Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass

Gundry, Steven R.; Romano, Matthew A.; Shattuck, O.Howard; Razzouk, Anees J.; Bailey, Leonard L.

doi:10.1016/s0022-5223(98)70209-0

Cited by 175 publications

(86 citation statements)

References 4 publications

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“…The results of the present study were similar to those found in an early small observational study of consecutive patients operated on between 1989 and 1990 by Gundry et al (26). They found that survival was equivalent at seven years, but OPCAB patients were almost three times more likely to require revascularization (20%) compared with CCAB patients (7%; P=0.01).…”

Section: Discussionsupporting

confidence: 90%

“…Ascione and Angelini (5) discussed the dilemma faced by many cardiac surgeons who perform CABG. On one hand, the literature is replete with studies that emphasize the potential for reducing postoperative morbidity and length of stay with OPCAB surgery (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24); on the other hand, there is continued concern regarding intraoperative myocardial ischemia, inadequate revascularization and the need for early revascularization (5,8,23,(25)(26)(27)(28)(29).…”

mentioning

confidence: 99%

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Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Ivanov

Borger

et al. 2008

Canadian Journal of Cardiology

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C oronary artery disease is associated with more death and disabilities than any other disease in industrialized nations. Coronary artery bypass graft surgery (CABG) is one of the most effective methods of treating symptomatic coronary artery disease and is performed in approximately 10,000 patients annually in Ontario.The majority of cardiac operations require the establishment of cardiopulmonary bypass and cardioplegic arrest. However, cardiopulmonary bypass is a well-recognized factor for generating a whole-body inflammatory response, which can contribute to postoperative morbidity including renal, pulmonary, neurological and bleeding complications (1,2). Benetti et al (3) and Buffolo et al (4) reintroduced beating heart surgery almost 20 years ago as a strategy to prevent complications in high-risk patients. Since that time, off-pump coronary artery bypass (OPCAB) surgery has gained increasing popularity and is challenging conventional on-pump coronary artery bypass (CCAB) as the standard of therapy for multivessel disease in many cardiac centres (2).The benefits of OPCAB remain controversial, despite the publication of numerous studies reporting equivalent or improved hospital outcomes and significantly shorter lengths of hospital stay. Ascione and Angelini (5) discussed the dilemma faced by many cardiac surgeons who perform CABG. On one hand, the literature is replete with studies that emphasize the potential for reducing postoperative morbidity and length of stay with OPCAB surgery (6-24); on the other hand, there is continued concern regarding intraoperative myocardial ischemia, inadequate revascularization and the need for early revascularization (5,8,23,(25)(26)(27)(28)(29).Therefore, the purpose of the present study was to evaluate midterm outcomes of OPCAB versus conventional CCAB in two wellmatched cohorts. CLINICAL STUDIES©2008 Pulsus Group Inc. All rights reserved OBJECTIVE: To evaluate survival and readmissions to hospital for cardiac events or coronary revascularization (REVASC) in patients having off-pump (OPCAB) versus conventional on-pump (CCAB) coronary artery bypass graft surgery (CABG). METHODS: Of 11,368 consecutive patients undergoing isolated CABG between 1996 and 2002, 514 had OPCAB surgery. Using propensity scores, 503 CCAB patients were randomly matched to 503 OPCAB patients. RESULTS: There were no clinical or statistical differences between the two groups for any prognostic variable. However, OPCAB patients received significantly fewer distal anastomoses than the CCAB group (2.6±1.0 versus 3.1±1.0; P<0.001). There was no difference in operative mortality (OPCAB 1.0%, CCAB 1.4%; P=0.6), but the OPCAB group had significantly fewer operative strokes (0.2% versus 1.8%; P=0.01). Follow-up was 99.7% complete at 2.2±1.2 years (range 0 to 6 years). Twice as many OPCAB patients (n=24) required REVASC compared with the CCAB (n=11) group. The following five-year actuarial outcomes are presented for CCAB and OPCAB, respectively: survival: 77±6%, 76±8%, P=0.8; freedom from REVASC: 95±3%, 92±2%, ...

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Ivanov

Borger

et al. 2008

Canadian Journal of Cardiology

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“…Regarding requirements of the experimenters in this sphere (5) there was developed miniature version of the perfusion system, tested in the first experiments on 17 rats, to which it was connected by the scheme: left middle -descending aorta, with retrograde pressurizing of blood (without occlusion of ascending aorta, in the conditions of cold cardioplegia (fibrillation of the ventricles). As a result of full heart-lung bypass in 13 cases there was observed spontaneous restoration of heart operation after 30-minute perfusion.…”

Section: Resultsmentioning

confidence: 99%

New type of pump for the heart-lung bypass system

Partsakhashvili¹,

Khodeli²,

Shengelia³

et al. 2014

ejcm

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SummaryObjective: Complications arising from roller pump usage in modern heart-lung bypass (HLB) systems are widely known. Alternative to roller pumps has existed as various devices. This work is dedicated to developing new, considerably simpler and less expensive pump device for HLB systems, which provides maximally physiological pulsating blood flow. Material and Method:We used pediatric cardiotomy reservoirs of HLB systems as blood chambers. Two such reservoirs were placed in front of the oxygenator, with their in-flow tubes connected to the venous blood tubes, and the outflow tubes -to the entry to the oxygenator. In each reservoir, 2 air outlets tubes were connected to pneumo-receivers of positive and negative pressure. We filled up one of the reservoirs whith closed of exit blood tube by creating negative pressure in it. Simultaneously, with closed entry blood tube of the second reservoir, we ejected blood from it by created positive pressure. Used external pulsator. Results:In stand testing under re-circulation regime, productivity of the device was 12,5 liters/minute. Pressure on exit blood pump was within 0 to 300mm.Hg. The pump operating system enabled laminar, as well as pulsating flow of liquid, with frequency of 0-200 pulses/minute. Research is based on experiments conducted on 14 mongrel dogs weighing 20 kg. Standard methodology was used to cannulate Venae cavae and aorta, and to connect perfusion system to body. Duration of complete HLB reached 2 hours. Systolic pressure was maintained within 120-130mm.Hg.; diastolic -70-80 mmHg. Velocity of blood flow in the aorta arc fluctuated within 950-1100 ml/min; in the femoral artery -within 60-80 ml/min. Conclusion:Preliminary tests of the new pump indicate that its hemodynamic characteristics are maximally approximated to physiological ones. In comparison to modern machines, a perfusion system with new pump type has minimal volume of fill-up and does not damage formative elements of blood.Keywords: Pulsatille flow, blood pump, perfusion.Please cite this article as: Khodeli N., Shengelia O., Chkhaidze Z., Partsakhashvili D., Sologashvili T. New type of pump for the heart-lung bypass system.EJCM 2014; 02 (2): 29-32.

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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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Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass

Cited by 175 publications

References 4 publications

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

New type of pump for the heart-lung bypass system

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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Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass

Cited by 175 publications

References 4 publications

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

New type of pump for the heart-lung bypass system

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

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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