Ten year experience of using a novel metabolic protocol in ‘off pump’ coronary artery bypass revascularization

David J. Perkowski, Susan Wagner, Kathryn Muller, Joseph R. Schneider, J. A St Cyr

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Assessment of both short- and long-term outcomes in patients undergoing off-pump coronary artery bypass using a perioperative metabolic protocol. Methods: A total of 975 of 995 adult patients underwent coronary artery bypass ‘off-pump’ from 1997 through 2006. Patients presenting in cardiogenic shock were excluded from this assessment. A perioperative metabolic protocol, which included the implementation of allopurinol, insulin supplementation, magnesium sulfate, supplemental corticosteroids, milrinone, norepinephrine (prn), aspirin, clopidogrel, statins and β-blockers, was used in these patients. Results: The mean age at the time of surgery was 70.5 years and the average number of bypass grafts was 4 per procedure; 18% (n = 176) of the cases had a preoperative intra-aortic balloon pump inserted for hemodynamic instability, tight left main coronary artery stenosis or angina. The 30-day mortality was 1.8% versus a Society of Thoracic Surgeons (STS) predicted mortality of 4.8%. Left main coronary artery disease was present in 38% (n = 371) of the patients. No strokes occurred intra-operatively and the postoperative incidence of stroke was 0.9% (n = 9). Incidence of renal failure requiring dialysis was 0.8% (n = 8). There was a single sternal infection. Mean follow up was 65 months with a survival rate of 90% (n = 955). Re-intervention, which commonly involved PTCA ± stent placement or re-do coronary artery bypass grafting (CABG), was 4% at 1 year and 11.6% (n = 113) during the 65-month follow-up period. Off-pump coronary artery bypass coupled with this novel metabolic protocol was associated with a low operative mortality and acceptable perioperative morbidities, including patients with left main coronary artery disease. These benefits are apparent at both short- and medium-term follow up.

Original languageEnglish (US)
Pages (from-to)336-341
Number of pages6
JournalTherapeutic Advances in Cardiovascular Disease
Volume9
Issue number6
DOIs
StatePublished - Dec 2015

Keywords

  • coronary artery bypass
  • metabolic
  • mortality
  • off-pump
  • revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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