Neurological outcomes after on‐pump vs off‐pump CABG in patients with cerebrovascular disease

Dominici, Carmelo; Salsano, Antonio; Nenna, Antonio; Spadaccio, Cristiano; El-Dean, Zein; Bashir, Mohamad; Mariscalco, Giovanni; Santini, Francesco; Chello, Massimo

doi:10.1111/jocs.14158

Cited by 31 publications

(27 citation statements)

References 27 publications

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“…The prevalence of POD after CABG was previously reported from 37 to 52% 1,2) . The recent studies 19,20) reported POD oc- this study might be associated with the prolonged duration of intubation and ICU stay. Fast-track protocols for cardiac surgery have been reported in the past 21) .…”

Section: Ramelteon Is An Agonist Binding To Melatonin (Mt1 and Mt2mentioning

confidence: 57%

Efficacy of Orexin Receptor Antagonist for Delirium after Coronary Artery Bypass Grafting Compared with Melatonin Receptor Agonist

Tamura

Maruyama

Sakurai

2020

Journal of Coronary Artery Disease

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Postoperative delirium (POD) represents a disturbance in attention, awareness, and cognition that develops over the postoperative period. The prevalence of POD after coronary artery bypass grafting (CABG) is reported from 37 to 52% 1,2) . Because POD increases postoperative complications and prolongs intensive care unit and hospital stay 3) , patient's outcomes could have been worse. Some medicines were reported to reduce the incidence of POD. Ramelteon, as a melatonin receptor agonist, regulates the sleep cycle and improves subjective sleep quality of patients with chronic insomnia 4) . Ramelteon also is reported to reduce the occurrence of delirium in patients admitted to the intensive care unit (ICU) 5) .Recently, Suvorexant, as a new type of sleep medication as an orexin receptor antagonist, is noted for subjective measures of sleep onset and maintenance 6) . The orexin neuropeptide signal system supports wakefulness, but Suvorexant inhibits the bind-ing of orexin neuropeptides to receptors and suppresses the wake drives. Recently, a few studies reported the effect of Suvorexant for delirium [7][8][9] .The purposes of this study were to investigate the availability of Suvorexant for POD after CABG and to evaluate the effect of Suvorexant for the operative outcome. II. Patients and methods Thisretrospective study was approved by the institutional review board of Soka municipal hospital. Cardiac surgery has started since February 2013 in our institution. In a total of 175 consecutive patients who underwent elective CABG from February 2013 to May 2019. We investigated the patients weaned ventilator support at the first postoperative day (under 24 hours after operation), excluded patients with a mental disorder, sleep disorder and dementia patient. And the patients with emergency operations were excluded. Because benzodiazepine could induce POD, patients with benzodiazepine sedative-hypnotic agent for insomnia after CABG were excluded, too. So, 138 patients (29 women, mean age 69.7 ± 3.4 years) were intended.Induction and maintenance of operative anesthesia were similar for all patients and consisted of weight-related doses of fentanyl, midazolam, and pancuronium bromide.

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Section: Ramelteon Is An Agonist Binding To Melatonin (Mt1 and Mt2mentioning

confidence: 57%

Efficacy of Orexin Receptor Antagonist for Delirium after Coronary Artery Bypass Grafting Compared with Melatonin Receptor Agonist

Tamura

Maruyama

Sakurai

2020

Journal of Coronary Artery Disease

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“…On the other hand, off-pump CABG is often performed in patients with markedly calcified ascending aorta or in patients with history of cerebrovascular events as it is associated with improved neurological outcomes compared with onpump CABG. 4,40 Postoperative stroke incidence is similar between OPBHC and off-pump CABG ( Table 6), suggesting that the sole effect of aortic cannulation might be marginal. However, the dynamics of aortic side-clamping for proximal anastomosis are markedly different: OPBHC might favor a "softer" aortic lateral clamping (because of rapid on-demand hypotension achieved with CPB), while in conventional off-pump CABG the same maneuver might result in a more traumatic side-clamping.…”

Section: Discussionmentioning

confidence: 91%

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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“…The incidence of cerebrovascular accidents following the surgical procedure has been related to the degree of aortic manipulation [3]. Indeed, handling of the aorta increases the risk of embolization of lipid debris originating from the atherosclerotic plaque [4]. The cardiopulmonary bypass (CPB) per se can be responsible for the genesis of solid and gaseous emboli, respectively as a result of inadequate anticoagulation and initiation of CPB [20].…”

Section: Discussionmentioning

confidence: 99%

“…Off-pump CABG (OPCAB), especially performed by means of the no-touch technique, theoretically represents a valid option for patients with extracardiac arteriopathy and diseased aorta, since the avoidance of aortic manipulation can prevent the embolization of atherosclerotic debris [4].…”

Section: Introductionmentioning

confidence: 99%

Incidence of Stroke in On-Pump Versus Off-Pump Coronary Artery Bypass Grafting: A Metanalysis on 11,500 Patients

Micali¹,

Alruwaili²,

Jong³

et al. 2019

Cardiol Cardiovasc Med

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Background and Aims: Conventional coronary artery bypass grafting (CCABG) has been associated with high incidence of stroke, especially for the high degree of aortic manipulation. Off-pump CABG (OPCAB) theoretically represents a valid option, since the avoidance of aortic manipulation can prevent the embolization of atherosclerotic debris. There is a lot of controversy about the outcomes of CCABG compared to OPCAB. The aim of this metanalysis is to examine the incidence of stroke within 30 days from the surgical procedure. Methods and Results:A literature search was conducted from 2009 to 2019 using PubMed database. Nine randomized control trials were included in the metanalysis.

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Neurological outcomes after on‐pump vs off‐pump CABG in patients with cerebrovascular disease

Cited by 31 publications

References 27 publications

Efficacy of Orexin Receptor Antagonist for Delirium after Coronary Artery Bypass Grafting Compared with Melatonin Receptor Agonist

Efficacy of Orexin Receptor Antagonist for Delirium after Coronary Artery Bypass Grafting Compared with Melatonin Receptor Agonist

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

Incidence of Stroke in On-Pump Versus Off-Pump Coronary Artery Bypass Grafting: A Metanalysis on 11,500 Patients

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