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Chervu N, Verma A, Sakowitz S, Bakhtiyar SS, Hadaya J, Sanaiha Y, Benharash P. Association of Hospital Volume and Outcomes Following Off-Pump Coronary Artery Bypass Grafting. Heart Lung Circ 2023; 32:1128-1135. [PMID: 37541816 DOI: 10.1016/j.hlc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Off-pump coronary artery bypass grafting (OPCAB) has been used to mitigate the negative systemic effects of cardiopulmonary bypass. Recent consortium and single-institution studies suggest an association between operator experience and long-term survival. We thus aimed to ascertain the relationship between institutional OPCAB volume and outcomes using a contemporary nationwide all-payer database. METHODS Adult admissions for elective isolated OPCAB were identified from the 2016-2019 Nationwide Readmissions Database. The primary outcome was major adverse events (MAE), defined as a composite of mortality, reoperation, prolonged mechanical ventilation, acute kidney injury requiring dialysis, or perioperative stroke during the index hospitalisation. Secondary outcomes included temporal trends, postoperative length of stay (pLOS), hospitalisation costs, non-home discharge, and 30-day readmission rate. High-volume hospitals (HVH) were defined to have annual caseloads >35 based on cubic spline analysis. RESULTS Of an estimated 41,154 patients, 59.9% were treated at HVH. The proportion of coronary artery bypass grafting operations that were OPCAB significantly decreased from 21.1% in 2016 to 18.3% in 2019. After adjustment, HVH status was associated with lower adjusted odds of MAE (adjusted odds ratio [AOR] 0.78, 95% confidence interval [CI] 0.70-0.88), compared to others. HVH were also associated with shorter pLOS (β -0.10, 95% -0.13, -0.07), reduced costs (β -US$4,900, - US$6,300, - US$3,600), non-home discharge (AOR 0.54, 95% CI 0.45-0.64), and 30-day readmission (AOR 0.86, 95% CI 0.77-0.96). CONCLUSIONS Our results suggest that OPCAB requires a distinct set of surgical expertise and institutional aptitude. As a result, centralisation of care to centres of excellence should be considered.
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Affiliation(s)
- Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA.
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Sakowitz S, Bakhtiyar SS, Sareh S, Ali K, Verma A, Chervu N, Sanaiha Y, Benharash P. Acute clinical and financial outcomes of on- versus off-pump coronary artery bypass grafting in octogenarians. Surgery 2023:S0039-6060(23)00168-X. [PMID: 37202306 DOI: 10.1016/j.surg.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/03/2023] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Coronary artery bypass surgery in octogenarians is associated with increased postoperative morbidity. Off-pump coronary artery bypass surgery eliminates potential complications of cardiopulmonary bypass, but its use remains controversial. This study aimed to evaluate the clinical and financial impact of off-pump coronary artery bypass surgery compared to conventional coronary artery bypass surgery among this high-risk population. METHODS Patients ≥80 years undergoing first-time, isolated, elective coronary artery bypass surgery were identified using the 2010-2019 Nationwide Readmissions Database. Patients were grouped into off-pump or conventional coronary artery bypass surgery cohorts. Multivariable models were developed to assess the independent associations between off-pump coronary artery bypass surgery and key outcomes. RESULTS Of ∼56,158 patients, 13,940 (24.8%) underwent off-pump coronary artery bypass surgery. On average, the off-pump cohort was more likely to undergo single-vessel bypass (37.3 vs 19.7%, P < .001). After adjustment, undergoing off-pump coronary artery bypass surgery was associated with similar odds of in-hospital mortality (adjusted odds ratio 0.90, 95% confidence interval 0.73-1.12) relative to conventional bypass. Additionally, the off-pump and conventional coronary artery bypass surgery groups were comparable in odds of postoperative stroke (adjusted odds ratio 1.03, 95% confidence interval 0.78-1.35), cardiac arrest (adjusted odds ratio 0.99, 95% confidence interval 0.71-1.37), ventricular fibrillation (adjusted odds ratio 0.89, 95% confidence interval 0.60-1.31), tamponade (adjusted odds ratio 1.21, 95% confidence interval 0.74-1.97), and cardiogenic shock (adjusted odds ratio 0.94, 95% confidence interval 0.75-1.17). However, the off-pump coronary artery bypass surgery cohort was linked with an increased likelihood of ventricular tachycardia (adjusted odds ratio 1.23, 95% confidence interval 1.01-1.49) and myocardial infarction (adjusted odds ratio 1.34, 95% confidence interval 1.16-1.55). Furthermore, those undergoing off-pump coronary artery bypass surgery demonstrated reduced odds of non-home discharge (adjusted odds ratio 0.91, 95% confidence interval 0.83-0.99) and a decrement in hospitalization expenditures ($-1,290, 95% confidence interval -$2,370 to $200). CONCLUSION Off-pump coronary artery bypass surgery was linked with increased odds of ventricular tachycardia and myocardial infarction, but no difference in mortality. Our findings point to the safety of conventional coronary artery bypass surgery in octogenarians. Yet, future work is needed to consider long-term outcomes in this complex surgical cohort.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA. https://twitter.com/sarasakowitz
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of Colorado, Aurora, CO. https://twitter.com/Aortologist
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA.
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Ishak NH, Chong SE, Zainal Abidin H, Mamat AZ, Mokthar AM, Dimon MZ, Dimon MZ. Off-Pump Coronary Artery Bypass Grafting Surgery: A Valuable 2-Day Experience. Malays J Med Sci 2022; 29:158-163. [PMID: 36818905 PMCID: PMC9910366 DOI: 10.21315/mjms2022.29.6.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022] Open
Abstract
Currently, coronary artery disease (CAD) has been identified as the leading cause of mortality in Malaysia and in other countries worldwide. Genetic predisposition and comorbidities such as hypertension and diabetes mellitus, gender, lifestyle, and several other risk factors can contribute to the development of CAD. Pharmacological and surgical treatments play a vital role in improving the quality of life of patients with CAD. New surgical techniques and continuous interventions have been introduced to improve the treatment outcome. Recently, cardiothoracic teams from Universiti Teknologi MARA (UiTM) and Universiti Sains Malaysia (USM) have conducted a 2-day live workshop on off-pump coronary artery bypass (OPCAB) surgery. In this brief communication, we share the highlights and clinical tips of the OPCAB surgery gained from the collaboration.
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Affiliation(s)
- Nadia Hanom Ishak
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Soon Eu Chong
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Huda Zainal Abidin
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ahmad Zuhdi Mamat
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ariffin Marzuki Mokthar
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Zamrin Dimon
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
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Van den Eynde J, Bomhals K, Noé D, Jacquemyn X, McCutcheon K, Bennett J, Puskas JD, Oosterlinck W. Revascularization strategies in patients with multivessel coronary artery disease: a Bayesian network meta-analysis. Interact Cardiovasc Thorac Surg 2022; 34:947-957. [PMID: 34964468 PMCID: PMC9159431 DOI: 10.1093/icvts/ivab376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022] Open
Abstract
Treatment modalities for multivessel disease have rapidly evolved, yet the preferred strategy remains controversial. This meta-analysis compared outcomes after on-pump (ONCAB), off-pump coronary artery bypass grafting (OPCAB), percutaneous coronary intervention (PCI) or hybrid coronary revascularization. A comprehensive search for observational studies and randomized controlled trials published by August 2020 was performed. A Bayesian network meta-analysis was conducted for early (<30 days) and late (>12 months) outcomes. A total of 119 studies were included (n = 700 458 patients). The main analysis was confined to 31 randomized controlled trials (n = 24 932 patients). PCI was associated with lower early mortality [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.31-0.79] and stroke (OR 0.22, 95% CI 0.06-0.60) rates compared with ONCAB, whereas a reduced risk of early myocardial infarction was observed with OPCAB compared with ONCAB (OR 0.53, 95% CI 0.32-0.83). Late target vessel revascularization and major adverse cardiac and cerebrovascular events were both increased with PCI compared with ONCAB, OPCAB and hybrid coronary revascularization (by 127-203% and 59-64%, respectively), and late major adverse cardiac events were increased in PCI compared with ONCAB and OPCAB (by 64% and 59%). However, PCI was associated with a significantly lower risk of late stroke compared with ONCAB (OR 0.70, 95% CI 0.52-0.89). Sensitivity analyses (i) including observational studies and (ii) limiting to studies with recent cohorts confirmed the findings of the main analysis. Surgical approaches for revascularization remain superior to PCI in patients with multivessel disease. Hybrid coronary revascularization might be viable for some patients, although more evidence from randomized controlled trials is warranted.
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Affiliation(s)
- Jef Van den Eynde
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Katrien Bomhals
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Dries Noé
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Xander Jacquemyn
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Johan Bennett
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Wouter Oosterlinck
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Benetti FJ, Scialacomo N, Mazzolino G. MINI OPCAB Operation: Surgical Technique. Surg Technol Int 2021; 38:290-293. [PMID: 33755939 DOI: 10.52198/21.sti.38.cv1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION We describe how to perform left internal mammary artery (LIMA) bypass to the left anterior descending (LAD) artery, the so-called MINI Off-pump Coronary Artery Bypass (MINI OPCAB). MATERIALS AND METHODS We included patients with a demonstrated predominant ischemia related to the LAD territory. Of 70 patients who were operated upon at the Benetti Foundation, 10 received hybrid revascularization. SURGICAL TECHNIQUE The patient is prepared as for a standard coronary bypass operation through sternotomy. The sternum is opened to the 3rd or 4th intercostal space depending on the anatomy, and a retractor is put in place. The left mammary artery is generally dissected to about 8 cm and isolated without the veins. Importantly, the angle of the superior part, where the mammary artery is attached to the sternum, needs to be below 20% to avoid any potential kinking. The pericardium is cleaned to identify the area of the pulmonary artery. The pericardium is opened to the apex and towards the right to around 5 to 6 cm initially. In most cases, the area of the LAD can be seen and the potential area of the anastomosis is defined. The patient is heparinized and the LAD is occluded with 5-0 Proline. A mechanical stabilizer is put in place and the anastomosis is performed. When the bypass is finished, and before sutures are tied, the stitches of 5-0 polypropylene around the artery are released, along with the clamp of the mammary artery; the anastomosis is then tied. The mechanical stabilizer is removed, the stitches of the pericardium are released and the flow of the graft is measured, while ensuring that there is no kinking. If the flow and Pulsatility and Resistance (PR) are acceptable, the mammary is fixed with 2 stitches of 7-0 polypropylene on both sides around 1 cm from the anastomosis. The heparin is reverted with protamine and a drain is put in place, while taking care to avoid any chance of touching the mammary artery or the anastomosis. The sternum is closed with 1 or 2 wires. RESULTS Operative mortality in this series was 0%; one patient was converted to sternotomy off-pump (1.4%). None of the grafts were revised after measurement with a Medistim system (Medistim ASA, Oslo, Norway). Fifty five patients (79%) were extubated in the operating room The average hospitalization stay was 60 hours (SD 17, 95% CI). Sixteen patients who underwent the LIMA-to-LAD procedure were restudied, with 100% patency. At 144 months, 82% of the patients were alive and 68% were asymptomatic. CONCLUSION Additional clinical experience is required to be able to reproduce this operation on a large scale and expand the MINI OPCAB operation in hybrid revascularization.
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Sarris-Michopoulos P, Markell E, Macias A, Magarakis M. Off-pump coronary artery bypass in patients with severe LV dysfunction. Is it really more challenging? J Card Surg 2021; 36:1010-1011. [PMID: 33503683 DOI: 10.1111/jocs.15361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Panagiotis Sarris-Michopoulos
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiac Surgery Section, University of Miami, Miami, Florida, USA
| | - Evan Markell
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiac Surgery Section, University of Miami, Miami, Florida, USA
| | - Alejandro Macias
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiac Surgery Section, University of Miami, Miami, Florida, USA
| | - Michael Magarakis
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiac Surgery Section, University of Miami, Miami, Florida, USA
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Magarakis M, Buitrago DH, Macias AE, Tompkins BA, Salerno TA. Off pump coronary artery bypass in patients with an ejection fraction of <20%. What is our strategy? J Card Surg 2021; 36:1067-1071. [PMID: 33476419 DOI: 10.1111/jocs.15330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
Patients with left ventricular dysfunction and low ejection fraction (EF) are at high risk of complication and mortality after coronary artery bypass grafting (CABG). The potential success of off-pump CABG in this high-risk population has yet to be illustrated. Herein, we present our experience in regards to surgical planning and strategy on how to perform off-pump CABG in patients with very low EF.
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Affiliation(s)
- Michael Magarakis
- Department of Surgery, Division of Cardiothoracic Surgery, Cardiac Surgery Section, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Daniel H Buitrago
- Department of Surgery, Division of Cardiothoracic Surgery, Cardiac Surgery Section, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Alejandro E Macias
- Department of Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Bryon A Tompkins
- Department of Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Tomas A Salerno
- Department of Surgery, Division of Cardiothoracic Surgery, Cardiac Surgery Section, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
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Thijssens KM, Rodrigus IE, Amsel BJ, Hert SGD, Moulijn AC. Coronary Artery Bypass Grafting on the Beating Heart using the Octopus Method. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2000.12098548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- K. M. Thijssens
- Department of Cardiac Surgery, University Hospital Antwerp, Edegem, Belgium
| | - I. E. Rodrigus
- Department of Cardiac Surgery, University Hospital Antwerp, Edegem, Belgium
| | - B. J. Amsel
- Department of Cardiac Surgery, University Hospital Antwerp, Edegem, Belgium
| | - S. G. De Hert
- Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium
| | - A. C. Moulijn
- Department of Cardiac Surgery, University Hospital Antwerp, Edegem, Belgium
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Van den Eynde J, Bennett J, McCutcheon K, Adriaenssens T, Desmet W, Dubois C, Sinnaeve P, Verbelen T, Jacobs S, Oosterlinck W. Heart team 2.0: A decision tree for minimally invasive and hybrid myocardial revascularization. Trends Cardiovasc Med 2020; 31:382-391. [PMID: 32712328 DOI: 10.1016/j.tcm.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022]
Abstract
Recent years have seen an important shift in the target population for myocardial revascularization. Patients are increasingly presenting with more complex coronary artery disease (CAD), but also with multiple comorbidities and frailty. At the same time, minimally invasive strategies such as Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) and Percutaneous Coronary Interventions (PCI) have been developed, which might be more appealing for this group of patients. As a result, the landscape of options for myocardial revascularization is evolving while adequate use of all resources is required to ensure optimal patient care. Heart Teams are confronted with the challenge of incorporating the new minimally invasive strategies into the decision process, yet current guidelines do not fully address this challenge. In this review, the current evidence regarding outcomes, indications, benefits, and risks of off-pump coronary artery bypass grafting (OPCAB), MIDCAB, PCI, and hybrid coronary revascularization (HCR) are discussed. Based on this evidence and on experiences from Heart Team discussions, a new decision tree is proposed that incorporates recent advances in minimally invasive revascularization strategies, thereby optimizing adequate delivery of care for each individual patient's needs. Introducing all important considerations in a logical way, this tool facilitates the decision-making process and might ensure appropriate use of resources and optimal care for individual patients.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Walter Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Peter Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Steven Jacobs
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Wouter Oosterlinck
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
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Commentary: What does the future hold for coronary bypass surgery? J Thorac Cardiovasc Surg 2020; 162:1120-1121. [PMID: 32087954 DOI: 10.1016/j.jtcvs.2020.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 11/23/2022]
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Raut MS, Hanjoora VM, Chishti MA. Sudden, new-onset aortic regurgitation during off pump coronary bypass surgery. Ann Card Anaesth 2019; 22:430-431. [PMID: 31621680 PMCID: PMC6813691 DOI: 10.4103/aca.aca_110_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
During off pump coronary artery bypass grafting surgery, it is common to observe mitral or tricuspid regurgitation due to heart displacement. But it's very unusual to notice new onset aortic regurgitation in OPCABG.
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Affiliation(s)
- Monish S Raut
- Department of Cardiac Anesthesiology, Artemis Hospitals, Gurugram, Haryana, India
| | - Vijay M Hanjoora
- Department of Cardiac Anesthesiology, Artemis Hospitals, Gurugram, Haryana, India
| | - Murtaza A Chishti
- Department of Cardiac Surgery, Artemis Hospitals, Gurugram, Haryana, India
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Prapas SN, Pangiotopoulos IA, Leivaditis VN, Katsavrias KP, Prapa VS, Linardakis IN, Koletsis EN, Grapatsas K. The π-Circuit Technique in Coronary Surgery: Analysis of 1359 Consecutive Cases. Open J Cardiovasc Surg 2019; 11:1179065219871948. [PMID: 31488952 PMCID: PMC6712752 DOI: 10.1177/1179065219871948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/14/2022] Open
Abstract
Coronary artery bypass surgery still has its unique role in the treatment of coronary artery disease. It faces, however, the continuous challenge of becoming even less invasive and more effective as cases become more complex. We here present the results of 1359 cases treated with the π-circuit technique which consists of an off-pump total myocardial revascularization using composite arterial grafts. The results demonstrate that it is a safe technique providing low mortality, stroke, renal failure, wound infection, and other complication rates. We suggest the application of this technique, as well as of other similar techniques regarding similar principles, especially in high-risk patients.
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Affiliation(s)
- Sotirios N Prapas
- 1st Department of Cardiac Surgery, Henry Dunant Hospital Center, Athens, Greece
| | | | - Vasileios N Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | | | - Vasiliki S Prapa
- Department of Anesthesiology, Henry Dunant Hospital Center, Athens, Greece
| | | | - Efstratios N Koletsis
- Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, Greece
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany
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13
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Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol 2019; 17:155-169. [DOI: 10.1038/s41569-019-0249-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
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14
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Farina P, Gaudino M, Angelini GD. Off-pump coronary artery bypass surgery: The long and winding road. Int J Cardiol 2019; 279:51-55. [DOI: 10.1016/j.ijcard.2018.09.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/27/2022]
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Okano R, Liou YJ, Yu HY, Wu IH, Chou NK, Chen YS, Chi NH. Coronary Artery Bypass in Young Patients-On or Off-Pump? J Clin Med 2019; 8:E128. [PMID: 30678203 PMCID: PMC6407132 DOI: 10.3390/jcm8020128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/12/2019] [Accepted: 01/20/2019] [Indexed: 11/29/2022] Open
Abstract
A definitive conclusion regarding whether on-pump or off-pump coronary artery bypass is preferable in young patients is lacking. The aim of our study was to perform a long-term comparison of the two approaches in young patients. We analyzed the National Health Insurance Research Database, using data for patients between 18 and 45 years of age who had undergone isolated coronary artery bypass between 2001 and 2011. The study endpoints were: all-cause death, major adverse cardiac and cerebrovascular events, and repeat revascularization within 30 days, 1 year, 5 years, and the entire 10-year follow-up period. A total of 344 patients received off-pump surgery and 741 patients received on-pump surgery. Preoperative characteristics and comorbidities were similar in both groups, and all-cause mortality was almost equal (p = 0.716). The 5-year survival rates were 93.9% and 92.2% in the off-pump and on-pump groups, respectively, and the 10-year survival rates were 86.3% and 82.1%, respectively. The repeat revascularization rate was significantly lower in the on-pump group (p = 0.0407). Both the on-pump and off-pump methods offer equally good long-term outcomes in terms of mortality and major adverse cardiac and cerebrovascular events. However, the need for repeat revascularization is a concern in the long term after off-pump surgery.
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Affiliation(s)
- Ryoi Okano
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan.
- Department of Cardiovascular Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan.
| | - Yi-Jia Liou
- Department of Life Science, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| | - I-Hui Wu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| | - Nai-Kuan Chou
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| | - Nai-Hsin Chi
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan.
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Abrantes RD, Hueb AC, Hueb W, Jatene FB. Behavior of Ultrasensitive C-Reactive Protein in Myocardial Revascularization with and without Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2019; 33:535-541. [PMID: 30652741 PMCID: PMC6326455 DOI: 10.21470/1678-9741-2018-0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/31/2018] [Indexed: 11/26/2022] Open
Abstract
Objective To analyze the inflammation resulting from myocardial revascularization
techniques with and without cardiopulmonary bypass, based on ultrasensitive
C-reactive protein (US-CRP) behavior. Methods A prospective non-randomized clinical study with 136 patients was performed.
Sixty-nine patients were enrolled for Group 1 (on-pump coronary artery
bypass - ONCAB) and 67 patients were assigned to Group 2 (off-pump coronary
artery bypass - OPCAB). All study participants had blood samples collected
for analysis of glucose, triglycerides, creatinine, total cholesterol,
high-density lipoprotein (HDL), low-density lipoprotein (LDL) and
creatinephosphokinase (CPK) in the preoperative period. The samples of
creatinephosphokinase MB (CKMB), troponin I (TnI) and US-CRP were collected
in the preoperative period and at 6, 12, 24, 36, 48 and 72 hours after
surgery. We also analyzed the preoperative biological variables of each
patient (age, smoking, diabetes mellitus, left coronary trunk lesion, body
mass index, previous myocardial infarction, myocardial fibrosis). All
angiographically documented patients with >70% proximal multiarterial
stenosis and ischemia, documented by stress test or classification of stable
angina (class II or III), according to the Canadian Cardiovascular Society,
were included. Reoperations, combined surgeries, recent acute myocardial
infarction, recent inflammatory disease, deep venous thrombosis or recent
pulmonary thromboembolism, acute kidney injury or chronic kidney injury were
not included. Results Correlation values between the US-CRP curve and the ONCAB group, the
treatment effect and the analyzed biological variables did not present
expressive results. Laboratory variables were evaluated and did not
correlate with the applied treatment (P>0.05). Conclusion The changes in the US-CRP at each moment evaluated from the postoperative
period did not show any significance in relation to the surgical technique
applied.
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Affiliation(s)
- Rafael Diniz Abrantes
- Cardiovascular Surgery Division, Hospital das Clínicas Samuel Libânio (HCSL), Pouso Alegre, MG, Brazil
| | - Alexandre Ciappina Hueb
- Cardiovascular Surgery Division, Hospital das Clínicas Samuel Libânio (HCSL), Pouso Alegre, MG, Brazil.,Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Whady Hueb
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Srivastava S, Gadasalli S, Agusala M, Kolluru R, Barrera R, Quismundo S, Srivastava V, Seshadri-Kreaden U. Robotically Assisted Beating Heart Totally Endoscopic Coronary Artery Bypass (TECAB). is There a Future? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698450800300202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sudhir Srivastava
- Alliance Hospital Chicago, IL
- Cardiac Surgical Associates of West Texas, Odessa, TX
| | | | | | | | - Reyna Barrera
- Cardiac Surgical Associates of West Texas, Odessa, TX
- Intuitive Surgical Inc, Sunnyvale, CA
| | - Shaune Quismundo
- Cardiac Surgical Associates of West Texas, Odessa, TX
- Intuitive Surgical Inc, Sunnyvale, CA
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Gaudino M, Angelini GD, Antoniades C, Bakaeen F, Benedetto U, Calafiore AM, Di Franco A, Di Mauro M, Fremes SE, Girardi LN, Glineur D, Grau J, He G, Patrono C, Puskas JD, Ruel M, Schwann TA, Tam DY, Tatoulis J, Tranbaugh R, Vallely M, Zenati MA, Mack M, Taggart DP. Off-Pump Coronary Artery Bypass Grafting: 30 Years of Debate. J Am Heart Assoc 2018; 7:e009934. [PMID: 30369328 PMCID: PMC6201399 DOI: 10.1161/jaha.118.009934] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mario Gaudino
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | | | | | | | | | | | - Antonino Di Franco
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | | | - Stephen E. Fremes
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | - Leonard N. Girardi
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
| | - David Glineur
- Division of Cardiac SurgeryOttawa Heart InstituteOttawaCanada
| | - Juan Grau
- Division of Cardiac SurgeryOttawa Heart InstituteOttawaCanada
| | - Guo‐Wei He
- TEDA International Cardiovascular HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeTianjinChina
| | - Carlo Patrono
- Department of PharmacologyCatholic University School of MedicineRomeItaly
| | - John D. Puskas
- Department of Cardiovascular SurgeryIcahn School of Medicine at Mount SinaiNew York CityNY
| | - Marc Ruel
- University of Ottawa Heart InstituteOttawaCanada
| | | | - Derrick Y. Tam
- Schulich Heart CentreSunnybrook Health ScienceUniversity of TorontoCanada
| | - James Tatoulis
- Department of SurgeryUniversity of MelbourneParkvilleAustralia
| | - Robert Tranbaugh
- Department of Cardio‐Thoracic SurgeryWeill Cornell MedicineNew York CityNY
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Hlavička J, Vaněk T, Jarkovský J, Benešová K. Use of OPCAB in Czechia 2010-2015: Have we learned any lessons? COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Minimally invasive direct coronary bypass surgery via distal mini-sternotomy : Promising clinical results with anaortic, multivessel, all-arterial technique. Herz 2018; 44:666-672. [PMID: 29637231 DOI: 10.1007/s00059-018-4696-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Minimally invasive direct coronary artery bypass grafting (MIDCAB) was developed to decrease perioperative morbidity, some of which may be related to the use of cardiopulmonary bypass and to cross-clamping of the aorta. We report our initial experience with multivessel MIDCAB via distal mini-sternotomy (DIMS). DIMS is performed to gain access to the left and right internal thoracic arteries and to reach the left anterior descending coronary artery (LAD), diagonal branches, and right coronary artery (RCA). METHODS Between January 2016 and January 2017, 12 patients with significant coronary artery disease of the LAD and the RCA underwent multivessel, all-arterial MIDCAB through a distal midline skin incision from the fourth intercostal space to the xyphoid process, with L‑ or T‑shaped division of the sternum. The mean age of the patients was 61.5 ± 5.2 years (range: 52-71 years). RESULTS We performed all-arterial revascularization using the left internal mammary artery in 12 patients, the radial artery in ten, and the right internal mammary artery in two patients. The mean number of grafts per patient was 2.08 ± 0.4 (range: 2-3). The mean length of the skin incision was 8.5 ± 1.3 cm (range: 7-11 cm). There was no perioperative ischemia, postoperative bleeding, or arrhythmia events. No postoperative cognitive dysfunction occurred. The mean hospital stay was 5.6 days. No major adverse cardiac events (MACE) occurred at the 12-month follow-up. At follow-up, all patients were in New York Heart Association class I and there were no wound complications. CONCLUSION Although MIDCAB-DIMS is technically more demanding than conventional procedures and our experience is limited, we conclude that this technique can be used safely in selected patients, with promising 12-month follow-up results.
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Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA, Almassi GH, Kozora E, Bakaeen F, Cleveland JC, Bishawi M, Grover FL. Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. N Engl J Med 2017; 377:623-632. [PMID: 28813218 DOI: 10.1056/nejmoa1614341] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coronary-artery bypass grafting (CABG) surgery may be performed either with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). We report the 5-year clinical outcomes in patients who had been included in the Veterans Affairs trial of on-pump versus off-pump CABG. METHODS From February 2002 through June 2007, we randomly assigned 2203 patients at 18 medical centers to undergo either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The two primary 5-year outcomes were death from any cause and a composite outcome of major adverse cardiovascular events, defined as death from any cause, repeat revascularization (CABG or percutaneous coronary intervention), or nonfatal myocardial infarction. Secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction. Primary outcomes were assessed at a P value of 0.05 or less, and secondary outcomes at a P value of 0.01 or less. RESULTS The rate of death at 5 years was 15.2% in the off-pump group versus 11.9% in the on-pump group (relative risk, 1.28; 95% confidence interval [CI], 1.03 to 1.58; P=0.02). The rate of major adverse cardiovascular events at 5 years was 31.0% in the off-pump group versus 27.1% in the on-pump group (relative risk, 1.14; 95% CI, 1.00 to 1.30; P=0.046). For the 5-year secondary outcomes, no significant differences were observed: for nonfatal myocardial infarction, the rate was 12.1% in the off-pump group and 9.6% in the on-pump group (P=0.05); for death from cardiac causes, the rate was 6.3% and 5.3%, respectively (P=0.29); for repeat revascularization, the rate was 13.1% and 11.9%, respectively (P=0.39); and for repeat CABG, the rate was 1.4% and 0.5%, respectively (P=0.02). CONCLUSIONS In this randomized trial, off-pump CABG led to lower rates of 5-year survival and event-free survival than on-pump CABG. (Funded by the Department of Veterans Affairs Office of Research and Development Cooperative Studies Program and others; ROOBY-FS ClinicalTrials.gov number, NCT01924442 .).
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Affiliation(s)
- A Laurie Shroyer
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Brack Hattler
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Todd H Wagner
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Joseph F Collins
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Janet H Baltz
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Jacquelyn A Quin
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - G Hossein Almassi
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Elizabeth Kozora
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Faisal Bakaeen
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Joseph C Cleveland
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Muath Bishawi
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Frederick L Grover
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
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Cartier R. From Idea to Operating Room: Surgical Innovation, Clinical Application, and Outcome. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/vc.2000.6488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Raymond Cartier
- Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
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23
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Boyd WD, Desai ND, Novick RJ, McKenzie FN, DelRizzo DF, Menkis AH. Use of Cardiopulmonary Bypass in High-Risk Patients Is a Predictor of Adverse Outcome. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/vc.2000.6480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
High-risk patients experience substantially more compli cations after coronary artery bypass grafting (CABG). We hypothesized that these patients are uniquely vulner able to cardiopulmonary bypass and compared postop erative outcomes between high-risk patients undergo ing off-pump CAB (OPCAB) and conventional CABG. Prospective provincial cardiac care registry and retro spective chart data were reviewed for 1,850 consecutive patients at our institution between January 1996 and January 1999. From this, 235 patients, 36 OPCAB and 199 CABG, were identified as high risk (modified Parson net score ≥15). Risk factor analysis showed the popula tions were equivalent in perioperative risk with mean modified Parsonnet scores of 18.1 ± 3.4 (OPCAB) and 18.7 ± 4.2 (CABG) (P = .4). In total, 6% of OPCAB and 40% of CABG patients suffered major complications leading to extended hospital/intensive care unit (ICU) stay or death ( P ≤ .001). Mean hospital stays were 7.0 ± 4.0 days (OPCAB) and 10.6 ± 10.2 days (CABG) ( P ≤ .001). Mean ICU stays were 23.9 ± 9.7 hours (OPCAB) and 64.9 ± 128.3 hours (CABG) ( P ≤ .001). Mortality was 0% in the OPCAB group and 6% in the CABG group (P = .2). Multivariate predictors of experiencing a major complication were: use of cardiopulmonary bypass (OR 5.1, 95 Cl 2.1-12.1), age > 80 (OR 2.5, 95 Cl 1.7-7.5), female (OR 3.0, 95 Cl 1.6-5.4), repeat operation (OR 2.5, 95 Cl 1.2-5.4), and ejection fraction <40% (OR 2.4, 95 Cl 1.2-4.7). Extracorporeal circulation is the most impor tant predictor of postoperative complications after CABG in high-risk patients. Off-pump surgery substantially reduces morbidity in this group, and further study of the protective effects of this emerging modality are war ranted.
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Affiliation(s)
- W. Douglas Boyd
- Department of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario
| | - Nimesh D. Desai
- Department of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario
| | - Richard J. Novick
- Department of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario
| | - F. Neil McKenzie
- Department of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario
| | | | - Alan H. Menkis
- Department of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario
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Taggart DP. Off-pump coronary artery bypass grafting (OPCABG)-a 'personal' European perspective. J Thorac Dis 2016; 8:S829-S831. [PMID: 27942402 DOI: 10.21037/jtd.2016.10.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although popularised over two decades ago off-pump coronary artery bypass grafting (OPCABG) has seen a decrease in utilisation especially over the last decade. This has been due to publication of a number of trials which suggested inferior outcomes with OPCABG. However, the validity of the findings in these trials has been questioned on the basis of doubts over operator experience as witnessed by large numbers of cross-overs. Two more recent large randomised trials have shown very similar outcomes between on and off-pump surgery up to 1- and 5-year outcomes are imminently due. Furthermore several meta-analyses have reported that OPCABG reduces mortality, myocardial infarction and major morbidity in higher risk patients. Consequently there is a clear rationale for OPCABG in certain cohorts of patients and especially when combined with a no touch aortic technique in those with significant disease of the ascending aorta. The article discusses the importance of routine performance of OPCABG if it is to produce high quality results and especially in higher risk patients.
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Affiliation(s)
- David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, Oxford, UK
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Li S, Gong W, Qi Q, Yuan Z, Chen A, Liu J, Cai J, Zhou M, Wang Z, Ye X, Zhao Q. Outcomes of off-pump versus on-pump coronary artery bypass graft surgery in patients with severely dilated left ventricle. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:340. [PMID: 27761444 DOI: 10.21037/atm.2016.08.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Currently, off-pump coronary artery bypass (OPCAB) grafting has been the standard procedure for surgical revascularization in patients with coronary artery disease (CAD). This study aimed to examine the safety and applicability of OPCAB compared with on-pump coronary artery bypass (ONCAB) in patients with severely dilated left ventricle. METHODS A retrospective study of giant left ventricle patients [left ventricular end diastolic diameter (LVEDD) ≥ VE mm] undergoing coronary bypass grafting from 2009 through 2015 at a single center was conducted. Preoperative and intraoperative risk factors, and postoperative outcomes were analyzed. Survival analysis was carried to analyze survival rate during follow-up. RESULTS A total of 24 patients underwent ONCAB, and 26 underwent OPCAB. Both groups had similar preoperative profiles. Two cases from each group died during in-hospital time. In comparison to OPCAB, there was longer operation and post-surgery intubation time and more renal dysfunction in ONCAB group (P<0.05). One-year survival between OPCAB and ONCAB were not significantly different (87.5% vs. 92.3%, P>0.05). CONCLUSIONS OPCAB is a safe and feasible alternative for CAD patients with giant left ventricle, offering a significant advantage over ONCAB with regards to renal function, operation duration and length of ventilation.
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Affiliation(s)
- Sen Li
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Wenhui Gong
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Quan Qi
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Zezhe Yuan
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Anqing Chen
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Jun Liu
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Junfeng Cai
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Mi Zhou
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Zhe Wang
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Xiaofeng Ye
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
| | - Qiang Zhao
- Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China
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Hussain G, Azam H, Baig MAR, Ahmad N. Early outcomes of on-pump versus off-pump coronary artery bypass grafting. Pak J Med Sci 2016; 32:917-21. [PMID: 27648039 PMCID: PMC5017102 DOI: 10.12669/pjms.324.9680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery. Methods: This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-I (On-pump group) and Group-II (Off-pump Group). SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher’s exact test were used to analyze qualitative variables. P-value ≤ 0.05 was considered significant. Results: Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group (p-value 0.05). Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group (p-value 0.001, <0.0001, 0.006, 0.025 and 0.001 resp.). Peri-operative chest drainage was significantly high in On-pump CABG group (p-value 0.027). Incidence of post-op complications was not statistically different between the groups. Conclusions: At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups.
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Affiliation(s)
- Ghulam Hussain
- Ghulam Hussain. FCPS Cardiac Surgery. Assistant Professor of Cardiac Surgery, Ch. Pervaiz Elahi Institute of Cardiology (CPEIC), Multan, Pakistan
| | - Hammad Azam
- Hammad Azam. FCPS (Surgery). Assistant Professor of Cardiac Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yaar Khan, Pakistan
| | - Mirza Ahmad Raza Baig
- Mirza Ahmad Raza Baig. BS in Cardiac Perfusion. Clinical Perfusionist, Ch. Pervaiz Elahi Institute of Cardiology (CPEIC), Multan, Pakistan
| | - Naseem Ahmad
- Naseem Ahmad. FCPS Cardiac Surgery. Assistant Professor of Cardiac Surgery, Ch. Pervaiz Elahi Institute of Cardiology (CPEIC), Multan, Pakistan
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Bablekos GD, Analitis A, Michaelides SA, Charalabopoulos KA, Tzonou A. Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:213. [PMID: 27386487 DOI: 10.21037/atm.2016.06.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Co-morbidity of primary lung cancer (LC) and heart disease (HD), both requiring surgical therapy, characterizes a high risk group of patients necessitating prompt diagnosis and treatment. The aim of this study is the review of available evidence guiding the management of these patients. METHODS Postoperative outcome of patients operated for primary LC (first meta-analysis) and for both primary LC and HD co-morbidity (second meta-analysis), were studied. Parameters examined in both meta-analyses were thirty-day postoperative mortality, postoperative complications, three- and five-year survival probabilities. The last 36 years were reviewed by using the PubMed data base. Thirty-seven studies were qualified for both meta-analyses. RESULTS The pooled 30-day mortality percentages (%) were 4.16% [95% confidence interval (CI): 2.68-5.95] (first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second meta-analysis). Higher percentages of squamous histology and lobectomy, were significantly associated with increased (P=0.001) and decreased (P<0.001) thirty-day postoperative mortality, respectively (first meta-analysis). The pooled percentages for postoperative complications were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95% CI: 35.62-55.74) (second meta-analysis). Higher percentages of squamous histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were associated with higher proportions of postoperative complications (second meta-analysis). The pooled three- and five- year survival probabilities were 68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11), respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009) significantly reduced the five-year survival probability. CONCLUSIONS Lobectomy and age were both accompanied by reduced five-year survival rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy for squamous pT1 or pT2 LC displayed a higher risk of postoperative complications. Moreover, medical decision between combined or staged surgery is suggested to be individualized based on adequacy of coronary arterial perfusion, age, patient's preoperative performance status (taking into account possible co-morbidities per patient), tumor's staging and extent of lung resection.
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Affiliation(s)
- George D Bablekos
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Antonis Analitis
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Stylianos A Michaelides
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Konstantinos A Charalabopoulos
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Anastasia Tzonou
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
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Black EA, Ghosh S, Sin K, Spyt T, Pillai R. Off-Pump Coronary Artery Bypass Surgery. Asian Cardiovasc Thorac Ann 2016; 12:379-86. [PMID: 15585716 DOI: 10.1177/021849230401200424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Off-pump coronary artery bypass surgery has been adopted enthusiastically worldwide. However, despite more than 6 years’ experience and refinement, many surgeons use it only sporadically and some hardly at all. This reluctance persists despite support for the procedure because of the lack of properly designed risk models and/or randomized studies. Although it has not been overwhelmingly shown that off-pump surgery is superior to the conventional on-pump procedure, the technique has its place in our specialty. It has been shown to be better for noncritical end points in selected patients in the hands of selected surgeons. That there are differences in surgical skill among surgeons is something we all know but rarely discuss in public. Until now, disparities in skill have been most salient with uncommon and extraordinarily challenging operations. Perhaps the off-pump procedure should be regarded as the “challenging” aspect of coronary artery bypass surgery, and self-restraint may need to remain in force if we are to continue to achieve the highest level of clinical excellence.
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Affiliation(s)
- Edward A Black
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK.
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Kohli V, Goel M, Sharma VK, Mishra Y, Malhotra R, Mehta Y, Trehan N. Off-Pump Surgery: A Choice in Unstable Angina. Asian Cardiovasc Thorac Ann 2016; 11:285-8. [PMID: 14681085 DOI: 10.1177/021849230301100403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The benefit and safety of off-pump coronary artery bypass surgery in patients with unstable angina was assessed retrospectively. From February 1996 to October 2001, 5,306 patients underwent multivessel off-pump coronary artery bypass, of whom 920 (17%) had unstable angina. In these 920 patients, ejection fractions ranged from 15% to 70%, 203 (22%) had an ejection fraction of 20%–35%, and 11 (1%) had an ejection fraction < 20%. Triple-vessel disease was present in 625 patients. Preoperative intraaortic balloon pump support was used in 28 patients. Operative approaches included mid sternotomy (86%), lower partial sternotomy (9%), and left anterior thoracotomy (2%). The number of grafts ranged from 1 to 5 with a mean of 2.43 ± 0.86, and 92.3% of patients received a left internal mammary artery graft. Twenty-two patients need intraoperative intraaortic balloon pumping. Ten patients (1%) suffered perioperative myocardial infarction. The mean hospital stay was 7.8 ± 4.3 days. Hospital mortality was 2/920 (0.22%). Intraaortic balloon pumping was helpful in these cases of unstable angina refractory to medical therapy. Off-pump coronary artery surgery was found to be safe and beneficial in these patients.
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Affiliation(s)
- Vijay Kohli
- Escorts Heart Institute and Research Centre, Okhla Road, New Delhi 110-025, India.
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Pereira SN, Zumba IB, Batista MS, Pieve DD, Santos ED, Stuermer R, Oliveira GPD, Senger R. Comparison of two technics of cardiopulmonary bypass (conventional and mini CPB) in the trans-and postoperative periods of cardiac surgery. Braz J Cardiovasc Surg 2016; 30:433-42. [PMID: 27163417 PMCID: PMC4614926 DOI: 10.5935/1678-9741.20150046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/23/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study aimed to compare the effects of two different perfusion techniques: conventional cardiopulmonary bypass and miniature cardiopulmonary bypass in patients undergoing cardiac surgery at the University Hospital of Santa Maria--RS. METHODS We perform a retrospective, cross-sectional study, based on data collected from the patients operated between 2010 and 2013. We analyzed the records of 242 patients divided into two groups: Group I: 149 patients undergoing cardiopulmonary bypass and Group II - 93 patients undergoing the miniature cardiopulmonary bypass. RESULTS The clinical profile of patients in the preoperative period was similar in the cardiopulmonary bypass and miniature cardiopulmonary bypass groups without significant differences, except in age, which was greater in the miniature cardiopulmonary bypass group. The perioperative data were significant of blood collected for autotransfusion, which were higher in the group with miniature cardiopulmonary bypass than the cardiopulmonary bypass and in transfusion of packed red blood cells, which was higher in cardiopulmonary bypass than in miniature cardiopulmonary bypass. In the immediate, first and second postoperative period the values of hematocrit and hemoglobin were higher and significant in miniature cardiopulmonary bypass than in the cardiopulmonary bypass, although the bleeding in the first and second postoperative days was higher and significant in miniature cardiopulmonary bypass than in the cardiopulmonary bypass. CONCLUSION The present results suggest that the miniature cardiopulmonary bypass was beneficial in reducing the red blood cell transfusion during surgery and showed slight but significant increase in hematocrit and hemoglobin in the postoperative period.
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Affiliation(s)
- Sergio Nunes Pereira
- Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | | | - Ralf Stuermer
- Hospital Universitário de Santa Maria, Santa Maria, RS, Brazil
| | | | - Roberta Senger
- Hospital Universitário de Santa Maria, Santa Maria, RS, Brazil
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Taggart DP. ¿Hay todavía un lugar para la cirugía coronaria sin circulación extracorpórea en 2015? Ciertamente sí. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2015.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Taggart DP. Is there still a role for off-pump CABG in 2015? Certainly yes. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2015.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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History of cardiopulmonary bypass (CPB). Best Pract Res Clin Anaesthesiol 2015; 29:99-111. [PMID: 26060023 DOI: 10.1016/j.bpa.2015.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/04/2015] [Accepted: 04/14/2015] [Indexed: 11/21/2022]
Abstract
The development of cardiopulmonary bypass (CPB), thereby permitting open-heart surgery, is one of the most important advances in medicine in the 20th century. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how recently it came into use (60 years) and how much the practice of CPB has changed during its short existence. In this paper, the development of CPB and the many changes and progress that has taken place over this brief period of time, making it a remarkably safe endeavor, are reviewed. The many as yet unresolved questions are also identified, which sets the stage for the other papers in this issue of this journal.
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Sepehripour AH, Suliman A, Stavridis G, Athanasiou T. Is the evidence from first time off-pump coronary artery bypass graft surgery transferable to re-operative off-pump surgery? Expert Rev Cardiovasc Ther 2014; 12:1327-35. [PMID: 25319147 DOI: 10.1586/14779072.2014.972372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
On-pump coronary artery surgery remains the gold standard treatment for multi-vessel disease. The technique of off-pump surgery has evolved since its first use; however, currently less than 20% of all cases worldwide are performed this way. This poor uptake has been both the cause and the effect of widespread scepticism regarding the validity of the data on the technique, as well as criticism regarding the conversion-related adverse outcomes, graft patency and completeness of revascularisation. Consequently, there has been focus on patient selection from subgroups most likely to benefit from the technique. Re-operative patients, by virtue of their advanced age, complex co-morbidities and the technical challenges of re-operation, fall into this category. In this review, the authors will discuss the outcomes of off-pump surgery in comparison to on-pump, explore the potential beneficial effects of off-pump in re-operative surgery and formulate a decision-making strategy in patients undergoing reoperative coronary artery surgery.
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Affiliation(s)
- Amir H Sepehripour
- Department of Cardiothoracic Surgery, Imperial College London, London, UK
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Nardi P, Pellegrino A, Bassano C, Mani R, Chiariello GA, Zeitani J, Chiariello L. The fate at mid-term follow-up of the on-pump vs. off-pump coronary artery bypass grafting surgery. J Cardiovasc Med (Hagerstown) 2014; 16:125-33. [PMID: 25022926 DOI: 10.2459/jcm.0000000000000041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To evaluate the fate of on-pump coronary artery bypass grafting (ON-pump CABG) vs. off-pump coronary artery bypass grafting (OP-CABG) surgery at mid-term follow-up. METHODS From January 2008 to December 2010, 369 patients underwent surgical myocardial revascularization by means of OP-CABG techniques (n = 166) or with ON-pump CABG (n = 203). Data of the two groups of patients were retrospectively analyzed. RESULTS As compared with OP-CABG, in the ON-pump CABG patients, mean value of Logistic EuroSCORE (8.1 ± 7.8% vs. 6.2 ± 5.9%, P = 0.04), more extended coronary disease (2.7 ± 0.5 vs. 2.5 ± 0.7 diseased vessels/patient, P < 0.001) consequently requiring greater number of grafts/patient (2.9 ± 0.9 vs. 2.3 ± 0.9, P < 0.0001), and emergency surgery (12 vs. 6%, P = 0.03) were more frequently observed. Operative mortality was 1.9% in ON-pump CABG vs. 1.2% in OP-CABG (P = 0.6) and incidence of stroke 2.46 vs. 1.81% (P = 0.7). The incidence of stroke was reduced at 1.2% when OP-CABG PAS-Port 'clamp-less' technique was used.Intraoperatively, costs per patient were higher for OP-CABG vs. ON-pump CABG (1.930,00 +1.050,00 €, if PAS-port system was included, vs. 1.060,00 € for ON-pump surgery). ICU stay (1.9 ± 1.0 days vs. 1.4 ± 0.7 days) and total postoperative in-hospital stay (5.3 ± 3.3 days vs. 5.5 ± 3.5 days) were similar in both groups.At 4 years, survival (91 ± 13% in the ON-pump CABG vs. 84 ± 19% in the OP-CABG), freedom from major adverse cardiac events (composite end-point of all-cause death, myocardial infarction, and repeat coronary revascularization of the target lesion) (82 ± 9% vs. 76 ± 14%), and major adverse cardiac and cerebrovascular events (80 ± 11% vs. 72 ± 16%) were not significantly different. Freedom from late cardiac death was slightly significant higher after ON-pump CABG (98 ± 4% vs. 90 ± 10%, P = 0.05). CONCLUSION Mid-term freedom from composite end-points is similar after ON-pump CABG and OP-CABG. Freedom from cardiac death appears to be better after ON-pump CABG. OP-CABG needs for more expensive surgical technique. OP-CABG performed by an experienced surgical team using 'clamp-less' techniques can be an effective strategy in reducing postoperative stroke.
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Affiliation(s)
- Paolo Nardi
- Cardiac Surgery Unit, Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy
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Cho Y, Shimura S, Aki A, Furuya H, Ueda T. Long-term outcomes and risk analyses of coronary bypass for left main disease. Asian Cardiovasc Thorac Ann 2014; 22:1031-8. [PMID: 24604554 DOI: 10.1177/0218492314527096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We retrospectively analyzed the long-term outcomes and risk predictors of conventional coronary artery bypass grafting routinely employed for patients with left main disease. METHODS From January 2000 through December 2009, conventional coronary artery bypass grafting was routinely employed in 193 consecutive patients with left main disease. Long-term analyses were performed, looking at the primary endpoint of major adverse cardiac and cerebrovascular events which included all-cause death, stroke, myocardial infarction, and repeat revascularization. We also analyzed the effects of variables on major adverse cardiac and cerebrovascular events at 9 years after the operation. RESULTS The overall 9-year rates of combined outcomes (death, stroke, myocardial infarction), repeat revascularization, and major adverse cardiac and cerebrovascular events were 20.2%, 8.9%, 27.7%, respectively. The SYNTAX score was demonstrated to be the only significant predictor of combined outcomes at 9 years (hazard ratio 1.04, p = 0.033), repeat revascularization at 9 years (hazard ratio 1.11, p = 0.0030), and major adverse cardiac and cerebrovascular events at 9 years (hazard ratio 1.07, p = 0.0003). CONCLUSIONS With our routine strategy of conventional coronary artery bypass for left main disease, patients revealed excellent long-term outcomes in terms of major adverse cardiac and cerebrovascular events. These results provide a suitable benchmark against which long-term outcomes of percutaneous coronary intervention for left main disease can be compared. The SYNTAX score, which was introduced to determine treatment for complex coronary disease, is indicative of long-term outcomes after coronary artery bypass for left main disease.
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Affiliation(s)
- Yasunori Cho
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Shinichiro Shimura
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Akira Aki
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hidekazu Furuya
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Toshihiko Ueda
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Early and mid-term results of minimally invasive coronary artery bypass grafting. Indian Heart J 2014; 66:193-6. [PMID: 24814114 DOI: 10.1016/j.ihj.2014.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 12/01/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Minimally invasive coronary artery bypass grafting (MICABG) is a less invasive method of performing surgical revascularization. This technique coupled with use of off pump technique of surgical revascularization makes it truly less invasive. This method is highly effective even in high-risk patients. Results of this procedure are comparable to standard off pump technique and are better than percutaneous coronary intervention utilizing drug-eluting stent. We present an early and mid-term result of the use of this technique. METHOD We enrolled 33 patients for analysis operated between 2008 and 2012. Operation was performed utilizing off-pump technique of coronary artery bypass grafting through a minimal invasive incision. Left internal mammary artery graft was done for single vessel disease and radial artery was utilized for other grafts if required. Median follow up of 2.5 years (6 months-4 years) is available. RESULTS Median age was 58.5 years (41-77) and all were male. Single vessel disease was present in 7, double vessel in 14 and triple vessel disease in 12 patients. All the patients had normal left ventricular size and function. There was no operative and 30-day mortality. Conversion to median sternotomy to complete the operation was done in 6.6% (2 out of 33 patients). One patient had acute myocardial infarction and there were no deaths during follow up. CONCLUSION MICABG is a safe and effective method of revascularization in low risk candidates for coronary artery bypass grafting.
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Coronary artery bypass graft surgery: the past, present, and future of myocardial revascularisation. Surg Res Pract 2014; 2014:726158. [PMID: 25374960 PMCID: PMC4208586 DOI: 10.1155/2014/726158] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/25/2013] [Indexed: 11/18/2022] Open
Abstract
The development of the heart-lung machine ushered in the era of modern cardiac surgery. Coronary artery bypass graft surgery (CABG) remains the most common operation performed by cardiac surgeons today. From its infancy in the 1950s till today, CABG has undergone many developments both technically and clinically. Improvements in intraoperative technique and perioperative care have led to CABG being offered to a more broad patient profile with less complications and adverse events. Our review outlines the rich history and promising future of myocardial revascularization.
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Tashiro T, Wada H, Nishimi M, Minematsu N. Off-pump coronary artery bypass: techniques, pitfalls, and results. Gen Thorac Cardiovasc Surg 2013; 61:429-34. [DOI: 10.1007/s11748-013-0240-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Indexed: 11/24/2022]
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Evolution of Off-Pump Coronary Artery Bypass Grafting over 15 Years: A Single-Institution Experience of 14,030 Cases. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 1:88-91. [PMID: 22436550 DOI: 10.1097/01.imi.0000189937.33748.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND : Off-pump coronary artery bypass grafting for multivessel disease is an important alternative to conventional myocardial revascularization using cardiopulmonary bypass. The development of exposure and stabilization techniques has made this surgery simple, safe, and routine. Experience with the technique, its evolution, the learning curve, and the pitfalls is presented. METHODS : A retrospective analysis was made of 28,216 patients who underwent elective coronary artery bypass grafting over a 15-year period from January 1990 through December 2004. Isolated off-pump coronary artery bypass grafting was performed in 14,030 patients and on-pump coronary artery bypass grafting in 14,186 patients. The overall period was divided into 3 groups of 5 years each: group I (1990-1994), group II (1995-1999), and group III (2000-2004). Initially, off-pump coronary artery bypass grafting was performed selectively in high-risk patients (eg, atheromatous aorta, severe systemic impairment, chronic obstructive pulmonary disease, octogenarian). Recently (2000-2004), multivessel off-pump coronary artery bypass grafting has been performed electively in 96% to 98% of patients undergoing coronary artery bypass grafting. Patients' medical charts were reviewed for age, preoperative risk factors, operative findings, intraoperative conversion rate to cardiopulmonary bypass, postoperative complications, and length of hospital stay. RESULTS : In the years 1990-1994 (group I), mostly high-risk cases and cases with left anterior descending coronary artery lesions were included for off-pump coronary artery surgery. In the years 1995-1999 (group II), patients with double and triple vessel disease presenting for coronary artery bypass surgery were accepted for off-pump surgery irrespective of preoperative risk factors. However, in the years 2000-2004 (group III), off-pump coronary artery bypass surgery was the first choice of approach for any patient presenting for coronary artery bypass surgery. The mean number of grafts was lower in off-pump cases than in on-pump cases in group I (2.0 ± 0.4 vs. 3.2 ± 0.80) and group II (2.6 ± 0.6 vs. 3.3 ± 0.4), whereas the mean number of grafts was higher in off-pump cases than in on-pump cases in group III (3.5 ± 0.2 vs. 3.4 ± 0.8). In groups I and II, the conversion to cardiopulmonary bypass was 5.2% and 5.9%, respectively. The conversion to cardiopulmonary bypass decreased to 1.7% in group III, which was statistically significant. Perioperative myocardial infarction was 5.2% in group I, 1.7% in group II, and 1.5% in group III. The difference between groups II and III was not statistically significant. Hospital mortality was higher in group I (5.2%) than in group II (1.2%) or III (1.1%). The difference between groups II and III was not statistically significant. Length of intensive care unit stay was 36 ± 8 hours in group I, 28 ± 7 hours in group II, and 20 ± 8 hours in group III. These differences were statistically significant. Length of postoperative hospital stay was 8 ± 2 days in group I, 7 ± 2 days in group II, and 5 ± 2 days in group III These differences were statistically significant. CONCLUSIONS : As surgeons' experience matures, off-pump coronary artery bypass surgery permits total myocardial revascularization in virtually all patients with multivessel coronary artery disease. Despite a significant learning curve, evolution to routine off-pump coronary artery bypass with good patient outcomes can be achieved with careful patient selection during the "learning curve." The method is safe and reproducible, and patients benefit with shorter intensive care unit and hospital stays.
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Wittwer T, Sabashnikov A, Rahmanian PB, Choi YH, Zeriouh M, Mehler TO, Wahlers T. Less invasive coronary artery revascularization with a minimized extracorporeal circulation system: preliminary results of a comparative study with off-pump-procedures. J Cardiothorac Surg 2013; 8:75. [PMID: 23577663 PMCID: PMC3639032 DOI: 10.1186/1749-8090-8-75] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/11/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Coronary-artery-bypass-grafting (CABG) with conventional extracorporeal circulation (CECC) is associated with adverse effects such as systemic inflammatory response leading to a decrease in systemic vascular resistance and hemodynamic instability. Modern "less invasive" procedures have been established recently which potentially avoid negative side effects of CECC. The aim of this study was to compare perioperative outcome following coronary revascularization using either a minimized extracorporeal circuit (Mini-HLM) or off-pump technique (OPCAB). METHODS In this prospective ethics-approved trial, 120 patients referred for CABG were randomly assigned either to off-pump coronary artery bypass (OPCAB) or to a Mini-HLM procedure. Patient demographics, preoperative characteristics and extensive postoperative outcome were analyzed for both groups. Hemodynamic data were measured at seven time points perioperatively. RESULTS Operation-time was longer in the Mini-HLM group (178,3 ± 32,9 min) compared to OPCAB (133,2 ± 32,7 min, p < 0,001) with higher graft numbers in Mini-HLM group (3,11 ± 0,7 vs. 1,78 ± 0,7, p < 0.001). There were no significant differences in perioperative hemodynamic criteria, catecholaminergic support, hospital (p = 0,534) and intensive care unit stay (p = 0,880), ventilation time (p = 0,113), blood loss (p = 0,570), transfusion requirements, postoperative atrial fibrillation rate (p = 0,706) and neurocognitive disturbance (p = 0,297). No deaths and no myocardial infarctions were observed. CONCLUSIONS Coronary revascularisation with Mini-HLM represents a suitable and "less invasive" procedure which achieves all benefits of OPCAB but may allow for less demanding revascularisation than OPCAB in special patients with complex coronary anatomy and can therefore be used both on a routine basis and in all "conversion" cases of OPCAB.
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Affiliation(s)
- Thorsten Wittwer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50924, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50924, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50924, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50924, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50924, Germany
| | - Thorsten O Mehler
- Department of Anesthesiology, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50924, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50924, Germany
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Clinical outcome and quality of life after reoperative CABG: off-pump versus on-pump - observational pilot study. J Cardiothorac Surg 2013; 8:66. [PMID: 23561396 PMCID: PMC3622626 DOI: 10.1186/1749-8090-8-66] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/19/2013] [Indexed: 11/11/2022] Open
Abstract
Background Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CBP) is associated with significant morbidity and mortality. In high-risk patients, doomed for reoperation the adverse effects of CBP may be more striking. We evaluated the results of reoperative CABG (redo-CABG) by either off-pump (OPCAB) or on-pump (ONCAB). Clinical endpoints were perioperative myocardial infarction, mortality, survival and as the most striking difference between prior studies the quality of life (QoL). Methods We performed a prospective, non-randomized assessment for patients who underwent redo-CABG by redo-OPCAB (n = 40) or redo-ONCAB (n = 40) at our institution between January 2007 and December 2010. For evaluation of QoL the SF-36 health survey was used with self-administered assessment. Results During follow-up 37 of 40 patients were alive in the redo-OPCAB group versus 32 of 40 patients in the redo-ONCAB group (p < 0.05). The shorter operation time, less blood loss, fewer perioperative myocardial infarctions, the higher rate of totally arterial revascularisation and shorter intensive care stay were the significantly beneficial differences for patients in the redo-OPCAB group (p < 0.05). The 3-year survival rate was higher in the redo-OPCAB group with 81 ± 12% versus 63 ± 9%in the redo-ONCAB group. The quality of life survey did not reveal any significant differences between both groups. Conclusion In conclusion, with our present retrospective study, we could demonstrate the safety and efficacy of the redo-OPCAB technique with even higher 3-year survival rate. Both techniques seem to have similar impact on the outcome of patients.
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Matsuura K, Mogi K, Sakurai M, Kawamura T, Misue, T, Hatakeyama I, Takahara Y. Preoperative High N-Terminal pro-B-Type Natriuretic Peptide Level Can Predict the Incidence of Postoperative Atrial Fibrillation Following Off-Pump Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg 2013; 19:375-81. [DOI: 10.5761/atcs.oa.12.01994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ochi M. Overview: Japanese guidelines for myocardial revascularization to treat stable ischemic heart disease 2012. Gen Thorac Cardiovasc Surg 2012; 61:246-53. [PMID: 23232903 DOI: 10.1007/s11748-012-0182-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Indexed: 11/25/2022]
Abstract
Since its introduction in the early 1970s, coronary artery bypass grafting (CABG) has become an established surgical treatment for coronary artery disease (CAD). Percutaneous coronary intervention (PCI), first clinically applied in 1977, was promoted as an alternative to CABG during the mid-1980s. Along with the nationwide expansion of PCI, the ratio of PCI to CABG has exceeded 6-7:1. The Japanese Circulation Society (JCS) published "Guidelines on elective coronary intervention, including coronary artery bypass grafting (CABG), for ischemic heart disease in 2000" and "Guidelines on the selection of bypass conduits and operative procedures in coronary artery bypass grafting for ischemic heart disease". The society intended to revise these guidelines in 2010 and to issue two new guidelines specific either to PCI or CABG. They also planned to issue joint guidelines for myocardial revascularization and PCI/CABG, which are primary indications for patients with stable CAD, especially with those with more complex left main trunk disease and/or multi-vessel disease. The scientific committee of JCS established the "Council for myocardial revascularization" that consisted of experts including interventional and non-interventional cardiologists, cardiac surgeons and physicians specialized in diabetes or nephrology selected by medical and surgical societies. After over 10 rounds of meetings, the Council prepared primary guidelines for myocardial revascularization to treat stable CAD, PCI/CABG. These guidelines consist of (1) Statements about myocardial revascularization, (2) Interpretation of the statements and (3) Indications for PCI/CABG including a table.
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Affiliation(s)
- Masami Ochi
- Department of Cardiovascular Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603, Japan.
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Ganushchak YM, Weerwind PW, Maessen JG. A glance to the future. Perfusion 2012; 27:95-6. [PMID: 22393038 DOI: 10.1177/0267659111432001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Apostolakis E, Baikoussis NG, Papakonstantinou NA. The role of myocardial ischaemic preconditioning during beating heart surgery: biological aspect and clinical outcome. Interact Cardiovasc Thorac Surg 2011; 14:68-71. [PMID: 22108934 DOI: 10.1093/icvts/ivr024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Short periods of ischaemia consecutive to reperfusion periods before a sustained ischaemic condition, the so-called ischaemic preconditioning (IP), aim to protect myocardial cells against prolonged ischaemia. IP appears as a considerable endogenous cardioprotective mechanism decreasing the infarct size after total occlusion in either experimental models or humans. Angina periods before an acute coronary syndrome limit the myocardial infarction being protective for the myocardium. Our report aims to review the international bibliography of the IP during off-pump coronary artery bypass grafting.
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Affiliation(s)
- Efstratios Apostolakis
- Department of Cardiac Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
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Liu Y, Tao L, Wang X, Cui H, Chen X, Ji B. Beneficial effects of using a minimal extracorporeal circulation system during coronary artery bypass grafting. Perfusion 2011; 27:83-9. [PMID: 21987667 DOI: 10.1177/0267659111424636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In this study, we assessed clinical results by using a minimal extracorporeal circuit (MECC) and compared it to a conventional cardiopulmonary bypass (CPB) system in patients undergoing coronary artery bypass grafting (CABG) procedures. Methods and Materials: From August to October 2006, forty consecutive patients undergoing isolated CABG procedures were randomly assigned to either a miniaturized closed circuit CPB with the Maquet-Cardiopulmonary MECC system (Group M, n=20) or to a conventional CPB system (Group C, n=20). Clinical outcomes were observed before, during and after the operation. Besides evaluating the perioperative clinical data, serial blood venous samples were obtained after induction, 30 minutes after CPB initiation, 2h, 6h, 12h, and 24h post-CPB. The focus of our study was on myocardial damage (cTnI), neutrophil and platelet counts, activated partial thromboplastin time (aPTT) and free hemoglobin. Results: Both the transfusion of packed red blood cells and fresh frozen plasma were significantly lower in Group M compared to Group C ( p<0.05). The levels of cTnI were lower in Group M at 2h, 6h and 12h post-CPB than in Group C ( p<0.01). The values of aPTT in Group M recovered to normal levels after surgery, but were prolonged in Group C at early post-CPB and were statistically longer than Group M at 2h, 6h, and 12h post-CPB ( p<0.05). The concentrations of free hemoglobin in Group C were higher than in Group M during and post-CPB, and there was a statistical difference at 2h post-CPB ( p<0.05). Conclusion: In conclusion, the MECC system is a safe alternative for patients who undertake extracorporeal circulation (ECC) for CABG surgery. Lower transfusion requirements and less damage to red cells may further promote the use of MECC systems, especially in higher risk patients.
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Affiliation(s)
- Y Liu
- Department of Cardiopulmonary Bypass, Wuhan Asia Heart Hospital, Wuhan 430022, Peoples R China
| | - L Tao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan 430022, Peoples R China
| | - X Wang
- Department of Cardiopulmonary Bypass, Chinese Acad Med Sci, Peking Union Med Coll, Fuwai Hosp & Cardiovasc Inst, Beijing 100037, Peoples R China
| | - H Cui
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan 430022, Peoples R China
| | - X Chen
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan 430022, Peoples R China
| | - B Ji
- Department of Cardiopulmonary Bypass, Chinese Acad Med Sci, Peking Union Med Coll, Fuwai Hosp & Cardiovasc Inst, Beijing 100037, Peoples R China
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Comparing Long-Term Survival Between Patients Undergoing Off-Pump and On-Pump Coronary Artery Bypass Graft Operations. Ann Thorac Surg 2011; 92:571-7; discussion 577-8. [DOI: 10.1016/j.athoracsur.2011.03.100] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/09/2011] [Accepted: 03/11/2011] [Indexed: 12/20/2022]
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Hariharan S, Chen D, Vialva M, Exeter H, Billingy I, Bobb KA, Rammekwa B, Reid D. Outcome evaluation of coronary artery bypass grafting surgery applying the EuroSCORE in a Caribbean developing country. Heart Surg Forum 2011; 13:E287-91. [PMID: 20961827 DOI: 10.1532/hsf98.20101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The risk-adjusted outcome of coronary artery bypass grafting (CABG) in Trinidad and Tobago was evaluated by applying the EuroSCORE scoring system. METHODS A retrospective study was undertaken by reviewing the case notes of patients who underwent CABG from 2003 to 2008 under Caribbean Heart Care. Data collected included age, sex, smoking status, comorbidities, chronic pulmonary disease, extracardiac arteriopathy, neurologic disease, previous cardiac surgery, serum creatinine, active endocarditis, critical preoperative state, and mode of surgery. Predicted mortality was calculated with the EuroSCORE, the model was calibrated by Hosmer-Lemeshow analysis, and the discriminant function was analyzed by using the receiver operating characteristic (ROC) curve. RESULTS We studied 1082 patients who underwent CABG, 75.6% of whom were of Asian Indian ethnicity. The overall mean (±SD) EuroSCORE was 2.87 ± 2.1. The predicted perioperative mortality rate was 2.3%, and the observed mortality rate was 1.2%. The overall standardized mortality ratio was 0.52. Eighty-six percent of the patients underwent off-pump CABG. Hosmer-Lemeshow analysis showed that the system calibrated well to our case mix (Hosmer-Lemeshow value, 6.87; degrees of freedom, 8; P = .551). The EuroSCORE discriminated patient outcomes well, as shown by the area under the ROC curve (0.78). Age and ethnicity did not influence the outcome. CONCLUSIONS The outcomes of CABG surgery patients are good in Trinidad and Tobago and are comparable to standards in developed countries when evaluated with the EuroSCORE. The proportion of patients undergoing off-pump CABG is high.
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Affiliation(s)
- Seetharaman Hariharan
- Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies-St. Augustine, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad, West Indies.
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Jansens JL. Beating heart totally endoscopic coronary artery bypass. Multimed Man Cardiothorac Surg 2011; 2011:mmcts.2010.004663. [PMID: 24413530 DOI: 10.1510/mmcts.2010.004663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Robotic coronary surgery has the potential advantages of decreasing surgical trauma, decreasing postoperative recovery period compared to conventional surgery, and provides surgeons the possibility to offer a competitive tool in response to the technological improvements of interventional cardiology. Since 2007, many technical issues have been solved by the new generation of robotic devices, allowing a safer, more reliable and reproducible totally endoscopic coronary bypass, on the beating heart.
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Affiliation(s)
- Jean-Luc Jansens
- Department of Cardiac Surgery, Europe Hospitals, Brussels, Belgium
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