Introduction: Ischemic heart disease is the most common form of heart disease. The incidence of ischemic heart disease is increasing rapidly. Among the various options of treatment of ischemic heart disease coronary artery bypass grafting (CABG) remains one of the standard modes of revascularization. Coronary artery bypass grafting can be done with or without using cardiopulmonary bypass (CPB). In off-pump coronary artery bypass (OPCAB) heart continues to beat except the portion to be anastomosed immobilized by commercially available stabilizing devices. Objective: To find out the Effect of Intact Pleura on Early Outcome after off-pump Coronary Artery Bypass Grafting. Methodology: This is a prospective observational study carried out at the Department of Cardiac surgery in Bangabandu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh for 2 years of period (from 1st August, 2017 to 31st July, 2019). This study was to compare postoperative early (up to 1 month) outcome of intact versus open pleura after off pump coronary artery bypass grafting (OPCAB). Adult patients (18-70 years) who are undergoing OPCAB in BSMMU during the study period. Forced expiratory volume in first second (FEV1) & Forced vital capacity. All data were recorded systematically in preformed data collection form (questionnaire). Statistical analyses were performed by using windows based computer software devised with Statistical Packages for Social Sciences (SPSS-25) (SPSS Inc, Chicago, IL, USA). Results: In this study, sixty patients aged 18-70 years admitted in Department of Cardiac Surgery, BSMMU who underwent OPCAB and fulfilled inclusion and exclusion criteria were selected for the study sample and divided into two groups. Groups I (n=30) consist of the patients who underwent OPCAB with pleurotomy and Group II (n=30) consists of patients who underwent OPCAB with intact pleura. During analysis, p value <0.05 was considered as significant. Patients having OPCAB with intact pleura showed lower incidence of atelectasis and pleural Effusion in 2nd postoperative & 5th postoperative day (p<0.05). Lower amount of chest tube drainage and transfusion requirement were observed in group II patients than Group I (530.00±28.97 vs. 485.96±38.62; p<0.05 and 611.23±99.22 vs. 577.93±135.38, p>0.05, respectively). Moreover, higher duration of ventilation were noted in group I (7.50±2.22 vs. 6.30±2.32, p<0.05). Beside these, total duration of ICU stay & hospital stay were significantly higher in patients OPCAB with open pleura (p<0.05). The major finding of the study was that intact pleura during OPCAB is associated with significantly better early outcome than who underwent pleurotomy during OPCAB. Conclusion: Keeping the pleura intact during OPCAB is significantly associated with low rate of atelectasis and pleural effusion. Clinically, it decreases postoperative amount of blood loss and significantly lowers ICU stay, mechanical ventilation time and hospital stay. Therefore, it can be concluded that intact pleura during OPCAB improves postoperative pulmonary outcomes. It also makes OPCAB surgery cost-effective reducing ventilation time, ICU & hospital stays. So, cardiac surgeons should try to avoid pleurotomy during OPCAB.
The early and late results of combined off-pump coronary artery bypass grafting and pulmonary resection in patients with concomitant lung cancer and unstable coronary heart disease☆☆☆