Haemodynamic changes during beating heart coronary surgery with the ‘Bristol Technique’

Watters, Malcolm; Ascione, Raimondo; Ryder, Ian; Ciulli, Franco; Pitsis, Antonis A.; Angelini, Gianni

doi:10.1016/s1010-7940(00)00603-5

Cited by 96 publications

(57 citation statements)

References 23 publications

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“…Anesthetic, cardiopulmonary bypass, and surgical technique for on-pump and off-pump surgery have been previously described (7,24). In brief, for on-pump patients, intravenous heparin (300 IU/kg) was administered immediately before cannulation for CPB, and additional doses were given to maintain an activated clotting time of 480 s or greater.…”

Section: Methodsmentioning

confidence: 99%

“…The method of exposure and stabilization for performing off-pump surgery has been described previously (24). The left anterior descending coronary artery was grafted first in all patients, followed by the right coronary and circumflex coronary artery distal anastomoses.…”

Section: Methodsmentioning

confidence: 99%

“…The proximal anastomoses onto the ascending aorta were constructed at the end. Postoperative management (fluid balance, transfusion requirements, and inotropic support, etc) were in accordance with unit protocols as previously described (7,24).…”

Section: Methodsmentioning

confidence: 99%

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Off-pump coronary artery bypass surgery is associated with fewer gene expression changes in the human myocardium in comparison with on-pump surgery

Ghorbel

Cherif

Mokhtari

et al. 2010

Physiological Genomics

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Ghorbel MT, Cherif M, Mokhtari A, Bruno VD, Caputo M, Angelini GD. Off-pump coronary artery bypass surgery is associated with fewer gene expression changes in the human myocardium in comparison with on-pump surgery. Physiol Genomics 42: 67-75, 2010. First published March 23, 2010 doi:10.1152/physiolgenomics.00174.2009.-Offpump coronary artery bypass surgery reduces the myocardial injury associated with on pump surgery with cardiopulmonary bypass (CPB) and ischemic-cardioplegic arrest (CA). We sought to find a mechanistic explanation for this by comparing the transcriptomic changes in the myocardium of patients undergoing on-and off-pump surgery. Transcriptomic analyses were performed on left ventricular biopsies obtained from patients prior to (pre-op) and after completion of all coronary anastomoses (post-op). Microarray results were validated with real-time polymerase chain reaction. In on-pump group, 68 genes were upregulated in post-op vs. pre-op biopsies (P Ͻ 0.01, Ն2-fold). They included inflammatory genes CCL3 and CCL4, apoptotic gene GADD45B and prostaglandin synthesis gene PTGS2 (COX-2). In the off-pump group, 17 genes were upregulated in post-op vs. pre-op biopsies (P Ͻ 0.01, Ն2-fold), all shared with on-pump patients. To uncover the genes implicated in CPB and ischemic-CA response, we compared the postoperative gene profiles of the two groups. Thirty-eight genes were upregulated in the on-pump vs. off-pump patients (P Ͻ 0.01, Ն2-fold). On-pump surgery induces injury-related response, as demonstrated by the upregulation of apoptosis and remodeling markers, whereas off-pump surgery ameliorates that by mainly upregulating a cytoprotective genetic program. Blood levels of the identified cytokines and chemokines followed the same pattern obtained by transcriptomics, suggesting that the myocardium is a likely source for these proteomic changes. In conclusion, offpump surgery is associated with fewer alterations in gene expression connected with inflammation, apoptosis, and remodeling seen after on-pump surgery with CPB and ischemic-CA.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Off-pump coronary artery bypass surgery is associated with fewer gene expression changes in the human myocardium in comparison with on-pump surgery

Ghorbel

Cherif

Mokhtari

et al. 2010

Physiological Genomics

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“…Other studies using a compression type stabilizer also showed transient hemodynamic changes which recovered after the heart returned to anatomic position. 29,30 One study evaluated cardiac function during OP-CABG with a compression type stabilizer using invasive hemodynamic and TEE monitoring. In this study, Jurmann et al 31 assessed 28 patients undergoing single bypass grafting to the LAD artery with the internal thoracic artery through a small left anterior thoracotomy.…”

Section: Dopamine Requiredmentioning

confidence: 99%

Mechanisms of hemodynamic changes during off-pump coronary artery bypass surgery

Couture

Denault

Limoges

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To describe the mechanisms of hemodynamic changes during off-pump coronary artery bypass graft surgery (OP-CABG).S So ou ur rc ce e: : Pertinent medical literature in the English and French languages was identified through a Medline computerized literature search and a manual search of selected articles, using off-pump coronary artery surgery, beating heart surgery, hemodynamic, and transesophageal echocardiography as key words. Human and animal studies were included. P Pr ri in nc ci ip pa al l f fi in nd di in ng g: : Hemodynamic variations in OP-CABG may be due to mobilization and stabilization of the heart, or myocardial ischemia occurring during coronary occlusion. Suction type and compression type stabilizers produce hemodynamic effects through different mechanisms. Heart dislocation (90° anterior displacement) and compression of the right ventricle to a greater extent than the left ventricle are responsible for hemodynamic alterations when using suction type stabilizers. Compression of the left ventricular outflow tract and abnormal diastolic expansion secondary to direct deformation of the left ventricular geometry are proposed mechanisms for hemodynamic derangements with compression type stabilizer. Coronary occlusion during the anastomosis can have additional effects on left ventricular function, depending on the status of collateral flow. The value and limitations of electrocardiographic (ECG), hemodynamic and echocardiographic monitoring modalities during OP-CABG are reviewed.C Co on nc cl lu us si io on ns s: : In summary, hemodynamic changes which can either be secondary to the stabilization technique or to transient ischemia represent an important diagnostic challenge during offbypass procedures. The mechanism can vary according to the stabilization system. Current monitoring such as ECG and hemodynamic monitoring are used but remain limited in establishing the cause of hemodynamic instability. Transesophageal echocardiography is used in selected patients to diagnose the etiology of hemodynamic instability and can direct therapy, particularly in those with severe myocardial systolic and diastolic dysfunction, mild to moderate mitral regurgitation, or for patients who are unstable during the procedure. Objectif : Décrire les mécanismes de changements hémodynamiques pendant le pontage aortocoronarien (PAC-CB). Source : La documentation pertinente en anglais et en français a été

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“…In the past, LMS disease was considered a relative contraindication for off-pump (OFP) coronary artery bypass grafting (CABG) mainly because of the haemodynamic changes occurring with changing the position of the heart during the process of grafting (4). However, emerging number of reports in literature have proven this method as a safe alternative to cardiopulmonary bypass (CPB) (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies

Athanasopoulos

Athanasiou

2016

J. Thorac. Dis.

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Left main stem (LMS) disease is known to be a poor prognostic factor in terms of morbidity or mortality. Traditionally, it has been treated with constitution of bypass to provide required haemodynamic stability. We searched the literature for evidence on off-pump (OFP) surgery for treating this high-risk group of patients focusing in our review on postoperative outcomes, concerns and controversies. The majority of the studies identified showed favourable or equal outcomes of OFP when compared to conventional approach. All of the studies, apart from two, which showed lower incidence of postoperative deaths, demonstrated equal mortality rates. Stroke rates were found less in three studies. Less blood transfusions, inotropic use and length of study has been also demonstrated. The main concerns of OFP surgery are: haemodynamic instability and less complete revascularization. Main controversies are: same or favourable outcomes despite lower number of grafts with OFP surgery and less stroke rates despite manipulation of aorta with side-clamping. Despite these concerns and controversies OFP surgery has been proven to be feasible and safe as demonstrated by results from numerous studies.

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Haemodynamic changes during beating heart coronary surgery with the ‘Bristol Technique’

Cited by 96 publications

References 23 publications

Off-pump coronary artery bypass surgery is associated with fewer gene expression changes in the human myocardium in comparison with on-pump surgery

Off-pump coronary artery bypass surgery is associated with fewer gene expression changes in the human myocardium in comparison with on-pump surgery

Mechanisms of hemodynamic changes during off-pump coronary artery bypass surgery

Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies

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