The Optimal Technique For Cabg Our Experience Of Opcab

Objectives. Coronary artery bypass surgery (CABG) is today a very widely practiced surgery with good outcome. It has been successfully performed during the past few decades with the help of the cardio pulmonary bypass machine and cardioplegia. The adverse effects generated by the CPB however have raised questions about its safety especially since the90s with the growing popularity of off pump CABG (OPCAB). Can the latter produce high quality anastomotic results at the same time decreasing the numerous adverse effects of the CPB and therefore the associated morbidity and mortality is a question of debate among different surgeons. Our retrospective study is designed to compare the two techniques of CABG along with the rate of conversion and its outcome. It also comprises a comparison of the different category risks of patients according to the EUROSCORE (European System for Cardiac Operative Risk Evaluation) and their outcome following OPCAB. After these analyses we also propose an algorithm for practising OPCAB as safely as possible.Method. Starting from September2010to end of2011, consecutive patients undergoing CABG surgery at our hospital, Second Xiangya Hospital of Central South University have been enrolled for this observational retrospective study. Data was collected directly from the medical files at the medical records and all required information were entered in a specially devised table. Patients were classified into OPCAB group(140), conversion to on pump CABG (10) and finally conventional on pump CABG (30), making a total of180cases. The OPCAB group was further divided into low risk, medium risk and high risk according to EUROSCORE evaluation. All the results were processed and analysed by SPSS, version19.0.Results. OPCAB showed lesser complications in terms of blood transfusion, ventilation time, ICU stay, post op discharge, low cardiac output syndrome, elevation of troponin post op, pulmonary edema, chest infection, renal impairment or failure, atrial fibrillation post op and gastro intestinal tract bleeding. In the140cases of OPCAB in our study there was0case of cerebro-vascular accident (CVA) post op while there wasl case of cerebral hemorrhage in the on pump CABG group post op. The odds ratio(OR) for mortality for the OPCAB group compared to the conventional on pump group has a value of0.203at95%confidence interval with a lower limit value of0.027and an upper limit of1.502, also the chi square p value>0.05, therefore we conclude that the mortality rate is not lower in the OPCAB group. The mortality remains high for the high risks patients in the OPCAB group. The rate of conversion in our study was around6.7%with a mortality of20%and also increased complications rate.Conclusion. In this modern era OPCAB obviously has its place, with more practice we will surely learn more about its benefits and limitations. The coronary artery disease patients having more comorbidities today, OPCAB can be an excellent technique for bypass surgery. From our experience we conclude that OPCAB can decrease the complications rate and morbidity in the coronary heart disease patients, but cannot conclude that mortality rate is decreased by OPCAB.