Coronary artery bypass grafting without cardiopulmonary bypass in acute coronary syndrome: focus on safety and completeness of revascularization

Jalilov Adkham Kakhramonovich, Merzlyakov Vadim Yurievich, Klyuchnikov Ivan Vyacheslavovich, Skopin Anton Ivanovich, Mammadova Sevinj

Emergency coronary artery bypass grafting (CABG) in the setting of acute coronary syndrome (ACS) is associated with an increased number of perioperative complications and mortality. Operations without cardiopulmonary bypass (CPB) have a number of advantages, but the role of off-pump CABG (OPCAB) coronary bypass surgery remains controversial, as the procedure has been associated with incomplete revascularization in several studies. The aim of this study was to evaluate the feasibility, efficacy, and outcome of OPCAB surgery in patients with ACS. Methods. We conducted a retrospective analysis of the treatment of patients with ACS who underwent emergency or delayed CABG with CPB (on-pump CABG, hereinafter referred to as ONCAB) or OPCAB in our hospital. Results. Between January 2008 and December 2015, a total of 205 ACS patients underwent either ONCAB (109 patients, 53.2%) or OPCAB (96 patients, 46.8%) surgery. EuroSCORE II risk (5.6±7.2 vs 4.9±6.5, p=0.226) and demographics were comparable between groups. A trend towards a decrease in postoperative mortality was observed in patients undergoing OPCAV (2.1 vs. 5.5%). The frequency of postoperative stroke and low cardiac output syndrome of the left ventricle (LV), as well as the duration of inotropic support and the need for resternotomy were significantly lower in the OPCAB group (p <0.05). Emergency CABG in the emergency setting was not associated with increased mortality or increased postoperative complications compared with delayed surgery, and OPCAB in emergency patients was associated with lower rates of postoperative complications and shorter ICU stay (p<0.05). There was no difference in completeness of revascularization between groups (median 1 [1–1.33; 0.33–1.67] OPCAB versus median 1 (1–1.33; 0.67–2) ONCAB, p = 0.617), even during emergency operations. Conclusion. OPCAB surgery is safe and effective in ACS and may be considered in hemodynamically stable patients in the emergency setting.

Keywords:coronary artery bypass grafting, coronary artery bypass grafting without cardiopulmonary bypass, acute coronary syndrome, myocardial infarction.