Off-pump coronary artery bypass grafting (OPCAB)

Abstract

Introduction: Off-pump coronary artery bypass or «beating heart» surgery is a form of coronary ar­tery bypass graft (CABG) surgery performed without cardiopulmonary bypass as treatment for cor­onary artery disease. When a cardiac surgeon chooses the CABG procedure off-pump, also known as OPCAB (Off-pump Coronary Artery Bypass), the heart is still beating while the graft attachments are made to bypass a blockage. Using the OPCAB technique for multi-vessel myocardial revascular­ization in high-risk patients significantly reduces the incidence of perioperative myocardial infarc­tion and other major complications. Even though the OPCAB group includes a significantly higher proportion of older patients with poor Left Ventricle (LV) function and renal problems, the benefi­cial effect of OPCAB is evident. Materials and methods: The case report describes a 75-year old man with class III angina pectoris, class II chronic left heart failure, class III hypertension, dyslipidaemia and LV hypertrophy who has been suffering from chest pain, breathlessness and easy tiredness. After cardiac catheterization, the patient was diagnosed with three vessel coronary artery disease. Due to the patient`s comorbidities, his age and the higher perioperative risk of conventional CABG, the patient was considered as suit­able for OPCAB surgery in planned order. Results: Blood flow in the coronary arteries was restored with four grafts - Left Internal Mammary Artery (LIMA) to Left Anterior Descending coronary artery (LAD), Right Coronary Artery (RCA) to Posterior Descending Coronary Artery (Pd) to First Marginal Branch of the circumflex coronary artery (OM1) to Ramus Intermedius Artery (RIM) - free Right Internal Mammary Artery (RIMA) jump. Proximally the free RIMA is anastomosed terminal-laterally to in situ LIMA. Postoperatively no rhythm or conduction disorders have been registered. Conclusion: OPCAB has advantages in reducing postoperative complications such as: systemic in­flammatory response and myocardial, renal and cerebral injuries compared to on-pump coronary ar­tery bypass grafting.