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Off-Pump Versus On-Pump Coronary Artery Bypass Grafting In Patients With Chronic Obstructive Pulmonary Disease
Karim Mohamed Mady1, Amr Ahmed Abdou Ettish1, Wael Mohamed Elfeky1
1Department of Cardiothoracic Surgery, Kafrelsheikh University,Egypt.
Insights
Off-pump coronary artery bypass grafting (CABG) offers a faster recovery for patients with chronic obstructive pulmonary disease (COPD). This method showed reduced mechanical ventilation and shorter hospital stays compared to traditional on-pump CABG.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Medicine
- Medical Technology
Background:
- Coronary artery disease (CAD) frequently coexists with chronic obstructive pulmonary disease (COPD).
- Surgical management of CAD in COPD patients presents unique challenges due to compromised pulmonary function.
- Cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) may exacerbate respiratory complications in COPD patients.
Purpose of the Study:
- To compare the postoperative outcomes of off-pump coronary artery bypass grafting (OPCAB) versus on-pump CABG in patients with both ischemic heart disease and COPD.
- To evaluate the impact of CPB on respiratory and overall recovery in this high-risk patient population.
Main Methods:
- A prospective, randomized, multicenter study involving 60 patients with ischemic heart disease and COPD.
- Patients were randomized into two groups: Group I (on-pump CABG) and Group II (off-pump CABG).
- Postoperative outcomes assessed included duration of mechanical ventilation, respiratory failure, pneumonia, intensive care unit (ICU) stay, and overall hospital stay.
Main Results:
- The off-pump group (Group II) demonstrated significantly shorter durations of mechanical ventilation (6.97±2.25 min vs. 12.07±5.18 min, p<0.001) and ICU stay (3.03±1.03 days vs. 4.17±1.64 days, p<0.001) compared to the on-pump group (Group I).
- Overall hospital stay was also significantly shorter in the off-pump group (5.93±1.17 days vs. 7.40±1.90 days, p<0.001).
- No significant differences were observed between the groups in the incidence of respiratory failure, pneumonia, atrial fibrillation, ARDS, pleural effusion, atelectasis, or sternal dehiscence.
Conclusions:
- Off-pump coronary artery bypass grafting is an efficient and safe alternative for patients with COPD, leading to a faster postoperative recovery.
- OPCAB reduces the duration of mechanical ventilation and hospital stay, potentially mitigating risks associated with cardiopulmonary bypass in this vulnerable population.
Objectives:
To compare the outcome of coronary artery bypass grafting with and without cardiopulmonary bypassin patients of chronic obstructive pulmonary disease.
Method:
The prospective randomised multicentre study was conducted in 2020 at Kafrelsheikh University Hospital, International Cardiac Centre and Alexandria New Medical Centre, Egypt. Patients regardless of age and gender who had ischaemic heart disease and chronic obstructive pulmonary disease were enrolled, and randomised into on-pump procedure group 1 and off-pump procedure group II. All patients were assessed preoperatively for pulmonary function tests and postoperatively for duration of mechanical ventilation, respiratory failure, pneumonia, atrial fibrillation, acute respiratory distresssyndrome, pleural effusion, lung atelectasis, sternal dehiscence, intensive care unit stay and overall hospital stay. Data was analysed using SPSS ver 25 Armonk, NY: IBM Corp.; Released 2017.
Results:
Of the 60 patients, 30(50%) were in each of the two groups. Overall, there were 20(33.3%) women and 40(66.6%) men with mean age 56.5±6.05 years. The mean duration of mechanical ventilation in group I was 12.07±5.18 minutes compared to 6.97±2.25 minutes in group II (p<0.001). The mean duration of stay in intensive care unit in group I was 4.17±1.64 days compared to 3.03±1.03 days in group II (p<0.001). The mean hospital stay was 7.40±1.90 days in group I and 5.93±1.17 days in group II (p<0.001). There was no significant difference between the groups regarding the frequency of respiratory failure, pneumonia, atrial fibrillation, acute respiratory distresssyndrome, pleural effusion, lung atelectasis and sternal dehiscence (p=1.000).
Conclusions:
Off-pump coronary artery bypass grafting wasfound to be efficient and had a faster postoperative course than on-pump procedure in patients with chronic obstructive pulmonary disease.
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