Off-Pump Coronary Artery Bypass Grafting in a Low-Volume Center

Saha, Kamales Kumar; Deval, Mandar; Jagdale, Lukash; Sahani, Preetam

doi:10.1532/hsf98.20111048

Cited by 5 publications

(5 citation statements)

References 18 publications

(23 reference statements)

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“…There have been reports of use of ventricular assist device to prevent conversions, however, IABP use during OPCAB to prevent conversion has not been reported before. 2 Various studies have suggested that preoperative IABP insertion in high-risk patients may facilitate OPCAB. 3 We perform OPCAB routinely in all isolated coronary artery bypass cases, and use an IABP to treat hemodynamic compromise rather than for preoperative prophylactic use.…”

Section: Introductionmentioning

confidence: 99%

Intraaortic balloon pump boon for off-pump coronary artery bypass grafting

Saha

Kaushal

Kumar

et al. 2014

Asian Cardiovasc Thorac Ann

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Section: Introductionmentioning

confidence: 99%

Intraaortic balloon pump boon for off-pump coronary artery bypass grafting

Saha

Kaushal

Kumar

et al. 2014

Asian Cardiovasc Thorac Ann

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“…Studies have confirmed that coronary artery bypass grafting-related bleeding greater than 4 U should be considered an independent risk factor for mortality [Stone 2012]. Some authors suggested that blood cell salvage should be made a conventional measure to improve safety of off-pump coronary artery bypass surgery [Saha 2011]. The application of autologous blood transfusion in off-pump coronary artery bypass grafting has clinical value.…”

Section: Discussionmentioning

confidence: 99%

Application of Autologous Blood Cell Salvage in Off-Pump Coronary Artery Bypass Graft Operation

Zhao

et al. 2017

HSF

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To analyze whether application of autologous blood cell salvage can reduce the transfusion volume of allogeneic blood and complications of blood transfusion in off-pump coronary artery bypass operations. Methods: We randomly divided 120 patients into autologous blood cell salvage group (experimental group, n = 60) and non-autologous blood cell salvage group (control group, n = 60). Volume of perioperative allogeneic blood transfusion of each patient was recorded. Moreover, complications and ICU retention times (H) of each patient were also recorded. The data were analyzed using t tests. Results: The volume of allogeneic blood transfusion was significantly less in the experimental group than in the control group. Conclusion: Application of autologous blood cell salvage in off-pump coronary artery bypass graft operation can reduce the volume of allogeneic blood transfusion, alleviate blood shortage, and reduce the incidence of postoperative complications, leading to medical, economic, and social benefits.

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“…2 We have even successfully performed 9 grafts in a patient using OPCAB. There is no constraint of increasing bypass or clamp time.…”

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confidence: 94%

“…5 In our series reported earlier, the average number of grafts per patient was >4. 2 We have even successfully performed 9 grafts in a patient using OPCAB. There is no constraint of increasing bypass or clamp time.…”

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Letter by Saha Regarding Article, “Should Off-Pump Coronary Artery Bypass Grafting Be Abandoned?”

Saha

2014

Circulation

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1 on off-pump coronary artery bypass grafting (OPCAB). I congratulate him for the exhaustive and lucid review. I would like to humbly express my opinion about the conclusions derived by the author.The Randomized On/Off Bypass (ROOBY) trial had 12.4% conversion to cardiopulmonary bypass. This is way too high and depicts the inexperience of the OPCAB surgeon. We have reported that it is possible to achieve nearly zero conversion to cardiopulmonary bypass in nonselected consecutive patients by the timely use of intra-aortic balloon pump and elective use of cell saver.2 OPCAB has a steep learning curve. The poor OPCAB graft patency rate may have resulted from the inexperience of the OPCAB surgeons (seen by high conversion rate). Moreover, the graft patency data from the Surgical Management of Arterial RevascularizationTherapy (SMART), and Coronary Artery Bypass Surgery Off or On Pump Revascularization Study (CORONARY) trials contradict Dr Lazar's conclusion that OPCAB has inferior long-term graft patency. 1The superiority of the bilateral internal mammary artery graft is well established. 3 We have reported a simple technique of using the bilateral internal mammary artery during OPCAB that can be performed in India with limited resources. 4 An additional benefit of OPCAB with aortic no touch is that it has a very low incidence of stroke, which compares favorably with percutaneous coronary intervention. 5In our series reported earlier, the average number of grafts per patient was >4. 2 We have even successfully performed 9 grafts in a patient using OPCAB. There is no constraint of increasing bypass or clamp time. All vessels, even the small and diffusely diseased vessels, can be grafted perfectly. Hence, I beg to differ that OPCAB leads to incomplete revascularization. Similar reports have been published from other parts of the world.A hypercoagulable state after OPCAB may affect graft patency. We routinely start the OPCAB patient on clopidogrel 4 to 6 hours after OPCAB and 2 hours after coronary endarterectomy. Moreover, only 50% of the heparin used during OPCAB is reversed with protamine. Cardiopulmonary bypass-induced coagulopathy may provide some protection against graft thrombosis in on-pump coronary artery bypass grafting. These aspects need to be studied.OPCAB in India was pioneered by surgeons trained in centers in the United States with excellent results in on-pump coronary artery bypass grafting. The majority of the surgeons now performing OPCAB, including me, received training in renowned centers of the United States. It is inappropriate to conclude that all these highly trained surgeons are committing judgmental errors by adopting OPCAB. In India, treatment is funded by the patient. It is more difficult to have a successful private practice with suboptimal patient outcomes. Moreover, with an aggressive interventional cardiologist breathing down the surgeon's neck, the surgical results have to be excellent.It is possible to perform complete revascularization with a very low conversion rate even with low su...

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Off-Pump Coronary Artery Bypass Grafting in a Low-Volume Center

Cited by 5 publications

References 18 publications

Intraaortic balloon pump boon for off-pump coronary artery bypass grafting

Intraaortic balloon pump boon for off-pump coronary artery bypass grafting

Application of Autologous Blood Cell Salvage in Off-Pump Coronary Artery Bypass Graft Operation

Letter by Saha Regarding Article, “Should Off-Pump Coronary Artery Bypass Grafting Be Abandoned?”

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