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Intermittent on-pump beating-heart coronary artery bypass grafting—a safer option

  • Sushil Kumar Singh
  • Sarvesh Kumar
  • Ved Prakash
  • Vijayant Devenraj
  • Vivek TewarsonEmail author
Original Article
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Abstract

Purpose

On-pump beating-heart coronary artery bypass grafting represents a merger of standard on and off-pump techniques and is thought to benefit patients by coupling the dual absence of cardioplegic arrest (conventional coronary surgery), with the hemodynamic instability during manipulation seen in off-pump surgery. However, the clinical benefits are still under discussion. We improvised on the standard on-pump beating-heart surgeries by introducing use of “intermittent” bypass as and when required.

Methods

This study involved 108 patients. “Intermittent” on-pump-beating heart coronary artery bypass grafting was done using suction stabilizer and placing aortic and venous cannula, electively in all patients (group 1) who were supported by pump intermittently (n = 54). Retrospective data of patients who underwent off-pump surgery electively by the same surgeon (group 2, n = 54) was collected.

Results

There was a significant advantage in the number of grafts performed for the lateral surface (circumflex branches) using the new technique compared to conventional technique (68vs22). Similarly, significant advantage was also noted in terms of total number of grafts along with shorter operating times. There were no mortalities in the new group compared to the off-pump group and blood loss was also lesser.

Conclusions

“Intermittent” on-pump coronary revascularization is a technically reliable method of coronary revascularization taking advantage of the off-pump and conventional on-pump techniques while considerably eliminating the disadvantages of both. It has shown its superiority in safety, number of grafts, blood loss, operating time and perioperative course.

Keywords

On-pump beating-heart coronary artery bypass grafting Cardiopulmonary bypass Off-pump surgery 

Notes

Compliance with ethical standards

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from the patient included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Perrault LP, Menasche P, Peynet J, et al. On-pump, beating heart coronary artery operations in high risk patients: an acceptable trade-off. Ann Thorac Surg. 1997;64:1368–73.CrossRefGoogle Scholar
  2. 2.
    Al-Ruzzeh S, Nakamura K, Athanasiou T, et al. Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients?: a comparative study of 1398 high risk patients. Eur J Cardiothorac Surg. 2003;23:50–5.CrossRefGoogle Scholar
  3. 3.
    Takagi H, Umemoto T. Worse long-term survival after off-pump than on-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2014;148:1820–9.CrossRefGoogle Scholar
  4. 4.
    Légaré JF, Buth KJ, Hirsch GM. Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial. Eur J Cardiothorac Surg. 2005;27:296–301.CrossRefGoogle Scholar
  5. 5.
    Chaudhry UA, Harling L, Sepehripour AH, et al. Beating- heart versus conventional on-pump coronary artery bypass grafting: a meta-analysis of clinical outcomes. Ann Thorac Surg. 2015;100:2251–60.CrossRefGoogle Scholar
  6. 6.
    Ueki C, Sakaguchi G, Akimoto T, Ohashi Y, Sato H. On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis. Eur J Cardiothorac Surg. 2016;50:813–21.CrossRefGoogle Scholar
  7. 7.
    Miyahara K, Matsuura A, Takemura H, et al. On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity. J Thorac Cardiovasc Surg. 2008;135:521–6.CrossRefGoogle Scholar
  8. 8.
    Izumi Y, Magishi K, Ishikawa N, Kimura F. On-pump beating- heart coronary artery bypass grafting for acute myocardial infarction. Ann Thorac Surg. 2006;81:573–6.CrossRefGoogle Scholar
  9. 9.
    Rastan AJ, Eckenstein JI, Hentschel B, et al. Emergency coronary artery bypass graft surgery for acute coronary syndrome: beating heart versus conventional cardioplegic cardiac arrest strategies. Circulation. 2006;114:I477–85.CrossRefGoogle Scholar
  10. 10.
    Brown WR, Moody DM, Challa VR, Stump DA, Hammon JW. Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli. Stroke. 2000;31:707–13.CrossRefGoogle Scholar
  11. 11.
    Gould BL, Clayton PD, Jensen RL, Liddle HV. Association between early graft patency and late outcome for patients undergoing coronary artery bypass surgery. Circulation. 1984;69:569–76.CrossRefGoogle Scholar
  12. 12.
    Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow- up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 1996;28:616–26.CrossRefGoogle Scholar
  13. 13.
    Synnergren MJ, Ekroth R, Oden A, Rexius H, Wiklund L. Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: role of off-pump surgery. J Thorac Cardiovasc Surg. 2008;136:29–36.CrossRefGoogle Scholar
  14. 14.
    Dayan V, Paganini JJ, Marichal A, Brusich D. On-pump beating/non-beating CABG in stable angina have similar outcomes. Braz J Cardiovasc Surg. 2018;33:183–8.CrossRefGoogle Scholar
  15. 15.
    Kim HJ, Oh YN, Ju MH, et al. On-pump beating heart versus conventional coronary artery bypass grafting: comparative study on early and long-term clinical outcomes. J Thorac Dis. 2018;10:2656–65.CrossRefGoogle Scholar
  16. 16.
    Borowski A, Korb H. Myocardial infarction in coronary bypass surgery using on-pump, beating heart technique with pressure and volume-controlled coronary perfusion. J Card Surg. 2002;17:272–8.CrossRefGoogle Scholar
  17. 17.
    Jones RH. Intraoperative crossover: the well-kept surgical secret to apparent surgical success. J Am Coll Cardiol. 2005;45:1529–31.CrossRefGoogle Scholar
  18. 18.
    Kapetanakis EI, Stamou SC, Dullum MK, et al. The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: a risk-adjusted study. Ann Thorac Surg. 2004;78:1564–71.CrossRefGoogle Scholar
  19. 19.
    Sergeant P, de Worm E, Meyns B, Wouters P. The challenge of departmental quality control in the re-engineering towards off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg. 2001;20:538–43.CrossRefGoogle Scholar
  20. 20.
    Sepehripour AH, Chaudhry UA, Harling L, Athanasiou T. Off-pump or on-pump beating heart: which technique offers better outcomes following coronary revascularization? Interact Cardiovasc Thorac Surg. 2015;20:546–9.CrossRefGoogle Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2019

Authors and Affiliations

  • Sushil Kumar Singh
    • 1
  • Sarvesh Kumar
    • 1
  • Ved Prakash
    • 1
  • Vijayant Devenraj
    • 1
  • Vivek Tewarson
    • 1
    Email author
  1. 1.Department of Cardiothoracic and Vascular surgeryKing George’s Medical UniversityLucknowIndia

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