Surgical steps toward complete revascularization in off-pump coronary bypass.

Surgical techniques aimed at complete myocardial revascularization without the use of cardiopulmonary bypass are described. Between January 1998 and June 2000, coronary artery bypass was performed in 3,003 patients; an off-pump technique was used in 676 and cardiopulmonary bypass was employed in 2,327. Patient characteristics, demography, and preoperative risk factors of the two groups were compared retrospectively, and differences in operative variables and postoperative outcomes were analyzed.

Is low ejection fraction safe for off-pump coronary bypass operation?

Background: Does the manipulation of the heart during off-pump coronary artery bypass (OPCAB) procedure further compromise the hemodynamic stability of a patient with depressed left ventricular function compared with the conventional coronary artery bypass (CCAB) approach? Does this manipulation induce a more dramatic hypoperfused state that may contribute to an increase in the incidence of related complications or mortality? This retrospective review of data attempted to answer the above concern.

Methods: Between January 1, 1998, and June 30, 1999, 177 patients with ejection fractions of 30% or less underwent full sternotomy coronary artery bypass grafting at our institution. Of these patients, 45 underwent OPCAB procedures and 132 patients underwent CCAB.

Safety and efficacy of off-pump coronary artery bypass grafting.

Background: We evaluated the application of the off-pump coronary artery bypass (OPCAB) procedure relative to safety and efficiency as measured by operative mortality postoperative complications and longitudinal outcome.

Methods: Three hundred and fifty OPCAB patients were compared to 3,171 on-pump or conventional coronary artery bypass (CCAB) patients between January 1, 1997 and December 31, 1998. The groups were divided into three preoperative predicted risk categories: low-risk (0 to 2.

Comparison between port-access and less invasive valve surgery.

Background: Valvular operations have followed coronary artery bypass grafting as procedures that are amenable to a minimally invasive approach. This study is a review of our brief experiences of less invasive valve surgery (LIVS) through a partial sternotomy approach and port-access valve surgery (PAVS) with an attempt to compare safety and cost-effectiveness of the surgical procedure and post-discharge follow-up.

Methods: Forty PAVS and 66 LIVS procedures performed between May 1996 and December 1998 were reviewed.

Establishing and using a local/regional cardiac surgery database.

Background: In 1993, the Minnesota Society of Thoracic Surgeons and the Minnesota Cardiac Surgery Database were organized in response to a third-party payer demand for data about practice protocols and patient outcomes. It has matured to an active organization of 46 cardiothoracic surgeons, 14 institutions, and more than 7,000 patients who have undergone coronary artery bypass grafting.

Methods: Data are validated for completeness and accuracy through a statewide auditing process.