Total arterial off-pump coronary revascularization

Raja, Shahzad G.

doi:10.1097/hco.0000000000000645

Cited by 12 publications

(15 citation statements)

References 27 publications

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“…Post-operative hemorrhage requiring re-exploration after cardiac surgery still remains a troublesome complication with an incidence of 15% in the early days of cardiac surgery to 2-6% now a days (5,6,9,10,16). There are many factors for reduction of the incidence of the re-exploration as well as blood transfusion out of which one of the factor is performing 'off -pump CABG' (OPCABG) for revascularization (12)(13)(14). However, need for re-exploration was not totally alleviated by using off pump coronary artery revascularization strategies and there is still lake of data regarding incidence, risk factors and effect of timing of re-exploration after OPCABG…”

Section: Discussionmentioning

confidence: 99%

“…Re-exploration after coronary artery bypass surgery (CABG), which still remain the standard treatment for most patients with left coronary artery disease and multivessel disease, is also associated with higher mortality and morbidity (9,10). Now a days, the off-pump CABG (OPCABG) strategy has been tried to demonstrate with a lower rate of adverse effects, such as neurological complications by avoiding aortic manipulation and bleeding complications by avoiding complete heparinization and the inflammatory reactions resulting from cardiopulmonary bypass (12)(13)(14). Also there is still lack of data about the factors associated with re-exploration and mortality in the patients undergoing off pump coronary arterial bypass surgery (OPCABG).…”

Section: Introductionmentioning

confidence: 99%

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Re-exploration after off pump coronary artery bypass grafting: incidence, risk factors and impact of timing

Patel¹,

Adalti²,

Runwal³

et al. 2020

Preprint

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Objective: Re-exploration after cardiac surgery still remained a troublesome complication. There is still scarcity of data about the effect of re-exploration after off-pump coronary arterial bypass grafting (OPCABG). We here represent our experience of re-exploration following OPCABG. Method: Total 5990 OPCABG were performed at our center, out-off these 132 (2.2%) patients were re-explored in the OR and were included in this study. The medical records of these patients were retrospectively reviewed. Results: The most common cause of re-exploration was bleeding (83.3%) and most common site of bleeding was from graft/anastomosis (53.8%). Mean time to re-exploration was 9.75±8.65 hours. 30-day mortality was 1.41%.On univariate and multiple regression analysis, emergency surgery, preoperative low platelet count, and number of grafts were found to be an independent risk factor for re-exploration. On multiple regression, emergency surgery, euroscoreII, low platelet count, low ejection fraction, re-exploration, time to re-exploration, blood products used, high post-op serum creatinine and bilirubin, were found to be an independent factor (p<0.001) for mortality. On receiver-operating characteristic analysis, optimum cut off for time to re-exploration was 14 hours with sensitivity 81.3%, specificity of 80% and area under curve of 0.798. Patients who re-explored late (>14 hour) had significantly high mortality (30.55%vs7.3%) and morbidity. Conclusion: Delaying the re-exploration is associated with three-fold increase in mortality and morbidity. So strategy of minimizing the incidence of re-exploration like use of minimally invasive surgery and early re-exploration with judicial use of products should be use to improve outcome after re-exploration following off-pump CABG.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Re-exploration after off pump coronary artery bypass grafting: incidence, risk factors and impact of timing

Patel¹,

Adalti²,

Runwal³

et al. 2020

Preprint

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“…6 Many trials have established a clear advantage of LITA-to-LAD in terms of survival and freedom from reintervention. 3,7 Despite the limited long-term patency, autologous SVG remains a frequently used conduit even in the case of grafting the LAD. 8,9 In one of the recent studies about outcomes percutaneous coronary interventions (PCIs) on different bypass grafts following the failure of the graft to the LAD, it was demonstrated that most patients (67.6%) had SVG-to-LAD graft failure as compared to the LITA graft and, in our opinion, the reported frequent use of SVG does not reflect the contemporary cardiac surgical practice.…”

Section: E D I T O R I a Lmentioning

confidence: 99%

“…On the other hand, failure of the LITA‐to‐left anterior descending (LAD) artery is a rare event 6 . Many trials have established a clear advantage of LITA‐to‐LAD in terms of survival and freedom from reintervention 3,7 . Despite the limited long‐term patency, autologous SVG remains a frequently used conduit even in the case of grafting the LAD 8,9 .…”

Section: Figurementioning

confidence: 99%

Is it better to treat bypass graft or native coronary artery following early graft failure?

Sef

Predrijevac²,

Raja

et al. 2020

J Card Surg

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“…На думку Raja Shahzad G., тотальна артеріальна реваскуляризація з усіма перевагами і покращенням виживаності, зменшенням кількості повторних реваскуляризацій та низькою частотою виникнення інсультів може розглядатися як Святий Грааль у реваскуляризації міокарда. Однак для обґрунтування цього статусу необхідні результати великого багатоцентрового дослідження [45].…”

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Coronary Bypass Grafting for High-Risk Patients (Literature review)

Gogayeva

2020

ujcvs

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Ischemic heart disease still remains one of the leading causes) of morbidity and mortality of population of high-developed countries. Annually we notice an increase of coronary artery bypass grafting (CABG) procedures, especially for high-risk patients. Objective. To perform literature review of CABG for high-risk patients. Results. According to literature data’s we reviewed and compared risks scores used in cardiovascular surgery for determination of patients’ severity and probability of death. The basic errors of the EuroSCORE I, II scales and the possibilities of their use in minimally invasive surgery were identified. According to modern randomized clinical trials (RCTs) comparing the OPCAB (off-pump coronary artery bypass (OPCAB) and ONCAB (on-pump coronary artery bypass) techniques, there is no clear difference in complications. Despite the small percentage of high-risk patients in RCTs (18% in the CORONARY trial), many authors consider that OPCAB has a lot of advantages for high-risk patients. Better results were obtained in elderly patients with neurocognitive disorders, porcelain aorta, diabetes mellitus, kidney insufficiency and low ejection fraction of left ventricle. Kowalewski et al. studied high-risk patients and used special statistical methods to compare patients by their risk profile. They concluded that high-risk patients have linear correlation between risk profile and increase in benefits from OPCAB: all-cause mortality (P<0.01), myocardial infarction (P<0.01) and stroke (P<0.01). According to Raja, Shahzad G., total arterial revascularization with all its advantages and improvement of survival, reduction in the number of repeated revascularizations and low stroke rates can be considered as the Holy Grail in myocardial revascularization. However, larger randomized research is needed to justify this status. Followers of ONCAB technique claim that OPCAB leads to incomplete revascularization, poor quality of grafts and repeated hospitalizations and revascularization. It should be noted that high-risk patients should be operated in expert centres by the team of skilled heart surgeons, anaesthesiologists and with competent medical support of cardiologist.

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Total arterial off-pump coronary revascularization

Cited by 12 publications

References 27 publications

Re-exploration after off pump coronary artery bypass grafting: incidence, risk factors and impact of timing

Re-exploration after off pump coronary artery bypass grafting: incidence, risk factors and impact of timing

Is it better to treat bypass graft or native coronary artery following early graft failure?

Coronary Bypass Grafting for High-Risk Patients (Literature review)

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