Adjunctive Atrial Fibrillation Therapy with Off-Pump Coronary Artery Bypass Grafting: Standard of Care?

2006 ◽  
Vol 1 (4) ◽  
pp. 146-150 ◽  
Author(s):  
James H. Wudel ◽  
Giles S. Hedderich ◽  
R. Kent Jex
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Bipolar Radiofrequency ◽  
Pulmonary Vein Ablation ◽  
Pump Coronary Artery Bypass

Objectives To validate the safety and applicability of a previously unreported innovative technique: bipolar epicardial radiofrequency pulmonary vein ablation for the treatment of atrial fibrillation (AF) in conjunction with off-pump coronary artery bypass surgery. Methods After the completion of off-pump coronary artery bypass grafting (OPCAB) via sternotomy, patients underwent epicardial pulmonary vein ablation using a bipolar radiofrequency clamp placed on the left atrial cuff. The left atrial appendage was removed or excluded in all patients. Results Fifteen patients (aged 59–81 years) were treated and reviewed. An average of 2.8 ± 1 grafts were performed per patient; all patients received left internal mammary artery grafts. All sets of pulmonary veins were encircled successfully and ablated. Four patients had additional lesions placed. No patient had pulmonary vein injury. There were no reoperations for bleeding and no mortality. Preoperatively, AF was continuous in 4 patients and intermittent in 11; 10 patients were taking Coumadin preoperatively and 11 were taking antiarrhythmic drugs (AAD). At the follow-up evaluation (7.6 ± 4.4 months; range 1–16 months), 12 patients (80%) are in sinus rhythm (100% in the intermittent AF group, 25% in the continuous AF group); Coumadin has been discontinued in 5 of 10 patients (50% reduction) and AAD have been discontinued in 7 of 11 patients (74% reduction). Conclusions Bipolar radiofrequency epicardial pulmonary vein ablation can be safely and reproducibly used for the treatment of AF in conjunction with OPCAB. Patients with intermittent AF should be strongly considered for adjunctive treatment at the time of OPCAB.

Abstract 11813: The Impact of Surgical Left Atrial Appendage Amputation/Ligation on Stroke Prevention in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Daisuke Endo ◽  
Tomoko S Kato ◽  
Tai Iwamura ◽  
Akie Shimada ◽  
Kan Kajimoto ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Stroke Prevention ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Background: Stroke is a major adverse event in patients developing atrial fibrillation (AF) after cardiac surgery. Left atrial appendage (LAA) closure using devices is expected to prevent stroke and enable patients to be warfarin free; however, problems such as procedure-related adverse events and possible residual flow remain unsolved. Concomitant “surgical” LAA amputation/ligation (LAA-A/L) during off-pump coronary artery bypass grafting (OPCAB) is actively performed in our institution. Methods: This is a prospective observational study of 578 consecutive patients (mean age 69 ± 9.8 years, Male 82%) undergoing OPCAB with or without concomitant LAA-A/L from 2011 to 2014. The safety and efficacy of the concomitant procedure, performed on 193 (33%) patients, on preventing early (<30 days) and late postoperative stroke were examined. Results: LAA was amputated in 154 patients (80%), and ligated in 39 (20%). Between patients with and without LAA-A/L, no difference was seen in the preoperative characteristics including CHADS2 and CHA2DS2-VASc scores, and no significant differences in their operative time, requirement of blood transfusion, length of ICU and total hospital stay were noted. The incidence of postoperative AF was not different (33% vs. 28%, p=0.18), and early and late stroke incidences were not significantly different between the groups (1.0% vs. 0.8%, p=0.75, 2.2% vs. 2.8% p=0.67, respectively). However, in patients without LAA-A/L, both early and late stroke occurred more frequently in those developing AF (2.8% vs. 0%, p=0.005, 6.2% vs. 1.5%; p=0.017, respectively), while stroke incidence in patients receiving LAA-A/L, was not significantly different between those with and without postoperative AF (0.8% vs. 1.6%, p=0.61, 1.6% vs. 2.5%; p=0.69, respectively). Multivariate logistic regression showed postoperative AF without LAA-A/L as the only independent positive predictor of early (OR: 6.8; 95% CI: 1.11 to 52.60; p=0.04) and late (OR: 3.7; 95% CI: 1.18 to 10.94; p=0.03) stroke. Conclusions: Concomitant LAA-A/L with OPCAB is safe and effective for stroke prevention in patients developing postoperative AF. This preventative procedure seems beneficial, since AF is the most common arrhythmia associated with the risk of stroke.

Routine Preoperative Insertion of IABP in High-Risk Off-Pump Coronary Artery Bypass Grafting

2005 ◽  
Vol 8 (2) ◽  
pp. 94 ◽  
Author(s):  
Hunaid A. Vohra ◽  
Norman P. Briffa
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
High Risk ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Beneficial Effects ◽  
Pump Coronary Artery Bypass

The beneficial effects of intraaortic balloon pump (IABP) in coronary artery bypass graft surgery with cardiopulmonary bypass have been reported. However, whether preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting (OPCAB) has any beneficial effects remains to be established. We report our experience of preoperative insertion of IABP in OPCAB.

Skeletonized Gastroepiploic Artery for Off-Pump Coronary Artery Bypass Grafting

2004 ◽  
Vol 7 (2) ◽  
pp. E164-E169 ◽  
Author(s):  
Ruzheng Li ◽  
Atsushi Amano ◽  
Hiroyuki Miyagawa ◽  
Shizuyuki Dohi ◽  
Ichirou Hayashi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Gastroepiploic Artery ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass
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