Abstract
To evaluate the decrease of CPB time and its related complications in CABG using a hybrid alternative method. Ninety patients were retrospectively analyzed between March 2000 and August 2006. All were treated with three or more grafts and divided into two groups: Group 1 was the hybrid group--45 patients who had been operated by the hybrid technique; Group 2 was the total group--45 patients operated in on-pump. In the hybrid group, the CPB time varied from 20 min. to 81 min. In the total group, the CPB time varied from 60 min. to 210 min. (p<0.001). The aorta cross-clamping time varied in the first group from 7 min. to 70 min. In Group 2, from 34 to 100 min. (p<0.001). A statistically significant difference was found between these two groups in relation to the occurrence of postoperative atrium fibrillation and renal dysfunction. Using the hybrid technique it is possible to reduce the CPB time, as well as the occurrence of some postoperative complications. Probably, this decreasing in atrial fibrillation and renal dysfunction incidences could be explained due to a less significant inflammatory activation, which is a consequence of a shorter CPB time.
Highlights
IntroductionThe off-pump coronary artery bypass graft (CABG) has been widely used in the treatment of multiarterial coronary disease; performing myocardial revascularization surgery without Cardiopulmonary bypass (CPB) is sometimes not possible due to the intra-operative hemodynamic instability caused by the traction and torsion maneuvers of the heart to expose the coronary vessels during bleeding of myocardial ischemia during anastomosis [1,2,3]
The off-pump coronary artery bypass graft (CABG) has been widely used in the treatment of multiarterial coronary disease; performing myocardial revascularization surgery without Cardiopulmonary bypass (CPB) is sometimes not possible due to the intra-operative hemodynamic instability caused by the traction and torsion maneuvers of the heart to expose the coronary vessels during bleeding of myocardial ischemia during anastomosis [1,2,3].The use of CPB and the diastolic arrest of the heart induced by cardioplegia solution favor the exposition of the epicardial vessels
Using a hybrid technique can reduce the CPB time and the incidence of some postoperative complications. This reduction in atrium fibrillation and renal dysfunction incidences could be explained by a less significant inflammatory activation evoked by a shorter CPB time
Summary
The off-pump coronary artery bypass graft (CABG) has been widely used in the treatment of multiarterial coronary disease; performing myocardial revascularization surgery without CPB is sometimes not possible due to the intra-operative hemodynamic instability caused by the traction and torsion maneuvers of the heart to expose the coronary vessels during bleeding of myocardial ischemia during anastomosis [1,2,3]. The use of CPB and the diastolic arrest of the heart induced by cardioplegia solution favor the exposition of the epicardial vessels. They maintain appropriate hemodynamic support and control the temperature of patient. Especially after an extended period of time time, the CPB, causes metabolic changes [4], endocrine responses [5], inflammatory responses [6], reduction of the number and function of platelets [7] and cognitive changes [8].
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