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Study documents a return to “beating-heart bypass”

OCTOBER 24, 2017
Clinical Congress Daily Highlights, Tuesday First Edition

Coronary artery bypass graft (CABG) surgery is the most common open-heart surgery in the U.S. The procedure, which involves taking a healthy artery or vein from the body and grafting it to bypass a blocked coronary artery, is usually performed while patients are supported by a cardiopulmonary bypass machine (CPB). The machine temporarily takes over for the immobilized heart and lungs, maintaining levels of oxygenation in the blood while the cardiothoracic surgeon works.

But it is also possible to do “beating-heart bypass surgery” without the aid of CPB. On Tuesday, Dr. Genevieve A. Fasano, Drexel University, Philadelphia, PA, presented data on the use of the technique, known as off-pump coronary artery bypass (OPCAB).

OPCAB was commonly performed in the 1960s, but with the introduction of reliable heart-lung machines it has become less frequent. Recent data suggesting higher risks for inflammatory responses and other post-operative complications with CPB, however, have led to a resurgence in the use of OPCAB [1].

Dr. Fasano’s retrospective analysis of 32,773 patients from the New Jersey Cardiac Surgery Database showed that about one-third of surgeons are implementing OPCAB when performing CABG. The use of OPCAB was highly variable and dependent on the comfort level of individual surgeons with the procedure. Yet the data showed that excellent mortality rates could be achieved with the approach.

“There were significant differences in outcome between individual surgeons and institutions,” Fasano said. “However, the rate of adoption of OPCAB did not influence these outcomes.”

References:

  1. Menasché P. The systemic factor: the comparative roles of cardiopulmonary bypass and off-pump surgery in the genesis of patient injury during and following cardiac surgery. Ann Thorac Surg. 2001;72:S2260–S2266

Click here to view the full study abstract.

Additional Information:
The Scientific Forum, The Impact of Off Pump Coronary Artery Bypass Surgery (OPCAB) on Surgical Outcomes for Coronary Artery Bypass Grafting (CABG): The New Jersey Cardiac Surgery Database Experience, was held October 24, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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