Coronary artery bypass grafting on the beating heart without the use of extracorporeal circulation: review of 2052 cases

Taşdemi̇r, Oğuz; Vural, Kerem M.; Karagöz, Haldun; Bayazıt, Kemal

doi:10.1016/s0022-5223(98)70244-2

Cited by 123 publications

(55 citation statements)

References 10 publications

(9 reference statements)

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“…[5][6][7] Several large, nonrandomized, retrospective case series comparing CABG surgery performed on the beating heart (off pump) and conventional CABG surgery performed with CPB (on pump) have indicated an advantage to CABG surgery without CPB; however, selection bias toward lower-risk cases in CABG without CPB remains an issue. 8 -14 The largest randomized studies published to date are conflicting, with some demonstrating decreased length of hospitalization and myocardial enzyme release, 15 whereas others demonstrate decreased incidence of atrial fibrillation, length of hospitalization, and blood-product utilization with CABG surgery performed on the beating heart.…”

Section: See P 810mentioning

confidence: 99%

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump

et al. 2004

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Background-There is increasing evidence that cardiopulmonary bypass (CPB) may be responsible for the morbidity associated with coronary artery bypass grafting (CABG) surgery. Recent developments in cardiac stabilization devices have made CABG without CPB feasible. However, there is conflicting evidence to date from published trials comparing outcomes between CABG performed with and without CPB, with some trials indicating an advantage to the avoidance of CPB and others showing little benefit. Methods and Results-In a single-center randomized trial, 300 patients requiring CABG surgery at a single institution were prospectively randomized to have the procedure performed with CPB (nϭ150) or on the beating heart (nϭ150). Exclusion criteria for the trial included emergency procedure, concomitant major cardiac procedures, ejection fraction Ͻ30%, and reoperation. In-hospital outcomes were analyzed on an intention-to-treat basis. A mean of 3.0Ϯ0.9 grafts were performed in the CPB group compared with 2.8Ϯ0.9 grafts in the beating-heart group (Pϭ0.06). There were no significant differences between the CPB group and the beating-heart group in mortality (0.7% versus 1.3%; Pϭ1.0), transfusion (8.7% versus 9.3%), perioperative myocardial infarction (0.7% versus 2.7%; Pϭ0.37), permanent stroke (0% versus 1.3%; Pϭ0.50), new atrial fibrillation (32% versus 25%; Pϭ0.20), and deep sternal wound infection (0.7% versus 0%; Pϭ1.0). The mean time to extubation was 4 hours, the mean stay in the intensive care unit was 22 hours, and the median length of hospitalization was 5 days in both groups (PϭNS). Conclusions-In

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Section: See P 810mentioning

confidence: 99%

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump

et al. 2004

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“…In addition, off-pump enables decreases in blood loss and blood and blood products, length of the intensive care unit stay, and hospital stay. 23,24) Our approach using off-pump had a shorter intubation time, shorter intensive care unit stay, and shorter hospital stay (Table IV). In all patients, we performed CEA before CABG in order to avoid hemodynamic disturbances in the carotid circulation while using the off-pump.…”

Section: Discussionmentioning

confidence: 90%

<b>Simultaneous Carotid Endarterectomy and Coronary Revascularization is Safe Using Either On-Pump or Off-Pump Technique</b>

et al. 2005

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SUMMARYThe appropriate surgical strategy for patients with combined carotid and coronary artery disease remains controversial. We retrospectively compared our surgical results for 2 types of approaches in this disorder.The records of 76 patients consecutively operated on for carotid and coronary artery disease between August 1993 and October 2004 were reviewed. There were 18 males (66.6%) and 9 females (33.3%) in group I. Group II consisted of 35 males (71.4%) and 14 females (28.5%). The patients were divided into two groups: patients with combined off-pump coronary artery bypass and carotid endarterectomy (group I, n = 27), and those with one-stage on-pump coronary artery bypass and carotid endarterectomy (group II, n = 49). Surgical mortality and morbidity and late outcome were compared among the two groups.The average number of grafts was 1.2 ± 0.4, with the average operative time of 3.3 ± 0.3 hours in group I, and 2.3 ± 0.5 grafts with operative time of 4.6 ± 0.4 hours in group II (P < 0.001 and P < 0.001, respectively). There was 1 death (3.7%) in group I and 2 deaths (4.8%) in group II (P = 0.937). No patient from either group I or group II had postoperative stroke. Mean hospital stay was 7.4 ± 1.9 days in group I and 11.3 ± 1.7 days in group II (P < 0.001). At a mean follow-up of 5.5 ± 3.3 years in group I, 1 patient had contralateral carotid endarterectomy (3.7%). Group II had a mean follow-up of 5.2 ± 3.0 years and contralateral carotid endarterectomy was performed in 1 patient (2.0%). There were no late strokes or deaths in either group.Combined coronary artery bypass grafting and carotid endarterectomy using 2 different types of technique is a safe and effective procedure in patients with significant concomitant monolateral carotid and coronary artery disease. (Int Heart J 2005; 46: 783-793)

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“…The rise in pulmonary artery pressure is followed by a drop in systolic pressure and a significant decrease in myocardial contractility, 2 compromising the safe completion of the procedures without cardiopulmonary bypass (CPB). Respiratory insufficiency accounts for one tenth (4/39) of the causes of early postoperative death in 2,052 patients receiving OPCAB surgery as reported by Tasdemir et al 3 A transesophageal echocardiographic study showed that a five-minute coronary occlusion was associated with significantly elevated left ventricular wall motion score and concomitant significantly increased pulmonary artery pressure in patients undergoing OPCAB surgery. 4 Other laboratory findings have shown that coronary artery occlusion caused pulmonary damage that was worsened by coronary reperfusion.…”

Section: Conclusion : Le Peo Par Occlusion Transitoire De L'artère Ilmentioning

confidence: 90%

Remote preconditioning lessens the deterioration of pulmonary function after repeated coronary artery occlusion and reperfusion in sheep

Xia

Herijgers

Nishida

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : We investigated whether remote organ preconditioning (RPC) can preserve pulmonary function following repeated myocardial ischemia/reperfusion in a model mimicking multi-vessel off-pump coronary artery bypass (OPCAB) revascularization.M Me et th ho od ds s: : Nine sheep (Group-RPC) underwent RPC by three episodes of five-minute occlusion and five-minute reperfusion of the iliac artery. Five sheep (Group-C) were time-matched controls. Afterwards, ten-minute occlusion and reperfusion of the left anterior descending, the first diagonal and the left circumflex coronary arteries were performed consecutively. Hemodynamic and respiratory parameters and arterial blood gases were measured until 120 min after the final coronary reperfusion. Anesthesia was maintained with halothane in oxygen and nitrous oxide. Animals were ventilated with a tidal volume of 15-20 mL·kg -1 in a non-rebreathing system, and a respiratory rate 14-16 min, with 5-cm H 2 O positive end expiratory pressure after thoracotomy.R Re es su ul lt ts s: : Repeated coronary occlusion and reperfusion was associated in this experimental model with an increase in pulmonary vascular resistance (PVR) and pulmonary arterial pressure (PAP) and a decrease in PaO 2 and PaO 2 /FIO 2 in Group-C. After 120 min reperfusion, PaO 2 and PaO 2 /FIO 2 in Group-RPC were higher (192 ± 69 mmHg and 241 ± 78 vs 115 ± 54 mmHg and 129 ± 64, P < 0.05), while PVR and PAP were lower than in Group-C. At 120 min of reperfusion, PaO 2 and PaO 2 /FIO 2 were inversely correlated with PVR (P < 0.01).C Co on nc cl lu us si io on ns s: : RPC by transient occlusion of the iliac artery improves lung gas exchange after repeated coronary artery occlusion and reperfusion mimicking OPCAB surgery, and preserves low PVR in sheep. Objectif : Nous avons vérifié si le préconditionnement éloigné d'un organe (PEO) peut préserver la fonction pulmonaire à la suite d'ischémie/reperfusion myocardique répétée chez un modèle imitant la revascularisation d'un pontage aortocoronarien plurivasculaire à coeur battant (PACCB) Méthode : Neuf moutons (Groupe PEO) ont subi un PEO en trois épisodes d'occlusion de cinq minutes suivis de reperfusion de cinq minutes de l'artère iliaque. Cinq moutons (Groupe T) ont constitué le groupe témoin apparié dans le temps. Par la suite, nous avons réalisé successivement l'occlusion et la reperfusion, en dix minutes, des

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Coronary artery bypass grafting on the beating heart without the use of extracorporeal circulation: review of 2052 cases

Abstract: On the basis of the presented data, off-pump coronary artery bypass grafting appeared to be a safe and effective technique in selected patients with appropriate coronary lesions.

Cited by 123 publications

References 10 publications

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump

<b>Simultaneous Carotid Endarterectomy and Coronary Revascularization is Safe Using Either On-Pump or Off-Pump Technique</b>

Remote preconditioning lessens the deterioration of pulmonary function after repeated coronary artery occlusion and reperfusion in sheep

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