Urgent off-pump coronary artery bypass grafting

Abstract

Urgent off-pump CABG is safe and provides early recovery, provided that the patient's intraoperative hemodynamics are taken into account.

Coronary artery bypass surgery for acute coronary syndrome: A network meta‐analysis of on‐pump cardioplegic arrest, off‐pump, and on‐pump beating heart strategies

“…Furthermore, high heterogeneity in terms of operative risk between the intervention groups resulting from selection bias was expected given that choice of surgical technique was based on surgeon preference rather than a strict criterion. Interestingly, the majority of studies reported no significant difference between preoperative risk (determined by EuroSCORE, cardiogenic shock, preoperative IABP, ejection fraction, renal function), whereas four studies reported higher preoperative risk in the control group 17,24,25,43 and three studies reported vice versa. 6,8,10 However, in these studies in which there was a higher preoperative risk in the OPCAB or OnBHCAB group, there were marginally better or similar short and intermediate term results compared to ONCAB.…”

“…A subgroup NMA looking at a higher acuity patient population was also performed. Nine studies 5,6,9,10,[24][25][26]31,32 assessing only patients with acute myocardial infarction (AMI) requiring emergency coronary revascularisation were identified.…”

Clinical outcomes of nonelective coronary revascularization with and without cardiopulmonary bypass

“…Nonelective off-pump CABG was associated with comparable operative mortality and stroke rates with conventional on-pump CABG, echoing previous studies. 10,11 Previously, we demonstrated a decreased incidence of operative mortality and stroke after off-pump CABG compared with that after on-pump CABG in a risk-adjusted population. 6,18 Failure to achieve statistical significance might be attributed to the relatively smaller number of patients analyzed in this report.…”

“…[5][6][7][8] However, there are few reports and comparative studies on outcomes with off-pump CABG in urgent and emergent cases versus the conventional approach with cardiopulmonary bypass. 9,10 Patients who undergo emergent or urgent CABG pose a greater challenge in terms of intraoperative and postoperative mortality and morbidity. Off-pump CABG might benefit these high-risk patients by eliminating the cardiopulmonary bypass and therefore decreasing the systemic inflammatory response associated with it.…”

“…Off-pump CABG might benefit these high-risk patients by eliminating the cardiopulmonary bypass and therefore decreasing the systemic inflammatory response associated with it. Preliminary reports have revealed improved outcomes associated with nonelective off-pump CABG in terms of mortality and morbidity 9,10 compared with conventional on-pump CABG. These reports, however, are limited by small sample size, inappropriate statistical methodology, or both.…”