Application of off-pump coronary artery bypass grafting surgery in coronary artery disease patients with dilated left ventricle_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yongyi ,  XUE Song , XU Genxing , HUANG Ritai , LIAN Feng , LI Wei

Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, P.R.China;

Corresponding author：

XUE Song, Email: xuesong64@163.com

Keywords：

Dilated left ventricle; coronary artery disease; off-pump coronary artery bypass grafting surgery; surgery

DOI：

10.7507/1007-4848.201909002

Video：

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Objective To describe our experiences of application of off-pump coronary artery bypass grafting surgery (OPCABG) in coronary artery disease (CAD) patients with dilated left ventricle.Methods A retrospective analysis of 303 patients with dilated left ventricle [left ventricular end-diastolic diameter (LVEDD)> 60 mm] who underwent OPCABG from January 2008 to December 2018 at a single center was conducted. There were 205 males and 98 females at age of 45-87 (66.9±9.3) years.Results The mean pulmonary artery pressure in 90 patients was more than 25 mm Hg. Sixteen patients underwent OPCABG with emergent transition of extracorporeal circulation (CPB). Twenty-one patients underwent OPCABG with CPB at the beginning of CABG. Thirty-five patients underwent intra-aortic balloon counterpulsation (IABP). Four patients died during in-hospital time with the experience of emergent transition of CPB. Six months after operation, LVEDD and left ventricular ejection fraction (LVEF) were improved.Conclusion OPCABG is a safe and effective alternative for CAD patients with dilated left ventricle. However, for patients with higher pulmonary pressure and a spherical left ventricle after cardiac reshaping, there is a high risk of emergent transition of CPB during OPCABG; for this kind of patients, it is necessary to start CPB at the beginning of OPCABG.

Citation： WANG Yongyi, XUE Song, XU Genxing, HUANG Ritai, LIAN Feng, LI Wei. Application of off-pump coronary artery bypass grafting surgery in coronary artery disease patients with dilated left ventricle. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(5): 544-547. doi: 10.7507/1007-4848.201909002 Copy

1.	Gaudino M, Benedetto U, Bakaeen F, et al. Off- versus on-pump coronary surgery and the effect of follow-up length and surgeons' experience: A meta-analysis. J Am Heart Assoc, 2018, 7(21): e010034.
2.	Chiarenza F, Tsoutsouras T, Cassisi C, et al. The effects of on-pump and off-pump coronary artery bypass surgery on respiratory function in the early postoperative period. J Intensive Care Med, 2019, 34(2): 126-132.
3.	Dieberg G, Smart NA, King N. On- vs. off-pump coronary artery bypass grafting: A systematic review and meta-analysis. Int J Cardiol, 2016, 223: 201-211.
4.	Carmona P, Paredes F, Mateo E, et al. Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience. Interact Cardiovasc Thorac Surg, 2016, 22(5): 612-618.
5.	Benedetto U, Angelini GD, Caputo M, et al. Off- vs. on-pump coronary artery bypass graft surgery on hospital outcomes in 134, 117 octogenarians. J Thorac Dis, 2017, 9(12): 5085-5092.
6.	Hu S, Zheng Z, Yuan X, et al. Increasing long-term major vascular events and resource consumption in patients receiving off-pump coronary artery bypass: a single-center prospective observational study. Circulation, 2010, 121(16): 1800-1808.
7.	Zhou P, Zhu P, Xiao Z, et al. Meta-analysis of repeat revascularization of off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg, 2018, 106(2): 526-531.
8.	Xia L, Ji Q, Song K, et al. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. J Cardiothorac Surg, 2017, 12(1): 11.
9.	沈金强, 季强, 丁文军, 等. 心肺转流不停跳与非体外循环冠状动脉旁路移植术治疗射血分数≤35%的冠心病的早期效果比较. 中华外科杂志, 2018, 56(4): 294-298.
10.	薛松, 黄日太, 申达浦, 等. 心脏停跳与不停跳冠状动脉旁路移植术在高危患者中应用的比较. 中华胸心血管外科杂志, 2006, 22(5): 334-335.
11.	Do QB, Goyer C, Chavanon O, et al. Hemodynamic changes during off-pump CABG surgery. Eur J Cardiothorac Surg, 2002, 21(3): 385-390.
12.	Patel N, Patel N, Loulmet D, et al. Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality. J Thorac Cardiovasc Surg, 2004, 128(5): 655-661.
13.	Landoni G, Pappalardo F, Crescenzi G, et al. The outcome of patients requiring emergency conversion from off-pump to on-pump coronary artery bypass grafting. Eur J Anaesthesiol, 2007, 24(4): 317-322.
14.	Malhotra A, Ananthanarayanan C, Wadhawa V, et al. OPCABG for moderate CIMR in elderly patients: a superior option? Braz J Cardiovasc Surg, 2018, 33(1): 15-22.
15.	Sun X, Huang J, Shi M, et al. Predictors of moderate ischemic mitral regurgitation improvement after off-pump coronary artery bypass. J Thorac Cardiovasc Surg, 2015, 149(6): 1606-1612.
16.	谢波, 薛松, 黄日太, 等. 主动脉内球囊反搏在不停跳冠状动脉搭桥术围手术期的应用. 上海交通大学学报(医学版), 2009, 29(4): 477-479.

1. Gaudino M, Benedetto U, Bakaeen F, et al. Off- versus on-pump coronary surgery and the effect of follow-up length and surgeons' experience: A meta-analysis. J Am Heart Assoc, 2018, 7(21): e010034.
2. Chiarenza F, Tsoutsouras T, Cassisi C, et al. The effects of on-pump and off-pump coronary artery bypass surgery on respiratory function in the early postoperative period. J Intensive Care Med, 2019, 34(2): 126-132.
3. Dieberg G, Smart NA, King N. On- vs. off-pump coronary artery bypass grafting: A systematic review and meta-analysis. Int J Cardiol, 2016, 223: 201-211.
4. Carmona P, Paredes F, Mateo E, et al. Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience. Interact Cardiovasc Thorac Surg, 2016, 22(5): 612-618.
5. Benedetto U, Angelini GD, Caputo M, et al. Off- vs. on-pump coronary artery bypass graft surgery on hospital outcomes in 134, 117 octogenarians. J Thorac Dis, 2017, 9(12): 5085-5092.
6. Hu S, Zheng Z, Yuan X, et al. Increasing long-term major vascular events and resource consumption in patients receiving off-pump coronary artery bypass: a single-center prospective observational study. Circulation, 2010, 121(16): 1800-1808.
7. Zhou P, Zhu P, Xiao Z, et al. Meta-analysis of repeat revascularization of off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg, 2018, 106(2): 526-531.
8. Xia L, Ji Q, Song K, et al. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. J Cardiothorac Surg, 2017, 12(1): 11.
9. 沈金强, 季强, 丁文军, 等. 心肺转流不停跳与非体外循环冠状动脉旁路移植术治疗射血分数≤35%的冠心病的早期效果比较. 中华外科杂志, 2018, 56(4): 294-298.
10. 薛松, 黄日太, 申达浦, 等. 心脏停跳与不停跳冠状动脉旁路移植术在高危患者中应用的比较. 中华胸心血管外科杂志, 2006, 22(5): 334-335.
11. Do QB, Goyer C, Chavanon O, et al. Hemodynamic changes during off-pump CABG surgery. Eur J Cardiothorac Surg, 2002, 21(3): 385-390.
12. Patel N, Patel N, Loulmet D, et al. Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality. J Thorac Cardiovasc Surg, 2004, 128(5): 655-661.
13. Landoni G, Pappalardo F, Crescenzi G, et al. The outcome of patients requiring emergency conversion from off-pump to on-pump coronary artery bypass grafting. Eur J Anaesthesiol, 2007, 24(4): 317-322.
14. Malhotra A, Ananthanarayanan C, Wadhawa V, et al. OPCABG for moderate CIMR in elderly patients: a superior option? Braz J Cardiovasc Surg, 2018, 33(1): 15-22.
15. Sun X, Huang J, Shi M, et al. Predictors of moderate ischemic mitral regurgitation improvement after off-pump coronary artery bypass. J Thorac Cardiovasc Surg, 2015, 149(6): 1606-1612.
16. 谢波, 薛松, 黄日太, 等. 主动脉内球囊反搏在不停跳冠状动脉搭桥术围手术期的应用. 上海交通大学学报(医学版), 2009, 29(4): 477-479.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of off-pump coronary artery bypass grafting surgery in coronary artery disease patients with dilated left ventricle

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