Multivessel sequential bypass grafting without cardiopulmonary bypass |
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Authors: | NV Mandke MCh AN Mandke MD Z Nalladaru MCh M Singh MD A Chougule MCh A Swarup MCh |
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Institution: | (1) Department of Cardiovascular Surgery, Lilavati Hospital & Research Centre, Mumbai, India;(2) Department of Cardiovascular Anaesthesiology, Lilavati Hospital & Research Centre, Mumbai, INDIA;(3) Present address: Dept. of Cardiovascular Surgery, Lilavati Hospital & Research Centre, Bandra Reclamation, 400 050 Mumbai, India |
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Abstract: | Background Multivessel sequential coronary artery bypass grafting without cardiopulmonary bypass has become a reality. Initially the
revascularization of posterior coronary arteries (obtuse marginal branches of the circumflex artery) was difficult due to
access and difficulty in stabilization of the heart as well as compromising the haemodynamic status of the heart. With stabilization
of the heart with Octopus II (Medtronic, Inc. Minnesota, USA) we have demonstrated that sequential grafts as well as composite arterial grafts can easily and safely be used in complete
arterial revascularization of the myocardium.
Methods From January 1, 1996 till December 31, 1999, 832 consecutive patients underwent coronary artery bypass surgery without cardiopulmonary
bypass. From July 1998, seventy-nine patients operated had atleast 1 conduit used as a sequential graft and 12 patients had
composite ‘Y’ grafts. Before July 1999, 67 patients (61 sequential and 6 ‘Y’ conduits) underwent surgery without mechanical
stabilization (Group A) and after July 1999 in 24 patients (18 sequential and 6 ‘Y’ conduits) mechanical stabilization (Octopus
II) was used.
Results Total number of sequential anastomosis including composite grafts was not significantly different in both groups. But due
to Octopus II stabilization, number of anastomosis in composite ‘Y’ graft group significantly increased from 2.96 ±0.2 to
4.02 ±0.3. Also intramyocardial coronary artery revascularization which was only 10.4% in Group A increased to 20.8% in Group
B. In Group A only 8.9% composite grafts were performed while in Group B it was 25% which was statistically significant.
Conclusions Cardiac stabilization with Octopus II has improved ability for revascularization of remote coronary arteries arising from
circumflex. Although overall anastomoses have not increased, the number of patients receiving composite grafts using all arterial
conduits have increased significantly. Patency rates of all sequential conduits as well as composite grafts have remained
equally good in both groups. |
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Keywords: | CABG OPCAB Stabilisers |
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