Conversions in off-pump coronary artery bypass grafting: analysis and outcome

ABSTRACT

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. 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. In all cases, improvements in intra-operative technique and/or judgment could be made retrospectively. Six of these patients were converted in emergency, and on electively to cardiopulmonary bypass. Three [3/77] patients had an unstable course and did not survive operation. 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