“On” or “Off” pump coronary artery bypass grafting – Is the last word out?

Yadava, Om Prakash; Kundu, Anirban

doi:10.1016/j.ihj.2013.02.008

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…Recent studies confirmed that coronary grafting on the beating heart is a viable alternative to conventional on-pump CABG and provides good long-term graft patency. [12][13][14] Acute renal failure necessitating the use of RRT is a rare but serious complication after CPB. However, AKI needing RRT is associated with an in-hospital mortality of 50 to 70%.…”

Section: Discussionmentioning

confidence: 99%

Off-Pump Technique May Prevent Worsening of Renal Function in CAD with CKD Undergoing CABG

Afsal

Sujani

Viswanathan

et al. 2021

Journal of Cardiac Critical Care TSS

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Cardiovascular disease (CVD) is a major cause for a significant proportion of all deaths and disability worldwide. Postoperative renal dysfunction following cardiac surgery is not an uncommon complication of cardiac surgery, which has serious implications with regard to morbidity, mortality, financial expenditure, and resource utilization. This study was performed to compare outcomes of patients with preoperative renal dysfunction with those having normal renal function undergoing off-pump coronary artery bypass grafting (OPCABG). Patients were divided into two categories, depending on their preoperative serum creatinine and glomerular filtration rate (GFR). The preoperative renal dysfunction was defined as serum creatinine >1.3 mg/dL and/or estimated GFR (eGFR) of <60 mL/min/1.73 m2. The category A patients had normal renal function defined as serum creatinine ≤1.3 mg/dL and/or eGFR of ≥60 mL/min/1.73 m2 while the category B patients had preoperative renal dysfunction that did not necessitate renal dialysis. Blood samples were collected from both category patients for serum creatinine prior to surgery, following surgery, on postoperative days 1, 2, 3, 4, 5, and on the day of discharge. The occurrence of acute kidney injury (AKI) was defined as an increase in the serum creatinine levels of ≥0.3 mg/dL within 48 hours or an increase of ≥1.5 above baseline known or presumed to have occurred within the previous 7 days based on Kidney Disease Improving Global Outcomes criteria. This study demonstrated that there was worsening of renal function in 7.4% of patients with normal renal function and 10.74% of patients with renal dysfunction that was not statistically different. Based on the results, we conclude that preoperative renal dysfunction may be a contributing predictor of AKI following OPCABG, and we recommend that the patients with more severe renal dysfunction with eGFR of 45–60 mL/min should be studied to demonstrate this hypothesis.

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Section: Discussionmentioning

confidence: 99%

Off-Pump Technique May Prevent Worsening of Renal Function in CAD with CKD Undergoing CABG

Afsal

Sujani

Viswanathan

et al. 2021

Journal of Cardiac Critical Care TSS

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“…The “real world” experience with off-pump surgery comes from the National Heart Institute in Delhi [ 45 ] of over 5000 cases done Off-pump with an impressive conversion rate of less than 1 % and mortality of 1.6 %; this shows that off pump is an effective and safe technique, provided it is adopted and practiced properly. The best technique is that which works best for that particular patient, in the context of his clinical setting and his treating surgeon's repertoire lending credence to the belief that it is the surgeon and not the technique, which is at the heart of the problem.…”

Section: Discussionmentioning

confidence: 99%

Current randomized control trials, observational studies and meta analysis in off-pump coronary surgery

Parissis

Lau

Parissis

et al. 2015

J Cardiothorac Surg

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The off-pump literature is divided into three eras: the “early phase” with results favouring off-pump surgery supported with randomized control trials (RCTs) mainly from Bristol, UK; an “intermediate phase” dominated by the results of the ROOBY trial and finally a more “contemporary phase” whereby the off/on-pump argument is unsettled. Although the literature has failed to project an overall superiority of off-pump versus on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies are concluding that the incidence of a stroke is less than 1 % when an aortic off-pump techniques (especially the non-touch technique) are advocated in patients with diseased ascending aorta. Furthermore, off-pump combined with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities.The current review attempts to bring an insight onto the last ten years knowledge on the on/off-pump debate, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject.

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“…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%

“…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.…”

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confidence: 99%

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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“On” or “Off” pump coronary artery bypass grafting – Is the last word out?

Cited by 10 publications

References 21 publications

Off-Pump Technique May Prevent Worsening of Renal Function in CAD with CKD Undergoing CABG

Off-Pump Technique May Prevent Worsening of Renal Function in CAD with CKD Undergoing CABG

Current randomized control trials, observational studies and meta analysis in off-pump coronary surgery

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

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