Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients

Athanasiou, Thanos; Al‐Ruzzeh, Sharif; Kumar, Pankaj; Crossman, Mary-Clare; Amrani, Mohamed; Pepper, John; Stanbridge, Rex; Casula, Roberto; Glenville, Brian

doi:10.1016/j.athoracsur.2003.07.002

Cited by 209 publications

(134 citation statements)

References 59 publications

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“…The most significant finding was a decreased incidence of postoperative neurological dysfunction in our off-pump cohort. This finding is in agreement with most recent reports of OPCAB versus CCAB surgery in this age group (8,(19)(20)(21). Adverse neurological events, including CVAs, transient ischemic episodes and other neurobehavioural dysfunction have been associated with cerebral hypoperfusion, edema and emboli generation in both OPCAB and CCAB patients (23).…”

Section: Discussionsupporting

confidence: 92%

“…Recent meta-analyses have suggested that compared with conventional coronary artery bypass (CCAB) surgery, OPCAB surgery may significantly reduce stroke (OR of 0.38, 95% CI 0.22 to 0.65) (8), duration of ventilation (3.4 fewer hours, 95% CI 1.7 to 5.0) (9), atrial fibrillation (OR of 0.58 to 0.7, 95% CI 0.44 to 0.89) (9,10), transfusion requirements (OR of 0.43, 95% CI 0.29 to 0.65) (9) and postoperative length of stay (LOS) (one fewer day in hospital, 95% CI 0.5 to 1.5) (9). Conversely, some randomized controlled trials have been unable to show such benefits (11)(12)(13), BACKGROUND: Off-pump coronary artery bypass (OPCAB) surgery has been successfully used in diverse patient populations and has been postulated to be safer than conventional coronary artery bypass (CCAB) surgery in some high-risk patients, including the elderly.…”

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confidence: 99%

See 1 more Smart Citation

Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

Nagpal¹,

Bhatnagar²,

Cutrara³

et al. 2006

Canadian Journal of Cardiology

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

Nagpal¹,

Bhatnagar²,

Cutrara³

et al. 2006

Canadian Journal of Cardiology

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“…Athanasiou et al in a systematic review concluded that the off-pump surgery method reduces the risk of neurological strokes compared with the on-pump procedure (14). The off-pump CABG method is more useful than the on-pump CABG method in patients with severe cardiovascular complications before the surgery.…”

Section: Discussionmentioning

confidence: 99%

Depression, Functionality and Adaptability of Elderly Patients After Open Heart Surgery Off- or On-Pump

Asgari

Bahramnezhad

Mehrdad

et al. 2015

Jundishapur J Chronic Dis Care

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Background:Open heart surgery is performed by two methods of off or on cardiopulmonary bypass. Both methods may affect the rate of depression, level of functionality and adaptation of the elderly undergoing the operations. Objectives: The current study aimed to assess depression, level of functionality and adaptability in elderly patients undergoing open heart surgery with off or on pump in the in open heart surgery intensive care unit of Imam Khomeini and Shariati Hospitals, Tehran University of Medical Sciences. Patients and Methods:This cross-sectional study was conducted from 23 September 2013 to 22 March 2014. The samples were 160 elderly patients who were selected by convenience sampling method and divided into two groups of on-and off-pump coronary artery bypass graft. The rate of depression and level of functionality of the patients were assessed before and six weeks after surgery by Geriatric Depression Scale (GDS) and Medical Outcome Study SF 12 (MOS SF-12) questionnaires respectively, in a self-reporting approach. The rate of patient's adaptability was also evaluated six weeks after the surgery by Ways of Coping Questionnaire (WOCQ). Results: In on-and off-pump groups, there were statistically significant differences in terms of depression rate and level of functionality before and six weeks after the surgery, respectively, as (P = 0.001) and (P = 0.0001). The t-test results also showed that the patients' adapt ability in the on-pump group with the mean ± SD of 111.1 ± 56.17 was significantly different from that of the off-pump group with the average changes of 70.88 ± 91.15 (P = 0.0001). Conclusions: It is recommended to further support the patients undergoing on-pump open heart surgery, and some programs will be designed to reduce the level of their depression and increase their adaptability and functionality levels.

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“…They found a trend towards a 60% reduction of stroke, which after risk adjustment, fell below the level of significance for the total population, but the benefit persisted for patients with severe stenosis of the internal carotid artery. In a meta-analysis of 9 observational studies, 37 off-pump coronary surgery was associated with a significantly lower incidence of stroke in patients over 70 years of age as compared to the on-pump technique (1% versus 3%), with an odds ratio of 0.38% (95% CI = 0.22 to 0.65). The incidence of atrial fibrillation was examined in another meta-analysis of eight non-randomized studies, which included 3,017 patients (764 off-pump and 2,253 on-pump).…”

Section: Risk Of Cerebral Injurymentioning

confidence: 99%

Controversies in Off-pump Coronary Artery Surgery

Pepper¹

2005

Clinical Medicine & Research

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Motivated by a desire to reduce the morbidity of a well-established and effective procedure for coronary artery disease, up to 25% of coronary artery bypass operations are being performed without the use of a heart-lung pump. Concerns remain about the quality of the coronary anastomoses and the completeness of revascularization. Randomized trials have not revealed the significant reduction in morbidity or mortality that the early enthusiasts had hoped for. Yet a number of non-randomized studies have shown clinical benefit from the avoidance of an extracorporeal circulation, but these have been criticized for potential bias in patient selection and management. A majority of surgeons have not yet adopted this technique and are waiting for the accumulation of more evidence. Although the mortality rate of coronary artery surgery is low, at approximately 2%, 1 it is age related and rises to over 6% in those over 75 years of age. This benefit is offset by a complication rate of 20% to 30%. In addition, there is a 2 to 3 month period of recovery from the fatigue that usually follows any major operation. The recent observation of neurocognitive impairment in up to 42% of patients 5 years after surgery has aroused additional concern. 3,4 The functional significance of the neurocognitive findings and the relative contribution of aging, atherosclerotic disease, and surgical procedures to the measured impairment remain unknown.Patients and their physicians desire a low morbidity procedure, preferably without general anesthesia and in an outpatient setting. These factors together with the avoidance of the adverse consequences of cardiopulmonary bypass have been the driving force behind the development of percutaneous coronary intervention (PCI). Recurrent angina and the need for subsequent re-intervention are more frequent after PCI than after conventional coronary artery bypass surgery, a performance gap that is likely to be narrowed by the emergence of drug-eluting stents.PCI has had a dramatic effect on coronary artery bypass surgery, arresting the dramatic growth of surgery in the 1980s and shifting the attention of surgeons to patients with more advanced coronary disease and extensive coexisting conditions. This has motivated surgeons to refine coronary revascularization techniques in order to maximize clinical effectiveness, limit costs, and reduce invasiveness.In contrast to the small incision approaches, off-pump coronary artery bypass surgery through a median sternotomy has gained clinical acceptance and in many centers constitutes 20% to 30% of the total volume of coronary surgery. Creation of the distal anastomoses is facilitated by the use of stabilizers that reduce the motion of the heart in an

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Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients

Cited by 209 publications

References 59 publications

Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

Depression, Functionality and Adaptability of Elderly Patients After Open Heart Surgery Off- or On-Pump

Controversies in Off-pump Coronary Artery Surgery

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