Kamales Kumar Saha1, Ram P Kaushal2, Ajay Kumar3, Mandar Deval4, Kakalee K Saha5, Shibban K Kaul4. 1. Private practice in multiple private hospitals in Mumbai, India Fortis SL Raheja Hospital, Mumbai, India MGM Medical College, Navi Mumbai, India. 2. Gandhi Medical College, Bhopal, India. 3. Private practice in multiple private hospitals in Mumbai, India. 4. MGM Medical College, Navi Mumbai, India. 5. Private practice in multiple private hospitals in Mumbai, India kamalessk@gmail.com.
Abstract
BACKGROUND: Off-pump coronary artery bypass techniques have evolved in the past decade, but there are some concerns about hemodynamic decompensation requiring conversion to cardiopulmonary bypass. These conversions are associated with higher morbidity and mortality. We use an intraaortic balloon pump to treat ischemia-induced hemodynamic instability and arrhythmias during off-pump coronary artery bypass. The objective of this study was to assess the impact of intraaortic balloon pump use in off-pump coronary artery bypass to prevent emergency conversion to cardiopulmonary bypass. METHODS: Data of 529 consecutive unselected patients who underwent isolated coronary artery bypass were included in this retrospective study of prospectively collected data and operation notes. Complete revascularization was performed using an off-pump technique. All arterial grafts using bilateral internal mammary arteries, and aortic no-touch technique were preferred. If the clinical situation demanded, vein grafts were used. During the procedure, any hemodynamic compromise not responding to conventional inotropic therapy was treated with intraaortic balloon pump insertion. RESULTS: Complete revascularization was possible in all 529 patients. An intraaortic balloon pump was inserted in 33 (6.2%) patients to treat hemodynamic instability; in all cases, conversion to cardiopulmonary bypass was avoided and complete revascularization was achieved. CONCLUSION: For treating hemodynamic instability during off-pump coronary artery bypass, we recommend intraaortic balloon pump insertion as the preferred bail-out method rather than conversion to cardiopulmonary bypass.
BACKGROUND: Off-pump coronary artery bypass techniques have evolved in the past decade, but there are some concerns about hemodynamic decompensation requiring conversion to cardiopulmonary bypass. These conversions are associated with higher morbidity and mortality. We use an intraaortic balloon pump to treat ischemia-induced hemodynamic instability and arrhythmias during off-pump coronary artery bypass. The objective of this study was to assess the impact of intraaortic balloon pump use in off-pump coronary artery bypass to prevent emergency conversion to cardiopulmonary bypass. METHODS: Data of 529 consecutive unselected patients who underwent isolated coronary artery bypass were included in this retrospective study of prospectively collected data and operation notes. Complete revascularization was performed using an off-pump technique. All arterial grafts using bilateral internal mammary arteries, and aortic no-touch technique were preferred. If the clinical situation demanded, vein grafts were used. During the procedure, any hemodynamic compromise not responding to conventional inotropic therapy was treated with intraaortic balloon pump insertion. RESULTS: Complete revascularization was possible in all 529 patients. An intraaortic balloon pump was inserted in 33 (6.2%) patients to treat hemodynamic instability; in all cases, conversion to cardiopulmonary bypass was avoided and complete revascularization was achieved. CONCLUSION: For treating hemodynamic instability during off-pump coronary artery bypass, we recommend intraaortic balloon pump insertion as the preferred bail-out method rather than conversion to cardiopulmonary bypass.