Comparative study of Short term results between On-pump versus Off-pump CABG in Patients with Preoperative mild to moderate renal impairment

Abstract Background Coronary artery diseases are one of the leading causes of death around the world. Great efforts to diagnose, evaluate, prevent and decreasing morbidity and mortality had been done. CABG is one of the most effective ways for treatment of CAD when compared to PCI or medical treatment. On pump CABG is the basic and gold standard technique for CABG surgery. Yet there are some burdensome complications from the use of CPB so surgeons developed off pump technique to decrease these complications. Objective In this study we compared the early results of isolated CABG, using onpump and off-pump, in patients with preoperative mild to moderate elevation of serum creatinine. We examined if off-pump coronary revascularization offers a superior renal protection and less in post-operative complications when compared with conventional coronary revascularization with cardiopulmonary bypass. Methods This study was prospective cohort, observational study, conducted in post open heart ICU at Ain Shams university hospitals, 6th October insurance hospital and National Heart Institute during the period between October 2018 and April 2019. We enrolled 1st 100 consecutive adult patients scheduled for isolated CABG surgery (with a median sternotomy) with or without cardiopulmonary bypass pump. The patients are allocated in 2 groups where 50 patients in each group (group A – On pump – ONCAB- conventional surgery) and (group B – Off pump –OPCAB – beating heart) after obtaining their written informed consent without cross over between both groups. Results In this study, we found that postoperative AKI among both study group was relatively common defined by AKIN criteria and there was significant difference between the incidences of postoperative AKI among both study groups. It was higher in ONCAB group than OPCAB group (52%, 30% respectively) with (p-value = 0.025). According to AKIN classification for complicated cases with postoperative renal impairment; there were 32% among ONCAB group had AKIN stage 1 renal impairment versus 22% among OPCAB group had the same stage. While, there were 6% versus 2% had AKIN stage 2 renal impairment among ONCAB group versus OPCAB group respectively. Also there were 14% versus 6% had AKIN stage 3 renal impairment among ONCAB group versus OPCAB group respectively. The need for dialysis was much greater in the ONCAB group 20% versus 8% in the OPCAB group with significant p-value (0.029). Early mortality was significantly higher in ONCAB group about 11 cases (22%) VS 4 cases (8%) in OPCAB group with p-value 0.033. Also there was statistically significant difference between ONCAB group and OPCAB group according to drainage amount (p-value 0.028), re-exploration for bleeding (p-value 0.018), mean ICU stay (p-value 0.027) and mean hospital stay (p-value 0.009). Conclusion The off pump CABG is superior and gives more renal protection in patients with preoperative mild to moderate renal impairment. It is also reducing the early mortality and morbidity in these patients.

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Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13629960047119 ◽

2013 ◽

Vol 95 (7) ◽

pp. 481-485 ◽

Cited By ~ 15

Author(s):

R Birla ◽

P Patel ◽

G Aresu ◽

G Asimakopoulos

Keyword(s):

Coronary Artery ◽

Blood Transfusion ◽

Minimally Invasive ◽

Hospital Stay ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Off Pump ◽

Opcab Group ◽

Significant Difference ◽

The Mean

Introduction Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy. Methods Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners. Results Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05). Conclusions MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.

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

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000000 ◽

2013 ◽

Vol 8 (4) ◽

pp. 269-275 ◽

Cited By ~ 11

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.

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Effect of Arterial Hypertension on Postoperative Mortality and Morbidity after Off-pump CABG Surgery

Cardiovascular Journal ◽

10.3329/cardio.v10i1.34356 ◽

2017 ◽

Vol 10 (1) ◽

pp. 13-16

Author(s):

Asraful Hoque ◽

Shahriar Moinuddin

Keyword(s):

Coronary Artery ◽

Arterial Hypertension ◽

Postoperative Mortality ◽

P Value ◽

Hypertensive Patients ◽

Mortality And Morbidity ◽

Off Pump ◽

Group A ◽

Pump Cabg ◽

Group B

Background: Arterial hypertension is one of the leading modifiable risk factor in coronary artery disease patients who underwent coronary artery bypass grafting (CABG) with the major impact on clinical outcome in these patients. This study was done to evaluate the effect of arterial hypertension on postoperative mortality and morbidity after off-pump CABG.Methods: 200 patients with mean age of 52 ± 6 years, (182 male/18 female) undergoing off pump CABG were divided equally into two groups, 100 patients with hypertension (Group A) and 100 patients without hypertension (Group B). Postoperative mortality and morbidities (Wound infection, AMI, TIA, Stroke) up to 6 months were recorded in the 2 groups.Results: In comparison with the normotensive patients, hypertensive patients had a higher mortality rate (Group A 10% and Group B 2%, p value-<0.05) and increased frequency of myocardial infarction (Group A 12 % and Group B 3%, p value - <0.05). There was also increased rate of infection in hypertensive patients (Group A 13 % and Group B 4%, p value - <0.05). We found that hypertensive patients developed post-operative cerebrovascular complications like TIA (Group A 8 % and Group B 1%, p value - <0.05) and stroke (Group A 11 % and Group B 2%, p value - <0.05) more frequently than normotensive patients. Post-operative ventilator support and duration of hospital stay were almost similar in both groups.Conclusions: Among CABG patients, those with a history of hypertension have an increased frequency of post-operative complications and increased mortality.Cardiovasc. j. 2017; 10(1): 13-16

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Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial

Indian Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/s12055-019-00869-0 ◽

2019 ◽

Vol 36 (2) ◽

pp. 93-104 ◽

Cited By ~ 3

Author(s):

Lokeswara Rao Sajja ◽

Kunal Sarkar ◽

Gopichand Mannam ◽

Venkata Krishna Kumar Kodali ◽

Chandrasekar Padmanabhan ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Randomized Trial ◽

Artery Bypass ◽

Coronary Bypass ◽

Graft Patency ◽

Conventional Coronary Angiography ◽

Off Pump ◽

Significant Difference ◽

Pump Cabg

Abstract Purpose Coronary artery bypass grafting (CABG) is performed either with the aid of cardiopulmonary bypass (on-pump) or without cardiopulmonary bypass (off-pump). There is a scarcity of angiographic data to support the non-inferiority of off-pump technique to on-pump technique. The objective of this study is to ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months. Methods A total of 320 patients with multivessel coronary artery disease were enrolled in a multicenter prospective randomized trial either to on-pump CABG (n = 162) or off-pump CABG (n = 158) between March 2016 through March 2017. Graft patency was evaluated by using either multidetector computerized tomographic angiography or conventional coronary angiography at 3 months. The major adverse cardiac and cardiovascular events (MACCE) were also analyzed at 3 months. Results The median number of grafts per patient in off-pump was 3.00 (Q1:3.00 and Q3:4.00) vs on-pump 4.00 (Q1:3.00 to Q3:4.00), and the mean number of grafts per patient was lower in the off-pump CABG at 3.45 ± 0.75 vs 3.64 ± 0.70 in the on-pump CABG (p = 0.01). There was no significant difference in mortality at 3 months between the off-pump (0.63%) and on-pump groups (1.85%) with p value of 0.62. The cumulative combined MACCE showed significant difference between off-pump group (0.63%) and on-pump group (5.55%), p = 0.01. Follow-up angiograms were done in 239 (75%) patients with 120 off-pump and 119 in the on-pump group. The analysis was also done regarding graft patency in a graded manner—when analysis of A (excellent) grafts vs B (stenosed) grafts and O (occluded) grafts were made, there was no statistically significant difference in overall graft patency at 3 months between on-pump [376 /429 grafts (87.6%)] and off-pump [366 /420 grafts (87.1%)] groups (p = 0.82). The patency rates were similar among bypass conduits (left internal thoracic artery (ITA) in off-pump (91.4%) vs on-pump (92.9%) p = 0.66, right ITA in off-pump (82.1%) vs on-pump (81.8%) p = 0.97, radial artery in off-pump (84.4%) vs on-pump (82.6%) p = 0.81; saphenous vein in off-pump (85.8%) vs on-pump (86.3%), p = 0.86 and among 3 coronary territories. Conclusions Off-pump CABG is non-inferior to on-pump CABG in terms of overall graft patency at 3 months and was associated with a fewer combined cumulative MACCE compared to on-pump CABG.

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P312 Early changes of left ventricular myocardial work performance in patients undergoing coronary artery bypass surgery: off-pump vs. on-pump

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.165 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

N Hatam ◽

K Spetsostaki ◽

G Musetti ◽

H Steffen ◽

R Autschbach ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Left Ventricular ◽

Lv Function ◽

Off Pump ◽

Arterial Blood ◽

Opcab Group ◽

Pump Cabg ◽

Global Work

Abstract Background Coronary-artery bypass grafting (CABG) without the use of cardio-pulmonary bypass (CPB) was introduced to avoid the potential damaging effects of fpreign surfaces. Nevertheless, the value of off-pump CABG (OPCAB) remains controversial. Regional myocardial work has been shown to reflect regional metabolic demand and provide a more comprehensive assessment of myocardial function. Recently a novel non-invasive method for assessing regional MW by LV pressure–strain loop analysis has been described. Purpose To detect changes of MW after CABG comparing off- and on-pump techniques. Methods We prospectively evaluated 93 patients undergoing CABG (50 on- vs. 43 off-pump). Patients underwent transthoracic echocardiography exams prior to and one week after surgery as well as concurrently systolic arterial blood pressure measurements at rest. Besides conventional echocardiography parameters, wemeasured global longitudinal strain (GLS), global work index (GWI) and global work efficiency (GWE). Results All patients survived surgery. Patients in the OPCAB group had significantly higher EuroSCORE II (3.3% vs. 1.1%, p < 0.001). Preoperatively, OPCABgroup had significantly lower EF (50.1 vs. 55.7%, p = 0.004), lower GWI (1411 vs. 1650mmHg%, p = 0.039) and lower GWE (86.7 vs. 91.6%, p = 0.017). GLS did not differ significantly between off- and on-pump groupspreoperatively. However, postoperatively GLS, MWI, MWE and EF decreased significantly within the on-pump group (p < 0.001, p < 0.001, p < 0.001 and p = 0.002, respectively). In the OPCAB group only GWI and GLSdecreased significantly (p = 0.028 and p = 0.017, respectively). Due to the fact, that mean differences between all pre- and postoperative values were higher in the on-pump group, no significant differences in systolic LV-function (sLVF) could be detected between on- and off-pump patients postoperatively. During the early postoperative phase, no correlation between GWI and GWE and clinical outcomes could be detected, onlylower preoperative-GWI values showed a weak correlation with the incidence of postoperative cardiogenic shock (r= -0.27, p = 0.029). Conclusion Despite having worse preoperative sLVF in the off-pump group determined by EF, GLS, GWI and GWE, the decrease in sLVF parameters was significantly higher in the on-pump group, leading to an equal distribution of LV-function parameters between off- and on-pump patients postoperatively. Our results suggest that off-pump CABG provides a better preservation of LV-function.

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Evaluation Of Pulmonary Functions Of Off-Pump Coronary Artery Bypass Graft Patients

KYAMC Journal ◽

10.3329/kyamcj.v4i1.32257 ◽

2017 ◽

Vol 4 (1) ◽

pp. 341-347

Author(s):

Md Masumul Gani Chowdhury ◽

Md Zakaria ◽

NAK Ahsan

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Gas Exchange ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Off Pump ◽

Pulmonary Functions ◽

Significant Difference ◽

Pump Cabg

Background: Cardiopulmonary bypass has been implicated in causing poor pulmonary gas exchange postoperatively in patients undergoing coronary artery bypass graft (CABG). This nonrandomized prospective study was conducted to determine whether patients undergoing off-pump CABG and thereby avoiding cardiopulmonary bypass will have improved pulmonary functions postoperatively.Method: Sixty patients undergoing elective CABG in the National Institute of Cardiovascular Diseases (NICVD), Dhaka between July 2005 and June 2006 were consecutively selected in the study. Sample was divided into two groups: Group A- off-pump CABG and Group-B on-pump CABG. The test statistics used to analyze the data were descriptive statistics as Chi-square (×2) and Student's t-test.Results: Preoperative arterial blood gas (ABG) analysis showed no significant difference. ABG immediately at ICU on FiO2 1 revealed significantly better gas exchange in off-pump group (PaO2: 296.5±32.4 torr vs 234.8±10.7 torr, p<0.001; D(A-a)O2: 378.5±27.3 torr vs 439.2±10.3 torr, p<0.001; PaCO2: 38.5±3.8 torr vs 40.1±1.8 torr, p=0.045). ABG on 3rd postoperative day revealed no significant difference between the two groups. Ventilation time in off-pump group was significantly less than in on-pump group (10.5±2.8 hours vs 14.8±3.7 hours, p<0.001). For ICU stay, there was no significant difference. Postoperative spirometry at 3 month and pulmonary complications within 3 months were not different between groups.Conclusion: off-pump CABG group yielded better gas exchange and earlier extubation than on-pump CABG group.KYAMC Journal Vol. 4, No.-1, July 2013, Page 341-347

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Significance of stress myocardial perfusion scans in predicting cardiovascular events and mortality in cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.17009 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 17009-17009

Author(s):

S. Chandra ◽

A. T. Tong ◽

A. Wei Wei ◽

S. W. Yusuf ◽

S. Javaid ◽

...

Keyword(s):

Survival Rate ◽

Myocardial Perfusion ◽

Cancer Patients ◽

Cardiac Death ◽

Coronary Revascularization ◽

Group Versus ◽

Event Free Survival ◽

Free Survival ◽

Stress Myocardial Perfusion ◽

Significant Difference

17009 Background: Cardiac risk assessment in cancer patients has not extensively been studied. We evaluated the role of stress myocardial perfusion scan (SMPS) in predicting cardiovascular outcomes in cancer patients. Methods: A retrospective chart review was performed on 787 patients who had a SMPS from 01/2002 - 03/2003. All patients were followed for at least 1.5 years. Cox proportional hazard model was used to determine the time-to-first event [cardiac death, myocardial infarction (MI) and coronary revascularization]. Cardiac death was defined as documented cardiac death or sudden unexplained death. Results: A total of 501/787 (64%) patients had normal SMPS, whereas 286/787 (36%) had abnormal SMPS. Adenosine [430/787 (55%)] and dobutamine [144/787 (14%)] were used for chemical stress while 213/787 (23%) patients underwent exercise testing. Mean age was 66±11 years and median follow-up duration was 1.8 years. The 3- year event-free survival rate was 0.71 (0.64–0.78) for abnormal SMPS and 0.87 (0.8–0.94) for normal SMPS (p<0.0001). Of all abnormal scans (n=286), 3-year event free-survival rate based on type of vascular defects varied from 0.79(0.67–0.93) for fixed defects, 0.68 (0.58-.08) for reversible defects and 0.63 (0.5–0.8) for co-existent fixed and reversible defects (p<0.0001). Other factors adversely affecting event-free survival were male gender (p=0.025), cardiomyopathy (p=0.001), coronary artery disease (p<0.0001), previous MI (p<0.0001), congestive heart failure (p=0.001) and hypercholesterolemia (p<0.0001). When we analyzed cardiac death as a separate event, SMPS results still made a significant difference with 3-year cardiac-survival rate of 0.79 (0.69–0.91) for abnormal scan group versus 0.88 (0.81–0.95) for normal scan group (p=0.05). Furthermore, the 3-year cardiac-survival rate in patients with both fixed and reversible defects was 0.4 (0.1–1), which was much worse than those with fixed [0.87 (0.76–0.99)] or reversible [0.85 (0.74–0.99)] defects alone (p=0.028). Conclusions: SMPS is a highly useful modality for predicting cardiac events and mortality in cancer patients. The characteristics of the perfusion defect further stratifies the patients at higher risk. No significant financial relationships to disclose.

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Abstract 15869: Off-Pump Coronary Artery Bypass Grafting is Associated With Higher Rate of Percutaneous Coronary Intervention at 8-Year Follow-Up

Circulation ◽

10.1161/circ.130.suppl_2.15869 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Fabio Barili ◽

Stefano Rosato ◽

Paola D’Errigo ◽

Alessandro Parolari ◽

Lorenzo Menicanti ◽

...

Keyword(s):

Risk Factor ◽

Univariate Analysis ◽

Hazard Ratio ◽

P Value ◽

Term Survival ◽

Off Pump ◽

Pump Cabg ◽

The Impact

Introduction: The debate on the advantages and limitations of off-pump (OPCAB) vs on pump CABG has not still arrived to a conclusion and concerns still exist on graft patency. This study was designed to compare the impact on mortality and morbidity of OPCAB and on-pump CABG, with a specific focus on mid-term need for percutaneous cardiac intervention (PCI). Methods: The PRIORITY project was designed to evaluate the mid-long term outcomes of 2 large prospective multicenter cohort studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG performed both on-pump and off-pump were derived from clinical dataset and linked to 2 administrative datasets. Time-to event analyses were performed in a competing risk framework to evaluate the potential role of surgical techniques on outcomes. Results: The population consisted of 11020 patients who underwent isolated CABG (27.2% OPCAB). Several risk factor but surgical technique independently affected in-hospital mortality. The incidence of postoperative PCI was significantly higher in OPCAB group (p<0.05) and the multivariate logistic regression demonstrated that on-pump CABG was the only factor that protects from PCI after surgery (OR 0.61). Although unadjusted long-term survival was significantly worst for OPCAB (Log-rank p-value 0.00), the adjustment for factors found significant in the univariate analysis did not confirm OPCAB as a risk factor for mortality (hazard ratio was 0.96 ± 0.05, p-value 0.407). On the contrary, the significantly better cumulative incidence function of hospitalization for PCI at follow-up (Gray test p-value 0.00) in the on-pump group was confirmed even by the adjustment for confounding factors (p-value 0.00, adjusted hazard ratio 0.70 ± 0.07) and hence OPCAB was demonstrated to be an independent risk factor for PCI with an hazard that is 42% higher than on-pump CABG. Conclusions: This study demonstrated that OPCAB did not affect short and long-term mortality. Nonetheless, it was a risk factor for re-hospitalization for PCI.

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Comparison of Post-Operative Morbidity and Mortality in Patients Undergoing On-Pump versus Off-Pump CABG

10.53350/pjmhs2115113098 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3098-3100

Author(s):

Mati Ur Rahman ◽

Ajwad Farogh ◽

Sadaf Iftikhar ◽

Naseem Ahmad ◽

Gohar Bashir ◽

...

Keyword(s):

Artery Bypass ◽

Cost Savings ◽

Current Data ◽

Morbidity And Mortality ◽

P Value ◽

Off Pump ◽

Total Data ◽

Pump Cabg ◽

Hospital Morbidity ◽

The Cost

Objective: The aim of this study is to compare in hospital morbidity and mortality in on pump versus off pump CABG. Methodology: All the patients undergoing CABG surgery were enrolled after taking informed consent. Demographic and postoperative variables were entered in the predesigned questionnaire and patients were followed for early outcomes after surgical procedure. Results: A total of 470 patients wasdivided in two groups 235 (on pump and off pump).The mean age of patients was 54.85 ± 9.57 (23-85).There were 400(85.1%) males and 70(14.9%) females. The total data of 470 patients was divided in two groups 235 in on Pump and 235 in off pump CABG.The mean age of patients was 54.85 ± 9.57 (23-85). There were 400(85.1%) males and 70(14.9%) females. Different clinical outcomes were compared in both groups (On-Pump versus Off-Pump CABG) by using Euro Score, we found Peripheral Disease in On-Pump CABG group compared with Off-Pump CABG as 11(4.68% vs 12(5.11%) with p-value=0.831 which was statistically insignificant, current data assessed lung disease in both groups as 11(4.68%) vs 13(5.53%) with statistically insignificant p-value (0.675). and unstable angina were 12(5.11%, p-value 1.00) patients founded and Peri and post myocardial infarction also assessed in both groups with p-value (0.74 & 1.20). respectively.Data regarding in hospital mortality was analyzed and found that 7(2.98%) in on pump group compare with off pump group was According to our research mean number of grafts placed in On-Pump CABG were 9(3.83%) with statistically insignificant p-value (0.611). Conclusion:Proof is presented that surgery on beating heart (Off-Pump) is as safe and effective as Conventional CABG, and cheaper than conventional surgery. However, it is uncertain whether the cost savings are sustained over a longer period of time. Keywords: Coronary artery Bypass grafting surgery, On Pump Off Pump

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No-Touch Sequential Saphenous Venous Harvesting Technique in Off-Pump Bypass Surgery: A Retrospective Study

10.21203/rs.3.rs-155554/v1 ◽

2021 ◽

Author(s):

Xuejian Hou ◽

Kui Zhang ◽

Taoshuai Liu ◽

Yang Li ◽

Yang Zhao ◽

...

Keyword(s):

Saphenous Vein ◽

Saphenous Vein Graft ◽

Artery Bypass ◽

Conventional Technique ◽

Wound Complications ◽

Off Pump ◽

Vein Grafts ◽

Harvesting Technique ◽

Significant Difference ◽

Pump Cabg

Abstract Background In the mid-1990s, the Swedish expert team proposed saphenous vein graft (SVG) harvesting with pedicle tissue. The short-term and long-term patency rates of the great saphenous vein obtained by the no-touch technique (NT) were higher than those obtained by the conventional technique (CON). In the past, NT technology was mainly used in on-pump coronary artery bypass grafting (CABG), and vein grafts were mostly single vein grafts. In this study, we retrospectively analysed the safety and effectiveness of sequential vein grafts using NT technology in off-pump CABG. Methods From 2017 to 2019, a total of 505 patients were included in the study. There were 150 patients in the NT group and 355 patients in the CON group. After applying propensity score matching (1:1 matching), 148 patients were included in each group. Baseline data, graft patency, postoperative complications, leg wound complications and 1-year major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups. Results There was no significant difference in the patency rate of sequential venous grafts between the two groups one year after the operation either before (NT: 7.1% (10/141) vs CON: 11.5% (38/331), p = 0.149) or after matching (NT: 7.1% (10/140) vs CON: 7.3% (9/124), p = 0.971). There was no significant difference in the composite clinical endpoint between the two groups either before (NT: 3 (2.3%) vs CON: 9 (2.8%), p = 1.000) or after matching (NT: 3 (2.3%) vs CON: 3 (2.5%), p = 1.000). There were differences in leg wound complications between the two groups both before (NT: 9 (6.9%) vs CON: 6 (1.9%), p = 0.007) and after matching (NT: 9 (6.9%) vs CON: 2 (1.7%), p = 0.043). Conclusions The application of the NT technique in off-pump CABG with sequential vein grafts is safe and effective. Leg wound complications are more common with the NT technique than with the conventional technique.

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