Off Pump CABG

[BobBarker]

Did one today. Thought it was a really fun case. Have to follow the surgery and definitely anticipate where things were going. Had to definitely titrate the drips!

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[Idiopathic]

its funny how youve been reading peoples posts for 5 years and you learn today they did their first OPCAB

 

[BobBarker]

I looked at it like a boxing match. Won more rounds than I lost, and the judges decided in my favor as the perfusionist enjoyed his day reading the Da Vinci Code. First time in a long time I have left a case thinking that was very challenging and fun.

 

[Oggg]

After my first OPCAB in private practice, I rewarded myself with Lagavulin 16yr

 

[BobBarker]

After my first OPCAB in private practice, I rewarded myself with Lagavulin 16yr

Sarcasm noted, appreciated. I rewarded myself with a hotdog from the snackbar at Sam's Club.

 

[Oggg]

? No sarcasm actually.

 

[sevoflurane]

I don't really mess around too much with vasoactive drips. Usually it's 1-2 vessels and the protoplasm is of decent quality (proper selection). A lot of the hemodynamic changes are due to mugging of the heart and going up and down on drip infisions can be combersome. A background infusion to keep pressures up is good... A stick of NTG and a stick of a pressor du juor come in handy.


OPCAB = CVICU @ 900am = 🙂

Def. a fun case.

 

[Noyac]

When I trained I was taught that OPCAGB was only for the healthy hearts like Sevo said. When I got to PP I was surprised to see that we chose the most sickly of hearts for OP as well. Actually, the only time we went on pump was for valves and the occasion crumpling pt that isn't tolerating the OP procedure which was pretty rare. Things got much less hemodynamically challenging when the cardiac stabilizer changed from the suction type to the type without suction ( don't know the actual name of it).
My approach was Aline, Swan, lg IV. Start a Lido drip and give some Mg. Syringe cowboy the rest. Usually used neo throughout the case as needed from a syringe. Occasionally needed NTG bumps but if that occurred I usually just started a drip as it would most likely be needed. Probably went to ICU on a dobutamine drip 80% of the time. Dobutamine was usually weaned off over the next 6-12 hrs. Pt extubated within 6 hrs but a few would be extubated in the OR.
In my opinion, these are much more fun that the pump cases. On a good day, we would do 3 in a room before 5pm. At least one would be sick as ****.

 

[BobBarker]

We had the octopus with suction. The surgeons goal is to do everyone off pump.

 

[OB1🤙]

I go back and forth on whether I like these. Some days they're a fun challenge. Some days they're a huge pain in my ass.

Until the long-term patency data looks better, if (or when) I need my own CABG, I'd rather get the pump run.

 

[Oggg]

Our surgeons say their patency rates are perfect. They say OPCAB is not for every surgeon. But of course they woul say that.

They like doing 3 vessels, and we will usually get to ICU at 1pm 🙁

 

[BobBarker]

Our surgeons say their patency rates are perfect. They say OPCAB is not for every surgeon. But of course they woul say that.

They like doing 3 vessels, and we will usually get to ICU at 1pm 🙁

Yes, same time for us!

 

[sevoflurane]

Our surgeons say their patency rates are perfect. They say OPCAB is not for every surgeon. But of course they woul say that.

They like doing 3 vessels, and we will usually get to ICU at 1pm 🙁

I would question the surgeons OPCAB patency rates if they are taking until 1pm for an off pump case. That is a loooooooong time. 😱

6:30-11:30 is pretty typical for an ON pump 3-5 vessel CABG. For a 1pm end time you'd have to add a Maze procedure and a valve.

 

[Noyac]

I agree, that s a long time for OP. the surgeons skill is a huge factor in this case. Patency is an often discussed issue. All surgeons claim to have better outcomes than the data but the fact is they don't or that don't follow their pts close enough. I really don't know how I would have my CaBG done if I were to need one.
The octopus retractor was the one I was talking about. I found that it caused more hemodynamics insults when in place and if your surgeons are taking as long as you stated I'm sure there are some wicked hickies (?) on the heart. We used the one that had a surface like the rough side of Velcro. It gently pressed down on the myocardium instead of sucking the myocardium up to the retractor. I found that pressing the heart down slightly allowed for better hemodynamics than sucking it upward. Not that it really pulls the heart up much but that little bit seemed to make a difference. Obviously, just my impression.