Should off-pump CABG be favoured for redo myocardial revascularization?

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
S Sadoni ◽  
E Trifan ◽  
I Kaczmarek ◽  
F Vogt ◽  
B Reichart ◽  
...  
Keyword(s):  
Myocardial Revascularization ◽  
Off Pump ◽  
Pump Cabg

scholarly journals Atrial fibrillation after Coronary Artery Bypass Surgery with and without Cardiopulmonary Bypass

2018 ◽  
Vol 10 (2) ◽  
pp. 171-179
Author(s):  
Md Rezaul Karim ◽  
Tawfiq Ahmed ◽  
Shahriar Moinuddin ◽  
Tariq Ahmed Chowdhury ◽  
Moshfequre Rahman Khan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Off Pump ◽  
Coronary Artery Bypass Operation ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Background:Atrial fibrillation (AF) is the most common postoperative supraventricular arrhythmi. 20% to 40% of patients have AF after coronary artery bypass operation (CABG).Arrhythmia of all grades may occur due to cardiopulmonary bypass (CPB) and injuries inflicted during operativeprocedures. Thus it has been proposed that CABG surgery would be safer if CPB could be avoided.Methods:Total 60 patients who underwentCABG were selected for the study and divided in two groups. Group A: 30 patients with Off-pump CABG (OPCAB) and Group B: 30 patients with On-pump CABG. 12 lead ECG was done at morning on the day of surgery, after surgery & when any arrhythmia are noted for at least 7days. Morbidity of patients like arrhythmia and hospital mortality were recorded and compared during the first week after surgery.Results:Off-pump group (group- A) had less incidence of post-operative AF than on-pump group(group-B) (10% vs 40%). Postoperative blood requirement,total operative time, the period of mechanical ventilation,ICU stay and total postoperative hospital stayis significantly shorter in off-pump than in on-pump group of patients.Conclusion: This study clearly demonstrates that off pump CABG procedure is associated with less incidence of AF. Therefore OPCAB procedure for myocardial revascularization is clearly justified whenever feasible.Cardiovasc. j. 2018; 10(2): 171-179

Abstract 2278: Long Term Clinical Follow-up and Graft Patency of Off-pump vs On-pump Coronary Artery Surgery in Patients with ST-Segment Elevation Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Khalil Fattouch ◽  
Giuseppe Runza ◽  
Roberta Sampognaro ◽  
Massimo Midiri ◽  
Giovanni Ruvolo
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Graft Patency ◽  
Early Mortality ◽  
Off Pump ◽  
Significant Difference ◽  
Pump Cabg

Off-pump coronary artery bypass grafting is better than on-pump in patients with STEMI underwent surgery within 2 days from onset of symptoms. Surgeons may be reluctant to use OPCAB due to concerns about completeness of myocardial revascularization and graft patency. The aim of this study was to assess long-term clinical outcomes and graft patency in this kind of patients. Participants in two previous randomized studies performed in our institution including 207 STEMI patients underwent emergent or urgent CABG within 48 hours from onset of symptoms were followed after surgery to assess graft patency and major adverse cardiac-related events (MACE). There were 145 patients operated in on-pump and 62 patients in off-pump. Patency was assessed by multidetector computed tomography coronary angiography (MDCTA) with a 64-slice scanner. Two blinded observers classified proximal, body and distal segments of each graft as occluded or not, or grade of stenosis. Clinical follow-up was obtained by our cardiologists. Overall early mortality was 5.3% (11 pts). Percentage of early mortality were 6.7% and 1.6% in on- and off-pump group respectively (p<0.05). Follow-up was obtained in all 196 survivors and was 100% complete. Overall late deaths occurred in 14 patients (7%) without statistical significant difference between both groups; of the remaining 182, 168 (92.3 %) had MDCTA scans (108 pts in on-pump vs 60 pts in off-pump). Patency was studied in 335 grafts in on-pump and 156 grafts in off-pump. Mean duration of follow-up were 38±16 months and 37±14 months for on- and off-pump, respectively. Overall, 449/491 (91.5%) of grafts were patent. Percentages of overall grafts classified as patent were similar in on-pump and off-pump groups (307/335, 91.6% and 142/156, 91% respectively) and for arterial and vein grafts separately. There were also no differences between groups in the incidence of late death and MACE. Long term graft patency and MACE are similar with on-pump vs off-pump CABG in high risk STEMI patients when operation was performed by experienced surgeons. Supported by this results and by low early mortality in off-pump group, we suggests strictly the use of off-pump CABG in this type of patients.

Immobilization of Ascending Aorta with Starfish Positioner in Off-Pump CABG

2006 ◽  
Vol 9 (1) ◽  
pp. E488-E489 ◽  
Author(s):  
Tamotsu Yasuda ◽  
Go Watanabe ◽  
Shigeyuki Tomita ◽  
Koichi Higashidani
Keyword(s):  
Ascending Aorta ◽  
Off Pump ◽  
Pump Cabg

Effects of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting: Apoptosis, Inflammation, and Oxidative Stress

2014 ◽  
Vol 17 (5) ◽  
pp. 271 ◽  
Author(s):  
Murat Bicer ◽  
Tunay Senturk ◽  
Murat Yanar ◽  
Ahmet Tutuncu ◽  
Arzu Yilmaztepe Oral ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Cabg Surgery ◽  
Off Pump ◽  
Pump Cabg ◽  
Hs Crp ◽  
And Oxidative Stress

<strong>Background</strong>: It has been suggested that off-pump coronary<br />artery bypass grafting (CABG) surgery reduces myocardial<br />ischemia-reperfusion injury, postoperative systemic<br />inflammatory response, and oxidative stress. The aim of this<br />study was to measure serum malondialdehyde (MDA), highsensitivity<br />C-reactive protein (hs-CRP), M30, and M65 levels<br />and to investigate the relationship between M30 levels and<br />oxidative stress and inflammation in patients undergoing onand<br />off-pump CABG surgery.<br /><strong>Methods</strong>: Fifty patients were randomly assigned to onpump<br />or off-pump CABG surgery (25 patients off-pump and<br />25 on-pump CABG surgery), and blood samples were collected<br />prior to surgery, and 30 minutes, 60 minutes, 6 hours,<br />and 24 hours after CABG surgery.<br /><strong>Results</strong>: Compared to the on-pump group, serum MDA<br />levels at 30 minutes, 60 minutes, 6 hours, and 24 hours after<br />the CABG surgery were significantly lower in the off-pump<br />group (P = .001, P = .001, P = .001, and P = .001, respectively).<br />Serum M30 levels were found to be elevated in both groups,<br />returning to baseline at 24 hours. When compared to baseline,<br />the hs-CRP level reached its peak at 24 hours at 13.28 ±<br />5.32 mg/dL in the on-pump group, and 15.44 ± 4.02 mg/dL<br />in the off-pump group.<br /><strong>Conclusion</strong>: CABG surgery is associated with an increase<br />in inflammatory markers and serum M30 levels, indicating<br />epithelial/endothelial apoptosis in the early period.

Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

2016 ◽  
Vol 65 (04) ◽  
pp. 265-271
Author(s):  
Andrea Perrotti ◽  
Enrica Dorigo ◽  
Camille Durst ◽  
Djamel Kaili ◽  
Sidney Chocron ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Wound Complication ◽  
Safe Procedure ◽  
Off Pump

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

Outcomes and Predictors of Mortality and Stroke after On-Pump and Off-Pump Coronary Artery Bypass Surgery in Octogenarians

2013 ◽  
Vol 8 (4) ◽  
pp. 269-275 ◽  
Author(s):  
Shahzad G. Raja ◽  
Jaymin Shah ◽  
Manoraj Navaratnarajah ◽  
Fouad Amin ◽  
Mohamed Amrani
Keyword(s):  
Coronary Artery ◽  
Hospital Mortality ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Mortality And Morbidity ◽  
Off Pump ◽  
Predictors Of Mortality ◽  
Major Complications ◽  
Significant Difference ◽  
Pump Cabg

Objective Octogenarians, as the fastest growing stratum of the population and with the highest prevalence of coronary artery disease, are being increasingly referred for coronary artery bypass grafting (CABG). The general perception is that the presence of comorbidities and the propensity for neurological injury expose them to a higher risk for mortality and morbidity after conventional on-pump CABG, and therefore, off-pump CABG should be preferentially offered to octogenarians to improve outcomes. This study evaluates the in-hospital outcomes and predictors of mortality and stroke in octogenarians undergoing on- and off-pump CABG at our institution. Methods From January 2000 to December 2010, a total of 290 octogenarians underwent off-pump (n = 217) and on-pump (n = 73) CABG. Their data were prospectively entered into the cardiac surgery database (Patients Analysis & Tracking System; Dendrite Clinical Systems, Ltd, Oxford, England, United Kingdom) and analyzed retrospectively. Outcome measures included in-hospital mortality, major complications, and length of stay. Multivariate analysis was performed to identify predictors of combined outcome of in-hospital mortality and stroke. Results The mean ± SD age of the patients was 82 ± 2.0 years. Preoperative demographics were similar for the on-pump and off-pump groups. The patients who underwent off-pump CABG had a lower number of distal anastomoses performed compared with the patients who underwent on-pump CABG [mean difference, 0.2; 95% confidence interval (CI), 0.02–0.4; P = 0.03]. However, the ratio of grafts (received/needed) was the same in both groups. In-hospital mortality for the entire cohort was 7.2%, with no significant difference between the groups for death (6.0% vs 11.0%; P = 0.08), stroke (2.8% vs 2.8%; P = 1.0), other major complications, and length of hospital stay. Independent predictors of combined outcome identified from the multiple logistic model included heart failure [odds ratio (OR), 4.4; 95% CI, 1.5–13.0; P = 0.008], diabetes (OR, 2.6; 95% CI, 1.0–6.0; P = 0.046), nitrate infusion (OR, 2.9; 95% CI, 1.1–8.0; P = 0.04), postoperative renal failure requiring hemofiltration (OR, 8.6; 95% CI, 3.5–21.1; P < 0.001), and postoperative ventricular arrhythmias (OR, 7.3; 95% CI, 1.9–27.8; P = 0.009). Conclusions Both on-pump and off-pump CABG are reasonable revascularization strategies in octogenarians. Careful patient selection and individualized treatment decisions can minimize postoperative mortality and morbidity in octogenarians undergoing on- and off-pump CABG.

scholarly journals Correlation of Blood Lactate and Mixed Venous Oxygen Saturation in Off-Pump CABG

2014 ◽  
Vol 04 (07) ◽  
pp. 131-138
Author(s):  
Ganapathy Sambandam Kamalakkannan ◽  
Ranjith Karthekeyan ◽  
Mahesh Vakamudi ◽  
Sandeep Bangale ◽  
Rajeshkumar Kodali ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Blood Lactate ◽  
Mixed Venous Oxygen Saturation ◽  
Off Pump ◽  
Venous Oxygen Saturation ◽  
Pump Cabg ◽  
Mixed Venous

scholarly journals A Case of Non-Occlusive Mesenteric Ischemia after Off-Pump CABG and Abdominal Aortic Aneurysm Replacement

2005 ◽  
Vol 34 (5) ◽  
pp. 386-388
Author(s):  
Toshiya Tokui ◽  
Shinji Kanemitsu ◽  
Keizou Tanaka ◽  
Hitoshi Suzuki ◽  
Toshihiko Kinoshita
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Mesenteric Ischemia ◽  
Off Pump ◽  
Abdominal Aortic ◽  
Occlusive Mesenteric Ischemia ◽  
Pump Cabg

scholarly journals Combined anesthesia for off-pump coronary artery bypass grafting in patients with visceral obesity

2020 ◽  
Vol 17 (3) ◽  
pp. 17-23
Author(s):  
M. I. Turovets ◽  
S. M. Shlakhter ◽  
A. M. Streltsova
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Visceral Obesity ◽  
Bypass Grafting ◽  
Off Pump ◽  
Duration Of Hospital Stay ◽  
Combined Anesthesia ◽  
Pump Cabg

The objective: to analyze results of the use of combined anesthesia for coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG) in patients with visceral obesity (VO). Subjects and methods. A randomized study of results of surgical treatment in patients with VO and coronary heart disease who underwent off-pump CABG was conducted. 197 patients were included in the study. The main group (n = 98) included patients who underwent combined anesthesia (with thoracic epidural analgesia (TEA)) and patients in the control group (n = 99) underwent total intravenous anesthesia (with narcotic analgesics). Results. In patients from the main group, a significant decrease in the incidence of acute kidney injury (p = 0.0180), respiratory complications (p = 0.0177), atrial and ventricular arrhythmias (p = 0.0029) was recorded. With the use of TEA, the duration of treatment of patients in the intensive care unit (p = 0.0229) and duration of hospital stay (p = 0.0419) significantly decreased. Conclusion: The use of combined anesthesia (with TEA) for off-pump CABG in patients with visceral obesity reduces the risk of early postoperative complications, the duration of hospital stay and treatment in the intensive care unit.

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