ABSTRACT 84

HOW SAFE IS MULTIVESSEL OFF-PUMP CORONARY ARTERY BYPASS SURGERY?

Ramakanta Panda,
Breach Candy Hospital. Bombay, INDIA

AIM:  To evaluate safety of off-pump coronary artery bypass surgery (OPCAB)

METHODS:  Between January and October 2000, 391  (88.8%) patients out of 440 isolated CABG patients underwent OPCAB.  Their age ranged between 35-80 (mean 60.6) years and 59 (15%) were females. Clinical profiles were diabetes 190(48.6%) patients, hypertension-186 (47.5%) patients, smokers-77 (19.7%) patients, unstable angina-81 (20.7%) patients and redo CABG-17 (4.37%) patients. Angiographically 292 (74.6%) patients had triple vessel disease, 49(12.5%) LM stenosis>70% and 95(24.3%) patients had EF<35%.

RESULTS: An average of 3.5 anastomoses per patient were constructed of which 3.34 were arterial.  Three hundred forty four (88%) had total arterial revascularisation.  An average of 0.4 units of blood were transfused per patient and 277 (71%) did not require blood transfusion.

Postoperative complications were peri-op MI-4(1%), AF-25 (6.4%), Re-exploration for bleeding-1(0.25%),Pleural effusion-16(4.1%), acute abdominal problems-4(1%). Twenty six patients(6.6%) required inotropes and IABP was used in 3(0.75%) patients of which two had pre-op IABP. There were 2 TIA without residual neurological deficit and no mortality. Even in the age group> 70(49 patients-12.5%), there was no significantly increased complication rate.

CONCLUSION: Multivessel OPCAB is a safe procedure but long term results needs to be evaluated.