Original article: cardiovascularOff-pump versus on-pump coronary bypass in high-risk subgroups☆
Section snippets
Patients and methods
Our database of OPCAB patients undergoing complete revascularization without CPB from 1997 to 1999 was compared to our database of routine coronary artery bypass grafting (CABG) cases utilizing CPB. Various preoperative, intraoperative, and postoperative variables were studied between the groups as a whole as well as within various high-risk subgroups. These high-risk subgroups included profound ventricular dysfunction (ejection fraction ≤ 0.25 as assessed by left ventriculography or
Results
There were 242 consecutive OPCAB patients; 7 cases were done utilizing a left posterolateral thoracotomy and the remainder using a full median sternotomy approach. These were compared to 483 standard CABG patients.
Preoperative risk factors were similar between the two groups. The preoperative incidence of COPD, preoperative stroke or transient ischemic attack, and renal insufficiency for the OPCAB versus on-pump groups was 14% versus 9%, 12% versus 8.3%, and 11% versus 9.5%, respectively. The
Comment
The interaction between the inflammatory, coagulation, and fibrinolytic cascades occurring during CPB, and their contribution to end-organ injury, are complex. Studies on the beneficial physiologic effects of aprotinin reveal how these pathways are closely linked and mutually dependent [10]. Aprotinin directly inhibits plasmin, as well as inhibiting kallikrein, thus reducing the activation of complement and the formation of bradykinin, tissue plasminogen activator, and factor XIIa. This limits
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Cited by (190)
Repeat Coronary Artery Bypass Grafting: A Meta-Analysis of Off-Pump versus On-Pump Techniques in a Large Cohort of Patients
2021, Heart Lung and CirculationCitation Excerpt :Perioperative data for the OPCAB and ONCAB procedures are presented in detail in Tables S2 and S3. Twenty-one (21) studies consistently reported data regarding perioperative mortality data [10,21–23,25–29,31–42]. The 30-day mortality rate was 3.4% (n=68/2,024) and 7.4% (n=238/3,225) in the OPCAB and ONCAB repeat CABG groups, respectively.
On- or off-pump coronary artery bypass grafting for octogenarians: A meta-analysis of comparative studies involving 27,623 patients
2017, International Journal of SurgeryOff-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis
2016, Journal of Thoracic and Cardiovascular SurgeryOff-pump coronary artery bypass reduces early stroke in octogenarians: A meta-analysis of 18,000 patients
2015, Annals of Thoracic Surgery
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