Coronary artery bypass grafting versus percutaneous coronary intervention in complex coronary artery disease: looking beyond clinical end-points

Garg, Aakash; Raheja, Hitesh; Cohen, Marc

doi:10.21037/atm.2017.10.05

Cited by 1 publication

(1 citation statement)

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“…The choice of optimal revascularization techniques for complex coronary artery disease (CAD) has been a matter of debate for the last two decades [12]. The most widely performed surgical coronary revascularization technique remains the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery and reversed long saphenous vein to other arteries, performed using cardiopulmonary bypass on an arrested heart [13].…”

Section: Discussionmentioning

confidence: 99%

On-Pump versus Off-Pump Coronary Artery Bypass Grafting in The Surgical Management of High-Risk Patients, A Clinical Randomized Study

Omara

Wahdan

Elgazzar

et al. 2020

Egypt. Cardiothoracic. Surg.

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Background: Surgical treatment modalities of coronary artery diseases (CAD) include on-pump or off-pump coronary artery bypass grafting (CABG). CABG performed on the beating heart can avoid complications that might occur on cardiopulmonary bypass. Our objective was to compare the effectiveness of on-pump versus off-pump CABG in high-risk patients stratified according to the EuroSCORE scoring system. Methods: This randomized clinical study included 80 high-risk patients who underwent CABG and assigned into two groups; each contains 40 patients. Patients with valvular affection, ischemic ventricular septal defect or left ventricle and aortic aneurysms, and/or those exhibiting significant neurological pathology were excluded from the study. Study outcomes were blood loss, length of ICU and hospital stay, inotropic use, re-exploration rate, and operative mortality. Results: The study showed significant higher use of inotropic drugs intra and post-operatively (57.5% vs 40%, p = 0.021), more low cardiac output (12.5% vs 2.5%, p = 0.031), lower blood loss (337±67 vs 498±68 ml, p = 0.01), lower blood transfusion (1.1±0.2 vs 1.2±0.4 unit, p = 0.024), more prolonged ICU stay (4.0±1.6 vs 3.0±0.9 day, p = 0.001) and the higher re-exploration rate (17.5% vs 7.5%, p = 0.035) in the on-pump group. Hospital stay (8.7±2 vs 8.1±1, p = 0.121) and early mortality (7.5% vs 2.5%, p = 0.451) did not differ significantly between the two groups. Conclusion: Management of coronary artery disease is still challenging, and there is still a place for off-pump CABG in CAD in high-risk patients due to its advantages in the early complications while has the same total hospital stay when compared with on-pump CABG.

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Section: Discussionmentioning

confidence: 99%