Off-Pump Coronary Artery Bypass Grafting Improves Early Clinical Outcomes Including Operative Mortality

Abstract

Whether coronary artery bypass grafting (CABG) should be performed on- or off-pump remains a matter of debate. We aim to present our experience with off-pump CABG. Early clinical outcome and adverse events were analyzed over the time course of the study. Methods: A total of 4310 patients undergoing isolated off- pump CABG from January 2002 until December 2016 at the Malabar Institute of Medical Sciences in India were included. Preoperative, intraoperative, and postoperative, as well as follow-up data were prospectively collected. To analyze the differences of patient characteristics and outcomes over time, five-year periods were created (early: 2002-2006; middle: 2007-2011; late: 2012-2016). Traditional techniques of quality control monitoring were applied. Results: The mean age of our patients was 59 ± 9 years, and 13% (533) were female. Postoperative mortality was observed in 0.7% (25), acute renal failure and stroke in 0.2% (8) each, and mediastinitis in 1.2% (53) of the patients. Despite the progressive worsening of the patient risk profile, significant improvement in mortality was observed over time, while stroke, acute renal failure, and mediastinitis remained similar. Continuous quality control monitoring revealed that the system was within the control boundaries for the entire period of the study. The current probability of 30-day mortality or conversion to on-pump CABG is about 0.5%. Conclusion: Off-pump CABG is safe and effective for patients undergoing CABG. It can provide superior results compared to on-pump CABG, particularly when performed by a dedicated off-pump surgeon.

Development of SIMS (Simple Indigenous Metallic Stabilizer) for OPCAB

“…Though none of these patients had to be converted on to the heart lung machine. In fact we had published our last data on our OPCABs which showed that over the last ten years we have had no conversions on to the Cardio-pulmonary bypass so far [8].…”

Revascularisation Strategies in OPCAB (Off Pump Coronary Artery Bypass)

“…The pods would cost about 10-15 dollars for one pod. This has in fact reduced our carbon footprint which we leave when we do cardiac surgery [9].…”

Зміни Гемодинаміки При Використанні Різних Інфузійних Розчинів Під Час Коронарного Шунтування На Працюючому Серці

“…Техніка виконання коронарного шунтування (КШ) на працюючому серці за останні роки значно розвинулась. Проте накладання дистальних анастомозів на задніх і бічних судинах серця може характеризуватися нестабільною гемодинамікою, що супроводжується зниженням серцевого індексу (СІ) та артеріального тиску (АТ) [4]. Хоча порушення волемічного статусу є однією з найпоширеніших причин нестабільності гемодинаміки при виконанні будь-яких кардіохірургічних втручань, найчастіше вони виникають саме при виконанні КШ на працюючому серці.…”