Off-pump Coronary Bypass Surgery Research Articles

Analysis of predictors of the development of chronic heart failure in pa-tients after coronary bypass on a working heart

Тhe article analyzes the prevalence of coronary heart disease (CHD) and its surgical treatment by performing coronary bypass surgery off-pump. The purpose of the study was to investigate echocardiography parameters in patients with CHD after off-pump coronary bypass surgery, depending on the number of shunts and their origin. The study included 521 people (416 men, 105 women), their average age was (64.2±3.4). All study participants underwent coronary bypass surgery off-pump. The article analyzes single-, two- and multi-vessel lesions of coronary arteries, paying attention to the origin of shunts. What were used during the provision of coronary bypass surgery off-pump. Attention is paid to echocardiography indicators, which are indicators of heart failure – left ventricular ejection fraction and end-diastolic volume. It has been established that coronary bypass surgery off-pump allows for the elimination of structural features (left ventricular ejection fraction, end-diastolic volume) and there are no restrictions on the number of applied shunts (distal anastomoses). Coronary bypass surgery off-pump is possible in severe clinical conditions of the patient, presence of concomitant pathology and is performed only if the operating surgeon has extensive operational experience. His assistants and the entire hearth team. Thus, it is extremely important to substantiate the indications for performing coronary bypass surgery on a working heart, taking into account the patient's personal characteristics, his age, the number of affected vessels, the structural features of the vascular bed, the functional state of the cardiovascular system and other body systems, which will allow to increase the efficiency surgical treatment of coronary heart disease, extend the duration and improve the quality of life of patients. Keywords: perforation, bleeding, stenosis, penetration, vagotomy, gastric resection.

Analysis of Cardiovascular Risk Factors in Patients with Coronary Heart Disease Qualified for Off-Pump Coronary Bypass

The aim. To analyze the prevalence of cardiovascular risk factors for circulatory diseases in patients with coronary heart disease (CHD) after coronary bypass surgery (off-pump coronary artery bypass grafting).
 Material and methods. The study included 991 subjects (786 men, 205 women), mean age 64.3 ± 1.4 years. All the study participants underwent off-pump coronary bypass surgery.
 Results. Based on modern ideas about risk factors for circulatory diseases and CHD, it is impossible to ignore the influence of cardiovascular factors, both modifiable and non-modifiable. The analysis of medical and social risk factors for CHD, which include age, body weight, eating habits and smoking, showed that these medical and social factors are common among patients with CHD. It was found that the prevalence of excess body weight among men with CHD was significantly higher in patients with multivessel lesions than in those with 1-vessel lesions (p=0.05, χ2=3.69). Among women with CHD, excess body weight was significantly higher in the clinical group with multivessel lesions compared to 2-vessel lesions (p=0.002, χ2=9.06). It was also found that the prevalence of excess body weight was significantly higher in clinical groups with 1-vessel lesions among men compared to women (p=0.04, χ2=3.95). It was established that the frequency of obesity was significantly more common in women of different clinical groups compared to men: with 1-vascular lesions (p=0.04, χ2=3.95); with 2-vessel lesions (p=0.0001, χ2=24); with multivessel lesions (p=0.0001, χ2=186.57). It was established that men smoke significantly more often than women (p=0.0001, χ2=31.22). The obtained results complement the scientific data of the world epidemiological studies regarding the determination of the role of medical and social factors in the development of CHD. The article analyzes excess body weight, obesity and smoking as the leading etiological factors for CHD. It was established that the risk of developing CHD is reliably associated with excess body weight, obesity and smoking, among different clinical groups of male and female patients, both with single-vessel lesions and with multivessel lesions in CHD.
 Conclusions. Analysis of cardiovascular risk factors for the development of CHD, which include age, body weight, eating habits, and smoking, showed that their further study is relevant, as these are common among patients with CHD. It was established that frequency of excess body weight in patients with CHD, both in men and women, was significantly higher among individuals with multivessel lesions. The prevalence of obesity among patients with CHD presented for off-pump coronary artery bypass grafting was significantly higher among women in groups with different numbers of affected coronary vessels. As for smoking, it was established that this behaviorally associated habit is significantly more common among men with CHD. The reliable patterns of prevalence of excess body weight, obesity and smoking in patients with CHD established as a result of the study of cardiovascular factors prove that these factors have high etiological contribution to the development, course and number of affected vessels in CHD.

Emergency coronary artery bypass surgery in octogenarians with acute coronary syndrome: off and on pump.

The risk of operation in cardiac surgery increases logarithmically with advanced age. In older individuals, additional comorbidities compel the clinician to deal with postoperative complications. The mortality and morbidity rates of emergency coronary artery bypass surgery (CABG) in the presence of acute coronary syndrome (ACS), or just after it, are higher than those of elective surgeries. In our study, we compared the outcomes of off-pump coronary bypass (OPCAB) and on-pump coronary bypass surgery (ONCAB) in this high-risk subgroup. 383 octogenarians who underwent isolated emergency CABG due to ACS were divided into two groups according to the coronary bypass technique. Group 1 (off-pump) median age (IQR) 84 years (min: 80-max: 99, n = 130); Group 2, (on-pump) median age 85 years (min: 80-max: 89, n=253). Preoperative, intraoperative, and postoperative data were collected retrospectively on standard variables. OPCAB and ONCAB outcomes were compared. ONCAB patients had a significantly longer intensive care unit stay, longer hospital stay, more transfused erythrocyte suspension, more low cardiac output syndrome and acidosis, a higher rate of acute renal failure and a higher rate of stroke than OPCAB patients (respectively; p=0.003; p=0.008; p=0.002; p=0.031; p=0.038, p=0.022, respectively). We showed that emergency OPCAB as a revascularization option in elderly patients with acute coronary syndrome is more advantageous in terms of preventing major postoperative complications.

Long-Term Survival Associated With Multiple Arterial Grafting in Off-Pump and On-Pump Coronary Bypass Surgery

There is a paucity of evidence on whether the survival advantage of multiple arterial revascularisation (MAG) would have an association with off-pump (OPCAB) or on-pump coronary artery bypass grafting (ONCAB). Therefore, this study sought to evaluate the long-term survival of using multi aterial grafting (MAG) vs single arterial grafting (SAG) in OPCAB and ONCAB cohorts.

(634) Is Off-Pump Coronary Bypass Surgery the Savior of Low EF Coronary Artery Disease Patients?

(634) Is Off-Pump Coronary Bypass Surgery the Savior of Low EF Coronary Artery Disease Patients?

Off-Pump Coronary Bypass Surgery: Time for the Myths to Face Reality

Off-Pump Coronary Bypass Surgery: Time for the Myths to Face Reality

Hemodilution on microvascular oxygen delivery potential of the blood during coronary bypass surgery.

The hematocrit-to-whole blood viscosity ratio (Hct/WBV) reflects the blood O2 delivery potential (O2-DP). WBV is variable to the dynamic vascular shear rate (SR), 1-5/s at microcirculation and 300/s at larger vessels. To estimate the impact of hemodilution on the blood O2-DP to the myocardium, we analyzed the hemodilution-induced change of Hct/WBV at SR 5/s (Hct/WBV5) during off-pump coronary bypass (OPCAB) surgery. During OPCAB surgery (n = 21), 10% acute normovolemic hemodilution (HD 10%) was applied. Arterial blood samples were taken: one before and two after HD 10%. One of which after HD 10% underwent an additional 33% in vitro hemodilution (reaching 40% hemodilution in total, HD 40%). WBV of all blood samples was determined using a scan-capillary tube viscometer (Hemovister™). The changes of Hct/WBV5 were analyzed as a primary measure of the study and compared with those of Hct/WBV at SR 300/s (Hct/WBV300). Median[IQR] of Hct/WBV5 [3.5 (2.8-4.2)%/cPoise] was significantly increased by HD 10 and HD 40% [3.6 (3.2-4.6)%/cPoise and 4.2 (3.3-5.2)%/cPoise, respectively, all P < 0.001], but the degrees of changes after HD 10 and HD 40% were not different. Median[IQR] of Hct/WBV300 [10.3(8.6‒10.8)%/cPoise] was not changed by HD 10% [10.3(9.1-11.1)%/cPoise], but it was significantly decreased by HD 40% [8.4(7.4‒9.2)%/cPoise, P < 0.001]. The increased Hct/WBV5 suggests that 10-40% hemodilution improves the blood O2-DP to the myocardium during OPCAB surgery. The SR-specific discrepancy in Hct/WBV changes advocates using microvascular WBV and Hct/WBV to evaluate the blood O2-DP changes to the myocardium. Further study is warranted to assess the actual changes in myocardial O2 delivery.

The use of intraoperative transit time flow measurement can reduce postoperative myocardial injury.

This study investigates the relationship between the use of transit time flow measurement (TTFM) and postoperative myocardial injury in off-pump coronary artery bypass grafting (OPCABG). In this retrospective study, we collected basic data from patients hospitalized for OPCABGin the Department of Cardiothoracic Surgery, Changzhou Second People's Hospital Affiliated with Nanjing Medical University. According to the academic research consortium (ARC)-2 definition of significant myocardial injury, we used cardiac troponin I >2380 ng/L as a criterion for significant postoperative myocardial injury. We use logistic regression and forest plots to assess the association of TTFM use with myocardial injury outcomes. One hundred and forty-six patients were included in this study. The overall median age of these patients was 65.05 years, and 32 (21.92%) experienced a postoperative myocardial injury. TTFM was independently associated with the incidence of postoperative myocardial injury (odds ratio = 0.34 [95% confidence interval = 0.15-0.78]; p = .01), and we found similar trends in regression analyses across subgroups of sex, age, number of bridging vessels, hypertension, diabetes mellitus, BMI, and percutaneous coronary revascularization. One hundred andsixpatients were followed for 1-year vessel permeability, and sevenpatients (6.6%) were occluded. The use of TTFM is independently associated with a reduced incidence of postoperative myocardial lesions during off-pump coronary bypass surgery. The TTFM procedure in OPCABGdeserves to be actively promoted to reduce the incidence of postoperative myocardial injury.

THE RELATIONS OF DIABETES, TRACE ELEMENT, OXIDATIVE STRESS, AND HOMOCYSTEINE IN PATIENTS UNDERGONE OFF-PUMP CORONARY ARTERY BYPASS SURGERY

Background: The main cause of atherosclerosis is the disruption of trace element biobalance and endothelial damage accompanied by increased oxidative stress. Methods: In this clinical prospective study, all diabetic patients were randomly selected according to the Euroscore II risk classication. Offpump coronary bypass surgery was performed in all cases. From the blood samples taken before and after the surgery, zinc and copper, malondialdehyde lipid peroxidase (MDA), superoxide dismutase (SOD), total oxidant/antioxidant capacity (TOS/TAC), nitric oxide (NO), HbA1c and homocysteine levels were analyzed. Results:Early postoperative processes were signicantly longer in the diabetic group. Trace elements did not change after surgery. TOS, NO, and SOD activities were signicantly increased in all groups compared with the control group. NO levels signicantly increased in the T1DM group compared with the control group. (p &lt;0.05). There was a positive correlation between HbA1c and homocysteine, especially in T1DM (p &lt;0.05). Conclusion: Zn/Cu and SOD levels were not affected by the operation in patients from the same risk group, and the hospital stay was longer in the diabetic group. NO, and MDA levels increased after surgery due to inammatory stress, but homocysteine levels did not change except in cases requiring a long hospital stay.

Robotic hybrid coronary revascularization versus conventional off-pump coronary bypass surgery in women with two-vessel disease.

Hybrid coronary revascularization (HCR) treats coronary artery disease (CAD) by combining a minimally invasive surgical approach with the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery and percutaneous coronary intervention (PCI) for non-LAD vessels. This study aimed to compare immediate and long-term outcomes between robotic HCRand off-pump coronary artery bypass (OPCAB) via sternotomy in women with two-vessel CAD. We compared all robotic HCR (LIMA-to-LAD plus stent; n = 55) and OPCAB (LIMA-to-LAD plus saphenous vein graft; n = 54) performed at a single institution between May 2005 and January 2021. To adjust for the selection bias of receiving either HCR or OPCAB, we performed a propensity score analysis of 31 matched pairs. In the immediate postoperative period, no statistically significant difference was observed for operative mortality and HCR was associated with lower rates of blood transfusion (25.8% vs. 54.8%; p = .038), and shorter hospital length of stay (4.0 vs. 6.0 days; p = .009). After a mean follow-up of 7.0 ± 4.9 years, we observed no statistically significant differences between the groups for overall survival (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.09-2.64, p = .401), myocardial infarction (HR: 1.60, 95% CI: 0.14-17.64, p = .703), stroke (HR not assessable; almost zero events), target vessel revascularization (HR: 0.45, 95% CI: 0.08-2.47, p = .359), angina (HR: 0.64, 95% CI: 0.20-2.01, p = .444) and major adverse cardiac and cerebrovascular events (HR: 0.46, 95% CI: 0.14-1.52, p = .202). Robotic HCR provides for women with two-vessel CAD a shorter postoperative recovery with fewer blood transfusions, with similar long-term outcomes when compared with conventional OPCAB via sternotomy.

Real-World Outcomes of On- vs Off-pump Coronary Bypass Surgery: Result From Korean Nationwide Cohort

BackgroundAlthough several randomized trials have shown conflicting results regarding the comparative effectiveness of on- and off-pump coronary artery bypass grafting (CABG), research on long-term outcomes in large-scale, real-world clinical settings are limited. The study sought to examine the comparative effectiveness of on- and off-pump CABG in a real-world clinical setting. MethodsUsing the nationwide claims database of the Korean National Health Insurance Service, the study identified patients who underwent isolated CABG from 2004 to 2013. Propensity-score matching with multivariable adjustment was used to assemble a cohort of patients with similar baseline characteristics. ResultsAmong 23 828 patients, 12 639 in the off-pump group (53.0%) and 11 189 in the on-pump group (47.0%) were enrolled. After matching, 6483 pairs were included in the final analysis. At 30 days, there was no significant difference in adjusted mortality between the off- and on-pump groups (hazard ratio [HR], 1.00; 95% CI, 0.87-1.16). During long-term follow-up (100% complete; median, 5.3 years; maximum, 13.2 years), however, off-pump CABG was associated with a higher risk of mortality than on-pump CABG (HR, 1.09; 95% CI, 1.03-1.15). The risks of myocardial infarction (HR, 1.3; 95% CI, 1.16-1.45) and repeat revascularization (HR, 1.50; 95% CI, 1.37-1.63) were also significantly higher in the off-pump CABG group than in the on-pump CABG group, whereas the stroke risk was similar between the groups (HR, 0.99; 95% CI, 0.87-1.13). ConclusionsIn this contemporary, nationwide, clinical practice claim registry, off-pump CABG was associated with higher long-term risks of mortality, myocardial infarction, and repeat revascularization than on-pump CABG.

Levels of phospholipids and triacylglycerol-containing omega 3 fatty acids in myocardial tissue of patients with myocardial infarction: analyzed by a lipidomics profiling method

Abstract Objective According to population-based studies, low omega 3 fatty acid (omega3FA) intake and high levels of serum triacylglycerol (TAG) are associated with cardiovascular diseases. Recent advances in mass spectrometry allow molecular lipid (lipidomics) profiling, which may enhance cardiovascular risk prediction. In this study, we assessed the levels of omega3FA-containing phospholipids (PL) and TAG in myocardial tissues of patients with and without myocardial infarction (MI) using a lipidomics profiling method. Methods We performed lipidomics profiling of human left atrial appendage (LAA) tissue of 29 consecutive patients receiving off-pump coronary bypass surgery with standard LAA resection. The patients were divided into the MI group (n=7) and an age- and gender-matched non-MI group (n=7). Results Lipidomics profiling revealed that the MI group tended to have low levels of phosphatidylcholines (PC), phosphatidylethanolamine (PE), lysophosphatidylethanolamine (LPE), and plasmalogen, and high levels of TAG species. Individual molecular species containing omega3FA, such as PC (18:0/20:5; 3,200±1,200 vs. 4,500±910 pmol/g tissue, p=0.04) and plasmalogen (18:1/20:5; 57,000±21,000 vs. 91,000±28,000 pmol/g tissue, p=0.02), were significantly lower in the MI group than in the non-MI group. Conclusions To our knowledge, this is the first study to determine the levels of omega3FA-containing PL and TAG in myocardial tissue using lipidomics profiling. We discovered that lower levels of omega3FA-containing PL and higher levels of TAG existed in myocardial tissues of patients with MI than in those of patients without MI. Accordingly, the lipidomics profiling method for human myocardial tissue may be useful for developing therapy targets for cardiovascular diseases. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): MEXT/JSPS KAKENHI Grant

Investigation of the Effect of Preoperative Hypoalbuminemia, Blood Urea Nitrogen and Creatinine Levels on Postoperative Atrial Fibrillation on Off-Pump Coronary Bypass Surgery Patients.

Postoperative atrial fibrillation (PoAF) is one of the most common complications to occur after open heart surgery. It has been shown that hypoalbuminemia accompanies some cardiovascular disorders. The present study evaluates the effects of pre-procedural albumin, blood urea nitrogen (BUN), and creatinine levels on PoAF. The data of 81 patients who underwent off-pump coronary artery bypass graft (CABG) surgery was evaluated. Patients who developed atrial fibrillation (AF) in the first 48 hours post surgery constituted the PoAF (+) group, while those without AF constituted the PoAF (-) group. The pre-procedural hematological parameters of patients in both groups were included in the analysis. The PoAF (+) group was comprised of 57 patients (70.3%) with a mean age of 65.5 ± 9.8 years, while the PoAF (-) group was comprised of 24 patients (29.7%) with a mean age of 60.6 ± 9.6 years. A comparison of the demographic characteristics of the two groups showed that age (P = .036), frequency of renal failure (P = .007), and frequency of DM (P = .001) were higher in the PoAF (+) group. An examination of the laboratory data revealed a negative correlation between Hct (P = .001) and albumin (P = .000) levels and presence of PoAF. Also, the MPV (P = .02), BUN (P = .007), and Cr (P = .043) values were higher in the PoAF (+) group. The present study, whose focus was on the effects of albumin levels on the occurrence of PoAF, found that low levels of pre-procedural albumin, as one of the major proteins in the blood, is a risk factor for the development of PoAF.

Prevention and management of suture piercel of intra-coronary shunt at off-pump coronary bypass surgery.

Prevention and management of suture piercel of intra-coronary shunt at off-pump coronary bypass surgery.

Fibrinolysis and the Influence of Tranexamic Acid Dosing in Cardiac Surgery

The present study aimed to determine whether underlying disease, performed surgery, and dose of tranexamic acid influence fibrinolysis measured with D-dimer levels. Retrospective analysis. Single institution (Department of Cardiac Surgery and Section of Clinical Hemostaseology at the Düsseldorf University Hospital). The study comprised 3,152 adult patients undergoing elective cardiac surgery between February 2013 and October 2016. Two doses of tranexamic acid during surgery were administered. D-dimer levels were analyzed at the start of surgery and before protamine administration. D-dimer levels at the start of surgery were compared according to disease. Intraoperative D-dimer development was analyzed according to the type of surgery and within 2 cohorts with different tranexamic acid doses. Interindividual variability was pronounced for D-dimer levels at the start of surgery, with significant differences among patients with coronary artery disease, valve disease, and aortic disease and patients undergoing heart transplantation compared with patients receiving a left ventricular assist device (p < 0.01). Aortic dissection, endocarditis, and extracorporeal life support were associated with higher D-dimer levels (p ≤ 0.01). With tranexamic acid at a fixed dose, intraoperative D-dimer levels decreased in on-pump and off-pump coronary bypass surgery, valve surgery, and left ventricular assist device surgery (p ≤ 0.02), but levels increased in aortic surgery and heart transplantations (p < 0.01). A decrease or increase in D-dimer levels during surgery was influenced significantly by a higher or lower tranexamic acid dose (p ≤ 0.01). D-dimer testing allows for the assessment of individual fibrinolytic activity in cardiac surgery, which is influenced by disease type, surgery type, and dose of tranexamic acid. The assessment of the fibrinolytic status may have the potential to facilitate dose-adjusted antifibrinolytic therapy in the future.

Retractor in retractor technique.

Placing retractor and stabilization devices during open heart surgery can be difficult in obese patients due to extremely short neck and excessive breast tissue. Off-pump coronary bypass operations in these patients can be particularly technically demanding. To overcome this difficulty, we have used two retractors concomitantly. The first retractor is placed to the edges of sternum and the second one is placed into this first retractor. This maneuver ensures an extra height, and placing stabilization devices in this second retractor is relatively easy. Thus, we suggest that adding this maneuver will facilitate off-pump coronary bypass operations.

The Impella Device: Historical Background, Clinical Applications and Future Directions.

The Impella device is a catheter-based miniaturized ventricular assist device. Using a retrograde femoral artery access, it is placed in the left ventricle across the aortic valve. The device pumps blood from left ventricle into ascending aorta and helps to maintain a systemic circulation at an upper rate between 2.5 and 5.0 L/min. This results in almost immediate and sustained unloading of the left ventricle, while increasing overall systemic cardiac output. The most common indications for using the Impella device are in the treatment of acute myocardial infarction complicated by cardiogenic shock and to facilitate high risk coronary angioplasty. Other indications include the treatment of cardiomyopathy with acute decompensation, postcardiotomy shock, and off-pump coronary bypass surgery. A growing body of observational and registry data suggest a potentially valuable role for the Impella system in reducing the mortality associated with cardiogenic shock. However, there are, as of yet, no randomized controlled trial data supporting this observation.

Diyalize Bağımlı Kronik Böbrek Yetmezlikli Hastalarda On-pump ve Off-pump Koroner Baypas Cerrahisi

Diyalize Bağımlı Kronik Böbrek Yetmezlikli Hastalarda On-pump ve Off-pump Koroner Baypas Cerrahisi

P01-1 - Preoperative haemoglobin A1c predicts outcome following off-pump coronary bypass surgery

Diabetes has long been acknowledged as a risk factor for adverse outcome in cardiac surgery. However, results regarding the influence of various levels of perioperative glycaemic control on outcome are inconsistent, not to mention that it has been mainly tested in surgeries requiring cardiopulmonary bypass, a major confounder of glycaemic control. Glycated haemoglobin (HBA1c) indicates the degree of glycaemic control over the last 3 months, which would be a better predictor of outcome. We evaluated the impact of preoperative HbA1c in diabetic patients on perioperative glycaemic variability and outcome after OPCAB.

Inflammation, Atrial Fibrillation and Cardiac Surgery: Current Medical and Invasive Approaches for the Treatment of Atrial Fibrillation.

Atrial fibrillation (AF) is a cardiac dysrhythmia commonly seen in clinical practice especially after cardiac surgery. It is associated with increased morbidity and mortality for the patients. The pathogenesis of AF is not exactly understood yet, but there is growing data about the relationship between AF and inflammation. Cardiac surgery itself is a big source for inflammation. It causes major surgical trauma, ischemia/reperfusion injury, hypothermia, low arterial pressure, and the equipment of cardiopulmonary bypass makes a large foreign surface thus it activates inflammatory response. There is a large number of data about the treatment options of AF and there are also strategies, which are related to reduction of inflammatory activation during cardiopulmonary bypass. In order to review the relationship between cardiac surgery, inflammation, AF and treatment strategies in patients with AF, we conducted a search through Pubmed for articles in English using the keywords: "atrial fibrillation, cardiac surgery, inflammation, medical therapy, surgical therapy, ablation therapy" from January 2012 to present. We also searched separately for each alternative treatment modality on Pubmed. To identify further articles, we also looked into related citations in review articles and commentaries. We searched thoroughly the guidelines published by the European Society of Cardiology (2016), and the American Heart Association/ American College of Cardiology/ Heart Rhythm Surgery (2014). Many studies concluded that inflammation contributes in the occurrence of AF. Inflammatory markers, such as CRP, interleukins and complements have high sensitivity and specificity for prediction of AF whether the patient having cardiac surgery or not. Betablockers, diltiazem and amiodarone are the most commonly used drugs for rate control in AF following surgery. Although there are some new therapeutic approaches to reduce postoperative inflammatory activation, such as the use of vitamins, fatty acids, statins, or technical improvements to cardiopulmonary bypass unit like miniaturized bypass circuits, heparin coating of the circuits, leukocyte filters, or various surgical approaches like off-pump coronary bypass surgery, we still need more effective strategies to reduce both postoperative inflammation and postoperative AF risk after cardiac surgery. Today we use more advanced invasive and surgical treatment strategies for AF although we need far more advanced technics to reduce perioperative inflammatory activation, which actually causes AF.