The Outcomes of Redo-Coronary artery Bypass Grafting

Document Type : Research Paper

Authors

1 Assistant Professor of cardiology, Ema Reza hospital, Mashhad University of Medical Sciences; Mashhad, Iran

2 Cardiac Surgeon, Emam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction
Application of off-pump technique for reoperative coronary artery bypass grafting (Redo CABG) has been limited by technical difficulties, potentiation for embolism of athermanous debris from the involved grafts, resulting in myocardial infarction, and rapid hemodynamic deterioration.
Materials and Methods
In this descriptive study from 2002, at Cardiac surgery Department of Emam Reza Hospital, a total of 77 consecutive patients underwent redo CABG (64 ONCAB and 13 OPCAB) The outcomes of off-pump (OPCAB) and on-pump (ONCAB) redo CABG were compared. Surgical technique in 2 patients (%11) was converted from OPCAB to ONCAB due to hemodynamic instability, severe adhesion or graft injury; and in one patient (%7) the conversion from ONCAB to OPCAB was for severe aorta calcification.
Conclusion
Propensity matched comparison of the outcome of OPCAB with ONCAB for redo CABG showed that OPCAB was associated with significant reduction in postoperative complications, volume of blood transfusion and hospitalization length. OPCAB can be safely and effectively applied for reoperative CABG, in selected cases.

Keywords

References

1- Puskas JD, Williams WH, Mahoney EM, Huber PR,Block PC,Duke PG, et al. Off-pump vs. conventional coronary
artery bypass grafting: early and one-year graft patency, cost, and quality of life outcomes: a randomized trial. JAMA
2004; 291:1841-1849.
2- Puskas JD, Williams WH, Duke PG, Staples IR, Glas KE, Marshall JJ, et al. Off-pump coronary artery bypass
grafting provides complete revascularization with reduced myocardial injury , transfusion requirements, and length of
stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump vs. conventional
coronary artery bypass grafting. J thorac Cardiovasc Surg. 2003; 125:797-808.
3- Dewey TM, Magee MJ, Acuff T,Princ S,Herbert M,Edyerton JR, et al. Beating heart surgery reduces mortality in the
reoperative bypass patient . Heart Surg Forum 2002; 5:S301-S316.
4- Alamanni F, Pompilio G, Polvani G,Agrifoglio M, Zanobini M,Parolari A, et al. Off-pump redo coronary artery
bypass grafting: technical aspects and early results. Heart surg Frorum. 2002; 5:432-S444.
5- Mack MJ. Off-pump surgery and alternative to standard operation in redo coronary surgery. J Card surg 2004; 19:313-319.
6- Lytle BW. Coronary artery reoperations. In: Cohn, LH Edmunds LH, eds. Cardiac Surgery in the Adult. New York:
McGraw-Hill; 2003.659-679.
7- Dewey TM, Mack MJ, Mack .Myocardial revascularization without cardiopulmonary bypass.In:Cohn LH, Edmunds
LH, eds. Cardiac surgery in the adult. New York: McGraw-Hill; 2003.609-625.
8- Arom KV, Flavin TF, Emery RW, Kshettry VK,Janey PA,Petersoen RJ. Safety and efficacy of off-pump bypass
grafting. Ann Thorac Surg 2000; 69:704.
9- Stamou SC, Pfister AJ, Dangas G,Dullum MK,Boyce SW,Bafi AS, et al. Beating heart versus conventional singlevessel
reoperative coronary artery bypass. Ann Thorac surg. 2000; 69:1383.
10- Carver JM, Hodakowski GT, Shen Y, Veintraub WS,Accola KD,Guyton RA,et al. Third-time coronary artery
bypass operations: surgical strategy and results. Ann Thorac surg 1996; 62; 1801-1807.
11-Trehan N, Mishra YK. Malhotra off-pump redoes coronary artery bypass grafting. Ann Thorac Surg. 2000; 70:1026.
12- Kleisli T, Cheeng W, Jacobs MJ, Mirocha J, Derobertis MA, Kass RM, et al. In the current era, complete
revascularization improves survival after coronary artery bypass surgry. J Thorac Cardiovasc Surg 2005; 129:1283-1291.
13- Osaka S, Ohsawa H, Nabuchi A. Redo off-pump coronary artery bypass grafting for high risk hemodialysis patients.
J Card Surg 2002; 17:383-386.
14- Vassiliades TA, Nielsen JL. Altenative approaches in off-pump redo coronary artery bypass grafting. Heart surg
Forum 2000; 3:203-206.
15- Di Mauro M, Iaco AL, Contini M, Teodori G,Vitolla G,Pano M,et al. Reoperative coronary artery bypass grafting:
analysis of early and late outcomes. Ann Thorac Surg 2005; 79:81-87. 
medical journal of mashhad university of medical sciences
Volume 51, Issue 4 - Serial Number 4
November and December 2008
Pages 225-228

Files

Share

How to cite

Statistics