The Results of the Enclose II Proximal Anastomotic Device in 178 Off-Pump Coronary Artery Bypass Surgeries

2012 ◽  
Vol 7 (4) ◽  
pp. 242-246 ◽  
Author(s):  
Yuki Seto ◽  
Hitoshi Yokoyama ◽  
Shinya Takase ◽  
Masahiro Tanji ◽  
Koki Takahashi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Graft Patency ◽  
Aortic Injury ◽  
Off Pump ◽  
New Device ◽  
Pump Cabg ◽  
Proximal Coronary Artery ◽  
Pump Coronary Artery Bypass

Objective Enclose II is a new device for proximal coronary artery bypass anastomoses. We evaluated the safety and effectiveness of Enclose II in patients who underwent off-pump coronary artery bypass grafting (CABG). Methods Enclose II was used for isolated off-pump CABG in 178 patients at six heart centers between October 2005 and December 2009. The preoperative characteristics of the patients, complications related to Enclose II, and early graft patency rates were examined. Results A total of 222 proximal anastomoses were performed in 178 patients using Enclose II. Forty-four of these patients had two proximal anastomoses using this device. New cerebral infarction that arose in two patients (1.1%) was not related to Enclose II. No aortic injury occurred. The graft patency rate was 96.4% at 1 year after surgery. Conclusions Enclose II is a safe and useful assist device for proximal anastomoses in patients undergoing off-pump CABG.

scholarly journals Off-Pump Coronary Artery Bypass Leads to a Regional Hypercoagulable State Not Detectable Using Systemic Markers

2006 ◽  
Vol 1 (5) ◽  
pp. 232-238 ◽  
Author(s):  
Zachary N. Kon ◽  
Michael H. Kwon ◽  
Michael J. Collins ◽  
Seeta Kallam ◽  
Rupali Sangrampurkar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Graft Patency ◽  
Hypercoagulable State ◽  
Ph Change ◽  
Off Pump ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass ◽  
Endothelial Integrity

Objective It is believed that off-pump coronary artery bypass grafting (OPCAB) leads to hypercoagulability, but efforts to document such a state have been unrevealing. We hypothesized that OPCAB increases the risk of developing a regional hypercoagulable state. Methods Blood was obtained from the aorta and coronary sinus (CS) after CABG performed off- (N = 69) or on-pump (N = 35) to determine the transcardiac gradients of F1.2 (thrombin production), XIIa (coagulation activation), myoglobin (ischemia) and IL-6, IL-8 using ELISA and platelet-derived microparticles using FACS. Platelet function was measured using aggregometry. Regional myocardial pH and SVG flow were recorded intraoperatively. SVG biopsies were analyzed for endothelial integrity (EI) using immunohistochemistry and graft patency was determined by predischarge CT angiography. Results Compared with on-pump, OPCAB provoked significantly higher transcardiac F1.2 (117±200 v. 31±38%), FXII-a (14±29 v. 2±4%), microparticles (14± −9.5% v. 6.4±—4.1%), IL-6 (119±183 v. 28±39%), and a trend toward increased IL-8 (67±94 v. 24±46%, P = 0.077). Myoglobin release after OPCAB, also greater than on-pump CABG (54±89 v. 8±14%, P < 0.01), correlated with regional pH change (R = −0.96, P < 0.0001), and F1.2 release (R = 0.55, P = 0.0002). In contrast, systemic changes in these markers were all less after OPCAB. SVG flow was significantly reduced in OPCAB (39.4 versus 66.5 mL/min, P = 0.0002), but EI and graft patency rates were the same. Conclusions Through the use of transcardiac assays, we illustrated that regional coagulation was enhanced after off- compared with on-pump CABG. If the findings of this pilot study are confirmed, OPCAB may require additional antithrombotic therapies to respond to this local hypercoagulable state.

Off-Pump Coronary Artery Bypass Grafting and Stroke—Exploratory Analysis of the GOPCABE Trial and Methodological Considerations

2018 ◽  
Vol 66 (06) ◽  
pp. 464-469 ◽  
Author(s):  
Michael Zacher ◽  
Jochen Boergermann ◽  
Utz Kappert ◽  
Michael Hilker ◽  
Gloria Färber ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Background Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG) may reduce severe adverse events including stroke. Methods In the German Off-Pump Coronary Artery Bypass Grafting in Elderly patients trial, the rate of major adverse cardiovascular events was compared in 2,394 elderly (≥ 75 years) patients undergoing CABG with (on-pump) or without (off-pump) cardiopulmonary bypass. This exploratory post-hoc analysis investigated the impact of surgical aortic manipulation on the rate of stroke. Results There was no significant difference in the rate of stroke within 30 days after surgery between both groups (off-pump: 2.2%; on-pump: 2.7%; odds ratio [OR]: 0.83 [0.5–1.38]; p = 0.47). Within the off-pump group, different degrees of aortic manipulation did not lead to significant different stroke rates (tangential clamping: 2.3%; OR 0.86 [0.46–1.60]; clampless device: 1.8%; OR 0.67 [0.26–1.75]; no aortic manipulation: 2.4%; OR 0.88 [0.37–2.14]). An aggregate analysis including more than 10,000 patients out of the four recent major trials also yielded comparable stroke rates for on- and off-pump CABG (off-pump: 1.4%; on-pump: 1.7%; OR 0.87 [0.64–1.20]). Conclusion Within recent prospective randomized multicenter trials off-pump CABG did not result in lower stroke rates. The possible intrinsic benefit of off-pump CABG may be offset by the complexity of the operative therapy as well as the multiple pathomechanisms involved in perioperative stroke.

scholarly journals Coronary Endarterectomy with off Pump Coronary Artery Bypass Surgery- A Review

2017 ◽  
Vol 10 (1) ◽  
pp. 84-90
Author(s):  
Redoy Ranjan ◽  
Dipannita Adhikary ◽  
Heemel Saha ◽  
Sanjoy Kumar Saha ◽  
Sabita Mandal ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Graft Patency ◽  
Coronary Endarterectomy ◽  
Off Pump ◽  
Diffuse Coronary Artery Disease ◽  
Artery Disease ◽  
Pump Coronary Artery Bypass

Coronary endarterectomy is first described as an alternative surgical procedure for myocardial revascularization against diffuse coronary artery disease by Baily et al. in 1956. Coronary endarterectomy provides complete surgical revascularization of the myocardium in diffuse and calcified coronary arteries with adequate blood flow to distal part of occluded arteries, thus improving ventricular function. However, the initial outcomes of coronary endarterectomy were not satisfactory but now-a-days different studies have shown that coronary endarterectomy with coronary artery bypass grafting can be done safely with acceptable morbidity and mortality. Moreover, the graft patency rate on angiographic evaluation is also good following coronary endarterectomy. So, it’s time to reevaluate this old techniques, and reanalysis the current outcomes of coronary endarterectomy and readdress its indication in diffuse coronary artery diseaseCardiovasc. j. 2017; 10(1): 84-90

Long-Term Graft Patency After Off-Pump and On-Pump Coronary Artery Bypass: A CORONARY Trial Cohort

2020 ◽  
Vol 110 (6) ◽  
pp. 2055-2061
Author(s):  
Limeng Yang ◽  
Shen Lin ◽  
Heng Zhang ◽  
Dachuan Gu ◽  
Sipeng Chen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Graft Patency ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

scholarly journals Evaluation of Pulmonary Function after Off-pump Coronary Artery Bypass Grafting in Patients Treated with Preoperative Bronchodilator

2015 ◽  
Vol 7 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Muhammad Abdul Quaium Chowdhury ◽  
Nazmul Hosain ◽  
Mohammad Fazle Maruf ◽  
Md Mostafizur Rahman ◽  
Md Aftabuddin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pulmonary Function ◽  
Coronary Artery Bypass ◽  
Vital Capacity ◽  
Artery Bypass ◽  
Off Pump ◽  
Group I ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass ◽  
Impaired Pulmonary Function

Background: Bronchodilators, by dilatation of bronchial tree through relaxation of bronchial smooth muscle increases the vital capacity, tidal volume and total lung capacity and reduces gas trapping. This study was conducted to assess the pulmonary function after off-pump coronary artery bypass graft (CABG) surgery between patients with impaired pulmonary function treated with or without preoperative bronchodilator. We also compared duration of mechanical ventilation and days spent in the surgical intensive care unit (ICU) after CABG in both group of patients. Methods: This prospective cohort study was carried out in the department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from July 2009 to April 2011. This study included 50 patients (25 patients in each group) with multi-vessels coronary artery disease with impaired pulmonary function who underwent off-pump CABG. Results: Spirometry was done in both groups of patients after admission, day before operation and on 7th post-operative day. The difference in Forced vital capacity (FVC) and Forced expiratory volume in 1st second (FEV1 ) between two groups were not statistically significant after admission (P>0.05). On the day before surgery the values of FVC and FEV1 were increased (more in Group-I who were treated with bronchodilator) and 7th postoperative day the values were decreased (more in Group-II who were not treated with bronchodilator). The results were found statistically significant in between groups (P<0.05). Conclusion: Bronchodilator should be considered pre-operatively in all patients having impaired pulmonary function undergoing off-pump CABG for better preservation of postoperative pulmonary function. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22260 Cardiovasc. j. 2015; 7(2): 123-127

scholarly journals Off Pump Coronary Artery Bypass in patients with severe LV dys-function. Is it really more challenging?

2021 ◽  
Author(s):  
Panagiotis Sarris-Michopoulos ◽  
Evan Markell ◽  
Alejandro Macias ◽  
Michael Magarakis
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Off Pump ◽  
Pump Cabg ◽  
Artery Disease ◽  
Pump Coronary Artery Bypass ◽  
Stable Field ◽  
Low Ejection Fraction

CABG (Coronary Artery Bypass Grafting) has been the treatment of choice for coronary artery disease for over 50 years and is the most common cardiac surgery procedure performed. Traditionally CABG was performed with the use of cardiopulmonary bypass and the use of cardioplegia to allow the surgeon to operate on a stable field. In the mid-1990s, interest emerged in performing CABG without the use of cardiopulmonary bypass - off pump CABG. This invited commentary focuses on sharing our experience with Low Ejection fraction off-pump CABG and why this approach could be beneficial to this patient population.

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