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Ki-Bong Kim, Cheong Lim, Hyuk Ahn, Jin-Kee Yang
Dept. of Thoracic & Cardiovascular Surgery,
Seoul National University Hospital, Seoul, Korea
Background. Displacement of the heart to expose the posterior
vessels during coronary artery bypass grafting without cardiopulmonary
bypass (OPCAB) may deteriorate cardiac function. We used intra-aortic
balloon pump (IABP) peri-operatively to reduce operative risk
and facilitate posterior vessel OPCAB in high risk patients with
left main disease (>75% stenosis), intractable resting angina,
post-infarction angina, or left ventricular dysfunction (ejection
fraction<35%).
Methods. One hundred and forty-two consecutive patients
who underwent multi-vessel OPCAB including posterior vessel revascularization
were studied prospectively. The patients were divided into group
I (n=57) who received preoperative or intraoperative IABP, and
group II (n=85) who did not receive IABP. In group I, there were
left main disease in 34 patients, intractable resting angina in
24 patients, left ventricular dysfunction in 8 patients, and postinfarction
angina in 5 patients. Seven patients received intraoperative IABP
support due to hemodynamic instability during OPCAB.
Results. There was no operative mortality in group I
and one mortality in group II. The average number of distal anastomosis
was not different between group I and group II (3.4 ±0.9 vs
3.5 ±0.9, p=NS). There was no significant difference in the number
of posterior vessel anastomosis per patient between two groups.
There were no differences in ventilator support time, length of
stay in the intensive care unit, hospital stay, and morbidities
between two groups. There was one case of IABP-related complication
in group I.
Conclusions. IABP facilitates posterior vessel OPCAB
in high risk patients, with comparable surgical results to those
in lower risk.
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