Comparison of Post-Operative Morbidity and Mortality in Patients Undergoing On-Pump versus Off-Pump CABG

2021 ◽  
Vol 15 (11) ◽  
pp. 3098-3100
Author(s):  
Mati Ur Rahman ◽  
Ajwad Farogh ◽  
Sadaf Iftikhar ◽  
Naseem Ahmad ◽  
Gohar Bashir ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Cost Savings ◽  
Current Data ◽  
Morbidity And Mortality ◽  
P Value ◽  
Off Pump ◽  
Total Data ◽  
Pump Cabg ◽  
Hospital Morbidity ◽  
The Cost

Objective: The aim of this study is to compare in hospital morbidity and mortality in on pump versus off pump CABG. Methodology: All the patients undergoing CABG surgery were enrolled after taking informed consent. Demographic and postoperative variables were entered in the predesigned questionnaire and patients were followed for early outcomes after surgical procedure. Results: A total of 470 patients wasdivided in two groups 235 (on pump and off pump).The mean age of patients was 54.85 ± 9.57 (23-85).There were 400(85.1%) males and 70(14.9%) females. The total data of 470 patients was divided in two groups 235 in on Pump and 235 in off pump CABG.The mean age of patients was 54.85 ± 9.57 (23-85). There were 400(85.1%) males and 70(14.9%) females. Different clinical outcomes were compared in both groups (On-Pump versus Off-Pump CABG) by using Euro Score, we found Peripheral Disease in On-Pump CABG group compared with Off-Pump CABG as 11(4.68% vs 12(5.11%) with p-value=0.831 which was statistically insignificant, current data assessed lung disease in both groups as 11(4.68%) vs 13(5.53%) with statistically insignificant p-value (0.675). and unstable angina were 12(5.11%, p-value 1.00) patients founded and Peri and post myocardial infarction also assessed in both groups with p-value (0.74 & 1.20). respectively.Data regarding in hospital mortality was analyzed and found that 7(2.98%) in on pump group compare with off pump group was According to our research mean number of grafts placed in On-Pump CABG were 9(3.83%) with statistically insignificant p-value (0.611). Conclusion:Proof is presented that surgery on beating heart (Off-Pump) is as safe and effective as Conventional CABG, and cheaper than conventional surgery. However, it is uncertain whether the cost savings are sustained over a longer period of time. Keywords: Coronary artery Bypass grafting surgery, On Pump Off Pump

scholarly journals Effects of Coronary Artery Bypass Grafting Surgery on Olfactory and Taste Functions

2019 ◽  
Vol 22 (5) ◽  
pp. E416-E422
Author(s):  
Kemalettin Erdem ◽  
Erhan Renan Ucaroglu ◽  
Abidin Sehitogullari ◽  
Ahmet Yuksel ◽  
Hikmet Tekce ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Coronary Artery ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Olfactory Function ◽  
P Value ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg

Background: Olfactory and taste sensations have a high impact on the quality of life. Impaired olfactory and taste functions may have a negative effect on physical and mental well-being, personal hygiene, and nutritional satisfaction, leading to the occurrence of depressive symptoms and impaired quality of life. Therefore, the recovery period of patients with disturbed olfactory and taste functions may be prolonged, and return to active life may be delayed. We designed this study to determine whether on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have any effects on olfactory and taste functions and compare these functions between the surgical groups. Methods: A total of 60 patients, who underwent elective isolated first-time CABG, were included in this study. Patients were divided into two groups as Off-Pump and On-Pump CABG groups with 30 patients in each group. In addition to patients' primary clinical and laboratory data, olfactory and taste functions were evaluated pre- and postoperatively in both groups separately, and then these functions were compared between the groups. Olfactory functions were evaluated by the Brief Smell Identification Test, while taste functions by the Burghart Taste test. Results: Olfactory functions significantly were disrupted in the postoperative period in patients undergoing on-pump CABG (P value < .05), while these functions significantly were not affected in patients undergoing off-pump CABG (P value > .05). During the preoperative period, advanced age and smoking were detected to be independent predictors of impaired olfactory function for the study population. During the postoperative period, smoking, amount of postoperative bleeding and serum low-density lipoprotein (LDL) level were found to be independent predictors of impaired olfactory function for just the On-Pump CABG Group. In both groups, no significant deterioration in taste functions occurred during the postoperative period (P value > .05). Conclusion: Our study demonstrated that olfactory function was impaired in patients, who underwent on-pump CABG in the postoperative period, and significant impairment in taste function was present in neither off-pump nor on-pump CABG patients. However, the results of our study should be supported by more comprehensive, prospective, randomized controlled trials with more extensive patient series and by further tests.

Effects of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting: Apoptosis, Inflammation, and Oxidative Stress

2014 ◽  
Vol 17 (5) ◽  
pp. 271 ◽  
Author(s):  
Murat Bicer ◽  
Tunay Senturk ◽  
Murat Yanar ◽  
Ahmet Tutuncu ◽  
Arzu Yilmaztepe Oral ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Cabg Surgery ◽  
Off Pump ◽  
Pump Cabg ◽  
Hs Crp ◽  
And Oxidative Stress

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

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 Comparing dexmedetomidine and propofol for sedation and hemodynamic stability in cardio-thoracic intensive care unit for patients following off-pump coronary artery bypass graft surgery

2021 ◽  
Vol 10 (2) ◽  
pp. 153
Author(s):  
Vasant P. Patil ◽  
Jacob Abraham ◽  
Grace M. George
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
P Value ◽  
Analgesic Requirement ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Background: Most patients in intensive care unit (ICU) require both sedation and analgesia to encourage natural sleep, facilitate assisted ventilation and modulate physiologic response to stress. The ideal sedative after Coronary artery bypass grafting (CABG) should have rapid onset, immediate resolution of both pain and anxiety, promote cardiac and respiratory stability, maintain a reusability during sedation, allow rapid recovery after discontinuation, and attenuate the cardiovascular, neuroendocrine, and inflammatory response. All these properties may improve outcome in cardiac patients after CABG.Methods: Setting-cardiac ICU. A prospective, randomised, single blind study including 60 patients divided into 2 groups. Data collection tools-study proforma and Ramsay sedation scale (RSS). Data analysed using science and statistical packaged (SPSS) version 20, independent sample `t` test, chi-square test, analysis of variance (ANOVA) and p value ≤0.05 was considered statistically significant.Results: Sedation levels and length of stay of patients on ventilator were comparable in both groups, however, analgesic requirement was significantly less in dexmedetomidine group. Dexmedetomidine group showed significantly lower heart rates compared to propofol group.Conclusions: Dexmedetomidine and propofol are safe sedative agents during mechanical ventilation in ICU for patients undergoing off pump coronary artery bypass (OPCAB). There is more than 50% reduction in analgesic requirement and a significant reduction in heart rate in dexmedetomidine sedated patients. 

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.

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.

Impact of Left Atrial Appendage Amputation on Left Atrial Morphology and Rhythm after Off-Pump CABG

2021 ◽  
Author(s):  
Muhammed Gerçek ◽  
Mina Ghabrial ◽  
Lina Glaubitz ◽  
Oliver Kuss ◽  
Anas Aboud ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Artery Bypass ◽  
Atrial Appendage ◽  
Control Group ◽  
Preoperative Risk ◽  
Off Pump ◽  
History Of ◽  
Pump Cabg

Abstract Objectives Left atrial appendage (LAA) amputation concomitant to coronary artery bypass grafting (CABG) has become an increasingly performed technique in patients with atrial fibrillation (AF) or with sinus rhythm and a CHA2DS2-VASc score ≥2. However, LAA amputation has come under suspicion to cause postoperative atrial fibrillation (POAF) due to left atrial (LA) dilation. This study aims to assess this assumption in patients undergoing CABG in off-pump technique with and without amputation of the LAA. Methods Patients who underwent isolated CABG in off-pump technique without history of AF were retrospectively examined. Cohorts were divided according to the concomitant execution of LAA amputation. LA volume was measured by transthoracic echocardiography and rhythm was analyzed by electrocardiography, medication protocol, and visit documentation. Propensity score (PS) matching was performed based on 20 preoperative risk variables to correct for selection bias. Results A total of 1,522 patients were enrolled, with 1,267 in the control group and 255 in the LAA amputation group. Occurrence of POAF was compared in 243 PS-matched patient pairs. Neither the unmatched cohort (odds ratio [OR] 0.82; 95% confidence interval or CI [0.61; 1.11], p = 0.19) nor the PS-matched cohort (OR 0.94; 95% CI [0.62; 1.41], p = 0.75) showed significant differences in POAF occurrence. Subgroup analysis of sex, use of β-blockers, pulmonary disease, ejection fraction, and CHA2DS2-VASc-Score also showed no tendencies. LA volume did not change significantly (p = 0.18, 95% CI [−0.29; 1.51]). Conclusion Surgical amputation of the LAA concomitant to CABG did not lead to LA dilation and has no significant impact on the occurrence of POAF.

Off-pump coronary artery bypass grafting

2021 ◽  
pp. 337-342
Author(s):  
Gianluca Torregrossa ◽  
David P. Taggart ◽  
John D. Puskas
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
High Risk Patient ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Hospital Morbidity ◽  
Pump Coronary Artery Bypass

Off-pump coronary artery bypass grafting is a highly specialized technique with the potential for reduction of in-hospital morbidity and mortality, particularly in high-risk patient populations. When possible, it should be performed as a clampless or no-aortic-touch technique with multiple or all-arterial conduits. By optimizing longevity of graft patency with arterial conduits and minimizing the risk of perioperative stroke by minimizing aortic manipulation, clampless and no-aortic-touch off-pump coronary artery bypass grafting techniques may be considered the ideal form of surgical coronary revascularization.

scholarly journals Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

2018 ◽  
Vol 10 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Tawfiq Ahmed ◽  
Md Rezaul Karim ◽  
Jahangir Haider Khan ◽  
Shahriar Moinuddin
Keyword(s):  
Coronary Artery ◽  
Postoperative Period ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Neurocognitive Dysfunction ◽  
Off Pump ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Objective: The Neurological injury is an important complication after coronary artery bypass surgery (CABG). The incidence of neurocognitive impairment after cardiac surgery varies from 20% to 80%. In this study we tried to analyze this difference of neurologic dysfunction between On-pump CABG and Off-pump CABG (OPCAB).Methods:This is a case control study done in National Institute of Cardiovascular Disease (NICVD), Dhaka during the period of July 2012 to June 2014. Sixty Patients with Ischemic heart disease were the study population. Group- A includes 30 patients underwent on pump CABG, Group-B 30 patients underwent OPCAB. All the patients of both the groups were followed up to 2 month’s postoperatively to find out any neurological and neurocognitive dysfunctionby observing motor function, sensory function,Mini Mantel state (MMS) Examination, orientation, memory, attention and calculation, recall and language test.Results: Neurocognitive dysfunction in the early postoperative period is significantly different among the groups.Neurocognitive dysfunction was more in Group A in comparison to Group B, On 3rd and 8th POD the MINI Mental Scores were found to be significantly lower in On-pump group than those in Off-pump group (22.0 ± 5.28 vs. 25.67 ± 3.34, p = 0.002 and 25.93 ± 3.11 vs. 26.63 ± 2.50, p = 0.023 respectively).This neurocognitive dysfunction gradually improved by the end of two month postoperative period. Only 6.66% patient in Group-A was found neurocognitically dysfunctional and was referred to neurophysician for further treatment. In case of OPCAB Group, no patient suffered fromneuorocognitive dysfunction.Conclusion: This study has convincingly shown cardio-pulmonary bypass (CPB) has had detrimental effect on neurocognitive function in patients who underwent CABG.Cardiovasc. j. 2018; 10(2): 186-193

P1832Myocardial injury assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting. a pre-specified analysis of mass V trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A R Dallazen ◽  
W Hueb ◽  
P C Rezende ◽  
G A B Boros ◽  
F F Ribas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
T1 Mapping ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Native T1 ◽  
Before And After ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Abstract Background Myocardial structural damage may occur during coronary artery bypass grafting (CABG) surgery and is identified by the significant release of cardiac biomarkers. However, the evidence of these structural myocardial changes after CABG by current imaging methods remains unknown. To evaluate myocardial structure, we used the T1 mapping of cardiac magnetic resonance (CMR) before and after on-pump and off-pump CABG. Methods Patients with multivessel coronary artery disease and preserved ventricular function were included and underwent on or off-pump CABG. CMR and T1 mapping were performed using the MOLLI technique (modified Look-Locker inversion-recovery). Values of native T1 and extracellular volume fraction (ECV) were compared before and after on and off-pump procedures. Results Of 110 eligible patients, 34 were excluded due to the presence of new late enhancement or edema. Of 76 patients remained, 32 (42%) underwent on-pump (Group A) and 44 (58%) off-pump CABG (Group B). All baseline characteristics were similar between groups, besides the Syntax Score that was higher in Group A (25 × 21, p=0.002). For group A, native T1 before and after procedures was 1013 ms (998–1043) and 1004 ms (793–1048), p=0.19, and ECV was 26.4 (23.9–27.6) and 31.2 (27.6–33.9), p<0.001. For group B, native T1 before and after procedures was 1015 ms (970–1044) and 992 ms (867–1051), p=0.003, and ECV 27.5 (25.3–29.9) and 30.3 (26.5–34.3), p=0.02. The comparison of native T1 difference before and after procedures between groups A and B was not significant (Delta T1 −9.8 (−102 to 51.8) × −25.4 (−119 to 51,2), p=0.87. However, the difference of ECV between groups was statistically significant (ECV Delta 3.8 (2.2 to 7.1) × 1.3 (−1.1 to 4.9), p=0.039, respectively, for groups A and B. Figure 1 Conclusion In this sample, T1 mapping identified significant myocardial structural changes in both surgical revascularization procedures. Additionally, a marked myocardial injury generated by ECV changes were observed after on-pump CABG.

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