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Patient Selection and Technical Considerations for Off-Pump Coronary Surgery

2003; Taylor & Francis; Volume: 16; Issue: 3 Linguagem: Inglês

10.1080/08998280.2003.11927916

1525-3252

Amit N. Patel, Federico Benetti, Baron L. Hamman,

Cardiac Valve Diseases and Treatments

The first successful operations on the coronary arteries were done without the assistance of extracorporeal circulation. Many published reports described operations performed while the heart continued beating (1–8). Advances in cardiopulmonary bypass (CPB) technology, myocardial protection, and cardiopulmonary support allowed surgeons to operate on these arteries with greater precision. It is widely accepted that the single most important development in cardiac surgery was the introduction and refinement of extracorporeal circulation via CPB. Event-free survival rates in cardiac surgery dramatically improved with advancements in myocardial protection that allowed operating in a quiet, motionless, and bloodless field. More recently, advances in 2 competing strategies, coronary artery bypass grafting (CABG) surgery and catheter-based intervention, have led to many debates regarding the optimal treatment of ischemic coronary artery disease. CABG has resulted in longer survival, better quality of life, and long-term event-free survival in patients with multivessel coronary artery disease (9–11). But what is old is new again. The option of not using the pump was the underlying assumption in the development of the concept of minimally invasive coronary surgery. Reports regarding systemic effects of CPB abound in the literature of the past 17 years. Such effects include hematologic, metabolic, pulmonary, cardiac, and cognitive dysfunctions (12–21).