Off-pump Coronary Artery Bypass Graft in a High Risk Patient: Review of Anaesthetic Challenges

Abstract

On-pump coronary artery bypass graft (CABG) entails the use of cardiopulmonary bypass (CPB). The  procedure is safe but it’s not without complications like neurocognitive deficits, cerebrovascular accidents, myocardial ischemic injury and activation of inflammatory pathways that contribute to pulmonary, renal, hematologic damage and alterations in quality of life1, 2. Off-pump coronary artery bypass (OPCAB) offers a promising alternative strategy to reduce perioperative morbidity, mortality and cost by eliminating CPB. Presently, in Asia and particularly India, 95% of CABG are performed off-pump3. This is an account of the  anaesthetic challenges of OPCAB in a high risk patient, the major reason for the technique of choice being due to consideration of old age, recurrent myocardial infarction, chronic renal failure, diabetes and to obviate the attendant complications of CPB and these risk factors.

Key words: Off-pump Coronary Artery Bypass Graft, High risk patient, Anaesthetic challenges.