Conversion from Off to On-Pump Coronary Artery Bypass Grafting. Is it Avoidable?

Tariq, Khuzaima; Zia, Kashif; Mangi, Ali R; Amanullah, Muneer; Chaudry, Pervaiz A; Karim, Musa

doi:10.7759/cureus.6791

Cited by 3 publications

(3 citation statements)

References 29 publications

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“…Preoperative screening determined the type of surgery, with 11 cases done on the pump due to preoperative left ventricular dysfunction (<30%). Emergency on-pump conversion occurred in 7.8% of cases due to intractable hemodynamic instability, aligning with Tariq K et al's 9% conversion rate [8].…”

Section: Discussionsupporting

confidence: 75%

Assessing the Patient Outcomes and Performance of a Cardiothoracic and Vascular Surgery (CTVS) Unit During Its First Two Years in a Tier-2 City in India: A Comprehensive Audit and Analysis

Tiwari¹,

Sharma²,

Jaswal³

et al. 2023

Cureus

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This detailed article presents a comprehensive overview of the initial two-year experience in establishing a new cardiothoracic vascular surgery (CTVS) facility in a tier-2 city in India. The article discusses various aspects of setting up and operating a specialized healthcare facility. The first two years of developing the CTVS facility were included in the study period. The manpower included one cardiothoracic vascular surgeon, one cardiac anesthesiologist, two perfusionists, and two physician assistants, along with four other ancillary staff to assist in the smooth functioning of the operation theater. The CTVS recovery staff included 15 nursing officers. There was only one modular operation theater reserved for cardiothoracic vascular surgeries, along with a five-bed recovery room (CTVS intensive care unit). One-hundred-seventy-two procedures were done, including 122 open heart surgeries, 36 vascular procedures, and 14 thoracic procedures. The majority of patients were discharged by the seventh day postoperatively. Overall complication and mortality rates were 8% and 4.6%, respectively. This article also discusses relevant hospital policy, challenges faced, and future recommendations for similar endeavors. The findings highlight the successful implementation of the facility and its impact on providing specialized cardiac care to the local population.

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Section: Discussionsupporting

confidence: 75%

Assessing the Patient Outcomes and Performance of a Cardiothoracic and Vascular Surgery (CTVS) Unit During Its First Two Years in a Tier-2 City in India: A Comprehensive Audit and Analysis

Tiwari¹,

Sharma²,

Jaswal³

et al. 2023

Cureus

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“…The short and long-term results of off-pump CABG were comparable to the on-pump technique, primarily when performed by experienced surgeons 9,11 . The hemodynamic instability associated with off-pump CABG increased the rate of incomplete revascularization and conversion to the on-pump CABG 12 . Hemodynamic compromise during the off-pump CABG resulted from biventricular dysfunction 13 , rather than right ventricular dysfunction only 14 .…”

Section: Discussionmentioning

confidence: 99%

Effect of Off-pump Coronary Artery Bypass Grafting on the Intraoperative Hemodynamics

Tantawy¹,

Al-mashtoly

Mosa

2020

Al-Azhar International Medical Journal

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Background: The hemodynamic instability during off-pump coronary bypass grafting (CABG) may impair the complete coronary revascularization. We evaluated the effect of off-pump CABG on intraoperative hemodynamic parameters. Aim of work: The purpose of this study is to assess the patients' hemodynamics during off-pump coronary artery bypass graft surgery. And the main challenge during the operation is to maintain hemodynamic stability during this procedure. Patient and Methods: We included 40 patients who underwent offpump CABG from 2017 to 2019. The mean age was 55.75± 6.73 years, and 28 patients were males (70%). The mean ejection fraction was 60.08 ± 3.81%. Study endpoints were the intraoperative hemodynamic parameters and postoperative complications. Results: Heart rate was significantly higher during the grafting of the posterior descending artery (PDA)(79.3± 2.8beats/min) and right coronary artery (79.5 ± 1.8 beats/min) compared to all other grafts (p<0.001). The highest central venous pressure(12.6± 1.2 mmHg)and mean pulmonary artery pressure (33.2± 1.4 mmHg) and the lowest mean arterial and pressure (68.1± 3.3 mmHg) were recorded during PDA grafting (p<0.001, for all parameters). There was no significant difference in adrenaline dose infused during the anastomosis of all grafts (p= 0.2). Ejection fraction significantly decreased predischarge (52.18 ± 2.58 %) and at 6 months (52.83 ± 3.57%) compared to the preoperative value (p<0.001). Conclusion: Off-pump CABG was associated with significant hemodynamic instability, which was more evident during the posterior descending artery grafting. Proper anesthetic management and fluid infusion are required, especially during the anastomosis of the right and posterior coronary systems.

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“…Moreover, they found that the AF tends to recur a lot in C-CABG patients [13] . In controversy, Puskas et al [20] , Tariq et al [21] , and Al-Ruzzeh et al [22] reported that operative AF incidence didn't show an advantage in OPCAB over C-CABG.…”

Section: Discussionmentioning

confidence: 99%

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

Asklany

Gamil

Mahmoud

et al. 2020

International Journal of Medical Arts

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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.

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Conversion from Off to On-Pump Coronary Artery Bypass Grafting. Is it Avoidable?

Cited by 3 publications

References 29 publications

Assessing the Patient Outcomes and Performance of a Cardiothoracic and Vascular Surgery (CTVS) Unit During Its First Two Years in a Tier-2 City in India: A Comprehensive Audit and Analysis

Assessing the Patient Outcomes and Performance of a Cardiothoracic and Vascular Surgery (CTVS) Unit During Its First Two Years in a Tier-2 City in India: A Comprehensive Audit and Analysis

Effect of Off-pump Coronary Artery Bypass Grafting on the Intraoperative Hemodynamics

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

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