Off-pump Coronary Artery Bypass Group Research Articles

The Impact of Intraoperative Transit-Time Flow Measurement on Off-Pump and On-Pump Bypass Surgery Based on Three Months: A Propensity Score Matching Study

Background: The goal of this study was to investigate how transit-time flow measurement (TTFM) parameters influenced the success of coronary bypass surgeries using the on-pump coronary artery bypass (ONCAB) and off-pump coronary artery bypass (OPCAB) techniques and to compare the rates of early graft failure and major adverse cardiac and cerebrovascular events (MACCE). Methods: We retrospectively analyzed subjects who underwent coronary bypass surgery at our institution between 2017 and 2023 and compared the TTFM data of patients divided into two groups based on the surgical method: ONCAB and OPCAB. We compared the postoperative and first three months' MACCE data to assess the impact of TTFM on the two surgical methods. Results: Of the 2032 patients who underwent coronary bypass, we analyzed data from 1540 patients in the ONCAB group and 194 patients in the OPCAB group. After propensity score matching, the TTFM data of 192 patients in both groups were compared. In the ONCAB group, a mean of 3.28 ± 0.7 grafts per patient was used, while 2.22 ± 0.6 grafts were used in the OPCAB group (p = 0.001). TTFM identified problems with 19 (4.7%) grafts in the ONCAB group and 29 (8%) grafts in the OPCAB group, leading to their revision (p = 0.001). Overall, the pulsatile index (PI) values in the OPCAB group were significantly higher than in the ONCAB group. Hospital mortality was 3.1% in the ONCAB group and 2.6% in the OPCAB group (p = 0.286). MACCE and graft failure rates were similar in the first three months. Conclusions: Utilizing TTFM to assess graft quality during surgery enhances coronary bypass surgery in both ONCAB and OPCAB procedures. The enhanced results are particularly crucial for a process like OPCAB surgery, which necessitates the expertise and experience of a surgeon and is challenging to execute.

Multi-vessel coronary artery grafting: analyzing the minimally invasive approach and its safety.

At our institution, we perform off-pump coronary artery bypass (OPCAB) as a standard procedure. Moreover, patients with favorable coronary anatomy and condition are selected for minimally invasive cardiac surgery (MICS)-OPCAB. We retrospectively compared early outcomes, focusing on safety, between MICS-OPCAB and conventional off-pump techniques for multivessel coronary artery bypass grafting (CABG). From August 2017 to September 2022, 1,220 patients underwent multivessel coronary artery grafting at our institution. They were divided into the MICS-OPCAB group (MICS group = 163 patients) and the conventional OPCAB group (MS group = 1057 patients). Propensity score matching (1 : 1 ratio) was applied to the MICS-OPCAB and MS groups (149 patients per group) based on 23 preoperative clinical characteristics. After matching, there were no significant differences in preoperative characteristics between the groups. The MICS group had a lower total graft number (2.3 ± 0.6 vs. 2.9 ± 0.8, p < 0.001) and fewer distal anastomoses (2.7 ± 0.8 vs. 3.2 ± 0.9, p < 0.001). There were no significant differences in hospital stay, intensive care unit stay, postoperative complications, and 30-day mortality. The MICS group had less drain output (MICS 350 ml [250-500], MS 450 ml [300-550]; p = 0.013). Kaplan-Meier analysis revealed no significant differences in postoperative MACCE (major adverse cardiac or cerebrovascular events)-free and survival rates between the groups (MACCE-free rate p = 0.945, survival rate p = 0.374). With proper patient selection, MICS-OPCAB can provide good short to mid-term results, similar to those of conventional OPCAB.

Does off-pump coronary bypass surgery reduce the incidence of postoperative atrial fibrillation?

Aim: We aimed to determine whether there was a difference in the incidence of new-onset postoperative atrial fibrillation (POAF) between off-pump coronary artery bypass (OPCAB) and conventional on-pump coronary artery bypass grafting (CCABG) surgery. In addition, we also aimed to determine the parameters that will help in the preoperative identification of patients who develop POAF. Material and Methods: A total of 100 patients who underwent CCABG (Group 1) and 100 patients who underwent OPCAB (Group 2) were included in this retrospective observational cohort study, and the groups were then compared with each other in terms of preoperative, operative and postoperative patient characteristics. In addition, patients with and without POAF were compared according to their characteristics in both groups. Results: New-onset POAF occurred in 16 of 100 patients in Group 1 and 18 of 100 patients in Group 2, and this difference was not statistically significant. Patients with POAF were significantly older than those without POAF in both Group 1 and Group 2. In addition, it was found that in only Group 2 the mean LVPS was significantly lower while the mean duration of hospital stay was significantly higher in patients with POAF than those without POAF. Conclusion: We suggested that advanced age was the most significant predictor of POAF development following CABG. According to the findings of our study, except for age there was no reliable indicator that can predict POAF development, although the mean LVPS was found to be lower in patients with POAF than those without POAF in OPCAB group. Nevertheless, further prospective well-designed studies with larger patient participation are required to support the findings of our study and obtain more valuable and powerful scientific evidence.

Comparison of Early Outcome of Off-pump and Conventional Coronary Artery Bypass Graft Surgery in Patients with Left Main Coronary Artery Disease with Left Ventricular Dysfunction

Left Main (LM) coronary artery disease and left ventricular dysfunction both are important predictors of in-hospital mortality. To avoid the harmful effects of cardio pulmonary bypass (CPB), many cardiac surgeons are using Offpump Coronary Artery Bypass (OPCAB) as an effective alternative to conventional CABG (CCAB) even in these sub-groups of patients. This study performed in the National Institute of Cardiovascular Diseases (NICVD) evaluated the early outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of CCAB in patients with left main coronary artery diseases with left ventricular (LV) dysfunction. Total 120 patients with left main coronary artery disease with reduced left ventricular ejection fraction (&lt;_40%) were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2012 and December 2017. All risk factors and co-morbidities were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarters (73.3%) of patients in OPCAB group and 80% in CCAB group received 3 grafts (p=0.470). The mean total operative time (p&lt; 0.001), intubation times (p&lt;0.001), blood losses (p &lt; 0.001); requirements for blood and blood products (p &lt; 0.0010), intensive care unit stays (p&lt;0.001) and hospital stays (p&lt; 0.001) were all significantly lower in the OPCAB group. OPCAB is a safe and effective operative revascularization procedure for patients with left main coronary artery disease with left ventricular dysfunction and is associated with reduced morbidity.&#x0D; Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):04-08

Outcome of Patients with Left Main Coronary Artery Disease Together with Left Ventricular Dysfunction Following OPCAB and Conventional CABG Surgery

In-hospital mortality and morbidities are significantly higher in patients who undergo coronary artery bypass graft (CABG) surgery having a depressed left ventricular function or a left main (LM) coronary artery disease. Due to the improvement in technique and clinical outcome, Off-pump Coronary Artery Bypass (OPCAB) is thought to be beneficial in patients with depressed left ventricular function by avoiding prolonged ischemic time. This study was performed with an aim to assess whether OPCAB is better than conventional on-pump CABG (CCAB) in these sub-groups of patients. We purposively selected 100 patients with left main coronary artery disease (defined as ≥50% stenosis) with reduced left ventricular ejection fraction (defined as ejection fraction 40% or less) who underwent elective CABG in National Institute of Cardiovascular Diseases (NICVD) between January 2014 and December 2020. Among them OPCAB was done in 50 patients and conventional CABG in another 50 patients. Both groups had similar pre-operative parameters. Total operative time, intubation time, blood loss, requirement for blood and blood products, intensive care unit (ICU) stay and hospital stay were all significantly lower in the OPCAB group. Post-operative complications were not statistically different among the two groups. Study finds that patients with left main coronary artery disease with left ventricular dysfunction can be safely revascularized in OPCAB technique.&#x0D; Bangladesh Med J. 2021 Sept; 50(3): 14-19

Minimal invasive coronary surgery is not associated with increased mortality or morbidity during the period of learning curve

Background Minimally invasive procedures for coronary revascularization have been performed for over 20 years; however, their technical complexity, steep learning curves and absence of training programs explain the weak acceptance of these techniques. The aim of this study is to describe the step-by-step learning process on how to establish a minimally invasive coronary artery revascularization program. The short-term outcomes of our first 30 patients were compared to our left internal mammary artery (LIMA) to left anterior descending (LAD) artery off pump coronary artery bypass (OPCAB) cohort as a quality control baseline. Methods All patients who benefited from an endoscopic atraumatic coronary artery bypass (Endo-ACAB) in our hospital, from July 2018 to May 2020 (n = 30) were identified. Baseline demographics, peri, postoperative and laboratory data were extracted from each patient’s medical records. These results were compared to our LIMA-LAD OPCAB cohort (n = 23). Results Twenty-eight patients were planned for a single LIMA-LAD Endo-ACAB. The remaining two had a T-graft double Endo-ACAB. Ten patients had a hybrid revascularization with the culprit lesion being treated first. Three patients were converted to sternotomy because of a LIMA lesion during thoracoscopic harvesting. We accounted three major adverse cardiovascular events (MACE). Demographic, peri and postoperative data showed no significant differences between the Endo-ACAB and the OPCAB group. Conclusion Endo-ACAB is a technically demanding operation, however, it can safely be introduced in centers with no previous experience with no extra cost in terms of morbidity or mortality. Thoracoscopic LIMA harvesting is the most demanding surgical skill to acquire.

Is postoperative cognitive decline after cardiac surgery associated with plasma beta amyloid 1\u201342 levels?

BackgroundPostoperative cognitive decline following cardiac surgery is one of the frequently reported complications affecting postoperative outcome, characterized by impairment of memory or concentration. The aetiology is considered multifactorial and the research conducted so far has presented contradictory results. The proposed mechanisms to explain the cognitive decline associated with cardiac surgery include the neurotoxic accumulation of β-amyloid (Aβ) proteins similar to Alzheimer's disease. The comparison of coronary artery bypass grafting procedures concerning postoperative cognitive decline and plasmatic Aβ1-42 concentrations has not yet been conducted.MethodsThe research was designed as a controlled clinical study of patients with coronary artery disease undergoing surgical myocardial revascularization with or without the use of a cardiopulmonary bypass machine. All patients completed a battery of neuropsychological tests and plasmatic Aβ1-42 concentrations were collected.ResultsThe neuropsychological test results postoperatively were significantly worse in the cardiopulmonary bypass group and the patients had larger shifts in the Aβ1-42 preoperative and postoperative values than the group in which off-pump coronary artery bypass was performed.ConclusionsThe conducted research confirmed the earlier suspected association of plasmatic Aβ1-42 concentration to postoperative cognitive decline and the results further showed that there were less changes and lower concentrations in the off-pump coronary artery bypass group, which correlated to less neurocognitive decline. There is a lot of clinical contribution acquired by this research, not only in everyday decision making and using amyloid proteins as biomarkers, but also in the development and application of non-pharmacological and pharmacological neuroprotective strategies.

Comparison of long-term outcomes between off-pump and on-pump coronary artery bypass grafting using Japanese nationwide cardiovascular surgery database.

In Japan, off-pump coronary artery bypass (OPCAB) is more common than on-pump coronary artery bypass. Superior early results of OPCAB have been reported; however, long-term results were still unclear. Purpose of this study is to evaluate the clinical outcomes of OPCAB in Japan using Japan Adult Cardiovascular Surgery Database. Between 2008 and 2010, 23,633 patients who underwent isolated coronary artery bypass were reported in database. We selected the cases from the hospital with mean annual coronary surgery volume of more than 50. Among the total of 7724 cases at 41 institutions, 2150 (31.2%) on-pump coronary artery bypass (ONCAB) and 5574 (68.8%) OPCAB cases were included. Propensity score (PS) matching was performed using PS developed from patient characteristics and preoperative factors resulting in 2007 cases matched pairs. Long-term follow-up data on patients' mortality and stroke were collected. In-hospital mortality was significantly lower in OPCAB (ONCAB 1.1%, OPCAB 0.4% p = 0.01). Stroke was low in OPCAB group (ONCAB 1.7%, OPCAB 0.8%, p = 0.01). There was no statistically significant difference between OPCAB and ONCAB regarding 7-year overall survival (86.1% vs 88.1% respectively), composite outcomes (72.0% vs 73.9% respectively), or cardiac deaths (97.3% vs 97.1% respectively). Subgroup analysis (more than 75 years old) showed a worse trend in OPCAB group. Only in OPCAB group, incomplete revascularization significantly influenced 7-year survival. OPCAB is associated with early prognostic benefits; however, it might be less favorable outcomes in the long term when patients are older or with incomplete revascularization.

On-pump beating heart versus off-pump myocardial revascularization-a propensity-matched comparison.

On-pump beating heart (OP-BH) coronary artery bypass grafting (CABG) is often undertaken as an alternative between off-pump coronary artery bypass (OPCAB) and conventional on-pump coronary artery bypass grafting (On-pump CABG), especially in India. However, outcome data following OP-BH surgery is sparse. The aim of this study was to compare the outcomes of OP-BH CABG with OPCAB. From our institutional database, all patients undergoing OP-BH CABG (n = 531) were identified. A propensity-matched cohort undergoing OPCAB (n = 531) was identified from the database. Nearest neighbor matching technique was used and the groups were matched for variables including age, gender, body mass index, EuroSCORE, history of recent myocardial infarction or unstable angina, hypertension, peripheral vascular disease, chronic obstructive airway disease, diabetes, pre-op renal impairment, pre-op neurological events, and left ventricular function. The propensity-matched groups were well matched in terms of baseline characteristics. The mean EuroSCORE was 3.17 and 3.20 in the OP-BH and the OPCAB groups. The unadjusted 30-day mortality in the propensity-matched OPCAB group was 2.07% (11/531) while mortality in the on-pump beating heart group was significantly higher at 6.9% (37/531). Multivariate analysis showed that OP-BH CABG was an independent risk factor for 30-day mortality as well as major adverse post-operative outcomes including renal, neurological, and respiratory outcomes and post-operative atrial fibrillation. OP-BH CABG is associated with worse clinical outcomes compared to patients undergoing OPCAB.

Risk-adjusted analysis of long-term outcomes after on- versus off-pump coronary artery bypass grafting.

Recent data suggested that off-pump coronary artery bypass (OPCAB) may carry a higher risk for mortality in the long term when compared to on-pump coronary artery bypass (ONCAB). We, therefore, compared long-term survival and morbidity in patients undergoing ONCAB versus OPCAB in a large single-centre cohort. A total of 8981 patients undergoing isolated elective/urgent coronary artery bypass grafting between January 2009 and December 2019 were analysed. Patients were stratified into 2 groups (OPCAB n = 6649/ONCAB n = 2332). The primary end point was all-cause mortality. Secondary endpoints included repeat revascularization, stroke and myocardial infarction. To adjust for potential selection bias, 1:1 nearest neighbour propensity score (PS) matching was performed resulting in 1857 matched pairs. Moreover, sensitivity analysis was applied in the entire study cohort using multivariable- and PS-adjusted Cox regression analysis. In the PS-matched cohort, 10-year mortality was similar between study groups [OPCAB 36.4% vs ONCAB 35.8%: hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.87-1.12; P = 0.84]. While 10-year outcomes of secondary endpoints did not differ significantly, risk of stroke (OPCAB 1.50% vs ONCAB 2.8%: HR 0.51, 95% CI 0.32-0.83; P = 0.006) and mortality (OPCAB 3.1% vs ONCAB 4.8%: HR 0.65, 95% CI 0.47-0.91; P = 0.011) at 1 year was lower in the OPCAB group. In the multivariable- and the PS-adjusted model, mortality at 10 years was not significantly different (OPCAB 34.1% vs ONCAB 35.7%: HR 0.97, 95% CI 0.87-1.08; P = 0.59 and HR 1.01, 95% CI 0.90-1.13; P = 0.91, respectively). Data do not provide evidence that elective/urgent OPCAB is associated with significantly higher risks of mortality, repeat revascularization, or myocardial infarction during late follow-up when compared to ONCAB. Patients undergoing OPCAB may benefit from reduced risks of stroke and mortality within the first year postoperatively.

Paraoxonase 1 low activity and SYNTAX score may predict postoperative complications after coronary artery surgery.

Coronary artery bypass grafting (CABG) seems to present a powerful trigger of oxidative stress (OS) and acute inflammatory response. This study aimed to estimate the effects of off-pump coronary artery bypass (OPCAB) grafting on the OS that is commonly observed in patients undergoing operation under cardiopulmonary bypass (CPB). Additionally, we aimed to examine the relationship between and paraoxonase 1 (PON1) activity and the degree of stenosis, severity and complexity of the atherosclerotic lesions, estimated by SYNTAX score (SS). Study group of 107 patients scheduled for CABG were divided into CPB and OPCAB group. Blood samples for OS markers measurement were collected at six-time intervals: before skin incision (t1), immediately after surgery (t2), 6h (t3), 24h (t4), 48h (t5) and 96h after cessation of the operation and surgical trauma (t6). SS was calculated. A significant decrease in lipid hydroperoxides (LOOH) and advanced oxidation protein products (AOPP) levels after both types of surgeries were observed, whereas PON1 reduction was observed higher in the CPB than in the OPCAB group. A significant inverse correlation between SS values and PON1 activity, preoperatively and during the early postoperative hours after surgery [in t2, t3 time intervals (p<0.05 for all)] was found. ROC analysis showed that for CPB patients, Model with all OS parameters showed excellent accuracy (AUC=0.957, p<0.001) for prediction postoperative complications. Decrease in PON1 activity during the early post-operative phases was related to higher SS. This relationship was more convincing in CPB, compared with OPCAB patients. Moreover, integrated models of OS status parameters have the capability to predict the development of postoperative complications.

New Markers of Platelet Activation and Reactivity and Oxidative Stress Parameters in Patients Undergoing Coronary Artery Bypass Grafting.

Objective Recent studies have shown that the red cell distribution width- (RDW-) to-platelet (PLT) count ratio (i.e., RPR) and the mean platelet volume (MPV)/PLT ratio (i.e. MPR) are more sensitive markers of atherosclerosis-connected risk than RDW and PLT alone. The present study is aimed at investigating the oxidative stress status and these two new markers of platelet activation in two different heart surgery modalities: cardiopulmonary bypass (CPB) and off-pump coronary artery bypass (OPCAB). We also aimed to test the possible relationship between RPR and MPR, respectively, and the severity and complexity of atherosclerotic plaque, measured as Syntax Score. Patients and Methods. A total of 107 patients encompassed this prospective study (i.e., 60 patients in CPB group and 47 patients in OPCAB). Blood samples were drawn at several time intervals: before skin incision (t1), immediately after intervention (t2), 6 h (t3), 24 h (t4), 48 h (t5), and 96 h after cessation of the operation (t6). Results The values of RPR and MPR were similar in CPB and OPCAB before surgery and started to rise in t2 (i.e., immediately after the intervention). This increase lasted to t5 (i.e., 48 hours after the intervention), when it became the highest. After that, both markers started to regress about the 96th hour after the beginning of surgery. Nominal values of both indices were higher in CPB than in OPCAB in all study points after the surgery. Furthermore, a significantly higher level of antioxidative parameters (i.e., total sulfhydryl groups and paraoxonase 1) in the OPCAB group compared to the CPB group was noted at t5 study point (i.e., 48 hours after the surgery), whereas no significant difference was noted in prooxidant levels (i.e., lipid hydroperoxides and advanced oxidation protein products) between these groups at this study point. MPR and RPR correlated positively with Syntax Score at several study points after the surgery completion. Syntax Score, MPR, and RPR showed good clinical accuracy in surgery-related complication prediction ((AUC = 0.736), 95th CI (0.616-0.856), P = 0.003)). Conclusion When combined, MPV, RDW, and platelet count, such as MPR and RPR, could be good predictors of coronary artery disease status, regarding the aspect of joint inflammation, oxidative stress, and thrombosis.

Comparison of Early Outcome of Off-pump and Conventional Coronary Artery Bypass Graft Surgery in Patients with Multivessel Coronary Artery Disease and Left Ventricular Dysfunction

Introduction: Left ventricular dysfunction is an important predictor of in-hospital mortality. Due to the theoretical and practical advantages to avoid the harmful effects of cardiopulmonary bypass (CPB), many cardiac surgeons are using Off-pump Coronary Artery Bypass (OPCAB)as an effective alternative to conventional CABG (CCAB) even in patients with reduced left ventricular (LV)ejection fraction. Objectives: This study performed in the National Institute of Cardiovascular Diseases (NICVD) evaluated the early outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of CCAB in patients with multivessel coronary artery diseases and reduced left ventricular (LV) function.&#x0D; Methods: Total 120 patients with multivessel coronary artery disease with reduced left ventricular ejection fraction (d”50%)were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2013 and December 2015. Pre-operative, peroperative and early post-operative variables were recorded, compiled and compared.&#x0D; Results: All risk factors and co-morbidities were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarter (73.3%) of patients in OPCAB group and 80% in CCAB group received 3 grafts (p=0.470). The mean total operative time (268.5 ± 33.5vs. 296.3 ± 34.8minutes, p &lt; 0.001), intubation times(8.6±0.3 vs. 12.3±0.5 hours, p&lt;0.001), blood losses (377.8378 ± 45 ml vs. 602 ± 60 ml, p &lt; 0.001); requirements for blood and blood products (689.7±21.1 vs. 1199.3±34.5ml, p &lt; 0.0010),intensive care unit stays (31.7±0.9 hours versus 41.6±1.5 hours; p&lt;0.001) and hospital stays (8.2 ± 0.2days vs.10.3 ± 0.3days, p &lt; 0.001)were all significantly lower in the OPCAB group.&#x0D; Conclusion: OPCAB is a safe and effective operative revascularization procedure for patients with multivessel coronary artery disease and left ventricular dysfunction and is associated with reduced morbidity. However, a larger and omized trial with long-term followup may show the real benefits of OPCAB.&#x0D; Bangladesh Heart Journal 2020; 35(1) : 20-27

Off-pump coronary artery bypass surgery lacks a longitudinal survival advantage in patients with left ventricular dysfunction.

This study evaluates the longitudinal impacts of off-pump coronary artery bypass (OPCAB) surgery in patients with reduced left ventricular ejection fraction (LVEF). Adults with LVEF ≤ 30% undergoing coronary artery bypass grafting between 2011 and 2020 were included. Patients were stratified based on the utilization of cardiopulmonary bypass into OPCAB or on-pump coronary artery bypass (ONCAB) groups. Primary outcomes included survival and hospital readmissions. Secondary outcomes evaluated postoperative morbidities. Multivariable regression evaluated risk-adjusted mortality and readmission. Propensity score matching was utilized to reduce bias. A total of 660 low LVEF patients were included, of which 28.5% (n = 188) were OPCAB and 71.5% (n = 472) were ONCAB. The rates of complete revascularization were similar between the groups (80.3% vs 82.0%; P = .67). Early survival between the unmatched groups was similar at 1-year follow-up (86.2% vs 87.9%; P = .53); however, at 5 years OPCABs had significantly worse survival compared with ONCABs (71.5% vs 64.2%; P = .02). These findings persisted in the matched cohort where survival at 1 year was comparable (86.8% vs 85.7%; P = .80), but 5-year survival was better for ONCABs (64.1% vs 69.9%; P = .03). The rates of readmission were similar between the unmatched and matched groups at all time intervals, including readmissions for cardiac-related and heart failure-related events (all, P > .05). In contemporary patients with reduced LVEF, survival after OPCAB was similar at 1 year but lower at 5-year follow-up compared with ONCAB, despite similar rates of complete revascularization. These findings suggest that there may be other factors influencing longitudinal mortality in the low LVEF cohort, beyond the use of cardiopulmonary bypass.

Do women benefit more than men from off-pump coronary artery bypass grafting?

ObjectivesOutcomes after coronary artery bypass grafting (CABG) are worse in women than in men. This study aims to investigate whether off-pump coronary artery bypass (OPCAB) surgery improves the outcomes in women by comparing different outcome measures in both genders.MethodsPatients who underwent isolated CABG, either on-pump (ONCAB) or OPCAB, between January 1998 and June 2017 were included. Primary endpoints were 30-day and 120-day mortality. Logistic regression models were constructed to evaluate the effect of the CABG technique on important outcomes such as mortality and the need for blood transfusion.ResultsThe data of 17,052 patients were analysed, 3,684 of whom were women (414 OPCAB) and 13,368 men (1,483 OPCAB). The mean number of grafts was lower in the OPCAB group of both genders (p < 0.001). Postoperatively, both men and women undergoing OPCAB surgery received fewer red blood cell transfusions (p < 0.001) and had higher postoperative haemoglobin levels (p < 0.001) than those undergoing ONCAB. Early mortality occurred less frequently after OPCAB surgery in both genders, although the difference was not significant. However, 120-day mortality was significantly lower after OPCAB surgery in women, even after correction for preoperative risk factors [odds ratio (OR) = 0.356, 95% confidence interval (CI) 0.144–0.882, p = 0.026]. The difference in 120-day mortality was not significant in men (OR = 0.787, 95% CI 0.498–1.246, p = 0.307).ConclusionsWomen undergoing CABG benefit more from OPCAB surgery than from ONCAB surgery in terms of 120-day mortality. This difference was not found in men in our patient population.

MIDCAB versus off-pump CABG: Comparative study

To investigate the clinical significance of minimally invasive direct coronary artery bypass (MIDCAB). Three hundred patients admitted to the Second Hospital of Shandong University from March 2006 to February 2010 were retrospectively analyzed and received off-pump operation under general anesthesia. Depending on surgical methods, patients were divided into the MIDCAB group (n=90) and the median sternotomy off-pump coronary artery bypass (OPCAB) group, named as the OPCAB group (n=210). Preoperative clinical data, perioperative clinical data, and mid-term follow-up at 7years after operation were analyzed and compared between the two groups. Age and the number of vascular lesions in the OPCAB group were higher than those in the MIDCAB group, whereas left ventricular ejection fraction (LVEF) in the former was lower than that in the latter (p<0.05). The number of distal anastomotic stomas, operation time, blood transfusion volume, postoperative cardiac troponin I (cTnI) peak value, ventilator use time, intensive care unit (ICU) stay, and hospital stay in the MIDCAB group were significantly lower than those in the traditional OPCAB group (p<0.05). Among the 294 recovered cases, 201 cases completed 7years of continuous follow-up, with a follow-up rate of 67.91%. The LVEF and the patency rate of vessels in the MIDCAB group were higher than those in the OPCAB group (p<0.05). Compared with the median sternotomy OPCAB, MIDCAB is characterized by small incision, small trauma, positive efficacy, and safety; therefore, it is worthy of being promoted.

Mid-term follow-up outcomes of 2-staged hybrid coronary revascularization compared with off-pump coronary artery bypass for patients with multivessel coronary artery disease.

IntroductionTwo-staged hybrid coronary revascularization (HCR) is a novel procedure in selected patients with multivessel coronary artery disease. However, few studies are available on the mid-term or long-term outcomes of this 2-staged procedure as compared to off-pump coronary artery bypass (OPCAB).AimTo compare in-hospital and mid-term follow-up outcomes of 2-staged HCR with OPCAB in patients with multivessel coronary artery disease.Material and methodsThe present retrospective study analyzed the data from 73 patients who underwent the 2-staged HCR (HCR group) during 2012–2014 at the heart center. Three hundred and eighty-three patients who underwent conventional OPCAB by the same surgeon were selected for the comparative analysis performed on in-hospital and mid-term follow-up outcomes between the two groups.ResultsNo significant difference was observed in the preoperative outcome between the two groups. The HCR group had a shorter operation duration (152.9 ±43.8 vs. 262.6 ±51.8 min, p < 0.05), less bleeding (558.6 ±441.3 vs. 1035.5 ±613.3 ml, p < 0.05), shorter mechanical ventilation (9.4 ±7.4 vs. 19.0 ±18.3 h, p < 0.05), and less blood transfusion (12 (16.4%) vs. 200 (52.2%), p < 0.05). The mean follow-up duration was 25.0 ±9.6 months in the HCR group and 22.8 ±10.6 months in the OPCAB group. The incidence of major adverse cardiac or cerebrovascular events (MACCE) was similar in both groups (4 (5.5%) vs. 10 (2.8%), p = 0.408). The estimated 3-year survival was similar in both groups (log-rank χ2 = 1.041, p = 0.308).ConclusionsThe 2-staged HCR is a safe and effective surgical procedure and may offer similar mid-term follow-up outcomes to OPCAB.

Meta-analysis of interleukin 6, 8, and 10 between off-pump and on-pump coronary artery bypass groups.

This study aimed to evaluate the role of off-pump coronary artery bypass (CAB) surgery on the decrease of postoperative inflammatory responses in patients. We systematically searched databases of PubMed and Embase to select the related studies. Interleukin (IL) 6, 8, and 10 were used as outcomes and pooled analysis was performed using R 3.12 software. Standardized mean differences (SMDs) and their 95% confidence intervals (95% CIs) were considered as effect estimates. A total of 27 studies, including 1340 participants, were recruited in this meta-analysis. The pooled analyses showed that postoperative concentration of IL-10 at 12 hours was significantly lower in off-pump CAB group compared to on-pump CAB group (SMD = -1.3640, 95% CI = -2.0086--0.7193). However, no significant differences were found in pre and postoperative concentrations of IL-6 and 8 between off-pump and on-pump CAB groups. These results suggest that there is no advantage of off-pump CAB surgery in the reduction of inflammation compared to on-pump CAB surgery.

Analysis of Risk Factors for Conversion from Off-Pump to On-Pump Coronary Artery Bypass Graft.

BackgroundOff-pump coronary artery bypass (OPCAB) is performed worldwide, but significant risks are associated with conversion to on-pump surgery. Therefore, we evaluated the composite outcomes between an OPCAB group and a conversion group.MethodsFrom January 2008 to December 2012, 100 consecutive patients underwent OPCAB at Hallym University Sacred Heart Hospital, of whom 84 underwent OPCAB without adverse events (OPCAB group), and 16 were converted to on-pump surgery (conversion group). Early morbidity, early and long-term mortality, and major adverse cardiac and cerebrovascular events (MACCEs) were the primary and long-term composite endpoints.ResultsThe mean follow-up period was 55±26 months, with 93% of the patients completing follow-up. The composite outcomes in the OPCAB and conversion groups were as follows: early morbidity, 2.3% versus 12.5%; early mortality, 4.7% versus 0%; long-term mortality, 14.3% versus 25.0%; and MACCEs, 14.3% versus 18.8%, respectively. No composite endpoints showed statistically significant differences. Preoperative acute myocardial infarction (AMI) was identified as an independent risk factor for conversion (p=0.025).ConclusionThe conversion group showed no statistically significant differences in early mortality and morbidity, MACCEs, or long-term mortality compared with the OPCAB group. The preoperative diagnosis of AMI was associated with an increased number of conversions to on-pump surgery.

Prospective evaluation of ADAMTS-13 and von Willebrand factor multimers in cardiac surgery.

Acquired thrombotic-thrombocytopenic purpura, one of the main representatives of thrombotic microangiopathies (TMAs), is caused by the accumulation of antibodies against ADAMTS-13. Several cases of postoperative TMAs have been observed during the past few years, but the pathogenesis remains unknown. In addition to this, it is unclear whether the use of extracorporeal circulation (ECC) during cardiac surgery has an influence on the occurrence of cardiac surgery-associated TMA. In this study, we investigated the relationship between ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type 1 motifs 13), ADAMTS-13 inhibitor, von Willebrand factor (VWF) and large VWF multimers in cardiac surgery with and without the use of ECC. Blood samples were taken preoperatively, intraoperatively and up to 6 days postoperatively. A total of 47 patients (median age 70 years, 18 women, 29 men) undergoing cardiac surgery were included; cardiac surgery with the use of ECC (cardiopulmonary bypass) was used in 39 patients, and the off-pump coronary artery bypass technique was used in eight patients. TMA was not diagnosed in any of the patients. Cardiac surgery led to a significantly reduced ADAMTS-13 activity (from 67 to 51%, P < 0.001 in the cardiopulmonary bypass group, from 64 to 48%, P = 0.02 in the off-pump coronary artery bypass group) and higher amounts of large VWF multimers. Development of ADAMTS-13 antibodies was not induced by cardiac surgery. Cardiac surgery led to a slight but significant decrease of ADAMTS-13, but this decrease was not associated with TMA.