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Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh
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作者 Ahmad Pear Salahuddin Md. Abir Tazim Chowdhury +6 位作者 Munama Magdum Dewan Iftakher Reza Chowdhury Nittya Nanda Pal Md. Nahedul Morshed Md. Zafar-Al-Nimari Latifa Nasrin Farooque Ahmed 《World Journal of Cardiovascular Surgery》 2024年第8期131-144,共14页
Background: Serum albumin, a vital plasma protein, helps maintain intravascular colloidal osmotic pressure, cardiac output, and renal function. Low preoperative serum albumin is linked to poor outcomes, including acut... Background: Serum albumin, a vital plasma protein, helps maintain intravascular colloidal osmotic pressure, cardiac output, and renal function. Low preoperative serum albumin is linked to poor outcomes, including acute kidney injury (AKI), after off-pump coronary artery bypass (OPCAB) surgery. This study aimed to assess the relationship between preoperative serum albumin levels and early postoperative renal injury. Methods: This prospective comparative cross-sectional study was conducted from August 2019 to February 2021 at the National Heart Foundation Hospital & Research Institute, Bangladesh. It included 160 adult patients with normal preoperative renal function undergoing OPCAB. Patients were divided into two groups: Group A (serum albumin ≥ 4.0 gm/dl) and Group B (serum albumin Results: Preoperative serum albumin was significantly different between groups (Group A: 4.21 ± 0.05 gm/dl, Group B: 3.69 ± 0.04 gm/dl, p = 0.028). Group B had a higher incidence of hypertension (71.25% vs. 51.25%, p st and 3rd postoperative days were higher in Group B (p th day. Postoperative AKI occurred in 18.75% of Group A and 36.25% of Group B. Multivariate regression indicated that low preoperative serum albumin is an independent risk factor for postoperative AKI (p = 0.012, OR = 1.815, CI: 0.675 - 1.162). Conclusion: Preoperative serum albumin level is a valuable predictor of postoperative renal function. Ensuring high normal serum albumin levels before surgery can help minimize the risk of postoperative AKI. 展开更多
关键词 Serum Albumin Acute Kidney Injury (AKI) off-pump coronary artery bypass Surgery BANGLADESH
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Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh
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作者 Muhit Abdullah Md. Abir Tazim Chowdhury +9 位作者 Satyajit Sharma Rehana Akther Munama Magdum Munjerin Refat Synthee Md. Zafar-Al-Nimari Saikat Das Gupta Saleh Ahmed Samir Kumar Biswas M. Quamrul Islam Talukder Farooque Ahmed 《World Journal of Cardiovascular Surgery》 2024年第9期145-156,共12页
Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-... Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk. 展开更多
关键词 off-pump coronary artery bypass Grafting Left Ventricular Dysfunction (LVD) Short-Term Outcomes
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Redo Coronary Artery Bypass Grafting: On-Pump and Off-Pump Coronary Artery Bypass Grafting Revascularization Techniques 被引量:5
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作者 Song Wu Feng Wan +3 位作者 Zhe Zhang Hong Zhao Zhong-qi Cui Ji-yan Xie 《Chinese Medical Sciences Journal》 CAS CSCD 2015年第1期28-33,共6页
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
关键词 REOPERATION coronary artery bypass grafting on pump off pump transmyocardial laser revascularization
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Clopidogrel improves aspirin response after off-pump coronary artery bypass surgery 被引量:5
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作者 Xuezhong Wang Xiaoxuan Gong +5 位作者 Tiantian Zhu Qiu Zhang Yangyang Zhang Xiaowei Wang Zhijian Yang Chunjian Lia 《The Journal of Biomedical Research》 CAS 2014年第2期108-113,共6页
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
关键词 ASPIRIN CLOPIDOGREL aspirin resistance off-pump coronary artery bypass (OPCAB)
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Off-pump coronary artery bypass grafting: Misperceptions and misconceptions 被引量:4
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作者 Shahzad G Raja Umberto Benedetto 《World Journal of Methodology》 2014年第1期6-10,共5页
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
关键词 coronary artery bypass GRAFTING Cardiopulmonary bypass off-pump coronary artery bypass GRAFTING Surgical myocardial revascularization coronary artery surgery
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Off-pump versus on-pump coronary artery bypass surgery for the treatment of left main with triple coronary artery disease 被引量:3
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作者 Zhibing Qiu Xin Chen Ming Xu Kaihu Shi Yinshuo Jiang Liqiong Xiao 《Journal of Nanjing Medical University》 2008年第3期159-163,共5页
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
关键词 left main coronary artery triple-vessel stenosis off-pump coronary artery bypass grafting
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Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass —A Vettath Modification 被引量:1
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作者 Murali P. Vettath Kannan A. Vellachamy +2 位作者 Nitin Gangadharan Sanooj Ottuparakuzhiyil Jayaprakash Moothencherie 《World Journal of Cardiovascular Diseases》 2016年第6期188-195,共8页
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
关键词 off-pump coronary artery bypass (OPCAB) Surgery Intra-Aortic Balloon pump (IABP)
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Incidence of Atrial Fibrillation after Off-pump versus On-pump Coronary Artery Bypass Grafting:A Meta-analysis of Randomized Clinical Trials and Propensity Score Matching Trials 被引量:1
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作者 吴创炎 王思桦 +1 位作者 尚玉强 夏家红 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 2017年第6期956-964,共9页
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
关键词 off-pump coronary artery bypass coronary artery bypass surgery atrial fibrillation
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OPCAB (Off Pump Coronary Artery Bypass) for Kawasaki Disease
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作者 Murali P. Vettath Madhu Ravisankar +1 位作者 Kannan Arunachalam Veluchamy Nitin Gangadharan 《Surgical Science》 2018年第9期287-292,共6页
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
关键词 coronary artery DISEASE coronary artery ANEURYSM KAWASAKI DISEASE OPCAB (off pump coronary artery bypass)
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Comparative study of graft flow between on-pump and off-pump coronary bypass surgery for patients with multivessel coronary artery disease
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作者 Xin Chen Ming Xu Zhibing Qiu Yinshuo Jiang Liming Wang Liqiong Xiao 《Journal of Nanjing Medical University》 2006年第6期351-354,共4页
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
关键词 off-pump coronary artery bypass grafting flow of grafts REVASCULARIZATION
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Awake off-pump coronary artery bypass surgery in 25 patients
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作者 郭惠明 Murali Chakravarthy +2 位作者 Vivek Jawali K Jayaprakash NV Shivananda 《South China Journal of Cardiology》 CAS 2003年第2期66-71,共6页
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
关键词 High thoracic epidural anesthesia off pump coronary artery bypass (OPCAB) surgery Conscious patients
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Association of Atrial Fibrillation and Amino-terminal Pro-brain Natriuretic Peptide Concentrations in Patients After Off-Pump Coronary Artery Bypass Grafting
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作者 李君权 张庆华 +1 位作者 田伟忱 刘宏宇 《South China Journal of Cardiology》 CAS 2008年第2期61-65,共5页
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
关键词 off-pump coronary artery bypass grafting atrial fibrillation amino-terminal pro-brain natriuretic peptide
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Off-Pump CABG for Mulitvessel Coronary Artery Disease-Safe Incorporation into Surgical Practice
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作者 Catharina Nesselmann Sadia Aftab +1 位作者 Manikandan Chandran Fraser W. H. Sutherland 《Open Journal of Thoracic Surgery》 2012年第3期78-86,共9页
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
关键词 off-pump Versus ON-pump coronary artery bypass GRAFTING Without CARDIOPULMONARY bypass Cardiac Surgery
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Coronary artery bypass grafting with concomitant resection for carcinoma of lung 被引量:4
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作者 Yangyang Zhang,Yanhu Wu ,Biao Yuan,Xiang Liu,Sheng Zhao,Zhi Li,Yu Xia Department of Cardiothoracic Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu Province,China 《The Journal of Biomedical Research》 CAS 2010年第1期77-80,共4页
A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left low... A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left lower lobectomy were performed through median sternotomy. This approach avoids complications due to staged operations and cardiopulmonary bypass (CPB). This report shows that simultaneous off pump CABG and pulmonary operations can be performed safely in patients with coronary artery disease (CAD) associated with lung cancer. 展开更多
关键词 lung cancer coronary artery disease luo- resection off-pump coronary artery bypass grafting
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Comparison of Sternal Wound Complication after Off-Pump CABG between Skeletonized and Pedicled LIMA Harvesting: A Single Centre Experience in Bangladesh
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作者 M. Asmaul Alam Al Nur Md. Aslam Hossain +2 位作者 Md. Abir Tazim Chowdhury Farhat Tabassum Nishat Munama Magdum 《World Journal of Cardiovascular Surgery》 2023年第6期101-110,共10页
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
关键词 Sternal Wound Complication (SWC) off-pump coronary artery bypass Grafting (OPCAB) Left Internal Mammary artery (LIMA) Skeletonized LIMA Harvesting Pedicle LIMA Harvesting
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Preoperative Intra-Aortic Balloon Counterpulsation in Coronary Artery Bypass Graft Patients with Severe Left Ventricular Dysfunction
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作者 Andrea Cristina Oliveira Freitas Danilo B. Gurian +3 位作者 Wladmir F. Saporito Leandro N. Machado Louise Horiuti Adilson C. Pires 《World Journal of Cardiovascular Diseases》 2016年第10期321-328,共9页
Background: The intra-aortic balloon pumping (IABP) is the most used ventricular mechanical assist device. In recent years, the preoperative use in patients with severe ventricular dysfunction presents itself as a gre... Background: The intra-aortic balloon pumping (IABP) is the most used ventricular mechanical assist device. In recent years, the preoperative use in patients with severe ventricular dysfunction presents itself as a great benefic strategy to the postoperative recovery. This paper aim is to evaluate the IABP post-operative benefit in patients with severe ventricular dysfunction. Methods: From January 2011 to March 2016, 125 patients underwent a coronary artery bypass graft (CABG) with cardiopulmonary bypass and preoperative IABP in Teaching Hospital of the ABC Medical School and Hospital Estadual Mario Covas. The inclusion criteria were the presence of severe ischemic cardiomyopathy with left ventricular ejection fraction (LVEF) less than or equal to 40%, estimated by Doppler echocardiography using the Simpson method. The preoperative LVEF was 30.25% ± 8.53% and the diastolic diameter of the left ventricle (LVDD) 67.75 ± 16.37 mm. IABP was installed approximately 15 hours before the surgery. Results: The patients required the IABP for 2.4 ± 1.58 days, and vasoactive drugs, 4.8 ± 2.12 days. We performed 3.2 ± 1.9 grafts per patient and the total length of stay was 07 ± 5.52 days. Cardiopulmonary bypass time was 67 ± 10.95 minutes and anoxia time, 46.4 ± 10.06 minutes. Twelve patients (9.6%) had pneumonia and four (3.2%), atrial fibrillation. We observed a LVDD reduction to 63 ± 16.26 (p = 0.068) and LVEF enhancement to 36.50 ± 16.86 (p = 0.144). The data were analyzed statistically according to the Wilcoxon test. There were no deaths. Conclusion: The initial experience of the authors with the preoperative IABP in patients with severe left ventricular dysfunction suggests great benefit in post-operative recovery with im-provement of LVEF and reduction of LVDD. 展开更多
关键词 Intra-Aortic Balloon pumping Left Ventricular Dysfunction coronary artery bypass Graft
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Off-Pump Complete Coronary Revascularization with 860 cases andtwo year experience
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作者 谢斌 张镜芳 《South China Journal of Cardiology》 CAS 2002年第1期18-21,25,共5页
Background Cardiopulmonary bypass (CPB) produces a well documented diffuse inflammatory response that affects multiple organ systems. To avoid the deleterious effects of cardiopulmonary bypass, off pump coronary art... Background Cardiopulmonary bypass (CPB) produces a well documented diffuse inflammatory response that affects multiple organ systems. To avoid the deleterious effects of cardiopulmonary bypass, off pump coronary artery bypass grafting is becoming increasingly popular world wide. We reviewed our experience of complete coronary artery revascularization on the beating heart without CPB. Methods From Aug 1998 to Aug 2000, 860 off pump revascularizations (99%since January 1999) were performed at Manipal Hospital Heart Foundation. The patients consist of males 757(88%), females 103(12%). Averaged age 64.2±15 years. All surgeries were performed through a median sternotomy. Exposure techniques are tailored to individual vessels and cardiac regions. Local immobilization is performed with octopus. Vascular control is achieved with occluders and shunts. Results Among 860 off pump CABG patients. Single graft 72 (8.3%), two grafts 208 (24.2%), three grafts 469 (54.5%), four grafts 101 (11.8%), five graft 10 (1.2%). The average number of grafts per patient was 2.72±0.32. Operative mortality was 0.69%(6 patients). Anesthetic time 3.9±1.2hours, extubation time 6±2.5 hours, Blood requirement 360±90 ml, Preoperative LVEF 60.2±8.5%, Post LVEF 64.1±14%Low cardiac output 48 patients (5.6%), IABP requirement: 25 patients(2.9%), 25 patients converted to CPB during OP CAB(2.9%)and 20 of them were done with on pump beating heart. 25 patients showed myocardial ischemic and 16 patients showed perioperative myocardial infarction. ICU stay 1.1±0.8 days, hospital stay 6.2±1.1 days. Conclusion Off-pump coronary artery bypass in complete revascularization is a safe, effective technique and suitable. 展开更多
关键词 coronary revascularization off pump coronary artery bypass Beating heart surgery Octopus
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Complete Coronary Revascularization with on Pump Beating Heart
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作者 谢斌 张镜芳 +1 位作者 Praveen Kumar Devi Prasad Shetty 《South China Journal of Cardiology》 CAS 2001年第1期17-20,共4页
Background Off-pump coronary artery bypass grafting (CABG) is becoming increasingly popular world - wide. But it is not always feasible. Current cardioplegic techniques do not consistently avoid myocardial ischemic da... Background Off-pump coronary artery bypass grafting (CABG) is becoming increasingly popular world - wide. But it is not always feasible. Current cardioplegic techniques do not consistently avoid myocardial ischemic damage. So we use on pump beating heart technique to supplement off-pump CABG. Methods Based on 860 off-pump CABG cases between Aug 1998 to Aug 2000. From Aug 1999 to Aug 2000, 46 CABG cases were performed with on pump beating heart technique at Mani-pal Hospital Heart Foundation, Bangalore, India. All surgeries were performed through a median sternotomy. Exposure techniques were tailored to individual vessels and cardiac regions and local immobilization was performed with octopus. Vascular control was achieved with occluders and shunts. Total cardiopulmonary bypass (CPB) was established before or during CABG and normolthemia was used. Results Among 46 on -pump beating heart CABG patients, 26 patients used CPB before or during OP - CABG because of unstable hemodynamics and electric instability , 7 had very deep intramyocardial left anterior descending arteries, 5 patients had poor LV function (LVEF < 30 % ), 8 patients had cardiomegaly. The average number of grafts was 3.5. No operative mortality. Three patients had postoperative myocardial infarction. Anesthetic time 4. 5±1. 2 hours, extubation time 10±2. 5 hours, blood lost 680±230 mL, blood requirement 540±150 mL, preoperative LVEF 50. 3±13 % , postoperative LVEF 64. 1±14 %, ICU stay 1. 5±0. 5 days, hospi- tal stay 9.2±1.8 days. Conclusion Complete coronary revascularization with on pump beating heart is a supplement for off - pump CABG when it is not feasible. It eliminates intraoperative globe myocardial ischemia and avoids transient myocardial injury during cardioplegic arrest and myocardial reperfusion. 展开更多
关键词 On - pump beating heart coronary revascularization off - pump Beating heart Octopus coronary artery bypass grafting
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Correlation of Blood Lactate and Mixed Venous Oxygen Saturation in Off-Pump CABG
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作者 Ganapathy Sambandam Kamalakkannan Ranjith Karthekeyan +4 位作者 Mahesh Vakamudi Sandeep Bangale Rajeshkumar Kodali Hemanand Nayagam Sushma Nandipati 《World Journal of Cardiovascular Surgery》 2014年第7期131-138,共8页
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
关键词 off-pump coronary artery bypass Grafting Blood LACTATE Mixed VENOUS Oxygen Saturation EJECTION Fraction DURATION of Ventilation DURATION of Intensive Care Unit Stay
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右美托咪定辅助全身麻醉对老年非体外循环冠状动脉搭桥术患者血流动力学、心肌保护效应及术后转归的影响
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作者 王岩英 刘海平 +2 位作者 王芳 刘晓宁 张光信 《临床和实验医学杂志》 2024年第8期882-886,共5页
目的探讨右美托咪定辅助全身麻醉对老年非体外循环冠状动脉搭桥术(CABG)患者血流动力学、心肌保护效应及术后转归的影响。方法前瞻性选取2021年6月至2023年6月邯郸市第一医院收治的110例非体外循环CABG患者,采用随机数字表法分为观察组... 目的探讨右美托咪定辅助全身麻醉对老年非体外循环冠状动脉搭桥术(CABG)患者血流动力学、心肌保护效应及术后转归的影响。方法前瞻性选取2021年6月至2023年6月邯郸市第一医院收治的110例非体外循环CABG患者,采用随机数字表法分为观察组和对照组,各55例。观察组给予右美托咪定辅助全身麻醉(麻醉诱导前15 min静滴0.6μg/kg,以0.2~0.4μg·kg^(-1)·h^(-1)持续泵注至手术结束),对照组给予等体积0.9%氯化钠溶液,其余同观察组。比较两组患者麻醉前(T_(0))、穿刺完毕5 min(T_(1))、手术结束即刻(T_(2))与手术后12 h(T_(3))的围手术期血流动力学指标[血氧饱和度(SpO_(2))与平均动脉压(MAP)、心率],手术前、手术后24、48 h的心肌损伤标志物[肌钙蛋白T(CTnT)和肌酸激酶同工酶(CK-MB)],手术前、手术后6、12、24 h的认知功能[蒙特利尔认知评估量表(MoCA)评分],术后转归情况(气管拔管、ICU滞留、苏醒、定向力恢复与术后住院时间)及躁动发生率。结果T_(0)时,两组SpO_(2)、MAP、心率比较,差异均无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时,观察组SpO_(2)、MAP、心率均高于对照组,差异均有统计学意义(P<0.05)。手术后24、48 h,观察组的cTnT和CK-MB水平均低于对照组,差异均有统计学意义(P<0.05)。手术后6、12、24 h,观察组的MoCA评分分别为(26.65±1.41)、(27.58±1.11)、(28.69±1.15)分,均高于对照组[(25.31±1.22)、(26.47±1.23)、(27.11±1.24)分],差异均有统计学意义(P<0.05)。两组苏醒时间、定向力恢复时间比较,差异均无统计学意义(P>0.05),观察组气管拔管时间、ICU滞留时间、术后住院时间分别为(15.86±3.36)h、(51.39±5.77)h、(11.39±2.48)d,均短于对照组[(19.75±3.41)h、(60.48±5.63)h、(13.65±2.61)d],差异均有统计学意义(P<0.05)。手术后6、24、48 h,观察组患者的躁动发生率分别为5.45%、3.64%、1.82%,均低于对照组(21.82%、16.36%、14.55%),差异均有统计学意义(P<0.05)。结论右美托咪定辅助全身麻醉在老年非体外循环冠脉搭桥术患者中可稳定患者围术期血流动力学,减少心肌损害,改善患者早期认知功能,同时可促进患者术后转归,降低术后躁动发生率。 展开更多
关键词 右美托咪定 全身麻醉 非体外循环冠状动脉搭桥术 心肌保护 术后转归
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