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Incidence of atrial fibrillation after off-pump versus on-pump coronary artery bypass grafting: A meta-analysis of randomized clinical trials and propensity score matching trials. Curr Med Sci 2017; 37:956-964. [DOI: 10.1007/s11596-017-1834-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/23/2017] [Indexed: 12/28/2022]
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Effect of on-pump versus off-pump coronary bypass surgery on cardiac function assessed by intraoperative transesophageal echocardiography. Adv Med Sci 2013; 58:58-66. [PMID: 23333896 DOI: 10.2478/v10039-012-0046-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare cardiac function assessed by intraoperative transesophageal echocardiography in patients undergoing cardiac revascularization with or without cardiopulmonary bypass. MATERIAL AND METHODS Forty-one patients scheduled for elective, isolated cardiac revascularization (21 on-pump and 20 off-pump) were prospectively analyzed. Patients were matched for demographic (age and gender), anthropometric (BMI), clinical (co-morbidities, EuroScore) and laboratory variables (blood counts, renal function, left ventricular function). Transesophageal echocardiography was performed after induction of anesthesia, protamine sulfate administration, and chest closure. Left ventricular wall motion score index, end-diastolic area, fractional area change, right ventricular area change and end-diastolic area were assessed. Troponin I and C-reactive protein concentrations were measured. RESULTS Regarding echocardiographic parameters of left and right ventricular function no significant differences between on-pump and off-pump groups at any point-of-time measurements were found. Troponin I and C-reactive protein were higher in on-pump as compared to off-pump group (p=0.001 and p=0.002; p=0.003 and p=0.001, respectively). CONCLUSIONS In elective patients scheduled for cardiac revascularization there were no difference in cardiac performance assessed by intraoperative echocardiography regardless of surgical method used.
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Torrati FG, Dantas RAS. Circulação extracorpórea e complicações no período pós-operatório imediato de cirurgias cardíacas. ACTA PAUL ENFERM 2012. [DOI: 10.1590/s0103-21002012000300004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Comparar a frequência de complicações apresentadas pelos pacientes, durante o pós-operatório imediato (POI), de cirurgias cardíacas de acordo com o tempo de circulação extra-corpórea (CEC). MÉTODOS: Estudo de natureza quantitativa, descritivo e correlacional com 83 pacientes adultos divididos em dois grupos de acordo com o tempo de CEC. RESULTADOS: Do total de pacientes, 44 (53%) tiveram o tempo de duração da CEC de até 85 minutos e 39 (47 %) tiveram o tempo acima de 85 minutos. As complicações foram comuns para ambos os grupos, sendo as mais frequentes dor e oligúria. No entanto, hemotórax, pneumotórax e infarto agudo do miocárdio ocorreram apenas no grupo com maior tempo de CEC. CONCLUSÃO: A maioria das complicações ocorridas no POI apresentou frequencia semelhante para os pacientes, independente do tempo de CEC.
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Maganti M, Rao V, Cusimano RJ. Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: a propensity score-matched cohort. Can J Cardiol 2009; 25:e151-6. [PMID: 19417865 DOI: 10.1016/s0828-282x(09)70498-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that off-pump coronary artery bypass surgery (OPCAB) is associated with less use of hospital resources compared with on-pump coronary artery bypass surgery (ONCAB). OBJECTIVE To determine whether there is a sex effect between the two procedures regarding resource utilization. METHODS Between 1996 and 2004, 13,522 patients (10,637 men and 2885 women) underwent coronary artery bypass grafting surgery at the Toronto General Hospital (Toronto, Ontario). Among the men, 10,121 patients underwent ONCAB and 516 underwent OPCAB. The female population consisted of 2723 ONCAB and 162 OPCAB patients. Both groups were matched to standard preoperative risk factors. A propensity score macro-matched 471 OPCAB men to 471 ONCAB men, and 148 OPCAB women to 148 ONCAB women. RESULTS The mean (+/- SD) postoperative length of stay (7.5+/-6.5 days versus 6.4+/-5.5 days; P<0.0001) was significantly higher in ONCAB compared with OPCAB in the male population. The mean length of stay in the intensive care unit and the mean ventilation time was similar between the groups. However, in the female population, there were no differences in mean postoperative length of stay (8+/-5.9 days versus 8+/-6 days; P=0.4), mean length of stay in the intensive care unit (43+/-38 h versus 53+/-81 h; P=0.4) or mean ventilation time (9.8+/-9.7 h versus 11+/-13 h; P=0.8). CONCLUSION These results suggest that the benefits of OPCAB in terms of hospital resource use are influenced by sex. The potential beneficial effects are not demonstrated in the female population.
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Affiliation(s)
- Manjula Maganti
- Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
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Bolotin G, Shapira Y, Gotler Y, Frolkis IV, Ben-Gal Y, Nesher N, Uretzky G. The potential advantage of “no-touch” aortic technique in off-pump complete arterial revascularization. Int J Cardiol 2007; 114:11-5. [PMID: 16690146 DOI: 10.1016/j.ijcard.2005.11.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 11/10/2005] [Accepted: 11/17/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Off-pump coronary artery bypass grafting (OPCAB) and complete arterial revascularization without proximal anastomosis to the aorta may decrease neurological events after open-heart surgery. Few reports exist regarding the combination of OPCAB and complete arterial revascularization exploring the theoretical advantage of avoiding manipulation of the aorta. We review our results in 110 patients who underwent multiple grafts off-pump complete arterial revascularization. METHODS 110 patients underwent multiple grafts OPCAB complete arterial revascularization, and were compared to 216 patients who underwent traditional multiple grafts on pump CABG. Preoperative renal failure was 12.7% (n=14) as compared to 5.1%, (n=11, p=0.01) in the control group and 33.6% (n=37) of the patients were 75 years or older as compared to 19.0% (n=41, p=0.003) in the control group. RESULTS The mean number of grafts per patient undergoing multiple OPCAB complete arterial revascularization was 2.3, as compared to 3.11 in the control group (p<0.001). The mortality rate was 2.73% as compared to 1.85% (NS) in the control group. The incidence of CVA was 0% as compared to 2.31% (p=0.17) in the control group. CONCLUSIONS Complete arterial OPCAB revascularization without manipulation of the aorta in high-risk patients can be performed with short-term similar results to conventional CABG and very low neurological complications.
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Affiliation(s)
- Gil Bolotin
- The Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv, 64239, Israel.
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Levi DS, Glotzbach JP, Williams RJ, Myers JL, Laks H. Right ventricular outflow tract transannular patch placement without cardiopulmonary bypass. Pediatr Cardiol 2006; 27:149-155. [PMID: 16261272 DOI: 10.1007/s00246-005-1110-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In children with pulmonary atresia not amenable to initial complete correction, antegrade pulmonary blood flow can be established with surgical right ventricular outflow tract (RVOT) patch enlargement. An 11-year experience with RVOT transannular patch (TAP) augmentation without the use of cardiopulmonary bypass (off-pump) is reported. From March 1993 to October 2004, off-pump surgical RVOT enlargement with a TAP was attempted in all patients in whom a concurrent procedure that required bypass was not required. The procedure was performed with cardiopulmonary bypass standby. Twenty-two consecutive patients in whom this procedure was attempted were reviewed. Twenty of 22 patients tolerated off-pump TAP placement. In 2 patients with ductal-dependent pulmonary blood flow, off-pump TAP placement was not tolerated. Adequate antegrade pulmonary blood flow was achieved in all patients without operative mortalities or complications. There was one death in the postoperative period from myocardial ischemia secondary to right ventricular-dependent coronary circulation. Transannular RVOT patch augmentation can be performed safely and effectively without cardiopulmonary bypass.
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Affiliation(s)
- D S Levi
- Divisions of Pediatric Cardiology, Mattel Children's Hospital at UCLA, B2-427 MDCC, Los Angeles, CA, 90095-1743, USA.
| | - J P Glotzbach
- Division of Cardiothoracic Surgery, Tulane University Medical School, New Orleans, LA, 70112-2669, USA
| | - R J Williams
- Divisions of Pediatric Cardiology, Mattel Children's Hospital at UCLA, B2-427 MDCC, Los Angeles, CA, 90095-1743, USA
| | - J L Myers
- Division of Cardiothoracic Surgery, Tulane University Medical School, New Orleans, LA, 70112-2669, USA
| | - H Laks
- Division of Cardiothoracic Surgery, Mattel Children's Hospital at UCLA, Los Angeles, CA, 90095-1743, USA
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Zangrillo A, Landoni G, Sparicio D, Benussi S, Aletti G, Pappalardo F, Fracasso G, Fano G, Crescenzi G. Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2004; 18:704-8. [PMID: 15650977 DOI: 10.1053/j.jvca.2004.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Atrial fibrillation is the most common complication after coronary artery bypass graft surgery. This arrhythmia may lead to hemodynamic compromise, prolonged hospitalization, and increased risk for cerebral thromboembolism. Older age is the only variable consistently associated with the development of postoperative atrial fibrillation; however, no strong predictive model exists. The purpose of this study was to identify perioperative characteristics associated with new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. DESIGN Prospective, observational. SETTING University tertiary care hospital. PARTICIPANTS One hundred sixty consecutive patients undergoing off-pump coronary artery bypass grafting. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Incidence of postoperative atrial fibrillation was the major outcome. Atrial fibrillation occurred in 33 patients (20.6%). Multivariate analysis identified reintervention (odds ratio 26.8), revascularization of the ramus medianus (odds ratio 3.9), and age (odds ratio 1.069 per year) as the only independent predictors of postoperative atrial fibrillation. All patients were in sinus rhythm at hospital discharge. One hospital death was noted. CONCLUSIONS Despite the less invasive approach, the incidence of postoperative atrial fibrillation is high after off-pump coronary artery bypass grafting. Older age, grafting of the ramus medianus, and a redo operation were predictors of new-onset postoperative atrial fibrillation. It is possible that left atrial stretching with heart dislocation during revascularization of the lateral wall could lead to postoperative atrial fibrillation.
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Affiliation(s)
- Alberto Zangrillo
- Department of Cardiovascular Anesthesia, IRCCS San Raffaele Hospital, Milan, Italy
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Hravnak M, Hoffman LA, Saul MI, Zullo TG, Cuneo JF, Pellegrini RV. Short-Term Complications and Resource Utilization in Matched Subjects After On-Pump or Off-Pump Primary Isolated Coronary Artery Bypass. Am J Crit Care 2004. [DOI: 10.4037/ajcc2004.13.6.499] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Studies suggest that patients who undergo off-pump coronary artery bypass grafting (OPCABG) have fewer short-term complications and use fewer inpatient resources than do patients who undergo standard coronary artery bypass grafting (CABG) with extracorporeal circulation. However, dissimilarity between groups in risk factors for complications has hindered interpretation of results.• Objectives To compare the prevalence of selected complications (atrial fibrillation, stroke, reoperation, and bleeding) and inpatient resource utilization (length of stay, discharge disposition, total charges) between subjects undergoing primary isolated CABG or OPCABG who were matched with respect to key risk factors.• Methods Retrospective, causal-comparative survey conducted in 1 center for 18 months. Patients who underwent primary isolated CABG or OPCABG were matched for sex, age (within 2 years), left ventricular ejection fraction (within 0.05), and graft-patient ratio (exact match) and compared for prevalence of new-onset atrial fibrillation, stroke, reoperation within 24 hours, and bleeding. Statistical analysis included Wilcoxon and t tests for paired comparisons.• Results The sample (107 matched pairs) was 63% male, with a mean age of 66 (SD 9.5) years, a mean left ventricular ejection fraction of 0.51 (SD 0.13), and a mean graft-patient ratio of 3.41 (SD 0.74). The 2 groups did not differ significantly in New York Heart Association class (P = .43), Acute Physiology and Chronic Health Evaluation III score (P = .22), postoperative β-blocker use (P = .73), or comorbid conditions. None of the complications examined differed significantly between pairs.• Conclusion Patients with comparable risk profiles have similar prevalences of selected complications after CABG and OPCABG.
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Affiliation(s)
- Marilyn Hravnak
- The Department of Acute/Tertiary Care, School of Nursing (MH, LAH, TGZ, JFC), Center for Biomedical Informatics (MIS), and Department of Cardiothoracic Surgery, School of Medicine (RVP), University of Pittsburgh, Pittsburgh, Pa
| | - Leslie A. Hoffman
- The Department of Acute/Tertiary Care, School of Nursing (MH, LAH, TGZ, JFC), Center for Biomedical Informatics (MIS), and Department of Cardiothoracic Surgery, School of Medicine (RVP), University of Pittsburgh, Pittsburgh, Pa
| | - Melissa I. Saul
- The Department of Acute/Tertiary Care, School of Nursing (MH, LAH, TGZ, JFC), Center for Biomedical Informatics (MIS), and Department of Cardiothoracic Surgery, School of Medicine (RVP), University of Pittsburgh, Pittsburgh, Pa
| | - Thomas G. Zullo
- The Department of Acute/Tertiary Care, School of Nursing (MH, LAH, TGZ, JFC), Center for Biomedical Informatics (MIS), and Department of Cardiothoracic Surgery, School of Medicine (RVP), University of Pittsburgh, Pittsburgh, Pa
| | - Julie F. Cuneo
- The Department of Acute/Tertiary Care, School of Nursing (MH, LAH, TGZ, JFC), Center for Biomedical Informatics (MIS), and Department of Cardiothoracic Surgery, School of Medicine (RVP), University of Pittsburgh, Pittsburgh, Pa
| | - Ronald V. Pellegrini
- The Department of Acute/Tertiary Care, School of Nursing (MH, LAH, TGZ, JFC), Center for Biomedical Informatics (MIS), and Department of Cardiothoracic Surgery, School of Medicine (RVP), University of Pittsburgh, Pittsburgh, Pa
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Berdat PA, Müller K, Schmidli J, Kipfer B, Eckstein F, Carrel T. Total Arterial Off-Pump versus On-Pump Coronary Revascularization:. Comparison of Early Outcome. J Card Surg 2004; 19:489-94. [PMID: 15548179 DOI: 10.1111/j.0886-0440.2004.04104.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM To assess differences in the early outcome after complete arterial myocardial revascularization with (ONCAB) or without cardiopulmonary bypass (OPCAB). METHODS Out of 870 consecutive CABG procedures 58 OPCAB and 91 ONCAB patients receiving exclusive arterial grafts were analyzed. OPCAB patients had more single-vessel (p < 0.0001), less triple-vessel (p < 0.0001) or left main disease (p = 0.0021), higher angina class (p = 0.003), unstable angina (p < 0.0001) or previous PTCAs (p < 0.0001). RESULTS ONCAB was associated with longer operations (182.5 +/- 38 vs. 147 +/- 56 min; p = 0.0001) and more anastomoses/patient (3.2 +/- 1 vs. 2 +/- 0.9; p < 0.0001), but incomplete revascularization was similar in both groups (11% vs. 17%; p = ns). ITA use was identical, whereas single left internal thoracic artery (LITA) use (25.9% vs.1%; p < 0.0001) and LITA jump anastomoses (10.3% vs. 7.7%; p < 0.0001) were more frequent in OPCAB. Radial artery (RA) use (89% vs. 46.6%; p < 0.0001) and RA jump anastomoses (57.1% vs. 12.1%; p < 0.0001) were more frequent in ONCAB. Mortality, arrhythmias, cerebro-vascular accidents (CVA), and renal failure were similar, but ventilatory support shorter (8.8 +/- 11.8 vs. 15.6 +/- 9.4 h; p < 0.0001) and cardiac enzyme release smaller (p < 0.0001) after OPCAB with a trend toward less myocardial infarction (1.7% vs. 7.7%; p = 0.12) and low output (1.7% vs. 8.8%; p = 0.089), and more respiratory complications (10.3% vs. 2.2%; p = 0.056). CONCLUSIONS Arterial OPCAB patients have less extensive CAD, but more severe symptoms. Early outcome is similar concerning mortality, arrhythmias, CVA, renal failure, or ICU and hospital stay, but with shorter ventilatory support and lower cardiac enzymes with a trend toward lower myocardial infarction and low output, but higher respiratory complication rates after OPCAB.
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Affiliation(s)
- Pascal A Berdat
- Clinic for Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
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Chavanon O, Abdennadher M, Blin D. Off-pump coronary artery bypass grafting using arterial grafts exclusively: aiming for an absolute “no-touch” aortic technique. Ann Thorac Surg 2004; 77:379-80; author reply 380-1. [PMID: 14726109 DOI: 10.1016/s0003-4975(03)01044-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bellomo R, Haase M, Sharma A, Fielitz A, Uchino S, Rocktaeschel J, Doolan L, Matalanis G, Rosalion A, Buxton BF, Raman JS. Reply. Ann Thorac Surg 2004. [DOI: 10.1016/s0003-4975(03)01045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reston JT, Tregear SJ, Turkelson CM. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg 2003; 76:1510-5. [PMID: 14602277 DOI: 10.1016/s0003-4975(03)01195-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Uncertainty continues to surround the relative benefits and harms of conventional coronary artery bypass grafting (CABG) and off-pump coronary artery bypass grafting (OPCABG). Possible reasons are that high-quality studies have not comprehensively examined relevant patient outcomes and have enrolled a limited range of patients. Some studies may have been too small to detect clinically important differences in patient outcomes. The present study addresses these issues using meta-analysis. METHODS We comprehensively retrieved randomized and nonrandomized controlled studies according to predetermined criteria. We performed meta-analyses for each outcome and empirically determined whether potential biases that might result from differences in study design or patient characteristics actually biased a study's results. We also conducted sensitivity analyses and tested for publication bias. RESULTS Rates of perioperative myocardial infarction, stroke, reoperation for bleeding, renal failure, and mortality were lower after OPCABG than after CABG. Reductions in length of hospital stay, atrial fibrillation, and wound infection were also associated with OPCABG, but statistically significant differences among study results for these outcomes could not be explained by available information. Midterm (3 to 25 months) angina recurrence did not appear to differ between treatments; a trend was noticed toward lower reintervention rates with CABG, and a trend toward lower overall mortality with OPCABG, at least when performed at experienced centers. These midterm outcome results require confirmation. CONCLUSIONS Off-pump coronary artery bypass grafting appears to reduce length of hospital stay, operative morbidity, and operative mortality relative to on-pump CABG. More studies are required before firm conclusions can be drawn concerning the effect of OPCABG on midterm mortality, angina recurrence, and repeat intervention.
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Affiliation(s)
- James T Reston
- Department of Health Technology Assessment, ECRI, Plymouth Meeting, Pennsylvania, USA
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