Off-pump coronary artery bypass surgery in selected patients is superior to the conventional approach for patients with severely depressed left ventricular function

Abstract

OBJECTIVES:Patients with coronary artery disease and left ventricular dysfunction have high mortality when kept in clinical treatment. Coronary artery bypass grafting can improve survival and the quality of life. Recently, revascularization without cardiopulmonary bypass has been presented as a viable alternative. The aim of this study is to compare patients with left ventricular ejection fractions of less than 20% who underwent coronary artery bypass graft with or without cardiopulmonary bypass.METHODS:From January 2001 to December 2005, 217 nonrandomized, consecutive, and nonselected patients with an ejection fraction less than or equal to 20% underwent coronary artery bypass graft surgery with (112) or without (off-pump) (105) the use of cardiopulmonary bypass. We studied demographic, operative, and postoperative data.RESULTS:There were no demographic differences between groups. The outcome variables showed similar graft numbers in both groups. Mortality was 12.5% in the cardiopulmonary bypass group and 3.8% in the off-pump group. Postoperative complications were statistically different (cardiopulmonary bypass versus off-pump): total length of hospital stay (days)—11.3 vs. 7.2, length of ICU stay (days)—3.7 vs. 2.1, pulmonary complications—10.7% vs. 2.8%, intubation time (hours)—22 vs. 10, postoperative bleeding (mL)—654 vs. 440, acute renal failure—8.9% vs. 1.9% and left-ventricle ejection fraction before discharge—22% vs. 29%.CONCLUSION:Coronary artery bypass grafting without cardiopulmonary bypass in selected patients with severe left ventricular dysfunction is valid and safe and promotes less mortality and morbidity compared with conventional operations.

Cardiology in Brazilian scientific journals: an overview

“…Rev Bras Cir Cardiovasc 2012;27 (2):302- 11 Armaganijan et al [8] conducted a metanalytical survey of randomized trials of N-3 polyunsaturated fatty acid use for postoperative atrial fibrillation using the PUBMED CENTRAL, PUBMED, EMBASE, and LILACS databases. Four randomized studies (three double-blind, one openlabel) that enrolled 538 patients were identified.…”

“…Although noise level, irrespective of measures, was not observed to be significantly associated with the selfassessed psychological and physiological responses, it was significantly associated with both heart rate and blood surprisingly, the most frequent entry. Caputti et al [2] compared 217 nonrandomized, consecutive, and nonselected patients with left ventricular ejection fractions of less than 20% who underwent coronary artery bypass graft, with or without cardiopulmonary bypass. They found that in selected patients with severe left ventricular dysfunction the procedure is valid and safe and promotes less mortality and morbidity, compared with conventional operations.…”

Long-Term Outcomes after Off-Pump Coronary Artery Bypass Grafting in Left Ventricular Dysfunction

“…They concluded that in-hospital mortality was signifi cantly lower in the off-pump group than the on-pump group (0% vs. 6.5%, p <0.05). Caputti and colleagues 19) conducted an observational study and found that in-hospital mortality was signifi cantly lower in patients undergoing offpump CABG than on-pump CABG (3.8% vs. 12.5%, p = 0.008). However, other studies did not fi nd that off-pump CABG had better outcomes than on-pump CABG.…”

Evaluation of Low-Dose Ketamine on Inflammatory Biomarker Profile Following Off-Pump Coronary Artery Bypass Grafting

“…16,17 Amelioration of SIRS with ketamine is thought to be mediated through inhibition of nuclear factor (NF)-kB, 7 which regulates the transcription of genes that encode the production of proinflammatory cytokines. 18,19 This positive modulation confers an anti-inflammatory potential to the drug by limiting the exacerbation of systemic inflammation with minimal effect on the local healing processes.…”