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.

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 Short Term Outcome of Off Pump Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

2019 ◽  
Vol 14 (2) ◽  
pp. 53-61
Author(s):  
Mohammad Serajus Salekin ◽  
Md Faizus Sazzad ◽  
Syed Al Nahian ◽  
Sumsul Arif Mohammad Musa ◽  
Mohammed Rabbikul Alam ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Ejection Fraction ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Coronary artery disease is increasing in developing countries. Revascularization surgery in such patients with amenable coronary anatomy is a valid option. Coronary artery bypass grafting in patients with low ejection fraction (EF <35%) is very challenging although it is performing successfully in department of Cardiac Surgery of Bangabandhu Sheikh Mujib Medical University now a days. The purpose of this study is to evaluate the safety and effectiveness of off pump coronary artery bypass grafting for EF e”35% and EF <35% and also to compare between pre and postoperative echocardiographic findings in this two groups. The preoperative, at discharge, 1 month and 3 month postoperative follow up data of total 60 patients in two groups ( EF e”35% and <35%) who underwent isolated off pump coronary artery bypass grafting between July 2012 – June 2014 was evaluated. In group 1 preoperative LVIDd and LVIDs was 54.86±3.45 mm and 45.23 ±4.13mm and LVEF was 42.7±4.66. Postoperatively at 3 month follow up the LVIDd 45.43±5.03 mm, LVIDs 34.7±5.33 mm and LVEF 53.46±5.06. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. But improvement of LVEF is not statistically significant (p>0.05). Similarly in group 2 patients preoperative LVIDd, LVIDs and LVEF is 67.06±3.67mm, 59.1±4.35mm and 29.26±4.25. Postoperatively at 3 months follow up of this group the LVIDd, LVIDs and LVEF is changed to 57.56±4.96 mm, 48.3±5.53 mm and 38.93±6.03. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. And the improvement of LVEF is also statistically significant (p<0.001). Significant improvement in terms of CCS grade and NYHA class was also observed specially in <35% ejection fraction group at 3moths follow up. We concluded that off pump coronary artery bypass grafting can be safely performed to the patients with normal and poor left ventricular ejection. Hence we recommended that off-pump CABG can be safely carry out in case of <35% ejection fraction patients. University Heart Journal Vol. 14, No. 2, Jul 2018; 53-61

Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Trial

2017 ◽  
Vol 70 (2) ◽  
pp. 106-110 ◽  
Author(s):  
Sheila da Silva Guimarães ◽  
Wanise de Souza Cruz ◽  
Licinio da Silva ◽  
Gabrielle Maciel ◽  
Ana Beatriz Huguenin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Ejection Fraction ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Bypass Grafting ◽  
Carnitine Supplementation ◽  
Artery Bypass Grafting

During cardiac failure, cardiomyocytes have difficulty in using the substrates to produce energy. L-carnitine is a necessary nutrient for the transport of fatty acids that are required for generating energy. Coronary artery graft surgery reduces the plasma levels of L-carnitine and increases the oxidative stress. This study demonstrates the effect of L-carnitine supplementation on the reverse remodeling of patients undergoing coronary artery bypass graft. Patients with ischemic heart failure who underwent coronary graft surgery were randomized to group A - supplemented with L-carnitine or group B controls. Left ventricular ejection fraction, left ventricular systolic and diastolic diameters were assessed preoperatively, 60 and 180 days after surgery. Our study included 28 patients (26 [93.0%] males) with a mean age ± SD of 58.1 ± 10.5 years. The parameters for the evaluation of reverse remodeling did not improve after 60 and 180 days of coronary artery bypass grafting in comparison between groups (p > 0.05). Evaluation within the L-carnitine group showed a 37.1% increase in left ventricle ejection fraction (p = 0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and diastolic diameters, respectively. L-carnitine supplementation at a dose of 50 mg/kg combined with artery bypass surgery did not demonstrate any additional benefit in reverse remodeling. However, evaluation within the L-carnitine group may indicate a clinical benefit of L-carnitine supplementation.

scholarly journals Off-pump coronary artery bypass grafting in patients with significant left ventricular dysfunction

2008 ◽  
Vol 24 (2) ◽  
pp. 110-115 ◽  
Author(s):  
Lokeswara Rao Sajja ◽  
Gopichand Mannam ◽  
Satya Bhaskar Raju Dandu ◽  
Satyendra Nath Pathuri ◽  
Krishnamurthy Venkata Sathya Shiva Saikiran ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

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.

Sign in / Sign up

Export Citation Format

Share Document