Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery

Abstract

Background-The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent introduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after off-pump surgery is similar to that for the on-pump procedure. Methods and Results-In a multicenter trial, 281 patients (mean age 61 years, SD 9 years) were randomly assigned to off-pump or on-pump CABG. In-hospital results and cardiac outcome and quality of life after 1 month are presented. Cardiac outcome was defined as survival free of stroke, myocardial infarction, and coronary reintervention. The mean numbers of distal anastomoses per patient were 2.4 (SD 1.0) and 2.6 (SD 1.1) in the off-pump and on-pump groups, respectively. Completeness of revascularization was similar in both groups. Blood products were needed during 3% of the off-pump procedures and 13% of the on-pump procedures (PϽ0.01). Release of creatine kinase muscle-brain isoenzyme was 41% less in the off-pump group (PϽ0.01). Otherwise, no differences in complications were found postoperatively. Off-pump patients were discharged 1 day earlier. At 1 month, operative mortality was zero in both groups, and quality of life had improved similarly. In both groups, 4% of the patients had recurrent angina. The proportions of patients surviving free of cardiovascular events were 93.0% in the off-pump group and 94.2% in the on-pump group (Pϭ0.66). Conclusions-In selected patients, off-pump CABG is safe and yields a short-term cardiac outcome comparable to that of

Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation

“…10,15 Moreover, the consistency of association between HSP65 antibodies and postoperative AF in both the overall and subgroup analyses validates our conclusion regardless of the operative technique used.…”

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump

“…[5][6][7] Several large, nonrandomized, retrospective case series comparing CABG surgery performed on the beating heart (off pump) and conventional CABG surgery performed with CPB (on pump) have indicated an advantage to CABG surgery without CPB; however, selection bias toward lower-risk cases in CABG without CPB remains an issue. 8 -14 The largest randomized studies published to date are conflicting, with some demonstrating decreased length of hospitalization and myocardial enzyme release, 15 whereas others demonstrate decreased incidence of atrial fibrillation, length of hospitalization, and blood-product utilization with CABG surgery performed on the beating heart. 16,17 The most recent trial demonstrated decreased blood-product requirement, myocardial enzyme release, and length of hospitalization in beating-heart surgery patients.…”

Custos comparativos entre a revascularização miocárdica com e sem circulação extracorpórea

“…Additionally, the duration of the ICU stay for patients submitted to the surgery without ECC was significantly shorter than for patients that underwent the surgery with ECC, similarly to that observed by another study 11 . Other results, concerning the cost analysis, did not show a decrease in the ICU stay for patients without ECC; however, all of them showed a shorter intubation time [16][17][18] .…”

“…The importance of the patients' extubation time in the mentioned studies 17,19 received a higher clinical attention, rather than an economical one. Furthermore, these authors did not consider, for the economic analysis, the ICU stay duration.…”

“…Several studies did not use stabilizers in all patients and, in many of them the equipment is re-usable [8][9][10][11][12][13][14][15][16][17][18] . The criteria for these procedures have not been discussed in depth; however, to ensure our patients' safety, especially those in whom the procedure involved the revascularization of latero-posterior wall of the left ventricle, the use of stabilizer was considered mandatory for all the patients in this group.…”