PPM increases perioperative and overall mortality proportionally to its severity. The identification of predictors for PPM may be useful to identify patients who are at higher risk for PPM. The findings of this study support the implementation of strategies to prevent PPM especially in patients <70 years of age and/or with concomitant coronary artery bypass graft.
ObjectiveOn pump beating/non-beating coronary artery bypass grafts (CABG) has been
compared in patients with unstable angina and/or severe left ventricular
dysfunction. There is scarce evidence regarding the beneficial use of
on-pump beating CABG in patients with stable angina and normal left
ventricular function. Our aim was to study the postoperative results using
both techniques in this group of patients.MethodsOne thousand one hundred and forty-five patients with stable angina underwent
on-pump isolated CABG in Uruguay from 2011 to 2015. Patients were grouped
into beating/non-beating CABG. Operative mortality and long-term survival
were evaluated as primary outcome. Logistic regression analysis was
performed to define the predictive role of aortic cross clamp (AXC) on
prolonged inotropic support, ventilator support and intraoperative
glycemia.ResultsAmong the included patients, 988 underwent aortic cross clamp. No differences
were found in operative mortality, stroke and long-term survival among both
groups. Patients without AXC showed higher intraoperative values of glycemia
and higher incidence of postoperative prolonged mechanical ventilator
support (7.6% vs. 2.4%; P=0.001). The need
for prolonged inotropic support was lower in this group of patients (27.4%
vs. 49.5%; P<0.001).ConclusionOn-pump beating CABG has similar operative mortality and long-term survival
compared with conventional AXC. Higher intraoperative glycemia and higher
incidence for prolonged mechanical ventilator is associated with on-pump
beating CABG. On the contrary, higher incidence for prolonged inotropic
support is associated with AXC. Taking these factors into consideration,
both techniques are safe and allow the surgeon to choose the most
comfortable option.
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