Is off-pump CABG really a better substitute for on-pump CABG in all cases of coronary artery disease? (original) (raw)
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Cardiovascular Outcomes in High-Risk Patients Undergoing OPCAB Surgery Compared to Traditional CABG
Jurnal Kedokteran Brawijaya, 2021
The benefit of coronary artery bypass graft (CABG) for coronary artery disease (CAD) with Ejection Fraction (EF) 30% and ischemic burden (IB) 10% is still debatable. The objective of this study is to analyze mortality and morbidity in patients with EF 30% and ischemic burden 10% undergoing OPCAB compared to traditional CABG (TCABG). The retrospective analytic cohort study was performed using data from January 2015–November 2018 at National Cardiovascular Center Harapan Kita Jakarta, Indonesia. 109 patients were included. 35 patients undergoing OPCAB and 74 patients undergoing TCABG. The primary outcomes were mortality rate, morbidity rate, and length of stay. Arrhythmia is statistically lower in OPCAB compared to TCABG (8.6% vs 39.2%; p=0.001). Kidney injury is statistically lower in OPCAB (8.6% vs 27.0 %; p=0.027). Stroke is statistically lower in OPCAB (1.0 % vs 17.6%; p=0,032). There is no significant difference between OPCAB and TCABG in mortality, 5.7% vs 16.2%, (RR=3.20; CI 9...
Journal of Cardiothoracic Surgery, 2013
Background: Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CBP) is associated with significant morbidity and mortality. In high-risk patients, doomed for reoperation the adverse effects of CBP may be more striking. We evaluated the results of reoperative CABG (redo-CABG) by either off-pump (OPCAB) or on-pump (ONCAB). Clinical endpoints were perioperative myocardial infarction, mortality, survival and as the most striking difference between prior studies the quality of life (QoL). Methods: We performed a prospective, non-randomized assessment for patients who underwent redo-CABG by redo-OPCAB (n = 40) or redo-ONCAB (n = 40) at our institution between January 2007 and December 2010. For evaluation of QoL the SF-36 health survey was used with self-administered assessment. Results: During follow-up 37 of 40 patients were alive in the redo-OPCAB group versus 32 of 40 patients in the redo-ONCAB group (p < 0.05). The shorter operation time, less blood loss, fewer perioperative myocardial infarctions, the higher rate of totally arterial revascularisation and shorter intensive care stay were the significantly beneficial differences for patients in the redo-OPCAB group (p < 0.05). The 3-year survival rate was higher in the redo-OPCAB group with 81 ± 12% versus 63 ± 9%in the redo-ONCAB group. The quality of life survey did not reveal any significant differences between both groups. Conclusion: In conclusion, with our present retrospective study, we could demonstrate the safety and efficacy of the redo-OPCAB technique with even higher 3-year survival rate. Both techniques seem to have similar impact on the outcome of patients.
Off-Pump CABG for Mulitvessel Coronary Artery Disease-Safe Incorporation into Surgical Practice
Open Journal of Thoracic Surgery, 2012
Introduction: Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We report a single surgeon, single center experience of the first 37 consecutive patients undergoing off-pump surgery. Patients were selected for OPCAB (study group) individually and matched retrospectively to a control group of 113 patients performed over an identical time frame. Data were retrieved from a hospital data base (TOMCAT). Results: Mean Logistic European System of Cardiac Operative Risk Stratification (EuroSCORE) was slightly higher in the off-pump group (3.8% versus 2.9%). One patient died during the study and this was in the off-pump CAB group (OPCAB-30 day mortality 2.7%). Operating time was slightly shorter in the off-pump group (3 hours 28 minutes versus 3 hours 49 minutes, p = 0.15). After exclusion of outliers, total hospital stay was significantly shorter for off-pump cases (mean 6.8 days versus 8.37 days), while Intensive Care Unit (ICU) stay (1.2 versus 1.4 days) and ventilation time were only slightly shorter (9.35 hours versus 10.6 hours) for off-pump cases. Chest tube drainage was significantly lower in the off-pump group (484 ml versus 744 ml, p = 0.04) with correspondingly slightly lower transfusion requirements and significantly increased discharge haemoglobin concentrations in OPCAB. There was one cerebrovascular accident (CVA) in the off-pump group and none in the on-pump group. Conclusion: In this study we show short term outcomes for introduction of off-pump into surgical technique. Length of ICU stay, ventilation times, chest tube drainage, transfusion requirements and pre-discharge haemoglobin concentration all appeared superior in the off pump group. The off-pump technique was safely introduced into the surgeon's service with relatively little mortality. Experience of surgeon was considered advantageous for fast adaption of the technique. However, numbers were too small to make strong inferences. With practice more patients should benefit from the technique.
Pakistan Journal of Medical and Health Sciences, 2021
Objective: The aim of this study is to compare in hospital morbidity and mortality in on pump versus off pump CABG. Methodology: All the patients undergoing CABG surgery were enrolled after taking informed consent. Demographic and postoperative variables were entered in the predesigned questionnaire and patients were followed for early outcomes after surgical procedure. Results: A total of 470 patients wasdivided in two groups 235 (on pump and off pump).The mean age of patients was 54.85 ± 9.57 (23-85).There were 400(85.1%) males and 70(14.9%) females. The total data of 470 patients was divided in two groups 235 in on Pump and 235 in off pump CABG.The mean age of patients was 54.85 ± 9.57 (23-85). There were 400(85.1%) males and 70(14.9%) females. Different clinical outcomes were compared in both groups (On-Pump versus Off-Pump CABG) by using Euro Score, we found Peripheral Disease in On-Pump CABG group compared with Off-Pump CABG as 11(4.68% vs 12(5.11%) with p-value=0.831 which was statistically insignificant, current data assessed lung disease in both groups as 11(4.68%) vs 13(5.53%) with statistically insignificant p-value (0.675). and unstable angina were 12(5.11%, p-value 1.00) patients founded and Peri and post myocardial infarction also assessed in both groups with p-value (0.74 & 1.20). respectively.Data regarding in hospital mortality was analyzed and found that 7(2.98%) in on pump group compare with off pump group was According to our research mean number of grafts placed in On-Pump CABG were 9(3.83%) with statistically insignificant p-value (0.611). Conclusion:Proof is presented that surgery on beating heart (Off-Pump) is as safe and effective as Conventional CABG, and cheaper than conventional surgery. However, it is uncertain whether the cost savings are sustained over a longer period of time.
Does off-pump coronary artery bypass surgery reduce morbidity and mortality in high-risk patients?
European Surgery, 2004
Background: The aim of this retrospective study was to compare outcome in two groups of patients who were classified according to their risk groups and underwent coronary revascularization with or without cardiopulmonary bypass. Material and Methods: Between January 1996 and July 2000, 480 cases that underwent coronary artery bypass surgery (CABG) were included in a retrospective nonrandomized manner for study. Group 1 included 210 patients who were revascularized using off-pump techniques. Octopus 2 and 3 (Medtronic, Inc., Minneapolis, MN) were used for tissue stabilization. Group 2 included 270 cases who underwent CABG using CPB. Emergency cases, combined operations, reoperations, and patients in cardiogenic shock were excluded. Demographic variables were comparable between two the groups. Using the Allegheny Clinic Risk Scoring Scale [Magovern 1996], patients in both groups were scored as low, moderate, and high risk. In Group 1, 37 % of patients consisted of high risk patients while Group 2 had 14% (p < 0.05). Student's t-test and chi-square test were used for statistical analysis and alfa < 0.05 was considered significant. Results: Mortality was 1.4% in Group 1 and 1.5% in Group 2 (p = ns). Mean anastomosis per patient was 2.6 ± 0.6 in Group 1 and 3.2 ± 0.5 in Group 2 (p < 0.05). Patients in Group 1 needed less blood transfusions and less inotropic support postoperatively (p < 0.05). There were also fewer minor neurological events (p < 0.05) and pulmonary complications (Type 2) in Group 1. Atrial fibrillation rate, infection, and major neurological deficit (Type 1) were similar in both groups. Mortality was less among Group 1 high risk patients (3.9 %) in comparison to Group 2 high risk patients (7.9 %), but this did not reach statistical significance. Conclusions: In low or moderate risk patients, CABG can be performed safely with or without CPB. In high risk
Early Outcomes of On-Pump versus Off-Pump CABG
Interventional Cardiology, 2021
Background: A post-surgical complication after on-pump and off-pump Coronary Artery Bypass Grafting (CABG) is a controversial issue among different cardiac surgeons to re-vascularize ischemic myocardia. Objective: The aim of this study is comparing early outcome after on-pump and off-pump CABG. Methods: This is a randomized clinical trial in ischemic heart disease patients who divided into 2 groups according to surgical method. Early outcomes for 30 days are evaluated in 104 patient undergone on-pump and off-pump CABG. SPSS analysis is used to compare incidence of stroke, infection, exploration surgery, myocardial infarction, renal failure, rate of survival and so on between two groups. Result: Among 104 patients who underwent CABG, 36 patients were treated by on-pump surgery and 68 patients by off-pump surgery. Homogeneity for demographic characteristics and risk factors are observed between two groups. Among 30 days, after surgery EF (p: 0.735), stroke (p: 0. 465), infection (p: 0...
Does off-pump coronary artery bypass grafting attenuate renal damage compared to on-pump CABG?
Indian Journal of Thoracic and Cardiovascular Surgery, 2006
Background: There is a concern to compare On-and Off-Pump coronary artery bypass grafting (CABG) regarding the benefits to the patient. The cardiopulmonary bypass (CPB) affects the left and the right ventricular functions. Is this the same with Off-Pump coronary artery bypass (OPCAB)? Patients and methods: Between January 2012 and December 2014, we revised 400 patients; 200 received on-pump CABG and 200 off-pump CABG (OPCAB). We included patients with ejection fraction (EF) of 35% or lower. The patients were followed up by preoperative echocardiography, intra-operative trans-esophageal echocardiography (TEE) and post-operative echocardiography: one week, 1 month, 3 months, 6 months, 1 year and 2 years after the CABG. The obtained results were compared statistically. We referred to the on-pump as group A and the off-pump as group B. Results: The operative and postoperative data showed significant statistical differences between both groups; better in group B regarding the length of the operation, the intra-operative use of inotropic support, the use of intra-aortic balloon pump (IABP) intraand post-operatively, the peri-operative myocardial infarction (MI), the post operative atrial fibrillation (AF), wound dehiscence, sternal wound infection, the incidence of strokes, renal impairment, chest infection and peripheral ischemia. The ICU stay and total hospital stay were longer in group A. The in-hospital mortality was more in group A. The LV function was more impaired in group A only in the first 3 months. Conclusion: The complications of the on-pump CABG were more than the OPCAB. Accordingly, we recommend the OPCAB technique especially in patients with ischemic cardiomyopathy (ICM).
Coronary angioplasty versus CABG: review of randomized trials
Arquivos brasileiros de cardiologia, 2011
We carried out a review that included results of randomized trials that made a comparison between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The 25 selected trials involved 12,305 patients, 11,103 of whom were from studies in patients with multi-vessel disease and 1,212 were from studies in patients with single lesion of the left anterior descending (LAD). In the studies of multi-vessel disease patients, the PCI showed a trend towards lower early mortality (1.2% versus 2%) and lower incidence of stroke: 0.7% versus 1.65%. There was no difference in the intermediate mortality (3.8% versus 3.8%). There was a trend towards the superiority of CABG in late mortality (10.5% versus 9.6%). The difference was exclusively due to "balloon era" studies, with a trend towards an inversion in the "stent era" (9.6% versus 9.9%). In studies of single lesion of LAD, there was no…
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2010
Objectives: Transmyocardial revascularization (TMR) has been used as an isolated or adjunctive revascularization therapy in patients presumed to have nonbypassable coronary artery disease. The purpose of this study is to evaluate the short-and midterm mortality for patients with complete revascularization using TMR and coronary artery bypass grafting (CABG) compared with those patients with incomplete CABG revascularization and to document longterm follow-up in patients receiving TMR ϩ CABG. Methods: Seventy TMR ϩ CABG patients were cohort matched with 70 patients undergoing isolated CABG with circumflex coronary artery disease, but with no bypassable distal targets, from 1999 to 2005 at Emory University Hospital. The data were retrospectively reviewed from a database after being prospectively entered. Results are presented in mean Ϯ standard deviation, and Kaplan-Meier curves were created for long-term all-cause mortality. Results: The TMR ϩ CABG patients had a similar incidences to the CABG only group for preoperative ejection fraction (50.9 Ϯ 11.2% vs. 50.7 Ϯ 10.3%, P ϭ 0.93), number of grafts (2.6 Ϯ 1.1 vs. 2.5 Ϯ 1.3, P ϭ 0.5), and number of diseased vessels (2.8 Ϯ 0.3 vs. 2.9 Ϯ 0.4, P ϭ 0.26). Off-pump surgery was used more often in the CABG alone group versus the TMR combined with CABG group (74.3% vs. 41.4%, P Ͻ 0.001). Postoperatively, there was no statistical difference among the TMR ϩ CABG and the CABG alone groups for intensive care unit length of stay (4.3 Ϯ 7.8 days vs. 2.6 Ϯ 3.4 days, P ϭ 0.026), postsurgical length of stay (7.6 Ϯ 6.1 days vs. 6.8 Ϯ 4.5 days, P ϭ 0.31), stroke events (1.4% vs. 1.4%, P ϭ 1.00), myocardial infarction (4.3% vs. 2.9%, P ϭ 0.65), and 30-day mortality (5.7% vs. 4.3%, P ϭ 0.70). Long-term survival rate was not statistically significant. In addition, 4-year follow-up in the TMR ϩ CABG group had symptom improvement with reduction in New York Heart Association classification for class III/IV (P Ͻ 0.0001, baseline vs. 4-year follow-up). Conclusions: The combination of TMR and CABG for complete revascularization is safe and carries no further risk to patients compared with CABG only. CABG ϩ TMR patients tend to have increased resource utilization. Long-term follow-up shows similar survival between the groups. TMR can be a useful adjunct to CABG for complete revascularization.
Mid-term outcomes of patients with PCI prior to CABG in comparison to patients with primary CABG
Vascular Health and Risk Management, 2010
The number of percutaneous coronary interventions (PCI) prior to coronary artery bypass grafting (CABG) increased drastically during the last decade. Patients are referred for CABG with more severe coronary pathology, which may influence postoperative outcome. Outcomes of 200 CABG patients, collected consecutively in an observational study, were compared (mean follow-up: 5 years). Group A (n = 100, mean age 63 years, 20 women) had prior PCI before CABG, and group B (n = 100, mean age 66, 20 women) underwent primary CABG. In group A, the mean number of administered stents was 2. Statistically significant results were obtained for the following preoperative criteria: previous myocardial infarction: 54 vs 34 (P = 0.007), distribution of CAD (P , 0.0001), unstable angina: 27 vs 5 (P , 0.0001). For intraoperative data, the total number of established bypasses was 2.43 ± 1.08 vs 2.08 ± 1.08 (P = 0.017), with the number of arterial bypass grafts being: 1.26 ± 0.82 vs 1.07 ± 0.54 (P = 0.006). Regarding the postoperative course, significant results could be demonstrated for: adrenaline dosage (0.83 vs 0.41 mg/h; [p is not significant (ns)]) administered in 67 group A vs 47 group B patients (P = 0.006), and noradrenaline dosage (0.82 vs 0.87 mg/h; ns) administered in 46 group A vs 63 group B patients (P = 0.023), CK/troponine I (P = 0.002; P , 0.001), postoperative resuscitation (6 vs 0; P = 0.029), intra aortic balloon pump 12 vs 1 (P = 0.003), and 30-day mortality (9% in group A vs 1% in group B; P = 0.018). Clopidogrel was administered in 35% of patients with prior PCI and in 19% of patients without prior PCI (P = 0.016). Patients with prior PCI presented for CABG with more severe CAD. Morbidity, mortality and reoperation rate during mid term were significantly higher in patients with prior PCI.