|
ABSTRACT 33
EMERGENCY OFF PUMP CORONARY ARTERY BYPASS:
SAFETY AND EFFICACY
Daniel P. OHair, Leonard H. Kleinman, Paul H. Werner,
Thomas P. Barragry, John D. Crouch. St. Lukes Medical Center,
Milwaukee, WI, USA
Surgical emergency has previously been considered a contraindication
to off pump coronary artery bypass (OPCAB). This study compares
the outcome of patients undergoing emergency myocardial revascualrization
with and without extracorporeal support (CPB).
Forty patients underwent emergency coronary bypass due to acute
myocardial infarction (MI), unrelenting angina, cardiogenic shock,
or failed PTCA. The operations were conducted with standard cardiopulmonary
bypass in Group 1 (n=19) and as OPCAB in Group 2 (n=21).
Preoperative characteristics show no significant differences
between Group 1 (CPB) and Group 2 (OPCAB) in age (65 vs. 69 years),
sex (70%m vs. 67%m), ejection fraction (39% vs. 33%), acute MI
(90% vs. 95%), or previous CVA (10% vs. 19%). Preoperative intraaortic
balloon pump was utilized in 47% of Group 1 and in 52% of Group
2 patients. Patients in Group 1 had 3.3 grafts versus 2.4 in Group
2 (p=NS). There were no conversions from OPCAB to CPB.
Postoperative complications in Group 1 (CPB) and Group 2 (OPCAB)
included prolonged intubation 44% vs. 26%; adverse neurologic
events 4/19 (21%) vs. 2/21 (9.5%) and hemodialysis in 3/19 (16%)
vs. 1/21 (5%) (p=NS). Length of stay was 11 days for Group 1
versus 10 days for Group 2. There were 4 deaths in Group 1 (21%)
and 2 in Group 2 (9.5%) (p=NS).
These data suggest that OPCAB is a safe and effective option
for patients requiring emergency bypass surgery.
|
