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The feasibility and safety of off-pump coronary bypass surgery in emergency revascularization

Authors
 Hyun-Chel Joo  ;  Young-Nam Youn  ;  Byung-Chul Chang  ;  Kyung-Jong Yoo 
Citation
 Journal of Thoracic Disease, Vol.10(4) : 2268-2278, 2018 
Journal Title
 Journal of Thoracic Disease 
ISSN
 2072-1439 
Issue Date
2018
Keywords
Emergency ; off-pump coronary artery bypass grafting (OPCAB)
Abstract
Background: The efficacy and safety of off-pump coronary artery bypass grafting (OPCAB) in emergency revascularization remains controversial despite its widespread use. The aim of our study was to examine the applicability and safety of OPCAB in patients who were indicated for emergency surgery. Methods: This single-center study reviewed the indication, operative data, and early and long-term outcomes of 113 patients (mean age, 67.2±9.0 years; logistic EuroSCORE, 14.3±13.5) who underwent emergency OPCAB from January 2003 to December 2014 and were followed up (94.6% completion rate) for a mean 51.1±40.3 (range, 1-135) months. Results: Emergency OPCAB was associated with favorable surgical outcomes (number of distal anastomoses per patient, 3.04±0.87; internal thoracic artery (IMA) use, 98.2%; complete revascularization, 79.6%) and in-hospital outcomes (mortality, 5.3%; low cardiac output syndrome, 5.3%; stroke, 2.7%; pulmonary complications, 8.8%; renal failure, 11.5%). Only five patients (4.4%) required on-pump conversion. The 10-year outcomes were also acceptable (survival, 75.4%±5.6%; major cerebral and cardiovascular events, 52.1%±1.8%). The multivariate risk factors for late mortality were peripheral vascular disease (HR 2.95, 95% CI: 1.11-11.83), cardiogenic shock (HR 3.67, 95% CI: 1.35-9.96), and incomplete revascularization (HR 3.41, 95% CI: 1.06-14.26). When patients were separated by whether the procedure was performed early (<2010) or late (≥2010) in the study period, the late period cohort had better outcomes despite containing higher-risk patients. Conclusions: Our study suggests that emergency OPCAB can be performed safely and effectively with good hospital outcomes and adequate long-term results. OPCAB strategy can be considered as a good option in emergency revascularization.
Files in This Item:
T201804078.pdf Download
DOI
10.21037/jtd.2018.03.190
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165491
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