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Ultimately, OPCAB is associated with less effective myocardial revascularization and does not entirely prevent complications traditionally associated with cardiopulmonary bypass. Mini-extracorporeal circulation MECC units were developed to reduce postoperative morbidity, transfusion requirements, and inflammation associated with conventional on-pump coronary artery bypass ONCAB surgery without the technical demands of the off-pump OPCAB technique.
We prospectively enrolled patients undergoing elective isolated coronary bypass grafting. Serial blood samples were collected to measure serum inflammatory markers. There were no operative deaths or strokes. Adjusted by Society of Thoracic Surgeons risk score and baseline level mean plasma level differences 24 hours postoperative - baseline of C-reactive protein for OPCAB Off-pump coronary artery bypass and MECC were associated with greater C-reactive protein elevation than ONCAB, suggestive of an increased inflammatory response to each of these techniques.
Kinetics of plasma heat shock protein HSP release in coronary artery surgery: Heat shock protein HSP is known as protective chaperone molecule synthetized in response following ischemia and stress agents. It is detected in the myocardium and endothelium as well as in the circulation. Damaged as well as viable but exposed to stress cells contribute to the release of HSP into the circulation.
Blood samples were taken preoperatively, twice intraoperatively, immediately after surgical procedure 1 h and hours thereafter. The concentration of plasma HSP was measured by means of immunoassay. The derived results were compared statistically with the frequency of incidence postoperative atrial fibrillation AF. In CABG group was observed continuous gradual increase of plasma HSP concentration during the operation with the peak 1 h after surgery P On pump versus off pump coronary artery bypass grafting in patients with end-stage renal disease and coronary artery disease - A nation-wide, propensity score matched database analyses.
The usage of on or off cardiopulmonary bypass in patients with coronary artery disease receiving coronary artery bypass grafting CABG surgery had been debated and had not yet been investigated thoroughly in patients with end-stage renal disease ESRD.
We aimed to study cardiovascular outcomes and total mortality in these patients by using our National Health Insurance NHI database. Baseline characteristics and underlying comorbidities were identified from the database. Propensity score PS method was used to match all the potential confounders between patients. Outcomes including mortality, myocardial infarction, stroke and repeat revascularization within 30days, 1year and whole follow-up period were also obtained.
A total of , ESRD patients were identified in the database. We included patients and patients who received off pump and on pump CABG respectively. The hazard ratios of different outcomes at 30days, 1year and a median of days after CABG did not show significant different between on, or off pump groups before and after PS match. Respiratory complications are common after cardiac surgery and the use of extracorporeal circulation is one of the main causes of lung injury. This is a retrospective, single-center study at a cardiothoracic intensive care unit ICU in a tertiary university hospital.
We also evaluated time to extubation, rates of reintubation, and use of noninvasive ventilation NIV. We used mixed-effects linear regression models with time as random effect for clustering of repeated measures adjusted for a predetermined set of covariates.
No differences were seen in Sao 2 values, time to extubation, rate of reintubation rate, and use of postoperative NIV. Current evidence of coronary artery bypass grafting off-pump versus on-pump: In the present systematic review with meta-analysis, we sought to determine the current strength of evidence for or against off-pump and on-pump coronary artery bypass grafting CABG with regard to hard clinical end-points, graft patency and cost-effectiveness.
We performed a meta-analysis of only randomized controlled trials RCT which reported at least one of the desired end-points including: A total of 16 patients from 51 studies were identified after literature search of the major databases using a predefined keyword list. While the incidence of mid-term graft failure OR: There was no difference with regard to hard clinical end-points between on- or off-pump surgery, including myocardial infarction or mortality. The present systematic review emphasizes that both off- and on-pump surgery provide excellent and comparable results in patients requiring surgical revascularization.
The choice for either strategy should take into account the individual patient profile comorbidities, life expectancy, etc. The Korean National Cohort Study. The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data.
On multivariable analysis, on-pump CABG was associated with a significantly higher adjusted risk of overall all-cause death hazard ratio [HR]: Does off-pump coronary artery bypass graft surgery have a beneficial effect on long-term mortality and morbidity compared with on-pump coronary artery bypass graft surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass grafting CABG surgery offered superior long-term outcomes compared with on-pump CABG surgery. Where potential duplicate data sets from the same institution were likely, the more credible and recently published study was included. Two hundred and fifty-six papers were found as a result of the reported search, of which 16 represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.
The 16 studies comprised 4 prospective randomized controlled trials RCTs , with the remaining 12 retrospective, of which 8 were propensity-score matched. All 4 RCTs contained fewer than participants. Two studies concluded with a survival advantage towards on-pump CABG: The remaining 14 studies all provided evidence to suggest comparable long-term survival.
In addition, all other long-term outcomes mentioned within these studies including angina recurrence, myocardial infarction heart failure, need for revascularization, stroke, graft patency, cognitive and quality of life showed similar results between the two groups. Other long-term indicators such as cardiovascular or cerebrovascular events or neuro-psychological outcomes were similar between the two groups.
Comparison of frequency of postoperative stroke in off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting versus percutaneous coronary intervention.
The stroke rate after coronary artery bypass grafting CABG compared to percutaneous coronary intervention PCI is generally considered high because cardiopulmonary bypass and aortic manipulations are often associated with cerebrovascular complications.
Median follow-up was 3. Stroke types were classified as early onset of stroke within 24 hours after revascularization , delayed within 30 days , and late after 30 days.
Occurrence of early stroke after OPCAB was lower than that after on-pump CABG, yet occurrences of delayed and late strokes were similar for the 3 revascularization strategies. Does off-pump coronary surgery reduce morbidity and mortality? To compare hospital outcomes of on-pump and off-pump coronary artery bypass surgery.
From to , primary coronary artery bypass grafting was performed in patients off pump and in patients on pump. Hospital outcomes were compared between propensity-matched pairs of on-pump and off-pump patients. In the matched pairs the mean number of bypass grafts was 2. Postoperative mortality, stroke, myocardial infarction, and reoperation for bleeding were similar in the 2 groups.
Both off- and on-pump procedures produced excellent early clinical results with low mortality. An advantage of an off-pump operation was less postoperative morbidity; however, less complete revascularization introduced uncertainty about late results. A disadvantage of on-pump bypass was higher morbidity that seemed attributable to cardiopulmonary bypass. Current randomized control trials, observational studies and meta analysis in off-pump coronary surgery.
The off-pump literature is divided into three eras: Furthermore, off-pump combined with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities. Off-pump grafting does not reduce postoperative pulmonary dysfunction. Objectives Pulmonary dysfunction is a recognized postoperative complication that may be linked to use of cardiopulmonary bypass.
The off-pump technique of coronary artery bypass aims to avoid some of the complications that may be related to cardiopulmonary bypass. In this study, we compared the influence of on-pump or off-pump coronary artery bypass on pulmonary gas exchange following routine surgery.
Methods Fifty patients mean age Conclusions Off-pump surgery is not associated with superior pulmonary gas exchange in the early postoperative period following routine coronary artery bypass grafting in patients with good left ventricular function and no preexisting lung disease. Short-term clinical outcomes after off-pump coronary artery bypass grafting at a single Veterans Affairs Medical Center.
We retrospectively assessed the outcomes after coronary revascularization at a single Veterans Affairs Medical Center when a strategy of assigning higher risk patients to off-pump coronary artery bypass grafting CABG was employed. The higher risk patients were assigned preferentially for off-pump revascularization.
There were no conversions from off-pump to on-pump surgery. A selective strategy to direct higher risk patients towards an off-pump revascularization yielded favorable outcomes in an unselected veteran population treated at a single VA Medical Center over a 5 year period. Off-pump coronary artery bypass surgery in severe left ventricular dysfunction. Our aim was to examine hospital outcomes of coronary artery bypass surgery in patients with and without left ventricular dysfunction, with regard to the surgical technique off- or on-pump.
Data of preoperative risk profiles and hospital outcomes were collected prospectively. Off-pump operations were performed in 49 The incidences of infectious, neurologic, and cardiac complications postoperatively were significantly higher in group 1.
In multivariate analysis, preoperative ejection fraction off-pump surgery in both groups had a significantly lower rate of total complications than those undergoing conventional on-pump operations, but no significant difference in mortality was observed between those undergoing off-pump or conventional surgery in either group. Off-pump surgery helped to limit the increased morbidity rate after coronary bypass in patients with ventricular dysfunction.
Current outcomes of off-pump coronary artery bypass grafting: Some surgeons, who are proponents of off-pump CABG, preferentially use this technique for the majority of operations, whereas others use it only in certain situations which warrant avoidance of CPB.
Several randomized controlled trials RCTs have been conducted that have either favored on-pump CABG or have failed to show a significant difference in outcomes between the two techniques.
However, these RCTs have been fraught with claims that they do not represent the majority of patients undergoing CABG in real world practice. Therefore, assessment of the benefits and drawbacks of each technique through observational and registry studies would be more representative of patients encountered in daily practice. The present review examines various retrospective studies and meta-analyses of observational studies that compare the early and long-term outcomes of off- and on-pump CABG, which assesses their safety and efficacy.
However, on-pump CABG provides a survival benefit in the long term according to a majority of publications in literature. A systematic review and meta-analysis. The aim of this work was to conduct a systematic review and meta-analysis of off-pump vs. To identify potential studies systematic searches were carried out using various databases. The search strategy included the key concepts of "cardiopulmonary bypass" AND "coronary artery bypass grafting" AND " off pump ".
Fifty four studies 59 intervention groups , totalling 16, participants were analysed. There was a strong trend towards a reduced incidence of stroke OR 0. Ventilation time mean difference MD Pulmonary hemodynamics and gas exchange in off pump coronary artery bypass grafting.
To investigate the influence of cardiopulmonary bypass on pulmonary hemodynamics and gas exchange. Central hemodynamics, gas exchange, and venous admixture were studied during and up to 20 h after surgery. This prospective, randomized study showed no difference in pulmonary hemodynamics, pulmonary gas exchange, and venous admixture, in low risk patients undergoing off pump compared to on pump coronary artery bypass surgery.
Off-pump supra-arterial myotomy for myocardial bridging. We report the results of surgery and midterm outcome in two patients with symptomatic myocardial bridging who underwent off-pump supra-arterial myotomy. Both patients were operated upon through a median sternotomy. The anterior wall of the heart was exposed in the same manner as in off-pump CABG. The left anterior descending coronary artery is unroofed from its myocardial bridge with the aid of a heart stabilizer and a blower. Neither heparin nor blood transfusion was required.
Both patients survived the operation and are asymptomatic. Postoperative coronary angiogram showed good resolution of the muscle bridge in one patient. We conclude that in symptomatic patients with myocardial bridging despite medical therapy, surgical myotomy can be considered an adequate therapy.
It can be safely done off-pump. Early and mid-term results of off-pump endarterectomy of the left anterior descending artery. Most reports of coronary endarterectomy describe an on-pump procedure. As off-pump coronary artery bypass graft has become safer and more routine, there is renewed interest in off-pump coronary endarterectomy.
We report on our series of patients who underwent off-pump coronary endarterectomy of the left anterior descending LAD artery using an open endarterectomy technique. A retrospective review of this database revealed 12 patients between January and June who underwent off-pump endarterectomy of the LAD as part of their coronary revascularization.
Additional data were collected from a review of the patients' charts. To determine to what extent chronic obstructive pulmonary disease COPD affects mortality and morbidity rates in patients treated with off-pump coronary artery bypass graft CABG. A total of patients treated with off-pump CABG were included in the present study.
We compared the data obtained from the patients in both groups. While preoperative spirometry values and arterial blood gas oxygen saturation levels were significantly lower, the partial values of carbon dioxide were higher in Group 1. Likewise, extubation time, the amount of drainage and blood transfusion, inotropic support, prolonged intubation, pulmonary complications, the use of bronchodilators, and steroids were statistically higher in Group 1 when compared with Group 2.
Overall, there was no marked difference between the two groups in terms of mortality incidence. Therefore, the present results indicate that the presence of COPD is not associated with in-hospital mortality or severe morbidity post-CABG by off-pump approach.
The benefit and safety of off-pump coronary artery bypass surgery in patients with unstable angina was assessed retrospectively. Assessment of cardiac autonomic regulation and ventricular repolarization after off-pump coronary artery bypass grafting. Altered autonomic regulation precipitates cardiac arrhythmias and increases the risk of sudden cardiac death.
This risk is further increased by changes in ventricular repolarization. Autonomic regulation is deranged in patients after myocardial on-pump revascularization. We aimed to clarify how off-pump coronary artery bypass grafting CABG affects postoperative cardiac autonomic regulation and ventricular repolarization within 4 weeks after CABG.
Forty-two patients mean age, The electrocardiographic and respiratory waveform recordings were performed in the afternoon in the supine position for 10 minutes. Autonomic modulation was assessed using heart rate variability analysis. Power spectra were computed from 5-minute stable RR intervals using Fourier Transform analysis.
Total power of spectra was defined in the range of 0. The high- and low-frequency power as well as their normalized values indicated cardiac vagal and sympathetic modulation, respectively. QT intervals were determined from the beginning of the 5-minute segments. QT interval variability was evaluated by a T-wave template-matching algorithm. The results were tested for significance using the Fisher exact test, nonpaired t test, and analysis of variance; a P Influence of body size on outcomes of off-pump coronary artery bypass surgery.
Our hospital demographics afford a unique opportunity to examine a group of small patients. Information was available over the past 4 years on patients who had isolated CABG and a calculable body surface area. Sixty-one patients had a body surface area of less than 1.
Patients were compared with respect to preoperative risk factors, operative procedures, and postoperative results. Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery.
Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting.
One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: Thromboelastographic tracings were analyzed before induction of anesthesia.
Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively. Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences.
The amounts of perioperative blood loss and blood transfusion required were all similar among the groups. Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.
On- or off-pump coronary artery bypass grafting for octogenarians: Coronary artery bypass grafting CABG is being increasingly offered to octogenarians. Both on- and off-pump CABG are reported as effective surgical revascularization strategies for octogenarians by single institution studies. However, the issue of superiority of one strategy over the other for octogenarians remains unresolved due to limited sample size of these studies.
A meta-analysis of studies comparing outcomes of on- and off-pump CABG in octogenarians was undertaken to address the issue. Primary outcomes of interest included in-hospital mortality and stroke.
Secondary outcomes of interest were atrial fibrillation, acute renal failure, reoperation for bleeding, deep sternal wound infection, myocardial infarction, intensive therapy unit ITU stay and hospital stay. The random effects model was used to calculate the outcomes of both binary and continuous data to control any heterogeneity between the studies.
Heterogeneity amongst the trials was determined by means of the Cochran Q value and quantified using the I 2 inconsistency test. Sixteen retrospective studies 18, on-pump patients and off-pump patients were included in the systematic review. Off-pump compared to on-pump CABG offers surgical myocardial.
Benefits of off-pump coronary artery bypass grafting in high-risk patients. Patients were divided into tertile based on their PROM. The question addressed was whether off-pump coronary artery bypass OPCAB grafting should be considered as an alternative to the conventional on-pump surgery ONCAB in patients presenting with acute coronary syndrome ACS requiring emergency revascularization. Eighty-two papers were identified by a systematic search, of which nine were judged to best answer the clinical question.
Of these, one was a randomized controlled trial and the remaining eight were retrospective observational studies. The author, journal, date, patient group, country of publication, relevant outcomes, results and study weaknesses were tabulated. The timing between the onset of ACS and operative intervention ranged from 6 to 72 h.
Six studies included patients with preoperative cardiogenic shock; however the majority of patients were haemodynamically stable at the time of surgery.
Three out of nine studies showed an improvement in day mortality with OPCAB although the remaining six reveal no significant mortality benefit. No difference in long-term mortality was observed between the two techniques. OPCAB was associated with significantly fewer grafts per patient six studies and less complete revascularization two studies.
We conclude that whilst OPCAB may have a beneficial effect on day mortality in haemodynamically stable patients undergoing emergency revascularization, there is a lack of high-quality data with clearly defined patient demographics. In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device. We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy CS implantation strategy.
Further large collaborative studies are needed to identify advantages of the MILT approach. Off-pump myocardial revascularisation in an octogenarian patient with dextrocardia and situs inversus. Dextrocardia associated with situs inversus totalis is a rare condition and there are few reports of myocardial revascularisation in such patients. An year-old woman with dextrocardia and situs inversus totalis underwent successful off-pump coronary artery bypass grafting using internal mammary arteries.
The operative technique was similar to that of off-pump coronary artery bypass grafting for situs solitus. However, for a right-handed surgeon the operation was easier standing on the left side of the patient. The feasibility and safety of off-pump coronary bypass surgery in emergency revascularization. Background The efficacy and safety of off-pump coronary artery bypass grafting OPCAB in emergency revascularization remains controversial despite its widespread use.
The aim of our study was to examine the applicability and safety of OPCAB in patients who were indicated for emergency surgery. Methods This single-center study reviewed the indication, operative data, and early and long-term outcomes of patients mean age, Only five patients 4. The year outcomes were also acceptable survival, The multivariate risk factors for late mortality were peripheral vascular disease HR 2.
When patients were separated by whether the procedure was performed early Off-pump repair of a post-infarct ventricular septal defect: We report a novel off-pump technique for the surgical closure of post-infarct ventricular septal defects VSDs. The case report describes the peri-operative management of a 76 year old lady who underwent the 'Hamburger procedure' for closure of her apical VSD. Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated.
We show that echocardiography guided off-pump posterior-anterior septal plication is a safe, effective method for closing post-infarct VSDs in unstable patients. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs. We describe the use of right pleurotomy combined with right pericardial release during off-pump coronary surgery.
The maneuver releases the compression exerted on the right cardiac chambers during cardiac verticalization and improves hemodynamic stability during exposure of the posterior or lateral coronary vessels. Target vessel detection by epicardial ultrasound in off-pump coronary bypass surgery. The detection of embedded coronary arteries is difficult especially in off-pump coronary bypass surgery.
From June , we introduced high-frequency epicardial ultrasound ECUS to assess and evaluate embedded arteries during off-pump coronary bypass surgery. Between June and June , a total of 89 consecutive patients underwent isolated coronary bypass surgery at our institution. The patients consisted of 72 men and 17 women with a mean age of We analyzed the impact of introducing the ECUS in terms of operative outcome.
All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during surgery. The total number of distal anastomoses was , and 12 target vessels could not be identified either visually or on palpation.
Thus, the frequency of the embedded coronary arteries was 4. The preoperative profiles of the two groups were not significantly different. There were no significant differences in postoperative outcome between the two groups. In the present study, in which the target coronary arteries could not be detected either visually or on palpation in 12 4.
High-frequency ECUS is therefore useful in off-pump coronary bypass surgery. To investigate the results of off-pump coronary artery grafting OPCAB with the proximal suture device PSD regarding postoperative stroke and graft patency.
The PSD was used in patients The hospital mortality rate was 1. The incidences of stroke at one month were: The rates of complete revascularisation were higher in the PSD and clamp groups It led to lower incidences of postoperative stroke and excellent rates of graft patency and complete revascularisation compared with conventional CABG. Published by Elsevier B. The off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: Especially in patients with a high number of comorbidities, redo coronary artery bypass grafting CABG remains a difficult entity of CABG, because patients are likely to have multiple risk factors and often have diseased patent grafts with adhesions.
By one-to-one PS matching, we selected pairs from each group. There was no significant difference in the mean number of distal anastomoses after matching 2. The off-pump technique reduced. A comparison of hybrid coronary revascularization and off-pump coronary revascularization. Minimally invasive approaches to treat vascular disease have been accruing significant popularity over the last several decades.
Due to progressive advances in technology, a variety of techniques are being now utilized in the field of cardiovascular surgery. The objectives of minimally invasive techniques are to curtail operative trauma and minimize perioperative morbidity without decreasing the quality of the treatment. The standard surgical approach for the treatment of coronary artery disease has traditionally been coronary artery bypass grafting surgery via median sternotomy.
Off-pump coronary artery bypass grafting surgery offers a less invasive alternative and enables coronary revascularization to be performed without cardiopulmonary bypass.
Hybrid coronary revascularization offers an even less invasive option in which minimally invasive direct coronary artery bypass can be combined with percutaneous coronary intervention. In this article, the authors review a recent publication comparing hybrid coronary revascularization and off-pump coronary artery bypass grafting surgery.
Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting. With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing.
The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described.
Right atrium positioning for exposure of right pulmonary veins during off-pump atrial fibrillation ablation. Concomitant surgical ablation of atrial fibrillation AF is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable haemodynamic conditions is crucial for proper completion of the ablation procedure.
This study evaluates the safety and feasibility of right atrial positioning using a suction-based cardiac positioner as opposed to compressive manoeuvres for exposure during off-pump surgical ablation for AF. Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins.
Safety and feasibility end points were analysed intraoperatively and in the early postoperative course. In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of ganglionated plexi and conduction block assessment.
In all patients, this entire right-sided ablation procedure was completed with a single exposure manoeuvre. Feasibility end points were achieved in all study patients. This report documents the safety and feasibility of right atrial exposure using a suction-based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable haemodynamic conditions and optimal visualization of the right pulmonary veins.
Brain function monitoring during off-pump cardiac surgery: Background Early postoperative stroke is an adverse syndrome after coronary bypass surgery. This report focuses on overcoming of cerebral ischemia as a result of haemodynamic instability during heart enucleation in off-pump procedure. Case presentation A 67 year old male patient, Caucasian race, with a body mass index of 28, had a recent non-Q posterolateral myocardial infarction one month before and recurrent instable angina.
His past history includes an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, epiaortic vessel stenosis. The patient was scheduled for an off-pump procedure and monitored with bilateral somatosensory evoked potentials, whose alteration signalled the decrement of the cardiac index during operation. The somatosensory evoked potentials appeared when the blood pressure was increased with a pharmacological treatment.
Conclusion During the off-pump coronary bypass surgery, a lower cardiac index, predisposes patients, with multiple stroke risk factors, to a reduction of the cerebral blood flow. Intraoperative somatosensory evoked potentials monitoring provides informations about the functional status of somatosensory cortex to reverse effects of brain ischemia.
This study aimed to evaluate the short- and long-term effects of conventional on-pump coronary bypass grafting cCABG compared with off-pump coronary artery bypass OPCAB on renal function. A retrospective review of patients undergoing coronary bypass grafting from through at a single center was conducted. Preoperative renal function, perioperative acute kidney injury, and long-term glomerular filtration were evaluated.
Multivariable analyses were used to determine factors contributing to short- and long-term renal impairment. Patients undergoing OPCAB were significantly older, had greater preoperative renal dysfunction, had greater functional dependence, and took more hypertension medications.
We sought to report our recent experience with off-pump coronary artery revascularization in multivessel disease. This cohort of patients was compared with patients operated on with cardiopulmonary bypass from to Mean age, sex distribution, and preoperative risk factors were comparable for the two groups.
Coronary anastomoses were achieved with myocardial mechanical stabilization and heart "verticalization. Off-pump compared to minimal extracorporeal circulation surgery in coronary artery bypass grafting.
However, alternative techniques have been developed to avoid ECC and its potential adverse effects. Of these, patients had been operated with MECC and off-pump. The primary endpoint was Troponin T level as an indicator for myocardial damage.
Study groups were not significantly different in general. Cardiopulmonary bypass usage provokes a systemic inflammatory response resulting in deterioration of renal function.
However, risk factors for requiring renal replacement therapy RRT following off-pump coronary artery bypass graft surgery CABG have not yet been fully elucidated. We reviewed consecutive patients undergoing elective off-pump CABG at our institution, excluding patients on chronic hemodialysis preoperatively. Sub-analysis of patients with preserved renal function, defined as a creatinine level below a cut-off value of 1. Of the patients, 41 5. There were patients In patients with preserved renal function, hypoalbuminemia was most significantly related to the RRT requirement.
Transapical aortic valve implantation and minimally invasive off-pump bypass surgery. Transcatheter aortic valve implantation TAVI has gained increasing popularity for high-risk patients with symptomatic aortic valve stenosis.
A concomitant coronary artery disease leads to a complicated management and an increased perioperative risk.
This case report describes the successful total arterial coronary revascularization of the left anterior descending and the left marginal branch of the circumflex artery utilizing the left internal mammary artery LIMA and left radial artery in off-pump technique in combination with the transapical transcatheter aortic valve implantation via minimally invasive anterolateral access in the fifth intercostal space.
Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: Meta-analyses from observational and randomized studies have demonstrated benefits of off-pump surgery for hard and surrogate endpoints. In some of them, increased re-revascularization was noted in the off-pump groups, which could impact their long-term survival. Therefore, we analyzed the course of all patients undergoing isolated coronary surgery regarding the major cardiac and cerebrovascular event MACCE criteria.
Propensity Score Matching was performed based on 28 preoperative risk variables. Both off-pump clampless techniques were associated with lower in-hospital mortality compared with conventional CABG. Presentation of a quality management program in off-pump coronary bypass surgery.
To increase the number of off-pump coronary procedures at our institution, a new surgical team was formed. The first 3 years of "learning period" were accompanied by a quality management program aimed to control and adjust the surgical process and to ensure the safety and quality of the procedure. All patients were operated on by the same surgeon between January and December ; all procedures were performed under the following quality management protocol.
First, a flow chart regulated surgical and anesthetic details. Second, an online file, named "disturbance file," was used to report work flow interruption, disturbance, and intraoperative events, that is, myocardial ischemia, hypotension, conversion to cardiopulmonary bypass, and any violation of the protocol. Each event was coded with 1 point and added to a score the higher the score is, the greater the disturbance.
Outcome parameters known as major events-major cardiac and cerebral events: Success was defined as freedom from any of those events and depicted in a cumulative sum control CUSUM chart. In total, off-pump coronary bypass operations were performed by the named surgeon during the study period. The day mortality was reduced from 4. Disturbance Index score of greater than 1 declined from All major cardiac and cerebral events declined. The CUSUM chart showed two critical periods during the learning period, which made an adjustment of the protocol necessary.
Quality management control is efficient in improving the postoperative results of a surgical procedure. A learning period is of cardinal importance for any new team wishing to engage.
Off-pump coronary bypass surgery adversely affects alveolar gas exchange. While the introduction of off-pump myocardial revascularization OPCAB has initially shown promise in reducing respiratory complications inherent to conventional coronary surgery, it has failed to eradicate them. Our study focused on quantifying the lactate release from the lungs and the dysfunction at the level of the alveolar-capillary membrane precipitated by OPCAB at different time points after the insult.
Furthermore, we aimed to determine the impact of pulmonary lactate production on systemic lactic acid concentrations. The study was conducted in a prospective observational fashion. The alveolar-arterial O2 gradient increased from 19 [range 9 to 30] to 26 [range 20 to 34] kPa P off pump myocardial revascularization was evidenced by a prompt increase in the alveolar-arterial oxygen gradient. The alveolar-arterial O2 gradient correlated with the duration of mechanical ventilation.
The importance of intraoperative selenium blood levels on organ dysfunction in patients undergoing off-pump cardiac surgery: Cardiac surgery is accompanied by an increase of oxidative stress, a significantly reduced antioxidant AOX capacity, postoperative inflammation, all of which may promote the development of organ dysfunction and an increase in mortality.
Selenium is an essential co-factor of various antioxidant enzymes. We hypothesized a less pronounced decrease of circulating selenium levels in patients undergoing off-pump coronary artery bypass OPCAB surgery due to less intraoperative oxidative stress. In this prospective randomised, interventional trial, 40 patients scheduled for elective coronary artery bypass grafting were randomly assigned to undergo either on-pump or OPCAB-surgery, if both techniques were feasible for the single patient.
Clinical data, myocardial damage assessed by myocard specific creatine kinase isoenzyme CK-MB , circulating whole blood levels of selenium, oxidative stress assessed by asymmetric dimethylarginine ADMA levels, antioxidant capacity determined by glutathionperoxidase GPx levels and perioperative inflammation represented by interleukin-6 IL-6 levels were measured at predefined perioperative time points.
At end of surgery, both groups showed a comparable decrease of circulating selenium concentrations. Likewise, levels of oxidative stress and IL-6 were comparable in both groups. Selenium levels correlated with antioxidant capacity GPx: Low postoperative selenium levels are predictive for the development of complications. Off-pump coronary artery bypass grafting.
The 1st Medical Faculty of Charles University study. To explore the surgical technique, anaesthesiological management, immediate and mid-term results, graft patency and effectiveness of less invasive coronary artery bypass grafting through a median sternotomy. From January through December , patients had coronary artery bypass grafting CABG without cardiopulmonary bypass CPB done by one surgeon through a median sternotomy. The cohort of men and 37 women averaged An average of 2.
In a random subgroup of patients 50 per group an angiographic control of graft patency was done. A non-CPB group showed less postoperative acute myocardial infarction 0.
We did not find an inordinate number of vein grafts occlusions 0. None of the arterial grafts in both groups were occluded. There was little known about the efficacy of the less invasive coronary artery bypass grafting at the beginning of our study. Starting with pioneering the operative technique, we have discovered and proposed three types of a heart verticalization and a reusable stabilizing device. We detected lower incidence of postoperative complications and decreased operative mortality in a non-CPB group.
Angiographic assessment displayed an excellent run-off in both groups of patients. The discontinuation of mechanical ventilation after coronary surgery may prolong and significantly increase the load on intensive care unit personnel.
The primary endpoint of our study was to assess the duration of postoperative mechanical ventilation during different modes of weaning from respiratory support RS after OPCAB. The secondary endpoint was to assess safety of the automated weaning mode and the number of manual interventions to the ventilator settings during the weaning process in comparison with the protocolized weaning mode. Patients were randomized into two groups: We assessed the duration of postoperative ventilation, incidence and duration of unacceptable RS, and the load on medical staff.
Realization of the automated weaning protocol required change in respiratory settings in 2 patients vs. Both incidence and duration of unacceptable RS were reduced significantly by means of the automated weaning approach. The FiO 2 during spontaneous breathing trials was significantly lower in the automated weaning group: Sixty patients who underwent surgery between February and August were randomized into 2 groups.
The time to extubation, chest tube drainage volume, postoperative white blood cell counts, amount of blood transfusion, sedimentation rate, C-reactive protein concentration, postoperative temperature, and the presence of atelectasis were recorded in the intensive care unit.
To develop and validate a real-time mitral valve annulus MVA tracking approach based on biplane transesophageal echocardiogram TEE data and magnetic tracking systems MTS to be used in minimally invasive off-pump beating heart mitral valve repair MVR. The authors' guidance system consists of three major components: TEE, magnetic tracking system, and an image guidance software platform.
TEE provides real-time intraoperative images to show the cardiac motion and intracardiac surgical tools. The magnetic tracking system tracks the TEE probe and the surgical tools. The software platform integrates the TEE image planes and the virtual model of the tools and the MVA model on the screen.
The image based gating step uses a small patch centered at each MVA point in the TEE images to identify images at optimal cardiac phases for updating the position of the MVA.
The predictive reinitialization step uses the position and orientation of the TEE probe provided by the magnetic tracking system to predict the position of the MVA points in the TEE images and uses them for the initialization of the registration component.
The registration based MVA tracking step aims to locate the MVA points in the images selected by the image based gating component by performing image based registration. The validation of the MVA tracking approach was performed in a phantom study and a retrospective study on porcine data.
In the phantom study, controlled translations were applied to the phantom and the tracked MVA was compared to its "true" position estimated based on a magnetic sensor attached to the phantom.
The MVA tracking accuracy was 1. In the study on. We sought to examine the relationship between preoperative platelet function and perioperative bleeding in patients undergoing CABG. There are many ways to measure platelet aggregability.
Little is known about their correlations with one another, or with bleeding. We prospectively studied 50 patients undergoing a first isolated off-pump CABG.
Thirty-four were exposed to a thienopyridine prior to surgery; 16 were not. Bleeding was assessed 2 ways: Correlation coefficients were calculated using Spearman's rank-order correlation. Mean age was 62 years. Patient characteristics and surgical details were similar between the thienopyridine-exposed and non-exposed patients.
The correlation coefficients between the 4 point-of-care platelet function measurements and hematocrit change ranged from The correlation coefficients between each of the 4 point-of-care platelet function tests and the chest tube drainage were also poor, ranging from The correlation among the 4 point-of-care platelet function measurements was poor, with coefficients ranging from We observed little correlation among 4 platelet function tests, and between those assays and perioperative bleeding defined 2 different ways.
Whether any of these assays should be used to guide decision making in individual patients is unclear. Reduced mortality in high-risk coronary patients operated off pump with preoperative intraaortic balloon counterpulsation. Preoperative intraaortic balloon pump IABP counterpulsation has better outcomes compared with perioperative or postoperative insertion in critical patients, and off-pump surgical procedures have been advocated to reduce mortality in high-risk patients.
However, some surgeons are reluctant to perform beating heart operations in specific patient subgroups, including those with unstable angina or patients with low ejection fraction, because of their possible perioperative hemodynamic instability.
IABP was inserted immediately before operation in group 1 and the day before the procedure in group 2. Group I predicted mortality was No specific complications from the use of IABP were encountered. During mid-term 2 years follow-up, no patient died from a cardiac cause or required percutaneous coronary intervention or subsequent reoperation due to incomplete revascularization.
The combined use of preoperative intraaortic counterpulsation and beating heart intervention allows complete revascularization in high-risk patients with a important reduction in operative mortality and excellent mid-term results. Results of completion arteriography after minimally invasive off-pump coronary artery bypass. The benefits of a minimally invasive approach to off-pump coronary artery bypass remain controversial.
The value of completion arteriography in validating this technique has not been investigated. From April to October , fifty-six patients underwent isolated minimally invasive coronary artery bypass grafting through a left thoracotomy without cardiopulmonary bypass.
Forty-three of these patients underwent completion arteriography. Sixty-five grafts were performed in these 56 patients, average, 1. Forty-eight grafts were studied in the 43 patients undergoing completion arteriography. There were 4 findings on arteriogram leading to further immediate intervention 8.
These included 3 grafts with anastomotic stenoses or spasm requiring stent placement, and 1 patient who had limited dissection in the left internal mammary artery graft and underwent placement of an additional vein graft.
These findings were independent of electrocardiographic changes or hemodynamic instability. The remainder of the studies showed no significant abnormalities. There were no deaths. One patient who did not have a completion arteriogram suffered a postoperative myocardial infarction requiring stent placement for anastomotic stenosis.
Patients were discharged home an average of 6. There were no instances of renal dysfunction postoperatively attributable to catheterization. Minimally invasive coronary artery bypass is safe and effective. Findings of completion arteriography occasionally reveal previously under-recognized findings that, if corrected in a timely fashion, could potentially impact graft patency and clinical outcomes.
Our experience validates this minimally invasive technique. Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy. Exclusion criteria included patients with an ejection fraction of 0. There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention.
Eight patients in each group required blood transfusion, with the average transfusion being 1. The mean duration of ventilation and intensive care unit stay was 5. Training models are essential in mastering the skills required for off-pump coronary artery bypass grafting OPCAB. We describe a new, high-fidelity, effective and reproducible beating-heart OPCAB training model in human cadavers.
Human cadavers were embalmed according to the 'Thiel method' which allows their long-term and repeated use. Research the benefits of hemp as a supplement in your quest to live a healthy life? Add it to your regimen today! All schoolbooks were made from hemp or flax paper until the s.
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