The impact of off-pump surgery in end-organ function: practical end-points

Abstract

Most surgeons perform coronary bypass surgery with the aid of cardiopulmonary bypass, which inflicts a massive systemic inflammatory response to the body leading to adverse clinical outcome. In an attempt to make CABG less invasive, interest have been diverted to the off pump technique.The current review attempts to bring an insight onto the last ten years knowledge on the off-pump impact in end organ function, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject.

Bedside Assessment of the Microvascular Venous Compartment in Cardiac Surgery Patients With Valvular Diseases Undergoing Cardiopulmonary Bypass

“…Cardiac surgery patients undergoing cardiopulmonary bypass (CPB) experience injury to organs and tissues in multiple systems. [1][2][3] The effects of CPB add to the cardiovascular adaptations induced by underlying cardiac diseases. In particular, valvular diseases induce compensatory mechanisms, resulting in pressure adjustments in the intravascular compartments that aim to maintain venous return.…”

Pulmonary Perfusion and Ventilation during Cardiopulmonary Bypass Are Not Associated with Improved Postoperative Outcomes after Cardiac Surgery

“…While Siepe et al (20) attributed the protective effects of pulmonary perfusion during CPB to the decreased pulmonary tissue expression and blood concentration of inflammatory cytokines, such as IL-6, IL-8, IL-10, and TNF-α, and others (5, 15, 19) could not reproduce these effects. Likewise, despite avoidance of CPB, pulmonary atelectasis and activation of inflammatory cascades associated with pulmonary ischemia–reperfusion injury, off-bypass technique of coronary revascularization offers only a modest clinical impact on pulmonary outcomes in patients with severe pulmonary disease (21–23). …”

Blood Lactate Level as Predictor of Early Outcome after Off-Pump Coronary Artery Bypass Grafting

“…Hence monitoring of postoperative lactate levels may be useful for assessing the status of aerobic metabolism. 9 Mean lactate concentrations during the first 12 hours of CVICU admission had the next best predictive ability. 1,9 Recent literatures demonstrate that elevated lactate concentrations and prolong lactate clearance time are associated with increased morbidity and death in patients undergoing CABG or valve operations or both.…”

“…9 Mean lactate concentrations during the first 12 hours of CVICU admission had the next best predictive ability. 1,9 Recent literatures demonstrate that elevated lactate concentrations and prolong lactate clearance time are associated with increased morbidity and death in patients undergoing CABG or valve operations or both. Timely monitoring of postoperative lactate levels and correction of hyperlactatemia may facilitate rapid recovery of aerobic metabolism and reduce postoperative complications.…”

“…Thus, this biochemical marker may provide clinicians with an early indication of a patient's likelihood of experiencing major complications even after off-pump coronary artery revascularization. 1,9 Methods: This Prospective observational study was carried out in the Department of Cardiac Surgery, at National Heart Foundation Hospital& Research Institute (NHFH&RI), Dhaka from July 2016 to March 2018. The study was carried out in all adult patients undergoing elective OPCAB surgery and fulfill the inclusion and exclusion criteria with.…”