ĐÁNH GIÁ KẾT QUẢ NGẮN HẠN SỬ DỤNG HAI ĐỘNG MẠCH NGỰC TRONG CHO PHẪU THUẬT BẮC CẦU MẠCH VÀNH KHÔNG SỬ DỤNG TUẦN HOÀN NGOÀI CƠ THỂ

Abstract

Introduction: Off-pump coronary artery bypass graft surgery with bilateral internal mammary artery graft is a still-controversial. We presented in this study our institutional experience in using bilateral internal mammary artery graft in coronary bypass to achieve complete revascularization. Method: We conducted a prospective study on 389 patients who underwent off-pump coronary artery bypass graft surgery at the Heart Institute of Ho Chi Minh city from Dec 2018 to Sep 2022. The mean age was 62.4 with male patients 73%. The most common comorbidities are hypertension (80%), hyperlipidemia (44%), and diabetes (31%). Majority of patients (71,2%) presented with unstable angina. 262 patients had left main disease and triple vessels disease. The mean pre-op EuroScore II index was 1,19. The mean left ventricular ejection fraction was 56.9 ± 13.3%. The most bilateral mammary artery composite graft configuration was the Y graft (85%). 229 patients were added graft by great saphenous vein. The mean bypass per patient was 2,9 ± 0,6. Two patients were required to convert to on-pump intraoperatively. Bacteremia (17 patients), and pneumonia (19 patients) are the two most common postoperative complications. Five patients developed severe heart failure that required intra-aortic balloon pump. Two patients died because of severe heart failure concurrent with bacteremia. At the three-month follow-up, 90% of the patient were in NYHA II and none of the patients had recurrent chest pain. Conclusion: Off-pump coronary artery bypass graft surgery using bilateral internal mammary artery graft is safe and effective for high-risk patients. This procedure can achieve total revascularization and have good outcomes.