Results of off-pump myocardial revascularization in patients with ccute coronary syndrome

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Sharipov I. M., Yarbekov R. R., Ismatov A. A., Muradov M. M., Omonov S. K., Vakhidov T. Z.

Republican Specialized Center of Cardiology (Tashkent, Uzbekistan);

OBJECTIVE Conventional on-pump coronary artery bypass surgery (CABG) in patients with acute coronary syndrome (ACS) is associated with higher risk of complications and mortality. The aim of the study was to assess feasibility of off-pump myocardial revascularization operations in patients with ACS. MATERIAL AND METHODS A comparative analysis of the results of off-pump myocardial revascularization surgery in 350 patients operated on at our centre was done. All the patients were divided into two groups according to the presence of ACS – Group I - 108 patients with ACS (30.8%) and Group II - 242 patients with stable angina (69.2%). Both groups were similar by age, gender and clinical and functional parameters. Fourty-five patients of the 1st group (41.7%) and one hundred-six patients of the 2nd group (43.8%) had left mainstem coronary artery disease. RESULTS The mean quantity of grafts in patients of the 1st group was 3,18±0,72 (range, 1 to 5 grafts) and 3,07±0,68 in the 2nd group (range, 1 to 5 grafts). The mean duration of the operations in the 1st and 2nd group was 266.3 + 10.9 mins and 254.6 + 12.2 mins, respectively (p=0.625). Inotropic support was required intraoperatively and immediately after surgery in 46 patients of the 1st group (42.6%) and in 59 patients of the 2nd group (24.4%) (p=0.09). The mean ICU stay was 50.2+4.1 hours in the 1st group and 42.3+2.1 hours in the 2nd group. There was no significant difference in quantity of non-fatal complications which occurred in 12 patients (11.1%) of the 1st and 26 patients (10.7%) of the 2nd group (p=0.333). Mortality was 2 patients (1.5%) in the I group and 2 patients (0.9%) in the II group (p=0.212). CONCLUSIONS Although the inotropic support was required more often in the patients with ACS, the overall results of off-pump myocardial revascularization surgery in our patients showed no statistical difference between the groups. This supports the view that off-pump myocardial revascularization is a feasible option in patients with ACS.

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