מתוך medicontext.co.il
By Joene Hendry
WESTPORT, CT (Reuters Health) – Coronary artery bypass grafting (CABG) without cardiopulmonary bypass may be more appropriate than conventional bypass surgery for patients with the highest risk of stroke or renal failure, Dr. Dale R. Levy reported Sunday. He spoke at the American Heart Association's Third Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke in Washington, DC.
Dr. Levy and colleagues at University Hospitals of Cleveland prospectively analyzed the outcomes of 687 patients who underwent CABG between January 2000 and June 2001. Fifty-three percent of the patients had off-pump surgery based on the surgeon's preference.
"Almost twice as many patients in the off-pump group had a history of stroke" compared with those in the on-pump group, Dr. Levy told Reuters Health. He added that the incidence of cerebral vascular disease was one and one-half times higher and the incidence of renal failure was nearly three times higher in the off-pump group.
"These findings indicate that surgeons are choosing patients that have a higher degree of coexisting medical problems for the off-pump procedure," he said.
The investigators found no difference between groups in the incidence of mortality, atrial fibrillation, postoperative bleeding, transfusion needs, or perioperative myocardial infarction. In the off-pump group, Dr. Levy's team did note a reduction in the length of ICU stay and the overall length of hospital stay as well as a slightly reduced time to extubation.
Dr. Levy concludes that off-pump CABG is a safe procedure. "The greatest benefit," he said, "is to patients with renal failure, cerebral vascular disease and peripheral vascular disease."
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