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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
[Results of coronary artery bypass grafting with left ventricular dysfunction (comparison of off-pump versus
M Ait Houssa1, Y Moutakiallah, A Abdou
1Service de chirurgie cardiovasculaire, hôpital militaire d'instruction Mohamed V, BP 10100, Rabat, Maroc.
Insights
Off-pump coronary artery bypass grafting (OCABG) offers favorable outcomes for patients with reduced left ventricular function compared to conventional coronary artery bypass grafting (CCABG). OCABG demonstrated reduced operative times and hospital stays, with similar mortality rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for myocardial revascularization.
- Patients with impaired left ventricular function present unique challenges during cardiac surgery.
- Comparing outcomes of on-pump versus off-pump CABG in this patient group is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the clinical outcomes of myocardial revascularization with and without cardiopulmonary bypass in patients with reduced left ventricular ejection fraction (EF).
- To evaluate the safety and efficacy of off-pump coronary artery bypass grafting (OCABG) versus conventional coronary artery bypass grafting (CCABG) in a specific patient cohort.
Main Methods:
- Retrospective analysis of 516 consecutive CABG patients (2000-2007), focusing on 108 with left ventricular EF ≤ 45%.
- Comparison between 78 patients undergoing CCABG and 30 patients undergoing OCABG.
- Evaluation of pre-, peri-, and postoperative variables, including operative time, hospital mortality, graft number, postoperative myocardial infarction, and ejection fraction changes.
Main Results:
- Patients in the CCABG group were older and had a significantly higher left ventricular EF compared to the OCABG group.
- CCABG involved more grafts per patient and longer operative times, operative room stays, and ventilation times.
- While CCABG showed a higher incidence of postoperative myocardial infarction, the EF improved more significantly in this group. Hospital mortality was not significantly different between groups.
Conclusions:
- Off-pump coronary artery bypass surgery demonstrates satisfactory operative results for patients with reduced left ventricular function.
- Further prospective and randomized studies are warranted to definitively establish the superiority of OCABG in this patient population.
Background:
The aim of this study was to compare the results of myocardial revascularisation with or without cardiopulmonary bypass in patients with impaired left ventricular function.
Patients And Methods:
Five hundred and sixteen consecutive patients who underwent coronary artery bypass grafting from January 2000 through December 2007 were analyzed retrospectively. One hundred and eight cases had a left ventricular EF (ejection fraction) of 45% or less. Of these patients, 78 underwent conventional coronary artery bypass (CCABG) and 30 underwent off-pump procedure (OCABG). The CCABG group received 300IU/kg of heparin while the OCABG received 100IU/kg. The off-pump coronary surgery was carried out using a tissue stabilizer Octopus II. Different pre-, per- and postoperative variables were evaluated among both groups. Statistical analysis was performed by SPSS 11.5. The variables were compared between these two groups using univariate analysis (Chi(2) test, Fisher's test exact) for qualitative variable and (Student's t test, Mann-Whitney's test) for quantitative variable.
Results:
Patients profiles and risk factors were similar among both groups except for age (CCABG: 57.8±9.2 year vs OCABG: 52±9.9 year; P=0.004) and left ventricular EF (CCABG: 37.4±6.3% vs OCABG: 34±7.8%; P=0.02). The number of grafts performed per patient was significantly more among patients who underwent extracorporeal circulation (CCABG: 2.53±0.7 graft/patient vs OCABG: 1.77±0.8 graft/patient; P<0.0001). The hospital mortality was more among CCABG group 9% vs 3.3% in OCABG but the difference was not significant (P=0.3). However, the operative time and the operative room stay were long in CCABG (252±61min vs 175±38min; P<0.0001 - 389±70min vs 298±54min; P<0.0001). The ventilation time was also long in CCABG (32.3±67hour vs 10.4±5.9hour; P=0.15). There was more postoperative myocardial infarction in CCABG (P=0.008), but the EF increased and was better in CCABG.
Conclusion:
Off-pump coronary artery bypass surgery provides satisfactory operative results for most patients with reduced left ventricular function. Prospective and randomly study will be necessary before concluding.
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