On-pump Group Research Articles

Effects of cardiopulmonary bypass on pulmonary function in COPD patients undergoing beating heart coronary artery bypass surgery.

The aim of this study was to compare the effects of cardiopulmonary bypass (CPB) on the postoperative course of patients with chronic obstructive pulmonary disease (COPD) following coronary artery bypass graft (CABG) surgery. This retrospective study included 375 COPD patients who underwent isolated CABG surgery with either on-pump (group 1) or off-pump beating heart techniques (group 2) between April 2014 and August 2018. Group 1 included 42 (11.2%) and group 2 included 333 (88.8%) patients. The mean mechanical ventilatory support times of groups 1 and 2 were 10.6 ± 36.2 and 5.1 ± 2.61 hours, respectively (p = 0.561). The mortality rates of groups 1 and 2 were 4.76% (two patients) and 1.50% (five patients), respectively (p = 0.142). The on-pump beating heart CABG surgery did not affect the postoperative mechanical ventilatory support times in patients with COPD.

Graft patency at 3\xa0months after off- and on-pump coronary bypass surgery: a randomized trial

PurposeCoronary artery bypass grafting (CABG) is performed either with the aid of cardiopulmonary bypass (on-pump) or without cardiopulmonary bypass (off-pump). There is a scarcity of angiographic data to support the non-inferiority of off-pump technique to on-pump technique. The objective of this study is to ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months.MethodsA total of 320 patients with multivessel coronary artery disease were enrolled in a multicenter prospective randomized trial either to on-pump CABG (n = 162) or off-pump CABG (n = 158) between March 2016 through March 2017. Graft patency was evaluated by using either multidetector computerized tomographic angiography or conventional coronary angiography at 3 months. The major adverse cardiac and cardiovascular events (MACCE) were also analyzed at 3 months.ResultsThe median number of grafts per patient in off-pump was 3.00 (Q1:3.00 and Q3:4.00) vs on-pump 4.00 (Q1:3.00 to Q3:4.00), and the mean number of grafts per patient was lower in the off-pump CABG at 3.45 ± 0.75 vs 3.64 ± 0.70 in the on-pump CABG (p = 0.01). There was no significant difference in mortality at 3 months between the off-pump (0.63%) and on-pump groups (1.85%) with p value of 0.62. The cumulative combined MACCE showed significant difference between off-pump group (0.63%) and on-pump group (5.55%), p = 0.01. Follow-up angiograms were done in 239 (75%) patients with 120 off-pump and 119 in the on-pump group. The analysis was also done regarding graft patency in a graded manner—when analysis of A (excellent) grafts vs B (stenosed) grafts and O (occluded) grafts were made, there was no statistically significant difference in overall graft patency at 3 months between on-pump [376 /429 grafts (87.6%)] and off-pump [366 /420 grafts (87.1%)] groups (p = 0.82). The patency rates were similar among bypass conduits (left internal thoracic artery (ITA) in off-pump (91.4%) vs on-pump (92.9%) p = 0.66, right ITA in off-pump (82.1%) vs on-pump (81.8%) p = 0.97, radial artery in off-pump (84.4%) vs on-pump (82.6%) p = 0.81; saphenous vein in off-pump (85.8%) vs on-pump (86.3%), p = 0.86 and among 3 coronary territories.ConclusionsOff-pump CABG is non-inferior to on-pump CABG in terms of overall graft patency at 3 months and was associated with a fewer combined cumulative MACCE compared to on-pump CABG.

Early and long-term outcomes of coronary artery bypass surgery with and without use of heart-lung machine and with special respect to renal function - A retrospective study.

The aim of our study was to compare early and long-term outcome of patients undergoing either on-pump or off-pump coronary artery bypass grafting with special focus on impairment of renal function. Five hundred ninety-three consecutive patients undergoing coronary artery bypass grafting were retrospectively analyzed. They were assigned either to on-pump (n = 281) or to off-pump (n = 312) group. Early and long-term outcomes were analyzed with special focus on renal function. Basic demographics and preoperative characteristics did not differ between groups (p>0.05) as well as postoperative renal parameters (p>0.05). Postoperative odds ratios (OR) of off-pump group in comparison to on-pump group were higher without reaching significance in terms of incidence of gastrointestinal complications and pneumonia (OR = 2.23 and 1.61, respectively) as well as hazard ratios (HR) on long-term follow-up for mortality and incidence of myocardial infarction (HR = 1.50 and 2.29, respectively). Kaplan-Meier estimation analysis also revealed similar results for both groups in terms of mid- and long-term survival (Breslow p = 0.062 and Log-Rank p = 0.064, respectively) and for incidence of myocardial infarction (Breslow p = 0.102 and Log-Rank p = 0.103, respectively). Our study suggests that use or not use of coronary artery bypass did not influence postoperative renal function. Odds of early outcomes were similar in both groups as well as incidence of myocardial infarction and mortality in long-term follow-up.

Effects of Coronary Artery Bypass Grafting Surgery on Olfactory and Taste Functions.

Olfactory and taste sensations have a high impact on the quality of life. Impaired olfactory and taste functions may have a negative effect on physical and mental well-being, personal hygiene, and nutritional satisfaction, leading to the occurrence of depressive symptoms and impaired quality of life. Therefore, the recovery period of patients with disturbed olfactory and taste functions may be prolonged, and return to active life may be delayed. We designed this study to determine whether on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have any effects on olfactory and taste functions and compare these functions between the surgical groups. A total of 60 patients, who underwent elective isolated first-time CABG, were included in this study. Patients were divided into two groups as Off-Pump and On-Pump CABG groups with 30 patients in each group. In addition to patients' primary clinical and laboratory data, olfactory and taste functions were evaluated pre- and postoperatively in both groups separately, and then these functions were compared between the groups. Olfactory functions were evaluated by the Brief Smell Identification Test, while taste functions by the Burghart Taste test. Olfactory functions significantly were disrupted in the postoperative period in patients undergoing on-pump CABG (P value < .05), while these functions significantly were not affected in patients undergoing off-pump CABG (P value > .05). During the preoperative period, advanced age and smoking were detected to be independent predictors of impaired olfactory function for the study population. During the postoperative period, smoking, amount of postoperative bleeding and serum low-density lipoprotein (LDL) level were found to be independent predictors of impaired olfactory function for just the On-Pump CABG Group. In both groups, no significant deterioration in taste functions occurred during the postoperative period (P value > .05). Our study demonstrated that olfactory function was impaired in patients, who underwent on-pump CABG in the postoperative period, and significant impairment in taste function was present in neither off-pump nor on-pump CABG patients. However, the results of our study should be supported by more comprehensive, prospective, randomized controlled trials with more extensive patient series and by further tests.

P1832Myocardial injury assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting. a pre-specified analysis of mass V trial

Abstract Background Myocardial structural damage may occur during coronary artery bypass grafting (CABG) surgery and is identified by the significant release of cardiac biomarkers. However, the evidence of these structural myocardial changes after CABG by current imaging methods remains unknown. To evaluate myocardial structure, we used the T1 mapping of cardiac magnetic resonance (CMR) before and after on-pump and off-pump CABG. Methods Patients with multivessel coronary artery disease and preserved ventricular function were included and underwent on or off-pump CABG. CMR and T1 mapping were performed using the MOLLI technique (modified Look-Locker inversion-recovery). Values of native T1 and extracellular volume fraction (ECV) were compared before and after on and off-pump procedures. Results Of 110 eligible patients, 34 were excluded due to the presence of new late enhancement or edema. Of 76 patients remained, 32 (42%) underwent on-pump (Group A) and 44 (58%) off-pump CABG (Group B). All baseline characteristics were similar between groups, besides the Syntax Score that was higher in Group A (25 × 21, p=0.002). For group A, native T1 before and after procedures was 1013 ms (998–1043) and 1004 ms (793–1048), p=0.19, and ECV was 26.4 (23.9–27.6) and 31.2 (27.6–33.9), p&lt;0.001. For group B, native T1 before and after procedures was 1015 ms (970–1044) and 992 ms (867–1051), p=0.003, and ECV 27.5 (25.3–29.9) and 30.3 (26.5–34.3), p=0.02. The comparison of native T1 difference before and after procedures between groups A and B was not significant (Delta T1 −9.8 (−102 to 51.8) × −25.4 (−119 to 51,2), p=0.87. However, the difference of ECV between groups was statistically significant (ECV Delta 3.8 (2.2 to 7.1) × 1.3 (−1.1 to 4.9), p=0.039, respectively, for groups A and B. Figure 1 Conclusion In this sample, T1 mapping identified significant myocardial structural changes in both surgical revascularization procedures. Additionally, a marked myocardial injury generated by ECV changes were observed after on-pump CABG.

Surgical Treatment for Stand-Alone Atrial Fibrillation in North America

Surgical treatment of symptomatic atrial fibrillation has been performed for 3 decades. We reviewed trends and outcomes of surgical ablation (SA) for stand-alone atrial fibrillation using The Society of Thoracic Surgeons Adult Cardiac Surgical Database (STS-ACSD). The STS-ACSD was reviewed from 2011 to 2017 (N = 7187) for trends. Contemporary data from 2014 to 2017 (n= 3893) were used to compare three subgroups: off pump (n= 3252), on pump (n= 491), and patients with incision conversion or conversion from off pump to on pump (n = 150). Propensity score matching was conducted to balance groups. Annual growth of stand-alone SA was 7%. Median age of patients was 64 years (interquartile range, 57 to 70), and 30% were female. Overall 30-day mortality was 0.8% and perioperative stroke incidence was 0.8%. Most SA procedures were off pump (84%), with 12% greater odds for off pump per year (odds ratio [OR] 1.12, P < .001). The off-pump group had fewer biatrial SA (21% vs 71%, P < .001) and left atrial appendage obliterations (53% vs 95%, P < .001) compared with the on-pump group. After matching, uneventful off-pump SA had similar mortality (0.4% vs 0.9%, P= .292) vs on-pump SA, but reduced incidence of renal failure (0.9% vs 2%, P= .033). After risk adjustment, the conversion group had worse perioperative outcomes vs the off-pump group, including greater incidence of stroke (OR 5.37, P< .001) and operative mortality (OR 9.98, P < .001). Mortality (OR 4.69, P= .011) was also greater for conversion vs on pump. Steady growth of stand-alone SA operations was noted. Procedures performed either on pump or off pump were relatively safe. However, intraoperative conversion was associated with significantly higher morbidity and mortality. Patient selection, improvement of surgical techniques, and long-term follow-up should be emphasized to improve decision making and outcome.

Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease

BackgroundConcerns remain for a greater risk of incomplete revascularization and reduced survival with off-pump coronary artery bypass grafting (CABG) surgery compared with on-pump surgery particularly in patients with left main disease and extensive underlying myocardial ischemia. ObjectivesThis study sought to compare outcomes following off-pump versus on-pump surgery for left main disease by performing a post hoc analysis from the multicenter, randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. MethodsThe EXCEL trial was designed to compare percutaneous coronary intervention with everolimus-eluting stents versus CABG in patients with left main disease. CABG was performed with or without cardiopulmonary bypass (on-pump vs. off-pump surgery) according to the discretion of the operator. The 3-year outcomes in the off-pump and on-pump groups were compared using inverse probability of treatment weighting (IPTW) for treatment effect estimation. ResultsAmong 923 CABG patients, 652 and 271 patients underwent on-pump and off-pump surgery, respectively. Despite a similar extent of disease, off-pump surgery was associated with a lower rate of revascularization of the left circumflex coronary artery (84.1% vs. 90.0%; p = 0.01) and right coronary artery (31.1% vs. 40.6%; p = 0.007). After IPTW adjustment for baseline differences, off-pump surgery was associated with a significantly increased risk of 3-year all-cause death (8.8% vs. 4.5%; hazard ratio: 1.94; 95% confidence interval: 1.10 to 3.41; p = 0.02) and a nonsignificant difference in the risk for the composite endpoint of death, myocardial infarction, or stroke (11.8% vs. 9.2%; hazard ratio: 1.28; 95% confidence interval: 0.82 to 2.00; p = 0.28). ConclusionsAmong patients with left main disease treated with CABG in the EXCEL trial, off-pump surgery was associated with a lower rate of revascularization of the coronary arteries supplying the inferolateral wall and an increased risk of 3-year all-cause death compared with on-pump surgery.

Neurological outcomes after on-pump vs off-pump CABG in patients with cerebrovascular disease.

The possible association of off-pump coronary artery bypass graft (CABG) with reduced risk of postoperative stroke and enhanced benefits in high-risk patients support the hypothesis that patients with a positive history of cerebrovascular disease would benefit from off-pump coronary surgery. This study aims to investigate the impact of off-pump CABG on the incidence of postoperative neurologic events in patients with a previous history of cerebrovascular disease. From January 2015 to September 2018, 414 patients underwent isolated CABG with a previous history of transient ischemic attack (TIA) or stroke: 295 patients had on-pump CABG and 119 patients had off-pump CABG. Neurological outcomes of interest are postoperative stroke (transient or permanent), delirium requiring pharmacological treatment or a combination of both, collectively defined "Major Adverse Neurological Events" (MANE). Propensity score (PS) adjusted analysis has been used for regression models. Off-pump CABG carried a lower incidence of postoperative stroke (3.4% vs 9.8%, P = .046, PS-adjusted odds ratio 0.34 with P = .044). Postoperative delirium occurred more than twice as often in the on-pump group (11.5% vs 4.2%, P = .034, PS-adjusted odds ratio 2.78 with P = .043). The composite outcome of MANE occurred in 20.3% in the on-pump group, and in 7.6% in the off-pump group (P = .003). Other complications were similar between groups. In patients with a previous TIA or stroke, off-pump CABG is associated with a reduced risk of stroke, delirium, and postoperative adverse neurological events, compared to on-pump CABG. Patients with high neurological risk can potentially benefit from off-pump CABG, due to an overall reduction of postoperative neurological complications.

PREOPERATIVE PREDICTIVE VALUE OF ECHOCARDIOGRAPHIC CHARACTERISTICS AND CARDIOVASCULAR RISK FACTORS IN POSTOPERATIVE ATRIAL FIBRILLATION

Objective: Postoperative atrial fibrillation (POAF) is the most common arrhythmia in patients after isolated coronary artery bypass grafting (CABG).With a reported incidence between 10% and 40%, it is associated with an increased morbidity, mortality and prolonged hospitalization which is very often followed by an increased hospital-related complications and costs.The aim of this study was to identify significant preoperative predictors for non-valvular POAF in patients undergoing CABG. Design and method: Retrospective study included 226 consecutive patients revascularized at Clinic of Cardiac Surgery, Clinical Center of Serbia, during the four months’ period. Patients were divided in two groups: on-pump (N: 176) and off-pump (N: 50). In both groups, we investigated the association of demographic characteristics (gender, age), echocardiographic characteristics (left ventricular systolic function, preoperative size of the left atrium and left ventricle) and cardiovascular risk factors (arterial hypertension, diabetes, hyperlipidemia) with the occurrence of non-valvular POAF, using the Logistic regression analysis. Exclusion criteria were severe MR and preoperative AF. Results: The incidence of POAF was 23.45% (on-pump: 22.2%, off-pump: 28%; p > 0.05). There were statistically significant differences between two study groups considering: left ventricular systolic function (X2 = 12,896; p < 0,001), preoperative size of the left atrium (X2 = 13,046; p < 0,001) and left ventricle (EDD:t = 3,439; p = 0,001, ESD: t = 3,162; p = 0,002) and presence of diabetes mellitus (X2 = 6,841; p = 0,009). In the off-pump group, an independent preoperative predictor of POAF was preoperative size of left atrium (OR 34.000; 95% CI 1.479–781.787; p: 0.027). Paradoxically, an independent inverse relationship of preoperative arterial hypertension and the risk of POAF was documented in the on-pump group(OR 0.088; 95% CI 0.009–0.874; p: 0.038), most likely due to the more frequent preoperative use of beta-blockers in patients with a history of hypertension. Conclusions: We found that patients with very enlarged left atrium (>5 cm) had significantly higher risk of POAF. Independent preoperative predictors for POAF are preoperative size of left atrium in off-pump and arterial hypertension in on-pump revascularized patients.

PREOPERATIVE PREDICTIVE VALUE OF HYPERTENSION, ECHOCARDIOGRAPHIC CHARACTERISTICS AND OTHER CARDIOVASCULAR RISK FACTORS IN POSTOPERATIVE ATRIAL FIBRILLATION

Objective: Postoperative atrial fibrillation (POAF) is the most common arrhythmia in patients after isolated coronary artery bypass grafting (CABG). The incidence is between 10% and 40%, and is associated with an increased morbidity, mortality and prolonged hospitalization. The aim of this study was to identify significant preoperative predictors for non-valvular POAF in patients undergoing CABG. Design and method: We included 226 consecutive patients, revascularized at Cardiac Surgery Clinic, Clinical Center of Serbia, during the four months’ period. Patients were divided in two groups: on-pump (N: 176) and off-pump (N: 50). In both groups, we investigated the association of demographic characteristics (gender, age), echocardiographic characteristics (left ventricular systolic function, preoperative size of the left atrium and left ventricle) and cardiovascular risk factors (arterial hypertension, diabetes, hyperlipidemia) with the occurrence of non-valvular POAF, using the logistic regression analysis. Exclusion criteria were severe MR and preoperative AF. Results: The incidence of POAF was 23.45% (on-pump: 22.2%, off-pump: 28%; p > 0.05). There were statistically significant differences between two study groups considering: left ventricular systolic function (p < 0,001), preoperative size of the left atrium (p < 0,001) and left ventricle (p = 0,001, ESD: p = 0,002) and presence of diabetes mellitus (p = 0,009). In the off-pump group, an independent preoperative predictor of POAF was preoperative size of left atrium (p: 0.027). Paradoxically, an independent inverse relationship of preoperative arterial hypertension and the risk of POAF was documented in the on-pump group (p: 0.038), most likely due to the more frequent preoperative use of beta-blockers in patients with a history of hypertension. Conclusions: We found that patients with very enlarged left atrium (>5 cm) had significantly higher risk of POAF. Independent preoperative predictors for POAF are preoperative size of left atrium in off-pump and arterial hypertension in on-pump revascularized patients.

Long Term Outcomes of The Off-Pump and On-Pump Coronary Artery Bypass Grafting In A High-Volume Center

Coronary artery bypass grafting (CABG) remains the most frequent surgery in the practice of an adult cardiac surgeon and the most frequently performed cardiac surgical procedure worldwide. Despite the ongoing debates regarding the superiority or inferiority of off-pump coronary artery bypass grafting, it still comprises 15–30% of all CABG cases varying in different national registries. We performed a propensity matched study of 302 consecutive CABG patients,143 off -pump cases performed by the four experienced off-pump surgeons and the on-pump CABG cases performed by those surgeons and four other experienced coronary surgeons. The five year follow up was performed and data collected comprised of mortality, rehospitalization due to cardiac origin, repeated revascularization, myocardial infarction and cerebrovascular accident. Overall, the off-pump group of patients had a higher risk profile than the patients in the on-pump group. After matching, fewer differences were found between the groups. Propensity score matching analysis showed no difference in long-term survival as well as MACCE and repeated revascularization. The higher risk profile of the patients subjected to OPCAB and the comparable survival to lower risk CPB patients in this series indicate that in experienced hands, OPCAB is a valuable option in this important subgroup of patients.

Off-pump versus on-pump coronary artery bypass grafting in patient of impaired renal function

The purpose of this study was to compare the renal function in patients undergoing coronary artery bypass grafting in off-pump and on-pump having pre-operative impaired renal function. In the on-pump, the serum creatinine and urea levels were significantly increased on post-operative day 1, 3 and 7. On day 1, it was maximum, then gradually decreased but not reached to pre-operative level. In case of off-pump, serum creatinine and urea levels were significantly increased on post-operative day 1 and 3. On day 1, it was maximum. Then decreased and the serum creatinine reached below pre-operative level on day 7. In case of on-pump, the creatinine clearance rate was significantly decreased on post-operative day 1, 3 and 7. On day 1, it was minimum. Then gradually increased but not reached the pre-operative level. In case off-pump, the creatinine clearance rate was significantly decreased on day 1 and 3. On day 1, it was minimum, then gradually increased and reached above the pre-operative level. A significant low level creatinine clearance rate was observed in on-pump group. Renal function was better preserved in patients undergoing off-pump in comparison to on-pump coronary artery bypass grafting.

Clinical Outcome of CABG on Off-pump Beating Heart and On-pump Beating Heart: Experience in Ibrahim Cardiac Hospital &amp; Research Institute (ICHRI)

Background: To avoid harmful effect of cardiopulmonary bypass (CPB) used in off-pump coronary artery bypass graft (CABG) surgery, cardiac surgeons are now inclined to on-pump beating heart surgery (ONBEAT). However, the superiority of ONBEAT over Off-pump has not yet been conclusively established. This study compares the outcomes between off-pump and on pump beating heart CABG surgery.&#x0D; Methods: A total 249 consecutive patients who underwent non-emergency, primary isolated CABG from January 2014 to December 2017 by a single surgeon were included. The selected patients were assigned to either OPCAB group (Patients who received Off-pump beating heart CABG surgery, n=193) or to ONBEAT group (patients who received On-pump beating heart CABG surgery, n=56). The clinical outcomes were investigated and compared.&#x0D; Result: Forty percent of the patients were in their 5th decade of life. A male predominance was also observed. The two study groups were almost identical in terms of age and sex (p=0.983 and p=0.153 respectively). None of the conventional risk factors of ischemic heart disease (smoking, diabetes, hypertension and dyslipidaemia) were any different between the study groups (p &gt; 0.05). Cerebrovascular disease, recent MI, congestive heart failure and left main disease were significantly higher in the on-pump beating heart group compared to those in the off-pump beating heart group (p &lt; 0.05). The left ventricular ejection fraction (LVEF) was significantly lower in the former group than that in the latter group (p= 0.007). Both groups required 3 grafts on an average. Two patients in the on-pump group required Intra-Aortic Balloon Pump (IABP) support as opposed to none in the off-pump group (p=0.050). The mean cardiopulmonary bypass (CPB) time was 105.8 ± 46.5 in the on-pump group. Fourteen patients (25%) from off-pump group needed urgent switching to on-pump group. Postoperative drainage in the first 24 hours was significantly voluminous in the on-pump group (p &lt; 0.001). The incidence of pneumonia, respiratory failure, arrhythmia, renal failure requiring haemodialysis and perioperative MI were significantly higher in the on-pump group (p &lt; 0.001, p &lt; 0.001, p=0.037, p &lt; 0.001 and p=0.050 respectively). The patients with prolonged mechanical ventilation were also more in the on-pump group. The left ventricular ejection fraction (LVEF) was much lower and Intensive Care Unit (ICU) stay was longer in the on-pump group compared to those in the off-pump group (p &lt; 0.001). The incidence of in-hospital mortality was also higher in the former group (p=0.037).&#x0D; Conclusion: OPCAB was associated with lower operative morbidity compared to ONBEAT cardiac surgery. However, the increased morbidity in ONBEAT group might have been influenced by a sizable proportion of patients from OPCAB group being switched to ONBEAT group due to their haemodynamic deterioration and frequent ventricular fibrillation. But on-pump CABG can be performed safely on high risk patients. Use of cardiopulmonary bypass and elimination of cardioplegic arrest may be beneficial to hemodynamically unstable patients.&#x0D; Ibrahim Card Med J 2017; 7 (1&amp;2): 15-22

Energy expenditure measured using indirect calorimetry after elective cardiac surgery in ventilated postoperative patients: A prospective observational study

Summary Background & aims Resting energy expenditure (REE) following cardiac surgery is not determined. We conducted this prospective observational study to clarify this, comparing REE to basal energy expenditure (BEE) estimated using the Harris-Benedict equation (HBE). Methods Consecutive patients who underwent cardiac surgery (coronary artery bypass graft sursgery, valve surgery, and total arch replacement) in our hospital from September 2013 to March 2015 were included. Patients who were Results We enrolled 47 patients. Mean age, body weight, and height were 73 ± 10 years (mean ± standard deviation), 55 ± 10 kg, and 155 ± 10 cm, respectively. BEE was 1147 ± 148 kcal/day. The average REE during ventilation was 1314 ± 148 kcal/day (23.9 ± 6.8 kcal/kg/day), significantly higher than estimated BEE (114 ± 35% BEE, p Conclusions REE was 1314 ± 148 kcal/day (23.9 ± 6.8 kcal/kg/day), or 1.14 times higher than the estimated BEE, in postoperative cardiac surgery patients. The average REE was not significantly different between the on-pump and off-pump groups.

Comparison of intestinal ischemia after on-pump versus off-pump coronary artery bypass grafting surgery

Background/aim Acute mesenteric ischemia (AMI), one of the gastrointestinal system complications, which occurs following cardiac surgery, is challenged in the literature with a diminished incidence of AMI by heart surgery without cardiopulmonary bypass (CPB) or with pulsatile CPB. This study aims to compare the incidence and mortality rate of mesenteric ischemia in a series of consecutive patients undergoing coronary artery bypass grafting (CABG) through on-pump and off-pump techniques.Materials and methods This study included patients who underwent CABG between 1 January 2010 and 31 June 2016. All patients were divided into two groups: Group 1 comprised 6396 CABG patients operated on with the off-pump technique. Group 2 included 1210 patients who received CABG with the on-pump technique. Preoperative data were collected on the studied variables. Postoperative data included the development of intestinal ischemia and in-hospital mortality.Results Of 7606 consecutive CABG patients, a total of 31 (0.4%) developed intestinal ischemia. The incidence of postoperative mesenteric ischemia was 0.28% in Group 1 and 1.07% in Group 2 (P = 0.000). The survival rates after AMI were 61.1% in Group 1 (off-pump) and 7.7% in Group 2 (on-pump) (P = 0.003). Time from the first occurrence of nonspecific GI complaints to laparotomy was similar in the off-pump and on-pump groups and had no effect on mortality.Conclusions: With regard to the incidence of mesenteric ischemia and survival after laparotomy, off-pump CABG patients revealed significant improvement compared with those operated on with the on-pump technique.

Coronary Artery Bypass in Young Patients-On or Off-Pump?

A definitive conclusion regarding whether on-pump or off-pump coronary artery bypass is preferable in young patients is lacking. The aim of our study was to perform a long-term comparison of the two approaches in young patients. We analyzed the National Health Insurance Research Database, using data for patients between 18 and 45 years of age who had undergone isolated coronary artery bypass between 2001 and 2011. The study endpoints were: all-cause death, major adverse cardiac and cerebrovascular events, and repeat revascularization within 30 days, 1 year, 5 years, and the entire 10-year follow-up period. A total of 344 patients received off-pump surgery and 741 patients received on-pump surgery. Preoperative characteristics and comorbidities were similar in both groups, and all-cause mortality was almost equal (p = 0.716). The 5-year survival rates were 93.9% and 92.2% in the off-pump and on-pump groups, respectively, and the 10-year survival rates were 86.3% and 82.1%, respectively. The repeat revascularization rate was significantly lower in the on-pump group (p = 0.0407). Both the on-pump and off-pump methods offer equally good long-term outcomes in terms of mortality and major adverse cardiac and cerebrovascular events. However, the need for repeat revascularization is a concern in the long term after off-pump surgery.

Effect of cardiopulmonary bypass versus off-pump coronary artery bupass grafting on platelet inhibition rate and Aspirin resistance after coronary artery bypass grafting surgery

Objective To investigate the effect of cardiopulmonary bypass(CPB)on platelet inhibition rate(INHAA)and Aspirin resistance(AR)after coronary artery bypass grafting(CABG)surgery. Methods A total of 114 patients undergoing CABG surgery were divided into two groups: on-pump group(n=54)and off-pump group(n=60). Aspirin treatment(100 mg/d)was paused 7 days before surgery and continued 6 hours after surgery.INHAA was detected and calculated by using thrombelastography(TEG)at 6 hours after taking the last dose of aspirin before surgery(T0), 12 hours(T1), 5 days(T2), 10 days(T3)and 15 days(T4)after surgery respectively.The incidence of AR was calculated. Results There was no significant difference in the overall INHAA between the two groups of on vs.off-pump(F=0.336, P=0.563), while the differences of INHAA index at each time point was statistically significant between two groups of on vs.off-pump(F=95.519, P=0.000). There was an interaction effect of timing and grouping(F=15.500, P=0.000). In comparison of INHAA between the two groups of on vs.off-pump at each time point, INHAA was higher in on-pump group than in off-pump group at T1(P 0.05). In the on-pump group, the total difference of INHAA at different time points was significant(P 0.05). In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point, the incidence of AR was lower in on-pump group than in off-pump group at T1(P 0.05). Conclusions The increase of platelet inhibition rate and aspirin resistance occurs in early period after CABG surgery.The platelet inhibition rate is higher and aspirin resistance rate is lower in on-pump group than in off-pump group at 12 h after surgery, and the platelet inhibition rate is lower at 5 days after CABG surgery in on-pump group than in off-pump group.CPB has little effect on the platelet inhibition rate and on the incidence of AR after 5 days of CABG surgery. Key words: Coronary artery disease; Extracorporeal circulation; Platelet aggregation inhibitors

Differences of early immunological responses in on-pump versus off-pump cardiac surgery.

Cardiopulmonary bypass surgery is accompanied by an inflammatory response and pulmonary dysfunction that renders patients vulnerable to postoperative complications. The majority of studies investigating the inflammatory response in cardiopulmonary bypass focus on cytokine measurements. This study investigated the early response of peripheral blood cell types and early changes in lung tissue in on-pump versus off-pump cardiopulmonary bypass surgery. Landrace pigs were assigned to the following groups (n = 6 per group): 1. off-pump cardiopulmonary bypass, 2. conventional cardiopulmonary bypass, 3. heparin-coated cardiopulmonary bypass, 4. surface-reduced cardiopulmonary bypass, and 5. surface-reduced cardiopulmonary bypass plus lung perfusion. Surgery was performed under mild hyperthermia (32°C), with 90-minute ischemia and 180-minute reperfusion. Histological and flow cytometric analyses were performed. Lung water content increased during reperfusion in heparin-coated (84.63 ± 2.99%) compared to conventional cardiopulmonary bypass (76.33 ± 4.56%, p = 0.04). Alveolar septal thickness increased during ischemia at heparin-coated (p < 0.01) and surface-reduced cardiopulmonary bypass plus lung perfusion (p = 0.05). Tumor necrosis factor expression increased significantly (p < 0.01) in peribronchial, perivascular, and peripheral lung areas in all on-pump groups, but not in off-pump cardiopulmonary bypass. The usage of heparin-coated cardiopulmonary bypass led to increased percentages of CD3+CD4+ (p = 0.03) and CD3+CD8+ (p = 0.01) T cells compared to an uncoated device. Natural killer and mature B lymphocytes decreased at conventional and surface-reduced cardiopulmonary bypass plus lung perfusion. Activated granulocytes and macrophages increased at conventional cardiopulmonary bypass and heparin-coated cardiopulmonary bypass. Off-pump cardiopulmonary bypass induces less immunological response and lung injury than on-pump surgery. The reduction of cardiopulmonary bypass surface reduces the inflammatory immune response induced by cardiopulmonary bypass. Lung perfusion of surface-reduced cardiopulmonary bypass diminished the extravasation caused by surface reduction of the cardiopulmonary bypass.

Efficacy of on-pump versus off-pump coronary artery bypass grafting in early-stage renal impairment without dialysis therapy

Background Coronary artery disease is the most common of the cardiovascular diseases that can be treated with coronary artery bypass grafting (CABG) surgery, with either on-pump or off-pump technique. In this study, we aimed to compare the early results of isolated CABG, using on-pump and off-pump techniques, in patients with preoperative mild-to-moderate elevation of serum creatinine (1.6–2.5 mg/dl) level who did not require maintenance dialysis to support renal function. Patients and methods This prospective nonrandomized study included 60 patients who complained of symptoms of coronary artery disease and subsequently underwent myocardial revascularization at Cardiothoracic Surgery Department, Shebin El-Kom Teaching Hospital, Menoufia, Egypt, between June 2017 and August 2018. Results In group A (the on-pump group), the mean age was 73.40 ± 6.38 years, whereas in group B (the off-pump group), the mean age was 72.87 ± 9.62 years. The mean of total pump time was 112.40 ± 37.80 min and the mean of total ischemic time was 67.50 ± 24.18 min Regarding the operation time, the mean of on-pump CABG operation time was 234.60 ± 57.54 min, and 273.77 ± 43.07 min for the off-pump CABG operation, with statistically significant difference (P = 0.004). The mean time of ICU stay was 4.66 ± 3.36 days in the on-pump CABG and 3.70 ± 2.15 days in the off-pump CABG group, with no statistically significant difference between the two groups (P = 0.191). Conclusion Regarding postoperative renal dysfunction and need for dialysis, results were in favor of the off-pump technique. Renal function is better preserved in patients undergoing off-pump CABG than those undergoing on-pump CABG.

Comparisons of heart-type fatty acid-binding protein (H-FABP) levels in off-pump versus on-pump coronary artery bypass grafting.

IntroductionHeart-type fatty acid-binding protein (H-FABP) is a novel indicator of myocardial damage. The aim of the study was to compare the levels of H-FABP in off-pump and on-pump coronary artery bypass grafting (CABG).Material and methodsThirty non-randomised 30 patients who underwent CABG between January 2009 and January 2010 were enrolled in the study. Patients were divided into two equal size (n = 15) groups as group A (off-pump CABG group) and group B (on-pump CABG group). Three arterial blood samples were obtained for H-FABP after sternotomy (H-FABP 1), after the last distal anastomosis in group A and immediately after the cross clamp was removed from the aorta in group B (H-FABP 2) and 24 h after the operation (H-FABP 3). Renal and liver functions and circulating fatty acid binding protein (FABP) levels were also assessed in blood samples obtained 24 h before and 1 h after the operation.ResultsAt all three assessment points patients in group B had significantly higher H-FABP values when compared with group A. Preoperative renal and liver functions were similar in both groups and they did not differ significantly in group A and group B when preoperative and postoperative values were compared. In both groups circulating FABP levels increased in the postoperative period, and the increase was more pronounced in the on-pump CABG group.ConclusionsOn-pump surgery resulted in higher levels of H-FABP as an ischaemic marker in patients receiving coronary artery bypass surgery.