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DOI: 10.1055/s-2007-967520
Conversion of OPCAB to cardiopulmonary bypass: The importance of the LAD bypass in patients with severe coronary artery disease
Objective: The purpose of this study was to characterize the predictors of conversion to cardiopulmonary bypass (CPB) due to hemodynamic instability in patients planed for OPCAB.
Methods: From January 2003 to December 2004, conversion to CPB was necessary in 13 of 456 patients (2.8%, group: A) planed for OPCAB. The reminder 443 patients (97.2%, group: B) were successfully revascularized by OPCAB.
Results: The number of distal anastomoses/patient was comparable between groups (A: 3.6±0.9, B: 3.8±0.8). Emergency operation was carried out significantly more frequently in group A (4/13, 30%) than in group B (24/443, 5.4%, p<0.05). Unstable angina was present in all patients in group A (100%) versus 35% (155/443) in group B (p<0.05). Eight out of nine patients in group A with a critical stenosis of the LAD had to be converted to CPB at the beginning of the procedure during the mobilization of the heart to expose the LAD. All 8 patients received a mammary graft to the LAD. Early mortality was 7.7% in group A (1/13) and 1.6% in group B (7/443, p<0.05). The incidence of perioperative myocardial infarction was 15% (2/13) in group A versus 3.3% in group B (15/443, p<0.05).
Conclusions: Conversion to CPB is required in a small number of patients planed for OPCAB. In high-risk patients with unstable angina undergoing emergency operation, critical stenosis of the LAD seems to predict the need for conversion to CPB. After successful off-pump revascularization of the LAD followed by the RCA, conversion to CPB is negligible during grafting the circumflex territory.