Off-pump Coronary Artery Bypass Grafting Research Articles

Simultaneous hybrid off-pump coronary artery bypass grafting and transcatheter aortic valve implantation in elderly patients.

Optimal strategy for transcatheter aortic valve implantation (TAVI) in patients with coronary artery disease (CAD) is unresolved. We evaluated the surgical outcomes of hybrid coronary artery bypass grafting (CABG) and TAVI in elderly patients. We retrospectively evaluated patients who underwent simultaneous TAVI and CABG at Wakayama Medical University, Japan. All patients underwent off-pump CABG (OPCAB) including minimally invasive cardiac surgery (MICS-CABG). In an earlier period, OPCAB + transfemoral TAVI (TF-TAVI) was the only method used, while in a later period, we introduced MICS-CABG and alternative approaches for TAVI. Twenty-seven patients were enrolled, the average age was 83.6 ± 5.1years. In the MICS-CABG and TAVI group, average patient age was higher (87.0 ± 3.1years) than in the earlier group. Thirty-day and in-hospital mortalities were zero. Incomplete revascularization rate was 33.3% and one patient required percutaneous coronary intervention after the operation. Graft patency rate was 100%. In MICS-CABG group, the number of distal anastomoses was smaller (1.29, range 1-2), but the number of days required to re-starting walking and postoperative hospital stay were shorter, and the rate of discharge to home was higher (100%) than in the other groups. Although 33.3% of patients did not achieve complete revascularization, there was no 30-day or in-hospital mortality. TAVI and hybrid OPCAB, including MICS-CABG, were suggested to be feasible treatment in elderly patients.

Effect of creatine kinase isoenzyme (CK-MB) on early prognosis after off-pump coronary artery bypass grafting.

This study aimed to analyze the effect of elevated creatine ki-nase isozyme levels on early prognosis after off-pump coronary artery bypass (OPCAB) grafting. Based on the levels of creatine kinase isoenzyme (CK-MB), 116 patients were divided into two groups: one with a mild increase (n=85) and another group with a severe increase (n=31) in the enzyme. Clinical data, changes in CK-MB levels at 12, 24, and 48 hours after surgery, changes in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVESD) before surgery, and seven days and three months after surgery were measured, and recorded. Also, the blood flow of the bridging vessel, vascular resistance, the diameter of the anterior descending branch, and the diameter of the distal target vessel were recorded during the operation (> 1.5 mm). A decrease in the level of LVEDD was recorded in both groups after the operation compared to the levels before. However, in the group with a mild increase in CK-MB, the LVEF after the operation increased compared to before the operation (p<0.05). The occurrence of angina pectoris 24 hours before surgery, high vas-cular resistance during surgery, and diameter of distal target vessel > 1.5 mm were related factors affecting the increase of CK-MB after surgery. The ratio of these factors was higher in the severe increase group than in the mild increase group (p<0.05). An increase in myocardial enzymes causes a slow recovery of myocardial function, so it can be used as a critical biological index to reflect the prognosis of patients.

PECAM-1/Thrombus Ratio Correlates with Blood Loss during Off-Pump Coronary Artery Bypass Grafting (OPCAB) Surgery: A Preliminary Study.

Platelet endothelial cell adhesion molecule 1 (PECAM-1) is considered an antiplatelet molecule. Previously, we introduced a new parameter called the PECAM-1/thrombus ratio, which indicates the proportion of PECAM-1 in the thrombus and provides a precise description of human platelet activity (in vitro). The aim of this study was to determine whether the PECAM-1/thrombus ratio could serve as a predictive factor for bleeding events during off-pump coronary artery bypass grafting (OPCAB). To achieve this, we collected blood samples from 20 patients scheduled to undergo OPCAB surgery. We assessed the PECAM-1/thrombus ratio by evaluating thrombus formation on collagen fibers under flow conditions. Subsequently, we compared the ability of the PECAM-1/thrombus ratio in predicting bleeding risk with other methods that evaluate hemostasis activity. These methods included assessing platelet P-selectin secretion, platelet exposure of phosphatidylserine, plasma coagulation and fibrinolysis system activity, and thrombus formation using the T-TAS assay. Our findings revealed a positive correlation between the PECAM-1/thrombus ratio and the amount of blood component units transfused (BCUT) during the OPCAB surgery. Furthermore, BCUT did not show any significant correlation with other measured hemostasis parameters. This preliminary study suggests that the PECAM-1/thrombus ratio might be a good predictor of bleeding risk during the OPCAB procedure.

Off Pump CABG Improves Postoperative Incidence of Coagulopathy Compared with CABG on Pump

Abstract Background Coronary artery bypass grafting remains the standard treatment for patients with extensive coronary artery disease. Coronary surgery without use of cardiopulmonary bypass avoids the deleterious systemic inflammatory effects of the extracorporeal circuit. However there is an ongoing debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass (ONCAB versus OPCAB) grafting surgery. Aim of the Work To compare the incidence of postoperative coagulopathy transfusion of blood product therapy, (Packed RBCs, FFP and platelet concentrate) bleeding (amount of blood in chest tube drains) and reexploration, that occur in adults off pump CABG surgery in comparison to on pump CABG. Patients and Methods We enrolled sixty consecutive adult patients scheduled for isolated CABG surgery (with a median sternotomy) with or without cardiopulmonary bypass pump. The patients are allocated in two groups where thirty patients in each group (group A – On pump – ONCAB- conventional surgery) and (group B – Off pump – OPCAB – beating heart) after obtaining their written informed consent. Results The clinical outcome measure was the incidence of bleeding in group B less than group A. In our study there was highly significant increase in the amount of blood in drains, transfusion requirements and need for re-exploration within twenty four hours after surgery in group A than group B. Conclusion We concluded that off pump cardiac surgery is better than on pump procedure in decreasing risk of bleeding, post-operative transfusion requirements and risk of re-exploration.

Blood Products Utilization Status in Off-Pump Cardiac Surgery Patients.

Background: Transfusion support has an essential role in coronary artery bypass graft (CABG). The time-honored gold standard for CABG is the on-pump procedure (ONCAB); however, off-pump coronary artery bypass (OPCAB) is also a safe, cost-benefit procedure with fewer blood transfusion requirements. This study was performed to evaluate transfusion patterns in OPCAB due to the diversity of transfusion practices. Materials and Methods: This retrospective study was performed to determine the transfusion rate and triggers in OPCAB patients. Medical files of all patients undergoing OPCAB surgery at Sanandaj Tohid Hospital in 2014 were reviewed. Patients' demographics data, preoperative laboratory tests (PT, aPTT, Hb, Hct, Platelet count), underlying medical conditions, and their possible relation to further transfusions and the ward department in which the transfusion had taken place were extracted. SPSS 16 Chicago software, T-student Test, One Way Anova, and χ2 exam were applied for data analysis. P values ≤0.05was considered significant. Results: Among 91 elective OPCAB patients: 28(30.8%) women and 63(69.2%) men with mean age of 64.80±9.02 years, 63(69.23%) received a blood product. Mean utilization of PRBC, FFP, Platelet, and Cryoprecipitate were 2.17±2.044, 2.46±2.86, 2.86±3.80 and 0.40±2.10 units, respectively. ICU revealed the highest consumption rate for all products. Female sex (p<0.001), Hypertension (P=0.002), and low hemoglobin(P=0.004) were noted as predictive factors for transfusion. Conclusion: This study concluded that the transfusion rate in OPCAB is still very high in Iran (regarding a study in a countryside hospital) and that the highest utilization rate is seen in the ICU.

Atrial Fibrillation and Perioperative Inflammation (FIBRILLAMMED Study): A Retrospective Analysis of the Predictive Role of Preoperative Albumin-Adjusted Platelet-Leukocytic Indices in OPCABG.

New-onset atrial fibrillation (NOAF), an important postoperative complication, has pertinent inflammatory links. Motivated by the encouraging literature on the prognostic role of hypoalbuminemia, leukocytic indices [LIs: neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR)], systemic inflammation response index (SIRI=NLR×monocyte) and platelet-leukocytic indices [PLIs: platelet-to-lymphocyte ratio (PLR)], systemic immune inflammation index (SII=NLR×platelet), aggregate index of systemic inflammation (AISI=NLR×platelet×monocyte), we sought to investigate the NOAF-predictive value of preoperative albumin-adjusted indices (aa-LIs and aa-PLIs) in an off-pump coronary artery bypass grafting (OPCABG) setting. Of 899 patients, 151 patients (16.79%) developed the primary outcome i.e. NOAF that was analyzed further retrospectively for its predictors instead of the highlighted text perioperative data of 899 patients undergoing elective OPCABG, were retrospectively analyzed. The study participants were categorized into non-NOAF and NOAF groups (defined as new-onset atrial arrhythmia with irregular RR interval with indistinct P wave in the first week postoperatively). One hundred and fifty-one patients (16.79%) developed NOAF. On univariate analysis: age, smoker status, The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, systemic hypertension, diabetes mellitus, prior congestive heart failure (CHF), and a higher preoperative NLR, PLR, SII, and albumin were significant predictors of NOAF. While age, CHF, and EuroSCORE II retained predictive significance in multivariate analysis, LI-PLIs and albumin did not emerge as independent NOAF predictors. Notably, aa-NLR, aa-PLR, and aa-SII independently predicted NOAF on the computation of model-estimates in the regression analysis (Odds ratio; 95% confidence interval: 31.05;15.75-70.61, 1.04;1.02-1.05, 1.12;1.10-1.14, respectively, P < 0.001). aa-NLR ≥1.32, aa-PLR ≥52.64, and aa-SII ≥344.38 predicted NOAF with the respective AUC;sensitivity;specificity of 0.66;63.6%;73.3%, 0.63;66.2%;59.0%, and 0.65;58.3%;78.2%. Preoperative aa-NLR, aa-PLR and aa-SII also positively correlated with CHA2DS2-VASc score (R=0.40, 0.45 and 0.42; P < 0.001). The independent NOAF predictive value of aa-NLR, aa-PLR, and aa-SII reiterates the inflammatory relationship of the arrhythmic complication following OPCABG.

On-Pump and Off-Pump Coronary Artery Bypass Grafting on 10-Year Mortality Versus Percutaneous Coronary Intervention

On-Pump and Off-Pump Coronary Artery Bypass Grafting on 10-Year Mortality Versus Percutaneous Coronary Intervention

Trend and early clinical outcomes of off-pump coronary artery bypass grafting in the UK.

The popularity of off-pump coronary artery bypass grafting (CABG) varies across the world, ranging from 20% in Europe and the USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the UK. All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on-pump CABG were compared using propensity score matching. A total of 351422 patients were included. The overall off-pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5%, respectively, of total cases performed. After propensity score matching for the period 1996-2019, off pump, when compared to on pump, was associated with a lower in-hospital/30-day mortality (1.2% vs 1.5%, P < 0.001), return to theatre (3.7% vs 4.5%, P < 0.001), cerebrovascular accident (transient ischaemic attack: 0.3% vs 0.6%, stroke: 0.3% vs 0.6%, P < 0.001) and deep sternal wound infection (0.8% vs 1.2%, P ≤ 0.001). In a sub-analysis from the introduction of EuroScore II (2012-2019), there were no differences in-hospital/30-day mortality (1.0% vs 1.0%, P = 0.71). However, on pump, had a higher return to theatre (4.2% vs 2.7%, P < 0.001), cerebrovascular accident (transient ischaemic attack: 0.4% vs 0.2%, stroke: 0.5% vs 0.3%, P = 0.003) and deep sternal wound infection (1.0% vs 0.6%, P = 0.004). Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question of whether it should be a specialized revascularization technique.

The never-ending story: On-pump and Off-pump Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention and long-term survival.

The never-ending story: On-pump and Off-pump Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention and long-term survival.

Ortalama trombosit hacmi ve trombosit dağılım genişliğinin off-pump koroner baypas greftleme ameliyatlarındaki değişimi ve bu değişimin ameliyat sonrası kanama miktarı ile ilişkisinin araştırılması

Objectives: This study aimed to examine the relationship between preoperative mean platelet volume (MPV) and platelet distribution width (PDW) values and postoperative drainage amounts in coronary artery bypass grafting operations without cardiopulmonary bypass support. Patients and methods: One hundred three patients (78 males, 25 females; mean age: 62.8±10.0 years; range, 40 to 85 years) who underwent off-pump coronary artery bypass grafting surgery between December 2015 and May 2018 were included in the retrospective study. Results: There was a negative and insignificant relationship between preoperative MPV values and postoperative drainage (p=0.223, r=-0.121). There was a positive and insignificant relationship between preoperative PDW values and postoperative drainage (p=0.167, r=0.137). Conclusion: According to the results of our study, PDW and MPV values did not correlate with postoperative bleeding in patients who underwent off-pump coronary artery bypass grafting.

Predicting Determinants for Conversion of Off-Pump Coronary Revascularization to On-Pump Surgery: A Retrospective Analysis.

A global consensus has not yet been reached regarding the preference for off-pump versus on-pump coronary revascularization. Although the coronary trial indicates that the secondary endpoint outcomes favor on-pump surgery, the cost-effectiveness and significantly lower immediate and early complications in off-pump surgery make it favorable for the Indian population. To analyze patients who underwent coronary revascularization, specifically coronary artery bypass grafting (CABG), a retrospective five-year study was conducted. During the given duration, a total of 652 patients underwent CABG. The study revealed a positive correlation between diabetes, high body surface area (BSA), and preexisting renal dysfunction as strong predictors for converting off-pump coronary artery bypass surgery (OPCABG) to on-pump surgery coronary artery bypass surgery (ONCABG). Preoperative electrocardiographic (ECG) changes and the use of intra-aortic balloon pulsation (IABP) as a mechanical assist device were strongly associated with the incidence of conversion from OPCABG to ONCABG. Tight left main disease and ostial coronary disease indicate a progressive dysfunction during off-pump surgery, necessitating early conversion to on-pump surgery to avoid complications. The on-pump group had more adverse outcomes in regard to renal and neurological dysfunction, which can be attributed to pump-induced dysfunction. In such scenarios, a surgeon's preparedness to convert an OPCABG to an ONCABG can be swift and efficient. In anticipation of increased pump-related complications in the ONCABG group, a measured approach can be implemented to avoid adverse postoperative outcomes in high-risk patients.

Five-year-outcome of new-onset perioperative atrial fibrillation after left atrial appendage amputation concomitant with cardiac surgery

BackgroundRecent data demonstrated the benefit of left atrial appendage (LAA)-amputation in patients with atrial fibrillation (AF). However, the long-term impact of LAA-amputation for patients with new-onset perioperative atrial fibrillation (POAF) is still unknown.MethodsPatients with no history of AF undergoing coronary artery bypass grafting by off-pump technique (OPCAB) between 2014 and 2016 were retrospectively examined. Cohorts were divided by the concomitant execution of LAA-amputation. Propensity score (PS) matching was applied by all available baseline characteristics. The composite of all-cause mortality, stroke and rehospitalization in patients with POAF and patients maintaining sinus rhythm posed as the primary endpoint.ResultsA total of 1522 patients were enrolled, of whom 1208 and 243 were included in the control and the LAA-amputation group, respectively and were matched to 243 patients in each group. In total, patients with POAF without LAA-amputation showed a significantly higher rate of the composite endpoint (17.3% vs 32.1%, p = 0.007). However, patients with LAA-amputation showed no significant difference in the composite endpoint (23.2% vs 26.7%, p = 0.57). The significantly higher occurrence of the composite endpoint was driven by all-cause mortality (p = 0.005) and rehospitalization (p = 0.029). Subgroup analysis revealed a CHA2DS2-VASc-score of ≥ 3 to be associated with the high rate of the primary endpoint (p = 0.004).ConclusionPOAF is associated with a higher rate of the combined endpoint of all-cause mortality, stroke and rehospitalization. The composite endpoint in patients with LAA-amputation concomitant with OPCAB surgery developing new-onset POAF in a 5-year follow-up was not increased compared to a control cohort maintaining sinus rhythm.Graphical abstractFive-year outcome of patients with POAF and LAA-amputation; 95% CI, 95% confidence interval, CPR, cardiopulmonary resuscitation, ECLS, extracorporeal life support, HR, hazard ratio, IABP, intra-aortic balloon pump, LAA, left atrial appendage, OPCAB, off-pump coronary artery bypass grafting, PAPs, systolic pulmonary artery pressure, SR, sinus rhythm, VT, ventricular tachycardia.

Characteristics of left ventricular and cardiac hemodynamic remodeling after on-pump or off-pump coronary artery bypass grafting

Aim. To study the comparative dynamics of left ventricular (LV) remodeling after on-pump and off-pump coronary artery bypass grafting.Materials and methods. The study included 129 patients with verified coronary artery disease (CAD) who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass (on-pump CABF) or beating heart surgery (off-pump CABG). All patients underwent transthoracic echocardiography (TTE) and volumetric compression oscillometry (VCO) before surgery, as well as one week and four months after it. The results were compared in groups divided according to the surgical technique and the presence of previous myocardial infarction using variation series, the Tukey’s post-hoc test, the Pearson correlation coefficient, and the Spearman’s rank correlation coefficient.Results. According to TTE data, no difference in hemodynamic parameters between the groups in the postoperative period was noted. According to VCO data, a significant difference was revealed in the off-pump group without previous MI one week after surgery: an increase in cardiac output (CO) (p &lt; 0.001), an increase in stroke volume (SV) and stroke index (SI) (p = 0.005), LV power (LVP) (p = 0.015), and also a rise in cardiac index and LVP four months after the surgery. In the on-pump group of patients with previous MI a week after CABG, a decrease in the LVP (p &lt; 0.001) and dynamic changes of energy expenditure (p &lt; 0.001) were observed. The correlation analysis revealed moderate correlations between the inotropic parameters of cardiac hemodynamics SV, SI, CO, LVP and blood pressure (BP) (rπ = 0.33–0.47; p &lt; 0.001) and strong correlations between SV, SI, CO, LVP and ejection fraction (EF) (rπ = 0.63–0.68; p &lt; 0.001).Conclusion. Seven days after the off-pump CABG, an improvement in some hemodynamic parameters and all inotropic parameters of the heart was revealed compared with the on-pump group. Four months after the off-pump surgery, positive hemodynamic remodeling was observed compared with the postoperative period after the onpump CABG.

Comparing results of bypass surgery and percutaneous coronary intervention for left main disease by surgical revascularization pump strategy

ObjectiveWe performed a post hoc analysis of the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial to determine the effect an on-versus off-pump strategy had on outcomes when compared with percutaneous coronary intervention. MethodsAll randomized patients in EXCEL (n = 1905) were included. The outcomes of interest were the primary end point composite of death from any cause, stroke, or myocardial infarction; the composite study end point or ischemia-driven revascularization; and the rate of death from any cause at 5 years. Event rates were based on Kaplan–Meier estimates in time-to-first-event analyses. ResultsPropensity matching resulted in groups of 1142 patients (571 each) for on-pump coronary artery bypass grafting versus percutaneous coronary intervention and 472 patients (236 each) for off-pump coronary artery bypass grafting versus percutaneous coronary intervention. In the on-pump coronary artery bypass grafting versus percutaneous coronary intervention matched groups, the composite end point was similar (18.0% vs 22.1%, P = .19) and the composite end point or ischemia-driven revascularization (23.3% vs 31.0%, P = .01) was lower, and mortality (7.6% vs 11.8%, P = .025) was lower in the on-pump coronary artery bypass grafting group at 5 years. In the off-pump coronary artery bypass grafting versus percutaneous coronary intervention matched groups, the composite end point (19.4% vs 22.2%, P = .47), composite end point or ischemia-driven revascularization (25.9% vs 34.2%, P = .07), and mortality (12.5% vs 14.2%, P = .59) were similar at 5 years. ConclusionsIn the EXCEL trial, on-pump coronary artery bypass grafting was associated with a decreased 5-year rate of the composite outcome of death, stroke, myocardial infarction, or ischemia-driven revascularization, and decreased mortality when compared with percutaneous coronary intervention, whereas outcomes of off-pump coronary artery bypass grafting were similar to percutaneous coronary intervention.

Effect of preoperative ivabradine on hemodynamics during elective off-pump CABG.

Ivabradine is a specific heart rate (HR)-lowering agent which blocks the cardiac pacemaker If channels. It reduces the HR without causing a negative inotropic or lusitropic effect, thus preserving ventricular contractility. The authors hypothesized that its usefulness in lowering HR can be utilized in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. To study the effects of preoperative ivabradine on hemodynamics (during surgery) in patients undergoing elective OPCAB surgery. Fifty patients, New York Heart Association (NYHA) class I and II, were randomized into group I (control, n = 25) and group II (ivabradine group, n = 25). In group I, patients received the usual anti-anginal medications in the preoperative period, as per the institutional protocol. In group II, patients received ivabradine 5 mg twice daily for 3 days before surgery, in addition to the usual anti-anginal medications. Anesthesia was induced with fentanyl, thiopentone sodium, and pancuronium bromide as a muscle relaxant and maintained with fentanyl, midazolam, pancuronium bromide, and isoflurane. The hemodynamic parameters [HR and mean arterial pressure (MAP)] and pulmonary artery (PA) catheter-derived data were recorded at the baseline (before induction), 3 min after the induction of anesthesia at 1 min and 3 min after intubation and at 5 min and 30 min after protamine administration. Intraoperatively, hemodynamic data (HR and MAP) were recorded every 10 min, except during distal anastomosis of the coronary arteries when it was recorded every 5 min. Post-operatively, at 24 hours, the levels of troponin T and brain natriuretic peptide (BNP) were measured. This trial's CTRI registration number is CTRI/005858. The HR in group II was lower when compared to group I (range 59.6-72.4 beats/min and 65.8-80.2 beats/min, respectively) throughout the study period. MAP was comparable [range (78.5-87.8 mm Hg) vs. (78.9-88.5 mm Hg) in group II vs. group I, respectively] throughout the study period. Intraoperatively, 5 patients received metoprolol in group I to control the HR, whereas none of the patients in group II required metoprolol. The incidence of preoperative bradycardia (HR <60 beats/min) was higher in group II (20%) vs. group I (8%). There was no difference in both the groups in terms of troponin T and BNP level after 24 hours, time to extubation, requirement of inotropes, incidence of arrhythmias, in-hospital morbidity, and 30-day mortality. Ivabradine can be safely used along with other anti-anginal agents during the preoperative period in patients undergoing OPCAB surgery. It helps to maintain a lower HR during surgery and reduces the need for beta-blockers in the intraoperative period, a desirable and beneficial effect in situations where the use of beta-blockers may be potentially harmful. Further studies are needed to evaluate the beneficial effects of perioperative Ivabradine in patients with moderate-to-severe left ventricular dysfunction.

No association between pulmonary artery catheter use and postoperative complications in off-pump coronary artery bypass grafting: a single-center pilot study.

A pulmonary artery catheter is often used in cardiac surgery despite its uncertain effectiveness. The aim of this pilot study was to investigate the associations between the use of a pulmonary artery catheter and clinical outcomes in off-pump coronary artery bypass grafting. Patients over 20 years of age who had undergone off-pump coronary artery bypass grafting between December 2018 and November 2021 were enrolled in this single-center retrospective pilot study. The propensity score of pulmonary artery catheterization was calculated. Multivariate analysis including the propensity score as a covariate was performed to assess clinical outcomes. The primary outcome was the composite outcome of in-hospital death, unplanned intraoperative conversion to cardiopulmonary bypass, resuscitated cardiac arrest, mechanical circulatory support, myocardial infarction, stroke, new initiation of renal replacement therapy, inhaled nitric oxide, re-intubation and tracheostomy. Among the 315 patients who were enrolled, 298 were included in the final analysis. A pulmonary artery catheter was inserted in 131 patients. There were 50 patients with the composite outcome including two in-hospital deaths. Multivariate logistic regression analysis showed that pulmonary artery catheterization was not significantly related to the composite outcome. Clinical outcomes worsened significantly as the number of anastomoses increased (odds ratio: 1.450, 95% confidence interval: 1.040-2.040, P=0.029). Pulmonary artery catheterization did not improve the clinical outcomes in off-pump coronary artery bypass grafting in this pilot study.

Comparison of Left Ventricular Global Longitudinal Strain with Ejection Fraction as a Predictor for Peri-operative IABP Insertion in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Pilot Study.

Prophylactic use of intra-aortic balloon pump (IABP) mainly depends on left ventricular (LV) systolic function. Global longitudinal strain (GLS) is a robust prognostic parameter for LV strain. It has proved to be more sensitive than LV ejection fraction (EF) as a measure of LV systolic function and is a strong predictor of outcome. To determine whether GLS can be used as a reliable marker and its cut-off value for IABP insertion in patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). A prospective observational clinical study which included 100 adult patients scheduled for elective OPCABG. Two-dimensional (2D) speckle tracking echocardiography (STE)-estimated GLS was computed and compared with LV EF measured by three dimensional (3D) echocardiography for the insertion of IABP. The intensive care unit (ICU) parameters were correlated with echocardiographic parameters to predict early post-operative outcome. IABP insertion correlates better with GLS (post-revascularization > pre-revascularization) than with 3D LV EF. Receiver operating characteristic (ROC) curve analysis revealed the highest area under the curve (AUC, 0.972) with a cut-off value of > -9.8% for GLS compared to 3D LV EF (AUC, 0.938) with a cut-off value of ≤ 44%. ICU parameters show better correlation with E/e'> GLS > WMSI than 3D LV EF. GLS is a better predictor of IABP insertion compared to 3D LV EF in patients undergoing OPCABG.

Development and validation of a diagnostic model based on left atrial diameter to predict postoperative atrial fibrillation after off-pump coronary artery bypass grafting.

This cohort study collected the clinical data of patients who underwent off-pump coronary artery bypass grafting (OPCABG) during hospitalization to observe the occurrence of postoperative atrial fibrillation (POAF), construct a POAF prediction model for CABG patients based on the left atrial diameter (LAD), and assist clinicians in making better medical decisions. In this study, all patients who had no prior history of arrhythmia and who had received isolated OPCABG between May 1, 2021, and February 1, 2022, at Beijing Anzhen Hospital Affiliated to Capital Medical University (n=749) were reviewed. Depending on an optimal cutoff obtained from receiver operating characteristic (ROC) curve analysis, patients were separated into two groups: a group with POAF (n=188) and a group without POAF (n=561). The incidence of POAF was then compared. Prediction models were built, and nomograms were plotted was plotted. Model evaluation, including calibration curve and decision curve analysis, was performed. In all, 188 out of 749 (25.1%) patients who underwent cardiac surgery experienced POAF. Multifactorial logistic regression analysis showed that age ≥66 years, LAD ≥39 mm, and post-OPCABG atrial fibrillation (AF) were independently associated. The prognostic nomogram model showed good concordance index (C-index) scores. Decision curve analysis suggested the clinical benefit of the prediction models. In this study, a prediction model for patients with POAF after OPCABG was assessed, which was shown to make more accurate predictions compared with the original risk prediction system. It may assist doctors to optimize management of patients with POAF.

High Thoracic Epidural Anesthesia and Dexmedetomidine for Awake Off-Pump Coronary Artery Bypass Grafting: A Feasible Option for Patients with Severe Pulmonary Disease.

High thoracic epidural anesthesia in cardiac surgery as the sole anesthetic technique is used in a select groups of patients having severe pulmonary co morbidities. We describe a case series of three patients at high risk for post operative pulmonary complications where this technique was used along with dexmedetomidine infusion for conscious sedation in off pump coronary artery bypass grafting. Proper selection of patients, proper placement of the epidural catheter at the appropriate level and timing of catheter insertion and removal are of paramount importance.

Minimally Invasive Off-Pump Anaortic Complete Arterial Coronary Artery Bypass: How to Do It?

Minimally invasive direct coronary artery bypass has empowered coronary artery bypass grafting to compete with the appeal of percutaneous coronary procedures. Successful results of off-pump coronary artery bypass surgery and without touching the aorta have facilitated the development and use of minimally invasive methods. Multivessel coronary bypass surgery performed using a minimally invasive method through a small thoracotomy in the left chest with off-pump, anaortic, and all-arterial grafts is described step by step. Technical considerations, description of operation stages, and tips and pitfalls will be examined. A 64-year-old male patient with no known comorbidities except smoking revealed 3 vessels and a side vessel disease, and the heart team decided on surgical revascularization with a low-risk procedure. Experienced surgeons may perform this operation successfully, and the development of efficient simulation systems will increase its use.