The Comparison of Clinical and Biochemical Outcomes in Off-Pump and Conventional Coronary Artery Bypass Grafting Surgery

Abstract

Objective: There is no common concencus the clinical results of coronary artery bypass grafting (CABG) surgery patients who underwent off-pump or conventional techniques. Our aim of this study was to compare the changes of myocardial functions, patients' clinical results, biochemical marker release during surgery and postoperatively in On-and Off-Pump CABG surgery. Method: A consecutive series of 50 coronary artery disease (CAD) patients who underwent elective CABG surgery included for this study. The patients were divided into two groups (Group 1, N = 25 and group 2, N = 25). Demographic data including the patients' age, gender, body mass index (BMI), diseased coronary artery numbers, LVEF were similar. Postoperative red package blood cell, fresh frozen plasma, and thrombocyte requirements were high in On-Pump group (p < 0.05). But there was not any significant difference when compared the number of unexpected surgery because of mediastinal bleeding after operations in both groups. Preoperative and postoperative N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), cardiac Troponin-I (cTnI) levels during and after surgery, and left ventricular ejection fractions (LVEF) prior to discharge from hospital were compared. Results: There were no statistical significancy when compared postoperative mortality and morbidity. The operations time was low in off-pump group (p < 0.05). The NT-proBNP levels were similar in both groups (p > 0.05). However, cTnI levels were significantly higher in the on-pump group (p = 0.0001). Postoperative LVEF decreased significantly in both groups when compared to preoperative echocardiography examinations (p = 0.001). But the changes of postoperative LVEFs in both groups were not statistical significant (p > 0.05). Conclusion: Our study results indicated that cardiac enzyme release was high after On-Pump CABG surgery. However, LVEF decreased in both techniques. There were some advantages of OPCAB operations such as decrease of inflammatory responses and angina pectoris incidence due to extracorporeal circulation; however, these techniques did not affect postoperative mortality and morbidity. Therefore, in selected cases to provide longer operation time, Off-Pump CABG could be used but it has no superiority over On-Pump CABG surgery.

Short –term outcome of off pump versus on pump coronary artery bypass grafting

“…In Hussain et al study (2016) the postoperative elevation of CK-mb displayed as mean ± SD was 57.69 ± 38.57 IU/L in on-pump group, while it was 30.27 ± 21.85 IU/L, (P-value < 0.001). 8 Moreover, Temizturk et al (2015) reported that troponin release was calculated at 4 hours; it was 5.78 ± 5.61 in on-pump group and 0.49 ± 0.27 ng/ml in offpump group (P-value < 0.001). At 8 hours, this value was measured as 6.58 ± 7.97 in on-pump group and 0.65 ± 0.34 ng/ml in off-pump group (P-value < 0.001).…”

“…These measurements were significantly different when compared to both groups. 9 Consequently, this elevation may correlate with intraoperative myocardial injury related to pericardium manipulation, cardiac manipulation, inadequate myocardial protection during bypass time, intraoperative defibrillation, or acute post-bypass hemodynamic instability .…”