Immediate and Intermediate Outcome After Off-Pump and On-Pump Coronary Artery Bypass Surgery in Patients With Unstable Angina Pectoris

Biancari, Fausto; Mahar, Muhammad Ali Asim; Mosorin, Martti; Heikkinen, Jouni; Pokela, Matti; Taskinen, Panu; Anttila, Vesa; Lahtinen, Jarmo; Lepojärvi, Martti

doi:10.1016/j.athoracsur.2008.05.037

Cited by 20 publications

(16 citation statements)

References 8 publications

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“…Despite advances in anesthesia, surgical techniques, perioperative care, and myocardial protection, low cardiac output syndrome after CABG for AMI confers substantial morbidity and mortality in this population, as high as 4-7% 30-day mortality in some recent series [2],[7]. Numerous myocardial protective solutions have been used after AMI, most notably warm whole blood and Buckberg solutions formulated to replenish ATP stores and essential electrolytes necessary for myocyte contractility [8].…”

Section: Discussionmentioning

confidence: 99%

Del Nido Cardioplegia can be safely administered in high-risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison

Yerebakan

Sorabella

Najjar

et al. 2014

J Cardiothorac Surg

120

136

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ObjectiveDel Nido (DN) cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60 minutes, and the addition of lidocaine may limit intracellular calcium influx. Single-dose DN cardioplegia solution may offer an alternative myocardial protection strategy to multi-dose cold whole blood (WB) cardioplegia following acute myocardial infarction (AMI).MethodsWe retrospectively reviewed 88 consecutive patients with AMI undergoing coronary artery bypass (CABG) surgery with cardioplegic arrest between June 2010 to June 2012. Patients exclusively received WB (n = 40, June 2010-July 2011) or DN (n = 48, August 2011-June 2012) cardioplegia. Preoperative and postoperative data were retrospectively reviewed and compared using propensity scoring.ResultsNo significant difference in age, maximum preoperative serum troponin level, ejection fraction, and STS score was present between DN and WB. A single cardioplegia dose was given in 41 DN vs. 0 WB patients (p < 0.001), and retrograde cardioplegia was used 10 DN vs. 31 WB patients (p < 0.001). Mean cardiopulmonary bypass and cross clamp times were significantly shorter in the DN group versus WB group. Tranfusion rate, length of stay, intra-aortic balloon pump requirement, post-operative inotropic support, and 30-day mortality was no different between groups. One patient in the WB group required a mechanical support due to profound cardiogenic shock.ConclusionsDN cardioplegia may provide equivalent myocardial protection to existing cardioplegia without negative inotropic effects in the setting of acute myocardial infarction.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0141-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Del Nido Cardioplegia can be safely administered in high-risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison

Yerebakan

Sorabella

Najjar

et al. 2014

J Cardiothorac Surg

120

136

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“…[8][9][10] Nevertheless, the role of OPCAB surgery in the setting of AMI remains controversial. Although it was associated with lower early mortality, 3,11,12 several studies identified incomplete revascularization as the greatest drawback of OPCAB surgery. 11,13,14 Although OPCAB has gained some popularity over the past decade, only 12% of all CABG procedures in Germany are performed off-pump.…”

Section: Introductionmentioning

confidence: 99%

“…Although it was associated with lower early mortality, 3,11,12 several studies identified incomplete revascularization as the greatest drawback of OPCAB surgery. 11,13,14 Although OPCAB has gained some popularity over the past decade, only 12% of all CABG procedures in Germany are performed off-pump. 15 In our institution, we try to perform an OPCAB procedure whenever possible.…”

Section: Introductionmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Grafting in Acute Coronary Syndrome: Focus on Safety and Completeness of Revascularization

Neumann

Vöhringer

Fischer

et al. 2019

Thorac Cardiovasc Surg

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Background Emergency coronary artery bypass grafting (CABG) in the setting of acute coronary syndrome (ACS) has been associated with increased morbidity and mortality. Avoiding cardiopulmonary bypass might be advantageous, but the role of off-pump CABG (OPCAB) remains controversial, as it has been associated with incomplete revascularization in several studies. The objective of this study was to evaluate the feasibility, efficacy, and outcome of OPCAB surgery in ACS patients. Methods We performed a retrospective review of ACS patients who underwent on-pump CABG (ONCAB) or OPCAB, either emergently or delayed, at our institution. Results Between January 2015 and December 2016, a total of 205 consecutive ACS patients underwent either ONCAB (109 patients, 53.2%) or OPCAB surgery (96 patients, 46.8%). EuroSCORE II levels (5.6 ± 7.2 vs 4.9 ± 6.5, p = 0.226) and demography were comparable between groups.A trend towards lower postoperative mortality was observed in OPCAB patients (2.1 vs 5.5%). The incidence of postoperative stroke and low cardiac output syndrome, as well as the duration of inotropic support and the need for re-sternotomy, was significantly lower in the OPCAB group (p < 0.05).CABG performed instantly in an emergency situation was not associated with increased mortality or morbidity when compared with delayed procedures, and OPCAB surgery in emergency patients was associated with lower postoperative morbidity and shorter stays in the intensive care unit (p < 0.05).There were no differences in completeness of revascularization between groups (median 1 [1–1.33;0.33–1.67] OPCAB versus median 1 (1–1.33;0.67–2) ONCAB, p = 0.617), even in the emergency setting. Conclusion OPCAB surgery is safe and effective in ACS and may be considered in hemodynamically stable patients in the emergency setting.

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“…Biancari et al [2] studied 314 patients (161 OPCAB, 153 ONCAB), and showed a lower 30-day mortality (P = 0.04) and risk of major adverse cardiac events (MACE) (P = 0.0009) with OPCAB (adjusted for logistic EuroSCORE). However, again OPACB resulted in significantly fewer grafts per patient.…”

Section: Resultsmentioning

confidence: 99%

“…Three [2,4,7] of nine studies showed a lower early mortality with OPCAB; however, the remaining six observed no mortality benefit [3,5,6,8,9]. No studies showed a difference in late mortality (>1 year) between OPCAB and ONCAB.…”

Section: Clinical Bottom Linementioning

confidence: 99%

Should we consider off-pump coronary artery bypass grafting in patients with acute coronary syndrome?

Moscarelli

Harling

Ashrafian

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass (OPCAB) grafting should be considered as an alternative to the conventional on-pump surgery (ONCAB) in patients presenting with acute coronary syndrome (ACS) requiring emergency revascularization. Eighty-two papers were identified by a systematic search, of which nine were judged to best answer the clinical question. Of these, one was a randomized controlled trial and the remaining eight were retrospective observational studies. The author, journal, date, patient group, country of publication, relevant outcomes, results and study weaknesses were tabulated. In total, these nine studies included 3001 patients (n = 817 OPCAB, 2184 ONCAB) undergoing emergency revascularization in the setting of ACS. The timing between the onset of ACS and operative intervention ranged from 6 to 72 h. All cases were categorized as urgent/emergent according to the National confidential enquiry into patient outcome and death classification of intervention. Six studies included patients with preoperative cardiogenic shock; however the majority of patients were haemodynamically stable at the time of surgery. Three out of nine studies showed an improvement in 30-day mortality with OPCAB although the remaining six reveal no significant mortality benefit. No difference in long-term mortality was observed between the two techniques. OPCAB was associated with significantly fewer grafts per patient (six studies) and less complete revascularization (two studies). We conclude that whilst OPCAB may have a beneficial effect on 30-day mortality in haemodynamically stable patients undergoing emergency revascularization, there is a lack of high-quality data with clearly defined patient demographics. Future studies must ensure adequate preoperative matching between OPCAB and ONCAB groups and clearly categorize haemodynamic status, disease pattern and time to surgery in order to determine the patients in whom OPCAB may confer the greatest benefit.

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Immediate and Intermediate Outcome After Off-Pump and On-Pump Coronary Artery Bypass Surgery in Patients With Unstable Angina Pectoris

Cited by 20 publications

References 8 publications

Del Nido Cardioplegia can be safely administered in high-risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison

Del Nido Cardioplegia can be safely administered in high-risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison

Off-Pump Coronary Artery Bypass Grafting in Acute Coronary Syndrome: Focus on Safety and Completeness of Revascularization

Should we consider off-pump coronary artery bypass grafting in patients with acute coronary syndrome?

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