Pump Coronary Bypass Grafting Research Articles

Off-Pump Revascularization in Moderate İschemic Mitral Regurgitation.

İschemic mitral regurgitation (IMR) is associated with high mortality and poor outcomes. The surgical management of moderate IMR is still an object of debate. Patients with moderate IMR who underwent isolated off pump coronary bypass grafting (OPCAB) with facile stabilization between January 2015 and February 2022 were analyzed. The primary end point was the remaining ischemic mitral regurgitation and echocardiographic findings while the secondary outcomes were defined as mortality, major adverse events and postoperative functional status. Of 541 patients who underwent isolated OPCAB in this period, there were 62 patients among with concomitant moderate IMR. The mean follow-up period was 19.4±21.6 months. The median number of the coronary anastomosis was 4(range.1-6). In 58.06% (n=36), the regurgitation regressed. Left atrial (LA) diameter significantly decreased postoperatively (p= .040). Increased LA diameter was associated with increased major adverse events (p=.010). Rehospitalization rates were higher in low EF. The postoperative poor functional status(NYHA III-IV) was correlated with increased postoperative left ventricular end-systolic diameter (41.75±6.13 v.s. 34.79±6.8 p=.05). Mortality(4.8%, n=3) was associated with elder age and increased preoperative systolic pulmonary artery pressure (p= .050; p= .046 respectively). LA diameter, LVESD, mean systolic pulmonary artery pressure, LVEF and age are important predictors for outcomes in IMR. Remaining IMR per se is not directly correlated with increased mortality and MACCE. Facile stabilization technique we use here, is advantegous due to the feasibility of full revascularization of all intended vessels particularly of the inferoposterior wall by providing an excellent vision without compression of the heart.

Simultaneous Operation on Pump Coronary Bypass Grafting and Left Hemicolectomy in Patient with Reduced Ejection Fraction

This is written so as to report the case of a 75-year-old male with a diagnosis of sigmoid adenocarcinoma accompanied by critical coronary artery disease and angina, which was subject to simultaneous surgical treatment. Was performed first an on – pump coronary artery revascularization and then a left colectomy. Our case suggests that performing an on-pump bypass in patient also with reduced ejection fraction procedure prior to cancer surgery can be a safe surgical in appropriately selected cases.

The impact of total arterial revascularization off pump coronary bypass grafting in impaired left ventricular function

BackgroundThe Arterial grafts have the advantage of durability and may have a protective effect by reducing the progression of native coronary artery disease (CAD) in grafted vessels. This study aimed to evaluate the impact of total arterial revascularization off pump coronary artery bypass grafting (CABG) in impaired left ventricular (LV) function patients with Ejection Fraction (EF) ≤ 35% concerning the short-term results. MethodsFrom August 2006 to August 2015, 287 patients with EF ≤ 35% out of 1950 patients underwent CABG in our Department of Cardiac-Thoracic Surgery, Zagazig University hospital, Egypt, for myocardial revascularization procedures were studied with a prospective registry of their data. Group 1 included 137 patients subjected to total arterial revascularization off Pump (TAROP) and Group 2 included 150 patients subjected to conventional technique (C-CABG). ResultsHospital mortality was less in group 1 (4.37% versus 4.66%). The duration of intensive care unit stay and the hospital stay were shorter in the group 1, with statistical significance. The mean graft patency rate for 113 (82.5%) patients of group 1 (TAROP) and 113 (75.3%) group 2 (C-CABG, utilizing internal mammary and venous grafts) at one month were 98.2% and 80.5% respectively. The short-term outcome revealed that the mean postoperative LVEF improved significantly, from 29% ± 1.7% to 41.0% ± 2.0% (p < 0.05) for group 1 with an improvement of the NYHA classification of the patients in both groups. ConclusionsTotal arterial revascularization off-pump CABG in impaired left ventricular function can be achieved in most cases with low complication and mortality rates and accepted results.

Postoperative Pain Management After Sternotomy In Off-Pump Coronary Artery Bypass Graft (CABG) Surgery - A Comparative Study Between NSAID (Diclofenac Sodium) and Opioid (Pethidine)

Background: Traditionally, postoperative pain has been managed either reactively with drugs given as needed or proactively with continuous infusion of analgesics. Objectives: The present prospective comparative study was carried out to find difference in efficacy between opioid and NSAID (Non-stroid anti-inflammatory drugs) in the post-sternotomy pain management following off pump coronary bypass graft surgery. Methods: A total of 30 patients were randomly divided into two groups. – 15 patients were treated with NSAID (Diclofenac sodium) and 15 patients with opioid (pethidine) which are not commonly used in cardiac surgery. Patients ranging from 40 – 60 years with ASA Grade I & II who underwent off-pump CABG with median sternotomy were included in the study. Statistics: The test statistics used to analyze the data were Chi-square Test and repeated measure ANOVA. Result & conclusion: The study concluded that the intensity of post-sternotomy pain was inappreciably higher in the NSAID group than that in the opioid group throughout the whole period of observation suggesting that opioid (pethidine) would be a promising analgesic in the post-sternotomy pain management than NSAID (diclofenac sodium) (p = 0.045). Key words: Post-sternotomy pain; OPCAB; choice of analgesic. DOI: 10.3329/bsmmuj.v3i2.7059 BSMMU J 2010; 3(2): 91-96

Prospective Randomized Clinical Study of Arterial Pumps Used for Routine on Pump Coronary Bypass Grafting

In a number of studies, centrifugal blood pumps--in comparison with roller pumps--have been shown to attenuate trauma to blood components. Nevertheless, the impact of these results on the postoperative course needs to be discussed controversially. In a prospective randomized study, 240 consecutive adult patients underwent elective myocardial revascularization with cardiopulmonary bypass employing five different pumps (Roller, Avecor, Sarns, Rotaflow, Bio-Medicus). We analyzed clinical course, blood loss, damage of blood components, and impairment of the hemostatic system. The study population was homogenous with respect to age, gender, myocardial function, and operative data. No differences were found with respect to time of ventilation, duration of intensive care stay, hospitalization, and laboratory data. The choice of arterial pump during standard extracorporeal bypass for elective coronary artery bypass grafting is no matter of concern.