We hereby report a case of Kawasaki disease in a 32 year old male, with giant aneurysm of both coronary arteries and severe LV (left ventricular) dysfunction who underwent OPCAB (off pump coronary artery bypass grafti...We hereby report a case of Kawasaki disease in a 32 year old male, with giant aneurysm of both coronary arteries and severe LV (left ventricular) dysfunction who underwent OPCAB (off pump coronary artery bypass grafting) two years ago. He presented with acute myocardial infarction of his anterior wall of left ventricle. He was stabilised with medical management and was taken up for surgery when his enzymes became normal. His LV function had improved over the time and now has a good ejection fraction.展开更多
Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative...Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative cardiovascular functioning is an important determinant for outcome of surgery. In On-Pump CABG (ONCAB), the cardiopulmonary bypass has a negative effect on myocardium. Off-Pump CABG (OPCAB) avoids the effect of CPB but complete revascularization with difficult positioning of heart is technically demanding. This study is aimed to compare the cardiovascular functioning in the immediate post-operative period after OPCAB and ONCAB. Methods: Total 106 patients were operated for CABG from January 2015 to June 2016, of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison, hemodynamic parameters were measured during anesthesia before surgery, postoperatively after 1 and 4 hours (h) in the ICU, and in the morning after surgery, approximately after 20 h. Results: The time-dependent rise of hemodynamic parameters like Cardiac Output (CO), Cardiac Index (CI), Stroke volume (SV) and Left Ventricular Stroke Work Index (LVSWI) in the immediate post-operative hours (1 h and 4 h) are more predominant in OPCAB group than ONCAB group although the difference is eliminated mostly at 20 h. The better peripheral vasodilation after OPCAB causes immediate fall of Systemic Vascular Resistance Index (SVRI) after OPCAB. Conclusion: Better cardiovascular functioning immediately after OPCAB than ONCAB may be important for better hemodynamic stability. The difference is however eliminated after 24 hours indicating little significance in long term outcome.展开更多
Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidi...Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidity and mortality. However, sternal wound complication (SWC) remains challenging following the procedure. The technique of left internal mammary artery (LIMA) harvesting has been shown to impact the incidence of SWC. This study aimed to compare the incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB. The patients were divided into two groups of 30 each based on the technique of LIMA harvesting used, i.e., skeletonized (group A) or pedicled (group B). The postoperative ICU care was given to each patient as per the protocol. The statistical analysis was conducted using the SPSS version 26.0 for Windows software. Results: The results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was not statistically significant between the two groups (p = 0.35). The mean age, gender distribution, and comorbidities such as hypertension, diabetes, dyslipidemia, and anemia were also not statistically significant between the two groups. The number of smokers was statistically significant between the two groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of operation, duration of mechanical ventilation, duration of chest drains, duration of the central venous line, and amount of postoperative mediastinal bleeding were also not statistically significant between the two groups. The distribution of wound complications, duration of ICU stays, and hospital stay between the two groups was also not statistically significant. Conclusion: In conclusion, this study found that the incidence of SWC was less in skeletonized LIMA harvesting than in pedicled LIMA harvesting after OPCAB. However, this finding was not statistically significant. Further studies with larger sample sizes may be needed to confirm these results and determine the appropriate technique of LIMA harvesting to decrease the incidence of SWC after OPCAB.展开更多
Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between Octo...Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Resuits The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotomy. There was no mortality. Mean length of stay in the intensive care unit was 16 .2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia展开更多
Objective To analyze the short-term outcomes of redo coronary artery bypass grafting(CABG) using on-pump and off-pump CABG techniques. Methods From January 2003 to August 2013, non-randomized 80 patients were treated ...Objective To analyze the short-term outcomes of redo coronary artery bypass grafting(CABG) using on-pump and off-pump CABG techniques. Methods From January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique(redo-ONCAB group) and 40 underwent off-pump CABG technique(redo-OPCAB group). Furthermore, transmyocardial laser revascularization was performed in high-risk patients who were not suitable to conventional grafting. Clinical data of the two groups were recorded and analyzed including operation time, coronary grafts, incomplete revascularization, postoperative ventilation, perioperative stroke, and low output syndrome, etc. Results There were no significantly differences in age, gender distribution, incidences of hypertension, stroke, and other clinical characteristics between redo-OPCAB group and redo-ONCAB group(all P>0.05), except for incidences of renal dysfunction and pulmonary disease(all P<0.05). The number of grafting vessels in the redo-ONCAB and redo-OPCAB groups was 2.1 ± 0.74 and 1.4 ±0.52 respectively. There was significant difference between the two groups(P=0.0243). Compared with the redo-ONCAB group, there was shorter operation time(P=0.0045), postoperative ventilation(P=0.0211) and intensive care unit stay(P=0.0400), as well as fewer use of platelet(P=0.0338) and blood transfusion(P=0.0034) in the redo-OPCAB group. The incidence of incomplete revascularization(P=0.0253) and the use of transmyocardial laser revascularization(P=0.0052) were higher in the redo-OPCAB group than those in the redo-ONCAB group(all P<0.05). However, no significant differences were showed for the incidence of the use of intra aortic balloon pump and continuous renal replacement therapy, perioperative stroke, low output syndrome, and in-hospital mortality between the two groups(all P>0.05). Conclusion Redo CABG is the safety and efficacy surgical procedure, and redo-OPCAB technique with better outcomes is commended especially in high-risk patients.展开更多
To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients w...To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.展开更多
We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB...We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group (30 patients) received mono-antiplatelet treatment (MAPT) with aspirin 100 mg daily and the other group received dual anfiplatelet treatment (DAPT) with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachi- donic acid (PLAA) and adenosine diphosphate (ADP) (PLADP) were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given (62.1% vs, 32.1%, 34.5% vs. 10.7%, respectively, both P 〈 0.05). There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.展开更多
Coronary artery bypass grafting(CABG) continues to be one of the most commonly performed cardiac surgical procedures worldwide. Conventional CABG performed on cardiopulmonary bypass termed on-pump CABG is regarded as ...Coronary artery bypass grafting(CABG) continues to be one of the most commonly performed cardiac surgical procedures worldwide. Conventional CABG performed on cardiopulmonary bypass termed on-pump CABG is regarded as the gold standard. However, on-pump CABG results in several physiologic derangements including but not limited to thrombocytopenia, activation of complement factors, immune suppression, and inflammatory responses leading to organ dysfunction.Furthermore, manipulating an atherosclerotic ascending aorta during cannulation and cross-clamping can predispose to embolization and stroke risk. Recognition of these detrimental effects of on-pump CABG resulted in resurgence of off-pump CABG nearly two decades ago.Off-pump CABG since its resurgence has been a subject of intensive scrutiny and speculation. Despite numerous retrospective nonrandomized studies, prospective randomized trials, and meta-analyses validating the safety and efficacy of off-pump CABG, opponents of the technique have persistently demanded abandonment of off-pump CABG. Several misconceptions and misperceptions are used as an excuse for such demands. This review article examines published scientific evidence to evaluate these misperceptions and misconceptions about off-pump CABG.展开更多
Objective:To obtain early results of off-pump coronarE~ artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar ...Objective:To obtain early results of off-pump coronarE~ artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB). Methods:Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demo- graphic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: The number of distal anastomo- sis and grafts varied from 3 to 6. The average number per patient was similar in the two groups (OPCAB group:3.76 ± 0.98, CCAB group:3.81 ± 1.02). Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance (P 〉 0.05). The frequency of atrial fibrillation (AF), IABP usage, mediastinitis, re-operation for bleeding (or tamponade) were similar in the two groups (P 〉 0.05). Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group(P 〈 0.05).Conclusion: Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.展开更多
The association between atrial fibrillation(AF) after coronary artery bypass grafting(CABG) and the surgical techniques selected has been extensively reported. However, no consistent results were obtained. In the ...The association between atrial fibrillation(AF) after coronary artery bypass grafting(CABG) and the surgical techniques selected has been extensively reported. However, no consistent results were obtained. In the present study, a meta-analysis was conducted by searching the electronic databases Pub Med, Embase, Web of Science, and Cochrane to identify the association of post-CABG AF with on-pump(conventional CABG, c CABG) or off-pump CABG(OPCABG). Outcomes from randomized clinical trials(RCTs) and propensity score matching(PSM) trials were pooled by using the fixed-effect or the random-effect modeling method, and verified by the quality-effect modeling method. There were 35 studies with 36 independent reports that met the inclusion criteria and were eventually included in our meta-analysis. The total odds ratio(OR) of the incidence of post-CABG AF between OPCABG and c CABG was 0.80(95% CI 0.71–0.91). The 25 randomized clinical trials(RCTs) had an OR of 0.69(95% CI 0.56–0.86), while the OR of the 11 PSM trials was 0.88(95% CI 0.77–1.00). Twenty-six studies involving the patients at a mean age no more than 65 years showed an OR of 0.76(95% CI 0.64–0.90), whereas 10 studies with patients greater than 65 years old showed an OR of 0.90(95% CI 0.78–1.05). The results of this meta-analysis suggest that OPCAB surgery may reduce the incidence of post-CABG AF when compared to c CABG and that younger patients may benefit more from OPCAB and have a lower incidence of post-CABG AF.展开更多
Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to...Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.展开更多
Objective: To compare function recovery of left ventricle after off-pump and on-pump coronary artery bypass (OPCAB and ONCAB) using Tei index. Methods: Twenty-four patients with coronary artery disease were enrolled, ...Objective: To compare function recovery of left ventricle after off-pump and on-pump coronary artery bypass (OPCAB and ONCAB) using Tei index. Methods: Twenty-four patients with coronary artery disease were enrolled, twelve of which received OPCAB and the others underwent ONCAB. Left ventricular ejection fraction (LVEF), E/A ratio at mitral orifice and Tei index were measured using transthoracic echocardiography before surgery and 3-7 days, 1 month, 3 months and 6 months after surgery. Results:Tei index of both groups decreased 3-7 days after surgery, with OPCAB group's lower than ONCAB group's. The difference between pre-and post-OPCAB was significant (P<0. 01 ), but not for ONCAB group (P>0. 05). Tei index of ONCAB decreased more significant than that of OPCAB 1 month after surgery, there was statistical difference between 3-7 days and 1 month after surgery in ONCAB (P<0. 01). Afterwards, Tei index of the 2 groups decreased steadily with no significant difference between them at other time points. LVEF and E/A ratio decreased at first, then increased gradually, with no statistical differences between the 2 groups at all time points. Conclusion: The recovery of left ventricular function after OPCAB is earlier than ONCAB. Tei index is more sensitive than LVEF and E/A ratio in detecting cardiac function recoveries and can be considered as an accurate and simple method to evaluate left ventricular systolic and diastolic function.展开更多
Background: The off-pump coronary artery bypass graft surgery (OPCAB) may produce significant hemodynamic instability necessitating conversion to on-pump surgery. This study evaluated the hemodynamic parameters in pat...Background: The off-pump coronary artery bypass graft surgery (OPCAB) may produce significant hemodynamic instability necessitating conversion to on-pump surgery. This study evaluated the hemodynamic parameters in patients undergoing OPCAB using pericardial bands for stabilization of the coronary target sites. Methods: In 250 patients undergoing OPCAB the hemodynamic parameters including continuous cardiac output and systemic venous oxygen saturation (SvO2) were recorded at baseline after pericardiotomy, during each coronary artery anastomosis at 3, 5, 10, 15 min, and after release of the pericardial bands used for target stabilization. Vasopressors were used to maintain mean arterial pressure (MAP) > 60 mmHg. Results: SvO2 and cardiac index (CI) decreased significantly after target stabilization and during all coronary anastomoses with greater decreases noted during obtuse marginal branch of left circumflex (OM) anastomosis. The MAP and heart rate were maintained without significant change but central venous pressure increased significantly during all coronary anastomoses. The significant increase in pulmonary capillary wedge pressure and mean pulmonary artery pressure were noted only during anastomosis of the left anterior descending artery. The highest dose of vasopressor was used during OM anastomosis. Conclusions: During OPCAB surgery using pericardial bands for coronary target stabilization, MAP was maintained constantly, but SvO2 and CI decreased immediately after target stabilization and reduced further during all coronary artery anastomoses. During OM anastomosis SvO2 and CI were significantly lower as compared to that of LAD and right coronary artery. Careful monitoring and management of hemodynamic variables are warranted to avoid conversion to on-pump technique.展开更多
Objective: To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods : The grafts flow was studied in 100 patients of OPCAB and...Objective: To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods : The grafts flow was studied in 100 patients of OPCAB and compared with 100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results: The mean number of the distal anastomosis was 3.78+ 1.11 in CCABG group, and 3.83 + 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 + 0.08, and 1.10+ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups. Conclusion: OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.展开更多
Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lact...Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lactate and mixed venous oxygen saturation were measured in 4 groups of patients—number of grafts, presence or absence of left main coronary artery disease, ejection fraction and serum creatinine. Blood samples were taken before induction, after grafting, on intensive care unit admission, 24 hours and 48 hours after surgery. The measured blood lactate and mixed venous oxygen saturation are compared to assess the outcomes in terms of duration of ventilation and intensive care unit stay. Results: The blood lactate and mixed venous oxygen saturation values increased post operatively but no statistically significant difference in three groups— number of grafts, left main coronary artery disease and ejection fraction. In serum creatinine group, the blood lactate value was found to be statistically significant after grafting in patients with creatinine <1.5 mg/dl, however, there was a significant disparity in numbers. Conclusion: Mixed venous oxygen saturation is a better predictor of morbidity than blood lactate in terms of intensive care unit stay in patients undergoing off pump coronary artery bypass grafting.展开更多
Introduction: Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We ...Introduction: Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We report a single surgeon, single center experience of the first 37 consecutive patients undergoing off-pump surgery. Patients were selected for OPCAB (study group) individually and matched retrospectively to a control group of 113 patients performed over an identical time frame. Data were retrieved from a hospital data base (TOMCAT). Results: Mean Logistic European System of Cardiac Operative Risk Stratification (EuroSCORE) was slightly higher in the off-pump group (3.8% versus 2.9%). One patient died during the study and this was in the off-pump CAB group (OPCAB-30 day mortality 2.7%). Operating time was slightly shorter in the off-pump group (3 hours 28 minutes versus 3 hours 49 minutes, p = 0.15). After exclusion of outliers, total hospital stay was significantly shorter for off-pump cases (mean 6.8 days versus 8.37 days), while Intensive Care Unit (ICU) stay (1.2 versus 1.4 days) and ventilation time were only slightly shorter (9.35 hours versus 10.6 hours) for off-pump cases. Chest tube drainage was significantly lower in the off-pump group (484 ml versus 744 ml, p = 0.04) with correspondingly slightly lower transfusion requirements and significantly increased discharge haemoglobin concentrations in OPCAB. There was one cerebrovascular accident (CVA) in the off-pump group and none in the on-pump group. Conclusion: In this study we show short term outcomes for introduction of off-pump into surgical technique. Length of ICU stay, ventilation times, chest tube drainage, transfusion re0 quirements and pre-discharge haemoglobin concentration all appeared superior in the off pump group. The off-pump technique was safely introduced into the surgeon`s service with relatively little mortality. Experience of surgeon was considered advantageous for fast adaption of the technique. However, numbers were too small to make strong inferences. With practice more patients should benefit from the technique.展开更多
Objectives To investigate the possible role of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in the occurrence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Methods This st...Objectives To investigate the possible role of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in the occurrence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Methods This study group included 70 consecutive patients scheduled for elective off-pump CABG. The patients with ejection fraction (EF) less than 0. 30, history of AF, use of class Ⅰ or Ⅲ antiarrhythmic drug, implanted pacemaker, postoperative myocardial infarction or chest reopening for pericardial tamponade were excluded. Preoperative and postoperative serum NT-proBNP levels were measured by radioimmunoassay technique. Results Postoperative AF occurred in 15 patients (21.4%); these patients had significantly higher median NT-proBNP levels when compared with those without AF after the operation ( P 〈 0. 01 ). Using multivariate logistic regression analyses, an increase in NT-proBNP level after CABG was found to be independently associated with AF ( OR = 3.78, 95% IC = 1.81 - 4. 89, P 〈 0. 01 ). Increased age, diabetes mellitus, preoperative use of β-blocker, proximal right coronary artery involvement, and longer operation time were al- so associated with AF. Conclusions These results indicated that AF was associated with higher NT-proBNP concentrations after off pump CABG; the increase in NT-proBNP after CABG may play an important role in the occurrence of AF after the operation. The further studies are needed to define the reason that lead to higher NT-proBNP concentrations among the patients who present AF after off pump CABG.展开更多
The use of bilateral internal thoracic arteries to treat coronary artery disease is very less despite of improved long-term survival. In this case report</span><span style="font-family:"">,&...The use of bilateral internal thoracic arteries to treat coronary artery disease is very less despite of improved long-term survival. In this case report</span><span style="font-family:"">,</span><span style="font-family:""> a patient presented with TVD has been managed with anaortic off-pump complete arterial revascularization (OPCABG) by using composite LIMA RIMA Y Sequential 5 grafts to achieve complete arterial revascularization successfully. This type of operative procedure is technically difficult in a resource poor country like Bangladesh. However, this has been done by a group of young cardiac surgeon. During follow up</span><span style="font-family:"">,</span><span style="font-family:""> the patient is in a good condition.展开更多
文摘We hereby report a case of Kawasaki disease in a 32 year old male, with giant aneurysm of both coronary arteries and severe LV (left ventricular) dysfunction who underwent OPCAB (off pump coronary artery bypass grafting) two years ago. He presented with acute myocardial infarction of his anterior wall of left ventricle. He was stabilised with medical management and was taken up for surgery when his enzymes became normal. His LV function had improved over the time and now has a good ejection fraction.
文摘Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative cardiovascular functioning is an important determinant for outcome of surgery. In On-Pump CABG (ONCAB), the cardiopulmonary bypass has a negative effect on myocardium. Off-Pump CABG (OPCAB) avoids the effect of CPB but complete revascularization with difficult positioning of heart is technically demanding. This study is aimed to compare the cardiovascular functioning in the immediate post-operative period after OPCAB and ONCAB. Methods: Total 106 patients were operated for CABG from January 2015 to June 2016, of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison, hemodynamic parameters were measured during anesthesia before surgery, postoperatively after 1 and 4 hours (h) in the ICU, and in the morning after surgery, approximately after 20 h. Results: The time-dependent rise of hemodynamic parameters like Cardiac Output (CO), Cardiac Index (CI), Stroke volume (SV) and Left Ventricular Stroke Work Index (LVSWI) in the immediate post-operative hours (1 h and 4 h) are more predominant in OPCAB group than ONCAB group although the difference is eliminated mostly at 20 h. The better peripheral vasodilation after OPCAB causes immediate fall of Systemic Vascular Resistance Index (SVRI) after OPCAB. Conclusion: Better cardiovascular functioning immediately after OPCAB than ONCAB may be important for better hemodynamic stability. The difference is however eliminated after 24 hours indicating little significance in long term outcome.
文摘Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidity and mortality. However, sternal wound complication (SWC) remains challenging following the procedure. The technique of left internal mammary artery (LIMA) harvesting has been shown to impact the incidence of SWC. This study aimed to compare the incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB. The patients were divided into two groups of 30 each based on the technique of LIMA harvesting used, i.e., skeletonized (group A) or pedicled (group B). The postoperative ICU care was given to each patient as per the protocol. The statistical analysis was conducted using the SPSS version 26.0 for Windows software. Results: The results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was not statistically significant between the two groups (p = 0.35). The mean age, gender distribution, and comorbidities such as hypertension, diabetes, dyslipidemia, and anemia were also not statistically significant between the two groups. The number of smokers was statistically significant between the two groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of operation, duration of mechanical ventilation, duration of chest drains, duration of the central venous line, and amount of postoperative mediastinal bleeding were also not statistically significant between the two groups. The distribution of wound complications, duration of ICU stays, and hospital stay between the two groups was also not statistically significant. Conclusion: In conclusion, this study found that the incidence of SWC was less in skeletonized LIMA harvesting than in pedicled LIMA harvesting after OPCAB. However, this finding was not statistically significant. Further studies with larger sample sizes may be needed to confirm these results and determine the appropriate technique of LIMA harvesting to decrease the incidence of SWC after OPCAB.
文摘Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Resuits The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotomy. There was no mortality. Mean length of stay in the intensive care unit was 16 .2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia
文摘Objective To analyze the short-term outcomes of redo coronary artery bypass grafting(CABG) using on-pump and off-pump CABG techniques. Methods From January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique(redo-ONCAB group) and 40 underwent off-pump CABG technique(redo-OPCAB group). Furthermore, transmyocardial laser revascularization was performed in high-risk patients who were not suitable to conventional grafting. Clinical data of the two groups were recorded and analyzed including operation time, coronary grafts, incomplete revascularization, postoperative ventilation, perioperative stroke, and low output syndrome, etc. Results There were no significantly differences in age, gender distribution, incidences of hypertension, stroke, and other clinical characteristics between redo-OPCAB group and redo-ONCAB group(all P>0.05), except for incidences of renal dysfunction and pulmonary disease(all P<0.05). The number of grafting vessels in the redo-ONCAB and redo-OPCAB groups was 2.1 ± 0.74 and 1.4 ±0.52 respectively. There was significant difference between the two groups(P=0.0243). Compared with the redo-ONCAB group, there was shorter operation time(P=0.0045), postoperative ventilation(P=0.0211) and intensive care unit stay(P=0.0400), as well as fewer use of platelet(P=0.0338) and blood transfusion(P=0.0034) in the redo-OPCAB group. The incidence of incomplete revascularization(P=0.0253) and the use of transmyocardial laser revascularization(P=0.0052) were higher in the redo-OPCAB group than those in the redo-ONCAB group(all P<0.05). However, no significant differences were showed for the incidence of the use of intra aortic balloon pump and continuous renal replacement therapy, perioperative stroke, low output syndrome, and in-hospital mortality between the two groups(all P>0.05). Conclusion Redo CABG is the safety and efficacy surgical procedure, and redo-OPCAB technique with better outcomes is commended especially in high-risk patients.
文摘To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.
基金supported by a grant from the National Natural Science Foundation of China(81170181)a Program for Development of Innovative Research Team in the First Affiliated Hospital of Nanjing Medical Universitya Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutes(PAPD)
文摘We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group (30 patients) received mono-antiplatelet treatment (MAPT) with aspirin 100 mg daily and the other group received dual anfiplatelet treatment (DAPT) with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachi- donic acid (PLAA) and adenosine diphosphate (ADP) (PLADP) were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given (62.1% vs, 32.1%, 34.5% vs. 10.7%, respectively, both P 〈 0.05). There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.
文摘Coronary artery bypass grafting(CABG) continues to be one of the most commonly performed cardiac surgical procedures worldwide. Conventional CABG performed on cardiopulmonary bypass termed on-pump CABG is regarded as the gold standard. However, on-pump CABG results in several physiologic derangements including but not limited to thrombocytopenia, activation of complement factors, immune suppression, and inflammatory responses leading to organ dysfunction.Furthermore, manipulating an atherosclerotic ascending aorta during cannulation and cross-clamping can predispose to embolization and stroke risk. Recognition of these detrimental effects of on-pump CABG resulted in resurgence of off-pump CABG nearly two decades ago.Off-pump CABG since its resurgence has been a subject of intensive scrutiny and speculation. Despite numerous retrospective nonrandomized studies, prospective randomized trials, and meta-analyses validating the safety and efficacy of off-pump CABG, opponents of the technique have persistently demanded abandonment of off-pump CABG. Several misconceptions and misperceptions are used as an excuse for such demands. This review article examines published scientific evidence to evaluate these misperceptions and misconceptions about off-pump CABG.
基金This work was supported by the Fund of Social Development in Jiangsu province(NO:BS2006013)
文摘Objective:To obtain early results of off-pump coronarE~ artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB). Methods:Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demo- graphic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: The number of distal anastomo- sis and grafts varied from 3 to 6. The average number per patient was similar in the two groups (OPCAB group:3.76 ± 0.98, CCAB group:3.81 ± 1.02). Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance (P 〉 0.05). The frequency of atrial fibrillation (AF), IABP usage, mediastinitis, re-operation for bleeding (or tamponade) were similar in the two groups (P 〉 0.05). Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group(P 〈 0.05).Conclusion: Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.
基金supported by the National Natural Science Foundation of China(No.81401323 and No.81130056)
文摘The association between atrial fibrillation(AF) after coronary artery bypass grafting(CABG) and the surgical techniques selected has been extensively reported. However, no consistent results were obtained. In the present study, a meta-analysis was conducted by searching the electronic databases Pub Med, Embase, Web of Science, and Cochrane to identify the association of post-CABG AF with on-pump(conventional CABG, c CABG) or off-pump CABG(OPCABG). Outcomes from randomized clinical trials(RCTs) and propensity score matching(PSM) trials were pooled by using the fixed-effect or the random-effect modeling method, and verified by the quality-effect modeling method. There were 35 studies with 36 independent reports that met the inclusion criteria and were eventually included in our meta-analysis. The total odds ratio(OR) of the incidence of post-CABG AF between OPCABG and c CABG was 0.80(95% CI 0.71–0.91). The 25 randomized clinical trials(RCTs) had an OR of 0.69(95% CI 0.56–0.86), while the OR of the 11 PSM trials was 0.88(95% CI 0.77–1.00). Twenty-six studies involving the patients at a mean age no more than 65 years showed an OR of 0.76(95% CI 0.64–0.90), whereas 10 studies with patients greater than 65 years old showed an OR of 0.90(95% CI 0.78–1.05). The results of this meta-analysis suggest that OPCAB surgery may reduce the incidence of post-CABG AF when compared to c CABG and that younger patients may benefit more from OPCAB and have a lower incidence of post-CABG AF.
文摘Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.
基金Supported by Scientific Technology development Foundation of Shanghai(024119028)
文摘Objective: To compare function recovery of left ventricle after off-pump and on-pump coronary artery bypass (OPCAB and ONCAB) using Tei index. Methods: Twenty-four patients with coronary artery disease were enrolled, twelve of which received OPCAB and the others underwent ONCAB. Left ventricular ejection fraction (LVEF), E/A ratio at mitral orifice and Tei index were measured using transthoracic echocardiography before surgery and 3-7 days, 1 month, 3 months and 6 months after surgery. Results:Tei index of both groups decreased 3-7 days after surgery, with OPCAB group's lower than ONCAB group's. The difference between pre-and post-OPCAB was significant (P<0. 01 ), but not for ONCAB group (P>0. 05). Tei index of ONCAB decreased more significant than that of OPCAB 1 month after surgery, there was statistical difference between 3-7 days and 1 month after surgery in ONCAB (P<0. 01). Afterwards, Tei index of the 2 groups decreased steadily with no significant difference between them at other time points. LVEF and E/A ratio decreased at first, then increased gradually, with no statistical differences between the 2 groups at all time points. Conclusion: The recovery of left ventricular function after OPCAB is earlier than ONCAB. Tei index is more sensitive than LVEF and E/A ratio in detecting cardiac function recoveries and can be considered as an accurate and simple method to evaluate left ventricular systolic and diastolic function.
文摘Background: The off-pump coronary artery bypass graft surgery (OPCAB) may produce significant hemodynamic instability necessitating conversion to on-pump surgery. This study evaluated the hemodynamic parameters in patients undergoing OPCAB using pericardial bands for stabilization of the coronary target sites. Methods: In 250 patients undergoing OPCAB the hemodynamic parameters including continuous cardiac output and systemic venous oxygen saturation (SvO2) were recorded at baseline after pericardiotomy, during each coronary artery anastomosis at 3, 5, 10, 15 min, and after release of the pericardial bands used for target stabilization. Vasopressors were used to maintain mean arterial pressure (MAP) > 60 mmHg. Results: SvO2 and cardiac index (CI) decreased significantly after target stabilization and during all coronary anastomoses with greater decreases noted during obtuse marginal branch of left circumflex (OM) anastomosis. The MAP and heart rate were maintained without significant change but central venous pressure increased significantly during all coronary anastomoses. The significant increase in pulmonary capillary wedge pressure and mean pulmonary artery pressure were noted only during anastomosis of the left anterior descending artery. The highest dose of vasopressor was used during OM anastomosis. Conclusions: During OPCAB surgery using pericardial bands for coronary target stabilization, MAP was maintained constantly, but SvO2 and CI decreased immediately after target stabilization and reduced further during all coronary artery anastomoses. During OM anastomosis SvO2 and CI were significantly lower as compared to that of LAD and right coronary artery. Careful monitoring and management of hemodynamic variables are warranted to avoid conversion to on-pump technique.
文摘Objective: To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods : The grafts flow was studied in 100 patients of OPCAB and compared with 100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results: The mean number of the distal anastomosis was 3.78+ 1.11 in CCABG group, and 3.83 + 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 + 0.08, and 1.10+ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups. Conclusion: OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.
文摘Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lactate and mixed venous oxygen saturation were measured in 4 groups of patients—number of grafts, presence or absence of left main coronary artery disease, ejection fraction and serum creatinine. Blood samples were taken before induction, after grafting, on intensive care unit admission, 24 hours and 48 hours after surgery. The measured blood lactate and mixed venous oxygen saturation are compared to assess the outcomes in terms of duration of ventilation and intensive care unit stay. Results: The blood lactate and mixed venous oxygen saturation values increased post operatively but no statistically significant difference in three groups— number of grafts, left main coronary artery disease and ejection fraction. In serum creatinine group, the blood lactate value was found to be statistically significant after grafting in patients with creatinine <1.5 mg/dl, however, there was a significant disparity in numbers. Conclusion: Mixed venous oxygen saturation is a better predictor of morbidity than blood lactate in terms of intensive care unit stay in patients undergoing off pump coronary artery bypass grafting.
文摘Introduction: Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We report a single surgeon, single center experience of the first 37 consecutive patients undergoing off-pump surgery. Patients were selected for OPCAB (study group) individually and matched retrospectively to a control group of 113 patients performed over an identical time frame. Data were retrieved from a hospital data base (TOMCAT). Results: Mean Logistic European System of Cardiac Operative Risk Stratification (EuroSCORE) was slightly higher in the off-pump group (3.8% versus 2.9%). One patient died during the study and this was in the off-pump CAB group (OPCAB-30 day mortality 2.7%). Operating time was slightly shorter in the off-pump group (3 hours 28 minutes versus 3 hours 49 minutes, p = 0.15). After exclusion of outliers, total hospital stay was significantly shorter for off-pump cases (mean 6.8 days versus 8.37 days), while Intensive Care Unit (ICU) stay (1.2 versus 1.4 days) and ventilation time were only slightly shorter (9.35 hours versus 10.6 hours) for off-pump cases. Chest tube drainage was significantly lower in the off-pump group (484 ml versus 744 ml, p = 0.04) with correspondingly slightly lower transfusion requirements and significantly increased discharge haemoglobin concentrations in OPCAB. There was one cerebrovascular accident (CVA) in the off-pump group and none in the on-pump group. Conclusion: In this study we show short term outcomes for introduction of off-pump into surgical technique. Length of ICU stay, ventilation times, chest tube drainage, transfusion re0 quirements and pre-discharge haemoglobin concentration all appeared superior in the off pump group. The off-pump technique was safely introduced into the surgeon`s service with relatively little mortality. Experience of surgeon was considered advantageous for fast adaption of the technique. However, numbers were too small to make strong inferences. With practice more patients should benefit from the technique.
文摘Objectives To investigate the possible role of amino-terminal pro-brain natriuretic peptide (NT-proBNP) in the occurrence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Methods This study group included 70 consecutive patients scheduled for elective off-pump CABG. The patients with ejection fraction (EF) less than 0. 30, history of AF, use of class Ⅰ or Ⅲ antiarrhythmic drug, implanted pacemaker, postoperative myocardial infarction or chest reopening for pericardial tamponade were excluded. Preoperative and postoperative serum NT-proBNP levels were measured by radioimmunoassay technique. Results Postoperative AF occurred in 15 patients (21.4%); these patients had significantly higher median NT-proBNP levels when compared with those without AF after the operation ( P 〈 0. 01 ). Using multivariate logistic regression analyses, an increase in NT-proBNP level after CABG was found to be independently associated with AF ( OR = 3.78, 95% IC = 1.81 - 4. 89, P 〈 0. 01 ). Increased age, diabetes mellitus, preoperative use of β-blocker, proximal right coronary artery involvement, and longer operation time were al- so associated with AF. Conclusions These results indicated that AF was associated with higher NT-proBNP concentrations after off pump CABG; the increase in NT-proBNP after CABG may play an important role in the occurrence of AF after the operation. The further studies are needed to define the reason that lead to higher NT-proBNP concentrations among the patients who present AF after off pump CABG.
文摘The use of bilateral internal thoracic arteries to treat coronary artery disease is very less despite of improved long-term survival. In this case report</span><span style="font-family:"">,</span><span style="font-family:""> a patient presented with TVD has been managed with anaortic off-pump complete arterial revascularization (OPCABG) by using composite LIMA RIMA Y Sequential 5 grafts to achieve complete arterial revascularization successfully. This type of operative procedure is technically difficult in a resource poor country like Bangladesh. However, this has been done by a group of young cardiac surgeon. During follow up</span><span style="font-family:"">,</span><span style="font-family:""> the patient is in a good condition.