Off-pump coronary artery bypass grafting in India

Saha, Kamales Kumar

doi:10.1016/j.ihj.2014.02.003

Cited by 14 publications

(11 citation statements)

References 19 publications

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“…OPCAB graft patency rates of Left Internal Mammary Artery (98.3%), Radial Artery (96%) and Saphenous Vein (91.2%) published in this study are excellent and far superior than both ONCAB and OPCAB graft patency rates of the recently published RCTs from the western world. The beneficial effects of dual anti-platelet therapy on OPCAB graft patency have been discussed in literature [4] and in this study too, Raghuram et al rightly used dual antiplatelet therapy immediately after OPCAB. However, I disagree with their viewpoint that maintaining activated clotting time (ACT) more than 350 seconds during OPCAB is mandatory.…”

Section: Opcab: the Future Of Surgical Coronary Revascularizationmentioning

confidence: 73%

“…Many studies published in international literature confirm this [4]. In a series of more than 600 consecutive unselected Indian patients, it was proven that complete revascularization can be better performed using OPCAB technique in spite of diffuse coronary artery disease (CAD), low ejection fraction or recent myocardial infarction without the anxiety of increasing cardiopulmonary bypass time or ischemic time [5].…”

Section: Opcab: the Future Of Surgical Coronary Revascularizationmentioning

confidence: 88%

“…Complete revascularization It is now well established that complete revascularization can be performed easily using OPCAB technique without any concern of increasing CPB time or ischemic time [4]. Many studies published in international literature confirm this [4].…”

Section: Opcab: the Future Of Surgical Coronary Revascularizationmentioning

confidence: 95%

“…Advantages of avoiding cardiopulmonary bypass (CPB) are well established [1,4]. In the current era there are two major areas of concern which prevent universal acceptance of OPCAB technique: complete revascularization and early graft patency.…”

Section: Opcab: the Future Of Surgical Coronary Revascularizationmentioning

confidence: 99%

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Off-pump coronary bypass grafting: the new gold standard!

Saha

2017

Indian J Thorac Cardiovasc Surg

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Off-pump coronary artery bypass (OPCAB) surgery is an evolution in the field of cardiac surgery which helped keep up with rapid technological advances in the field of percutaneous coronary intervention (PCI). In spite of the cardiologist being the Bgate keeper^for referring patients for PCI or surgery, preference for OPCAB has grown over on-pump coronary artery bypass grafting surgery (ONCAB). The advantages of OPCAB over ONCAB can be debated and the final verdict is yet to come [1]. In India OPCAB has become the preferred mode of revascularization in private health care system. This is because surgeons who are efficient in OPCAB often migrate to private hospitals for better compensation. Private hospitals use proficiency in OPCAB as one of the major criteria for selecting surgeons. The polarization is complete in private sector in favor of OPCAB. Cardiologists are the end result assessor of both procedures. In spite of the obvious conflict of interest, OPCAB remains the preferred mode of revascularization over both PCI and ONCAB.However, in western world the situation is different probably because healthcare is funded by either insurer or tax-payer. The patient prefers the less invasive procedure even though it may not necessarily be the treatment with best long-term result. The insured patient is not deterred by the possibility of a costly second procedure after PCI. That is why major hindrance to development of OPCAB in western world is probably the stent industry. If superiority of OPCAB is established, stent industry will incur huge revenue loss. Any trial publishing inferior OPCAB results is often highlighted in western literature. All trials comparing coronary artery bypass grafting (CABG) and PCI have proven that stroke is the Achilles' heel of CABG. OPCAB with aortic no touch can eliminate this disparity. It is not surprising that no single trial is designed to compare OPCAB with aortic no touch to multivessel PCI. Even arterial revascularisation therapy study (ARTS) had only 40% OPCAB patients [2].In spite of growing popularity there are few OPCAB publications from India. There are various factors for lack of Indian publications:Reluctant to publish: Surgeons with good results are often reluctant to publish. With experience, we learn many tricks, and unless we share with the future generation, these tricks will not survive. By publishing our technique and results, we can share our experience beyond geographical borders. Inadequate prospective data collection: Prospective data collection is often neglected in our country across all centers. Case papers are destroyed after 5 years, the mandatory period by law. Prospective collection of preoperative and postoperative data is required. We need to move to electronic record keeping so that the collected data can be preserved, accessed, and analyzed. We can only publish superior OPCAB results if we have access to properly collected patient data. Lack of regular self audit: Regular self audit is mandatory for quality improvement. Sometimes regular self audit c...

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Section: Opcab: the Future Of Surgical Coronary Revascularizationmentioning

confidence: 73%

Section: Opcab: the Future Of Surgical Coronary Revascularizationmentioning

confidence: 88%

Section: Opcab: the Future Of Surgical Coronary Revascularizationmentioning

confidence: 95%

Section: Opcab: the Future Of Surgical Coronary Revascularizationmentioning

confidence: 99%

See 2 more Smart Citations

Off-pump coronary bypass grafting: the new gold standard!

Saha

2017

Indian J Thorac Cardiovasc Surg

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“…On the other hand, in OPCAB the stabilizer can be reused after sterilization and the price is divided among several patients. Given to this and to a shorter ICU stay, it is reported that an OPCAB patient will generally pay a lower price for a CABG procedure (49). In Japan, OPCAB is slightly less common than in India but still prevails over ONCAB.…”

Section: Regional Variationsmentioning

confidence: 99%