Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study

Muneretto, Claudio; Bisleri, Gianluigi; Negri, Alberto; Manfredi, Jacopo; Metra, Marco; Nodari, Savina; Dei, Livio

doi:10.1016/s0003-4975(03)00564-2

Cited by 103 publications

(53 citation statements)

References 16 publications

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“…Approximately half of the Fitz Gibbon grade B arterial grafts in the early angiograms became grade A at 5 years after surgery, but the proportion of grade B saphenous vein grafts gradually increased over the 5 postoperative years. Muneretto et al [76] prospectively enrolled 176 patients undergoing total arterial myocardial revascularization and assigned them at random to one of two groups: group 1 was composed of 88 patients undergoing coronary surgery with cardiopulmonary bypass (CPB); group 2 consisted of 88 patients receiving the OPCAB procedure. They concluded that Off-pump coronary artery surgery could be successfully used for total arterial grafting without compromising the completeness of revascularization.…”

Section: Length Of Hospital Stay Mortality Rates and Cost Savingsmentioning

confidence: 99%

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

Hijazi¹

2010

Rev Bras Cir Cardiovasc

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Section: Length Of Hospital Stay Mortality Rates and Cost Savingsmentioning

confidence: 99%

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

Hijazi¹

2010

Rev Bras Cir Cardiovasc

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“…Furthermore, this finding of increased ROS may help to explain arrhythmia generation after beating heart bypass, in particular, for multivessel revascularization, when significant manipulation of the heart is undertaken. 6 …”

Section: Methods and Resultsmentioning

confidence: 99%

Displacement of the Beating Heart Induces an Immediate and Sustained Increase in Myocardial Reactive Oxygen Species

Almsherqi

McLachlan

Kostetski

et al. 2006

Circ J

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isplacement of the heart during beating heart surgery can reduce coronary blood flow and cardiac output (CO) 1 and to normalize hemodynamics the Trendelenburg position is often employed with or without fluid and pharmacological intervention. 1 Methods to reestablish coronary flow could be deemed reperfusion therapy and cardiac reperfusion after a brief ischemic insult can increase reactive oxygen species (ROS), 2 which may promote cardiac dysfunction and/or arrhythmias. 3-5 However, no studies have investigated the effects of dislocating the beating heart on possible associated reperfusion and free radical production. Thus, the aim of the present study was to examine heart dislocation and its re-positioning on myocardial ROS generation in dogs.The AEC National University of Singapore approved the experimental protocols. Seven male dogs (17-21 kg) were fasted overnight and anesthetized via intramuscular injection of ketamine (20 mg/kg) and intravenous thiopentone (30 mg/kg), intubated and ventilated. Anesthesia was maintained via 1.5 L oxygen/air and 1.5-2% isoflurane. Ventilation rate (20 strokes/min), tidal volume and FiO2 were adjusted to maintain arterial PO2 >100 mmHg. A left thoracotomy was performed in the fifth intercostal space and the heart was suspended in a pericardial cradle. A catheter was inserted into the coronary sinus for blood sampling of venous effluent.After 20-min stabilization, the heart was displaced by 90 degrees (dislocation) manually until the apex pointed upward to expose the left circumflex coronary artery (LCx). After 10 min each dog was placed in the Trendelenburg position (20 degrees head down) for 15 min without changing the position of the displaced heart. The operating table was then returned to horizontal and the heart returned to its anatomical position. ROS measurements began immediately after the heart was replaced in its normal position.Dogs were instrumented for hemodynamic measurements during heart displacement. Intra-aortic pressure was measured by inserting a fluid-filled 20 g Huber point needle cannula into the ascending aorta. CO and flow for the left anterior descending coronary artery (LAD), right coronary artery (RCA) and LCx was measured via ultrasonic probes (Power Lab/4S).ROS were measured in blood samples prior to heart dislocation procedures (control) and at 3, 30 and 60 min after the heart had been replaced in its anatomical position. A 2-ml sample of venous blood from the coronary sinus was collected in a 5-ml syringe pre-filled with 1 ml ofphenyl-N-tert-butylnitrone (PBN, 50 mmol/L) and gently mixed with brief periods of exposure to room air for 1 min and then immediately frozen in liquid nitrogen. For EPR measurements, samples were thawed on ice and transferred into glass tubes containing 1.5 ml spectroscopic-grade toluene, gently shaken and centrifuged for 5 min at 4,000 rpm Background Heart manipulation and displacement are common maneuvers during beating heart surgery to expose coronary arteries for revascularization. Effects of heart displacement on fr...

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“…Carotid artery [15,16] and coronary bypass surgery [17] have acceptable mortality and morbidity rates. So that the same seansta continues to be the result of the debate whether or not to intervene.…”

Section: Intraoperative Data Numbermentioning

confidence: 99%

A New Approach to Myocardial Revascularization in Patients with Severe Carotid Lesions: Simultaneous Cardiopulmonary Bypass and Local Carotid Endarterectomy

Teker¹

2017

J Cardiovasc Dis Diagn

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Aim: In the present study, we aimed to present the retrospective outcomes of the patients who underwent carotid endarterectomy under local anesthesia followed by cardiopulmonary bypass under general anesthesia during the same session.Material and methods: 52 patients (36 male, 16 female patients; mean age was 69.0 ± 8.5 years: range 42 to 75 years) with carotid lesions underwent carotid endarterectomy under local anesthesia and simultaneous cardiopulmonary bypass between 1 st March 2015 and 1 st March 2016 in our center. This study involved patients with myocardial revascularization and 80% or more carotid stenosis (with or without contralateral disease). Preoperative, preoperative and postoperative characteristics of the patients were retrospectively analyzed.Results: Operative mortality rate was 1.9% with one patient. Early postoperative revision was performed in 3 patients (5.7%) bleeding. Postoperative atrial fibrillation developed in 6 patients (11.5%). There was no cerebrovasculary accident postoperatively. Conclusion:The incidence of coronary and carotid artery disease coexistence is not too low. The combined approach increases the stroke and mortality rate by using general anesthesia in the procedure, although the odds of complications appearing to reduce the duration of hospitalization with the performance of a single seansta procedure. In this study, we reported that local carotid artery intervention and simultaneous coronary artery bypass surgery reduced the stroke risk and mortality rates.

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Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study

Cited by 103 publications

References 16 publications

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

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

Displacement of the Beating Heart Induces an Immediate and Sustained Increase in Myocardial Reactive Oxygen Species

A New Approach to Myocardial Revascularization in Patients with Severe Carotid Lesions: Simultaneous Cardiopulmonary Bypass and Local Carotid Endarterectomy

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