scholarly journals Decrease of Perforin Expressing Lymphocytes after On-Pump Coronary Artery Bypass Grafting Surgery Irrespective of Carbohydrate Preoperative Oral Feeding

2019 ◽  
Vol 22 (3) ◽  
pp. E218-E224 ◽  
Author(s):  
Jadranko Sokolic ◽  
Danijel Knezevic ◽  
Janja Kuharic ◽  
Igor Medved ◽  
Alan Sustic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Oral Feeding ◽  
Bypass Grafting ◽  
Cabg Surgery ◽  
Off Pump ◽  
Pump Cabg ◽  
Perforin Expression

Background: Coronary artery bypass grafting (CABG) surgery continues to be the gold standard for treating the patients with coronary artery disease. CABG surgery can be performed on or off cardiopulmonary bypass, termed as on-pump or off-pump CABG, respectively. It has been shown that CABG surgery, preferably on-pump CABG surgery, leads to the changes of cell immunity during perioperative and early postoperative period. The mechanisms of regulation of the immune response in patients during and early after surgical revascularization are not fully understood. The aim of this study was to investigate the influence of carbohydrate preoperative oral feeding on frequency and perforin expression in peripheral blood lymphocytes in patients after on- or off-pump CABG surgery in early postoperative period. Patients and methods: In this prospective clinical study, 80 patients scheduled for CABG surgery were included in the study. The patients were randomly allocated into four groups (20 in each group): patients in Group 1 underwent on-pump CABG and did not receive carbohydrate preoperative oral feeding; patients in Group 2 underwent on-pump CABG and were preoperatively fed; patients in Group 3 underwent off-pump CABG and did not receive carbohydrate preoperative oral feeding; while patients in Group 4 underwent off-pump CABG and received carbohydrate preoperative oral feeding. Blood samples were collected immediately before (T1), 24 (T2) and 72 (T3) hours after the surgery. Peripheral blood mononuclear cells were isolated by gradient centrifugation and simultaneously labelled by antigens using fluorochrome-conjugated monoclonal antibodies. Frequency of T lymphocytes, NK and NKT cells, their subsets as well as their perforin expression were detected, and analyzed by flow cytometry. Results: There was significant decrease in frequency of CD3+ and CD3+CD4+ cells, as well as perforin expressing CD3+CD8+ cells in patients who underwent on-pump CABG in comparison to patients who underwent off-pump CABG 24 hours after the surgery. Carbohydrate preoperative oral feeding did not effect changes in lymphocytes subpopulations and perforin expression at any time point. Conclusion: Decreases of CD3+ cells on account of CD3+CD4+ subsets, and perforin expressing cells on account of CD3+CD8+ perforin+ cells were found in patients who had undergone on-pump CABG, but not in patients who had undergone off-pump CABG surgery, irrespectively of carbohydrate preoperative oral feeding.

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 Off-Pump Coronary Artery Bypass Grafting Improves Early Clinical Outcomes Including Operative Mortality

2018 ◽  
Vol 21 (3) ◽  
pp. 151 ◽  
Author(s):  
Murali P. Vettath, ◽  
Madhu Ravisankar ◽  
Tomislov Kopjar ◽  
AV Kannan ◽  
Nitin Gangadharan
Keyword(s):  
Renal Failure ◽  
Quality Control ◽  
Acute Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg ◽  
Over Time

Background: Whether coronary artery bypass grafting (CABG) should be performed on- or off-pump remains a matter of debate. We aim to present our experience with off-pump CABG. Early clinical outcome and adverse events were analyzed over the time course of the study. Methods: A total of 4310 patients undergoing isolated off- pump CABG from January 2002 until December 2016 at the Malabar Institute of Medical Sciences in India were included. Preoperative, intraoperative, and postoperative, as well as follow-up data were prospectively collected. To analyze the differences of patient characteristics and outcomes over time, five-year periods were created (early: 2002-2006; middle: 2007-2011; late: 2012-2016). Traditional techniques of quality control monitoring were applied. Results: The mean age of our patients was 59 ± 9 years, and 13% (533) were female. Postoperative mortality was observed in 0.7% (25), acute renal failure and stroke in 0.2% (8) each, and mediastinitis in 1.2% (53) of the patients. Despite the progressive worsening of the patient risk profile, significant improvement in mortality was observed over time, while stroke, acute renal failure, and mediastinitis remained similar. Continuous quality control monitoring revealed that the system was within the control boundaries for the entire period of the study. The current probability of 30-day mortality or conversion to on-pump CABG is about 0.5%. Conclusion: Off-pump CABG is safe and effective for patients undergoing CABG. It can provide superior results compared to on-pump CABG, particularly when performed by a dedicated off-pump surgeon.

scholarly journals Haemodynamic assessment during off pump coronary artery bypass grafting in patients with ejection fraction ≥40% and it’s relation to myocardial ischaemia in early postoperative period

2020 ◽  
Vol 8 (11) ◽  
pp. 4079
Author(s):  
Surendra Singh Yadav ◽  
Ushnish Chakrabarty ◽  
Swernendu Datta ◽  
Plaban Mukherjee
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Ejection Fraction ◽  
Arterial Pressure ◽  
Troponin I ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Background: Subtle haemodynamic alterations that happen during manipulation, displacement and mechanical stabilization of the heart in off pump coronary artery bypass grafting (CABG), may be missed if only conventional parameters like Central venous pressure (CVP); Mean arterial pressure (MAP) and Mean pulmonary arterial pressure (MPAP) are being monitored. In this study we have tried to find out if such alterations may be detected by monitoring cardiac output (CO), cardiac index (CI) and stroke volume (SV) in addition to the conventional parameters.Methods: Over a period of one year (February 2014 to January 2015), 40 patients with left ventricular ejection fraction (LVEF) ≥40%, undergoing off-pump CABG were monitored for the above parameters at baseline and while grafting the anterior, lateral and inferior surfaces of heart. Their quantitative Troponin-I values were also measured preoperatively and 24 hours after shifting to intensive therapy unit (ITU) to find out if the subtle haemodynamic compromises were in anyway related to myocardial injury.Results: CO, CI and SV decreased significantly compared to baseline values while grafting anterior, lateral and inferior surfaces of heart in every patient. MAP decreased significantly only while grafting the left circumflex territory. Only 8 patients showed an elevation of troponin-I value postoperatively (p>0.05).Conclusions: We concluded that during Off-pump CABG (OPCABG) there will be subtle alterations in haemodynamic. However, pharmacological interventions, addition of fluids and lowering head end of table based on the changes seen by the new monitoring parameters are more logically guided and becomes more scientific and objective rather than being just arbitrary decisions.

Off-Pump Minimally Invasive Coronary Artery Bypass Grafting with a Heart Positioner Direct Retraction for a Better Exposure

2015 ◽  
Vol 10 (3) ◽  
pp. 183-187 ◽  
Author(s):  
Keita Kikuchi ◽  
Dai Une ◽  
Koutaro Suzuki ◽  
Yoshiki Endo ◽  
Takayoshi Matsuyama ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg ◽  
Good Exposure

Objective Lateral and inferior territories are difficult to expose during off-pump minimally invasive coronary artery bypass grafting (MICS CABG). The use of cardiopulmonary bypass is required at times. We initiated a direct retraction method by using a cardiac positioner for a better exposure, in order to complete off-pump, multivessel MICS CABG safely. Methods We recently initiated multivessel MICS CABG, performed via a 6- to 9-cm left thoracotomy. For distal anastomoses, the lateral pericardial edge was pulled to the chest wall to optimize exposure of the lateral and inferior area. Next, a single- or multisuction cardiac positioner was put on the sides of the target vessel through the small thoracotomy and pulled directly toward the incision. Finally, a distal anastomosis was made with an epicardial stabilizer via the thoracotomy, as in standard off-pump CABG. Results There was no mortality or conversion to sternotomy. A total of 10 cases were targeted for off-pump multivessel MICS CABG with this approach. Nine were completed, while 1 still required pump assist. The average number of distal anastomoses was 2.8 ± 0.8. Two were successful off-pump quadruple bypass grafting with sequential anastomoses. All patients were discharged and remain well to this day. Conclusions Most multivessel MICS CABG was feasible without pump assist even at the initiation period. This approach is easy and helpful in providing good exposure of target vessels without requirement of additional incisions.

scholarly journals Surgical revascularization on the beating heart in patients with low ejection fraction

2011 ◽  
Vol 139 (7-8) ◽  
pp. 452-457 ◽  
Author(s):  
Svetozar Putnik ◽  
Milos Velinovic ◽  
Aleksandar Mikic ◽  
Mile Vranes ◽  
Bojan Nikolic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Length Of Stay ◽  
Ejection Fraction ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg

Introduction. The subset of patients most likely to benefit from off-pump coronary artery bypass grafting (OPCABG) remains a controversial issue, but the technique has been proposed to decrease postoperative mortality and morbidity. Coronary artery bypass grafting (CABG) with a cardiopulmonary bypass carries a significant risk for patients with severe left ventricular (LV) dysfunction. Objective. The objective of this study was to compare off-pump to on-pump CABG in patients with ejection fraction (EF) lower than 30%. Methods. Prospective randomized study was carried out between June 2004 and March 2006 at the Institute for Cardiovascular Diseases of the Clinical Centre of Serbia. Sixty prospectively randomized high-risk patients divided into two groups to undergo off-pump or on-pump CABG. All recruited patients had left ventricular ejection fraction lower than 30%. Results. Thirty patients averaging 59.2 years of age underwent 2.30 grafts on pump, and another 30 averaging 59.6 years of age underwent 2.03 grafts off pump. OPCABG patients exhibited a significantly less release of TnI (average 0.71 ?/L) than on-pump patients (3.00 ?/L). Inotropic requirements were less in the off-pump group. The patients undergoing OPCABG received fewer units of blood and had shorter postoperative length of stay in intensive care unit and hospital stay. There was no significant difference in hospital mortality and complication rate. Conclusion. The present study suggests that off-pump CABG in patients with poor LV function when compared with conventional CABG achieved similar number of grafts per patient, similar in-hospital outcomes, shorter length of stay, reduced transfusion requirement, and less myocardial injury.

scholarly journals A Comparative Study of Hemodynamic Effects of Levosimendan and Milrinone in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

2020 ◽  
Vol 5 (1) ◽  
pp. 131-136
Author(s):  
Chand Kishan Vyas ◽  
Ramesh Kumar ◽  
Neelu Sharma ◽  
Indu Verma ◽  
Anjum Saiyed
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Ejection Fraction ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Loading Dose ◽  
Off Pump ◽  
Pump Cabg ◽  
Lactate Levels ◽  
Pump Coronary Artery Bypass

Background: Off-Pump CABG or “beating heart” surgery possess a challenge to the anesthesiologist. Main goals are provision of safe anesthesia with maximum myocardial protection and maintenance of hemodynamics with various manipulation of heart during in order to visualize and graft the coronary arteries. Anesthetic regimen and ionotropic support influences postoperative myocardial function and outcome in coronary bypass surgery patients.Objective:  To compare and assess haemodynamic effects of  Levosimendan and Milrinone in patient undergoing off pump coronary artery bypass grafting with compromised cardiac function (NYHA III,IV) and pre-operative, left ventricular ejection fraction (LVEF) < 45%.Subjects and Methods:Patients were randomly allocated to 2 groups (64 patients in each group). Levosimendan Group (Group A) received infusion of Inj. Levosimendan 0.1µg/kg/min after loading dose of 12μg/kg over 10 mins. While Milrinone Group (Group B) received infusion of inj. Milrinone 0.5µg/kg/min after loading dose of 50 μg/kg over 10 mins. HR, MAP, CVP, CI, SVRI, lactate levels were  monitored at baseline, after induction, after sternotomy, at 30mins ,thereafter  6, 12, and 24 hours using Flo-Trac sensor (Edwards Life sciences).Results:Heart Rate, CI was significantly higher in Levosimendan group while MAP, SVRI and lactate levels were lower in Levosimendan group as compared to Milrinone group. Need of other inotropic support is more in Milrinone group.Conclusion:Levosimendan maintained the haemodynamic parameters better as compared to Milrinone in off pump CABG patients with low preoperative ejection fraction and also better end organ perfusion represented by lower lactate levels.

scholarly journals Immediate results of minimally invasive redo off-pump coronary artery bypass grafting

2021 ◽  
Vol 6 (5) ◽  
pp. 222-229
Author(s):  
V. A. Podkamenniy ◽  
A. A. Sharavin ◽  
D. I. Likhandi ◽  
Yu. V. Zheltovsky ◽  
A. V. Vyrupaev
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Redo Surgery ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg ◽  
Mini Thoracotomy

Coronary heart disease (CHD) ranks first among the causes of death from cardiac events. Patients who have previously undergone surgical treatment – coronary artery bypass grafting (CABG) – are not immune from the return of angina due to the progression of atherosclerosis in the native coronary arteries or degenerative changes in the shunts. Therefore, the issue of redo surgery in this group of patients is debatable.The aim of the research is to show that the use of alternative sternotomy approaches and the rejection of artificial blood circulation (ABC) are considered as possible measures to improve the results of redo CABGs.Materials and methods. In the Cardiac Surgery Unit No. 1 of the Irkutsk Regional Clinical Hospital from 2003 to 2020, 6773 off-pump CABG surgeries were performed. Of these, 6338  (93.6  %) surgeries were performed using median sternotomy and  435  (6.4  %) surgeries were performed using minitoracotomy or subxyphoid access. Of the 6338 CABG surgeries performed using sternotomy, 58 (0.9 %) were performed repeatedly. All redo surgeries during the period under review were performed by minithoracotomy or subxyphoid access. The indication for redo surgery was the return of angina of III or IV functional class, which did not respond to optimal drug therapy. When performing 54 redo surgeries, the access was leftsided mini-thoracotomy. In 3 patients, CABG was performed by subxyphoid access and in 1 patient – from right-sided mini-thoracotomy.Results. 58 redo CABG surgeries were performed. There was no damage to the access of the heart or functioning shunts. Complications were noted in 5 (8.6 %) patients. In 1 case, a second operation was required due to bleeding from the intercostal artery. In other cases, there were rhythm disturbances, or the need for inotropic support.Conclusion. Performing redo off-pump CABG surgeries using mini-accesses reduces the risk of damage to the heart and functioning shunts, eliminates manipulations on the ascending aorta, and avoids difficulties with cardioplegic protection of the myocardium with a functioning mammarocoronary graft. 

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