Off-pump multivessel coronary artery surgery in high-risk patients

Meharwal, Zile Singh; Mishra, Yugal; Kohli, Vijay; Bapna, Ramesh; Singh, Sandeep; Trehan, Naresh

doi:10.1016/s0003-4975(02)03915-2

Cited by 69 publications

(49 citation statements)

References 18 publications

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“…OPCAB has gained worldwide popularity 4,5) and is associated with fewer postoperative complications and shorter lengths of stay in the hospital or intensive care unit than conventional CABG. 4) Nonrandomized studies report significant reductions in mortality and major neurologic events with OPCAB.…”

Section: Discussionmentioning

confidence: 99%

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Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Kanemitsu

Tanabe

Ohue

et al. 2011

Annals of Vascular Diseases

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Objectives: Atherosclerosis has been identified as a risk factor for both morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG). To investigate outcomes following CABG for severe atherosclerosis, and to determine whether different surgical techniques can reduce the risk of neurologic events in these patients. Methods: We studied 225 consecutive patients who underwent elective isolated CABG. Routine preoperative and intraoperative examinations identified patients with severe atherosclerosis. We compared the outcomes between patients with (group A; 42 ceses) and those without (group N; 183 cases) severe atherosclerosis. Results: 36 patients (85.7%) in group A and 176 (96.2%) in group N underwent off-pump coronary artery bypass (OPCAB); 6 (14.3%) in group A and 7 (3.8%) in group N underwent on-pump beating CABG. Three patients in group A suffered deep sternal infection (7.1%), and one suffered stroke (2.4%) compared with none in group N. No cerebral infarction or neurologic events occurred in patients who underwent OPCAB (n = 212, 94.2%). Conclusions: Prevalence of complications was significantly greater among patients with severe atherosclerotic disease who underwent OPCAB than in those without atherosclerotic disease. Careful selection of surgical strategies can prevent perioperative stroke and reduce mortality.

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Section: Discussionmentioning

confidence: 99%

“…Off-pump coronary artery bypass (OPCAB) has gained worldwide popularity. 4,5) Comparative reports demonstrate significant reductions in mortality and major neurologic events following the use of OPCAB. 6,7) In this study, we compared the outcomes of CABG in patients with and without severe atherosclerosis.…”

Section: Introductionmentioning

confidence: 99%

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Kanemitsu

Tanabe

Ohue

et al. 2011

Annals of Vascular Diseases

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“…Ве-роятность дисфункции венозных шунтов состав-ляет от 13 до 29 % в 1 год и до 50 % через 10 лет после операции [26,27].…”

Section: в и ганюков р с тарасов и дрunclassified

Hybrid minimally invasive myocardial revascularization in multivessel coronary disease . Current status of the issue

Ганюков¹,

Тарасов²,

Шилов³

et al. 2016

Kompleks. probl. serdečno-sosud. zabol.

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В. И. ГАНЮКОВ, Р. С. ТАРАСОВ, А. А. ШИЛОВ, Н. А. КОЧЕРГИН, Л. С. БАРБАРАШФедеральное государственное бюджетное научное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», лаборатория интервенционных методов диагностики и лечения атеросклероза. Кемерово, Россия В данной статье приводится обзор литературы по проблеме малоинвазивной гибридной реваскуляризации миокарда у па-циентов со стабильной ИБС при многососудистом поражении коронарного русла. Анонсируется дизайн собственного рандомизи-рованного исследования HREVS (Hybrid REvascularization Vs Surgery), сравнивающего результаты реваскуляризации миокарда с применением трех стратегий: 1) гибридной реваскуляризации (шунтирование передней нисходящей артерии из мини-доступа на работающем сердце и стентирование других коронарных артерий с использованием стентов с лекарственным покрытием); 2) стан-дартного коронарного шунтирования в условиях искусственного кровообращения; 3) многососудистого стентирования коронарных артерий с применением стентов с лекарственным покрытием.Ключевые слова: гибридная реваскуляризация миокарда, чрескожное коронарное вмешательство, коронарное шунтиро-вание. this article provides an overview of the literature on the issue of minimally invasive hybrid revascularization in patients with stable multivessel coronary artery disease. It is announced design of randomized study HREVS (Hybrid REvascularization Vs Surgery), to compare the results of myocardial revascularization using three strategies: 1) hybrid revascularization minimally invasive on pump coronary artery bypass surgery LIMA to LAd (MId CAB) and stenting of other coronary arteries using drug-eluting stents); 2) coronary artery bypass grafting with cardiopulmonary bypass; 3) multivessel coronary stenting with drug-eluting stents. HYBRID MINIMALLY INVASIVE MYOCARDIAL REVASCULARIZATION

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“…5 All this suggests that although OPCAB surgery allows avoiding the deleterious pulmonary effects of CPB, there still might be pulmonary dysfunction caused by the OPCAB procedure. 6,7 Therefore, techniques to reduce pulmonary dysfunction may enhance the safety of coronary artery bypass surgery even when extracorporeal circulation is avoided.…”

Section: Conclusion : Le Peo Par Occlusion Transitoire De L'artère Ilmentioning

confidence: 99%

Remote preconditioning lessens the deterioration of pulmonary function after repeated coronary artery occlusion and reperfusion in sheep

Xia

Herijgers

Nishida

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : We investigated whether remote organ preconditioning (RPC) can preserve pulmonary function following repeated myocardial ischemia/reperfusion in a model mimicking multi-vessel off-pump coronary artery bypass (OPCAB) revascularization.M Me et th ho od ds s: : Nine sheep (Group-RPC) underwent RPC by three episodes of five-minute occlusion and five-minute reperfusion of the iliac artery. Five sheep (Group-C) were time-matched controls. Afterwards, ten-minute occlusion and reperfusion of the left anterior descending, the first diagonal and the left circumflex coronary arteries were performed consecutively. Hemodynamic and respiratory parameters and arterial blood gases were measured until 120 min after the final coronary reperfusion. Anesthesia was maintained with halothane in oxygen and nitrous oxide. Animals were ventilated with a tidal volume of 15-20 mL·kg -1 in a non-rebreathing system, and a respiratory rate 14-16 min, with 5-cm H 2 O positive end expiratory pressure after thoracotomy.R Re es su ul lt ts s: : Repeated coronary occlusion and reperfusion was associated in this experimental model with an increase in pulmonary vascular resistance (PVR) and pulmonary arterial pressure (PAP) and a decrease in PaO 2 and PaO 2 /FIO 2 in Group-C. After 120 min reperfusion, PaO 2 and PaO 2 /FIO 2 in Group-RPC were higher (192 ± 69 mmHg and 241 ± 78 vs 115 ± 54 mmHg and 129 ± 64, P < 0.05), while PVR and PAP were lower than in Group-C. At 120 min of reperfusion, PaO 2 and PaO 2 /FIO 2 were inversely correlated with PVR (P < 0.01).C Co on nc cl lu us si io on ns s: : RPC by transient occlusion of the iliac artery improves lung gas exchange after repeated coronary artery occlusion and reperfusion mimicking OPCAB surgery, and preserves low PVR in sheep. Objectif : Nous avons vérifié si le préconditionnement éloigné d'un organe (PEO) peut préserver la fonction pulmonaire à la suite d'ischémie/reperfusion myocardique répétée chez un modèle imitant la revascularisation d'un pontage aortocoronarien plurivasculaire à coeur battant (PACCB) Méthode : Neuf moutons (Groupe PEO) ont subi un PEO en trois épisodes d'occlusion de cinq minutes suivis de reperfusion de cinq minutes de l'artère iliaque. Cinq moutons (Groupe T) ont constitué le groupe témoin apparié dans le temps. Par la suite, nous avons réalisé successivement l'occlusion et la reperfusion, en dix minutes, des

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Off-pump multivessel coronary artery surgery in high-risk patients

Cited by 69 publications

References 18 publications

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Hybrid minimally invasive myocardial revascularization in multivessel coronary disease . Current status of the issue

Remote preconditioning lessens the deterioration of pulmonary function after repeated coronary artery occlusion and reperfusion in sheep

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