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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Off pump coronary artery surgery and intraoperative safety-experience at AFIC/NIHD, Rawalpindi
Mahrukh Zahoor1, Muhammed Mafsheen Iqbal, Shahab Naqvi
1Department of Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan. mahrukh04@yahoo.com
Insights
Off-pump coronary artery bypass (OPCAB) surgery is associated with more intraoperative dysrhythmias and inotropic use compared to conventional on-pump coronary artery bypass grafting (CABG). This suggests OPCAB may have lower procedural safety.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
Background:
- Conventional Coronary Artery Bypass Grafting (CABG) using cardiopulmonary bypass (CPB) offers controlled hemodynamics but carries risks.
- Off-pump coronary artery bypass (OPCAB) has gained interest due to CPB risks, but faces challenges like hemodynamic instability and dysrhythmias.
- These complications can necessitate emergency conversion to on-pump procedures.
Purpose of the Study:
- To compare intraoperative dysrhythmias during OPCAB versus conventional CABG.
- To evaluate the need for inotropic support for hemodynamic stabilization in OPCAB versus CABG.
Main Methods:
- A comparative study of consecutive CABG cases between June 2003 and May 2006.
- Exclusion of cases involving conversion to on-pump surgery.
- Analysis of primary endpoints using chi-square and t-tests, with results presented as percentages, means, and p-values.
Main Results:
- The study included 684 patients: 574 on-pump (Group A) and 97 OPCAB (Group B).
- Intraoperative dysrhythmias were significantly higher in OPCAB (15%) compared to on-pump CABG (3.5%, p < 0.0001).
- Inotropic support was also significantly higher in OPCAB (30.3%) versus on-pump CABG (15.3%, p < 0.0001).
Conclusions:
- Off-pump coronary artery bypass surgery demonstrates a higher incidence of intraoperative dysrhythmias.
- Increased use of inotropic agents is required for hemodynamic stabilization in OPCAB procedures.
- These findings indicate potentially lower procedural safety for OPCAB compared to conventional CABG.
Background:
Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass (CPB) on one hand allows controlled haemodynamics with superior graft quality while on the other hand carries inherent risks of CPB which has renewed interest in Off-pump coronary artery bypass (OPCAB). Haemodynamic instability and intraoperative dysrythmias are major procedural complications of OPCAB, threatening conversion to emergency on-pump surgery. The purpose of this study was to compare intraoperative dysrythmias and inotropic use for haemodynamic stabilization during OPCAB surgery against conventional CABG.
Methods:
Consecutive CABG cases operated between 1st June 2003 and 31st May 2006 were included while conversions were excluded. Primary end points were analyzed using chi square and t test and values described in percentages, means and probability (p value).
Results:
Six hundred and eighty-four cases were divided in group-A (on-pump, n = 574) and B (OPCAB, n = 97). Conversion rate was 11.8%. Intraoperative dysrythmias (A, 3.5%, B, 15%, p < 0.0001) and use of inotropic support was higher in group-B (A, 15.3%, B, 30.3%, p < 0.0001). Actual mortality in group-B was higher than the predictive value (A, 3.8%, B, 3.6%, Predictive value 3-5% and 0-3% respectively).
Conclusion:
OPCAB leads to higher frequency of dysrythmias and inotropic use intraoperatively, highlighting lower procedural safety over conventional CABG.
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