On Pump Beating Heart Coronary Artery Surgery in Patients Requiring Urgent Revascularization

Authors

  • Yasin Kilic Department of Cardiovascular Surgery, Medical Faculty, Atatürk University, 25030 Erzurum, Turkey
  • Izatullah Jalalzai Department of Cardiovascular Surgery, Medical Faculty, Atatürk University, 25030 Erzurum, Turkey
  • Ebubekir Sonmez Department of Cardiovascular Surgery, Medical Faculty, Atatürk University, 25030 Erzurum, Turkey
  • Bilgehan Erkut Department of Cardiovascular Surgery, Medical Faculty, Atatürk University, 25030 Erzurum, Turkey

DOI:

https://doi.org/10.59958/hsf.6923

Keywords:

coronary artery bypass grafting, on-pump cardiac surgery, beating heart surgery, myocardial revascularization, acute coronary syndrome, emergency surgery

Abstract

Background: When acute coronary syndrome patients necessitate immediate revascularization, heart-on-pump coronary artery bypass grafting may be regarded as a viable substitute for conventional on-pump surgery. Our clinical experience and initial outcomes of heart-on-pump coronary surgery in patients with acute coronary syndrome are detailed in this article. Method: This research endeavor was a retrospective analysis that spanned the years March 2011 to August 2023. The sample size comprised 2816 patients who had undergone coronary artery surgery. During this period, the same surgical team performed coronary artery bypass surgery on 411 of these patients, who underwent beating heart surgery while on cardiopulmonary bypass support and without cardioplegic arrest; this was done under emergency conditions. Result: 9.3 ± 2.2 hours elapsed between the initiation of acute myocardial infarction and the commencement of coronary artery bypass grafting (CABG). A mean of 4.0 grafts was applied (2.2 ± 1.1). Mortality in hospitals was calculated for sixteen patients. Following surgery, twenty-six patients developed an inadequate cardiac output syndrome. Despite having renal dysfunction, none of the eight individuals needed hemodialysis. The mean duration of stay in intensive care was 3.2 (2.2 ± 1.1) days, while the mean length of hospitalization was 9.2 (4.3 ± 2.4) days. Conclusion: We believe that for high-risk patients with multivascular coronary artery disease who require an emergency coronary artery bypass graft, on-pump beating heart revascularization could be a viable option.

References

Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. 2004; 110: e340–e437.

Kaul TK, Fields BL, Riggins SL, Dacumos GC, Wyatt DA, Jones CR. Coronary artery bypass grafting within 30 days of an acute myocardial infarction. The Annals of Thoracic Surgery. 1995; 59: 1169–1176.

Zaroff JG, diTommaso DG, Barron HV. A risk model derived from the National Registry of Myocardial Infarction 2 database for predicting mortality after coronary artery bypass grafting during acute myocardial infarction. The American Journal of Cardiology. 2002; 90: 1–4.

Kirklin JK. Prospects for understanding and eliminating the deleterious effects of cardiopulmonary bypass. The Annals of Thoracic Surgery. 1991; 51: 529–531.

Wan S, Yim APC, Ng CSH, Arifi AA. Systematic organ protection in coronary artery surgery with or without cardiopulmonary bypass. Journal of Cardiac Surgery. 2002; 17: 529–535.

Bergsland J, Hasnan S, Lewin AN, Bhayana J, Lajos TZ, Salerno TA. Coronary artery bypass grafting without cardiopulmonary bypass–an attractive alternative in high risk patients. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 1997; 11: 876–880.

Arom KV, Flavin TF, Emery RW, Kshettry VR, Janey PA, Petersen RJ. Safety and efficacy of off-pump coronary artery bypass grafting. The Annals of Thoracic Surgery. 2000; 69: 704–710.

Mehlhorn U, Allen SJ, Adams DL, Davis KL, Gogola GR, Warters RD. Cardiac surgical conditions induced by beta-blockade: effect on myocardial fluid balance. The Annals of Thoracic Surgery. 1996; 62: 143–150.

Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. Journal of the American College of Cardiology. 2011; 58: e123–e210.

Prifti E, Bonacchi M, Giunti G, Frati G, Proietti P, Leacche M, et al. Does on-pump/beating-heart coronary artery bypass grafting offer better outcome in end-stage coronary artery disease patients? Journal of Cardiac Surgery. 2000; 15: 403–410.

Rastan AJ, Eckenstein JI, Hentschel B, Funkat AK, Gummert JF, Doll N, et al. Emergency coronary artery bypass graft surgery for acute coronary syndrome: beating heart versus conventional cardioplegic cardiac arrest strategies. Circulation. 2006; 114: I477–I485.

Wasvary H, Shannon F, Bassett J, O'Neill W. Timing of coronary artery bypass grafting after acute myocardial infarction. The American Surgeon. 1997; 63: 710–715.

Quigley RL, Milano CA, Smith LR, White WD, Rankin JS, Glower DD. Prognosis and management of anterolateral myocardial infarction in patients with severe left main disease and cardiogenic shock. The left main shock syndrome. Circulation. 1993; 88: II65–II70.

Yamagishi I, Sakurada T, Abe T. Emergency coronary artery bypass grafting after acute myocardial infarction. What influences early postoperative mortality? Annals of Thoracic and Cardiovascular Surgery: Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 1998; 4: 28–33.

Rastan AJ, Bittner HB, Gummert JF, Walther T, Schewick CV, Girdauskas E, et al. On-pump beating heart versus off-pump coronary artery bypass surgery-evidence of pump-induced myocardial injury. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2005; 27: 1057–1064.

Prifti E, Bonacchi M, Frati G, Giunti G, Proietti P, Leacche M, et al. Beating heart myocardial revascularization on extracorporeal circulation in patients with end-stage coronary artery disease. Cardiovascular Surgery (London, England). 2001; 9: 608–614.

Borowski A, Korb H. Myocardial infarction in coronary bypass surgery using on-pump, beating heart technique with pressure- and volume-controlled coronary perfusion. Journal of Cardiac Surgery. 2002; 17: 272–278.

Locker C, Shapira I, Paz Y, Kramer A, Gurevitch J, Matsa M, et al. Emergency myocardial revascularization for acute myocardial infarction: survival benefits of avoiding cardiopulmonary bypass. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2000; 17: 234–238.

Ben-Gal Y, Stone GW, Smith CR, Williams MR, Weisz G, Stewart AS, et al. On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. The Journal of Thoracic and Cardiovascular Surgery. 2011; 142: e33–e39.

Gundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery. 1998; 115: 1273–1278.

Published

2023-12-27

How to Cite

Kilic, Y. ., Jalalzai, I. ., Sonmez, E. ., & Erkut, B. (2023). On Pump Beating Heart Coronary Artery Surgery in Patients Requiring Urgent Revascularization. The Heart Surgery Forum, 26(6), E808-E816. https://doi.org/10.59958/hsf.6923

Issue

Section

Article