Outcome of Coronary Artery Bypass Grafts: Comparison between on Pump and off Pump
AbstractThe present study was undertaken to compare the in hospital results of coronary artery bypass graft (CABG) with (on pump) or without (off pump) cardiopulmonary bypass (CPB). Data were collected on all first-time isolated CABGs with saphenous vein and/or artery grafts at Shahid Madani Hospital in Tabriz-Iran, between 2006 and 2009. Age and clinical profile were marched between on pump and off pump group patients. Patients with concomitant cardiac operations or beating pump technique were excluded from the study. The study included 994 patients; CABG with CPB (ONCABG) was done in 578 (58%) and CABG without CPB (OPCABG) in 416 (42%). For pump and off pump group respectively, mortality rate was 2/3%, and 0.2%, the number of grafts was2/92 ± 0.82 and 2/12 ±o.73 and the use of intra aortic balloon-pump (IABP) was1.5% and5.4%. Post operative ejection fraction (EF) was improved in off pump group (47.9±0.6) versus on pump group (44.53±1.5) and the latter group had more post operative atrial fibrillation, Stroke, acute renal failure, bleeding rate and blood products transfusion, prolonged intubation time but was not statistically significance. Meanwhile Hospitalization time and use of inotrops was less in comparison with former patients group. Off pump CABG was a safe method in our series. Patients with comparable risk profiles have similar prevalence's of selected complications after ONCABG and OPCABG, though some clinical and hemodynamic results are better with off pump technique.
FitzGibbon GM, Leach AJ, Keon WJ, Burton JR, Kafka HP. Coronary bypass graft fate. Angiographic study of 1,179 vein grafts early, one year, and five years after operation. J Thorac Cardiovasc Surg 1986;91(5):773-8.
Kirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983;86(6):845-57.
Edmunds LH Jr. The evolution of cardiopulmonary bypass: lessons to be learned. Perfusion 2002;17(4):243-51.
Safaei N. Outcomes of coronary artery bypass grafting in patients with a history of opiate use. Pak J Biol Sci 2008;11(22):2594-8.
Levy JH, Hug CC Jr. Use of cardiopulmonary bypass in studies of the circulation. Br J Anaesth 1988;60(8 Suppl1):35S-37S.
Kolkka R, Hilberman M. Neurologic dysfunction following cardiac operation with low-flow, low-pressure cardiopulmonary bypass. J Thorac Cardiovasc Surg 1980;79(3):432-7.
Pacifico AD, Digerness S, Kirklin JW. Acute alterations of body composition after open intracardiac operations. Circulation 1970;41(2):331-41.
Lloyd J, Newman J, Brigham K: Permeability pulmonary edema: diagnosis and management. Arch Intern Med 1984;144:143.
Tönz M, Mihaljevic T, von Segesser LK, Fehr J, Schmid ER, Turina MI. Acute lung injury during cardiopulmonary bypass. Are the neutrophils responsible? Chest 1995;108(6):1551-6.
Abel RM, Buckley MJ, Austen WG, Barnett GO, Beck CH Jr, Fischer JE. Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. J Thorac Cardiovasc Surg 1976;71(3):323-33.
Krasna MJ, Flancbaum L, Trooskin SZ, Fitzpatrick JC, Scholz PM, Scott GE, et al. Gastrointestinal complications after cardiac surgery. Surgery 1988;104(4):773-80.
Darwazah AK, Abu Sham'a RA, Hussein E, Hawari MH, Ismail H. Myocardial revascularization in patients with low ejection fraction < or =35%: effect of pump technique on early morbidity and mortality. J Card Surg 2006;21(1):22-7.
Yokoyama T, Baumgartner FJ, Gheissari A, Capouya ER, Panagiotides GP, Declusin RJ. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg 2000;70(5):1546-50.
Kerendi F, Puskas JD, Craver JM, Cooper WA, Jones EL, Lattouf OM, et al. Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients. Ann Thorac Surg 2005;79(3):801-6.
Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA 1996;276(4):300-6.
Almassi GH, Sommers T, Moritz TE, Shroyer AL, London MJ, Henderson WG, et al. Stroke in cardiac surgical patients: determinants and outcome. Ann Thorac Surg 1999;68(2):391-7; discussion 397-8.
Haase M, Sharma A, Fielitz A, Uchino S, Rocktaeschel J, Bellomo R, et al. On-pump coronary artery surgery versus off-pump exclusive arterial coronary grafting: a matched,cohort comparison. Ann Thorac Surg 2003;75(1):62-7.
Louagie Y, Jamart J, Broka S, Collard E, Scavée V, Gonzalez M. Off-pump coronary artery bypass grafting: a case-matched comparison of hemodynamic outcome. Eur J Cardiothorac Surg 2002;22(4):552-8.
Diegeler A, Doll N, Rauch T, Haberer D, Walther T, Falk V, et al. Humoral immune response during coronary artery bypass grafting: A comparison of limited approach, "offpump" technique, and conventional cardiopulmonary bypass. Circulation 2000;102(19 Suppl 3):III95-100.
Place DG, Peragallo RA, Carroll J, Cusimano RJ, Cheng DC. Postoperative atrial fibrillation: a comparison of offpump coronary artery bypass surgery and conventional coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2002;16(2):144-8.
Magee MJ, Jablonski KA, Stamou SC, Pfister AJ, Dewey TM, Dullum MK, et al. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients. Ann Thorac Surg 2002;73(4):1196- 202; discussion 1202-3.
Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;125(4):797-808.
Järvinen O, Laurikka J, Tarkka MR. Off-pump versus onpump coronary bypass. Comparison of patient characteristics and early outcomes. J Cardiovasc Surg (Torino) 2003;44(2):167-72.
Lee JH, Abdelhady K, Capdeville M. Clinical outcomes and resource usage in 100 consecutive patients after offpump coronary bypass procedures. Surgery 2000;128(4):548-55.
Ascione R, Reeves BC, Rees K, Angelini GD. Effectiveness of coronary artery bypass grafting with or without cardiopulmonary bypass in overweight patients. Circulation 2002;106(14):1764-70.
Mack MJ, Pfister A, Bachand D, Emery R, Magee MJ, Connolly M, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg 2004;127(1):167-73.