Is there a hypercoagulable state after off-pump coronary artery bypass surgery? What do we know and what can we do?

Journal of Thoracic and Cardiovascular Surgery (Impact Factor: 4.17). 08/2003; 126(1):7-10. DOI: 10.1016/S0022-5223(02)73472-7
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Available from: Paul Kurlansky, Jan 14, 2015
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    ABSTRACT: Objective: Minimally invasive direct coronary artery bypass (MIDCAB) surgery in the awake patient with epidural anesthesia had been previously reported. However, there is no prospective randomized study comparing MIDCAB surgery with epidural anesthesia versus general anesthesia. Methods: The study was conducted as a prospective and randomized study. Between January 2002 and May 2003, 76 patients were randomly assigned into either MIDCAB under general anesthesia (GA Group) or MIDCAB under epidural anesthesia (EA Group). The EA Group patients did not receive concomitant general anesthesia and they were conscious throughout the procedure. All patients had a left internal thoracic artery to left anterior descending coronary artery bypass using the same MIDCAB techniques. There were 42 patients in the GA Group and 34 patients in the EA Group. For statistical analysis, unpaired t-test for independent samples was used for comparison of continuous variables, and Pearson Chi-Square test was used for comparison of discrete variables. Results: The demographic characteristics of the groups were similar. There was no mortality or major morbidity in both groups. The EA Group patients had lower arterial oxygen saturations (93.3±3.2% versus 97.4±1.3%, p
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    ABSTRACT: Despite many years of clinical and experimental research, the contribution of Cardiopulmonary Bypass (CPB) and cardioplegic arrest to morbidity and mortality following cardiac surgery remains unclear. In the last few years, Off-Pump Coronary Artery Bypass grafting (OPCAB) has gained widespread attention as an alternative technique to conventional On-Pump Coronary Artery Bypass grafting (ONCAB). It has provided an opportunity to compare the operations, in similar patient groups, with or without CPB and cardioplegic arrest. Although initial studies performed on low risk patients preferably with single vessel disease showed favorable outcome, we currently lack larger properly randomized high quality studies which show definite benefit. Proponents of off-pump surgery state that the avoidance of the CPB leads to significantly reduced myocardial ischemia-reperfusion injury, post-operative systemic inflammatory response, postoperative pulmonary complications, hospital stay and cost, a feature that may improve the clinical and economical outcomes. However, perfection in surgical technique, completeness of revascularization and whether the off pump method leads to improved outcome are still burning issues. In this review, OPCAB is found to be significantly better than the ONCAB in reducing cost, hospital stay, blood transfusion requirements, incidence of post-operative pulmonary complications, systemic inflammation and post-operative atrial fibrillations in most of the studies. The comparison show almost equivocal results regarding mortality, survival, quality of life, re-intervention rate, risk of stroke, cognitive decline and GI complication.
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