Masud Malik Waqar, Ullah Kifayat, Gohar Muhammad Ali, Siddique Sobia, Hameed Hira, Mansoor Tariq Muhammad, Iqbal Amir, Nisar Muhammad, Ur Rahman Ubaid, Abdul Haseeb Muhammad, Khan Fahad R
Cardiac Surgery, Peshawar Institute of Cardiology, Peshawar, PAK.
Cardiac Surgery, Armed Forces Institute of Cardiology, Rawalpindi, PAK.
Cureus. 2024 Nov 6;16(11):e73177. doi: 10.7759/cureus.73177. eCollection 2024 Nov.
This study evaluated the incidence, causes, and predictors of intraoperative conversion from off-pump coronary artery bypass grafting (OPCAB) to on-pump coronary artery bypass grafting (ONCAB), identifying risk factors to improve surgical planning.
This retrospective case-control study included patients who underwent OPCAB at the Peshawar Institute of Cardiology, Peshawar, Pakistan, between December 8, 2021, and December 7, 2023. Among 714 patients, 27 (3.78%) required conversion to ONCAB. For comparison, 108 (15.1%) controls were randomly selected from those who completed OPCAB successfully. Preoperative and intraoperative data were analyzed, and logistic regression identified predictors of conversion.
The most frequent cause of conversion was hemodynamic instability, which occurred in 18 (66.67%) cases. Persistent hypotension and ST-segment changes lasting approximately 10-20 minutes were primary indicators before conversion, highlighting the need for close intraoperative monitoring. Left main coronary artery stenosis of 50%-70% emerged as the only independent predictor of conversion (odds ratio (OR) 7.60, 95% CI: 2.91-19.83, p < 0.001). This study emphasizes the importance of robust patient selection criteria, especially for cases with borderline coronary anatomy.
Hemodynamic instability and moderate left main coronary artery stenosis significantly contribute to OPCAB-to-ONCAB conversion. Enhanced preoperative imaging and hemodynamic management protocols can potentially reduce conversion rates, improving surgical outcomes.
本研究评估了非体外循环冠状动脉旁路移植术（OPCAB）转为体外循环冠状动脉旁路移植术（ONCAB）的术中发生率、原因及预测因素，以识别风险因素来改进手术规划。
这项回顾性病例对照研究纳入了2021年12月8日至2023年12月7日在巴基斯坦白沙瓦心脏病学研究所接受OPCAB的患者。在714例患者中，27例（3.78%）需要转为ONCAB。为作比较，从成功完成OPCAB的患者中随机选取108例（15.1%）作为对照。分析术前和术中数据，并通过逻辑回归确定转为体外循环的预测因素。
转为体外循环最常见的原因是血流动力学不稳定，18例（66.67%）出现此情况。持续低血压和持续约10 - 20分钟的ST段改变是转为体外循环前的主要指标，突出了术中密切监测的必要性。50% - 70%的左主干冠状动脉狭窄是转为体外循环的唯一独立预测因素（比值比（OR）7.60，95%置信区间：2.91 - 19.83，p < 0.001）。本研究强调了严格的患者选择标准的重要性，尤其是对于冠状动脉解剖结构临界的病例。
血流动力学不稳定和中度左主干冠状动脉狭窄显著促成了从OPCAB转为ONCAB。加强术前影像学检查和血流动力学管理方案可能会降低转换率，改善手术结果。
