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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
[Operative invasiveness of off-pump coronary artery bypass grafting]
Takanori Suezawa1, Atsushi Aoki, Mitsuhisa Kotani
1Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
Insights
Off-pump coronary artery bypass grafting (OPCAB) offers benefits like reduced blood loss but shows a more severe inflammatory response. Anti-inflammatory medication may enhance OPCAB
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Immunology
Background:
- Steroids are used in conventional coronary artery bypass grafting (CABG) to mitigate inflammatory responses.
- Steroids are typically omitted in off-pump coronary artery bypass grafting (OPCAB) due to its perceived lower invasiveness.
Purpose of the Study:
- To compare the early outcomes and postoperative inflammatory markers between conventional CABG with steroid use and OPCAB.
- To evaluate the impact of steroid administration on inflammatory response in different CABG techniques.
Main Methods:
- A retrospective analysis of 120 patients undergoing elective CABG from May 2004 to April 2010.
- Patients were divided into two groups: conventional CABG (n=28) and OPCAB (n=92).
- Perioperative courses were analyzed and compared between the two groups.
Main Results:
- OPCAB demonstrated shorter operative duration, reduced blood transfusion needs, and improved myocardial protection compared to conventional CABG.
- Postoperative paroxysmal atrial fibrillation rates were similar between the two techniques.
- Early postoperative C-reactive protein levels were significantly higher in the OPCAB group, indicating a more pronounced inflammatory response.
Conclusions:
- OPCAB offers advantages in blood loss and myocardial protection over conventional CABG.
- The inflammatory response following OPCAB is significantly more severe than with conventional CABG.
- Incorporating anti-inflammatory medications could potentially reduce the invasiveness of OPCAB procedures.
Objective:
In our institution, steroid is administrated intravenously during the anesthesia induction for conventional coronary artery bypass grafting( CABG) to prevent the inflammatory response due to cardiopulmonary bypass and reperfusion injury, however, steroid is not used for off-pump CABG (OPCAB) with expectation of less invasiveness of the procedure. We evaluated the early outcomes and postoperative inflammatory response of conventional CABG with preoperative steroid use and OPCAB.
Methods:
From May 2004 to April 2010, 120 patients underwent elective CABG requiring the ventricle elevation to expose the target vessels. Twenty eight patients(group C)treated with conventional CABG and 92 patients (group O) with OPCAB. Perioperative course was analyzed and compared between the 2 groups.
Results:
OPCAB had several advantages such as shorter operative duration, decreased requirement of blood transfusion and myocardial protection compared with conventional CABG. However, frequency of postoperative paroxysmal atrial fibrillation was similar between these techniques and early postoperative C-reactive protein levels were shown to be significantly higher in OPCAB.
Conclusions:
OPCAB has advantage over conventional CABG in blood loss during surgery and myocardial protection. However the inflammatory response was significantly severe in OPCAB. OPCAB might become less invasive with the anti-inflammatory medication.
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