Off-pump versus on-pump coronary artery bypass grafting in acute coronary syndrome: a clinical analysis

Abstract

BackgroundAlthough off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome.MethodsBetween January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded.ResultsOPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique.ConclusionsThe patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.

Circulação extracorpórea e complicações no período pós-operatório imediato de cirurgias cardíacas

“…In general, it is known that the duration of surgery is directly connected with the duration of CBP (17) . As for complication, pain was the most frequent in both groups under analysis, which can be explained by the extent of the tissue trauma patients were submitted to during cardiac surgeries.…”

Surgical revascularization for acute coronary syndromes: a narrative review

“…In two studies, mortality was lower in off-pump vs. on-pump procedures (5% vs. 24%, P = 0.015 and 3.5% vs. 5.4%, P = 0.690) [53,54] . Additionally, a European study with a cohort of 624 patients demonstrated that stratification and preselection of patients, as well as the timing of the intervention, are crucial considerations for ensuring that only appropriate candidates undergo and derive benefits from the procedure [55] .…”

“…There has been some suggestions, however, that even in higher-risk patients, early CABG is associated with very low in-hospital mortality and, therefore, could be considered in appropriate situations [8] . For OPCABG, data suggest that patients taken to the operating room within 6 h from the onset of chest pain are more suitable for off-pump surgery and have a low incidence of conversion to on-pump CABG, which, as mentioned above, carries severe risks and consequences [54] .…”

“…Additionally, a European study with a cohort of 624 patients demonstrated that stratification and preselection of patients, as well as the timing of the intervention, are crucial considerations for ensuring that only appropriate candidates undergo and derive benefits from the procedure [55] . An updated algorithm to stratify patients and better address the issue of conversion from off-to on-pump CABG has been put forth, which may help to reduce the frequency of off-pump to on-pump conversion in ACS patients [54,56] .…”

Overweight And Obesity Repercussion In The Postoperative Of Myocardial Revascularization Surgery

“…In general, it is known that the time of surgery is directly related to CPB time (19) . In some studies (17,20) in which there was statistically significant difference, the CPB time was lower in patients without excess of weight and overweight and higher in obese patients.…”