Multivessel off-pump revascularization in patients with severe left ventricular dysfunction

Goldstein, Daniel J.; Beauford, Robert B.; Luk, Brandon; Karanam, Ravindra; Prendergast, Thomas; Sardari, Frederic; Burns, Paul; Saunders, Craig R.

doi:10.1016/s1010-7940(03)00174-x

Cited by 36 publications

(34 citation statements)

References 19 publications

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“…This may reflect a certain fear of performing off-CPB operations in high-risk patients. From our point of view, this is not the case in two studies that we evaluated 13,14 , in which one can clearly see that high-risk patients are the ones who benefit most from off-pump surgery.…”

Section: Discussionmentioning

confidence: 72%

“…A key study published 14 by Goldstein et al evaluated 100 patients with an ejection fraction less than 30% who had undergone total myocardial revascularization. Each patient received, on average, 3.5 bypasses; the incidence of mediastinitis, chronic renal failure, cerebrovascular accident, myocardial infarction, and atrial fibrillation was lower than that observed by the STS database.…”

Section: Discussionmentioning

confidence: 99%

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Revascularização total do miocárdio sem circulação extracorpórea em pacientes com disfunção ventricular esquerda

Milani¹,

Brofman²,

Moutinho³

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjective: To assess off-pump myocardial revascularization in patients with significant left ventricular dysfunction.Methods: Four hundred and five patients with an ejection fraction less than 35% underwent myocardial revascularization without extracorporeal circulation. The procedure was performed with the aid of a suction stabilizer and the LIMA stitch. The distal anastomoses were performed first.Results: A total of 405 patients were evaluated whose mean age was 63.4±9.78 years. Two hundred and seventy-nine patients were men (68.8%). With regard to risk factors, 347 patients were hypertensive, 194 were smokers, 202 were dyslipidemic, and 134 had diabetes. Two hundred and sixty patients were classified as NYHA functional class III and IV. Twenty patients suffered from chronic renal disease and were under dialysis. Fifty-one underwent emergency surgery, and 33 had been previously operated on. The mean ejection fraction was 27.2±3.54%. The mean EuroSCORE was 8.46±4.41. The mean number of anastomoses performed was 3.03±1.54 per patient. Forty-nine patients (12%) needed an intra-aortic balloon inserted after induction of anesthesia, whereas 73 (18%) needed inotropic support during the perioperative period. As to complications, 2 patients (0.49%) had renal failure, 2 had mediastinitis (0.49%), 7 (1.7%) needed to be reoperated because of bleeding, 5 patients (1.2%) suffered acute myocardial infarction, and 70 patients (17.3%) experienced atrial fibrillation. Eighteen (4.4%) patients died. Conclusion

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Revascularização total do miocárdio sem circulação extracorpórea em pacientes com disfunção ventricular esquerda

Milani¹,

Brofman²,

Moutinho³

et al. 2007

Arq. Bras. Cardiol.

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“…According to the age distribution highest number of patients was in 61-70 yr group in both groups. Study conducted by Goldstein et al also found highest number of patients belonging to 61-70 year age group [8].…”

Section: Discussionmentioning

confidence: 79%

“…Furthermore, there are several reports that off-pump CABG is a safe alternative to on-pump grafting in high-risk patients such as redo CABG cases or those with advanced age, female sex, or impaired LV function [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Short Term Outcome of Off Pump Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

MS¹

2017

Insights Chest Dis

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Objectives: Coronary artery bypass grafting in patients with low ejection fraction (<35%) still remains a high-risk procedure due to its high mortality and morbidity. Off pump coronary artery bypass grafting surgery can be an alternative technique in these patients. The aim of this study is to find out the short-term outcome of the patients with low ejection fraction (<35%) after off pump coronary artery bypass grafting and to quantify any improvement in overall functional status.Methods: Low ejection fraction was confirmed preoperatively and the short-term outcome after off pump coronary artery bypass grafting was be determined by follow-up at the time of discharge, after 1 month of surgery and after 3 month of surgery.Results: Significant improvement in terms of CCS grade and NYHA class was observed specially in <35% ejection fraction group. While there was a significant change between preoperative and postoperative 3 month follow up of patients in <35% ejection fraction group which was observed through echocardiographic evaluation and clinical assessment. The overall mortality was 2 in number. This was comparable with other international publications.

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“…La mortalidad hospitalaria en las décadas de los años setenta y ochenta variaba alrededor del 10%, con cifras entre el 2,9% y el 39%, según la presencia o no de hipertensión pulmonar, insuficiencia cardíaca, arritmias ventriculares y estudios preoperatorios de viabilidad 60 . Las mejoras de las técnicas anestésicas y de monitorización, la protección miocárdica con cardioplejía y la cirugía coronaria sin CEC, así como el perfeccionamiento de las técnicas de cuantificación de la isquemia y viabilidad, ofrecen a los pacientes con evidencia de miocardio hibernado una mortalidad hospitalaria quirúrgica inferior al 3% 61,62 . En las regiones sin potencial para la recuperación funcional, ha sido descrita recientemente una adaptación menor con hipertrofia celular miocárdica menos pronunciada, una destrucción mayor de la arquitectura miocárdica y un grado mayor de expresión genética antiapoptosis.…”

Section: Indicacionesunclassified

Cirugía coronaria. Evolución en la última década. Indicaciones y resultados actuales

Herreros

2005

Revista Española de Cardiología

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La cirugía coronaria está avalada por unos excelentes resultados, bien documentados a largo plazo como consecuencia de la revascularización completa y la utilización de una o 2 arterias mamarias. En este artículo se revisan los resultados y las indicaciones de la cirugía y se valoran los nuevos retos y las oportunidades que incluyen la cirugía más segura, menos agresiva y asociada a otros procedimientos quirúrgicos. El objetivo es desarrollar estrategias ligadas a un ciclo innovador que adapte la cirugía a las necesidades de la población, las nuevas tecnologías y a las actividades pioneras. INTRODUCCIÓNLa cirugía coronaria tiene un origen incierto, en función de la localización geográfica y las preferencias del autor: Senning en Europa (1966), Garrett (1996) Coronary artery bypass surgery is endorsed by the excellent, well-documented, long-term results that follow complete revascularization and the use of 1 or 2 mammary artery grafts. This article contains a review of the current indications for and the results of such surgery and an evaluation of new challenges and opportunities, including the implementation of safer and less aggressive surgery, and surgery associated with other operative procedures. The aim was to develop a strategy linked to a cycle of innovation that could be used to adapt surgery to the needs of the population, to new technologies, and to pioneering developments.

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Multivessel off-pump revascularization in patients with severe left ventricular dysfunction

Abstract: We conclude that multivessel off-pump revascularization in patients with severe left ventricular dysfunction is a safe and effective alternative to conventional grafting. Long-term follow-up is mandatory to confirm these encouraging intermediate outcomes.

Cited by 36 publications

References 19 publications

Revascularização total do miocárdio sem circulação extracorpórea em pacientes com disfunção ventricular esquerda

Revascularização total do miocárdio sem circulação extracorpórea em pacientes com disfunção ventricular esquerda

Short Term Outcome of Off Pump Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction

Cirugía coronaria. Evolución en la última década. Indicaciones y resultados actuales

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