Improved Short-Term Outcomes with Off-Pump Reoperative Coronary Artery Bypass Grafting

Objective Reoperative coronary surgery patients are usually sicker and older, and the procedure is more technically demanding. Comparisons between coronary surgery with (coronary artery bypass [CAB] surgery on cardiopulmonary bypass [CPB]) and without (off-pump CAB [OPCAB]) the pump have been conducted; however, few studies showed results in reoperative cases. We investigate the potential superiority of one technique over the other in redo coronary surgeries. Methods Our institutional Society of Thoracic Surgery database was used to gather the data for 266 isolated reoperative coronary artery surgeries from January 2004 to July 2011. These were divided into the CAB surgery in CPB group (n = 204) and the OPCAB group (n = 62). Results Baseline characteristics of the two groups were similar, except for a significantly higher prevalence of cerebrovascular disease among the off-pump group ( P = 0.01). There was also a trend toward fewer vessels bypassed among the same group ( P = 0.07). Risk adjustment was done using multivariable analyses for detection of independent effects. The use of CPB was an independent predictor of increased rates of postoperative events (odds ratio, 3.9; P = 0.004) and atrial fibrillation (odds ratio, 5.9; P < 0.005) and longer intensive care unit (0.006) and hospital stay (0.004). Conclusions Redo OPCAB seems to offer favorable short-term outcomes compared with redo CAB. Our results suggest a reduced rate of overall postoperative events, decreased new postoperative atrial fibrillation, reduced hours stayed in the intensive care unit, and fewer days stayed from surgery to discharge. This was not associated with an increase in morbidity and mortality. A randomized study with a larger number of patients and with a longer follow-up is needed.

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Impact of postoperative hypothermia on outcomes after off-pump coronary artery bypass grafting

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211019530 ◽

2021 ◽

pp. 021849232110195

Author(s):

Vasileios Ntinopoulos ◽

Nestoras Papadopoulos ◽

Achim Haeussler ◽

Dragan Odavic ◽

Patricia Fodor ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Coronary Artery ◽

Propensity Score ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Off Pump ◽

Pump Coronary Artery Bypass

Background Even though the physiological derangements caused by hypothermia are well described, there is no consensus about its impact on postoperative outcomes. The aim of this study is to assess the effect of postoperative hypothermia on outcomes after off-pump coronary artery bypass surgery. Methods A total of 1979 patients undergoing isolated off-pump coronary artery bypass surgery in a single center in the period 2007–2018 were classified according to their axillary temperature measurement at intensive care unit admission postoperatively to either hypothermic (<36°C) or normothermic (≥36°C). Between-group differences on baseline characteristics and postoperative outcomes were assessed before and after propensity score matching. Results Data analysis showed that 582 patients (29.4%) were hypothermic (median temperature 35.5°C) and 1397 patients (70.6%) were normothermic (median temperature 36.4°C). Using propensity score matching, 567 patient pairs were created. Patients with hypothermia exhibited a higher rate of postoperative transfusion of at least three red cell concentrate units (14.3% vs 9%, p = 0.005), a longer intubation duration (median duration, 6 vs 5 h, p < 0.0001), and a longer intensive care unit stay (median stay, 1.6 vs 1.3 days, p = 0.008). There was no difference in reoperation for bleeding, renal replacement therapy, infections, and mortality between the two groups. Conclusions Even though associated with a higher blood transfusion requirement and a slightly longer intensive care unit stay, mild postoperative hypothermia was not associated with a higher morbidity and mortality.

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Comparing dexmedetomidine and propofol for sedation and hemodynamic stability in cardio-thoracic intensive care unit for patients following off-pump coronary artery bypass graft surgery

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20210085 ◽

2021 ◽

Vol 10 (2) ◽

pp. 153

Author(s):

Vasant P. Patil ◽

Jacob Abraham ◽

Grace M. George

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

P Value ◽

Analgesic Requirement ◽

Off Pump ◽

Pump Coronary Artery Bypass

Background: Most patients in intensive care unit (ICU) require both sedation and analgesia to encourage natural sleep, facilitate assisted ventilation and modulate physiologic response to stress. The ideal sedative after Coronary artery bypass grafting (CABG) should have rapid onset, immediate resolution of both pain and anxiety, promote cardiac and respiratory stability, maintain a reusability during sedation, allow rapid recovery after discontinuation, and attenuate the cardiovascular, neuroendocrine, and inflammatory response. All these properties may improve outcome in cardiac patients after CABG.Methods: Setting-cardiac ICU. A prospective, randomised, single blind study including 60 patients divided into 2 groups. Data collection tools-study proforma and Ramsay sedation scale (RSS). Data analysed using science and statistical packaged (SPSS) version 20, independent sample `t` test, chi-square test, analysis of variance (ANOVA) and p value ≤0.05 was considered statistically significant.Results: Sedation levels and length of stay of patients on ventilator were comparable in both groups, however, analgesic requirement was significantly less in dexmedetomidine group. Dexmedetomidine group showed significantly lower heart rates compared to propofol group.Conclusions: Dexmedetomidine and propofol are safe sedative agents during mechanical ventilation in ICU for patients undergoing off pump coronary artery bypass (OPCAB). There is more than 50% reduction in analgesic requirement and a significant reduction in heart rate in dexmedetomidine sedated patients.

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Is Off-Pump Coronary Artery Bypass Surgery Superior to On-Pump Coronary Artery Bypass Surgery on Postoperative Paradoxical Ventricular Septal Motion?

The Heart Surgery Forum ◽

10.1532/hsf98.2014305 ◽

2014 ◽

Vol 17 (4) ◽

pp. 191 ◽

Cited By ~ 1

Author(s):

Murat Günday ◽

Mete Alpaslan ◽

Özgür Çiftçi ◽

Mehmet Özülkü ◽

Gülay Çopur ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Off Pump ◽

Pump Coronary Artery Bypass ◽

Septal Motion

Background: The aims of this study were to investigate the appearance of paradoxical ventricular septal motion (PSM) after coronary artery bypass graft (CABG) surgery and to identify factors that might be related to this abnormality.Methods: This prospective study included 119 consecutive patients (38 women, 81 men) who underwent CABG. Patients who underwent on-pump surgery (22 women, 45 men) and patients who underwent off-pump surgery (16 women, 36 men) were studied separately. All subjects underwent preoperative angiographic septal perfusion evaluation, pre- and postoperative echocardiography, and standard electrocardiographic and laboratory investigations, including troponin I and CK-MB levels. Multivariate logistic regression analysis was also performed for a variety of related parameters.Results: Significant differences in EuroSCORE, length of intensive care unit stay, length of hospital stay, PSM (assessed using echocardiography), septal perfusion (observed using preoperative angiography), postoperative pleural effusion, and intensive care unit recidivism were observed between the two groups (P < .05). Moreover, postoperative PSM was correlated with septal perfusion (r = -0.687**, P < .001), type of operation (r = -0.194*, P = .035), diabetes mellitus (r = 0.273**, P = .003), carotid stenosis (r = 0.235*, P = .011), the number of distal anastomoses (r = 0.245**, P = .008), pleural effusion (r = 0.193*, P = .037), and intensive care unit recidivism (r = 0.249**, P = .007). However, multivariate analysis demonstrated that only preoperative septal perfusion (odds ratio: 0.037; 95% confidence interval: 0.011-0.128; P < .05) constitutes an independent risk factor for PSM (P < .05).Conclusions: This study demonstrated that preoperative septal perfusion deficiency represents an independent risk factor for postoperative PSM in patients undergoing CABG. Further investigations addressing the timing of the appearance of PSM and the correlation of this finding with perfusion imaging studies may provide new details concerning the mechanisms that underlie this abnormality.

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Do patients after off-pump coronary artery bypass grafting need the intensive care unit? A prospective audit of 85 patients

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2007.164855 ◽

2008 ◽

Vol 7 (1) ◽

pp. 32-36 ◽

Cited By ~ 2

Author(s):

N. Noiseux ◽

D. Bracco ◽

I. Prieto ◽

T. M. Hemmerling

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Prospective Audit ◽

Off Pump ◽

Pump Coronary Artery Bypass

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Post-operative ventilatory nursing regime of research coronary artery bypass graft patients

Health SA Gesondheid ◽

10.4102/hsag.v4i4.382 ◽

1999 ◽

Vol 4 (4) ◽

pp. 29-36

Author(s):

H Potgieter ◽

H Uys ◽

W E Nel

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Full Text ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Independent Practitioner

The nurse working in the intensive care unit functions as an independent practitioner under the Nursing Act and arising SANC regulations. OpsommingDie doel van hierdie navorsing is om die invloed van 'n pre-operatiewe bloedgasanalise op die post-operatiewe ventilatoriese verplegingsregime van 'n koronere vatomleidingspasient te bepaal. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

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

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2020-17-3-17-23 ◽

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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Effect of preoperative atrial fibrillation on long-term results after Off Pump Coronary Artery Bypass

Perm Medical Journal ◽

10.17816/pmj3865-15 ◽

2021 ◽

Vol 38 (6) ◽

pp. 5-15

Author(s):

Soslan T. Enginoev ◽

Dmitriy A. Kondratiev ◽

Gasan M. Magomedov ◽

Tamara K. Rashidova ◽

Bakytbek K. Kadyraliev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Sinus Rhythm ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Long Term Results ◽

Off Pump ◽

Group I ◽

Pump Coronary Artery Bypass

Objective. To study the effect of preoperative atrial fibrillation (AF) on the risk of stroke and long-term mortality after Off Pump Coronary Artery Bypass (OPCAB). Materials and methods. A retrospective analysis of the results of OPCAB in 212 patients with coronary artery disease (CAD), who were operated on from May 2009 to November 2013, was carried out. After propensity score matching, patients were divided into 2 groups: Group I 82 patients with sinus rhythm (SR) before surgery, Group II (control) 102 patients with AF before surgery. The average age of the included patients was 61 6.7 years, with 95 % CI: 6062. Fifty-four (29.3 %) patients were over 65 years of age. There were 162 men (88 %) and 22 women (12 %). The median follow-up was 93.5 (66.7102.0) months. Results. The time spent in the clinic was statistically significantly shorter in the SR group than in the AF group (10 (911) and 14 (1116) hours, respectively, p 0.001). There was no statistically significant difference in the number of perioperative myocardial infarctions (in the group with SR it occurred in 1 (1.2 %) patient, in the group with AF 2 (2 %), p = 0.7), strokes (in the group with SR 1 (1.2 %), in the group with AF 3 (2.9 %), p = 0.6), as well as a 30-day mortality (in the group with SR it was 0 %, in the group with AF 3 (2.9 %), p = 0.2). In the long-term postoperative period, there were statistically significantly fewer strokes in the group with SR than in the group with AF (in the group with SR, the 10-year stroke freedom was 88.8 %, and in the group with AF 71.8 %, p = 0.018), and also better long-term survival in the group with sinus rhythm (in the group with SR, the 10-year survival rate was 79 %, in the group with AF 63.9 %, p = 0.016). Conclusions. In the group with preoperative AF, the frequency of distant strokes and deaths is higher than in patients with sinus rhythm.

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