New CABG Hybrid Approach Safe, Effective

Pump-assisted direct coronary artery bypass grafting (PAD-CAB) is a safe and effective alternative to the traditional approaches commonly used with coronary artery bypass grafting (CABG), according to a recent study.

Findings were presented by Dr Louis Samuels on August 31, 2017, at the 19th Annual Cardiology Conference in Philadelphia, Pennsylvania.
____________________________________________________________________________________________________________________

RELATED CONTENT
Iron Levels Linked to Risk of Coronary Artery Disease
Does Ultrasound-Guided Stenting Improve Outcomes with Coronary Artery Disease?
____________________________________________________________________________________________________________________

Traditional approaches to CABG include cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest and totally off-pump (OP-CAB) without CPB. However, hybrid approaches like PAD-CAB with the aid of CPB could potentially eliminate the risks associated with aortic cross-clamping and cardioplegic arrest found in traditional approaches.

To further assess the safety and efficacy of this hybrid approach, Dr Samuels performed PAD-CAB on 317 patients between November 2003 and December 2016. The majority of patients were men, and mean patient age was 67 years. Dr Samuels performed each PAD-CAB procedure with standard CPB via sternotomy under normothermic conditions with the mean arterial pressures kept between 60 and 80 mmHg.

Outcomes including hospital mortality and specific major adverse events were measured and benchmarked against the Society of Thoracic Surgeons (STS) database. Also evaluated were a number of bypass grafts, status of the case, specific patient factors, and postoperative length of stay.

Results indicated that the outcomes associated with PAD-CAB were equivalent or superior to those reported in the STS registry for CABG. According to Dr Samuels, the mean ejection fraction (EF) was 50%, and 66 cases had an EF below 40%. A total of 277 (87.4%) cases were classified as non-emergent, while 40 (12.6%) cases were deemed emergent/salvage. The average of number of bypass grafts was 3.24, and the mean postoperative hospital length of stay was 7.5 days.

Two hospital deaths were reported, and major adverse events included 1 deep sternal wound infection, 3 cerebrovascular accidents, and 5 POBs.

“PAD-CAB is a safe and effective operation with outcomes that are equivalent or superior to the outcomes reported in the STS registry for CABG,” Dr Samuels concluded. “The PAD-CAB technique takes advantage of the circulatory stability achieved with CPB assistance and eliminates the potential risks associated with aortic cross-clamping and cardioplegic arrest.”

—Christina Vogt

Reference:

Samuels L. Pump-assisted beating-heart coronary artery bypass grafting: application and advantages. Paper presented at: 19th Annual Cardiology Conference; August 31-September 1, 2017. Philadelphia, PA. http://cardiac.conferenceseries.com/abstract/2017/pump-assisted-beating-heart-coronary-artery-bypass-grafting-application-and-advantages.