Role of Off-Pump Coronary Artery Bypass Grafting in Patients With Malignant Neoplastic Disease

Ochi, Masami; Yamada, Kenichi; Fujii, Masahiro; Ohkubo, Naoko; Ogasawara, Hidetsugu; Tanaka, Shigeo

doi:10.1253/jcj.64.13

Cited by 28 publications

(34 citation statements)

References 15 publications

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“…The non-pulsatile flow of cardiopulmonary bypass can obstruct the physiological distribution of blood, whereas off-pump CABG maintains the physiological pulsatile flow to organs during the surgical procedure. 3 In the present case, we speculate that CABG may have disturbed the cerebral circulation resulting in perioperative stroke. Although an off-pump strategy seemed to be indicated in this patient, atheroembolism from the ascending aorta has been reported to be cause of stroke after surgery.…”

Section: Discussionmentioning

confidence: 58%

“…Although an off-pump strategy seemed to be indicated in this patient, atheroembolism from the ascending aorta has been reported to be cause of stroke after surgery. [2][3][4][5] Ura et al reported that flail atheromatous plaque can develop at the site of total or sidebiting clamping, even if the epiaortic echogram shows mild or moderate atheromatous change in the ascending aorta. 6,7 An atherosclerotic ascending aorta is closely related to carotid occlusive disease in CABG candidates, 8 and regardless of the degree of disease in the ascending aorta sidebiting clamps should be applied with great care.…”

Section: Discussionmentioning

confidence: 99%

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Cerebral Embolism in Off-Pump Coronary Artery Bypass Grafting.

Fukuda¹,

Nakata²,

Sakamoto³

et al. 2002

Circ J

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ff-pump coronary artery bypass grafting (CABG) has been reported as decreasing the occurrence of stroke in patients with significant cerebrovascular disease. 1 However, manipulation of the ascending aorta can induce atheroembolism to brain, 2 and we report a case of postoperative stroke after off-pump CABG caused by a small cholesterin embolus to the cerebral circulation. Case ReportThe patient was 64-year-old female, who was admitted because of acute posterior myocardial infarction. Emergency coronary angiography revealed occlusion on the left circumflex artery and significant stenosis was noted in the left anterior descending artery and the right coronary artery. Direct coronary angioplasty with stent implantation of the circumflex artery was performed successfully. The peak MB fraction of the creatine kinase level was 10 IU/L and complete restoration of posterior wall motion was verified by echocardiography. Because she had had a previous cerebral infarction with hemianopia, detailed evaluation of the cerebral perfusion was performed. Plain computed tomography of the brain revealed right occipital infarction. Carotid and vertebral angiography revealed complete occlusion of the right middle cerebral artery and the right posterior cerebral artery. The distal portion of the middle cerebral artery was fed by collateral blood flow from the anterior cerebral artery. The cervical internal carotid arteries were normal. Single photon emission tomography of the brain revealed decreased blood flow in the postero-temporal region of the right hemisphere. Cerebral hypoperfusion during extracorporeal circulation was anticipated, so offpump CABG was performed. The left internal thoracic artery was anastomosed to the left anterior descending artery and the left radial artery was anastomosed to the right coronary artery. Epiaortic echography showed only mild atherosclerotic change in the ascending aorta, so a side- Circulation Journal Vol.66, August 2002biting clamp was applied to allow the creation of a proximal anastomosis of the radial artery (Fig 1). Blood pressure was kept below 90 mmHg during clamping to prevent the ascending aorta bearing excessive stress. The intraoperative course was uneventful and the endotracheal tube was extubated 30 min after surgery. The patient recovered without any neurological complications.On postoperative day 2, she suddenly exhibited left hemiplegia during breakfast. Sinus rhythm had been maintained during the postoperative period. Plain computed tomograpy of the brain taken immediately after the onset showed no newly emerged low-density area, but immediate carotid angiography revealed occlusion of the distal anterior cerebral artery that had been feeding the peripheral portion of middle cerebral artery (Fig 2). Intra-arterial thrombolysis was performed with a micro-catheter system. Mechanical destruction of the embolus was attempted, but complete recanalization could not be achieved because the embolus was very small and compact (Fig 3). There was no complication relevant to the thrombol...

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Cerebral Embolism in Off-Pump Coronary Artery Bypass Grafting.

Fukuda¹,

Nakata²,

Sakamoto³

et al. 2002

Circ J

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“…Schoenmakers and colleagues, 11) however, found no evidence that off-pump surgery is superior to on-pump in patients undergoing concomitant cardiac and pulmonary surgery. Dyszkiewicz et al and Ochi et al, 2,12) on the other hand, do cite benefits of off-pump coronary artery bypass grafting (OPCAB) with lung resection.…”

Section: Discussionmentioning

confidence: 99%

Early to Midterm Results of Cardiac Surgery with Concomitant Pulmonary Resection

Hosoba

Hanaoka

Suzuki

et al. 2012

ATCS

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Background: We report our experience of cardiac surgery with concomitant pulmonary resection, based on analysis of the results. Methods: Eleven patients (1 woman, 10 men) underwent cardiac surgery simultaneously with pulmonary resection; ten of them through median sternotomy. The cancer pathology consisted of non-small cell carcinoma (n = 10), and benign teratoma (n = 1). All lung lesions were removed using a wedge resection. Cardiac procedures consisted of off-pump coronary artery bypass grafting (n = 4), aortic valve replacement (n = 3), mitral valve plasty (n = 2), total arch replacement (n = 1), and descending aorta replacement (n = 1). Lung wedge resections were performed after induction with protamine sulfate. Results: The mean follow-up period was 19 ± 11 months (2-34). There was no operative mortality and no major cardiac complications. Three patients underwent a subsequent lobectomy through lateral thoracotomy. There were two postoperative deaths: one was from an unknown cause, 8 months postoperatively and another was from a lung cancer recurrence, 9 months after surgery. There were two local recurrences, 9 months and 14 months, postoperatively. The mean cancer-free period was 17 ± 10 (2-32) months. Conclusion: Rates of operative mortality and morbidity following cardiac surgery with concomitant pulmonary resection were favorable, and early to midterm results were acceptable. Keywords: lung cancer, concomitant cardiac surgery, wedge resection Ann Thorac Cardiovasc Surg 2012; 18: 8-11 doi: 10.5761/atcs.oa.11.01717 sequential and concomitant procedures, 1-4) the choice of which depends on the individual institution. Some institutions conduct a staged surgical procedure in which the cardiac surgery is mostly performed first followed by the lung surgery. Potential problems with this approach include delay in the lung resection due to the postoperative recovery phase and the additional cost of two operations. However, the concomitant procedure also has its shortcomings, such as the risk of dissemination due to manipulation of the pulmonary lobe, mechanical stress on the cardiac chambers, inability to perform radical lymph node dissection, and the risk of increasing the amount of blood loss due to the effect of heparinization.We studied a series of eleven patients who underwent concomitant pulmonary wedge resection and cardiac surgery. The aim of the study was to analyze the outcome of

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“…Recently, several reports suggested that patients with concomitant malignant neoplastic disease, OPCAB surgery has better outcomes and lowered operative mortality because of spared platelet function, less blood loss, and avoidance of infection. [7][8][9] Other than the abovementioned points, a unique situation exists in patients with a brain tumor. Application offpump bypass to these patients is of paramount importance because cardiopulmonary bypass causes tissue edema and consequently increased compression effect of the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several reports suggested that patients with concomitant malignant neoplastic disease, the OPCAB surgery has better outcomes and lowered operative mortality because of spared platelet function, less blood loss, and avoidance of infection. [7][8][9] Other than patients having solitary cancer, patients with a low-grade lymphocytic malignancy (including some types of non-Hodgkin's lymphoma and chronic lymphocytic leukemia) can be referred for coronary bypass surgery if a long-term survival is expected.…”

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confidence: 99%