Off-Pump Coronary Artery Bypass Grafting: The Zurich Experience

Authors

  • R. Tavakoli
  • O. Reuthebuch
  • C. Hofer
  • J. Grünenfelder
  • M. Genoni

DOI:

https://doi.org/10.1532/HSF98.20051133

Abstract

Coronary artery bypass grafting (CABG) is the surgical procedure of choice for treatment of multi-vessel coronary artery disease. The rising risk profile of the patients requiring isolated CABG and the economic pressure have prompted us to devise new operative strategies to treat these patients. Elimination of the cardiopulmonary bypass is one possible answer to the dilemma of maintaining the quality of care and reducing the exploding costs of our health system. Therefore, we developed the off-pump coronary artery bypass grafting (OPCAB) for patients requiring isolated CABG. In our experience the key to successful OPCAB relies on the order of revascularization of the myocardial walls (anterior, inferior, lateral), use of intracoronary shunt, no-touch technique for the proximal aortic anastomosis with heart string â (Guidant, IN, USA), close collaboration with the anesthesiologists, early and aggressive administration of anti-platelet therapy, endoscopic vein harvest by perfusionists, and improved body temperature control. Following these concepts, we have been able to offer the OPCAB procedure to over 90% of our patients and to reduce perioperative morbidity and global costs.

References

Antunes PE, de Oliveira JF, Antunes MJ. 2003. Predictors of cerebrovas cular events in patients subjected to isolated coronary surgery. The importance of aortic cross-clamping. Eur J Cardiothorac Surg 23:328-33.nCohen M, Lillehei CW. 1953. Autogenous lung oxygenator with total cardiac bypass for intracardiac surgery. Surg Forum 4:34-40.nFavaloro RG. 1968. Saphenous vein autograft replacement of severe seg mental coronary artery occlusion: operative technique. Ann Thorac Surg 5:334-9.nGenoni M, Wilhelm M, Tavakoli R. 2004. Conversion of off-pump surgery to extracorporeal circulation: the importance of the LAD bypass in patients with severe coronary artery pathology. Brit J Surg 91:916.nHofer CK, Worn M, Tavakoli R, et al. Influence of body temperature on blood loss and transfusion requirements during off-pump coronary artery bypass grafting: a comparison of 3 warming systems. J Thorac Cardio-vasc Surg, in press.nJones RE, Donald DE, Swan HJ, Harshbarger HG, Kirklin JW, Wood EH. 1955. Apparatus of Gibbon type for mechanical bypass of the heart and lungs; preliminary report. Mayo Clin Proc 30:105-13.nNashef SA, Rocques F, Gauduscheau E, Lemeshow S, Salamon R, the EuroSCORE study group. 1999. Eur J Cardiothorac Surg 16:9-13.nSchurr UP, Lachat ML, Reuthebuch O, et al. 2002. Endoscopic saphe nous vein harvesting for CABG - a randomized, prospective trial. Thorac Cardiovasc Surg 50:160-3.nTavakoli R, Genoni M, Graves K. 2004. Superior flow pattern of internal thoracic artery over saphenous vein graft during OPCAB procedures. Brit J Surg 91:916.n

Published

2005-07-07

How to Cite

Tavakoli, R., Reuthebuch, O., Hofer, C., Grünenfelder, J., & Genoni, M. (2005). Off-Pump Coronary Artery Bypass Grafting: The Zurich Experience. The Heart Surgery Forum, 8(4), E246-E248. https://doi.org/10.1532/HSF98.20051133

Issue

Section

Articles

Most read articles by the same author(s)