Coronary artery bypass surgery without cardioplegia: hospital results in 8515 patients

Antunes, Pedro E.; Oliveira, J. Ferrão de; Prieto, David Cantarero; Coutinho, Gonçalo F.; Correia, Pedro; Branco, Carlos; Antunes, Manuel J.

doi:10.1093/ejcts/ezv177

Cited by 12 publications

(11 citation statements)

References 20 publications

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“…In addition to PVR, coronary artery bypass graft (CABG) surgery is the procedure for which VF is applicable with intermittent aortic cross clamping. There are several contradictory results about this VF during CABG . Some researchers have advocated that intermittent cross clamping with VF is superior to ACC because ischemic preconditioning and a shorter duration of total aortic cross clamping can provide safer and more reliable myocardial protection ; however, others have demonstrated that measurement of myocardial pH in intermittent cross clamping with VF does not represent reliable reperfusion of myocardium .…”

Section: Discussionmentioning

confidence: 99%

Myocardial Protective Effect of Antegrade Cardioplegic Cardiac Arrest Versus Ventricular Fibrillation During Cardiopulmonary Bypass on Immediate Postoperative and Mid‐Term Left Ventricular Function in Right Ventricular Outflow Tract Surgery

et al. 2017

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The objective of this study is to examine the myocardial protective effect of antegrade cardioplegic cardiac arrest (ACC) versus ventricular fibrillation (VF) on short-term and mid-term left ventricular (LV) function in right ventricular outflow tract (RVOT) surgery. RVOT operations conducted from January 2006 to December 2015 were reviewed. The numbers of cases using ACC and VF were 71 and 49, respectively. Postoperative mortality and morbidity were compared between the two groups. Before and after propensity score matching, left ventricular ejection fraction (LVEF) and left ventricular end-systolic/end-diastolic diameter (LVESD/LVEDD) in echocardiography were measured immediately after operation and at mid-term follow-up between postoperative 6 and 24 months. There was no perioperative mortality or cerebrovascular accident. There was no statistically significant difference in the incidence of ventricular and atrial arrhythmia. In the overall patient group, LVESD was significantly decreased in the ACC group compared to the VF group immediately after operation (-0.65 ± 3.55 mm vs. 2.99 ± 4.98 mm, P = 0.001). Mid-term follow-up data demonstrated that LVEF at midterm was higher in the ACC group than in the VF group (64.80% ± 7.40% vs. 60.24% ± 7.93%, P = 0.022). However, the increased amount compared to preoperative value was not statistically significant (1.94% ± 12.65% vs. -2.94% ± 9.41%, P = 0.059). After propensity score matching, the LVEF was significantly improved in the ACC group compared to the VF group at the mid-term follow-up (6.16% ± 6.77% vs. -5.41% ± 9.05%, P = 0.001). Multiple linear regression model demonstrated that lower preoperative LVEF, ACC rather than VF, and exclusion of RVOT reconstruction procedure were positive prognostic factors for the improvement of LVEF at mid-term follow up. The results of this study suggest that myocardial protection using ACC is safe and may be more beneficial in LV function recovery up to the mid-term follow-up after pulmonary valve replacement and other RVOT procedures.

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Section: Discussionmentioning

confidence: 99%

Myocardial Protective Effect of Antegrade Cardioplegic Cardiac Arrest Versus Ventricular Fibrillation During Cardiopulmonary Bypass on Immediate Postoperative and Mid‐Term Left Ventricular Function in Right Ventricular Outflow Tract Surgery

et al. 2017

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“…Scientific evidence on the topic derives from retrospective observational studies mainly focused on high-risk patients. Literature search yielded a total of 279 records, and 17 studies 7,10,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28] and two meta-analyses 29,30 published between 2000 and 2020 were finally included in the systematic review (PRISMA flow diagram, Figure 1). Quality assessment is shown in Table 2; study characteristics and collected outcomes are summarized in Tables 3 and 4 and described below.…”

Section: Resultsmentioning

confidence: 99%

“…10,18,20,[24][25][26] Generalized data from all-comers population might support the idea of using OPBHC also in unselected patients. 7,15,19,23 Certainly, this hypothesis should be adequately investigated in future clinical trials.…”

Section: Discussionmentioning

confidence: 99%

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

et al. 2020

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Background Operative technique for surgical myocardial revascularization in high‐risk patients remains an argument of debate. On‐pump coronary artery bypass graft (CABG) with cardioplegic arrest and off‐pump CABG have intrinsic limitations. The hybrid approach of on‐pump beating‐heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta‐analysis intends to summarize the contemporary literature. Methods A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study. Results Compared with on‐pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36‐0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39‐0.91). Also, interesting trends towards reduced postoperative intra‐aortic balloon pump use (RR, 0.56, 95% CI, 0.31‐1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22‐1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off‐pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off‐pump CABG (RR, 0.53, 95% CI, 0.33‐0.87) but higher than conventional on‐pump CABG (RR, 1.71, 95% CI, 1.23‐2.39). Conclusion OPBHC is an effective technique to perform surgical revascularization in high‐risk patients as preventing haemodynamic deterioration and guaranteeing adequate end‐organ perfusion. OPBHC represents an alternative technique to on‐pump and off‐pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.

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“…All patients: Perhaps the most extensive experience with on-pump beating heart CABG is the one reported by Antunes and colleagues from Portugal [19]. For over twenty years, this investigator has evolved to performing CABG without aortic crossclamping and cardioplegia.…”

Section: Discussionmentioning

confidence: 99%

Pump-Assisted Beating-Heart Coronary Artery Bypass Grafting: The Pursuit of Perfection

Samuels¹,

Samuels²

2017

J Clin Exp Cardiolog

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Background: The techniques utilized to accomplish Coronary Artery Bypass Grafting (CABG) include the traditional use of cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest to totally OffPump (i.e. OP-CAB) without CPB. The purpose of this report is to describe a hybrid approach-Pump-Assisted Direct CABG (PAD-CAB)--with the aid of CPB without aortic cross-clamping and cardioplegic arrest.

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Coronary artery bypass surgery without cardioplegia: hospital results in 8515 patients

Abstract: Isolated CABG with CPB using non-cardioplegic methods proved very safe, with low mortality and morbidity. These methods are simple and expeditious and remain as very useful alternative techniques of myocardial preservation.

Cited by 12 publications

References 20 publications

Myocardial Protective Effect of Antegrade Cardioplegic Cardiac Arrest Versus Ventricular Fibrillation During Cardiopulmonary Bypass on Immediate Postoperative and Mid‐Term Left Ventricular Function in Right Ventricular Outflow Tract Surgery

Myocardial Protective Effect of Antegrade Cardioplegic Cardiac Arrest Versus Ventricular Fibrillation During Cardiopulmonary Bypass on Immediate Postoperative and Mid‐Term Left Ventricular Function in Right Ventricular Outflow Tract Surgery

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

Pump-Assisted Beating-Heart Coronary Artery Bypass Grafting: The Pursuit of Perfection

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