On-pump versus off-pump coronary artery bypass surgery for multi-vessel coronary revascularization

Abstract

Background: This study aims to compare the operative and postoperative results of on-pump (ONCAB) and off-pump (OPCAB) coronary artery bypass surgery (CABG) for multi-vessel coronary revascularization (≥4 anastomoses). Methods: From May 2018 to August 2019, a total of 120 patients (22.5% women, mean age 61.5±8.4 years) received either ONCAB (Group 1, n=60) or OPCAB (Group 2, n=60) for multi-vessel coronary artery disease (CAD). Preoperative left ventricular (LV) ejection fraction (EF) was 53.1%±8.4%.Median EuroSCORE II was 1.59 (interquartile range, 1.01-2.54). The median number of performed coronary anastomoses was 4 (interquartile range, 4-5), with equal distribution in both groups (P=0.4). All procedures were performed by highly experienced surgeons. The primary endpoints were overall survival at 30 days and freedom from severe adverse events (SAE), which included myocardial infarction (MI), coronary artery re-operation, and re-thoracotomy, caused by bleeding and stroke. Results: The overall survival in both groups was 100% with no intraoperative OPCAB-to-on-pump conversion. The median procedure time was 169 min (interquartile range, 150-179 min) for Group 1 and 183 min (interquartile range, 169-205 min) for Group 2 (P<0.001). The overall freedom from SAE numbered 93.3% (98.3% vs. 88.3%, P=0.030). Postoperative MI rate was 2.5% (n=3) with no significant difference for either group (0 vs. 5.0%, P=0.100). One MI patient underwent a re-operation, and two other patients received a conservative treatment. A total of 2.5% (n=3) of patients underwent a re-thoracotomy on account of bleeding (0 vs. 5.0%, P=0.100); no anastomosis-related bleeding was detected. Blood transfusion was applied in 31.7% of patients (38.3% vs. 25.0%, P=0.090). A total of 1.7% of patients (1.7% vs. 1.7%, P=0.800) developed a stroke. Ventilation time, intensive care unit stay, and hospital stay were similar in both groups. Conclusions: ONCAB showed superior freedom from SAE and shorter procedure times when compared to OPCAB for multi-vessel coronary artery revascularization. 5640Zubarevich et al. On-pump versus off-pump for multi-vessel coronary revascularization

Simultaneous transaortic transcatheter aortic valve implantation and off‐pump coronary artery bypass: An effective hybrid approach

“…OPCAB procedures have already been reported to be a safe and feasible for multivessel coronary revascularization also in high‐risk patients 24–26 . OPCAB is associated with lower rates of postoperative myocardial ischemia and disabling strokes because of reduced manipulation on the aorta 25,27 .…”

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting

“…No-touch technique for proximal anastomoses, offpump surgery, and hybrid procedures can be reliable alternatives in patients with AC to prevent POND and overall mortality. [ 24 ] These strategies may be more important for patients with preoperatively detected AC to prevent POND and CVA.…”

Induced blood oxidation in myocardial revascularization

“…Реваскуляризация в условиях искусственного кровообращения продемонстрировала меньшую частоту серьезных осложнений в течение 30 дней у пациентов, которым требовалось наложение ≥4 сосудистых анастомозов, согласно исследованию А. Zubarevich и соавт. [20]. Метаанализ исследований, прове-ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ https://doi.org/10.17816/clinpract107847 денных у пациентов с систолической дисфункцией левого желудочка (фракция выброса ≤40%), продемонстрировал преимущество OPCAB в отношении 30-дневной выживаемости и частоты послеоперационных осложнений [21].…”