Anaortic coronary surgery using the Π-circuit is associated with a low incidence of perioperative neurological complications

Prapas, Sotirios; Calafiore, Antonio M.; Katsavrias, Konstantinos P; Panagiotopoulos, Ιoannis; Linardakis, Ioannis N.; Tancredi, Fabrizio; Foschi, Massimiliano; Mauro, Michele Di

doi:10.1093/ejcts/ezy224

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…However, the dynamics of aortic side-clamping for proximal anastomosis are markedly different: OPBHC might favor a "softer" aortic lateral clamping (because of rapid on-demand hypotension achieved with CPB), while in conventional off-pump CABG the same maneuver might result in a more traumatic side-clamping. Furthermore, the anaortic or "no touch" approach 41,42 18 Our systematic review suggests that patients with reduced LVEF can benefit from OPBHC. 10,18,20,[24][25][26] Generalized data from all-comers population might support the idea of using OPBHC also in unselected patients.…”

Section: Discussionmentioning

confidence: 96%

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

et al. 2020

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Background Operative technique for surgical myocardial revascularization in high‐risk patients remains an argument of debate. On‐pump coronary artery bypass graft (CABG) with cardioplegic arrest and off‐pump CABG have intrinsic limitations. The hybrid approach of on‐pump beating‐heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta‐analysis intends to summarize the contemporary literature. Methods A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study. Results Compared with on‐pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36‐0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39‐0.91). Also, interesting trends towards reduced postoperative intra‐aortic balloon pump use (RR, 0.56, 95% CI, 0.31‐1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22‐1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off‐pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off‐pump CABG (RR, 0.53, 95% CI, 0.33‐0.87) but higher than conventional on‐pump CABG (RR, 1.71, 95% CI, 1.23‐2.39). Conclusion OPBHC is an effective technique to perform surgical revascularization in high‐risk patients as preventing haemodynamic deterioration and guaranteeing adequate end‐organ perfusion. OPBHC represents an alternative technique to on‐pump and off‐pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.

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Section: Discussionmentioning

confidence: 96%

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

et al. 2020

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“…OPBHC promotes a "softer" aortic lateral clamping, whereas, in standard off-pump CABG, the same maneuver may result in a more traumatic side clamping. Finally, the "no touch" approach [41,42] prevents the need for aortic side-clamping and in theory, is the ideal technique in patients with markedly calcified ascending aorta [42]. Consequently, there are plenty of options in the treatment of patients at high risk for stroke and OPBHC may be one of them.…”

Section: Discussionmentioning

confidence: 99%

On‐pump beating‐heart coronary artery bypass grafting: Single Center Experience and Literature Review

Triantafillou¹

2023

GSC Adv. Res. Rev.

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Purpose: In this retrospective, observational, non-randomized study, we present the results of our department in on‐pump beating‐heart coronary artery bypass grafting and we review the relevant medical literature. Methods: All data related to patients who underwent on‐pump beating‐heart coronary artery bypass grafting at our center for three consecutive years were collected. These patients were classified into two groups: isolated bypass grafts or combined with aortic valve replacement. All data related to preoperative characteristics, procedural characteristics, and clinical outcomes are presented separately for the two groups. Results: During the study period, 175 patients underwent on‐pump beating‐heart bypass grafting alone and 32 combined with aortic valve replacement. Despite higher than average Euroscore in both groups, mortality, and morbidity were satisfactory while the rate of complete revascularization was higher than previously reported for classic off-pump surgery. Conclusion: On‐pump beating heart coronary artery bypass grafting offers an excellent alternative in the surgical treatment of coronary artery disease. Patient selection is very important, and in the hands of skilled surgeons, it may prevent intraoperative complications and offer the appropriate revascularization, especially for high-risk patients.

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“…1,33,34 Off-pump coronary artery bypass surgery combined with total arterial revascularization can reduce the rate of cerebrovascular accidents up to 75%. 35…”

Section: Discussionmentioning

confidence: 99%

The π-Circuit Technique in Coronary Surgery: Analysis of 1359 Consecutive Cases

Prapas

Pangiotopoulos

Leivaditis

et al. 2019

Open�J Cardiovasc Surg

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Coronary artery bypass surgery still has its unique role in the treatment of coronary artery disease. It faces, however, the continuous challenge of becoming even less invasive and more effective as cases become more complex. We here present the results of 1359 cases treated with the π-circuit technique which consists of an off-pump total myocardial revascularization using composite arterial grafts. The results demonstrate that it is a safe technique providing low mortality, stroke, renal failure, wound infection, and other complication rates. We suggest the application of this technique, as well as of other similar techniques regarding similar principles, especially in high-risk patients.

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Anaortic coronary surgery using the Π-circuit is associated with a low incidence of perioperative neurological complications

Abstract: The ∏-circuit should be included as a possible choice among no-touch techniques. The observed rate of CVAs of 75% is lower than the expected rate.

Cited by 7 publications

References 26 publications

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

On‐pump beating‐heart coronary artery bypass grafting in high‐risk patients: A systematic review and meta‐analysis

On‐pump beating‐heart coronary artery bypass grafting: Single Center Experience and Literature Review

The π-Circuit Technique in Coronary Surgery: Analysis of 1359 Consecutive Cases

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