On-pump Technique Research Articles

Off versus on pump myocardial revascularization in patients with severe asymptomatic carotid stenosis.

Coronary artery disease is a global cause of morbidity and mortality, often managed by coronary artery bypass grafting (CABG). This study addresses a critical decision-making dilemma in CABG procedures for patients with severe asymptomatic carotid stenosis, comparing off-pump and on-pump techniques. We conducted a retrospective single-center analysis, employing propensity scored matched-pair methodology to compare perioperative outcomes in patients with asymptomatic severe carotid stenosis undergoing off-pump or on-pump CABG. The primary endpoint was the occurrence of perioperative stroke. Secondary endpoints included postoperative delirium, intrahospital mortality, intensive care unit stay, length of hospitalization and long-term survival. The study involved 243 patients with asymptomatic severe carotid stenosis operated between July 2009 and October 2018, subsequently propensity score matched into two groups of 78 patients each (off-pump and on-pump). The incidence of perioperative stroke was significantly higher in the On-Pump group compared to the off-pump group (10.3% vs. 1.3%, P=0.03). However, secondary endpoints, such as intrahospital mortality and length of hospitalization, showed no significant differences between the two groups. Long-term survival rates were also comparable. Our findings indicate that off-pump CABG significantly reduces the risk of perioperative stroke in patients with severe asymptomatic carotid stenosis compared to on-pump CABG, without compromising long-term outcomes. These results support the preference for off-pump CABG in this high-risk patient population, highlighting the need for tailored surgical approaches based on individual patient risk profiles.

Improved Early Outcomes With Off-Pump Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction: A Systematic Review and Meta-Analysis.

The ongoing debate surrounding coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass persists, particularly in individuals with left ventricular dysfunction. The objective of this study was to evaluate the safety and efficacy of these 2 strategies through a comprehensive meta-analysis of existing studies. A systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Central Registry was conducted from inception to July 2023. The primary focus was on studies comparing on-pump versus off-pump CABG as the primary treatment for multivessel coronary artery disease in patients with left ventricular dysfunction (ejection fraction ≤40%), with mortality as the primary outcome. The meta-analysis included 26 studies with a total of 35,863 patients. The results revealed a significant reduction in mortality risk [risk ratio (RR), 0.75; 95% confidence interval (CI), 0.60-0.93; P = 0.009] and other perioperative morbidities associated with off-pump CABG. These included stroke (RR, 0.67; 95% CI, 0.54-0.82; P = 0.0002), myocardial infarction (RR, 0.74; 95% CI, 0.56-0.97; P = 0.03), pulmonary complications (RR, 0.71; 95% CI, 0.55-0.92; P = 0.010), postoperative transfusion (RR, 0.70; 95% CI, 0.55-0.88; P = 0.002), neurological dysfunction (RR, 0.80; 95% CI, 0.64-1.00; P = 0.05), infection (RR, 0.74; 95% CI, 0.56-0.97; P = 0.03), renal failure (RR, 0.79; 95% CI, 0.67-0.95; P = 0.010), and reoperation for bleeding (RR, 0.66; 95% CI, 0.52-0.84; P = 0.0006). However, no significant difference was observed between the 2 groups regarding postoperative atrial fibrillation (RR, 0.97; 95% CI, 0.84-1.12; P = 0.69). In conclusion, off-pump CABG demonstrates a lower perioperative mortality risk and improved overall early outcomes compared with on-pump techniques in individuals with reduced left ventricular function.

Effect of on-Pump and Off-Pump Coronary Artery Bypass Graft on Length of Icu Stay among Low Ejection Fraction Patients Going through Cardiac Revascularization

Background Coronary artery bypass grafting (CABG) remains a cornerstone in the management of coronary artery disease, especially for patients with severe left ventricular dysfunction. The debate between on-pump and off-pump CABG techniques centers on their impact on postoperative outcomes, particularly the length of ICU stay, which has significant implications for patient recovery and healthcare resources. Objective This study aimed to compare the effects of on-pump and off-pump coronary artery bypass grafting on the length of ICU stay among patients with severe left ventricular dysfunction undergoing cardiac revascularization, with a view to optimizing postoperative outcomes and resource utilization in this high-risk patient population. Methods A longitudinal cross-sectional study was conducted, enrolling 78 participants scheduled for CABG at a single center over one year. Participants were divided into two groups: those undergoing on-pump CABG (n=44) and those undergoing off-pump CABG (n=34). Data collection focused on demographic information, clinical characteristics, and the length of ICU stay. Statistical analysis employed SPSS v25, utilizing means, standard deviations, and Independent t-tests to compare outcomes between the two groups. Results The study revealed that patients undergoing on-pump CABG had a significantly shorter mean ICU stay (4 ± 3.9 days) compared to the off-pump CABG group (5 ± 4.4 days), with a P value of 0.01. Further stratification showed that older patients and those with comorbidities such as diabetes and hypertension experienced longer ICU stays, irrespective of the surgical technique used. Conclusion On-pump CABG is associated with shorter ICU stays compared to off-pump CABG in patients with severe left ventricular dysfunction, suggesting that the on-pump technique may be preferable for optimizing postoperative recovery and resource allocation in this patient cohort.

Reverse Septal Movement: A Step Forward in the Comprehension of the Underlying Causes.

(1) Background: Reverse septal movement (RSM) often occurs after cardiac surgery, consisting of a paradoxical systolic movement of the interventricular septum. In this retrospective study, we aimed to investigate possible determinants of RSM after coronary artery bypass surgery (CABG). (2) Methods: Patients who underwent CABG with on- or off-pump techniques at our center from March 2019 to October 2021 were retrospectively included. Exclusion criteria were: exposure to combined procedures (e.g., valve implantation), prior cardiac surgery, intraventricular conduction delays, and previous pacemaker implantation. Laboratory tests and echocardiographic and cardiopulmonary bypass (CPB) duration data were collected. (3) Results: We enrolled 138 patients, of whom 32 (23.2%) underwent off-pump CABG. Approximately 89.1% of the population was male; the mean age was 70 ± 11 years. There was no difference in RSM incidence in patients undergoing the off-pump and on-pump techniques (71.9% vs. 62.3%; p = 0.319). In patients undergoing on-pump surgery, the incidence of RSM was slightly higher in longer CPB procedures (OR 1.02 (1.00-1.03) p = 0.012), and clamping aortic time was also greater (OR 1.02 (1.00-1.03) p = 0.042). (4) Conclusions: CPB length seems to be correlated with a higher RSM appearance. This better knowledge of RSM reinforces the safety of CABG and its neutral effect on global biventricular function.

Five-year outcomes of off and on-pump CABG: Insights from PROMOTE Patency Trial.

There are limited studies reporting follow-up outcome data comparing of off-pump coronary artery bypass (OPCAB) with on-pump (ONCAB) technique. The aim of the study was to report the 5-year clinical outcomes of OPCAB and ONCAB in a post hoc analysis of the PROMOTE patency trial. From March 2016 through March 2017, a total of 321 patients undergoing coronary artery bypass grafting (CABG) were randomised to either the off-pump or the on-pump technique. Data on all-cause mortality, myocardial infarction (MI), cerebrovascular accident (CVA), repeat revascularisation and need for renal replacement therapy (RRT) were recorded. The composite and each of these individual outcomes are reported at 5-year interval. The mean follow-up period was 65.9 months (±3.39). A total of 275 (85.93%) patients followed up at the 5-year interval who underwent CABG by the off-pump (n = 158) and the on-pump (n = 162) technique. The all-cause mortality was 8.9% and 5.7% in ONCAB and OPCAB, respectively (hazard ratio [HR] = 0.62; 95% confidence interval [CI] 0.25-1.57, p = 0.31). The composite of all-cause mortality, non-fatal MI, non-fatal CVA, RRT and need for repeat revascularisation was comparable in both groups (7.1% vs. 11.9%, HR = 0.57; 95% CI 0.25-1.31, p = 0.18 in OPCAB and ONCAB, respectively). The rates of 5-year non-fatal MI (p = 0.2), non-fatal CVA (p = 0.36) and need for repeat revascularisation (p = 1) were similar in both groups. A sub-group analysis did not show any significant interaction or effect modification with either of the techniques. The 5-year clinical outcomes of OPCAB are comparable to ONCAB in low-risk patients undergoing CABG. Off-pump coronary artery bypass had no additional benefit in any subgroup.

Blood Urea Level After on Pump and Off Pump Coronary Artery Bypass Grafting

CABG being one of the most common types of cardiac surgery, lowers the risk of Myocardial Infarctions and patients can remain symptom free for as long as 10-15 years. Though this surgery became more common, there are 2 methods of performing CABG, and they are On-pump and Off-pump techniques. Recent studies reveals several advantages for Off-pump technique than performing On-pump technique. So the intention of this study was to analyze if there is anyphysiological significance of doing On-pump over Off-pump technique. The physiological parameter being considered in this study includes Blood urea level. Post CABG results of blood urea level showed almost similar outcomes among both the techniques of performing CABG surgery. Thus, renal function is unaffected by the technique if CABG, whether with or without cardiopulmonary bypass, in spite of the theoretical advantage of off-pump surgery.

(889) Off-Pump Less Invasive HeartMate3 LVAD Implantation is Safe and Feasible Compared to the On-Pump Technique

(889) Off-Pump Less Invasive HeartMate3 LVAD Implantation is Safe and Feasible Compared to the On-Pump Technique

Female gender does not have any significant impact on the early postoperative outcomes after coronary artery bypass grafting: a propensity-matched analysis.

Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure performed in India. There are fundamental differences between males and females in the incidence and responses of the body to various diseases. These differences are noticeable, more so in conditions relating to cardiovascular health, particularly coronary artery disease (CAD). This study aims to assess the gender differences in the early postoperative outcomes following CABG. Between April 1999 through February 2018, 13,415 patients underwent isolated CABG in our practice. Propensity score matching was performed to yield 1825 well-matched pairs in each gender. These groups were compared in terms of various early postoperative outcomes. There were no significant differences between females and males in terms of early postoperative composite outcomes (4.2% vs. 5.2%) (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.60-1.12, p = 0.213) of 30-day mortality, non-fatal myocardial infarction (MI), non-fatal cerebrovascular accidents (CVA), and need for renal replacement therapy (RRT), 30-day mortality (0.7% vs. 0.7%) (OR 1.11; 95%CI 0.50-2.45, p = 0.796), MI (2.7% vs. 3.1%) (OR 0.93; 95%CI 0.63-1.37, p = 0.708), CVA (0.4% vs. 0.8%) (OR 0.46; 95%CI 0.19-1.14, p = 0.096), and need for RRT (0.7% vs. 0.7%) (OR 0.88; 95%CI 0.40-1.93, p = 0.753). Females have similar early postoperative outcomes compared to males in terms of composite outcomes of 30-day mortality, non-fatal MI, non-fatal CVA, and RRT among patients undergoing CABG. The outcomes are also similar when individually assessed. The off-pump technique has no additional benefit compared to the on-pump technique in females undergoing CABG.

Off-pump implantation of left ventricular assist device via minimally invasive left thoracotomy: Our single-center experience.

The aim of this study was to compare our experience of left ventricular assist device implantation via minimally invasive left thoracotomy with off-pump versus on-pump technique. Between June 2013 and April 2020, nine patients (8 males, 1 female; mean age: 47±11.9 years; range, 30 to 61 years) who underwent off-pump left ventricular assist device implantation and nine patients (8 males, 1 female; mean age: 47±11.4 years; range, 29 to 60 years) who underwent on-pump minimally invasive left thoracotomy were retrospectively analyzed. Postoperative outcomes and mid-term results of both groups were evaluated. Outflow graft was anastomosed to the ascending aorta with J-sternotomy in all patients. The median duration of intubation and intensive care unit stay were one (IQR: 1.5) day and eight (IQR: 6.5) days in the off-pump group, respectively and one (IQR: 0) day and seven (IQR: 7) days in the on-pump group, respectively. Intra-aortic balloon pump was needed during the weaning of cardiopulmonary bypass in one (11%) of the patients in both groups. Postoperative right ventricular failure was observed in two (22%) patients in the offpump group who were treated medically and recovered. There was no need for revision due to bleeding or postoperative extracorporeal membrane oxygenator implantation in either group. In the off-pump group, three patients underwent heart transplantation after median 854 (IQR: 960) days. Three patients died one month, two and four years after implantation. Three patients were still alive with left ventricular assist device and were being uneventfully followed for 365, 400, and 700 days after implantation. Off-pump technique is safe and feasible option for implantation of left ventricular assist device via minimally invasive left thoracotomy.

The role of immature platelet count and immature platelet fraction in determining the need for transfusion in patients undergoing CABG.

Platelet dysfunction has been shown to play a role in postoperative bleeding, however it is not clear whether immature platelets (IP) can induce appropriate homeostasis to prevent excessive bleeding in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to evaluate the postoperative change in IP count (IPC), IP fraction (IPF) and mean platelet volume (MPV), and to examine their relationship with postoperative bleeding and blood transfusion. One hundred and forty-nine consecutive patients undergoing elective CABG were included in this prospective study. All CABGs were performed by the same surgical team in a standardised method, utilising the on-pump technique. IPC, MPV and IPF were measured pre-operatively, after the completion of surgery, and at the postoperative first, third and fifth days. The primary outcome measure of this study was whether the need for transfusion was associated with IP, IPF, MPV and platelet count. There was a significant decrease of 7.77% in IPC on the day of the operation. Pre-operative IPC and IPF were correlated with postoperative drainage (p < 0.001), intraoperative blood transfusion (p < 0.001) and intensive care unit blood transfusion (p < 0.001). Pre-operative haemoglobin levels were significantly correlated with length of hospital stay. However, neither pre-operative IPC nor IPF were associated with length of hospital stay. Postoperative IPC was however associated with the length of hospital and intensive care unit stay (p = 0.008 and p = 0.009, respectively). Pre-operative IPC and IPF were significantly correlated with postoperative drainage and blood transfusion frequency. In patients undergoing CABG, these can be seen as serious guiding parameters in the estimation of postoperative bleeding.

CABG in patients with liver cirrhosis: to pump or not to pump?

ABSTRACT Introduction Coronary artery bypass grafting in patients with established liver cirrhosis is generally associated with poor outcomes. Avoiding cardiopulmonary bypass (CPB) in these patients has not demonstrated any advantage over the use of CPB. We review the current available literature that compared the outcome of both on-pump (ONCABG) and off-pump (OPCAB) techniques in cirrhotic patients in terms of morbidity and mortality. Areas covered A comprehensive search was conducted in the PubMed/MEDLINE and EMBASE databases in January 2021. Articles that reported outcomes of OPCAB and/or ONCABG in cirrhotic patients with no concomitant surgical procedures were included. 829 unique abstracts were retrieved with title and abstract screening completed independently by two reviewers. Two case studies and six retrospective cohort studies were included. The largest study comprised more than 98% of the total population, showing some survival benefit for OPCAB over ONCABG. However, it was population-based and did not report the severity of liver. The remaining studies reported no clear difference in outcome between the two techniques. Expert opinion Surgical myocardial revascularisation carries high perioperative risk in patients with liver cirrhosis irrespective of the surgical technique. There is a lack of evidence to suggest that avoiding CPB in these patients may be beneficial.

Long-Term Follow-Up of Device-Assisted Clampless Off-Pump Coronary Artery Bypass Grafting Compared with Conventional On-Pump Technique.

Study objective: To evaluate the long-term outcomes of clampless off-pump coronary artery bypass grafting (C-OPCAB) compared with conventional on-pump double clamping coronary artery bypass grafting (C-CABG). Methods: From October 2006 to December 2011, 366 patients underwent isolated coronary artery bypass grafting. After propensity score matching of preoperative variables, 143 pairs were selected who received C-OPCAB with the use of device-assisted PAS-Port proximal venous graft anastomoses or C-CABG, performed by the same surgeon experienced in both techniques. Data of the two groups of patients were retrospectively analyzed up to 14 years of follow-up. Results: As compared with C-OPCAB, in the C-CABG patients, the performed number of grafts per patient was higher (2.9 ± 0.5 vs. 2.6 ± 0.6, p-value 0.0001). At 14 years, overall survival, including in-hospital death, was 64 ± 4.7% for the C-OPCAB vs. 55 ± 5.5% for the C-CABG, freedom from overall MACCEs 51 ± 6.2% vs. 41 ± 7.7%, and from late cardiac death 94 ± 2.4% vs. 96 ± 2.2% (p-value not significant, for all comparisons). No significant statistical differences were observed in the actual rates of adverse events during follow-up. Independent predictors of survival were advanced age at operation (p-value 0.001) and a lower mean value of preoperative left ventricular ejection fraction (p-value 0.015). Conclusions: Our single-center study analysis suggests that clampless OPCAB using device-assisted proximal anastomoses proved to be not inferior to double-clamping CABG in the long-term follow-up, provided that involved surgeons are familiar with both techniques. These conclusions are supported by a large and long-term follow-up period, eliminating potential bias, i.e., by means of the propensity score matching and analyzing single-surgeon experience.

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery; statistical challenges in comparison

BackgroundDespite several studies comparing off- and on-pump coronary artery bypass grafting (CABG), the effectiveness and outcomes of off-pump CABG still remain uncertain.MethodsIn this registry-based study, we assessed 8163 patients who underwent isolated CABG between 2014 and 2016. Propensity score matching (PSM), inverse probability of weighting (IPW) and covariate adjustment were performed to correct for and minimize selection bias.ResultsThe overall mean age of the patients was 62 years, and 25.7% were women. Patients who underwent off-pump CABG had shorter length of hospitalization (p < 0.001), intubation time (p = 0.003) and length of ICU admission (p < 0.001). Off-pump CABG was associated with higher risk of 30-days mortality (OR: 1.7; 95% CI 1.09–2.65; p = 0.019) in unadjusted analysis. After covariate adjustment and matching (PSM and IPW), this difference was not statistically significant. After an average of 36.1 months follow-up, risk of MACCE and all-cause mortality didn’t have significant differences in both surgical methods by adjusting with IPW (HR: 1.03; 95% CI 0.87–1.24; p = 0.714; HR: 0.91; 95% CI 0.73–1.14; p = 578, respectively).ConclusionOff-pump and on-pump techniques have similar 30-day mortality (adjusted, PSM and IPW). Off-pump surgery is probably more cost-effective in short term; however, mid-term survival and MACCE trends in both surgical methods are comparable.

Perioperative Evaluation of Heart Echinococcus Cyst in a 14-Year-Old Child

BACKGROUND: Echinococcosis of the heart has a rate 0.02–2% of all hydatid diseases. Clinical presentation is depending of the location of hydatid cyst in the heart. Patients can be an asymptomatic case or lethal stroke, arrhythmias, valvular dysfunction, pulmonary edema, cardiac tamponade, cardiac failure, shock, and even death.&#x0D; CASE REPORT: We present a case report, a 14-year-old child with 2 weeks of sore throat, whooping cough, subfebrile condition, sweating, fatigue and physical weakness, nausea, abdominal pain, and decreased appetite. He came to emergency room with cardiogenic shock and pulmonary edema. He was diagnosed with intramyocardial hydatid cyst.&#x0D; CONCLUSION: Echinococcus cyst lesion in the LV in lateral wall, not communicating with the LV cavity, has been removed successfully with on-pump technique in a 14-year-oldchild. Median sternotomy was preferred and cardiopulmonary bypass has been considered the safest method. Supplemental medical therapy with albendazole is recommended to reduce the risk of recurrence.

ON-PUMP VERSUS OFF-PUMP CORONARY ARTERY BYPASS GRAFTING in PATIENTS with POOR LEFT VENTRICULAR FUNCTION

Background: There is an increase in the number of patients with severely impaired left ventricle function who referred for CABG. Many studies showed that surgical intervention for those high-risk patients has high survival and wonderful outcome compared to medical treatment. Aim of work: This study aimed to evaluate our experience with coronary artery bypass surgery in patients with EF [ 25% up to 40%] either to perform surgery using off or on-pump technique and try to conclude which technique may be safer regarding cardiac function. Patients and Methods: This prospective observational patient cohort study from August 2017 to July 2019 enclosed forty consecutive patients divided into 2 teams every 20 patients either off or on pump technique according to surgeons' expertise. Pre-, intra- and post-operative data were collected for all patients. All survivors were subjected to a 6-months follow-up clinically and by Echocardiograghy assessment. Results: Improvement of ejection fraction [EF] was encountered in our study; the mean 6-months operative EF improved for each team by [36% versus 37%] for off-pump and on-pump interventions, respectively. There was no statistically important difference in the information collected for each technique [p-value>0.05] regarding most points of comparison. Conclusion: Results of CABG in high-risk patients were acceptable with on-pump and off-pump techniques with nearly comparable results in our study, at least in the early 6-months after intervention. Intra-aortic balloon usage is valuable when indicated.

OFF PUMP VERSUS ON PUMP CORONARY ARTERY BYPASS SURGERY in ISCHEMIC HEART DISEASE PATIENTS with IMPAIRED CONTRACTILITY and RENAL DYSFUNCTION ;ACOPARATIVE STUDY.

Background: Coronary artery bypass surgery using cardiopulmonary bypass [CPB] carries the risk of renal impairment, which cannot be attributed to a single factor. This study compared the off-pump technique with the on-pump technique on kidney function in ischemic heart disease patients. Aim of the work: The study aimed to compare off-pump with on-pump technique on kidney and heart functions in patients with renal impairment with no need for dialysis but with impaired Ejection fraction [EF]. Patients and methods: This prospective non-randomized study included 60 patients who presented with symptoms of ischemic heart disease and subsequently underwent myocardial revascularization with preoperative serum creatinine levels between 1.6 to 2.5 mg/dl and EF below 45%. Patients were as following: Group A patients [on-pump]: included those who underwent surgery on cardiopulmonary bypass. Group B patients [off-pump]: included those who underwent off-pump surgery. Both groups were compared in terms of renal impairment markers and needed for dialysis and early postoperative outcome. Results: Renal impairment needs management by dialysis was developed in nine patients [30%] in the pump group [group I] and two patients [7.67%] in the off-pump group, with a significant difference. Group [I] showed a significant increase of transfused blood, blood urea nitrogen, serum creatinine, acute kidney injury [13 patients], reopening for bleeding, postoperative renal impairment, need for renal dialysis, total intensive care unit stay, and the total duration of hospital admission. However, it had a significant reduction in hemoglobin and creatinine clearance. Conclusion: Off-pump coronary revascularization offers a better kidney function preservation and has a decreased risk for kidney dysfunction in patients with renal impairment without dialysis compared with coronary revascularization with cardiopulmonary bypass.

Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial

ObjectiveWe performed a post hoc analysis of the Arterial Revascularization Trial to compare 10-year outcomes after off-pump versus on-pump surgery. MethodsAmong 3102 patients enrolled, 1252 (40% of total) and 1699 patients received off-pump and on-pump surgery (151 patients were excluded because of other reasons); 2792 patients (95%) completed 10-year follow-up. Propensity matching and mixed-effect Cox model were used to compare long-term outcomes. Interaction term analysis was used to determine whether bilateral internal thoracic artery grafting was a significant effect modifier. ResultsOne thousand seventy-eight matched pairs were selected for comparison. A total of 27 patients (2.5%) in the off-pump group required conversion to on-pump surgery. The off-pump and on-pump groups received a similar number of grafts (3.2 ± 0.89 vs 3.1 ± 0.8; P = .88). At 10 years, when compared with on-pump, there was no significant difference in death (adjusted hazard ratio for off-pump, 1.1; 95% confidence interval, 0.84-1.4; P = .54) or the composite of death, myocardial infarction, stroke, and repeat revascularization (adjusted hazard ratio, 0.92; 95% confidence interval, 0.72-1.2; P = .47). However, off-pump surgery performed by low volume off-pump surgeons was associated with a significantly lower number of grafts, increased conversion rates, and increased cardiovascular death (hazard ratio, 2.39; 95% confidence interval, 1.28-4.47; P = .006) when compared with on-pump surgery performed by on–pump-only surgeons. ConclusionsThe findings showed that in the Arterial Revascularization Trial, off-pump and on-pump techniques achieved comparable long-term outcomes. However, when off-pump surgery was performed by low-volume surgeons, it was associated with a lower number of grafts, increased conversion, and a higher risk of cardiovascular death.

P312 Early changes of left ventricular myocardial work performance in patients undergoing coronary artery bypass surgery: off-pump vs. on-pump

Abstract Background Coronary-artery bypass grafting (CABG) without the use of cardio-pulmonary bypass (CPB) was introduced to avoid the potential damaging effects of fpreign surfaces. Nevertheless, the value of off-pump CABG (OPCAB) remains controversial. Regional myocardial work has been shown to reflect regional metabolic demand and provide a more comprehensive assessment of myocardial function. Recently a novel non-invasive method for assessing regional MW by LV pressure–strain loop analysis has been described. Purpose To detect changes of MW after CABG comparing off- and on-pump techniques. Methods We prospectively evaluated 93 patients undergoing CABG (50 on- vs. 43 off-pump). Patients underwent transthoracic echocardiography exams prior to and one week after surgery as well as concurrently systolic arterial blood pressure measurements at rest. Besides conventional echocardiography parameters, wemeasured global longitudinal strain (GLS), global work index (GWI) and global work efficiency (GWE). Results All patients survived surgery. Patients in the OPCAB group had significantly higher EuroSCORE II (3.3% vs. 1.1%, p &amp;lt; 0.001). Preoperatively, OPCABgroup had significantly lower EF (50.1 vs. 55.7%, p = 0.004), lower GWI (1411 vs. 1650mmHg%, p = 0.039) and lower GWE (86.7 vs. 91.6%, p = 0.017). GLS did not differ significantly between off- and on-pump groupspreoperatively. However, postoperatively GLS, MWI, MWE and EF decreased significantly within the on-pump group (p &amp;lt; 0.001, p &amp;lt; 0.001, p &amp;lt; 0.001 and p = 0.002, respectively). In the OPCAB group only GWI and GLSdecreased significantly (p = 0.028 and p = 0.017, respectively). Due to the fact, that mean differences between all pre- and postoperative values were higher in the on-pump group, no significant differences in systolic LV-function (sLVF) could be detected between on- and off-pump patients postoperatively. During the early postoperative phase, no correlation between GWI and GWE and clinical outcomes could be detected, onlylower preoperative-GWI values showed a weak correlation with the incidence of postoperative cardiogenic shock (r= -0.27, p = 0.029). Conclusion Despite having worse preoperative sLVF in the off-pump group determined by EF, GLS, GWI and GWE, the decrease in sLVF parameters was significantly higher in the on-pump group, leading to an equal distribution of LV-function parameters between off- and on-pump patients postoperatively. Our results suggest that off-pump CABG provides a better preservation of LV-function.

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.

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.