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.

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

2019 ◽  
Vol 36 (2) ◽  
pp. 93-104 ◽  
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.

Long-Term Follow-up of Off-Pump and On-Pump Coronary Artery Bypass Grafting

2014 ◽  
Vol 9 (2) ◽  
pp. 122-129 ◽  
Author(s):  
Shahzad G. Raja ◽  
Umberto Benedetto ◽  
Dimple Chudasama ◽  
Siobhan Daley ◽  
Mubassher Husain ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Long Term Follow Up ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass ◽  
Long Term Mortality

Objective Despite increasing recognition of the benefits of off-pump coronary artery bypass grafting (CABG), concerns persist regarding its impact on long-term mortality and freedom from reintervention. In this study, we assessed the impact of off-pump CABG on long-term outcomes. Methods From January 2002 to December 2002, a total of 307 consecutive patients who underwent isolated multivessel off-pump CABG at our institution were compared with a control group of 397 patients who underwent multivessel on-pump CABG during the same period. Perioperative data were prospectively collected and compared. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years. Results After adjusting for clinical covariates, off-pump CABG did not emerge as a significant independent predictor of long-term mortality [hazard ratio (HR), 0.91; 95% confidence interval (CI), 0.70–1.12], readmission to hospital for cardiac cause (HR, 0.96; 95% CI, 0.78–1.10), or the need for reintervention (HR, 0.93; 95% CI, 0.87–1.05). Conclusions At long-term follow-up, off-pump CABG remains a safe and effective myocardial revascularization strategy with no adverse impact on survival or freedom from reintervention.

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 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 Risk-Adjusted Short- and Long-Term Outcomes for On-Pump Versus Off-Pump Coronary Artery Bypass Surgery

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Matthew L. Williams ◽  
Lawrence H. Muhlbaier ◽  
Jacob N. Schroder ◽  
Jonathan A. Hata ◽  
Eric D. Peterson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Outcomes ◽  
Short Term ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
To Receive

Background— Surgeons have adopted off-pump coronary artery bypass grafting (OPCAB) in an effort to reduce the morbidity of surgical revascularization. However, long-term outcome of OPCAB compared with conventional coronary artery bypass grafting (CABG) remains poorly defined. Methods and Results— Using logistic regression analysis and proportional hazards modeling, short-term and long-term outcomes (perioperative mortality and complications, risk-adjusted survival, and survival/freedom from revascularization) were investigated for patients who underwent OPCAB (641 patients) and CABG-cardiopulmonary bypass (5026 patients) from 1998 to 2003 at our institution. For these variables, follow-up was 98% complete. OPCAB patients were less likely to receive transfusion (odds ratio for OPCAB, 0.80; P =0.037), and there were trends toward improvement in other short-term outcomes compared with CABG-cardiopulmonary bypass. Long-term outcomes analysis demonstrated no difference in survival, but OPCAB patients were more likely to require repeat revascularization (OPCAB hazard ratio, 1.29; P =0.020). Conclusions— OPCAB patients were less likely to receive transfusion during their hospitalization for surgery but had higher risk for revascularization in follow-up. These results highlight the need for a large randomized, controlled trial to compare these 2 techniques.

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

KYAMC Journal ◽  
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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