TITLE

Miniaturized versus conventional cardiopulmonary bypass in high-risk patients undergoing coronary artery bypass surgery

AUTHOR(S)
Koivisto, Simo-Pekka; Wistbacka, Jan-Ola; Rimpiläinen, Riikka; Nissinen, Juha; Loponen, Pertti; Teittinen, Kari; Biancari, Fausto
PUB. DATE
March 2010
SOURCE
Perfusion;Mar2010, Vol. 25 Issue 2, p65
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective: To review our results with the use of miniaturized cardiopulmonary bypass (Mini-CPB) versus conventional cardiopulmonary bypass (C-CPB) in high-risk patients (additive EuroSCORE≥6) who have undergone coronary artery bypass graft surgery (CABG). Patients and methods: This study includes a consecutive series of 236 patients with an additive EuroSCORE≥6 who underwent CABG, employing either C-CPB or Mini-CPB. Propensity score analysis was performed. Results: The study groups had similar EuroSCOREs. Stroke rate was significantly higher among C-CPB patients (5.4% vs. 0%, p=0.026). In-hospital mortality (4.8% vs. 3.4%, p=0.75) and combined adverse end-point rate were higher in C-CPB patients (20.4% vs. 13.5%, p=0.18). Postoperative bleeding and need for transfusion were similar in the study groups, but re-sternotomy for bleeding was more frequent among C-CPB patients (4.8% vs. 1.1%, p=0.26). Seventy-four propensity matched pairs had similar immediate postoperative results: C-CPB patients had higher mortality (6.8% vs. 4.1%, p=0.72), stroke (5.4% vs. 0%, p=0.12) and combined adverse end-point rates (27.0% vs. 16.2%, p=0.11), but such differences failed to reach statistical significance. Conclusions: Mini-CPB achieved somewhat better results than C-CPB in these high-risk patients undergoing isolated CABG. This study confirmed that cerebral protection could be the main benefit associated with the use of Mini-CPB.
ACCESSION #
50229741

 

Related Articles

  • Impact of avoiding cardiopulmonary bypass for coronary surgery on perioperative cardiac enzyme release and survival Kuduvalli, Manoj; Newall, Nick; Stott, Anthony; Grayson, Antony D.; Fabri, Brian M. // European Journal of Cardio-Thoracic Surgery;May2006, Vol. 29 Issue 5, p729 

    Abstract: Objective: This study examines the association between avoiding the use of cardiopulmonary bypass (CPB) for coronary surgery and postoperative cardiac enzyme (CE) release, and its subsequent impact on survival. Methods: Between January 1999 and September 2002, 3734 consecutive patients...

  • Improvement of cognitive test performance in patients undergoing primary CABG and other CPB-assisted cardiac procedures. van den Goor, J. M.; Saxby, B. K.; Tijssen, J. G.; Wesnes, K. A.; deMol, B. A.; Nieuwland, R. // Perfusion;Sep2008, Vol. 23 Issue 5, p267 

    Cardiac surgical procedures assisted by cardiopulmonary bypass (CPB) impair cognitive functions. Several studies, however, showed that cognitive functions were unaffected in patients undergoing either primary coronary artery bypass grafting (CABG) or more complex surgery assisted by CPB....

  • Effect of cardiopulmonary bypass on lactate metabolism. Mustafa, Iqbal; Roth, Hubert; Hanafiah, Asikin; Hakim, Tarmizi; Anwar, Maizul; Siregar, Erwin; Leverve, Xavier M. // Intensive Care Medicine;Aug2003, Vol. 29 Issue 8, p1279 

    Objective: We have investigated the role of cardiopulmonary bypass on lactate metabolism in patients undergoing uncomplicated surgery for elective coronary artery bypass grafting (CABG).Design: Prospective non-randomized observational study.Settings:...

  • Using decision-analysis and meta-analysis to predict coronary artery bypass surgical outcomes - a model for comparing off-pump surgery to miniaturized cardiopulmonary bypass circuits. Sistino, J. J. // Perfusion;Sep2008, Vol. 23 Issue 5, p255 

    Coronary artery bypass (CABG) surgery with cardiopulmonary bypass (CPB) has been the "gold standard" for many years. However, methods to conduct off-pump coronary artery bypass (OPCAB) surgery with a beating heart have decreased the use of CPB. Improvements in cardiopulmonary bypass technology,...

  • A comparison of several variables of off-pump coronary artery bypass procedures versus myocardial revascularization utilizing cardiopulmonary bypass. Zarro, Debra L; Palanzo, David A; Montesano, Ralph M // Perfusion;Jan2002, Vol. 17 Issue 1, p9 

    An investigation was conducted to compare several variables of off-pump coronary artery bypass (OPCAB) procedures with those using cardiopulmonary bypass (CPB) for myocardial revascularization by two surgeons. The patients were divided into four groups: group 1 patients received CPB for their...

  • Is cardiopulmonary bypass a reason for aspirin resistance after coronary artery bypass grafting? Zimmermann, Norbert; Kurt, Muhammed; Wenk, Angela; Winter, Joachim; Gams, Emmeran; Hohlfeld, Thomas // European Journal of Cardio-Thoracic Surgery;Apr2005, Vol. 27 Issue 4, p606 

    Abstract: Objective: ‘Off-pump’ coronary artery bypass grafting (OPCAB) is an alternative to conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB). While midterm results after OPCAB have become available, systematic studies of changes in platelet...

  • Comparison of Pulmonary Gas Exchange in OPCAB Versus Conventional CABG. Syed, Aitizaz; Fawzy, Hosam; Farag, Atef; Nemlander, Arto // Heart, Lung & Circulation;Jun2004, Vol. 13 Issue 2, p168 

    Background. Cardiopulmonary bypass has been implicated as a cause of acute lung injury in cardiac surgical patients. This could be avoided with off-pump coronary artery bypass surgery.Aim. To ascertain the possible benefit of OPCAB surgery on pulmonary gas exchange.Methods. We randomized 75...

  • Off-Pump Bypass Surgery—Ready for the Big Dance? Peterson, Eric D.; Mark, Daniel B. // JAMA: Journal of the American Medical Association;4/21/2004, Vol. 291 Issue 15, p1897 

    Presents an editorial that discusses coronary artery bypass graft surgery with cardiopulmonary bypass versus off-pump coronary artery bypass surgery. Description of the two procedures; Controversial aspect of off-pump coronary artery bypass surgery; Background on the development of the...

  • Tubular proteinuria and enzymuria following open heart surgery. Blaikley, John; Sutton, Peter; Walter, Mary; Lapsley, Martha; Norden, Anthony; Pugsley, Wilf; Unwin, Robert // Intensive Care Medicine;Aug2003, Vol. 29 Issue 8, p1364 

    Objective: We investigated the effect of cardiac surgery on a marker of tubular damage, an enzyme called neutral endopeptidase (NEP), and on a marker of tubular function, retinol binding protein (RBP). Markers of tubular damage or function are useful in the early detection of acute...

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