On-pump beating heart versus conventional coronary artery bypass grafting: comparative study on early and long-term clinical outcomes

Kim, Ho Jin; Oh, You Na; Ju, Min Ho; Kim, Joon Bum; Jung, Sung-Ho; Chung, Cheol Hyun; Lee, Jae Won; Choo, Suk Jung

doi:10.21037/jtd.2018.05.14

Cited by 11 publications

(16 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…So a new hybrid method, the on-pump beating-heart [6] (OPBH) CABG, has been used in these high-risk patients in recent years [7,8] . This technique could maintain the coronary blood flow to reduce myocardial injury [9] and reduce the preload and afterload to decrease myocardial oxygen demand.…”

Section: Introductionmentioning

confidence: 99%

Early and Medium Outcomes of On-Pump Beating-Heart versus Off-Pump CABG in Patients with Moderate Left Ventricular Dysfunction

Wang¹,

Wang²,

Piao³

et al. 2019

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

Objective This study aims to compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. Methods This is a retrospective study of ischemic heart disease patients with LVEF between 30% and 40% who underwent surgical revascularization from January 2013 to December 2017. Patients were divided into OPBH group (n=44) and OPCABG group (n=68), according to the surgical method. Clinical material with early and medium outcomes were investigated and compared between these groups. Results The two groups had similar baseline. Two OPBH patients and 3 OPCABG patients died in the hospital, which had no statistical significance ( P >0.05). OPBH patients received a greater number of grafts (3.74±0.84) and presented more improved LVEF (45.92±7.11%) than OPCABG patients (3.36±0.80) and (42.81±9.29%), respectively, which had statistical significance ( P <0.05). An increased amount of drainage during the first 12 hours was found in the OPBH group ( P <0.05). Reoperation for bleeding, duration of mechanic ventilation, and other early outcomes had no statistical significance between the two groups. During the medium-time follow-up, OPBH patients showed significantly lower major adverse cardiovascular events (MACE)-free survival time ( P =0.049) than OPCABG patients. Conclusion The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better mid-term MACE-free survival compared with OPCABG.

show abstract

Section: Introductionmentioning

confidence: 99%

Early and Medium Outcomes of On-Pump Beating-Heart versus Off-Pump CABG in Patients with Moderate Left Ventricular Dysfunction

Wang¹,

Wang²,

Piao³

et al. 2019

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…As a conclusion, both these techniques scored even and the decision rested upon the surgeon to choose the most appropriate technique. Another new study showed that the use of CPB support makes ON-BH CABG technically similar to C-CABG, and there were no obvious clear differences between these two strategies either short or long term [15]. We would like to state here that it should be however considered that technically and biochemically, ON-BH CABG differs from classical C-CABG in that there is no aortic cross clamping, rendering the procedure more physiological.…”

Section: Discussionmentioning

confidence: 84%

Intermittent on-pump beating-heart coronary artery bypass grafting—a safer option

Singh

Kumar

Prakash

et al. 2019

Indian J Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Purpose On-pump beating-heart coronary artery bypass grafting represents a merger of standard on and off-pump techniques and is thought to benefit patients by coupling the dual absence of cardioplegic arrest (conventional coronary surgery), with the hemodynamic instability during manipulation seen in off-pump surgery. However, the clinical benefits are still under discussion. We improvised on the standard on-pump beating-heart surgeries by introducing use of Bintermittent^bypass as and when required. Methods This study involved 108 patients. BIntermittent^on-pump-beating heart coronary artery bypass grafting was done using suction stabilizer and placing aortic and venous cannula, electively in all patients (group 1) who were supported by pump intermittently (n = 54). Retrospective data of patients who underwent off-pump surgery electively by the same surgeon (group 2, n = 54) was collected. Results There was a significant advantage in the number of grafts performed for the lateral surface (circumflex branches) using the new technique compared to conventional technique (68vs22). Similarly, significant advantage was also noted in terms of total number of grafts along with shorter operating times. There were no mortalities in the new group compared to the off-pump group and blood loss was also lesser. Conclusions BIntermittent^on-pump coronary revascularization is a technically reliable method of coronary revascularization taking advantage of the off-pump and conventional on-pump techniques while considerably eliminating the disadvantages of both. It has shown its superiority in safety, number of grafts, blood loss, operating time and perioperative course.

show abstract

“…Scientific evidence on the topic derives from retrospective observational studies mainly focused on high-risk patients. Literature search yielded a total of 279 records, and 17 studies 7,10,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28] and two meta-analyses 29,30 published between 2000 and 2020 were finally included in the systematic review (PRISMA flow diagram, Figure 1). Quality assessment is shown in Table 2; study characteristics and collected outcomes are summarized in Tables 3 and 4 and described below.…”

Section: Resultsmentioning

confidence: 99%

“…10,18,20,[24][25][26] Generalized data from all-comers population might support the idea of using OPBHC also in unselected patients. 7,15,19,23 Certainly, this hypothesis should be adequately investigated in future clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The use of cardiopulmonary bypass (CPB) and cardioplegic arrest could be responsible for cardiac and systemic complications, therefore off-pump CABG has been gradually developed as an alternative technique especially in case of markedly calcified ascending aorta. [3][4][5][6] Beside the concerns related to higher incidence of incomplete revascularization and potentially inferior long-term outcomes in off-pump surgery, 7 transitory haemodynamic instability caused by surgical manipulation, especially in case of severe coronary disease, might require emergent conversion to on-pump conventional CABG, increasing enormously the operative risk. 1,2 Patients at high risk of complications, such as those with recent myocardial infarction (MI), impaired left ventricular ejection fraction (LVEF) or poor hemodynamics might benefit from on-pump beating-heart CABG (OPBHC, also known as ONBEAT in some studies).This CPB-assisted approach was introduced by Perrault et al 8 more than 20 years ago and immediately fueled great interest in the treatment of high-risk patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

et al. 2020

View full text Add to dashboard Cite

Background Operative technique for surgical myocardial revascularization in high‐risk patients remains an argument of debate. On‐pump coronary artery bypass graft (CABG) with cardioplegic arrest and off‐pump CABG have intrinsic limitations. The hybrid approach of on‐pump beating‐heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta‐analysis intends to summarize the contemporary literature. Methods A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study. Results Compared with on‐pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36‐0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39‐0.91). Also, interesting trends towards reduced postoperative intra‐aortic balloon pump use (RR, 0.56, 95% CI, 0.31‐1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22‐1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off‐pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off‐pump CABG (RR, 0.53, 95% CI, 0.33‐0.87) but higher than conventional on‐pump CABG (RR, 1.71, 95% CI, 1.23‐2.39). Conclusion OPBHC is an effective technique to perform surgical revascularization in high‐risk patients as preventing haemodynamic deterioration and guaranteeing adequate end‐organ perfusion. OPBHC represents an alternative technique to on‐pump and off‐pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.

show abstract

On-pump beating heart versus conventional coronary artery bypass grafting: comparative study on early and long-term clinical outcomes

Abstract: The OPB strategy may be as safe and effective as the conventional strategy during CABG among patients with similar risk profiles. A prospective randomized trial is warranted to better ascertain the beneficial impact of OPB-CABG as both a viable and a durable alternative strategy to C-CABG.

Cited by 11 publications

References 26 publications

Early and Medium Outcomes of On-Pump Beating-Heart versus Off-Pump CABG in Patients with Moderate Left Ventricular Dysfunction

Early and Medium Outcomes of On-Pump Beating-Heart versus Off-Pump CABG in Patients with Moderate Left Ventricular Dysfunction

Intermittent on-pump beating-heart coronary artery bypass grafting—a safer option

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

Contact Info

Product

Resources

About