Coronary Artery Bypass Performed Without the Use of Cardiopulmonary Bypass Is Associated With Reduced Cerebral Microemboli and Improved Clinical Results

Bowles, B. Jason; Lee, Jeffrey D.; Dang, Collin R.; Taoka, S; Johnson, E. William; Lau, Eileen M.; Nekomoto, Kathy

doi:10.1378/chest.119.1.25

Cited by 135 publications

(59 citation statements)

References 26 publications

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“…CABG on the beating heart is associated with a reduction in cerebral microemboli and inflammatory response and with a better renal protection [1,20,21]. Better results compared to the conventional technique have been presented in subgroups of patients with higher surgical risk, including patients with significant ventricular dysfunction [22] and patients submitted to coronary artery reoperations [23].…”

Section: Commentsmentioning

confidence: 99%

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

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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Section: Commentsmentioning

confidence: 99%

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

Milani¹,

Brofman²,

Varela³

et al. 2005

Braz. j. cardiovasc. surg.

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“…This should reduce the incidence of embolic events from the atheromatous aorta. [4][5][6] The glial protein S100 has recently been shown to be an early marker of brain injury after cardiac surgery, and the majority of S100 studies have been related to cardiac surgery and CPB.…”

Section: Discussionmentioning

confidence: 99%

Effect of Different Anesthetic Techniques on Mental Outcome in Elderly Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

Özer¹,

Yilmaz²

2017

Turkiye Klinikleri J Cardiovasc Sci

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : In this article, we aimed to test the hypothesis that maintenance of hemodynamic stability with anesthesia and no-touch aortic technique in off-pump coronary artery bypass graft surgery (CABG) may diminish postoperative mental complications in elderly patients. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Between June 2009 and December 2009, 88 elderly patients (53 males, 35 females; mean age 71±7 years; range 64 to 78 years) with a physical status of ASA II-III who underwent elective off-pump CABG surgery in our hospital's operating rooms and cardiovascular and thoracic intensive care units were included in this prospective randomized study with signed informed consents. Patients undergoing off-pump CABG surgery performed by a surgeon were randomly assigned into two groups, including total intravenous anesthesia (group TIVA, n=40; mean age 66±4) or inhalational anesthesia (group IA, n=40; mean age 69±3). The effect of off-pump CABG surgery on mental outcome was assessed with S100 protein, a neurochemical marker of brain injury under ischemic conditions. Comparison of mental function before and after off-pump CABG surgery, hemodynamic stability and time to discharge were the main outcomes of the study. R Re es su ul lt ts s: : Hemodynamic values were stable in both groups. None of the patients showed marked increase in serum concentrations of S100 postoperatively (p<0.001). The mean total off-pump CABG time was 48±15 minutes in both groups. There was no difference between the groups in terms of time to discharge. C Co on nc cl lu us si io on n: : We believe that well-performed hemodynamic stability with either intravenous or general anesthesia may offer a well-controlled mental function in elderly patients undergoing offpump CABG surgery. K Ke ey yw wo or rd ds s: : Coronary artery bypass, off-pump; coronary artery bypass; anesthetics, inhalation; anesthetics, intravenous Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada, atan kalpteki koroner arter baypas greft (KABG) cerrahisinde hemodinamik stabilitenin anestezi, iyi premedikasyon ve dokunmasız aort tekniğiyle sağlanmasının yaşlı-larda ameliyat sonrası zihinsel komplikasyonları azaltabileceği hipotezi test edildi. G Ge er re eç ç v ve e Y Yö ön n--t te em ml le er r: : Haziran-Aralık 2009 tarihleri arasında, hastanemizin ameliyathaneleri ve kardiyovasküler ve torasik yoğun bakım ünitelerinde elektif olarak atan kalpte KABG cerrahisi geçiren ve fiziksel durumu ASA II-III olan 88 yaşlı hasta (53 erkek, 35 kadın; ortalama yaş 71± 7yıl; dağılım aralığı 64 ile 78 yıl) bilgilendirilmiş onam alınarak bu prospektif ve randomize çalışmaya dahil edildi. Tek cerrah tarafından yürütülen atan kalpte KABG cerrahisi geçiren hastalar total intravenöz anestezi (grup TIVA, n=40; ortalama yaş 66±4) veya inhalasyon anestezisi (grup IA, n=40; ortalama yaş 69±3) olmak üzere iki gruba ayrıldı. Atan kalpte KABG cerrahisinin beyindeki sonuçları iskemik durumlarda nörokimyasal belirteç olan S100 proteini ile değerlendiril...

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“…CPB can potentially contribute to neurological injury by loss of autoregulation of cerebral flow at low temperatures or by low perfusion pressure, micro and macroemboli, and alteration of the blood-brain barrier by the systemic inflammatory response, resulting in cerebral edema [15]. Randomized studies [16,17] on on-pump CABG versus off-pump CABG in multivessel disease patients clearly demonstrate significant radiological and biochemical evidence of greater brain injury, as well as greater numbers of cerebral emboli detectable [18] in patients undergoing on-pump CABG. This information is consistent with our findings, in which women undergoing OPCAB had significantly reduced rates of stroke and TIA postoperatively compared to those undergoing on-pump CABG.…”

Section: Discussionmentioning

confidence: 99%

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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Coronary Artery Bypass Performed Without the Use of Cardiopulmonary Bypass Is Associated With Reduced Cerebral Microemboli and Improved Clinical Results

Cited by 135 publications

References 26 publications

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

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

Effect of Different Anesthetic Techniques on Mental Outcome in Elderly Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

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

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