Off-pump Coronary Bypass Grafting Research Articles

Circulating Neuropeptide Y as a Biomarker in Postoperative Atrial Fibrillation Cases Administered Off-Pump Coronary Bypass Graft Surgery

Background and AimsPostoperative atrial fibrillation (POAF) is considered the most prevalent irregular heart rhythm after heart surgery. The cardiac autonomic nervous system significantly affects POAF, and neuropeptide Y (NPY), an abundant neuropeptide in the cardiovascular system, is involved in this autonomic regulation. The current work aimed to examine the potential association of NPY with POAF in individuals administered isolated off-pump coronary artery bypass grafting. MethodsFrom January 1 to May 31, 2020, we examined consecutive cases administered successful isolated off-pump coronary artery bypass grafting with no previously diagnosed atrial fibrillation (AF). Clinical characteristics and plasma samples were collected before surgery. NPY was quantified by enzyme-linked immunosorbent assay (ELISA) in peripheral blood, and POAF cases were identified through a 7-day Holter monitoring. ResultsAmong 120 cases with no previously diagnosed AF, 33 (27.5%) developed POAF during hospitalization. Median NPY levels were markedly elevated in the POAF group in comparison with the sinus rhythm group (31.72 vs. 27.95, P=0.014). Multivariable logistic regression analysis revealed age (OR=1.135, 95%CI 1.054-1.223; p=0.001), left atrial size (OR=1.136, 95%CI 1.004-1.285; p=0.043), and NPY levels in peripheral blood (OR=1.055, 95%CI 1.002-1.111; p=0.041) independently predicted POAF. Additionally, NPY levels were positively correlated with high-frequency (HF) (r=0.2774, p=0.0022) and low-frequency (LF) (r=0.2095, p=0.0217) components of heart rate variability. ConclusionIn summary, this study demonstrates an association between elevated NPY levels in peripheral blood before surgery and POAF occurrence.

Evaluating the Efficacy of the Erector Spinae Plane Block as a Supplementary Approach to Cardiac Anesthesia during Off-Pump Coronary Bypass Graft Surgery via Median Sternotomy: A Randomized Clinical Trial.

Background: Pain control after off-pump coronary artery bypass graft (OPCAB) facilitates mobilization and improves outcomes. The efficacy of the erector spinae plane block (ESPB) after cardiac surgery remains controversial. Methods: We aimed to investigate the analgesic effects of ESPB after OPCAB. Precisely 56 patients receiving OPCAB were randomly divided into ESPB and control groups. The primary outcome was visual analog scale (VAS) pain scores at 6, 12, 24, and 48 h postoperatively. Secondary outcomes were the dose of rescue analgesics in terms of oral morphine milligram equivalents, the dose of antiemetics, the length of intubation time, and the length of stay in the intensive care unit (ICU). Results: The VAS scores were similar at all time points in both groups. The incidence of severe pain (VAS score > 7) was significantly lower in the ESPB group (50% vs. 15.4%; p = 0.008). The dose of rescue analgesics was also lower in the ESPB group (19.04 ± 18.76, 9.83 ± 12.84, p = 0.044) compared with the control group. The other secondary outcomes did not differ significantly between the two groups. Conclusions: ESPB provides analgesic efficacy by reducing the incidence of severe pain and opioid use after OPCAB.

Clinical outcomes of different revascularization approaches for patients with multi-vessel coronary artery disease: A network meta-analysis.

As surgical techniques continue to evolve, the optimal approach for revascularizing multi-vessel coronary artery disease (CAD) remains a matter of ongoing debate. Accordingly, our objective was to compare and contrast various surgical techniques utilized in the management of multi-vessel CAD. A systematic literature review was performed using PubMed, Embase, and Cochrane central register of controlled trials from inception to May 2022. Random-effects network meta-analysis was performed for the primary outcome; target vessel revascularization (TVR), and secondary outcomes; mortality, major adverse cardiac and cerebrovascular events, postoperative myocardial infarction, new-onset atrial fibrillation, stroke, new-onset dialysis, in patients undergoing percutaneous coronary intervention (PCI) with a stent, off-pump coronary bypass graft, on-pump coronary artery bypass graft (ONCABG), hybrid coronary revascularization, minimally-invasive coronary artery bypass, or robot-assisted coronary artery bypass (RCAB) surgeries. A total of 8841 patients were included from 23 studies. The analysis showed that ONCABG had the highest freedom from TVR, with a mean (SD) absolute risk of 0.027 (0.029); although ONCABG was found to be superior to all other methods, it was only significantly better than first-generation stent PCI. While RCAB did not demonstrate significant superiority over other treatments, it showed a greater probability of preventing postoperative complications. Notably, no significant heterogeneity was calculated for any of the reported outcomes. ONCABG shows a better rank probability compared to all other techniques for preventing TVR, while RCAB offers greater freedom from most postoperative complications. However, given the absence of randomized controlled trials, these results should be interpreted with caution.

Gut Microbiota in Patients with Postoperative Atrial Fibrillation Undergoing Off-Pump Coronary Bypass Graft Surgery.

Post-operative atrial fibrillation (POAF) is one of the most common complications of cardiac surgery. However, the underlying mechanism is not well understood. Alterations in the gut microbiota are associated with the development of atrial fibrillation (AF). The aim of this study was to explore the relationship between gut microbiota and POAF. Fecal samples were collected before surgery from 45 patients who underwent coronary artery bypass grafting with POAF and 90 matched patients without POAF (1:2). 16S rRNA sequencing was used to detect the microbiome profiles of 45 POAF patients and 89 matched patients (one sample in the no-POAF group was deleted owing to low quality after sequencing). Plasma 25-hydroxy vitamin D level was measured by ELISA. Compared to the patients without POAF, gut microbiota composition was remarkably changed in the patients with POAF, with an increase in Lachnospira, Acinetobacter, Veillonella and Aeromonas, and a decrease in Escherichia-Shigella, Klebsiella, Streptococcus, Brevundimonas and Citrobacter. Furthermore, plasma 25-hydroxy vitamin D levels were decreased in POAF patients and negatively correlated with an abundance of Lachnospira. The gut microbiota composition between patients with and without POAF is significantly different, implying that gut microbiota may play a role in the pathogenesis of POAF. Further studies are needed to fully clarify the role of gut microbiota in the initiation of AF.

The effect of off-pump coronary bypass graft surgery on subfoveal choroidal thickness, ganglion cell complex, and retinal nerve fiber layer thickness.

Cardiac surgery has been associated with adverse ocular events. Off-pump coronary artery bypass graft surgery evades the systemic inflammatory response seen in extracorporeal circulation and is superior to on-pump surgery with regard to end-organ dysfunction and neurological outcomes. To determine the effects of off-pump (without extracorporeal circulation) coronary artery bypass graft surgery on choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer. Prospective, longitudinal study. Patients who underwent off-pump surgery were examined preoperatively and postoperatively at 1 week and 6 weeks after surgery. Choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer measurements were recorded, and the effects of off-pump coronary artery bypass on these parameters were assessed. A total of 44 eyes of 44 patients were included in the study. There was a statistically significant increase in subfoveal choroidal thickness from 252.84 ± 56.24 µm preoperatively to 273.82 ± 39.76 µm at 1 week and 301.97 ± 44.83 µm at 6 weeks after off-pump coronary artery bypass graft surgery (p = 0.044; p ⩽ 0.001). Ganglion cell complex and retinal nerve fiber measurements showed no significant difference compared to preoperative values. Off-pump coronary artery bypass graft surgery showed no negative effects on ganglion cell complex and retinal nerve fiber measurements. A significant increase in subfoveal choroidal thickness was seen after off-pump surgery, which might be advantageous in patients who are at high risk or have preexisting ocular diseases that are affected by the choroid.

The effect of systemic intraoperative warming on cardiac function of patients after off-pump coronary bypass grafting

The effect of systemic intraoperative warming on cardiac function of patients after off-pump coronary bypass grafting

Early pharmacologic conversion of atrial fibrillation after off-pump coronary artery bypass grafting.

BackgroundThe aim of this study was to evaluate the efficacy of early amiodarone-based pharmacological cardioversion for postoperative atrial fibrillation (POAF) following off-pump coronary bypass grafting (OPCAB).MethodsA total of 507 patients who underwent OPCAB between 2015 and 2017 were categorized into POAF (n=94) and no-POAF (n=413) groups. Patients in the POAF group were treated according to the following institutional protocol: 150 mg loading dose of intravenous amiodarone, followed by oral administration with sequential maintenance doses at 600, 400, and 200 mg per day. If sinus rhythm was restored before discharge, patients were discharged without amiodarone or anticoagulants, except for dual antiplatelets.ResultsBefore discharge at index hospitalization, 97.8% of POAF patients had restored sinus rhythm. Independent risk factors for POAF were age, unstable angina, prior percutaneous transluminal coronary angioplasty, and left atrial diameter. The mean follow-up duration was 41.1±12.8 months. Freedom from overall mortality and composite events, including mortality, major bleeding requiring admission and cerebrovascular events, were similar between the 2 groups. Results were consistent after propensity-score matching.ConclusionsAmiodarone-based rapid pharmacological cardioversion of POAF resulted in a high sinus rhythm conversion rate (97.9%). Rate of late adverse cardiovascular events including stroke, were low even without anticoagulation. As optimal treatment and anticoagulation guidelines for POAF after OPCAB have not yet been established, amiodarone-based treatment protocols may be considered as a useful option.

Effect of Off-pump Coronary Artery Bypass Grafting on the Intraoperative Hemodynamics

Abstract: Background: The hemodynamic instability during off-pump coronary bypass grafting (CABG) may impair the complete coronary revascularization. We evaluated the effect of off-pump CABG on intraoperative hemodynamic parameters. Methods: We included 40 patients who underwent off-pump CABG from 2017 to 2019. The mean age was 55.75± 6.73 years, and 28 patients were males (70%). The mean ejection fraction was 60.08 ± 3.81%. Study endpoints were the intraoperative hemodynamic parameters and postoperative complications. Results: Heart rate was significantly higher during the grafting of the posterior descending artery (PDA) (79.3± 2.8 beats/min) and right coronary artery (79.5 ± 1.8 beats/min) compared to all other grafts (p < 0.001). The highest central venous pressure (12.6± 1.2 mmHg) and mean pulmonary artery pressure (33.2± 1.4 mmHg) and the lowest mean arterial and pressure (68.1± 3.3 mmHg) were recorded during PDA grafting (p < 0.001, for all parameters). There was no significant difference in adrenaline dose infused during the anastomosis of all grafts (p= 0.2). Ejection fraction significantly decreased predischarge (52.18 ± 2.58 %) and at 6 months (52.83 ± 3.57%) compared to the preoperative value (p < 0.001). Conclusion: Off-pump CABG was associated with significant hemodynamic instability, which was more evident during the posterior descending artery grafting. Proper anesthetic management and fluid infusion are required, especially during the anastomosis of the right and posterior coronary systems.

Feasibility and safety of minimally invasive cardiac coronary artery bypass grafting surgery for patients with multivessel coronary artery disease: Early outcome and short-mid-term follow up results

To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery. Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD). There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P < 0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up. The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.

Off-pump coronary bypass grafting with or without the use of intracoronary shunts

Background: There is scarce literature comparing the role of the intracoronary shunt during off-pump coronary artery bypass grafting (CABG). This study aimed to compare off-pump CABG using intracoronary shunt versus the coronary clamp during distal coronary artery anastomosis.&#x0D; Methods: We conducted this randomized study between January and June 2018. We randomized 30 patients into two groups. Group A (n= 15) included patients who had coronary clamping during off-pump CABG, and Group B (n= 15) included patients who had intracoronary shunt during off-pump CABG. Study endpoints were anastomosis time and postoperative cardiac enzyme levels.&#x0D; Results: The mean age of the shunt group was higher than the mean age of the clamp group (61.06 ± 7.26 vs. 56.72 ± 12.44, respectively, p=0.03). Our study showed no statistical difference between the two groups regarding sex (p˃0.99), hypertension (p˃0.99), and diabetes (p=0.14). The distal anastomosis time was longer in the shunt group than in the clamp group (39.80±4.55 vs. 32.27±6.06 minutes, respectively, p=0.001). The postoperative troponin I (0.61±0.11 vs. 0.26±0.089 ƞg/ml, p&lt;0.001), and CK-MB levels (44.27±5.34 vs. 35.5±4.86 IU/L, p&lt;0.001) were significantly higher in the clamp group.&#x0D; Conclusion: The intracoronary shunt could be associated with lower cardiac enzyme release compared to the clamp technique. However, it was associated with a longer distal anastomosis time.

Natriuretic Peptides as a Prognostic Marker for Delirium in Cardiac Surgery-A Pilot Study.

Background and Objectives: Delirium is a common and major complication subsequent to cardiac surgery. Despite scientific efforts, there are no parameters which reliably predict postoperative delirium. In delirium pathology, natriuretic peptides (NPs) interfere with the blood–brain barrier and thus promote delirium. Therefore, we aimed to assess whether NPs may predict postoperative delirium and long-term outcomes. Materials and Methods: To evaluate the predictive value of NPs for delirium we retrospectively analyzed data from a prospective, randomized study for serum levels of atrial natriuretic peptide (ANP) and the precursor of C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a validated chart-based method. Long-term outcomes were assessed 10 years after surgery by a telephone interview. Results: The overall incidence of delirium in the total cohort was 48% regardless of the surgical approach (CABG vs. OPCAB). Serum ANP levels > 64.6 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 100% (75.3–100) and specificity of 42.9% (17.7–71.1). Serum NT-proCNP levels >1.7 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 92.3% (64.0–99.8) and specificity of 42.9% (17.7–71.1). Both NPs could not predict postoperative survival or long-term cognitive decline. Conclusions: We found a positive correlation between delirium and preoperative plasma levels of ANP and NT-proCNP. A well-powered and prospective study might identify NPs as biomarkers indicating the risk of delirium and postoperative cognitive decline in patients at risk for postoperative delirium.

Blood flow assessment by transit time flow measurement and its prognostic impact in coronary bypass surgery.

The competitive coronary flow is influenced by the severity of the stenosis and may affect graft patency. Transit time flow measurement (TTFM) enables intraoperative graft evaluation and cardiac magnetic resonance (MRI) allows for graft evaluation during follow-up. Competitive flow and target vessel diameters were determined in 35 patients undergoing off-pump coronary bypass graft surgery (CABG) and correlated to TTFM. Cardiac function, ischemia, and graft flow were evaluated using cardiac MRI during the follow-up period to determine the impact of above-mentioned parameters on graft patency. Competitive flow led to reduced mean graft flow (MGF) and increased pulsatility index (PI) in arterial grafts. This effect to was not observed in veins. Smaller target coronary arteries (<1.5 mm) were associated with reduced MGF, more pronounced in veins, which presented increased PI and shortened diastolic flow fraction (DF). No death and no re-hospitalization for acute coronary syndrome occurred. Borderline values of TTFM (mean MGF 13±4 mL/min; PI 3.8±1) in left internal mammary artery (LIMA) were mainly observed due to increased native anterior descending artery (LAD) flow. These LAD's collateralized occluded right coronaries (RCA). The corresponding LIMA to LAD grafts showed a bypass flow increase at cardiac MRI follow-up. Two graft occlusions occurred: one in LIMA-to-LAD bypass with borderline TTFM, which did not collateralize the RCA and one in a vein graft with borderline TTFM bypassed on a narrow vascular target. Competitive flow has an impact on arteries contrary to veins. Veins are at risk for occlusion when grafted to smaller targets. Borderline LIMA flow should be considered as potentially dangerous, if satisfactory explanations are missing, e.g. in the absence of a large coronary target without flow competition.

Remifentanil and sevoflurane based anesthesia combined with bilateral erector spinae plane block in patients undergoing off-pump coronary artery bypass graft surgery.

IntroductionWorking on the institutional Enhanced Recovery After Surgery (ERAS Cardio) protocol for off-pump coronary artery bypass graft surgery (OP-CABG) we have noticed that patients treated according to the modified anesthesia protocol had not only significantly shorter time of respiratory support and intensive care unit stay but also lower postoperative troponin T concentration than patients who had standard fentanyl/sevoflurane-based anesthesia.AimTo compare the perioperative course of patients undergoing OP-CABG surgery and receiving standard fentanyl/sevoflurane anesthesia and those anesthetized according to the institutional ERAS Cardio protocol with remifentanil, sevoflurane, and bilateral extensor spinae plane (ESP) block.Material and methodsDesign: a prospective, open-label, observational study performed in a tertiary health center. Participants: 30 consecutive patients undergoing off-pump coronary bypass graft surgery. Interventions: 15 patients had standard anesthesia with etomidate, fentanyl, and rocuronium for induction and fentanyl/sevoflurane for maintenance (standard group); 15 others had bilateral single shot ESP block, then etomidate, remifentanil and rocuronium for induction, and remifentanil/sevoflurane for maintenance of anesthesia.ResultsMedian time to extubation was 7.6 (5.5–12.5) h and 1.7 (1–3.25) h in “standard care” and ERAS groups, respectively (p = 0.00002). Length of stay in the intensive care unit was also shorter for patients in the ERAS group 20.5 (18–24) vs. 48 (42–48) h (p = 0.00001). Troponin concentration increased to a lesser extent in patients from the ERAS group: an increase of 151.8 (71.9–174.3) ng/ml vs. 253.8 (126.6–373.1) ng/ml, p = 0.008.ConclusionsRemifentanil/sevoflurane anesthesia combined with bilateral ESP block shortens mechanical ventilation time and ICU stay, and decreases postoperative troponin-T concentration in patients undergoing off-pump coronary bypass graft surgery.

Prediction of complications and death in octogenarians with left main coronary artery disease after coronary artery bypass implantation - off-pump, on-pump and minimally invasive techniques comparison.

IntroductionOff-pump coronary artery bypass grafting is considered potentially more effective than on-pump surgery in elderly patients.AimTo compare the early and long-term results of these techniques in patients ≥ 80 years of age with left main coronary artery disease.Material and methodsAll patients ≥ 80 years of age (N = 3648) who were reported to the Polish National Registry of Cardiac Surgery Procedures between 2006 and 2016 and underwent primary, isolated coronary artery bypass surgery were included in the study. The patients were divided into 2 groups: group A – without significant left main stenosis (LMS) (n = 2094) and B group – with LMS ≥ 50% (n = 1524). The groups were compared according to the type of surgery: on-pump (A = 1107 vs. B = 891), off-pump (A = 908 vs. B = 616) and MIDCAB (A = 79 vs. B = 17).ResultsThere were significant differences in preoperative status between the groups in the whole cohort, which were not observable after propensity score matching. The in-hospital mortality was significantly higher in the LMS group operated on-pump (10.5% vs. 7.0%; p = 0.01) and non-significant in the off-pump group (5.1% vs. 5.7%; p = 0.78), as well as in the MIDCAB subgroup (5.9% vs. 5.1%; p = 0.64). 10-year survival in all subgroups was comparable and remained at a level of 50–60%. The mean entire cohort follow-up was 3.4 ±2.7 vs. 3.7 ±2.8 years (p = 0.2).ConclusionsOff-pump coronary bypass grafting may optimize the outcomes in elderly patients with significant left main stenosis. Octogenarians surgically treated for coronary artery disease, despite increased post-operative risks, present encouraging long-term survival.

Predictors of early vein graft failure after off-pump coronary artery bypass grafting: angiocomputed tomographic results of 233 patients.

Low saphenous vein graft (SVG) patency has become the bottleneck in surgical revascularization. This study aimed to identify the predictors of early vein graft failure (VGF) after off-pump coronary bypass grafting (OPCAB). A total of 233 patients who had OPCAB were postoperatively evaluated by coronary computed tomography angiography. Logistic regression analyses were performed to detect the predictors of early VGF (FitzGibbon-B/O) at both the patient and the graft level. Overall FitzGibbon-A patency of SVG at 1 week after OPCAB was 94.1% (659/700). At the patient level, a patient who had at least 1 VGF was regarded as an event, and increased preoperative platelet count [odds ratio (OR) 9.848], quantity of perioperatively transfused red blood cells (RBC) (U, OR 1.544) and creatinine clearance rate (CCr) (ml/min, OR 1.037) were predictors of early VGF, whereas use of a left internal mammary artery graft was a protective factor (OR 0.348). At the graft level, when VGF was regarded as an event, increased preoperative platelet count (OR 17.450), CCr (ml/min, OR 1.034), quantity of perioperatively transfused RBC (U, OR 1.505) and endarterectomy (OR 5.499) were predictors of early VGF. Under the same circumstances, dual antiplatelet therapy (OR 0.419), recipient vessel diameter (mm, OR 0.052), graft run-off (ml/min, OR 0.949), preoperative RBC count (×1012, OR 0.576) and a side-to-side (when compared with end-to-side) anastomosis (OR 0.276) were protective factors. The patency of SVGs sutured to vessels with a larger diameter (>1.5 mm) was significantly higher than that of the others (96.6% vs 91.1%). SVGs with greater run-off (>25 ml/min for each anastomosis) were significantly more patent than others (95.1% vs 88.7%). Early SVG patency after OPCAB was satisfactory. Increased preoperative platelet count, more perioperative RBC transfusions and higher CCr were predictors of patients with early VGF, whereas use of a left internal mammary artery graft was a protective factor. Increased preoperative platelet count, higher CCr, more perioperative RBC transfusions and endarterectomy were predictors of VGF, whereas dual antiplatelet therapy, larger recipient vessel diameter, greater graft run-off, higher preoperative RBC count and side-to-side anastomosis were protective factors. Recipient diameter >1.5 mm and graft run-off >25 ml/min were cut-off values for detecting VGF.

Mid- and long-term prognosis of off- vs. on-pump coronary artery bypass graft in patients with multisite artery disease

Among patients with coronary artery disease (CAD), around 25% have multisite artery disease (MSAD). Patients with CAD and MSAD are at higher risk of peri-operative and long-term cardiovascular events. Whether off-pump coronary bypass grafting (CABG) can improve their prognosis is unknown. We aimed to assess the benefits of off- vs. on-pump cardiac surgery in patients undergoing CABG, according to coexistence of extra-cardiac artery disease. Between April 1998 and September 2008, 1221 patients undergoing CABG without any other intervention were enrolled. Overall death and major cardiovascular events were recorded at 1-month and during long-term follow-up. A propensity score (PS), derived from all relevant variables (P<0.25) associated with on-pump as compared to off-pump CABG, and representing the likelihood for each individual patient to receive off-pump CABG, was calculated. MSAD was observed in 279 patients (23%). Off-pump CABG was performed in 208 (17%) patients. The median follow-up was 7.6 years. The 10-year mortality was significantly lower in off- vs. on-pump CABG group (74±4% vs. 68±2%, P=0.024). In patients with MSAD, there was a trend for better survival for off- vs. on-pump CABG (63±8% vs. 50±4%, P=0.078). After adjustment for PS, we found no further difference between on- and off-pump CABG both in the whole cohort (HR=1.30, P=0.10), as well as in MSAD patients (HR=1.51, P=0.14). Patients with MSAD receiving CABG are at worst prognostic than those with isolated CAD. In these patients, we found no significant difference in the long-term mortality and cardiovascular events between on- and off-pump CABG.

Changes in coagulation hemostasis when using colloidal solutions during off-pump coronary artery bypass grafting surgery

The results of the use of colloidal and crystalloid solutions during surgical intervention of patients with coronary heart disease are presented. The effect of colloidal solutions on the coagulation hemostasis system and the associated perioperative complications were studied. The study included 60 patients operated in the NIST named after O.O. Shalimov on coronary heart disease who underwent off-pump coronary bypass grafting surgery: 40 patients (in the intraoperative period solutions of hydroxyethyl starch 130/0.4 were used (20 patients) and 4% gelatin (20 patients) were used in the intraoperative period); the comparison group included 20 patients (only crystalloid solutions were used in the intraoperative period). The results of general and biochemical analysis of blood, electrolyte, acid-base and gas composition of blood were analyzed, prothrombin time was determined, prothrombin index, international normalized ratio, activated partial thromboplastin time, thromboelastometry. The statistical analysis of the material was carried out using standard methods using the application package “MS Excel” and “StatPlus 2007 Professional”. Evaluated the average, standard errors, the authenticity of the differences. To estimate the intergroup difference, the parametric t-criterion of the Student was used, while the links between the indicators were determined - a correlation analysis by Pierson. The results obtained showed a negative effect on the coagulation hemostasis system of colloidal solutions (changes in the thromboelastometry, prothrombin time and index) and an increase in the frequency of postoperative complications (blood loss, the need for blood transfusion, prolonged stay in the intensive care unit and hospital). The results of the study provide a perspective in the further study of the effect of colloidal solutions on coagulation hemostasis during other surgical interventions (thoracic, abdominal, etc.), as well as the use of the thromboelastometry method in clinical practice for early diagnosis of coagulation hemostasis disorders.

Concurrent Carotid Endarterectomy and Off-Pump Coronary Artery Bypass Graft Surgery in Bangladesh: A Prospective Cohort Study

A patient of ischemic heart disease (IHD) with additional carotid artery stenosis (CAS) has been distinguished as a high risk group for both heart and cerebral inconveniences following surgical intervention. We aimed to review the outcome of concurrent carotid endarterectomy (CEA) and off-pump coronary bypass graft (OPCABG)in a patient undergoing surgical revascularization for IHD and CAS at our institute.In the vicinity of 2014 and 2016, fifteen patients experienced OPCABG and CEA associatively in a single Surgeon's Practice. Six (40%) patients had a history of myocardial infarction (MI), four (26.66%) had unstable angina (USAP), and three (20%) had USAP together with MI, though two (13.33%) were asymptomatic. Nine (60%) patients demonstrated no neurological manifestations, three (20%) had transient ischemic assaults (TIAs), two (13.33%) experienced stroke, and 1 (6.66%) experienced both. Majority 7 (46.66%) patients had 75-90% carotid artery stenosis and 6(40%) patients experienced right though 8 (53.33%) experienced left CEA and only 1 (6.66%) had bilateral CEA. Five (33.33%) patients were found left main disease (&gt;50% lesion) and 100% patients have had significant Left Anterior Descending (LAD) lesion in this study. Twelve (80%) patients show significant lesion in Right Coronary Artery (RCA) and ten (66.66%) patients had Obtuse marginal (OM) branch disease. CEA was performed before OPCABG in all cases. There were 15 patients (mean age 62.5±2.8 years; 80% were male), two (13.33%) had a perioperative stroke while one of them had TIAs (6.6%). Mean ICU stay was 36.6±4.5 h and patients were released in 10 days. There was no mortality in the early postoperative period and co-morbidity was less significant (6.6% myocardial ischemia, 13.33% atrial fibrillation, 6.66% TIA, 13.33% Stroke). There was 1 (6.66%) postoperative acute renal failure evidenced by raised serum creatinine level. Two (13.33%) patients showed respiratory complications; only 6.6% of them suffered from wound infection. A combined strategy by means of CEA with OPCABG is safe and savvy in view of the satisfactory consequences of morbidity and mortality rates and also short ICU and hospital stay status.Faridpur Med. Coll. J. Jan 2018;13(1): 2-7

Concurrent Carotid Endarterectomy and off-Pump Coronary Artery Bypass Graft Surgery in Bangladesh: a Prospective Cohort Study

Background: A patient of ischemic coronary artery disease (IHD) with additional carotid artery stenosis (CAS) has been distinguished as a high risk group for both heart and cerebral inconveniences following surgical intervention. We review the outcome of concurrent carotid endarterectomy (CEA) and off-pump coronary bypass grafting (OPCABG)in a patient undergoing surgical revascularization for IHD and CAS in a single surgeons practice.Materials and Methods: In the vicinity of January 2012 and December2016,fifteen patients experienced OPCABG and CEA associatively in a single Surgeon's Practice. Majority 46.66% patient have 75-90% Carotid artery stenosis and 40%patients experienced right sided lesion, though 53.33% experienced left sided lesion. 33.33% patients were found Left main coronary artery disease (&gt;50% lesion) and 100% patients have had significant LAD lesion in this study. CEA was performed before OPCABG in all cases.Result: Themean age was 62.5±2.8 years; 80% were male. 13.33% had a perioperative stroke while one of them had TIAs (6.6%). Mean ICU stay was 36.6±4.5 hours and patients were released in 10±2 days. There was no mortality in the early postoperative period and co-morbidity was less significant; only 6.6% myocardial ischemia, 13.33% Atrial fibrillation, 6.66% TIA, and 13.33% Stroke.Conclusion: A combined strategy by means of CEA with OPCABG is safe and savvy in view of the satisfactory consequences of morbidity and mortality rates and also short ICU and hospital stay status.Anwer Khan Modern Medical College Journal Vol. 9, No. 1: Jan 2018, P 15-21

Respiratory function following on-Pump versus off-pump coronary bypass grafting surgery

Objective: Respiratory dysfunction is a very common postoperative complication that occurs after cardiac surgery. Among the suggested causes is cardiopulmonary bypass. We compared the effect of on-pumpcoronary artery bypass grafting (ONCABG) versus off-pumpcoronary arterybypass grafting (OPCABG) on postoperative respiratory function. Methods: Patients were prospectively divided into two groups ONCABG and OPCABG, (n=100 in each). Respiratory variables (Pao2, Paco2, Sao2, and Pao2/Fio2 ratio) were measured prior to induction of anaesthesia then at seven time points (ICU admission, postoperative hours 1, 3, 6, 12, 18, and 24). Time to extubation, rates of reintubation, and use of noninvasive ventilation (NIV) were also evaluated. Results: Baseline preoperative arterial blood gases and alveolar/arterial oxygen pressure gradients were similar in both groups. Postoperatively, all values were significantly higher in the OPCABG group only at ICU admission (p<0.05). No differences were seen in time to extubation, rate of reintubation rate, and use of postoperative NIV. Conclusion: There is a slightly less incidence of lung injury with OPCABG as compared to ONCABG in low-risk patients especially in the early postoperative period.