Preoperative risk factors of emergency conversion to artificial circulation during off-pump coronary artery bypass grafting in patients with ischemic congestive heart disease

• Main Authors: G. G. Khubulava, A. E. Sukharev, V. N. Kravchuk, A. M. Volkov, A. I. Lyubimov, E. A. Knyazev, A. S. Kusay, D. U. Romanovskiy, A. V. Birukov, V. I. Zvoznikov
• Format: Article
• Language: Russian
• Published: Pavlov First Saint Petersburg State Medical University 2020-05-01
• Series: Вестник хирургии имени И.И. Грекова
• Subjects: coronary artery disease; congestive heart failure; ischemic cardiomyopathy; coronary artery bypass grafting; risk factors
• Online Access: https://www.vestnik-grekova.ru/jour/article/view/1445
• ISSN: 0042-4625

INTRODUCTION.  Coronary  artery   bypass  surgery is  the  most   popular   method  of  surgical   treatment of  patients with chronic   heart   failure  of  ischemic  origin.  Modern   direction   of  developing  the  cardiac  surgery  in  treating   patients  with chronic  heart   failure  of  ischemic origin  is  «off-pump»   techniques. However,   the  high  risk  of  emergency  conversion  to«on  pump»   reduce the  availability  for using  «off pump»   techniques with this  kind  of patients. Preoperative risk  factors for  unplanned conversion to  cardiopulmonary bypass  have   not  been studied.The  OBJECTIVE  was  to  determine preoperative risk factors  of urgent  conversion to  bypass in patients with congestive ischemic heart   failure  during  off-pump  coronary artery  bypass  grafting.METHODS  AND MATERIALS. The  results of 44 coronary artery  bypass grafting  (CABG) off-pump  procedures in patients with  ischemic  cardiomyopathy were  retrospectively analyzed.  Emergent  conversion to  artificial  circulation  was   needed due   to  acute heart   failure  in  8  (18  %)  patients. All patients were   divided  into  2  groups depending on  the  necessity for  emergency using  the  cardiopulmonary bypass.  Then  the  patients’   preoperative status was  analyzed.RESULTS.   We  determined  that   the   risk  factors   of  emergent  conversion  to  cardiopulmonary bypass  were   observed in the  following cases:  patients after  70  years old  with a  combined left main  coronary artery  lesion  and  right  coronary artery  occlusion; left  ventricle  end-diastolic size  more  than  70  mm;  mild  mitral  insufficiency;  the  presence of  atrial  or ventricle  rhythm  disturbances;  EuroSCORE logistic  score more  than  4.9  %.CONCLUSION.  The  identified  risk  factors   allow  to  minimize  the  risk  of  urgent   conversion to  bypass circulation  during off-pump  myocardial revascularization  in  patients with  congestive  ischemic heart   failure.  When   these risk  factors   are present, it is  recommended to  use   on-pump or  on-pump beating  heart   techniques of  coronary artery  bypass  grafting in  these  patients.