OFF PUMP CORONARY ARTERY BYPASS AT UNIVERSITAS HOSPITAL

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OFF PUMP CORONARY ARTERY BYPASS AT UNIVERSITAS
HOSPITAL
Dr W De Vries. DEPARTMENT CARDIOTHORACIC SURGERY
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INTRODUCTION
For the past 3 decades Conventional Coronary
artery bypass- With heart lung machine has been
the golden standard
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INTRODUCTION
SIRS GLOBAL ISCHEMIA
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INTRODUCTION
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INTRODUCTION
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INTRODUCTION
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INTRODUCTION
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INTRODUCTION
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Pericardial Traction Stitch
LIMA
Snares
LIMA Anstomosis
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OPCAB

• AIM
• - What is the mortality and morbidity compared to
  CABG
• - Is the procedure feasible at our unit

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OPCAB

• AIM
• - What is the mortality and morbidity compared to
  CABG
• - Is the procedure feasible at our unit

• Methods
• - 3 Year period , records of patients were
  prospectively entered in a database , according
  to the criteria of the STS

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OPCAB

• AIM
• - What is the mortality and morbidity compared to
  CABG
• - Is the procedure feasible at our unit

• Methods
• - 3 Year period , records of patients were
  prospectively entered in a database , according
  to the criteria of the STS

• Total 809 patients - OPCAB(104) - CABG(705)

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Patient Characteristics
OBCAB()
CABG()
P
N 104
N705
0,06 0,08 0,72 0,08
60.4(35-82) 31 (29.8) 60 (57,6) 19
(18,2) 35 (33,6)
Age gt70 50-69 lt50 GENDER Female
60(24-84) 153 (21) 467 (66) 119
(16,8) 181 (25,6)
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Patient Characteristics
OPCAB(104)
CABG(704)
P
N

N

Smoking Diabetes Previous CVA Renal
Failure Obesity COPD NYHA III or IV CCS III or
IV Previous MI Angina Stable Unstable
Asymptomatic
57 16 6 9 4 12 35 40 57 27 68 9
54.8 15,3 5,7 8,6 3,8 11,5 33,6 38,4 54,
8 25,9 65,3 8,6
417 134 61 29 44 48 263 393 415 171 450 82
59,1 19 8,6 4,1 6,2 0,9 37,3 55,7 58,8
24,5 63.8 11,6
0,46 0,37 0,31 0,04 0,33 0,08 0,47 0,0009 0,85
0,75 0,75 0,35
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Previous Interventions
OPCAB
CABG
N104
N705
P


Procedures
CABG First Operation Reop 1 Reop 2 Reop
3 Unknown Total Previous Stent Previous PTCA
957 0 1 1 104 10 6
64151 2 4 7 705 27 56
91,36,70,0 0,9 0.9 9,6 5,7
90,97,20,2 0,5 0,9 3,8 7,9
0,880,830,28 0,63 0,87 0,08 0,43
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Vessels Affected
OPCAB(104)
CABG(705)
P
N

N

19 50 32 13 3
18 48 30 12.5 2.8
34 145 467 87 57
4.8 23 66 12.3 8.0
0.0002 0.0001 0.0001 0.96 0.05
Single Double Triple Left Main Unkown
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Vessels Done
OPCAB(104)
CABG(705)
P
N

N

0,0001 0.11 0.06 lt0,00 lt0,006 lt0,001 lt0,001 0,03
0,03 0,15 lt0,004
No Dist Anast 6 5 4 3 2 1 LIMA
Single Double None Radial
2,1 0 1 8 21 50 20 78 2 21 4
(1-5) 0 0,9 12.5 2.8 48 19,2 75 1,9 20 3
,8
(1-6) 0,14 4,9 27.9 39,2 16,3 3,2 59 7,6
26 0,4
3,1 1 35 197 277 115 23 422 54 88 3
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Aortic Balloonpump
CABG
OPCAB
N104
N705


P
Indications
Low CO (preop)LowCo (postop)PTCA Supp Unstable
Angina Prophylactic Total
00012 1 13
158377 8 103
00011 0,9 12,5
2.11.10.410 1.1 14,6
0.34 0.870.46 0.85 0.87 0.87
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RESULTS
OPCAB(104)
CABG(704)
P
N

N

Bloodloss Bloodloss gt 500 ml Blood
transfusion NEUROLOGICAL Disorientation
Permanent Stroke Transient ischemic RYTHM
atrium fibrillation Block Ventricular
extrasystoles Reoperation Reason reop -
Graft occ Post myocardial infarction
Mortality
377 30 39 1 1 0 9 0 2 3 1 2 3
28,8 37,5 0,9 0,9 0 8,6 0 1,9 2,8 0,9
1,9 0,9
478 205 348 7 15 4 110 2 17 17 2 4 29
29,0 49,3 0,9 2,1 0,56 15,6 0,2 2,4 2,
4 0,2 0,5 4,1
0,99 0,94 0,002 0,72 0,36 0,49 0,06 0,25 0,75 0
,77 0,28 0,13 0,11
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Results ..Inotropes
OPCAB
CABG
N104
N705


P
Indications
Inotropic support No Inotropic supportUnknown
Dopamine lt 5ug/kg Dopamine 5 -10 ug/kg
Dopamine gt 10 ug/kg Phenylephrine Adrenaline Anti
arrhytmic
7130341 24 03 4 1
6551139201 431 2 98 57 37
68,228.82.8 38 23 02.8 3.8 0.9
921.55.528.5 61.1 0.0113.9 8.0 5.2
lt0,001 lt0.001 0.250.020.010.28 0.001 0.12 0.05
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RESULTS Cont.
OPCAB(104)
CABG(704)
P
N

N

0,4 1,9 0,1 2,6 0 0,56 2,2 2,4 82 1,8
1,1 0,5 82 4,1
RENAL New Failure Ventilation gt 5 days
Pneumonia Lengthy pleural drainage
Chylothorax ARDS Sternum Dehicence ICU
lt2 days 2- 5 days 6-10 days
gt 10 days Hospital lt5days 5-10
days gt 10 days
1 1 2 3 1 0 8 34 60 3 2 15 78 17
0,9 0,9 1,9 2,8 0,9 0 5,7 32 57 2,8 1,9
14,4 75 16,3
3 14 1 16 0 4 16 19 584 13 8 48 583 110
0,46 0,46 0,006 0,69 0,11 0,63 0,03 lt0,001 lt0,00
1 0,47 0,46 0,006 0,05 0,85
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Conclusion
OPCAB is a feasable procedure in our Unit , our
learning curve was not steep . The Morbidity was
the same in the two groups with a tendencay
towards a lower mortality in the OPCAB patients.

• Less use of blood and bloodproducts
• Shorther ICU and Hospital Stay
• Less Inotropic Support (Less Myocardial Damage)
• Less SIRS
• Cost - Reduction of R20,000 / patient

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82(65)
34(27)
8(6)
1(0.8)
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