Off-pump surgery decreases postoperative complications and resource utilization in the elderly

Boyd, W. Douglas; Desai, Nimesh D.; Rizzo, Dario F. Del; Novick, Richard J.; McKenzie, Francine; Menkis, Alan H.

doi:10.1016/s0003-4975(99)00951-0

Cited by 169 publications

(95 citation statements)

References 8 publications

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“…However, multivariate regression analysis identified the use of the pump to be significantly associated with longer lengths of time on the ventilator. This is in accordance with previous studies (17)(18)(19) that reported reduced requirements for mechanical ventilation in OPCAB patients. A recent meta-analysis (20) of 37 randomized trials of OPCAB versus ONCAB also reported shorter VENTHR in OPCAB patients.…”

Section: Discussionsupporting

confidence: 94%

“…ONCAB men stayed nearly one day longer in the hospital than OPCAB men. These study results support the findings of previous reports (17)(18)(21)(22)) that also demonstrated that ONCAB patients stayed significantly longer in the hospital compared with OPCAB patients. Nevertheless, some studies (14-15) reported no differences in the length of stay between the two operative procedures.…”

Section: Discussionsupporting

confidence: 93%

“…This is in agreement with previous reports (13)(14)(15). Other studies (16)(17)(18) have reported significant differences in ICULOS between ONCAB and OPCAB groups; however, these have been mostly retrospective, unadjusted observational studies.…”

Section: Discussionsupporting

confidence: 92%

See 2 more Smart Citations

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Maganti

Rao

Cusimano

2009

Canadian Journal of Cardiology

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B eating heart revascularization gained popularity several years previously as an attractive method to reduce the morbidity and mortality associated with cardiopulmonary bypass surgery (CPB). As technological advances improved the ability of surgeons to reproduce the results of 'off-pump' coronary artery bypass surgery (OPCAB), several clinical trials were initiated to compare the early clinical outcomes of OPCAB with those of standard myocardial revascularization using a CPB circuit (on-pump coronary artery bypass surgery [ONCAB]).While the majority of observational studies favoured clinical outcomes following OPCAB, these results were not substantiated in subsequent randomized clinical trials. Indeed, a recent meta-analysis (1) suggested very little benefit of OPCAB over conventional ONCAB. Despite these findings, most surgeons continue to believe that OPCAB is beneficial in certain high-risk subgroups. The present study examined whether there are sex-specific benefits of OPCAB, particularly with respect to hospital resource use. To adjust for the selected nature of OPCAB patients, a propensity score analysis was performed to match male and female cohorts with standard preoperative demographic characteristics. The present study demonstrates that the potential beneficial effects of OPCAB are not observed in female patients. In contrast, there were significant benefits in resource use for male patients undergoing isolated myocardial revascularization using an off-pump technique. BACkgROunD: Previous studies have demonstrated that off-pump coronary artery bypass surgery (OPCAB) is associated with less use of hospital resources compared with on-pump coronary artery bypass surgery (ONCAB). OBJECTiVE: To determine whether there is a sex effect between the two procedures regarding resource utilization. METHODS: Between 1996 and 2004, 13,522 patients (10,637 men and 2885 women) underwent coronary artery bypass grafting surgery at the Toronto General Hospital (Toronto, Ontario). Among the men, 10,121 patients underwent ONCAB and 516 underwent OPCAB. The female population consisted of 2723 ONCAB and 162 OPCAB patients. Both groups were matched to standard preoperative risk factors. A propensity score macro-matched 471 OPCAB men to 471 ONCAB men, and 148 OPCAB women to 148 ONCAB women. RESuLTS: The mean (± SD) postoperative length of stay (7.5±6.5 days versus 6.4±5.5 days; P<0.0001) was significantly higher in ONCAB compared with OPCAB in the male population. The mean length of stay in the intensive care unit and the mean ventilation time was similar between the groups. However, in the female population, there were no differences in mean posoperative length of stay (8±5.9 days versus 8±6 days; P=0.4), mean length of stay in the intensive care unit (43±38 h versus 53±81 h; P=0.4) or mean ventilation time (9.8±9.7 h versus 11±13 h; P=0.8). COnCLuSiOn: These results suggest that the benefits of OPCAB in terms of hospital resource use are influenced by sex. The potential beneficial effects are not demonstrated in the female ...

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 93%

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Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Maganti

Rao

Cusimano

2009

Canadian Journal of Cardiology

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“…Reported postoperative hospital stay in the elderly population ranges from 4.4 to 14.9 days following OPCAB surgery and from 4.9 to 20.0 days following CCAB surgery (19,21,(25)(26)(27)(28)(29). Our observed median postoperative LOS was seven days for OPCAB surgery and 7.5 days CCAB surgery (P=0.43).…”

Section: Discussionmentioning

confidence: 63%

Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

Nagpal¹,

Bhatnagar²,

Cutrara³

et al. 2006

Canadian Journal of Cardiology

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“…8,9 Ek ola rak mor ta li te ve morbi di te nin azal ma sı te me lin de, bir çok cer rah ta rafın dan özel lik le yük sek risk li has ta lar da OP CAB (off-pump ko ro ner ar ter bay pas) pro se dü rü ma liye ti avantajı kabul edilmektedir. [10][11][12] Esas ola rak gerek li et kin lik ve uzun dö nem de prog no zu için tam re vas kü la ri zas yo nun öne mi bü yük tür. 13 Dü şük mor ta li te ve mor bi di te oran la rı ile atan kalp te baypas uy gu la ma la rı nın çok sa yı da da mar lez yo nu olan has ta lar da, tam re vas kü la ri zas yon im ka nı nı zor laş -tır dı ğı gö rül mek te dir.…”

Section: Tar Tiş Maunclassified

The First Use of the Impella Microaxial VAD^®Ventricular Assist Device in Our Country for Coronary Artery Bypass Surgery in the Beating Heart: Case Report

Yıldız¹,

Ergenoglu²,

Yerebakan³

et al. 2010

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T Kalp-akciğer makinesi (CPB) desteği olmaksızın (off-pump) uygulanan minimal invazive kalp ameliyatlarının önemi gittikçe artmaktadır. Uzun dönem sonuçların iyi olması için tıkalı koroner arterlerin tam revaskülarizasyonu gerekir. Hemodinamik yetersizlik nedeniyle kalbin arka duvarında yer alan önemi büyük hedef koroner artere ulaşılamadığı durumlarda, planlanan off-pump stratejiden geleneksel kalp-akciğer makinesi destekli (on-pump) koroner baypas ameliyatına dö-nülmesi arzu edilmediğinde, sol ventrikül içine yerleştirilen mikroaksiyal pompanın (Impella LD/LP, Abiomed, Aachen, Germany) etkinliği yol göstericidir. Bu nedenle, bu tip vakalarda, mikroaksiyal intrakardiyak pompa desteği ile hemodinamik stabilite sağlanarak rahatlıkla atan kalpte (off-pump) tam revaskülarizasyon uygulanabilmektedir. Bu raporda, ülkemizde ilk kez yüksek riskli (EUROSCORE ® ) iki hastada atan kalpte koroner arter baypas ameliyatı sırasında destek alınan Impella Microaxial VAD ® uygulaması anlatılmaktadır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Kalp destek cihazları; kalp yetersizliği; koroner damar baypas, pompasız A AB BS S T TR RA AC CT T Off-pump or minimally invasive cardiac surgery without the support of cardiopulmonary bypass (CPB) is becoming increasingly more important. Complete revascularisation of the occlused arteries is essential for better long term outcomes. A microaxial pump (Impella LD/LP, Abiomed, Aachen, Germany) placed in the left ventricle is effective in conditions when the main coronary arteries in the posterior cardiac wall can not be reached due to hemodynamic instability, or when switching from the planned off-pump strategy to the conventional cardiopulmonary bypass (on-pump) is not desired. For this reason, in such cases, microaxial intracardiac pump support may provide hemodynamic stability by comfortably enabling complete revascularisation in the beating heart (off-pump). In this paper, we report the use of the Impella Microaxial VAD ® in two high risk (EUROSCORE ® ) patients during coronary artery bypass operations in the beating heart for first time in our country.K Ke ey y W Wo or rd ds s: : Heart-assist devices; heart failure; coronary artery bypass, off-pump

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Off-pump surgery decreases postoperative complications and resource utilization in the elderly

Cited by 169 publications

References 8 publications

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

The First Use of the Impella Microaxial VAD^®Ventricular Assist Device in Our Country for Coronary Artery Bypass Surgery in the Beating Heart: Case Report

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Off-pump surgery decreases postoperative complications and resource utilization in the elderly

Cited by 169 publications

References 8 publications

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

The First Use of the Impella Microaxial VAD®Ventricular Assist Device in Our Country for Coronary Artery Bypass Surgery in the Beating Heart: Case Report

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Product

Resources

About

The First Use of the Impella Microaxial VAD^®Ventricular Assist Device in Our Country for Coronary Artery Bypass Surgery in the Beating Heart: Case Report