Safety and efficacy of off-pump coronary revascularization in severe left ventricular dysfunction
Tóm tắt
Myocardial revascularization in presence of severe Left Ventricular Dysfunction (LVD) presents a challenging surgical scenario. To improve the results of this high risk procedure, off-pump revascularization is being increasingly used; yet without conclusive evidence of definite benefit. Present study aims to assess the early outcome of coronary revascularization in presence of severe Left Ventricle (LV) dysfunction by off pump method as against conventional on- pump technique. 125 consecutive cases of isolated coronary artery disease with severe LVD, having undergone Coronary Artery Bypass Grafting (CABG) over a two and a half year period (January 1, 2006 to June 30, 2008) were studied retrospectively. Group I consisted of 78 cases of Off-Pump Coronary Artery Bypass Grafting (OPCAB), while group II consisted of 47 cases of on-pump CABG. The follow up period was 5 to 30 months (mean 14 months). There were 5 hospital deaths, 3 in the OPCAB group and 2 in group II of on-pump CABG (p= ns). Two patients in the OPCAB group required conversion to on pump surgery due to hemodynamic instability. No patient in either group had recurrence of symptoms. Patients in both groups had comparable inotropic requirement, length of ICU stay and total hospital stay. There was no incidence of neurologic injury in either group. Blood transfusion requirement was significantly less in the OPCAB group (P <0.001) while there was significant worsening of pre-existing renal insufficiency as well as an increased incidence of postoperative renal failure in the on-pump group (p=0.01). OPCAB is a safe and effective method in the presence of significant LVD. It may be preferentially applied to patients with pre-existing renal insufficiency.
Tài liệu tham khảo
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