Article Sidebar

Submitted
December 31, 2023
Accepted
December 31, 2023
Published
December 31, 2023
Download
PDF
Statistic
Read Counter : 469 Download : 287

Main Article Content

Abstract

Background
Coronary artery disease has increasing frequency worldwide and considered as important cause
of mortality, Off-pump coronary artery bypass grafting (OPCAB) has been shown to be a good way
for surgical revascularization.
Aim of study
The aim is to find any correlation between the demographic and clinical characteristic
of the patients from a side and the need for an assisted option while the patient having an
OPCAB and interpretation of any possible cause factor.
Patients and Methods
A retrospective study enrolled a 168 patients who underwent an OPCAB in Al-Najaf Cardiac
center in the period from the 1
st of January 2015 till the 1
st of December 2018. The Preoperative demographic and clinical characteristics of the studied group were gathered to detect
possible cause factors for using any OPCAB assisted option like the conversion to
cardiopulmonary bypass machine, Intra-Aortic balloon pump (IABP) use or the epi-cardial
pacing. Descriptive statistics used to interpret the data, Chi-squared and Fisher’s exact tests used
to detect the significant correlation between the dependent and the independent variables beside
the bivariate correlation analysis.
Results
Smoking, arrhythmia, low left ventricular ejection fraction (EF) and left circulation dominancy
were significantly associated with higher conversion rate (Pvalue<0.005), in other hand the use of
IABP show significant association with lager body mass indices, renal impairment, arrhythmia, left
main stem involvement (LMS), low EF, multi-vessel disease and left coronary circulation dominancy,
while temporary pacing implantation show only correlation with age off more than 55 year. Rate of
conversion and the use of an assisted option correlated with more mortality and ICU stay time.
Conclusions
Higher conversion rate, use of IABP and pacing associated with older age, smokers, those with
low EF, multi-vessel disease and LMS involvement who required planned application of preoperative IABP. Assisted options are predictors of mortality and associated with longer ICU stay
time.

Keywords

Off-Pump Coronary Artery Bypass (OPCAB) Surgery Assisted option On-Pump conversion Intra-Aortic Balloon Pump (IABP) Pacing

Article Details

License

Copyright (c) 2023 University of Thi-Qar Journal Of Medicine

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Jameson JN, Kasper DL, Harrison TR, Braunwald E, Fauci AS, Hauser SL, Longo DL
  2. (2005). Harrison's principles of internal medicine (16th ed.). New York: McGraw-Hill Medical
  3. Publishing Division. Archived from the original on 19 February 2014. Retrieved 26 October 2015.
  4. Abramowitz Y, Roth A, Keren G, et al. Whole-exome sequencing in individuals with
  5. multiple cardiovascular risk factors and normal coronary arteries. Coron Artery Dis. 2016 Jun. 27
  6. (4):257-66.
  7. Samady H, Eshtehardi P, McDaniel MC, et al. Coronary artery wall shear stress is associated
  8. with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with
  9. coronary artery disease. Circulation. 2011 Aug 16. 124(7):779-88.
  10. Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, et al. Intraplaque
  11. hemorrhage and progression of coronary atheroma. N Engl J Med. 2003 Dec 11. 349(24):2316-25.
  12. Ross R (January 1999). "Atherosclerosis--an inflammatory disease". The New England
  13. Journal of Medicine. 340 (2): 115–26.
  14. Mack M, Gopal A. Epidemiology, traditional and novel risk factors in coronary artery disease.
  15. Heart Fail Clin. 2016 Jan. 12 (1):1-10.
  16. Wang TJ, Gona P, Larson MG, et al. Multiple biomarkers for the prediction of first major
  17. cardiovascular events and death. N Engl J Med. 2006 Dec 21. 355(25):2631-9.
  18. Kontos, MC; Diercks, DB; Kirk, JD (Mar 2010). "Emergency department and office-based
  19. evaluation of patients with chest pain". Mayo Clinic Proceedings. 85 (3): 284–99.
  20. Fihn, SD; et al. (2014), "2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the
  21. guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of
  22. the American College of Cardiology/American Heart Association Task Force on Practice
  23. Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses
  24. Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic
  25. Surgeons", Circulation, 30 (19): 1749–1767.
  26. European Society of Cardiology (2014), Stable Coronary Artery Disease (Management
  27. of): ESC Clinical Practice Guidelines, retrieved 2017-09-14.
  28. Anderson JL, et al. ACC/AHA 2007 guidelines for the management of patients with
  29. unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of
  30. Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to
  31. Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-STElevation Myocardial Infarction) developed in collaboration with the American College of Emergency
  32. Physicians, the Society for Cardiovascular Angiography and Interve... J Am Coll Cardiol. 2007 Aug
  33. 50(7):e1-e157.
  34. McGill, Henry C.; McMahan, C. Alex; Gidding, Samuel S. (2008-03-04).
  35. "Preventing Heart Disease in the 21st Century". Circulation. 117 (9): 1216–1227.
  36. Robin Smithuis, Tineke Wilems (Publicationdate October 14, 2008). Coronary
  37. anatomy and anomalies. Retrieved November 29, 2018,from
  38. http://www.radiologyassistant.nl/en/p48275120e2ed5/coronary- anatomy-and-anomalies.html
  39. Altin C, Kanyilmaz S, Koc S, et al. Coronary anatomy, anatomic variations and
  40. anomalies: a retrospective coronary angiography study. Singapore Med J. 2015;56(6):339–345.
  41. Aquilina O, Grech V, Felice H, Debono J. Normal adult coronary angiography. Images
  42. Paediatr Cardiol. 2006;8(2):1–16.
  43. Eagle, KA; Guyton RA; Davidoff R; et al. (October 5, 2004). "ACC/AHA 2004
  44. guideline update for coronary artery bypass graft surgery: a report of the American College of
  45. Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update
  46. the 1999 Guidelines for Coronary Artery Bypass Graft Surgery)". Circulation. 110 (14): e340–437.
  47. Hillis LD, Smith PK, Anderson JL , et al.. 2011 ACCF/AHA guideline for
  48. coronary artery bypass graft surgery: a report of the American College of Cardiology
  49. Foundation/American Heart Association Task Force on Practice Guidelines. .December 6, 2011, Vol
  50. , Issue 23.
  51. SoS Investigators (September 28, 2002). "Coronary artery bypass surgery versus
  52. percutaneous coronary intervention with stent implantation in patients with multivessel coronary
  53. artery disease (the Stent or Surgery trial): a randomised controlled trial". Lancet. 360 (9338): 965–70.
  54. Zhao, Dong Fang (February 28, 2017). "Coronary Artery Bypass Grafting With and
  55. Without Manipulation of the Ascending Aorta: A Network Meta-Analysis". Journal of the American
  56. College of Cardiology. 69 (8): 924–936.
  57. Misfeld, Martin; Brereton JL; et al. (August 2011). "Neurological complications
  58. after off-pump coronary artery grafting with and without aortic manipulation". J. Thorac. Cardiovasc.
  59. Surg. 142 (2): e11–e17.
  60. Ross, Donald (Summer 2012). "Anaortic Coronary Bypass Surgery". Seminars in
  61. Thoracic and Cardiovascular Surgery. 24 (2): 90–92.
  62. Godinho, Ana Sofia, Alves, Ana Sofia, Pereira, Alexandre José, & Pereira, Telmo
  63. Santos. (2012). On-pump versus off-pump coronary-artery bypass surgery: a meta-analysis.
  64. Arquivos Brasileiros de Cardiologia, 98(1), 87-94.
  65. Livesay J. J. (2003). The benefits of off-pump coronary bypass: a reality or an
  66. illusion?. Texas Heart Institute journal, 30(4), 258–260.
  67. N.A. Scott, J.L. Knight, B.P. Bidstrup, H. Wolfenden, R.N. Linacre, G.J. Maddern,
  68. Systematic review of beating heart surgery with the Octopus® Tissue Stabilizer, European Journal of
  69. Cardio- Thoracic Surgery, Volume 21, Issue 5, May 2002, Pages 804–817
  70. Ranucci M, Castelvecchio S, Biondi A, de Vincentiis C, Ballotta A, Varrica A,
  71. Frigiola A, Menicanti L; Surgical and Clinical Outcome Research (SCORE) Group. A randomized
  72. controlled trial of preoperative intra-aortic balloon pump in coronary patients with poor left
  73. ventricular function undergoing coronary artery bypass surgery*. Crit Care Med. 2013
  74. Nov;41(11):2476-83.
  75. Caputti, G. M., Palma, J. H., Gaia, D. F., & Buffolo, E. (2011). Off-pump coronary
  76. artery bypass surgery in selected patients is superior to the conventional approach for patients with
  77. severely depressed left ventricular function. Clinics (Sao Paulo, Brazil), 66(12), 2049–2053.
  78. Liebold A., Wahba A., Bimbaum D.E. et al. Low-energy cardioversion with epicardial
  79. wire electrodes: new treatment of atrial fibrillation after open heart surgery. Circulation. 1998; 98: 883-
  80. National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI). The
  81. practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Bethesda:
  82. National Institutes of Health. 2000, NIH publication 00- 4084.
  83. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh
  84. report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High
  85. Blood Pressure. Hypertension. 2003 Dec. 42(6):1206-52.
  86. Fredrickson DS, Lees RS. A system for phenotyping hyperlipidaemia. Circulation. Mar
  87. ;31:321-7.
  88. Ayalew Tefferi, MD, ed. Primary Hematology. Totowa, NJ: Humana Press, 2001.
  89. Ministry of Health - Manatū Hauora. Definitions of smoking status. New Zealand:
  90. Ministry of Health; 2015.
  91. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart
  92. disease and acute coronary syndrome. Ann Transl Med. 2016;4(13):256.
  93. World Health Statistics 2016: Monitoring health for the SDGs Annex B: tables of health
  94. statistics by country, WHO region and globally. World Health Organization. 2016. Retrieved 27 June
  95. Shao-peng Fu, MD, Zhe Zheng, MD, Xin Yuan, MD et al. Impact of Off-Pump Techniques
  96. on Sex Differences in Early and Late Outcomes After Isolated Coronary Artery Bypass Grafts.
  97. April 2009. The Annals of Thoracic Surgery , Volume 87 , Issue 4 , 1090 – 1096.
  98. Tomaso Bottio, MD, Rizzoli, G., Caprili, L., Nesseris, G., Thiene, G., & Gerosa, G.
  99. (2003). Full-sternotomy off-pump versus on- pump coronary artery bypass procedures: in-hospital
  100. outcomes and complications during one year in a single center. Texas Heart Institute journal, 30(4),
  101. -7.
  102. Louis-Mathieu Stevens, Nicolas Noiseux, Alvaro Avezum, Dharma Rakshak Ayapati, Xin
  103. Chen, Fernando Antonio Lucchese, Horacio Cacheda, Sirish Parvathaneni, Yongning Ou, André Lamy,
  104. on behalf of the CORONARY Investigators†; Conversion after off- pump coronary artery bypass
  105. grafting: the CORONARY trial experience. 1 March 2017. European Journal of Cardio-Thoracic
  106. Surgery, Volume 51, Issue 3, Pages 539–546.
  107. Hendrik M. Nathoe, M.D., Diederik van Dijk, M.D., Ph.D., Erik
  108. W.L. Jansen, M.D., Ph.D. et al. January 30, 2003. A Comparison of On-Pump and Off-Pump
  109. Coronary Bypass Surgery in Low-Risk Patients. N Engl J Med 2003; 348:394-402.
  110. Minoru Tabata Shuichiro Takanashi Tetsuya Horai Toshihiro Fukui Yasuyuki Hosoda. 1
  111. October 2006. Emergency conversion in off-pump coronary artery bypass grafting. Interactive
  112. CardioVascular and Thoracic Surgery, Volume 5, Issue 5, , Pages 555–559.
  113. Robertson M.W. et al. 2011. 712 Complete revascularization is compromised in off-pump
  114. coronary artery bypass grafting. Canadian Journal of Cardiology , Volume 27 , Issue 5 , S324 -
  115. S325.
  116. Dayal Mukherjee, MBBS, Kamran Ahmed, MRCS, Kamran Baig, MRCS, Vanash M. Patel,
  117. MS, MRCS, Ara Darzi, FRCS, KBE, and Thanos Athanasiou, PhD, FETCS. Conversion and Safety in
  118. Off- Pump Coronary Artery Bypass: A System Failure That Needs Re- Emphasis. Ann Thorac Surg
  119. ;91:630 –9.
  120. Borde, D. P., Asegaonkar, B., Apsingekar, P., Khade, S., Futane, S., Khodve, B.,
  121. Annachhatre, A., Puranik, M., Sargar, S., Belapurkar, Y., Deodhar, A., George, A., … Joshi, S. (2016).
  122. Intraoperative conversion to on-pump coronary artery bypass grafting is independently associated
  123. with higher mortality in patients undergoing off-pump coronary artery bypass grafting: A
  124. propensity-matched analysis. Annals of cardiac anaesthesia, 19(3), 475-80.
  125. Puskas John & Sharoni Erez & H Williams, Willis & Petersen, Rebecca & Duke,
  126. Peggy & A Guyton, Robert. (2003). Is routine use of temporary epicardial pacing wires necessary
  127. after either OPCAB or conventional CABG/CPB?. The heart surgery forum. 6. E103-6

Similar Articles

You may also start an advanced similarity search for this article.