On-pump Beating-heart Coronary Artery Bypass Research Articles

Short-term and long-term outcomes of on-pump beating-heart coronary artery bypass surgery in dialysis and non-dialysis patients: a retrospective study in a single center

BackgroundThis study aimed to evaluate the short-term and long-term outcomes of dialysis and non-dialysis patients after On-pump beating-heart coronary artery bypass grafting (OPBH-CABG).MethodsWe retrospectively reviewed medical records of 659 patients underwent OPBH-CABG at our hospital from 2009 to 2019, including 549 non-dialysis patients and 110 dialysis patients. Outcomes were in-hospital mortality, length of stay, surgical complications, post-CABG reintervention, and late mortality. The median follow-up was 3.88 years in non-dialysis patients and 2.24 years in dialysis patients. Propensity matching analysis was performed.ResultsAfter 1:1 matching, dialysis patients had significantly longer length of stay (14 (11–18) vs. 12 (10–15), p = 0.016), higher rates of myocardial infarction (16.85% vs. 6.74%, p = 0.037) and late mortality (25.93% vs. 9.4%, p = 0.005) after CABG compared to non-dialysis patients. No significant differences were observed in in-hospital mortality, complications, or post-CABG reintervention rate between dialysis and non-dialysis groups.ConclusionsOPBH-CABG could achieve comparable surgical mortality, surgical complication rates, and long-term revascularization in dialysis patients as those in non-dialysis patients. The results show that OPBH-CABG is a safe and effective surgical option for dialysis patients.

Retrospective assessment of the early and medium outcomes of on-pump beating-heart versus off-pump CABG in patients with moderate left ventricular dysfunction (LVEF)

Aim: To compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. Material & Methods: This study was conducted as a retrospective observation over a period of 1 year at the Department of Cardiothoracic and Vascular Surgery, Indira Gandhi Institute of medical Sciences, Patna, Bihar, India.130 patients were selected for this study. All patients were divided into 2 groups, according to the revascularization method: OPCABG group and OPBH group. Results: LVEF before discharge significantly improved from 34.39 ± 4.21 to 44.27 ± 7.29 in the OPBH group and from 34.27±4.61 to 42.66 ± 8.20in the OPCABG group (P<0.001). All survival patients have been echocardiographically examined after 6 months which showed a significant higher early postoperative LVEF in the OPBH group than in the OPCABG group (45.28 ± 6.10 versus 44.42 ± 7.08%, respectively; P=0.002). Conclusion: The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better midterm MACE-free survival compared with OPCABG.

Use of Carbon dioxide versus air blower in on-pump beating-heart coronary artery bypass surgery

Introduction: The use of carbon dioxide blower has been recognized as the standard of care in patients undergoing beating coronary artery bypass grafting (CABG) due to higher solubility and lower risk of embolization. On the other hand, the compressed air blower has gone out of use since air can be easily trapped and is less soluble which can cause coronary embolism. The present study aimed to compare the outcomes of patients undergoing on-pump beating CABG using CO2, as opposed to an air blower. Materials and Methods: A total number of 125 patients requiring coronary revascularization underwent on-pump beating CABG within February 2017-February 2018. In the current cross sectional study, 45 patients underwent CABG with CO2 blower and other patients were operated using air blower. The reported postoperative outcomes included mortality, low cardiac output state, malignant arrhythmia, postoperative myocardial infarction, blood transfusion, transient ischemic attack or stroke, intra-aortic balloon pump (IABP), as well as intensive care unit and hospital length of stay. Results:Demographic characteristics of patients in two groups in terms of age, sex, risk factors, echocardiographic and angiography data were similar and demonstrated no significant difference. Patients' outcomes, such as cardiac arrhythmias, myocardial infarction, ICU and hospital stays, were also similar in both groups. In addition, the overall morbidity and hospital mortality showed no significant difference between the two groups. Conclusion: Although the use of CO2 during beating CABG has been advocated with its theoretical advantages, no significant difference was observed between the two groups in terms of mortality and morbidity using CO2, as opposed to air blower.

Intermittent on-pump beating-heart coronary artery bypass grafting-a safer option.

On-pump beating-heart coronary artery bypass grafting represents a merger of standard on and off-pump techniques and is thought to benefit patients by coupling the dual absence of cardioplegic arrest (conventional coronary surgery), with the hemodynamic instability during manipulation seen in off-pump surgery. However, the clinical benefits are still under discussion. We improvised on the standard on-pump beating-heart surgeries by introducing use of "intermittent" bypass as and when required. This study involved 108 patients. "Intermittent" on-pump-beating heart coronary artery bypass grafting was done using suction stabilizer and placing aortic and venous cannula, electively in all patients (group 1) who were supported by pump intermittently (n = 54). Retrospective data of patients who underwent off-pump surgery electively by the same surgeon (group 2, n = 54) was collected. There was a significant advantage in the number of grafts performed for the lateral surface (circumflex branches) using the new technique compared to conventional technique (68vs22). Similarly, significant advantage was also noted in terms of total number of grafts along with shorter operating times. There were no mortalities in the new group compared to the off-pump group and blood loss was also lesser. "Intermittent" on-pump coronary revascularization is a technically reliable method of coronary revascularization taking advantage of the off-pump and conventional on-pump techniques while considerably eliminating the disadvantages of both. It has shown its superiority in safety, number of grafts, blood loss, operating time and perioperative course.

On-pump beating-heart coronary artery bypass grafting: a literature review

Coronary artery bypass grafting techniques have been unchangeable for many years, whereas development and enhancement of myocardial protection methods in coronary bypass grafting for patients with ischemic heart disease are still actual issues of current coronary surgery. Coronary artery bypass grafting techniques include the traditional/conventional technique with cardiopulmonary bypass, aortic cross-clamping and cardioplegia, off-pump and on-pump beating heart coronary artery bypass grafting. Coronary artery bypass grafting with cardiopulmonary bypass and cardioplegia remains the most common method of coronary revascularization. However the cardiac arrest inevitably leads to global cardiac ischemia, and current cardioplegias do not prevent ischemic damage to the myocardium in all cases, especially in high-risk surgical patients. Off-pump coronary artery bypass grafting allows preventing global myocardial ischemia (due to the constant native coronary blood-flow) and avoiding possible negative consequences of cardiopulmonary bypass use. The main limitations of this technique are associated with high risk of hemodynamic instability due to low cardiac output and systolic output caused by target arteries exposition. On-pump beating heart technique is a reasonable compromise between conventional on-pump coronary artery bypass grafting, cardioplegia and off-pump procedure. It is a safe and effective technique with outcomes that are equivalent or superior to the outcomes reported for conventional coronary artery bypass grafting in patients with unstable hemodynamics, low left ventricular ejection fraction and in high-risk patients. The literature review presents the results of on-pump beating heart coronary artery bypass grafting.

Outcome of Coronary Artery Bypass Graft with On-pump Beating-heart Technique

Background: This paper intends to evaluate the effects of on-pump beating-heart coronary artery bypass graft (CABG) in patients with coronary artery disease. Studies have shown that this surgical procedure can have acceptable results. Objectives: This study intends to share experiences and results of on-pump beating-heart CABG. Methods: We reported preliminary results related to mortality and morbidity in patients who underwent CABG in the period from 2015 to 2017 in Ghaem hospital, Mashhad, Iran. Results: 80 patients, in the period from 2015to 2017, underwent general anesthesia and on-pump beating-heart CABG surgery was done for them. The average number of grafts was 3.18± 0.474 and two patients died, unfortunately: one during surgery and one in ICU. There were no postoperative myocardial infarctions during the study. None of the patients reported kidney dysfunction. The average length of hospitalization was 4±1.11 days and the mean follow-up of the patients was 6 months. The average ejection fraction (EF) of patients was 43. 28± 9.58. Conclusion: In the last decade there has been a big challenge between using off-pump CABG and on-pump CABG, on-pump beating method could present acceptable and effective results.

Preoperative planning of on-pump beating-heart coronary artery bypass grafting based on prediction of intraoperative complications

The aim — to improve the results of coronary artery bypass grafting in patients with ischemic heart disease by determining indications for direct myocardial revascularization on a beating­heart in conditions of parallel blood circulation based on the study of risk factors of intraoperative complications.Materials and methods. A retrospective analysis was performed of case histories of 4068 patients who underwent an isolated coronary artery bypass grafting on a working heart in 2009 — 2013 in the department of surgical treatment of coronary artery disease in M. M. Amosov National Institute of Cardiovascular Surgery. Were analyzed clinical­anamnestic and instrumental data.Results and discussion. Postoperative complications were frequently associated with intraoperative — unstable hemodynamics, cardiac rhythm disturbances, myocardial ischemia, bleeding and thrombosis of shunts, which are the cause of an emergency on­pump conversion. Emergency conversion significantly worsens the results of surgical intervention. The optimal way of its prevention is preoperative planning with the identification of patients with a high risk of intraoperative complications. A through pre­operative examination allows to identify potential predictors of intraoperative complications, and their complex evaluation makes it possible to optimize the definition of indications to on­pump beating­heart coronary artery bypass grafting, which will prevent an emergency conversion by reasonable planning of surgery.Conclusions. The proposed regression model of the probability of development of intraoperative complications is an effective help in deciding on the use of on­pump beating­heart coronary artery bypass grafting.

A Case of Malignant Hyperthermia During On-Pump Beating-Heart Coronary Artery Bypass Surgery

A Case of Malignant Hyperthermia During On-Pump Beating-Heart Coronary Artery Bypass Surgery

A comparison of off- and on-pump beating-heart coronary artery bypass surgery on long-term cardiovascular events.

SummaryObjectiveOur aim was to compare short-term outcomes and long-term major adverse cardiovascular event (MACE)-free survival and independent predictors of long-term MACE after off-pump (OPCAB) versus on-pump beating-heart (ONBHCAB) coronary artery bypass grafting (CABG).MethodsWe retrospectively reviewed data of all consecutive patients who underwent elective CABG, performed by the same surgeon, from January 2003 to October 2009. A propensity score analysis was carried out to adjust for baseline characteristics and a total of 398 patients were included: ONBHCAB (n = 181), OPCAB (n = 217).ResultsOPCAB was associated with significantly shorter ventilation times (p < 0.001), intensive care unit stay (p < 0.001) and hospital stay (p < 0.001). The total blood loss was significantly more in the ONBHCAB group (p < 0.001), and accordingly, the number of transfused blood units was significantly lower in the OPCAB group (p < 0.001). Incidence of peri-operative renal complications were significantly higher in the ONBHCAB group (p = 0.004). The OPCAB group showed significantly lower long-term MACE-free survival (p = 0.029). The mean number of transfused blood units was the only independent predictor of MACE (HR: 1.218, 95% CI: 1.089–1.361; p = 0.001).ConclusionOPCAB provided better long-term MACE-free survival compared with ONBHCAB. Fewer units of blood transfused following OPCAB surgery may have been the main reason for this result.

On-pump beating-heart coronary artery bypass surgery in acute myocardial infarction complicated by cardiogenic shock

On-pump beating-heart coronary artery bypass surgery in acute myocardial infarction complicated by cardiogenic shock

On-pump beating-heart coronary artery bypass provides efficacious short- and long-term outcomes in hemodialysis patients

On-pump beating-heart coronary artery bypass grafting surgery (CABG) is beneficial due to the elimination of cardioplegic arrest. However, there are few reports regarding its efficacy in chronic hemodialysis patients. This study investigated the potential benefits of on-pump beating-heart CABG in chronic hemodialysis patients. From January 2002 to January 2010, 186 patients with chronic hemodialysis underwent CABG in our institution. In total, 82 patients underwent conventional CABG with cardioplegic arrest, 56 underwent off-pump CABG and 48 underwent on-pump beating-heart CABG. The early results and long-term outcomes were compared among these three groups. On-pump beating-heart CABG significantly reduced the duration of cardiopulmonary bypass (CPB) compared with conventional CABG. The post-operative pericardial drainage amount (P < 0.01), length of hospital stay (P < 0.001) and length of post-operative intensive care unit stay (P < 0.001) were significantly lower in the on-pump beating-heart and off-pump CABG groups than in the conventional CABG group. No significant difference was found regarding 30-day mortality and morbidity rates including stroke, pneumonia, arrhythmia, intestinal complication and low cardiac output syndrome. There were no statistical differences in the freedom from cardiac events (P = 0.323), but on-pump beating-heart CABG provided better long-term survival than conventional CABG (P = 0.009). On-pump beating-heart CABG is a safe procedure that provides optimal operative exposure in chronic hemodialysis patients. The use of CPB and the elimination of cardioplegic arrest may be beneficial for the short- and long-term survival of chronic hemodialysis patients.

On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity

The mortality of conventional coronary artery bypass grafting after acute myocardial infarction remains high. This study compared the clinical outcomes of patients undergoing conventional and on-pump beating-heart coronary artery bypass grafting and evaluated the efficacy of an on-pump beating-heart technique for the surgical treatment of these critically ill patients. Between January 1999 and March 2005, 61 patients underwent emergency coronary artery bypass grafting for acute myocardial infarction. In the first 23 patients, the conventional cardioplegic method was performed. In the most recent 38 patients, the on-pump beating-heart procedure was used without cardioplegic arrest. A significant reduction occurred in the observed mortality between the conventional and on-pump beating groups (21.7% vs 2.6%, P = .04), despite a higher predicted mortality risk calculated by using EuroSCORE (9.0 +/- 1.6 vs 9.6 +/- 1.6, P = .048) and a greater use of a preoperative intra-aortic balloon pump (43.5% vs 78.9%, P = .005). On-pump beating-heart patients received fewer bypass grafts than conventional patients (2.0 vs 2.9, P = .001), but the internal thoracic artery was used more often in on-pump beating-heart patients (P = .014). Three patients in the conventional coronary artery bypass grafting group required new insertion of an intra-aortic balloon pump, whereas no patients required this in the on-pump beating-heart group (P = .220). Postoperative renal failure requiring hemodialysis occurred in 2 patients in the conventional coronary artery bypass grafting group but in no patients in the on-pump beating-heart group (P = .138). On-pump beating-heart coronary artery bypass grafting is the preferred method of emergency myocardial revascularization for patients with acute myocardial infarction who might tolerate cardioplegic arrest poorly. It has lower postoperative mortality and morbidity than conventional coronary artery bypass grafting.

On-Pump Beating-Heart Coronary Artery Bypass: A Propensity Matched Analysis

It remains unclear how cardioplegic arrest affects surgical results after coronary artery bypass grafting surgery (CABG). This study compares early outcomes after on-pump beating-heart CABG and conventional CABG. From 2002 to 2005, 114 patients underwent on-pump beating-heart CABG. Multivariate logistic regression revealed five characteristics according to which technique is liable to be used: history of cerebral infarction, urgent or emergent operation, lower ejection fraction, preoperative creatine kinase, and lower number of diseased vessels. The early clinical outcome for these patients was compared against 114 conventional CABG patients, matched using a propensity score constructed with these five significant variables and with two nonsignificant variables: history of diabetes mellitus and hypertension. On-pump beating-heart CABG significantly reduced the duration of operation and cardiopulmonary bypass, total blood loss, and peak creatine kinase (p < 0.05). The number of patients requiring additional intra-aortic balloon pump support was significantly lower in the on-pump beating-heart CABG group (2 versus 13, p < 0.01). No patients required percutaneous cardiopulmonary support after on-pump beating-heart CABG, whereas 4 patients needed it after conventional CABG. Complete revascularization was significantly lower (42.1% versus 77.2%, p < 0.0001), but in-hospital mortality was less in the on-pump beating-heart CABG group (2.6% versus 9.6%, p < 0.05). No significant difference was found in morbidity including stroke, renal failure, mediastinitis, and prolonged ventilation. On-pump beating-heart CABG can be performed safely, including on high-risk patients. Use of cardiopulmonary bypass and the elimination of cardioplegic arrest may be of most benefit to hemodynamically unstable patients.

On-Pump Beating-Heart Coronary Artery Bypass Grafting for Acute Myocardial Infarction

The early results of emergent coronary artery bypass grafting by conventional operative method for acute myocardial infarction are reported to be poor. The purpose of this study is to evaluate on-pump beating-heart coronary artery bypass grafting for acute myocardial infarction. Thirty-one patients with acute myocardial infarction underwent emergent surgery between January 1998 and June 2004 at Nayoro City General Hospital. In 16 patients, on-pump surgery was performed on the arrested heart, and in the other 15, on-pump surgery was performed on the beating heart. Early results were compared between the two groups. Preoperative and perioperative patient characteristics revealed no significant differences between the two groups. Although there was no statistically difference between the two groups, the early mortality rates of on-pump arrested-heart coronary bypass grafting (31.3%) was higher than that of on-pump beating-heart coronary bypass grafting (13.3%). Postoperatively, the creatine kinase myocardial band value for the on-pump beating-heart group was significantly lower than that for the on-pump arrested-heart group (221 +/- 200 IU/L versus 666 +/- 540 IU/L, p = 0.008). The incidence of postoperative acute renal failure was significantly higher in the on-pump arrested-heart group than in the on-pump beating-heart group (p = 0.034). The durations of ventilator use and inotropic agent use were longer in the on-pump arrested-heart group than in the on-pump beating-heart group, though the differences were not statistically different (p = 0.152, p = 0.223). On-pump beating-heart coronary artery bypass grafting has the possibility to eliminate intraoperative global myocardial ischemia and to be an acceptable surgical option for acute myocardial infarction associated with lower postoperative mortality and morbidity.

Febrile Seizures

Coronary artery disease (CAD) is commonly associated with abdominal aortic aneurysms (AAAs) in elderly patients. When severe CAD requiring coronary artery bypass grafting (CABG) is associated with an impending AAA in a high-risk patient, the options for the suitable timing of CABG and AAA repair strategy (one-stage or two-stage) are still being debated.An 87-year-old man with non-ST-segment elevation myocardial infarction and a giant abdominal aortic aneurysm was transferred to our centre. Coronary angiography revealed triple-vessel coronary disease, and computed tomography confirmed a giant infrarenal fusiform abdominal aortic aneurysm 9 cm in maximal diameter. We simultaneously performed endovascular aneurysm repair prior to on-pump beating-heart coronary artery bypass grafting. The postoperative course was uneventful, and the patient was discharged on the 15th postoperative day.Combined endovascular aneurysm repair and on-pump beating heart coronary artery bypass grafting in a one-stage operation is a promising strategy to improve therapeutic efficiency in octogenarians. More studies are needed to compare the efficacy and safety of one-stage and two-stage operations to treat concomitant coronary artery disease and aortovascular pathology in the high-risk octogenarian patients.