Comparison of the Early Results of Coronary Artery Bypass Grafting With and Without Extracorporeal Circulation

Abstract

To compare the safety and efficacy of coronary artery bypass grafting without using extracorporeal circulation with standard cardiopulmonary bypass technique, based on certain early postoperative criteria, we designed a fully randomized and prospective study on two similar groups of 25 patients (off-pump and on-pump groups). The groups were compared for hemodynamic data (cardiac index, systemic vascular resistance, left- and right-ventricular stroke-work indices, inotropic and mechanical support needs) and enzyme levels (CK-MB and SGOT), as well as mortality, perioperative infarction rate, homologous transfusion requirements, and the symptomatology in the first follow-ups. There was no mortality or perioperative myocardial infarction in either group. Inotropic (25% vs. 4%) and mechanical (4% vs. 0) support requirements and homologous blood consumption (percentages of patients that needed no transfusion: 20% vs. 72%) were greater in the on-pump group. Results were otherwise similar. It is concluded that, in technically suitable cases, off-pump coronary artery bypass surgery is as safe and efficient as the standard on-pump technique and can be used in particular when cannulation, hypothermia, or cardiopulmonary bypass must be avoided. With these properties, this technique could take an important place in the cardiac surgeon's armamentarium.

Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury

“…A total of 6256 potentially relevant citations were identified and screened, of which 5232 originated from MEDLINE; 224 articles were retrieved for detailed evaluation, of which 22 fulfilled eligibility criteria ( Figure 1) (25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53).…”

“…All 22 studies reported on the incidence of AKI, with seven studies defining AKI exclusively as the need for dialysis (25,26,33,47,49 -51). Six studies did not describe the criteria used to define AKI (27,34,35,42,46,48). The remaining nine studies defined AKI using variable absolute or relative increases in serum creatinine, decreases in GFR, decreases in urine output, or need for dialysis (Table 2) (28 -30,32,43-45, 52,53).…”

“…The remaining nine studies defined AKI using variable absolute or relative increases in serum creatinine, decreases in GFR, decreases in urine output, or need for dialysis (Table 2) (28 -30,32,43-45, 52,53). Death was ascertained in-hospital in nine trials (25,(27)(28)(29)32,34,46,48,51), at 30 days in nine trials (25,26,30,33,35,44,45,47,53), and at 60 days in one trial (42). The duration of follow-up was not documented in the three remaining studies (43,50,52).…”

Revascularización miocárdica de la arteria descendente anterior con arteria mamaria interna izquierda: comparación de dos técnicas en el largo plazo

“…La revascularización de la arteria descendente anterior se ha efectuado clásicamente con el uso de circulación extracorpórea y realizando una anastomosis entre la arteria mamaria interna izquierda y la arteria descendente anterior [1][2][3][4][5][6][7][8][9][10][11][12][13][14] .…”

“…Algunos estudios han demostrado buenos resultados con una baja morbilidad y mortalidad en el período post operatorio, menores costos y uso de hemoderivados [7][8][9][10][11] .…”