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

Abstract

Purpose On-pump beating-heart coronary artery bypass grafting represents a merger of standard on and off-pump techniques and is thought to benefit patients by coupling the dual absence of cardioplegic arrest (conventional coronary surgery), with the hemodynamic instability during manipulation seen in off-pump surgery. However, the clinical benefits are still under discussion. We improvised on the standard on-pump beating-heart surgeries by introducing use of Bintermittent^bypass as and when required. Methods This study involved 108 patients. BIntermittent^on-pump-beating heart coronary artery bypass grafting was done using suction stabilizer and placing aortic and venous cannula, electively in all patients (group 1) who were supported by pump intermittently (n = 54). Retrospective data of patients who underwent off-pump surgery electively by the same surgeon (group 2, n = 54) was collected. Results There was a significant advantage in the number of grafts performed for the lateral surface (circumflex branches) using the new technique compared to conventional technique (68vs22). Similarly, significant advantage was also noted in terms of total number of grafts along with shorter operating times. There were no mortalities in the new group compared to the off-pump group and blood loss was also lesser. Conclusions BIntermittent^on-pump coronary revascularization is a technically reliable method of coronary revascularization taking advantage of the off-pump and conventional on-pump techniques while considerably eliminating the disadvantages of both. It has shown its superiority in safety, number of grafts, blood loss, operating time and perioperative course.

Isolated tricuspid valve surgery: Beating or nonbeating surgery?

“…The existing literature has shown in‐hospital mortality of 2%–13% 7 . The results produced by Flagiello et al 6 were also within this range, with an overall in‐hospital mortality rate of 8.5%.…”

“…However, the BH technique is arguably technically more challenging due to an obscured exposure of the surgical field when the heart is beating and a large volume of blood returns. This can be overcome by placing an appropriate sucker in the coronary sinus and adequate snaring of both superior and inferior vena cavae to provide a bloodless field 4,7 …”

“…Whilst the BH technique may not be a technical solution, it can certainly be used as an alternative and safe approach. Furthermore, the BH technique may be favored in patients with ventricular failure, as it offers a lower risk of ischemia‐reperfusion injury 4,7 . A further advantage of the BH technique is identification of any significant rhythm abnormalities whilst operating on the septal part of the TV, which can be relieved or restored to baseline by adjusting the stitches.…”