cases or 3.8%) occurred in patients of Group 1 (P=0.008).
Conclusion: The OPCABG operation in patients of high-risk group is a safe method and can be performed without compromising the completeness of myocardial revascularization with the same low mortality as in low-risk patients. The most common type of complication in high-risk patients is on-pump conversion, which at earlier and planned implementation is not reflected significantly at the level of hospital mortality. 

Keywords: 
off-pump CABG • high-risk patients • EuroSCORE • myocardial revascularization
References: 
  1. Sharipov I, Yarbekov RR, Omonov SKh, Vahidov TZ, Kurbanov RD. Effects of the presence of left main coronary artery disease on the results of off-pump coronary artery bypass grafting surgery. International Journal of Biomedicine. 2017;7(3):175-179.
  2. Kim KB, Kim JS, Kang HJ, Koo BK, Kim HS, Oh BH, Park YB. Ten-year experience with off-pump coronary artery bypass grafting: lessons learned from early postoperative angiography. J Thorac Cardiovasc Surg. 2010;139(2):256-62. doi: 10.1016/j.jtcvs.2009.08.040.
  3. Møller CH, Perko MJ, Lund JT, Andersen LW, Kelbaek H, Madsen JK, et al. No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the best bypass surgery trial. Circulation. 2010;121(4):498-504. doi: 10.1161/CIRCULATIONAHA.109.880443.
  4. Parolari A, Pesce LL, Trezzi M, Loardi C, Kassem S, Brambillasca C, et al. Performance of EuroSCORE in CABG and off-pump coronary artery bypass grafting: single institution experience and meta-analysis. Eur Heart J. 2009;30(3):297-304. doi: 10.1093/eurheartj/ehn581.
  5. Puskas JD, Thourani VH, Kilgo P, Cooper W, Vassiliades T, Vega JD, et al. Off-pump coronary artery bypass disproportionately benefits high-risk patients. Ann Thorac Surg. 2009;88(4):1142-7. doi: 10.1016/j.athoracsur.2009.04.135.
  6. Shahzad G.Raja, Amrani M. Off-pump coronary artery bypass grafting: outcomes, concerns and controversies. NY: Nova Science Publishers; 2012:146-149.
  7. Youn YN, Kwak YL, Yoo KJ. Can the EuroSCORE predict the early and mid-term mortality after off-pump coronary artery bypass grafting? Ann Thorac Surg. 2007;83(6):2111-7.
  8. Buffolo E, Branco JN, Gerola LR, Aguiar LF, Teles CA, Palma JH, Catani R. Off-pump myocardial revascularization: critical analysis of 23 years’ experience in 3,866 patients. Ann Thorac Surg. 2006;81(1):85–9.
  9. Cartier R. Off pump coronary artery bypass surgery. 1st ed. Georgetown: Landes Bioscience; 2005.
  10. Chamberlain MH, Ascione R, Reeves BC, Angelini GD. Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study. Ann Thorac Surg. 2002;73(6):1866–73.
  11. Godinho AS, Alves AS, Pereira AJ, Pereira TS. On-pump versus off-pump coronary-artery bypass surgery: a meta-analysis. Arq Bras Cardiol. 2012; 98(1): 87-94.
  12. Sellke FW, Chu LM, Cohn WE. Current state of surgical myocardial revascularization. Circ J. 2010;74(6):1031–7.
  13. Stamou SC, Corso PJ. Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future. Ann Thorac Surg 2001;71(3):1056-61.
  14. Emmert MY, Salzberg SP, Seifert B, Schurr UP, Hoerstrup SP, Reuthebuch O, Genoni M. Routine off-pump coronary artery bypass grafting is safe and feasible in high-risk patients with left main disease. Ann Thorac Surg 2010;89(4):1125–30. doi: 10.1016/j.athoracsur.2009.12.059.
  15. Yaku H, Doi K, Okawa K. Off-Pump coronary artery bypass grafting revisited: experience and evidence from Japan. Ann Thorac Cardiovasc Surg. 2013;19(2):83–94.
  16. Maroto Castellanos LC, Carnero M, Cobiella FJ, Alswies A, Ayaon A, Reguillo FJ, García M. Off-Pump to On-Pump Emergency Conversion: Incidence, Risk Factors, and Impact on Short- and Long-Term Results. J Card Surg. 2015;30(10):735-45. doi: 10.1111/jocs.12614.
  17. Pullan M, Oo A, Poullis M. Off-Pump Conversion: In-hospital Mortality and Long-Term Survival. Thorac Cardiovasc Surg. 2017;65(4):296-301. doi: 10.1055/s-0035-1566742.
  18. Turner WF Jr. “Off-pump” coronary artery bypass grafting: the first one hundred cases of the Rose City experience. Ann Thorac Surg. 1999;68(4): 1482–5.
  19. Stevens LM, Noiseux N, Avezum A, Ayapati DR, Chen X, Lucchese FA, et al.; CORONARY Investigators.Conversion after off-pump coronary artery bypass grafting: the CORONARY trial experience. Eur J Cardiothorac Surg. 2017;51(3):539-546. doi: 10.1093/ejcts/ezw361.
  20. Archbold RA, Curzen NP. Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation. Heart. 2003;89(10):1134-7.

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Received February 17, 2019.
Accepted March 11, 2019.
©2019 International Medical Research and Development Corporation.