Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort

Pandey, R. K.; Grayson, Antony D.; Pullan, D. Mark; Fabri, Brian M.; Dihmis, Walid C.

doi:10.1016/j.ejcts.2004.10.049

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…Therefore, avoiding the use of CPB and its adverse physiological impact in the short‐term together with the long‐term beneficial effects of total arterial revascularization appears as a logical association. This association has been reported with good results 20,21 . Because of the technical challenge and the concern about the quality of anastomosis raised by both techniques, their introduction in our setting was performed in a stepwise manner.…”

Section: Discussionmentioning

confidence: 71%

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Introduction of an OPCAB Program Aimed at Total Arterial Grafting in a Multidisciplinary Setting: Feasible and Safe?

et al. 2007

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Section: Discussionmentioning

confidence: 71%

“…This association has been reported with good results. 20,21 Because of the technical challenge and the concern about the quality of anastomosis raised by both techniques, their introduction in our setting was performed in a stepwise manner. At present, we do not have a long-term follow-up to ascertain the long-term patency of the grafts.…”

Section: Discussionmentioning

confidence: 99%

Introduction of an OPCAB Program Aimed at Total Arterial Grafting in a Multidisciplinary Setting: Feasible and Safe?

et al. 2007

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“…Increasing experience with this technique is being published with encouraging results. [23][24][25][26][27][28] Avoiding the use of CPB and its adverse physiological consequences in the short-term together with the potential long-term beneficial effects of total arterial revascularization seems to be an ideal myocardial revascularization strategy.…”

Section: Discussionmentioning

confidence: 99%

Impact of Off-Pump Coronary Artery Bypass Surgery on Graft Patency: Current Best Available Evidence

Raja

Dreyfus

2007

J Cardiac Surgery

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For more than three decades cardiac surgeons have been used to perform delicate coronary anastomoses on cardiopulmonary bypass (CPB). However, the price of a still and bloodless field is ultimately paid by the patients in the form of sequelae of negative effects of CPB including blood trauma, activation of a series of inflammatory responses, nonpulsatile flow, and possible embolization of air or debris. In an attempt to avoid these deleterious effects of CPB, off-pump coronary artery bypass surgery (OPCAB) has been rediscovered and refined. Although abundant evidence is available to suggest that excellent results can be achieved when CPB is avoided, concerns have been raised about quality of anastomosis and graft patency rates after OPCAB surgery. We are currently practicing in an era of evidence-based medicine that mandates the prospective randomized controlled trial (RCT) as the most accurate tool for determining a treatment benefit compared with a control population. This review article attempts to evaluate the current best available evidence from RCTs on the impact of OPCAB surgery on graft patency.

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“…In zahlreichen vergleichenden Studien konnte nachgewiesen werden, dass bei Verzicht auf die EKZ die proinflammatorischen Zytokine Tumor-Nekrose-Faktor-(TNF-)α, Interleukin-(IL-)2 und IL-6 signifikant geringer freigesetzt wurden [14], die Komplementaktivierung reduziert [30] und das Gerinnungssystem weniger aktiviert waren [44] sowie eine geringere Expression des Reparaturproteins HSP-(Hitzeschockprotein-)70 erfolgte [18]. Die EKZ führt zu einer Aktivierung neutrophiler Granulozyten und Thrombozyten sowie zahlreicher Proteinkaskaden (extrinsische und intrinsische Gerinnung, Komplementsystem, Kontaktaktivierung, Fibrinolysesystem).…”

Section: Vorteile Der Opcab-chirurgieunclassified

“…Zusammenfassend fand sich in allen Studien einheitlich eine signifikante Kostenreduktion bei Anwendung der OPCAB-Chirurgie, die zwischen 15% und 79% betrug [33,43,44,49,63]. Dabei kann der Kostenunterschied zwischen dem HLM-und dem OPCAB-Equipment je nach den verwendeten Materialen sehr variieren und muss heute allenfalls als marginal angesehen werden.…”

Section: Intensivstations-und Krankenhausaufenthalt Sowieunclassified

Off-Pump-Koronarrevaskularisation

Rastan

Walther

Falk

et al. 2006

Herz

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Adverse clinical consequences associated with conventional coronary artery bypass surgery (CCAB) have largely been attributed to cardiopulmonary bypass circuit (CPB), hypothermic cardiac arrest, aortic cannulation, and cross-clamping. Consequently, there has been a growing interest in safer alternatives to CCAB including off-pump beating-heart bypass surgery (OPCAB). Initial concerns regarding completeness of revascularization at the lateral wall were addressed by using modern stabilizers and heart positioning devices. First studies tended to be nonrandomized clinical reports rather than controlled clinical trials with the potential risk of unbalanced baseline characteristics leading to biases in favor of OPCAB. Since these early reports, several randomized trials including mixed-risk patient populations have been completed. Most of them failed to reveal superiority of OPCAB concerning mortality and major perioperative morbidity due to statistically underpowered design to detect clinically important but infrequent adverse outcome events. Likewise, in most of the recently published meta-analyses of randomized trials no difference in early mortality, myocardial infarction or stroke rate was found, but OPCAB was superior regarding blood loss, transfusion requirement, rethoracotomy, ventilation time, ICU (intensive care unit) and hospital stay and resource utilization as illustrated in Table 1. Most of the large observational studies comparing OPCAB and CCAB strategies demonstrated a benefit of OPCAB concerning early mortality, myocardial infarction and stroke rate as summarized in Table 2. However, in few published follow-up studies no significant differences concerning recurrence of angina, reintervention rate und late mortality were found. The decision between OPCAB and CCAB has to weigh several factors, including the likely risks and benefits of the two approaches for the particular patient, the experience of the surgeon, the complexity of the coronary disease, and the required coronary revascularization.

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Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort

Abstract: Off-pump coronary surgery with complete arterial revascularisation can significantly reduce in-hospital morbidity and lengths of stay compared to conventional on-pump coronary surgery.

Cited by 13 publications

References 23 publications

Introduction of an OPCAB Program Aimed at Total Arterial Grafting in a Multidisciplinary Setting: Feasible and Safe?

Introduction of an OPCAB Program Aimed at Total Arterial Grafting in a Multidisciplinary Setting: Feasible and Safe?

Impact of Off-Pump Coronary Artery Bypass Surgery on Graft Patency: Current Best Available Evidence

Off-Pump-Koronarrevaskularisation

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