Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Consecutive Patients: Decision-Making Algorithm and Outcomes

Brown, James M.; Poston, Robert; Gammie, James S.; Cardarelli, Marcello G.; Schwartz, Kimberly; Sikora, Jo Ann H.; Yi, Susan; Pierson, Richard N.; Griffith, Bartley P.

doi:10.1016/j.athoracsur.2005.06.081

Cited by 26 publications

(17 citation statements)

References 33 publications

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“…In general, patients who were elderly with 2 or more comorbidities, such as calcified aorta, recent stroke, severe carotid disease, and renal dysfunction, were preferentially approached by an off-pump technique, given that their anatomy allowed this approach to be effective and safe. 30,31 In our study, the patients undergoing OPCAB were more current smokers and had a higher incidence of hypertension and peripheral vascular disease. Otherwise, the patients undergoing OPCAB had a lower logistic European System for Cardiac Operative Risk Evaluation than those undergoing ONCAB.…”

Section: Discussionmentioning

confidence: 58%

The effect of coronary angiography timing and use of cardiopulmonary bypass on acute kidney injury after coronary artery bypass graft surgery

Kim

Joung

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 58%

The effect of coronary angiography timing and use of cardiopulmonary bypass on acute kidney injury after coronary artery bypass graft surgery

Kim

Joung

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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“…In addition, an intramuscular coronary artery is considered a relative contraindication to minimally invasive coronary surgery. It has been suggested that a preoperative diagnosis of myocardial bridging on CCTA may help in making the decision between coronary artery bypass grafting through the midsternotomy with or without cardiopulmonary bypass (coronary artery bypass graft or off-pump coronary bypass graft, respectively) or a minimally invasive approach through the small left anterior thoracotomy, but no data are available to support this hypothesis (34,35). Study limitations.…”

Section: Discussionmentioning

confidence: 97%

The Prevalence and Anatomical Patterns of Intramuscular Coronary Arteries

Konen

Goitein

Sternik

et al. 2007

Journal of the American College of Cardiology

176

111

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Prevalence of intramuscular coronary arteries on CCTA is in concordance with most pathological reports and higher than in angiographic series. The CCTA clearly showed presence, course, and anatomical features of intramuscular coronary arteries. Coronary computed tomographic angiography may provide potentially useful information in the preoperative evaluation of candidates for coronary bypass surgery.

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“…Because of the nonrandomized assignment of patients to on-versus off-pump CABG, we noted significant difference in three variables: age, which was higher in OPCAB; weight and the prevalence of diabetes, which were both higher in on-pump CABG. This disproportion is most likely because of the decision-making algorithm used by the surgeons at our center 22 and therefore is an integral part of each procedure. Finally, bypass graft flow was lower within SVG grafted off-pump.…”

Section: Discussionmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Leads to a Regional Hypercoagulable State Not Detectable Using Systemic Markers

Kon

Kwon

Collins

et al. 2006

Innovations�(Phila)

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Objective It is believed that off-pump coronary artery bypass grafting (OPCAB) leads to hypercoagulability, but efforts to document such a state have been unrevealing. We hypothesized that OPCAB increases the risk of developing a regional hypercoagulable state. Methods Blood was obtained from the aorta and coronary sinus (CS) after CABG performed off- (N = 69) or on-pump (N = 35) to determine the transcardiac gradients of F1.2 (thrombin production), XIIa (coagulation activation), myoglobin (ischemia) and IL-6, IL-8 using ELISA and platelet-derived microparticles using FACS. Platelet function was measured using aggregometry. Regional myocardial pH and SVG flow were recorded intraoperatively. SVG biopsies were analyzed for endothelial integrity (EI) using immunohistochemistry and graft patency was determined by predischarge CT angiography. Results Compared with on-pump, OPCAB provoked significantly higher transcardiac F1.2 (117±200 v. 31±38%), FXII-a (14±29 v. 2±4%), microparticles (14± −9.5% v. 6.4±—4.1%), IL-6 (119±183 v. 28±39%), and a trend toward increased IL-8 (67±94 v. 24±46%, P = 0.077). Myoglobin release after OPCAB, also greater than on-pump CABG (54±89 v. 8±14%, P < 0.01), correlated with regional pH change (R = −0.96, P < 0.0001), and F1.2 release (R = 0.55, P = 0.0002). In contrast, systemic changes in these markers were all less after OPCAB. SVG flow was significantly reduced in OPCAB (39.4 versus 66.5 mL/min, P = 0.0002), but EI and graft patency rates were the same. Conclusions Through the use of transcardiac assays, we illustrated that regional coagulation was enhanced after off- compared with on-pump CABG. If the findings of this pilot study are confirmed, OPCAB may require additional antithrombotic therapies to respond to this local hypercoagulable state.

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Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Consecutive Patients: Decision-Making Algorithm and Outcomes

Cited by 26 publications

References 33 publications

The effect of coronary angiography timing and use of cardiopulmonary bypass on acute kidney injury after coronary artery bypass graft surgery

The effect of coronary angiography timing and use of cardiopulmonary bypass on acute kidney injury after coronary artery bypass graft surgery

The Prevalence and Anatomical Patterns of Intramuscular Coronary Arteries

Off-Pump Coronary Artery Bypass Leads to a Regional Hypercoagulable State Not Detectable Using Systemic Markers

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