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Abstract

Background: Off-pump coronary artery bypass graft (CABG) surgery is supposed to reduce perioperativemortality and morbidity compared with on-pump coronary bypass graft surgery. The causes ofhemodynamic collapse during off-pump coronary artery bypass (OPCAB) remain scarcely defined. Wepresent an analysis of 7 cases who were converted to conventional CABG due to sustained hemodynamiccollapse or else, during elective off- pump CABG.Method: During a 12-month period, we performed 77 elective OPCAB procedures through a sternotomy,constituting 56.2% of the total CABG procedures performed. Six patients (1.6%) experienced hemodynamiccollapse intra-operatively and one (0.23%) electively requiring immediate cardiopulmonary bypass.Preoperative characteristics, intraoperative data, and postoperative outcome were retrospectively reviewed.Results: In all cases, improvements in intra-operative technique and/or judgment could be maderetrospectively. Six of these patients were converted in emergency, and one electively to cardiopulmonarybypass. Three (3/77) patients had an unstable course and did not survive operation.Conclusions: The causes of hemodynamic collapse during elective OPCAB were ischemic, mechanical, or acombination of both. Based on these results, strong consideration should be given for a planned strategy ofCPB in high risk patients.