Abstrakt

Off-pump versus on-pump coronary artery by-pass surgery in patient with left main coronary artery disease

Kazi Zahidul Hoque1*, Masumul Gani Chowdhury, Ashraful Islam, Makbul Hossain, Md. Mostafizur Rahman, Sohail Ahmed, Lieutenant Colonel Md. Zakir Hossain

Introduction: Coronary artery bypass surgery both conventional method (Conventional Coronary Artery Bypass surgery-CCAB) and off-pump method (Off-pump Coronary Artery Bypass Surgery-OPCAB) are frequently performed operation especially in our National Institute of Cardiovascular Disease and Hospital. Surgical attempts at increasing blood flow to the ischemic myocardium originated a century ago when Alexis Carrel anastomosed a carotid artery segment between the descending aorta and the left coronary artery. Objective: To evaluate the safety of off-pump coronary artery bypass grafting in patient with left main coronary artery disease. Patients and Methods: The study was conducted in the department of Cardiovascular Surgery, National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh. A Prospective Nonrandomized clinical study From January 2006 to November 2007. Study population the patients with ischemic heart disease with left main coronary artery disease who underwent off pump and on pump CABG in NICVD. Non probability sampling technique. Total Sample Size number of selected patients was sixty. Thirty patients in each group. Results: This study was performed to reiterate the same inference that OPCAB technique is safe and effective in our country context to treat surgically in patients with left main coronary artery disease. This study was performed in NICVD, Dhaka, Bangladesh which included 60 patients of coronary artery disease with left main stem stenosis. In group I age range from 40 to 70 years with a mean ± SD of 51.5 ± 7.3 years. Total operation time in group I median value is 137.1 ± 30.7 and in group II 241.0 ± 21.6, in chi square test P value was found statistically significant (p<.05) means less time was taken in off pump group to complete entire operation. The median value of total number of graft given in group I is 2.6±0.9 and 3.3±0.5 in group II. Unpaired t test is performed for LVIDd, LVIds, EF value and Chi square test is performed for wall motion abnormality value. No statistically significant(p>.#5) difference is found among two groups in successive three months which means either off pump or on pump technique of CABG do not cause any effect on LVIDd, LVIDs, EF and wall motion abnormality change post operatively in CABG patients. Conclusion: In our institution more than a decade has almost over since the start of OPCAB surgery with gradual success and integrity. However development of new technology and strategy for off pump bypass surgery eliminated few obstacles in the pathway of progress.