CONVERSIONS IN OFF-PUMP CORONARY ARTERY BYPASS GRAFTING: ANALYSIS AND OUTCOME

Abstract

Background: Off-pump coronary artery bypass graft (CABG) surgery is supposed to reduce perioperative
mortality and morbidity compared with on-pump coronary bypass graft surgery. The causes of
hemodynamic collapse during off-pump coronary artery bypass (OPCAB) remain scarcely defined. We
present an analysis of 7 cases who were converted to conventional CABG due to sustained hemodynamic
collapse or else, during elective off- pump CABG.
Method: During a 12-month period, we performed 77 elective OPCAB procedures through a sternotomy,
constituting 56.2% of the total CABG procedures performed. Six patients (1.6%) experienced hemodynamic
collapse intra-operatively and one (0.23%) electively requiring immediate cardiopulmonary bypass.
Preoperative characteristics, intraoperative data, and postoperative outcome were retrospectively reviewed.
Results: In all cases, improvements in intra-operative technique and/or judgment could be made
retrospectively. Six of these patients were converted in emergency, and one electively to cardiopulmonary
bypass. Three (3/77) patients had an unstable course and did not survive operation.
Conclusions: The causes of hemodynamic collapse during elective OPCAB were ischemic, mechanical, or a
combination of both. Based on these results, strong consideration should be given for a planned strategy of
CPB in high risk patients.