Pro: All Off-Pump Coronary Artery Bypass Graft Surgeries Should Include Intraoperative Transesophageal Echocardiography Assessment

Abstract

HISTORICALLY, THE cardiopulmonary bypass machine was necessary for cardiac surgeons to perform complex operations on the heart. 1 Weir I. Coronary artery bypass. Ann R Coll Surg Engl. 2006; 88: 99-102 Crossref PubMed Google Scholar Cardiopulmonary bypass (CPB) allows for a stable operative site and a bloodless field while ensuring end-organ perfusion and cooling of the patient during cardiorespiratory arrest. 1 Weir I. Coronary artery bypass. Ann R Coll Surg Engl. 2006; 88: 99-102 Crossref PubMed Google Scholar CPB has been implicated as the cause of many adverse effects of cardiac surgery including a systemic inflammatory response and end-organ damage, especially neurologic injury and cognitive decline. 2 Roach G.W. Kanchuger M. Mangano C.M. et al. Adverse cerebral outcomes after coronary bypass surgery Multicenter study of perioperative ischemia research group and the ischemia research and education foundation investigators. N Engl J Med. 1996; 335: 1863-1875 Crossref Scopus (1670) Google Scholar , 3 Yacoub M. Off-pump coronary bypass surgery: In search of an identity. Circulation. 2001; 104: 1743-1745 PubMed Google Scholar , 4 Elahi M.M. Khan J.S. Matata B.M. Deleterious effects of cardiopulmonary bypass in coronary artery surgery and scientific interpretation of off-pump's logic. Acute Card Care. 2006; 8: 196-209 Crossref PubMed Scopus (33) Google Scholar In recent years, it has become possible to safely perform coronary artery bypass graft (CABG) surgery without the use of CPB. It was initially postulated that avoidance of cannulation and CPB would decrease the incidence of end-organ damage in all patients. Several clinical studies have not confirmed this, but off-pump CABG (OPCAB) surgery has been shown to be beneficial in a subset of patients that are at higher risk for developing neurologic complications. 5 Sharony R. Bizekis C.S. Kanchuger M. et al. Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: A case control study. Circulation. 2003; 108: II15-II20 PubMed Google Scholar , 6 Sharony R. Grossi E.A. Sounders P.C. et al. Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease. J Thorac Cardiovasc Surg. 2004; 127: 406-411 Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar