Immediate Proximal Coronary Graft Anastomosis after Completion of Related Distal Anastomosis, During Off Pump Cabg; Is It Efficient?

Background: It has been suggested that off-pump coronary artery bypass grafting (CABG) surgery reduces myocardial ischemia-reperfusion injury, postoperative systemic inflammatory response, and oxidative stress. The aim of this study was to measure serum malondialdehyde (MDA), highsensitivity C-reactive protein (hs-CRP), M30, and M65 levels and to investigate the relationship between M30 levels and oxidative stress and inflammation in patients undergoing onand off-pump CABG surgery. Methods: Fifty patients were randomly assigned to onpump or off-pump CABG surgery (25 patients off-pump and 25 on-pump CABG surgery), and blood samples were collected prior to surgery, and 30 minutes, 60 minutes, 6 hours, and 24 hours after CABG surgery. Results: Compared to the on-pump group, serum MDA levels at 30 minutes, 60 minutes, 6 hours, and 24 hours after the CABG surgery were significantly lower in the off-pump group (P = .001, P = .001, P = .001, and P = .001, respectively). Serum M30 levels were found to be elevated in both groups, returning to baseline at 24 hours. When compared to baseline, the hs-CRP level reached its peak at 24 hours at 13.28 ± 5.32 mg/dL in the on-pump group, and 15.44 ± 4.02 mg/dL in the off-pump group. Conclusion: CABG surgery is associated with an increase in inflammatory markers and serum M30 levels, indicating epithelial/endothelial apoptosis in the early period.

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Outcomes and Predictors of Mortality and Stroke after On-Pump and Off-Pump Coronary Artery Bypass Surgery in Octogenarians

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000000 ◽

2013 ◽

Vol 8 (4) ◽

pp. 269-275 ◽

Cited By ~ 11

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.

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Correlation of Blood Lactate and Mixed Venous Oxygen Saturation in Off-Pump CABG

World Journal of Cardiovascular Surgery ◽

10.4236/wjcs.2014.47020 ◽

2014 ◽

Vol 04 (07) ◽

pp. 131-138

Author(s):

Ganapathy Sambandam Kamalakkannan ◽

Ranjith Karthekeyan ◽

Mahesh Vakamudi ◽

Sandeep Bangale ◽

Rajeshkumar Kodali ◽

...

Keyword(s):

Oxygen Saturation ◽

Blood Lactate ◽

Mixed Venous Oxygen Saturation ◽

Off Pump ◽

Venous Oxygen Saturation ◽

Pump Cabg ◽

Mixed Venous

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A Case of Non-Occlusive Mesenteric Ischemia after Off-Pump CABG and Abdominal Aortic Aneurysm Replacement

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.34.386 ◽

2005 ◽

Vol 34 (5) ◽

pp. 386-388

Author(s):

Toshiya Tokui ◽

Shinji Kanemitsu ◽

Keizou Tanaka ◽

Hitoshi Suzuki ◽

Toshihiko Kinoshita

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Mesenteric Ischemia ◽

Off Pump ◽

Abdominal Aortic ◽

Occlusive Mesenteric Ischemia ◽

Pump Cabg

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

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2020-17-3-17-23 ◽

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.

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Perioperative outcomes of combined heart surgery and lung tumor resection: A systematic review and meta-analysis

10.21203/rs.3.rs-86694/v1 ◽

2020 ◽

Author(s):

Shizhao Cheng ◽

Yiyao Jiang ◽

Xin Li ◽

Xike Lu ◽

Xun Zhang ◽

...

Keyword(s):

Complication Rate ◽

Subgroup Analysis ◽

Heart Surgery ◽

Lung Tumor ◽

Meta Analysis ◽

Tumor Resection ◽

Perioperative Outcomes ◽

Off Pump ◽

Lung Cancer Patients ◽

Pump Cabg

Abstract Objective: The coexistence of concomitant lesions of the heart and lungs needed surgical intervention is increasing. Simultaneous cardiac surgery with pulmonary resection can solve the lesions at the same time, thus avoiding the second operation. However, concern exists regarding the potentially increased mortality and complication rate of simultaneous surgery and the adequacy of lung exposure during heart surgery. Therefore, we performed a meta-analysis to evaluate the perioperative mortality and complication rate of combined heart surgery and lung tumor resection.Methods: A comprehensive literature search was performed in July 2020. PubMed, Embase and Web of Science databases were searched to collect studies reported the perioperative outcomes of combined heart surgery and lung tumor resection. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Pooled proportion and its 95% confidence intervals (95% CI) was performed by R version 3.6.1 using the meta package.Results: A total of 536 patients from 29 studies were included in this analysis. Overall, the results of this meta-analysis showed that the pooled proportion of operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57) for patients underwent combined cardiothoracic surgery. Subgroup analysis by lung pathology revealed that, for lung cancer patients, the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95, 1.00), and the pooled proportion of systematic lymph node dissection or sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery procedures found that the pooled proportion of postoperative complications of coronary artery bypass grafting (CABG) patients using off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled proportion of on-pump method was 0.61 (95% CI: 0.38, 0.82).Conclusion: This study presented that combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analysis revealed most lung cancer patients underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG could potentially reduce the complication rate compared with on-pump CABG. While further researches are still needed.

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