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https://www.readbyqxmd.com/read/28074802/goal-directed-therapy-improves-the-outcome-of-high-risk-cardiac-patients-undergoing-off-pump-coronary-artery-bypass
#1
Poonam Malhotra Kapoor, Rohan Magoon, Rajinder Singh Rawat, Yatin Mehta, Sameer Taneja, R Ravi, Milind P Hote
BACKGROUND: There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28074788/comparison-of-two-doses-of-heparin-on-outcome-in-off-pump-coronary-artery-bypass-surgery-patients-a-prospective-randomized-control-study
#2
Murali Chakravarthy, Dattatreya Prabhakumar, Patil Thimmannagowda, Jayaprakash Krishnamoorthy, Antony George, Vivek Jawali
INTRODUCTION: While off pump coronary artery bypass surgery is practiced with an intention to reduce the morbidity associated with cardiopulmonary bypass, the resultant 'hypercoagulability' needs to be addressed. Complications such as cavitary thrombus possibly due to the hyper coagulability after off pump coronary artery bypass surgery have been described. Many clinicians use higher doses of heparin - up to 5 mg/kg in order to thwart this fear. Overall, there appears to be no consensus on the dose of heparin in off pump coronary artery bypass surgeries...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27955911/impact-of-multiple-arterial-grafts-in-off-pump-and-on-pump-coronary-artery-bypass-surgery
#3
Umberto Benedetto, Massimo Caputo, Giovanni Mariscalco, Mario Gaudino, Pierpaolo Chivasso, Alan Bryan, Gianni D Angelini
OBJECTIVES: There is growing concern that off-pump coronary artery bypass (OPCAB) is associated with reduced long-term survival compared with traditional on-pump coronary artery bypass (ONCAB); however, most of available comparisons between OPCAB and ONCAB focus on single-artery (SA) revascularization. We sought to investigate the impact of using multiple arterial (MA) conduits in the comparison between OPCAB versus ONCAB by performing a single-center, long-term propensity score base analysis...
November 16, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27942403/the-future-of-off-pump-coronary-artery-bypass-grafting-a-north-american-perspective
#4
Bobby Yanagawa, Rashmi Nedadur, John D Puskas
Off-pump coronary artery bypass graft (OPCAB) is currently performed routinely in a minority of specialized centers and in many more centers, utilized only when a porcelain aorta mandates a no-touch aortic technique. The OPCAB literature can be summarized as follows: (I) large-scale randomized trials in relatively low risk patients that include surgeons with a range of experience demonstrating no consistent beneficial differences in major cardiovascular and cerebrovascular outcomes but lower transfusion rates and shorter length of stay, tempered by some reports of higher rates of incomplete revascularization and lower rates of long term graft patency; (II) smaller randomized controlled trials (RCTs) from highly specialized programs demonstrating equivalent or superior outcomes with OPCAB and similar completeness of revascularization and graft patency; and (III) observational data from large databases demonstrating a consistent benefit of OPCAB, especially in higher-risk patient subsets...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27942401/two-decades-of-off-pump-coronary-artery-bypass-surgery-harefield-experience
#5
REVIEW
Shahzad G Raja
The morbidity and mortality associated with conventional coronary artery bypass grafting (CABG) attributed to invasiveness of cardiopulmonary bypass (CPB) has been well documented. Recognition of this invasiveness with a focus centered on abolishing, or at least reducing the CPB associated morbidity and mortality led to the resurgence of off-pump coronary artery bypass (OPCAB) surgery nearly two decades ago. At about the same time, OPCAB was adopted at Harefield hospital partly as an institutional drive to promote innovation and partly as a strategy to improve outcomes...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27942400/we-should-ban-the-opcab-approach-in-cabg-just-as-we-should-ban-jetliners-and-bicycles-or-maybe-not
#6
REVIEW
Paul Sergeant
Implementing a new technical process demands a complex preparation. In cardiac surgery this complex preparation is often reduced to visiting a surgeon who is familiar with a technique. The science of learning has identified that several steps are needed towards a successful implementation. The first step is the creation of a complete conceptual approach; this demands the deposit in writing of the actions and reactions of every involved party in this new approach. By definition a successful implementation starts with the creation of a group of involved individuals willing to collaborate towards a new goal...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27942399/impact-of-off-pump-coronary-artery-bypass-grafting-on-survival-current-best-available-evidence
#7
REVIEW
Pierpaolo Chivasso, Gustavo A Guida, Daniel Fudulu, Vito D Bruno, Roberto Marsico, Hristo Sedmakov, Mustafa Zakkar, Filippo Rapetto, Alan J Bryan, Gianni D Angelini
The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass grafting (CABG) remains unclear despite a large body of literature evidence comparing the two approaches. The potential advantages of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation and maintaining pulsatile flow may be associated with reduced inflammatory responses and embolic events. Numerous studies compared OPCAB with ONCAB and the cumulative data have been presented in meta-analyses of both randomized and observational studies...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27942398/off-pump-coronary-artery-bypass-grafting-in-octogenarians
#8
REVIEW
Shahzad G Raja
Enhanced life expectancy has confronted cardiac surgery with a rapidly growing population of octogenarians needing coronary artery bypass grafting (CABG). Octogenarians are deemed a high-risk patient population with increased postoperative morbidity and mortality following conventional CABG using cardiopulmonary bypass (CPB). In such patients reducing the invasiveness of the surgical procedure by avoiding CPB may be tried in an attempt to improve outcomes. The increasing performance of off-pump coronary artery bypass (OPCAB) grafting within certain centers reflects surgeon preference to avoid the inherent risks of CPB and cardioplegic arrest including hemodilution, nonpulsatile arterial flow, global myocardial ischemia, atherosclerotic embolization from aortic manipulation, and systemic inflammatory response...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27942397/off-pump-coronary-artery-bypass-grafting-in-high-risk-patients-a-review
#9
REVIEW
Gustavo A Guida, Pierpaolo Chivasso, Daniel Fudulu, Filippo Rapetto, Christo Sedmakov, Roberto Marsico, Mustafa Zakkar, Alan J Bryan, Gianni D Angelini
The role of off-pump coronary artery bypass (OPCAB) grafting in high risk patients remains controversial. While there have been studies showing the potential benefits of it, there is still a lot to be learned from the application of this technique in this sub-group of patients. The results of the different trials and papers that we reviewed seem to indicate a benefit in the OPCAB group. Despite of the fact that trials were significantly different in methodology, especially when choosing the risk score stratification tool or the cut-off to define high risk the literature seems to suggest a benefit from the use of OPCAB surgery...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27942394/current-outcomes-of-off-pump-versus-on-pump-coronary-artery-bypass-grafting-evidence-from-randomized-controlled-trials
#10
REVIEW
Daniel Fudulu, Umberto Benedetto, Gustavo Guida Pecchinenda, Pierpaolo Chivasso, Vito Domenico Bruno, Filippo Rapetto, Alan Bryan, Gianni Davide Angelini
Coronary artery bypass grafting remains the standard treatment for patients with extensive coronary artery disease. Coronary surgery without use of cardiopulmonary bypass avoids the deleterious systemic inflammatory effects of the extracorporeal circuit. However there is an ongoing debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass (ONCAB versus OPCAB) surgery. The current review is based on evidence from randomized controlled trials (RCTs) and meta-analyses of randomized studies...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27931550/off-pump-coronary-artery-bypass-grafting-using-continuous-heparin-infusion
#11
Kamales Kumar Saha, Dinesh Kumar Sangwan, Pravin K Shroff, Mandar Manohar Deval, Kakalee K Saha, Rinu V Jacob, Ratnaprobha Adsul, Lukash Jagdale
OBJECTIVES: Levels of anticoagulation during off-pump coronary artery bypass grafting (OPCAB) remain controversial. Prolonged activated clotting time (ACT) during OPCAB increases blood loss during surgery and can also cause paradoxical increase in postoperative myocardial infarction. Shorter ACT can increase thrombotic complication. Maintaining a steady ACT level is challenging. We have used continuous heparin infusion after initial bolus during OPCAB to maintain a steady low target ACT...
November 2016: Indian Heart Journal
https://www.readbyqxmd.com/read/27894326/preserved-autoregulation-of-coronary-flow-after-off-pump-coronary-artery-bypass-grafting-retrospective-assessment-of-intraoperative-transit-time-flowmetry-with-and-without-intra-aortic-balloon-counterpulsation
#12
Hiroyuki Nakajima, Atsushi Iguchi, Mimiko Tabata, Masaru Kambe, Masahiro Ikeda, Kazuhiko Uwabe, Toshihisa Asakura, Hiroshi Niinami
BACKGROUND: Intra-aortic balloon pumping (IABP) markedly increases graft flow after coronary artery bypass grafting (CABG) with cardiopulmonary bypass. We sought to delineate the effects of IABP on graft flow after off-pump CABG (OPCAB). METHODS: The clinical records of 32 patients (25 male, 7 female; mean age: 70 ± 9 years) who underwent OPCAB with IABP between January 2011 and May 2015 were retrospectively reviewed. Thirteen patients (41%) had a history of myocardial infarction, and 13 patients (41%) had a history of percutaneous coronary intervention...
November 28, 2016: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/27856132/long-term-outcome-of-isolated-off-pump-coronary-artery-bypass-grafting-in-patients-with-coronary-artery-disease-and-mild-to-moderate-aortic-stenosis
#13
Kizuku Yamashita, Tomoyuki Fujita, Hiroki Hata, Yusuke Shimahara, Yuta Kume, Yorihiko Matsumoto, Junjiro Kobayashi
BACKGROUND: The best management strategy for patients with coronary disease and mild to moderate AS requires the clinician to consider the operative risks of isolated coronary artery bypass grafting (CABG) against the risks of untreated aortic stenosis (AS). METHODS: Between 2000 and 2014, isolated off-pump CABG (OPCAB) was performed in 2023 patients. Of these patients, 103 presented with mild or moderate AS (mean age 72.7±6.3 years; 23 females), 96 (93.2%) presented with mild AS and seven (6...
November 14, 2016: Journal of Cardiology
https://www.readbyqxmd.com/read/27830337/the-impact-of-surgical-left-atrial-appendage-amputation-ligation-on-stroke-prevention-in-patients-undergoing-off-pump-coronary-artery-bypass-grafting
#14
Daisuke Endo, Tomoko S Kato, Tai Iwamura, Atsumi Oishi, Yasutaka Yokoyama, Kenji Kuwaki, Hirotaka Inaba, Atsushi Amano
Stroke is a major adverse event in patients developing atrial fibrillation (AF) after cardiac surgery. Surgical left atrial appendage amputation/ligation (LAA-A/L) during off-pump coronary artery bypass grafting (OPCAB) is routinely performed in our institution. We analyzed 578 consecutive patients (mean age 69 years, male 82%) undergoing OPCAB with or without concomitant LAA-A/L from 2011 to 2014 at our institution in a prospective observational manner. The safety and efficacy of the concomitant LAA-A/L on preventing early (<30 days) and overall postoperative stroke were examined...
November 9, 2016: Heart and Vessels
https://www.readbyqxmd.com/read/27821823/-new-intracoronary-shunt-cannula-in-off-pump-coronary-artery-bypass-grafting
#15
Masaki Tabuchi, Ryo Harada, Akitatsu Yamashita, Seiichi Funamoto, Kazutoshi Tachibana, Yasuko Miyaki, Nobuyuki Takagi, Shinya Terada, Daisuke Toritsuka, Akihiko Yamauchi, Tetsuya Higami
In off-pump coronary artery bypass grafting(OPCAB), a bloodless operative field has great influence on the quality of anastomosis. In addition, maintenance of distal coronary flow during anastomosis stabilizes hemodynamics. We introduced a new intracoronary shunt cannula, Mini Shunt Pro (MSP). MSP adopts the step-tip, which allows easy insertion and reduces the risk of intimal injury. The distal and proximal sides of the tips of MSP are 0.25 mm different in diameter, which improves its fitness to the coronary artery and enhances a bloodless operative field...
November 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27782315/minimally-circulatory-assisted-on-pump-beating-coronary-artery-bypass-grafting-for-patients-with-complex-conditions-for-off-pump-surgery
#16
Tomohiro Mizuno, Koso Egi, Kenji Sakai, Keiji Oi, Tsuyoshi Hachimaru, Tohru Makita, Kiyotoshi Oishi, Hirokuni Arai
Off-pump coronary artery bypass grafting (OPCAB) in patients with acute myocardial infarction (AMI) is difficult because of circulatory deterioration during displacement of the heart. At our institution, we performed minimally circulatory-assisted on-pump beating coronary artery bypass grafting (MICAB) in these patients. During MICAB, support flow was controlled at a minimal level to maintain a systemic blood pressure of approximately 100 mm Hg and a pulmonary arterial systolic pressure of <30 mm Hg, providing optimal pulsatile circulation for end-organ perfusion and prevention of heart congestion...
October 26, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27777946/the-effects-of-diabetes-mellitus-in-patients-undergoing-off-pump-coronary-artery-bypass-grafting
#17
Yu Liu, Jinsong Han, Tao Liu, Zhonglu Yang, Hui Jiang, Huishan Wang
Objective. To investigate the effects of diabetes mellitus (DM) in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Method. A total of 728 patients with DM and 1380 patients without DM who underwent OPCAB treatment from March 2012 to April 2015 were reviewed. The effects of DM on intraoperative variables and postoperative complications were determined using propensity score analysis. Results. Two well-matched subgroups were selected using propensity score analysis (DM = 728, no-DM = 728) to compare the perioperative outcome...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27777290/long-term-survival-and-freedom-from-reintervention-after-off-pump-coronary-artery-bypass-grafting-a-propensity-matched-study
#18
Bilal H Kirmani, Michael V Holmes, Andrew D Muir
BACKGROUND: The long-term outcomes of off-pump coronary artery bypass grafting (CABG) are the subject of speculation. Our institution has >15 years of experience performing CABG both off-pump (OPCAB) and on cardiopulmonary bypass (CPB). Our null hypothesis was that there would be no difference in a long-term composite of death and revascularisation between the 2 methods. METHODS: We performed a retrospective cohort study of all isolated CABG at our institution from 2001 to 2015...
October 25, 2016: Circulation
https://www.readbyqxmd.com/read/27761444/outcomes-of-off-pump-versus-on-pump-coronary-artery-bypass-graft-surgery-in-patients-with-severely-dilated-left-ventricle
#19
Sen Li, Wenhui Gong, Quan Qi, Zezhe Yuan, Anqing Chen, Jun Liu, Junfeng Cai, Mi Zhou, Zhe Wang, Xiaofeng Ye, Qiang Zhao
BACKGROUND: Currently, off-pump coronary artery bypass (OPCAB) grafting has been the standard procedure for surgical revascularization in patients with coronary artery disease (CAD). This study aimed to examine the safety and applicability of OPCAB compared with on-pump coronary artery bypass (ONCAB) in patients with severely dilated left ventricle. METHODS: A retrospective study of giant left ventricle patients [left ventricular end diastolic diameter (LVEDD) ≥ VE mm] undergoing coronary bypass grafting from 2009 through 2015 at a single center was conducted...
September 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27665857/atrial-fibrillation-following-off-pump-versus-on-pump-coronary-artery-bypass-grafting-incidence-and-risk-factors
#20
Łukasz Lewicki, Janusz Siebert, Jan Rogowski
BACKGROUND: Postoperative atrial fibrillation (AF) is a common arrhythmia that occurs after coronary artery bypass grafting (CABG). New surgical techniques, particularly off-pump coronary artery bypass (OPCAB), are thought to be less invasive and results in fewer complications, i.e. AF, but available data are inconsistent. The aim of this study is to present the incidence and risk factors of AF in patients operated on with or without cardiopulmonary bypass. METHODS: We studied 1836 consecutive patients with stable coronary artery disease who were operated on with (CABG) or without (OPCAB) cardiopulmonary bypass...
September 26, 2016: Cardiology Journal
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