Researchers from Australia have published (before print) an analysis of non-elective
CABG using bypass, cardiac arrest and aortic cross clamping compared with beating-heart revascularization.
They did a retrospective review of 5851 patients who had urgent CABG within 7 days of acute MI (AMI). Only 77 patients had beating-heart surgery. Factors associated with off-pump operations were:
- Age in the 70s
- Peripheral vascular disease
- Redo surgery
- Cardiogenic shock
- Single-vessel disease
When patients were matched for statistical analysis, there was no significant difference in 30-day mortality (p=0.85), major adverse cardiac and cerebrovascular events (death within 30 days, postop MI, postop stroke, or non-elective surgical redo) (p=0.84), or 12-year survival (p=0.89) ~64%
Beating heart patients were more likely to have fewer distal anastamoses and incomplete revascularization (some resulting stenosis).
Bottom Line
The authors note that fewer patients had off-pump surgery because the surgeons were less experienced with that technique. However, for at-risk patients, the technique is safe and effective in high-risk patients requiring CABG shortly after acute MI. Off-pump surgery is an acceptable approach in those are not good candidates for cardioplegic cardiac arrest and aorta cross-clamping, and in patients who are hemodynamically unstable.
Zhu MZL et al.: On-pump beating heart versus conventional coronary artery bypass grafting early after myocardial infarction: A propensity-score matched analysis from the anzscts database. Heart, Lung and Circulation 2018; https://doi.org/10.1016/j.hlc.2018.06.1051
