OFF-PUMP CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH CORONARY HEART DISEASE AND CONCOMITANT VALVULAR HEART DISEASE

Highlights

The relevance of the study is determined by the high importance of optimizing surgical approaches to treating patients with coronary artery disease and concomitant valve lesions: comparing myocardial revascularization techniques on a beating heart (OPCABG) and under conditions of extracorporeal circulation (ONCABG) allows identifying a strategy that ensures a reduction in intraoperative risks (shortening the time of aortic clamping and extracorporeal circulation), decreasing the need for blood transfusion, and reducing the duration of surgery and hospital stay. This collectively enhances the safety of the intervention and improves treatment outcomes for this complex category of patients.

Aim. To compare the results of myocardial revascularisation (MR) in the working heart (OPCABG) with MR on cardiopulmonary bypass (ONCABG) in patients with coronary heart disease (CHD) and combined mitral and aortic valve damage.

Methods. The study included 132 patients with CAD and concomitant valvular heart disease who underwent one-stage revascularization and valve surgery. Patients were divided into 4 groups: ONCABG + AV (n = 36); OPCABG + AV (n = 36); ONCABG + MV (n = 31); OPCABG + MV (n = 29).

Results. The OPCABG technique demonstrated several advantages over the ONCABG technique: shorter aortic cross-clamp time (AV: 106,4 ± 25,1 min vs 83,3 ± 24,7 min / MV: 115,6 ± 21,9 min vs 84,07 ± 21,3 min, p < 0.05), reduced CPB time (AV: 139,4 ± 26,8 min vs 123,5 ± 25 min / MV: 166,2 ± 32,7 min vs 133,2 ± 34,9 min, p < 0.05), and shorter total operation time (AV: 336,1 ± 66,4 min vs 306,4 ± 71 min / MV: 352,5 ± 100,7 min vs 298,1 ± 84 min, p = 0.07). There was also a lower need for blood and blood product transfusions: packed red blood cells (AV: 2,56 ± 0,84 vs 2,2 ± 0,47 / MV: 2,81 ± 0,47 vs 2,38 ± 0,56); erythrocyte concentrate (AV: 2,36 ± 0,48 vs 1,94 ± 0,53 / MV: 2,23 ± 0,49 vs 1,83 ± 0,35), respectively p < 0.05, and a trend towards a shorter length of hospital stay (AV: 16,6 ± 6,68 vs 13,7 ± 4,3 / MV: 17,5 ± 6,4 vs 13,5 ± 4,8).

Conclusions. Coronary artery bypass grafting on the beating heart in patients with concomitant valvular heart disease demonstrated several important advantages: it is a safe and effective technique that can be successfully applied in clinical practice, which in turn reduces aortic cross-clamp time, cardiopulmonary bypass time, operation time, transfusion requirements, and length of hospital stay.

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