Titre
On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Ferrari, E.
Auteure/Auteur
Stalder, N.
Auteure/Auteur
von Segesser, L.K.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1749-8090
Statut éditorial
Publié
Date de publication
2008
Volume
3
Numéro
38
Première page
1
Dernière page/numéro d’article
6
Peer-reviewed
Oui
Langue
anglais
Résumé
BACKGROUND: Cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience. METHODS: Out of 290 patients operated for CABG from January 2005 to January 2006, 25 (8.6%) selected high-risk patients suffering from life threatening coronary syndrome (mean age 69 +/- 7 years) and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction (LVEF) was 27 +/- 8%. The majority of them (88%) suffered of tri-vessel coronary disease and 6 (24%) had a left main stump disease. Nine patients (35%) were on severe cardiac failure and seven among them (28%) received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients (73%). RESULTS: All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.9 +/- 0.6 and the internal mammary artery was used in 23 patients (92%). The mean CPB time was 84 +/- 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 +/- 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 +/- 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an implantable cardiac defibrillator. One year after surgery they all had a standard trans-thoracic echocardiogram showing a mean LVEF rate of 36 +/- 11.8%. CONCLUSION: Standard on-pump arrested heart coronary surgery has higher mortality and morbidity in emergencies. The on-pump beating heart myocardial revascularization seems to be a valid alternative for the restricted and selected cohort of patients suffering from life threatening coronary syndrome and requiring multiple emergency CABG.
PID Serval
serval:BIB_3E562FE590C8
PMID
Open Access
Oui
Date de création
2009-01-22T11:16:10.061Z
Date de création dans IRIS
2025-05-20T14:04:15Z
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Nom
BIB_3E562FE590C8.P001.pdf
Version du manuscrit
preprint
Taille
225.56 KB
Format
Adobe PDF
PID Serval
serval:BIB_3E562FE590C8.P001
URN
urn:nbn:ch:serval-BIB_3E562FE590C85
Somme de contrôle
(MD5):dbda72aca6a02c519130e10df8e4d49b