Our Summary

This research paper is about a study done on patients with acute coronary syndrome, a term used to describe conditions that occur when the blood supply to the heart muscle is suddenly blocked. These patients often need immediate heart surgery to restore blood flow.

Traditionally, this is done using a method called on-pump surgery, where the heart is stopped and a machine takes over the function of the heart and lungs. However, this study focuses on a different technique called heart-on-pump coronary artery bypass grafting. In this method, the heart continues to beat during the surgery with the support of a machine, and is performed under emergency conditions.

The study looked back at patients who had this type of surgery between 2011 and 2023. Out of 2816 patients, 411 had their surgeries done by the same surgical team using the heart-on-pump method.

The researchers found that on average, the surgery took place about 9.3 hours after the onset of a heart attack. They also noted that the average number of bypass grafts (segments of blood vessel taken from elsewhere in the body to replace blocked coronary arteries) applied was 4.0.

Of the patients studied, 16 died in the hospital and 26 experienced inadequate cardiac output syndrome, a condition where the heart can’t pump enough blood to meet the body’s needs. None of the patients with kidney dysfunction needed dialysis, a treatment to filter and purify the blood when the kidneys can’t do it. The average stay in intensive care was 3.2 days and in the hospital was 9.2 days.

Based on these findings, the researchers suggest that heart-on-pump surgery could be a good option for high-risk patients with severe coronary artery disease who need emergency bypass surgery.

FAQs

  1. What is the significance of heart-on-pump coronary artery bypass grafting in acute coronary syndrome patients?
  2. How many patients were involved in this retrospective analysis of heart-on-pump coronary artery bypass surgery?
  3. What were the results of the study in terms of patient mortality and post-surgery complications?

Doctor’s Tip

One helpful tip a doctor might tell a patient about heart bypass surgery is to follow a healthy lifestyle post-surgery to ensure the success of the procedure. This includes maintaining a balanced diet, engaging in regular exercise, quitting smoking, managing stress levels, and attending follow-up appointments with your healthcare provider. These measures can help improve your overall heart health and reduce the risk of future cardiovascular events.

Suitable For

Patients who are typically recommended for heart bypass surgery include those with acute coronary syndrome, multivessel coronary artery disease, and those who are at high risk for complications or have unstable angina. In particular, patients who require immediate revascularization and are not suitable candidates for conventional on-pump surgery may benefit from heart-on-pump coronary artery bypass grafting. This procedure may be considered in cases where cardioplegic arrest is not feasible or when there is a need for emergency coronary artery bypass surgery. Overall, heart bypass surgery may be recommended for patients who have significant coronary artery disease and are at risk for adverse cardiac events.

Timeline

Before heart bypass surgery:

  • Patient experiences symptoms of acute myocardial infarction (heart attack).
  • Patient is diagnosed with coronary artery disease and deemed in need of immediate revascularization.
  • Patient undergoes pre-operative evaluations and discussions with medical team.
  • Surgery is scheduled and patient is prepared for the procedure.

After heart bypass surgery:

  • Surgery is performed with the patient on-pump beating heart while on cardiopulmonary bypass support.
  • Mean of 4.0 grafts applied during surgery.
  • Mortality in hospitals calculated for sixteen patients.
  • Twenty-six patients develop inadequate cardiac output syndrome post-surgery.
  • Eight patients with renal dysfunction do not require hemodialysis.
  • Mean duration of stay in intensive care is 3.2 days, while mean length of hospitalization is 9.2 days.
  • Patient undergoes post-operative care and rehabilitation to recover from surgery.

What to Ask Your Doctor

  1. What are the risks and benefits of heart-on-pump coronary artery bypass grafting compared to conventional on-pump surgery for someone with acute coronary syndrome?

  2. How long does it typically take to recover from heart bypass surgery, and what should I expect during the recovery process?

  3. Are there any lifestyle changes or medications I should consider after undergoing heart bypass surgery?

  4. What follow-up appointments and tests will be necessary after the surgery to monitor my heart health?

  5. How will my overall quality of life be impacted by undergoing heart bypass surgery?

  6. What is the success rate of heart-on-pump coronary artery bypass grafting in patients with acute coronary syndrome?

  7. Are there any alternative treatment options to consider before deciding on heart bypass surgery?

  8. How experienced is the surgical team in performing heart-on-pump bypass surgery for patients with acute coronary syndrome?

  9. What are the potential complications or side effects that could arise from this type of surgery?

  10. What is the expected long-term outcome for someone who undergoes heart-on-pump coronary artery bypass grafting for acute coronary syndrome?

Reference

Authors: Kilic Y, Jalalzai I, Sonmez E, Erkut B. Journal: Heart Surg Forum. 2023 Dec 27;26(6):E808-E816. doi: 10.59958/hsf.6923. PMID: 38178340