Is it time to adopt beating-heart coronary artery bypass grafting? A review of literature

Hijazi, Emad M.

doi:10.1590/s0102-76382010000300017

Cited by 8 publications

(10 citation statements)

References 75 publications

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“…In the 1990s, OPCAB was developed to be used without cardioplegia, aortic cross-clamping, or hypothermia to avoid adverse events such as systematic inflammation and renal failure (26). Previous studies have demonstrated that compared with conventional CABG, OPCAB showed decreased morbidity and mortality and is favorable for severe coronary disease patients, especially for those with contraindications for CPB (27,28). However, despite those advantages, OPCAB still has inherent defects compared with conventional CABG, such as incomplete revascularization and inferior long-term graft patency (3).…”

Section: Discussionmentioning

confidence: 99%

Beating-heart on-pump coronary artery bypass grafting vs. off-pump coronary artery bypass grafting: a systematic review and meta-analysis

Jiang¹,

Xu²,

Liu³

et al. 2021

J Thorac Dis

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Background: Beating-heart on-pump coronary artery bypass grafting (CABG), otherwise known as BH-ONCAB, can reduce myocardial injury by preserving native coronary blood flow while maintaining hemodynamic stability by the effective support of cardiopulmonary bypass (CPB). This study aimed to identify whether BH-ONCAB confers a survival, mortality, or morbidity benefit over off-pump CABG (OPCAB). Methods: A systematic literature review identified 18 studies incorporating 5,615 patients (1,548 BH-ONCAB and 4,067 OPCAB cases) who satisfied the inclusion criteria. Outcome measures were metaanalyzed using random-effects modeling. Between-study heterogeneity was investigated through quality assessment and risk of bias analysis. Results: The results demonstrated comparable early mortality and long-term survival between BH-ONCAB and OPCAB coronary revascularization with no significant statistical differences. The incidences of stroke, renal failure, blood loss, and arrhythmias were significantly higher in patients who underwent BH-ONCAB than patients who underwent OPCAB. However, BH-ONCAB conferred lower rates of incomplete revascularization and greater numbers of distal anastomoses. Conclusions: BH-ONCAB is a safe and comparable alternative to OPCAB in terms of early mortality and late survival. BH-ONCAB may confer particular advantages in preventing incomplete revascularization and allowing more distal anastomoses compared to OPCAB. However, BH-ONCAB was associated with more postoperative complications due to the use of CPB. Future work should focus on larger matched studies and multicenter randomized controlled trials to optimize our surgical revascularization strategies.

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Section: Discussionmentioning

confidence: 99%

Beating-heart on-pump coronary artery bypass grafting vs. off-pump coronary artery bypass grafting: a systematic review and meta-analysis

Jiang¹,

Xu²,

Liu³

et al. 2021

J Thorac Dis

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“…Lower release of enzymes (parameters of myocardial injury) from myocardial injury in the postoperative period in patients undergoing off-pump CABG compared to on-pump CABG was reported, suggesting a lower degree of myocardial injury in off-pump CABG. 19,20) The regional normothermic ischemia in off-pump CABG and the temporary interruption of coronary flow approached seemed to cause less myocardial injury compared to hypothermic global ischemia induced by CPB and cardioplegic arrest, which made patients develop smaller rates of LCOS after CABG. 21) Emergent CPB was also a risk factor for LCOS following isolated CABG.…”

Section: Predictors Of Lcos After Cabgmentioning

confidence: 99%

Predictors of Low Cardiac Output Syndrome After Isolated Coronary Artery Bypass Grafting

Ding

Shi

et al. 2015

Int. Heart J.

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SummaryLow cardiac output syndrome (LCOS) is one of the most important complications following coronary artery bypass grafting (CABG) and results in higher morbidity and mortality. However, few reports have focused on the predictors of LCOS following CABG. This study aimed to evaluate the predictors of LCOS following isolated CABG through the review of 1524 consecutive well-documented patients in a single center, retrospective trial.The relevant preoperative and intraoperative data of patients with complete information from medical records undergoing isolated CABG from January 2010 to December 2013 in our center were investigated and retrospectively analyzed. LCOS was considered when the following criteria were met: signs of impairment of body perfusion and need for inotropic support with vasoactive drugs or mechanical circulatory support with an intra-aortic balloon pump to maintain systolic blood pressure greater than 90 mmHg.LCOS developed in 205 patients following CABG, accounting for 13.5% of the total population. The in-hospital mortality in the LCOS group was significantly higher than that in the non-LCOS group (25.4% versus 1.8%, P < 0.0001). In addition to the length of ICU stay and postoperative hospital stay, LCOS was correlated with negative cerebral, respiratory and renal outcomes. Through univariate analysis and then logistic regression analysis, the predictors of LCOS following CABG included older age (age > 65 years) (OR = 1.85, 95%CI 1.27-3.76), impaired left ventricular function (OR = 2.05, 95%CI 1.53-4.54), on-pump CABG (OR = 2.16, 95%CI 1.53-4.86), emergent CPB (OR = 9.15, 95%CI 3.84-16.49), and incomplete revascularization (OR = 2.62, 95%CI 1.79-5.15).LCOS following isolated CABG caused higher mortality, higher rates of morbidity, and longer ICU and postoperative hospital stays. Older age, impaired left ventricular function, on-pump CABG, emergent CPB, and incomplete revascularization were identified as 5 predictors of LCOS following isolated CABG surgery. (Int Heart J 2015; 56: 144-149)

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“…Off pump coronary artery bypass (OFCAB) has been around since the times of Kolesov. But it gained popularity, as a variant of on-pump coronary artery bypass, due to its recently discovered effects of causing less inflammation, less morbidity and being more cost effective ( Hijazi, 2010 ). Hence in this review we will discuss the advantages of ONCAB over OFCAB and vice versa.…”

Section: Introductionmentioning

confidence: 99%

On Pump Coronary Artery Bypass Graft Surgery Versus Off Pump Coronary Artery Bypass Graft Surgery: A Review

Khan¹,

Islam²,

Ahmed³

et al. 2014

GJHS

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There are two basic ways of performing coronary artery bypass graft surgery (CABG): on pump CABG and off pump CABG. Off pump CABG is relatively a newer procedure to on-pump CABG and does not require the use of the cardiopulmonary bypass machine. On pump CABG is the more traditional method of performing bypass surgery. However its resultant inflammatory effects cause renal dysfunction, gastrointestinal distress and cardiac abnormalities which have forced the surgeons to look for alternatives to the procedure. An extensive literature search revealed that on pump CABG causes better revascularization as compared to off pump CABG while off pump CABG has a much lower post operative morbidity and mortality especially in high risk patients. We suggest that the technique used should depend on the ease of the surgeon doing the operation as both the methods seem almost equally efficient according to the review.

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Is it time to adopt beating-heart coronary artery bypass grafting? A review of literature

Cited by 8 publications

References 75 publications

Beating-heart on-pump coronary artery bypass grafting vs. off-pump coronary artery bypass grafting: a systematic review and meta-analysis

Beating-heart on-pump coronary artery bypass grafting vs. off-pump coronary artery bypass grafting: a systematic review and meta-analysis

Predictors of Low Cardiac Output Syndrome After Isolated Coronary Artery Bypass Grafting

On Pump Coronary Artery Bypass Graft Surgery Versus Off Pump Coronary Artery Bypass Graft Surgery: A Review

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