TITLE

Myocardial revascularization with and without cardiopulmonary bypass: advantages, disadvantages and similarities

AUTHOR(S)
Calafiore, Antonio Maria; Di Mauro, Michele; Canosa, Carlo; Di Giammarco, Gabriele; Iacò, Angela Lorena; Contini, Marco
PUB. DATE
December 2003
SOURCE
European Journal of Cardio-Thoracic Surgery;Dec2003, Vol. 24 Issue 6, p953
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objectives: Off-pump coronary artery bypass surgery is becoming increasingly popular although its effectiveness remains controversial. Our goal was to investigate the effectiveness of on-pump and off-pump coronary artery bypass surgery on early (30 days) and long-term (5 years) clinical outcome in two groups of patients selected using propensity scores. Methods: From November 1994 to December 2001, 4381 patients underwent isolated coronary surgery. Applying propensity score matching, 1922 patients were selected (off-pump n=961, on-pump n=961). Results: Stepwise logistic regression analysis showed that the use of cardiopulmonary bypass was an independent predictor for early death, cerebral vascular accident, early negative primary endpoints (ENPEP), and early major events (EME). Five years freedom from both events was similar in the two groups. However, freedom from acute myocardial infarction (AMI) in grafted areas was higher in the off-pump than in the on-pump patients, a possible explanation being the lower postoperative creatine kinase myocardial band (CKMB) release. Grouping all patients according to CKMB peak release also showed that patients with normal release values had higher freedom from all cardiac events investigated. A subgroup analysis of 59 patients converted from off-pump to on-pump showed higher early mortality, ENPEP, and EME. Conversion, however, did not affect late clinical outcome. Conclusions: These results suggest that off-pump surgery reduces early mortality and morbidity. Conversion to on-pump carries high in-hospital mortality and morbidity. Long-term clinical outcome is similar in the two groups; however, off-pump patients seemed to have a higher freedom from AMI in the grafted area which might be related to the lower CKMB peak release when compared with patients undergoing on-pump surgery.
ACCESSION #
11468904

 

Related Articles

  • Lipopolysaccharide Binding Protein and sCD14 are Not Produced as Acute Phase Proteins in Cardiac Surgery. Kudlova, Manuela; Kunes, Pavel; Kolackova, Martina; Lonsky, Vladimir; Mandak, Jiri; Andrys, Ctirad; Jankovicova, Karolina; Krejsek, Jan // Mediators of Inflammation;2007, Vol. 2007, Special section p1 

    Objectives. The changes in the serum levels of lipopolysaccharide binding protein (LBP) and sCD14 during cardiac surgery were followed in this study. Design. Thirty-four patients, 17 in each group, were randomly assigned to coronary artery bypass grafting surgery performed either with...

  • OFF-PUMP CORONARY ARTERY BYPASS GRAFTING: A CASE REPORT. Behny, Leanne P. // AANA Journal;Feb2006, Vol. 74 Issue 1, p39 

    It is easy to take for granted the seemingly effortless way cardiovascular surgeons are able to bypass atherosclerotic coronary arteries. The process used today was developed over many years of rigorous study, experimentation, success, and failure. Early cardiac surgery was performed blindly,...

  • Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve Song, Howard K.; Petersen, Rebecca J.; Sharoni, Erez; Guyton, Robert A.; Puskas, John D. // European Journal of Cardio-Thoracic Surgery;Dec2003, Vol. 24 Issue 6, p947 

    Objective: Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon''s...

  • Cardiopulmonary Bypass during Cardiac Surgery Modulates Systemic Inflammation by Affecting Different Steps of the Leukocyte Recruitment Cascade. Rossaint, Jan; Berger, Christian; Van Aken, Hugo; Scheld, Hans H.; Zahn, Peter K.; Rukosujew, Andreas; Zarbock, Alexander; Schulz, Christian // PLoS ONE;Sep2012, Vol. 7 Issue 9, Special section p1 

    Background: It is known that the use of a cardiopulmonary bypass (CPB) during cardiac surgery leads to leukocyte activation and may, among other causes, induce organ dysfunction due to increased leukocyte recruitment into different organs. Leukocyte extravasation occurs in a cascade-like...

  • Statewide quality improvement initiatives and mortality after cardiac surgery. Ghali, Willam A.; Ash, Arlene S. // JAMA: Journal of the American Medical Association;2/5/97, Vol. 277 Issue 5, p379 

    Presents a study which compared trends in mortality after coronary artery bypass graft surgery (CABG) in Massachusetts with the decreases reported from New York and northern New England. Design of study; Setting; Patients and data sets; Main outcome measures; Results and conclusions.

  • Comparison of gastrointestinal complications in on-pump versus off-pump coronary artery bypass grafting. Croome, Kris P.; Kiaii, Bob; Fox, Stephanie; Quantz, Mackenzie; McKenzie, Neil; Novick, Richard J. // Canadian Journal of Surgery;Apr2009, Vol. 52 Issue 2, p125 

    Background: Gastrointestinal (GI) complications following coronary artery bypass grafting (CABG), although infrequent, are associated with significant morbidity and mortality. It has been suggested that systemic inflammatory response plays an important role in these complications....

  • Automatic connector devices for proximal anastomoses do not decrease embolic debris compared with conventional anastomoses in CABG. Martens, Sven; Dietrich, Markus; Herzog, Christopher; Doss, Mirko; Schneider, Gunnar; Moritz, Anton; Wimmer-Greinecker, Gerhard // European Journal of Cardio-Thoracic Surgery;Jun2004, Vol. 25 Issue 6, p993 

    Objective: Emboli generated during cardiac surgery have been associated with aortic clamping and manipulation. Proximal anastomotic devices are thought to be less traumatic by eliminating partial clamping, potentially resulting in fewer adverse outcomes. Intra-aortic filtration has been shown to...

  • Changes in total and unbound concentrations of sufentanil during target controlled infusion for cardiac surgery with cardiopulmonary bypass. Jeleazcov, C.; Saari, T. I.; Ihmsen, H.; Schüttler, J.; Fechner, J. // BJA: The British Journal of Anaesthesia;Nov2012, Vol. 109 Issue 5, p698 

    Background Target controlled infusion (TCI) with sufentanil is usually performed using the Gepts model, which was derived from patients undergoing general surgery. It is, however, known that pharmacokinetics of sufentanil can be changed during cardiopulmonary bypass (CPB). We tested whether TCI...

  • Highest core temperature during cardiopulmonary bypass and rate of mediastinitis. Groom, Robert C.; Rassias, Athos J.; Cormack, John E.; DeFoe, Gordon R.; DioDato, Christian; Krumholz, Charles K.; Forest, Richard J.; Pieroni, John W.; Brian O'Connor; Warren, Craig S.; Olmstead, Elaine M.; Ross, Cathy S.; O'Connor, Gerald T. // Perfusion;Mar2004, Vol. 19 Issue 2, p119 

    Temperature control during cardiopulmonary bypass (CPB) may be related to rates of bacterial infection. We assessed the relationship between highest core temperature during CPB and rates of mediastinitis in 6955 consecutive isolated coronary artery bypass graft (CABG) procedures in northern New...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics