Autor:

Ennker, IC.; Buhmann, U.; Rosendahl, U.; Bauer, S.; Schröder, T.; Ennker, J.

Erscheinungsort:

The Thoracic and Cardiovascular Surgeon 2000; 48, Suppl. 1:44

Inhalt:

Background: Increasing numbers of patients undergo off-pump CABG for revascularisation of the anterior myocardial wall. Grafting posterior wall vessels still carries technical challenges. Purpose of this study was to determine whether perioperative morbidity differs between patients undergoing CABG with or without cardio pulmonary bypass and cardioplegia.

Methods: From August 1997 through August 1999 266 patients underwent off pump CABG (group A), (192 male/74 female), median age 66.2 range 41-85. 227 patients with conventional CABG within the same time period served as a control (group B). 146 patients had a single vessel disease, 68 patients two vessel disease and 52 patients a three vessel disease (LAD, RCX, RCA). In all patients complete revascularisation of all stenosed vessels could be achieved. 229 patients with off pump CABG were operated with a stabiliser and 37 patients using a octupus-system. 221 patients were operated with a median sternotomy, 15 patients employing an anterolateral sternotomy and 30 patients by a ministernotomy.

Results: The incidence of postoperative neurological disorders was 1/266=0.4% in group A, 4/227=1.8% in group B respectively. 7/266=2.6% patients in group A developed a perioperative myocardial infarction versus 8/227=3.5% in group B. Respiratory problems causing the need of prolonged mechanical ventilation occurred 9/266=3.4% in group A and 10/227=4.4% in group B. The median length of hospital stay was 7.5 days (range 4 - 20) in group A and 10 days (range 5 -40) in group B respectively.

In hospital mortality was 4/266=1.5% in group A and 3/227=1.3% in group B. Due to a progressive learning curve a zero mortality could be reached during the last hundred patients in group A.

Conclusion: Peri- and postoperative morbidity with regard to neurological disorders, respiratory insufficiency, perioperative mycardial infarction and hospital stay is significantly lower in patients undergoing off pump CABG as compared with the conventional group. It could be demonstrated that complete revascularisation including posterior wall vessels without cardiopulmonary bypass is safe and beneficial.