On-Pump Beating/Non-Beating CABG in Stable Angina Have Similar Outcomes

Abstract

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.

Early and Medium Outcomes of On-Pump Beating-Heart versus Off-Pump CABG in Patients with Moderate Left Ventricular Dysfunction

“…Accordingly, for patients with normal EF, on-pump or off-pump CABG would not influence the operative mortality and long-term survival [23] . But for patients with poor EF, an ideal treatment is not only safe and easy during the manipulation, but also avoids the complications caused by aortic cross-clamping with CPB [24] .…”

Intermittent on-pump beating-heart coronary artery bypass grafting—a safer option

“…Due to theoretical uncertainties regarding the ON-BH CABG technique, interest in this has not been significant and hence studies are scarce when we compare the other two strategies. For example in a recent study in 2018 by Dayan et al, it was concluded that both ON-BH CABG and C-CABG where similar in terms of long-term survival rates and operative mortalities [14]. While higher rates of prolonged ventilator support and blood sugar levels were seen in ON-BH CABG, C-CABG was associated with a higher need of longer inotropic support.…”

Operating with Data - Statistics for the Cardiovascular Surgeon: Part II. Association and Risk

“…To make the concept clearer, let's make use of a practical example. In a previous issue of the BJCVS, Dayan et al analyzed the outcomes of coronary artery bypass graft (CABG) with and without aortic cross-clamp (AXC) [ 2 ] . One of the dependent variables analyzed by the authors was the need for postoperative prolonged ventilatory support (PVS).…”