Beta-Blockade in 200 Coronary Bypass Grafting Procedures

Abstract

Background: Continuous perfusion of the coronary arteries with high-dose β-blocker (esmolol)-enriched blood has been shown to represent an alternative for myocardial protection during coronary bypass grafting (CABG). Here, we will report on our experience in 200 unselected consecutive cases where this technique was used. Methods: Eighty percent of the patients (age: 63.3 ± 0.6 years, ejection fraction: 60 ± 1.2 %, emergency cases: 11 %) had 3-vessel disease, 34 % had a history of myocardial infarction within less than 90 days preoperatively. The Euro score amounted to 6 ± 0.3. During 52 ± 1.2 min of aortic cross-clamp time on normothermic cardiopulmonary bypass, 2.9 ± 0.1 distal anastomoses were performed on a slow hypocontractile beating heart induced by continuous infusion of 788 ± 20 mg esmolol per operation. All data: mean ± SEM. Results: Postoperatively, patients were ventilated for 25 ± 5.1 hours and stayed on ICU for 2.3 ± 0.3 days. The postoperative myocardial infarction rate was 4%. Patients left the hospital after 11.2 ± 0.4 days. Thirty-day mortality was 2.5 %, and 3-month mortality was 3 %. Conclusions: High-dose β-blockade is a safe and effective technique in CABG procedures. It may be especially advantageous in high-risk patients.

Key words

Beta-blocker - Myocardial protection - Coronary artery bypass grafting - High-risk patient - Cardiopulmonary bypass

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1 This paper was presented in part at the 3^rd Joint meeting of the German, Austrian and Swiss Societies for Thoracic and Cardiovascular Surgery in Lucerne on February 9 - 12, 2000