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Journal of Cardiothoracic Surgery

, 3:38

First Online: 02 July 2008Received: 17 September 2007Accepted: 02 July 2008

Abstract

BackgroundCardiopulmonary bypass CPB with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience.

MethodsOut of 290 patients operated for CABG from January 2005 to January 2006, 25 8.6% selected high-risk patients suffering from life threatening coronary syndrome mean age 69 ± 7 years and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction LVEF was 27 ± 8%. The majority of them 88% suffered of tri-vessel coronary disease and 6 24% had a left main stump disease. Nine patients 35% were on severe cardiac failure and seven among them 28% received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients 73%.

ResultsAll patients underwent on-pump-beating heart coronary revascularization. The mean number of graft-patient was 2.9 ± 0.6 and the internal mammary artery was used in 23 patients 92%. The mean CPB time was 84 ± 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 ± 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 ± 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an implantable cardiac defibrillator. One year after surgery they all had a standard trans-thoracic echocardiogram showing a mean LVEF rate of 36 ± 11.8%.

ConclusionStandard on-pump arrested heart coronary surgery has higher mortality and morbidity in emergencies. The on-pump beating heart myocardial revascularization seems to be a valid alternative for the restricted and selected cohort of patients suffering from life threatening coronary syndrome and requiring multiple emergency CABG.

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Autor: Enrico Ferrari - Nicolas Stalder - Ludwig K von Segesser

Fuente: https://link.springer.com/







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