Comparison of Off-Pump versus Conventional Coronary Revascularization

Abstract

Between May 1999 and August 2001, 231 patients underwent off-pump coronary bypass, of whom 171 required revascularization of the anterior vessels of the heart. They were compared with a group matched for age, sex, and risk factors undergoing revascularization of the same group of vessels under cardiopulmonary bypass. Mortality was comparable in both groups but the incidence of cerebrovascular accident, respiratory insufficiency, and renal failure was less in the off-pump group. Postoperative drainage and blood transfusion requirements were significantly less in the off-pump group. Intensive care and hospital stay were shorter in the off-pump patients. A considerable number of patients are potential candidates for off-pump coronary bypass, the only contraindication being technical limitations. Follow-up at 6 to 24 months indicates that off-pump coronary bypass can be performed safely with a decrease in morbidity and more rapid return to normal lifestyle.

Outcome of CABG with or without Coronary Endarterectomy in Bangladesh: A Retrospective Cohort Study

“…Our protocol is that, once postoperative blood draining is settle down (usually 3-4 hours following surgery), we started Heparin usually for 48 hours, followed by bridging to Warfarin (5mg) orally from 1 st post-operative day. From 3 rd Post-operative day, we prescribed Warfarin (2.5mg) for next 6 months and dose adjusted according to INR findings (our targeted is INR 1.5-2.5).We also prescribed Clopidogrel and Aspirin (75mg) for life long following CE with OPCABG, which also described in other articles 2,3,13,14 .In our review, only 0.76% and 1.5% patientshad transient ischemic attack (TIA) in only CABG group and CE with CABG group respectively with complete recovery, which agrees in the review of Naseri et al who revealed no neurologic deficit 18 . In a study, Djalilian et al shows only 9% of their patients got angina at 46±19 months follow up, though Gill et al observed intermittent angina in 15% of their patients at a mean followup of 36±16 months 14, 16 .…”

“…We observed, early mortality is accounted to be higher after LAD endarterectomy and in patients experiencing endarterectomy of more than one coronary artery, which is supported by other authors 7, 15 . In a study following CE with OPCABG, Erylimaz et al shows no mortality at one-year follow-up 19 .Naseri et al who compared both on pump and off pump CABG with CE, described a mortality of 2.2% in a series of 44 patients 18 . The number of multiple endarterectomies in our review was 16.5%, which is higher in compared to other study 21 24 .…”

“…The mean age of study population was 59.75±2.5 and 62.5±3.5 18.5% conversions to on-pump CABG using cardiopulmonary bypass in CE with CABG Group andPost-operative ICU mortality rate was 1.68% in Group -1, and 1.8% in Group -2. There were no intra-operative mortalities in this study.…”

Early and mid-term results of coronary endarterectomy: Influence of cardiopulmonary bypass and surgical techniques

“…In addition to, in the current study, the outcomes were examined of patients who underwent CE with either on-or off-pump CABG. Naseri et al [18] reported that OPCAB-CE can be performed safely with morbidity and mortality comparable with those of ONCAB-CE.…”

Coronary Endarterectomy with off Pump Coronary Artery Bypass Surgery- A Review

“…1,17 Since then, several study have shown that the complete myocardial revascularization of coronary artery disease by CABG with CE can be done safely and it enhanced the post-operative outcomes by improving myocardial function. [18][19][20] Definition and types of Coronary Endarterectomy Coronary Endarterectomy is a surgical procedure involving the removal of atheromatous plaque, and isolating the outer media and adventitia layers of artery and reestablishing the blood flow to the distal part of to the coronary artery ( Figure-1). A conclusive decision to do endarterectomy of a vessel is made per-operatively and depends on technical contemplations.…”