Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease

Mack, Michael J.; Pfister, Albert J.; Bachand, Donna; Emery, Robert W.; Magee, Mitchell J.; Connolly, Mark W.; Subramanian, Valavanur A.

doi:10.1016/j.jtcvs.2003.08.032

Cited by 186 publications

(135 citation statements)

References 16 publications

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“…On-pump CABG activates the complement and fibrinolytic cascade, contributing to postoperative bleeding [12]. In our study, we observed lower rates of hemorrhagic shock and also decrease in the need for blood transfusions in the OPCAB group compared to on-pump CABG group.…”

Section: Discussionsupporting

confidence: 58%

Estudo comparativo entre cirurgia de revascularização miocárdica com e sem circulação extracorpórea em mulheres

Sá

Lima

Rueda

et al. 2010

Rev Bras Cir Cardiovasc

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Estudo comparativo entre cirurgia de revascularização miocárdica com e sem circulação extracorpórea em mulheresComparative study between on-pump and off-pump coronary artery bypass graft in women of Abstract Background: It has been well documented that women have higher morbidity and mortality rates than men following coronary artery bypass graft (CABG) surgery. In view of this evidence, it is necessary to know if there is benefit to off-pump CABG surgery in women in comparison to on-pump CABG.Objectives: Compare outcomes between off-pump CABG and on-pump CABG in women.Methods: Retrospective study. Our investigation analyzes comparatively clinical profile, thirteen procedure complications and mortality of a population of 941 consecutive women undergoing CABG surgery (549 off-pump and 392 on-pump) at two hospitals for the period January 2000 to December 2005.Results: Mortality rate for women undergoing off-pump CABG surgery is lower than for women undergoing on-pump surgery, however, not statistically significant (3.1% vs 5.3%; P=0.134). The complication rates analyzed (hemorrhagic shock, neurologic, respiratory, acute renal failure, adult respiratory distress syndrome, septicemia, pneumonia, atrial fibrillation) were lower (significant statistically difference) for women off-pump than women on-pump, with the exception of low cardiac output and wound infection.Conclusions: Evidence suggests that off-pump CABG surgery may be better for women than on-pump CABG 239 SÁ, MPBO ET AL -Comparative study between on-pump and off-pump coronary artery bypass graft in women Bras Cir Cardiovasc 2010; 25(2): 238-244 in outcomes in female patients undergoing on-pump CABG compared with those undergoing OPCAB, tracing the preoperative clinical profile and analyzing the differences in rates of complications and possible differences in mortality rates. Rev METHODSWe studied 941 female patients undergoing CABG with two centers:

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Section: Discussionsupporting

confidence: 58%

Estudo comparativo entre cirurgia de revascularização miocárdica com e sem circulação extracorpórea em mulheres

Sá

Lima

Rueda

et al. 2010

Rev Bras Cir Cardiovasc

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“…In one initial phase of the experiment, the occurrence of arrhythmia and hemodynamic instability is expected even during the preparation of anastomoses in the anterior wall, which, with experience, rarely happens even when three or four grafts into the lateral and posterior heart walls are necessary. Studies suggest a great benefit of off-pump surgeries compared to conventional surgeries [24][25][26], which are already giving good results over the medium term [27][28][29]. With the greater advances in interventionist cardiology, the heart surgeon is put under great pressure to use less invasive surgery and provide excellent results, which, we believe, start with offpump surgeries.…”

Section: Resultsmentioning

confidence: 99%

<![CDATA[<B>Total myocardium revascularization without extracorporeal circulation</B>: <B>five-year experience</B>]]>

Milani¹,

Brofman²,

Varela³

et al. 2005

Braz. j. cardiovasc. surg.

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Objective: To evaluate the immediate postoperative results of off-pump myocardium revascularization surgery by analyzing complications and mortality.Method: A total of 1440 patients were submitted to offpump myocardium revascularization. The surgical technique consisted in proximal occlusion of the approached artery, the application of the LIMA graft in the posterior pericardial deflection and stabilization of the target artery with a suction stabilizer. The distal anastomoses were performed first.Results: Among the patients evaluated, 924 were male and 516 were female, with a mean age of 63.12 ± 8.76 years. The ejection fraction was normal in 749 patients, 740 (51.4%) patients had suffered previous myocardial infarction and 687 (47.6%) patients were in functional class III or IV. The mean EuroSCORE was 4.93 ± 3.32. The mean number of distal anastomoses was 3.12 ± 1.23 per patient. A total of 1173 (81.5%) patients remained less than 12 hours on mechanical ventilation and among these, 888 (61.7%) remained for less than six hours. The stay in the ICU was of one night for 330 (22.8%) patients, for two nights for 930 (64.6%) patients and 182 (12.4%) patients remained for three or more nights. In regards to complications, three (0.2%) patients presented with renal insufficiency, six (0.4%) patients suffered strokes, nineteen (1.3%) patients were reoperated for bleeding, nineteen (1.3%) patients had mediastinitis, eighteen (1.25%) patients suffered severe myocardial infarction and 212 (14.7%) presented atrial fibrillation. There were 50 (3.5%) deaths, 29 (2.5%) of them being among the 1148 patients operated electively, 9 (4.7%) among 190 patients submitted to coronary re-operation and 12 (11.7%) among 102 patients undergoing emergency operations.Conclusion: With the evolution of biomedical technological, all the vessels of the heart are now approached. These data suggest that the operation for myocardial revascularization is safe and efficient. It can be applied to all patients who need coronary surgery, with low rates of complication and mortality.

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“…Bottio et al [29] in a prospective study with 324 patients who underwent CABG, of whom 216 underwent on-pump CABG and 108 underwent off-pump, observed there was a lower incidence of sternal dehiscence with mediastinitis in the off-pump group, although this difference was not statistically significant. Mack et al [30] observed a lower incidence of wound infection in patients undergoing off-pump compared to on-pump. Sabik et al [31] in the Cleveland Clinic study involving 812 patients undergoing CABG (half on-pump and half off-pump) have identified a higher incidence of wound infection in the onpump group (2.0% versus 0.2%, P = 0.04).…”

Section: Discussionmentioning

confidence: 97%

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease

Abstract: In 4 centers with beating-heart operation experience, there is an overall early benefit in off-pump surgery, especially in patients traditionally considered at high risk for coronary artery bypass grafting.

Cited by 186 publications

References 16 publications

Estudo comparativo entre cirurgia de revascularização miocárdica com e sem circulação extracorpórea em mulheres

Estudo comparativo entre cirurgia de revascularização miocárdica com e sem circulação extracorpórea em mulheres

<![CDATA[<B>Total myocardium revascularization without extracorporeal circulation</B>: <B>five-year experience</B>]]>

Risk factors for mediastinitis after coronary artery bypass grafting surgery

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