Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis

Perfusion ◽  
2020 ◽  
pp. 026765912096031
Author(s):  
Pengbin Zhang ◽  
Liping Wang ◽  
Kerong Zhai ◽  
Jian Huang ◽  
Weifan Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Transfusion Rate ◽  
Bypass Grafting ◽  
Off Pump ◽  
Operative Complications ◽  
Hospital Stays

Background: Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG. Methods: Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays. Results: The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = −8.21 h, 95% CI = −11.74 to −4.68, p < 0.00001; MD = −0.77 d, 95% CI = −0.81 to −0.73, p < 0.00001; MD = −2.24 d, 95% CI = −3.17 to −1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization. Conclusion: In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.

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

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.

scholarly journals Risk Factors for Delirium and Cognitive Decline Following Coronary Artery Bypass Grafting Surgery: A Systematic Review and Meta‐Analysis

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Danielle Greaves ◽  
Peter J. Psaltis ◽  
Daniel H. J. Davis ◽  
Tyler J. Ross ◽  
Erica S. Ghezzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Risk Factor ◽  
Intensive Care ◽  
Cognitive Decline ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Significant Risk ◽  
Bypass Grafting ◽  
Intubation Time

Background Coronary artery bypass grafting (CABG) is known to improve heart function and quality of life, while rates of surgery‐related mortality are low. However, delirium and cognitive decline are common complications. We sought to identify preoperative, intraoperative, and postoperative risk or protective factors associated with delirium and cognitive decline (across time) in patients undergoing CABG. Methods and Results We conducted a systematic search of Medline, PsycINFO, EMBASE, and Cochrane (March 26, 2019) for peer‐reviewed, English publications reporting post‐CABG delirium or cognitive decline data, for at least one risk factor. Random‐effects meta‐analyses estimated pooled odds ratio for categorical data and mean difference or standardized mean difference for continuous data. Ninety‐seven studies, comprising data from 60 479 patients who underwent CABG, were included. Moderate to large and statistically significant risk factors for delirium were as follows: (1) preoperative cognitive impairment, depression, stroke history, and higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) score, (2) intraoperative increase in intubation time, and (3) postoperative presence of arrythmia and increased days in the intensive care unit; higher preoperative cognitive performance was protective for delirium. Moderate to large and statistically significant risk factors for acute cognitive decline were as follows: (1) preoperative depression and older age, (2) intraoperative increase in intubation time, and (3) postoperative presence of delirium and increased days in the intensive care unit. Presence of depression preoperatively was a moderate risk factor for midterm (1–6 months) post‐CABG cognitive decline. Conclusions This meta‐analysis identified several key risk factors for delirium and cognitive decline following CABG, most of which are nonmodifiable. Future research should target preoperative risk factors, such as depression or cognitive impairment, which are potentially modifiable. Registration URL: https://www.crd.york.ac.uk/prosp​ero/ ; Unique identifier: CRD42020149276.

scholarly journals Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting

Medicina ◽  
2010 ◽  
Vol 46 (7) ◽  
pp. 460 ◽  
Author(s):  
Ieva Norkienė ◽  
Robertas Samalavičius ◽  
Irina Misiūrienė ◽  
Kotryna Paulauskienė ◽  
Valmantas Budrys ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cognitive Decline ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Asymptomatic Carotid ◽  
Postoperative Cognitive Decline ◽  
Asymptomatic Carotid Artery Stenosis

Background. The aim of our study was to evaluate the incidence of early postoperative cognitive decline (POCD) and determine perioperative risk factors as well as the impact of asymptomatic cerebral vascular lesion on the development of neurocognitive complications. Materials and methods. A total of 127 consecutive adult patients undergoing on-pump coronary artery bypass grafting were studied. Neuropsychological testing was performed the day before surgery and 7–9 days after operation. Stepwise logistic regression analysis determined independent predictors of POCD. Results. The incidence of postoperative cognitive decline was 46% (n=59). Patients in the POCD group were older (P=0.04) and had an increased prevalence of asymptomatic carotid artery stenosis (P=0.0001). POCD was associated with longer time in surgery (P=0.018), inotropic support intraoperativelly (P=0.02) and during postoperative period (P=0.008). Patients in the POCD group had an increased incidence of postoperative bleeding (P=0.037), delirium (P=0.016) and stayed in hospital for a longer period (P=0.007). Age of more than 65 years (OR, 2.7), asymptomatic carotid artery stenosis of more than 50% (OR, 26.89), duration of surgery of more than 4 hours (OR, 4.08), postoperative mechanical ventilation of more than 6 hours (OR, 3.33), and stay in an intensive care unit for more than 3 days (OR, 3.38) were significant independent predictors of cognitive decline. Conclusions. Increased age, preoperative prevalence of craniocervical atherosclerotic lesions, longer time in surgery, longer stay in an intensive care unit and mechanical ventilation time were found to be the risk factors for developing postoperative cognitive decline.

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

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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