On-pump versus off-pump coronary revascularization: evaluation of renal function

Ascione, Raimondo; Lloyd, Clinton; Underwood, Malcom J.; Gomes, Walter J.; Angelini, Gianni

doi:10.1016/s0003-4975(99)00566-4

Cited by 366 publications

(192 citation statements)

References 24 publications

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Section: Discussionmentioning

confidence: 99%

“…Even though the controversy still exists, there are clinical situations as in the elderly (>75 years) and ascending aorta with calcium plaques and /or former history of stroke, in which off-pump coronary artery bypass grafting shows better results [18]. Off-pump bypass has been associated to a lesser impairment of the postoperative renal function expressed as lower reduction in glomerular filtration and a better preservation of the albumin/creatinine in the first 48 hours of coronary revascularization, especially in high-risk patients [19].Finally, if we compare the results obtained in a group of patients undergoing on-pump coronary surgery, there is no difference in hospital mortality. Nevertheless, a detailed analysis proves that with this new coronary bypass grafting technique, total revascularization is possible with more grafts per patients without using venous conduits.…”

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confidence: 99%

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<![CDATA[<B>Off-pump coronary artery bypass with multiple arterial conduits</B>]]>

Navia¹,

Vrancic²,

Vaccarino³

et al. 2005

Braz. j. cardiovasc. surg.

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Objective: to analyze intra-hospital results in patients undergoing elective off-pump total arterial revascularization and identify morbidity and mortality predictors using this surgical strategy.Methods: From May 1999 to February 2004, 203 myocardial revascularization procedures with total arterial revascularization without cardiopulmonary bypass (off-pump) were carried out in patients with multivessel disease (three vessels 81.7 %, one vessel disease was excluded). We report pre-surgical variables and co-morbidities: average age 63.9 ± ± ± ± ± 9.13 years, men 182 (89.5%), hypertension 132 (65%), smokers 125 (61%), hypercholesterolemia 152 (74.8%), previous myocardial infarction (> 30 days) 73 (35%), moderate to severe ventricular dysfunction 31 (15%), redo 5 (2.5%). Total arterial revascularization included T-grafts and sequential grafts with left internal mammary (100%), right internal mammary (56.6%) and radial (63%) arteries. The total number of distal anastomosis was 576 (mean of 3 grafts/patient), all carried out with external mechanical stabilizers. There were no proximal aortic anastomoses. Conversion to on-pump surgery occurred in 3 patients (1.5%). 90% of the patients was extubated in the operating room. The multiple logistic regression test was used for statistical analysis.Results: The postoperative incidence of atrial fibrillation was 12.8% (26), oligoanuric renal failure 3% (6), dialysis 0.49% (1), postoperative myocardial infarction 1.47% (3), low cardiac output 4% (8), Redo for bleeding 1.47% (3), mediastinitis 1.47% (3), stroke 1.47% (3). Intra-hospital mortality was 2.45% (5). The only independent 30 day morbidity predictor was age (p=0.033; OR 1.04; IC 95%: 1-1.08).Conclusion: Off-pump myocardial revascularization with arterial conduits for multiple vessel disease is feasible with a low 30-day morbidity and mortality.Descriptors: Coronary surgery. Off-pump circulation. Multiple vessel disease. Arterial conduits Cirurgia coronária com condutos arteriais múltiplos sem circulação extracorpóreaOff-pump coronary artery bypass with multiple arterial conduits 40 NAVIA, D ET AL -Off-pump coronary artery bypass with multiple arterial conduits Braz J Cardiovasc Surg 2005; 20(1): 39-45 INTRODUCTIONThe use of cardiopulmonary bypass (CPB) by heart surgeons over the last 35 years has enabled coronary artery bypass grafting in more complex patients with higher surgical risk giving better results. Nevertheless, its use is associated to a certain degree of morbidity and in some clinical situations to a higher incidence of post-surgical morbidity and mortality. The undesirable effects of cardiopulmonary bypass are expressed as physiological disorders secondary to the exposure of blood to plastic tubes, oxygenators and filters, which, combined with the use of surgical field aspirators, destroy red and white blood cells and platelets. Likewise, it has been shown that this activates the inflammatory system with the release of cytokines and the increase of capillary patency and the potential threat to ...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

<![CDATA[<B>Off-pump coronary artery bypass with multiple arterial conduits</B>]]>

Navia¹,

Vrancic²,

Vaccarino³

et al. 2005

Braz. j. cardiovasc. surg.

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“…5 In general, cardiopulmonary bypass leaves patients feeling like they have been "hit by a truck," and their actual recovery can take weeks to months. 6 However, with the new developments in conducting cardiopulmonary bypass, surgeons in many centers worldwide are now able to fast-track their on-pump low-risk patients towards an average of 12 to 16 hours ICU time, and 4-5 days of total hospital time.…”

Section: Discussionmentioning

confidence: 99%

Off-Pump Beating Heart Coronary Artery Bypass Surgery in Low-Risk Patients: Does it Really Enhance Early Recovery?

Fouda

2001

Annals of Saudi Medicine

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M Fouda, Off-Pump Beating Heart Coronary Artery Bypass Surgery in Low-Risk Patients: Does it Really EnhanceEarly Recovery?. 2001; 21(5-6): [347][348] Off-pump coronary artery bypass (OPCAB) surgery is an established mode of revascularization in many cardiac centers. The avoidance of cardiopulmonary bypass surgery has obvious advantages in high-risk patients. In patients with poor left ventricular function, our recent study, 1 like others, has documented the superiority of this technique over conventional bypass surgery. The aim of this retrospective analysis was to identify the benefits of this OPCAB surgery in a low-risk group of patients in comparison to conventional coronary artery bypass technique in a similar group of patients, with regards to intensive care unit (ICU) length of stay and total hospitalization time. In the comparison of the two techniques, the study showed a marginal superiority of the off-pump technique, though no significant statistical differences were reached. Materials and MethodsDuring a 32-month period ending in December 2000, a total of 282 patients underwent coronary artery bypass surgery using the off-pump technique. Of the total number, 200 were classified as low-risk, identified as patients with reasonable ventricular ejection fraction, good target vessels, and with no other comorbid factors. The total number of coronary artery bypass surgery cases during this period was 430.The criteria for on-pump surgery in our institution over the last three years have changed as the center has gained more experience in OPCAB surgery. As of now, absolute contraindications to off-pump surgery in our center are diffusely diseased vessels, emergency surgery and oversized hearts with poor function needing posterior revascularization.The off-pump cases were mainly done by our surgeon. The approach was a standard median sternotomy with full heparinization. Mechanical stabilization was achieved by using the Octopus II and Octopus III (Medtronic) system. Exposure of the back of the heart was achieved by using a double-armed sling fixed in its midpoint to the posterior pericardium between the right and left inferior pulmonary veins. Temporary occlusion of the vessel was achieved by-using a 4/0 prolene suture. For the right coronary artery, an intra-arterial shunt was used if the vessel was big and the stenosis was less than 80%, as temporary occlusion of such a vessel can cause serious arrhythmias. No pharmacological stabilization was used, but a small dose of dopamine was needed in a few cases. ResultsThere were 650 grafts using the off-pump technique, and these were predominantly in male patients. The demographic comparison between off-pump and the control group and the total number of grafts in each group are as shown in Tables 1 and 2. Although grafting of posterior vessels was extremely difficult initially in the off-pump group, with new techniques and instruments to visualize those vessels without hemodynamic compromise, the number of posterior vessels grafted in the group was comparable to the ...

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“…Even in a large meta-analysis by Cheng et al (21) showing an odds ratio of 0.58 in favour of OPCAB the confidence limits were too wide to allow statistical significance. On the other hand, when comparing biochemical markers of sub-clinical renal damage, evidence from several clinical trials is in favour of OPCAB (11,(60)(61). This difference is clear whether glomerular or tubular damage is compared (60).…”

Section: Renal Functionmentioning

confidence: 99%

“…On the other hand, when comparing biochemical markers of sub-clinical renal damage, evidence from several clinical trials is in favour of OPCAB (11,(60)(61). This difference is clear whether glomerular or tubular damage is compared (60). In one study, the difference between creatinine clearance after CCABG compared to OPCAB was especially high in patients with diabetes, hypertension and heart failure (11).…”

Section: Renal Functionmentioning

confidence: 99%

Current Evidence of On-Pump Versus Off-Pump Coronary Artery By-Pass Surgery

Houlind¹

2012

Special Topics in Cardiac Surgery

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On-pump versus off-pump coronary revascularization: evaluation of renal function

Cited by 366 publications

References 24 publications

<![CDATA[<B>Off-pump coronary artery bypass with multiple arterial conduits</B>]]>

<![CDATA[<B>Off-pump coronary artery bypass with multiple arterial conduits</B>]]>

Off-Pump Beating Heart Coronary Artery Bypass Surgery in Low-Risk Patients: Does it Really Enhance Early Recovery?

Current Evidence of On-Pump Versus Off-Pump Coronary Artery By-Pass Surgery

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