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Published on: March 27, 2018
Early Outcome of On-pump Versus Off-pump Elective Surgical Revascularization in Patients with Prior ST-Segment
S I Jahan1, M K Hassan, A S M Khan
1Dr Sakila Israt Jahan, Assistant Professor, Department of Cardiac Surgery, National Institute of Cardiovascular Disease (NICVD), Dhaka, Bangladesh;
Insights
Off-pump coronary artery bypass graft (CABG) surgery is a superior option for patients with a history of ST-elevation myocardial infarction (STEMI). This approach demonstrated better outcomes and improved Left Ventricular Ejection Fraction (LVEF) compared to on-pump CABG.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Trials
Background:
- Coronary artery bypass graft (CABG) surgery is a standard treatment for coronary artery disease.
- A history of ST-elevation myocardial infarction (STEMI) is an independent risk factor influencing CABG outcomes.
- Both on-pump and off-pump CABG are viable options for patients with prior STEMI.
Purpose of the Study:
- To compare the efficacy and outcomes of off-pump versus on-pump CABG in patients with a history of STEMI.
- To identify the optimal surgical revascularization strategy for elective procedures in this patient cohort.
Main Methods:
- A prospective clinical trial involving 60 eligible patients with prior STEMI.
- Patients were divided into two groups: 30 undergoing off-pump CABG (Group A) and 30 undergoing on-pump CABG (Group B).
- Outcomes were assessed from surgery to one month postoperatively, with data analyzed using SPSS 25.0.
Main Results:
- Both surgical approaches were successful, with observed differences in mean grafts per patient and operation duration.
- A significant postoperative improvement in Left Ventricular Ejection Fraction (LVEF%) was noted in both groups (p<0.05).
- On-pump CABG was associated with increased need for ionotropic support, blood transfusion, longer hospital stay, and less LVEF% improvement.
Conclusions:
- Off-pump CABG is a preferable surgical option compared to on-pump CABG for patients with a prior STEMI.
- This finding supports optimizing surgical strategies to improve recovery and cardiac function in post-STEMI patients.
Abstract:
Coronary artery bypass graft surgery (CABG) is a proven treatment for coronary artery disease. History of a ST-elevation myocardial infarction (STEMI) is considered an independent risk factor for CABG irrespective of timing for an emergency or elective surgery. Patients with STEMI are candidates for both On-pump and Off-pump CABG procedures. This paper discusses the possible best option for elective surgical revascularization in patients with prior STEMI. This prospective clinical trial of 60 eligible patients with prior STEMI was conducted in a Tertiary Care Hospital from April 2018 to March 2019. Among them, 30 patients underwent off-pump (Group A) and 30 patients underwent on-pump (Group B) CABG procedures. Outcomes between both groups were observed from surgery to 1 month postoperatively. Data was analysed by the software statistical program for social science (SPSS 25.0 Inc). The surgery was successful in both groups of patients. Differences were observed by mean number of grafts per patient (2.77±0.43 vs. 3.10±0.71) and duration of operation (4.41±0.35 hours vs. 5.71±0.48 hours). An improvement in Left Ventricular Ejection Fraction (LVEF %) was observed in both groups postoperatively (17.98% vs. 10.98%) and the postoperative LVEF% at different time points were found statistically significant (p<0.05) over preoperative LVEF%. Multivariable stepwise logistic regression analysis correlated on-pump CABG with prolonged need for ionotropic support, need for blood transfusion, longer hospital stay and less improvement in LVEF%. The study supports the Off-pump CABG as a better surgical option over on-pump CABG in patients with prior STEMI.
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