Coronary artery bypass surgery cardiopulmonary bypass
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.
Synonyms and keywords:
There are alternative operative strategies such as off-pump or beating heart, which have their own risks and benefits. These alternatives could be used when the risks of aortic manipulation outweigh the safe use of a cross-clamp or cannulation of the ascending aorta. Furthermore, surgeon experience with the strategies mentioned above should be considered.
Cardiopulmonary Bypass in CABG Patients
- The risks and benefits of alternative operative strategies such as off-pump or beating heart, can be considered when the risks of aortic manipulation outweigh the safe use of a cross-clamp or cannulation of the ascending aorta.
- Furthermore, surgeon experience with the aforementioned strategies should be taken into consideration.
- One major concern that exists for the off-pump approach is the technical difficulty of bypassing coronary arteries in the circumflex distribution, in addition to small and intramyocardial segments. This concern created a tendency toward fewer grafts per patient, a higher rate of incomplete revascularization, and more concern regarding the graft patency in long term.
- The following are some of the advantages of off-pump coronary artery bypass surgery compared with on-pump CABG:
- Earlier extubation
- Lower rate of blood transfusion
- Better outcome for patients with increased pulmonary disease risks
- Cardiopulmonary bypass is associated with a less systemic inflammatory response, and therefore has a less negative impact on pulmonary function.
2021 ACA Revascularization Guideline
|Class 2a Recommendation, Level of Evidence: B-R |
|When significant calcification of the aorta is present, usage of techniques such as off-pump techniques or beating heart (to avoid aortic manipulation) is rational to reduce the perioperative stroke incidence when performed by experienced surgeons.|
|Class 2b Recommendation, Level of Evidence: B-R |
|Utilizing off-pump surgery could be rational for patients with significant pulmonary disease in order to decrease perioperative risk when performed by experienced surgeons.|
- ↑ 1.0 1.1 1.2 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
- ↑ 2.0 2.1 2.2 2.3 2.4 Smart NA, Dieberg G, King N (2018). "Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting". J Am Coll Cardiol. 71 (9): 983–991. doi:10.1016/j.jacc.2017.12.049. PMID 29495998.
- ↑ Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ; et al. (2016). "Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16,900 patients investigated in randomized controlled trials†". Eur J Cardiothorac Surg. 49 (4): 1031–41, discussion 1041. doi:10.1093/ejcts/ezv268. PMID 26276839.
- ↑ Edelman JJ, Yan TD, Bannon PG, Wilson MK, Vallely MP (2011). "Coronary artery bypass grafting with and without manipulation of the ascending aorta--a meta-analysis". Heart Lung Circ. 20 (5): 318–24. doi:10.1016/j.hlc.2011.02.003. PMID 21511187.
- ↑ Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z; et al. (2016). "Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting". N Engl J Med. 375 (24): 2359–2368. doi:10.1056/NEJMoa1601564. PMID 27771985.
- ↑ Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA; et al. (2017). "Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass". N Engl J Med. 377 (7): 623–632. doi:10.1056/NEJMoa1614341. PMID 28813218.
- ↑ Takagi H, Matsui M, Umemoto T (2010). "Off-pump coronary artery bypass may increase late mortality: a meta-analysis of randomized trials". Ann Thorac Surg. 89 (6): 1881–8. doi:10.1016/j.athoracsur.2010.03.010. PMID 20494043.
- ↑ Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C (2012). "Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease". Cochrane Database Syst Rev (3): CD007224. doi:10.1002/14651858.CD007224.pub2. PMID 22419321.
- ↑ 9.0 9.1 9.2 Al-Ruzzeh S, George S, Bustami M, Wray J, Ilsley C, Athanasiou T; et al. (2006). "Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial". BMJ. 332 (7554): 1365. doi:10.1136/bmj.38852.479907.7C. PMC 1476725. PMID 16740529.
- ↑ 10.0 10.1 10.2 Angelini GD, Taylor FC, Reeves BC, Ascione R (2002). "Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials". Lancet. 359 (9313): 1194–9. doi:10.1016/S0140-6736(02)08216-8. PMID 11955537.
- ↑ 11.0 11.1 11.2 Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH; et al. (2012). "On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study". Circulation. 125 (20): 2431–9. doi:10.1161/CIRCULATIONAHA.111.052571. PMID 22523305.
- ↑ 12.0 12.1 12.2 Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E; et al. (2013). "Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year". N Engl J Med. 368 (13): 1179–88. doi:10.1056/NEJMoa1301228. PMID 23477676.
- ↑ Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E; et al. (2012). "Off-pump or on-pump coronary-artery bypass grafting at 30 days". N Engl J Med. 366 (16): 1489–97. doi:10.1056/NEJMoa1200388. PMID 22449296.