Article

Coronary surgery without cardiopulmonary bypass.

Heart (Impact Factor: 6.02). 04/1995; 73(3):203-5. DOI: 10.1136/hrt.73.3.203
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    • "The first instance of consecutive patients operated upon without CPB was reported by our group in 1982 [Buffolo 1982] and by Benetti in Argentina [Benetti 1985]. During the following decade, only a few centers [Buffolo 1985, Laborde 1989, Buffolo 1990, Fanning 1993, Buffolo 1996, Buffolo 1997] reported good results using this alternative for myocardial revascularization, but it led to new concerns and controversies regarding the quality of anastomoses and the benefits of the procedure [Messmer 1990, Westaby 1995]. With the benefit of additional experiences , other groups began to achieve results comparable to the ones initially reported by us [Buffolo 1991, Folliguet 1997]. "
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    ABSTRACT: The objective of this contribution is to review the results of operations we have performed upon patients using the off-pump coronary artery bypass grafting (OPCAB) technique. The OPCAB technique was examined as a cause of death in 2495 cases from September 1981 to September 1999. Our results indicated four deaths due to stroke and a total hospital mortality of 1.9% (48/2495). When myocardial revascularization without cardiopulmonary bypass (CPB) is appropriately chosen, it is a treatment to be highly recommended for patients with coronary insufficiency.
    The Heart Surgery Forum 02/2002; 5(2):154-6. · 0.56 Impact Factor
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    • "More and more CABG procedures are performed on the beating heart and evidence is growing that beating heart CABG reduces the morbidity of coronary surgery. Still it is obvious that beating heart surgery remains technically demanding and that the highest care is required to perform coronary anastomoses with the same quality as done on the cardioplegic arrested heart [12]. The success of beating heart CABG is based on the development of improved stabilizers and techniques to manipulate the heart. "
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    ABSTRACT: Objective: To analyze the difference in coronary artery bypass grafting (CABG) performed with normothermic cardiopulmonary bypass (CPB) and CABG supported with the intracardiac microaxial pump (ICP, Impella, Aachen, Germany). Methods: A prospective randomized study was conducted in seven centers. The study population consists of 199 patients undergoing isolated primary CABG (CPB group 94 patients, ICP group 105 patients). Both groups are equal in demographic variables, number of bypasses performed, and Euroscore predicted mortality. We analyzed clinical outcome, myocardial enzymes and blood parameters of hemolysis, organ function and inflammatory response. Results: Seventeen patients (16%), randomized in the ICP group, were switched to the CPB group. This was due to the inability to position the right side catheter adequately ðn ¼ 8Þ, to a pump failure ðn ¼ 1Þ or to the perioperative decision that beating heart surgery is technically not possible ðn ¼ 8Þ. There was no significant difference between the two study arms regarding the pump assistance time (CPB 67.1 ^ 22.9 min; ICP 67.7 ^ 30.3 min; P ¼ 0:88861), the number of grafts (CPB 2.4 ^ 0.7; ICP 2.3 ^ 0.8) and the number of grafts to the back wall (CFX; both groups n ¼ 37). There is no significant difference in clinical outcome, evolution of myocardial enzymes, indices of organ function and hemolysis. There is a reduced inflammatory response in the ICP group as indicated in the postoperative release of granulocyte elastase (CPB 259 ^ 195; ICP 150 ^ 126 mg/l; P , 0:00001) and complement C3 (CPB 0.73 ^ 0.2; ICP 0.65 ^ 0.2 g/l; P ¼ 0:008). Conclusion: The intracardiac pump for the right heart is difficult to introduce. As a consequence the right side pump underwent design modifications. There were no differences in clinical outcome between both groups. The inflammatory response is significantly reduced in the ICP group. q 2002 Elsevier Science B.V. All rights reserved.
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