Original article: cardiovascular
One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: early and midterm follow-up

https://doi.org/10.1016/S0003-4975(01)02798-9Get rights and content

Abstract

Background. The aim of this study was to compare hospital, early, and late clinical outcomes for patients undergoing one-stage, coronary and abdominal aortic surgical intervention with and without cardiopulmonary bypass.

Methods. From March 1990 to September 1999, 42 consecutive patients underwent combined operations at a single institution. Cardiopulmonary bypass and cardioplegic arrest were used during coronary revascularization in the first 20 patients (on-pump group), and the next 22 patients received the one-stage operations on the beating heart (off-pump group).

Results. Baseline characteristics were similar between groups. Three cardiac-related hospital deaths occurred in the on-pump group and one such death in the off-pump group (p = 0.25). Cardiac-related events, pulmonary complications, inotropic support, blood loss and transfusion requirements, intensive care unit stay, and hospital stay were significantly reduced in the off-pump group (all, p < 0.05). The actuarial survival rates in the on-pump and off-pump groups were 80% and 95%, respectively, at 1 year (p = 0.13) and 75% and 89%, respectively, at 3 years (p = 0.22). Freedom from cardiac-related events at 1-year follow-up was 91% in the off-pump group and 65% in the on-pump group (p < 0.05). No difference in cardiac-related events between groups was observed at 3 years.

Conclusions. Off-pump coronary surgical procedures decrease postoperative complications in high-risk patients undergoing simultaneous coronary and abdominal aortic operations compared with the conventional one-stage procedure. The early benefits achieved with off-pump surgical intervention are not at the expense of the long-term clinical outcome.

Section snippets

Material and methods

Our unit accepts patients referred from the southwest region of Italy. Routine practice includes cardiac and major vascular operation. Therefore, in the presence of concomitant symptoms in different vascular territories, patients undergo complete investigation, which includes cardiac catheterization, abdominal computed tomographic scanning, and aortic and peripheral angiography, where appropriate. The combined approach was used for patients with CAD (Canadian Cardiovascular Society class III to

Results

Baseline and operative characteristics are shown in Table 1, Table 2, respectively. Twenty-eight patients (13 on-pump group, 15 off-pump group) were seen with a history of previous MI. Of the 11 patients with AOD, only one patient in each group presented with signs of lower limb ischemia, whereas the remnant had intermittent claudication. No differences were observed between groups in regard to mean number of grafts placed and distribution of grafts. One patient (aged 58 years) in the off-pump

Comment

Severe correctable CAD is identified in a third of patients with abdominal aortic disease 9, 27. The mortality rate is reported to be 10% ± 20% in elderly high-risk patients undergoing conventional CABG and in elderly high-risk patients seen with poor left ventricular function, a heavily calcified aorta, or associated cerebral, pulmonary, renal, hepatic, and vascular comorbid diseases 28, 29. Conversely, OPCAB avoids exposure to the detrimental effects of CPB and cardioplegic arrest on

References (34)

Cited by (29)

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