Coronary surgery without cardiopulmonary bypass.

Heart 04/1995; 73(3):203-5.
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    ABSTRACT: The use of miniaturized cardiopulmonary bypass (CPB) circuits and avoidance of cardioplegic arrest are attempts to reduce the inflammatory response to cardiac surgery. We studied the effects of beating heart surgery (BHS) with assistance of simplified bypass systems (SBS) on global hemodynamics, myocardial function and the inflammatory response to CPB. We hypothesized that the use of SBS was associated with less hemodynamic instability after CPB resulting from attenuation of the inflammatory response when compared with surgery performed with a conventional CPB (cCPB) circuit. Forty-five patients undergoing coronary artery bypass grafting were prospectively studied. Fifteen patients were randomized to the use of a cCPB circuit, cold crystalloid cardioplegia, and moderate hypothermia. Two groups of 15 patients underwent BHS during normothermia with assistance of two different SBS consisting of only blood pump and oxygenator. Hemodynamic variables were assessed with transpulmonary thermodilution and transesophageal echocardiography. Plasma levels of proinflammatory and antiinflammatory mediators were measured perioperatively. After CPB, variables of global hemodynamics and systolic ventricular function did not differ among groups. Left ventricular diastolic function was impaired after CPB equally in all groups (P < 0.01 versus pre-CPB). At the end of surgery, there was more need for vasopressor (norepinephrine) support in both SBS groups than in the cCPB group (P < 0.01). After CPB, the release of interleukin (IL)-6 did not differ significantly among groups, whereas plasma levels of IL-10 were higher in the cCPB group (P < 0.01 versus SBS). The extent of myocardial necrosis (Troponin T) was comparable in all groups. We conclude that in our study, miniaturizing bypass systems and avoidance of cardioplegic arrest were not effective in improving hemodynamic performance and in attenuating the proinflammatory immune response after CPB.
    Anesthesia and analgesia 03/2006; 102(2):352-62. · 3.08 Impact Factor
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    ABSTRACT: Coronary artery bypass grafting is a highly investigated surgical procedure and yet continues to attract rigorous research aimed at reducing observed and potential morbidity and mortality. Improvements in perioperative care, surgical technique and methods of attenuating the untoward effects of cardiopulmonary bypass have resulted in improved clinical outcome of on-pump myocardial revascularisation. The continuing drive to improve clinical outcome and compete with the ever-evolving non-surgical methods of myocardial revascularisation has provided the incentive for the rebirth of off-pump coronary artery bypass grafting (OPCAB). The appeal of avoiding cardiopulmonary pass with its direct and indirect physiological insult, the prospect of improved clinical outcomes, and the favourable economic impact gives OPCAB the potential of preference that may mark the dawn of a new era in our search for the optimal surgical strategy for the treatment of coronary artery disease. However, there are very genuine and serious concerns with this surgical technique. The logical appeal of OPCAB can only be validated by scientific scrutiny otherwise it would remain a myth. This comprehensive review examines the "physiological cost" of cardiopulmonary bypass, the theoretical and clinical benefits of OPCAB, the concerns with this technique and strategies for maximizing the benefits. And in so doing, explore the myth, the logic and the science of this surgical technique.
    European Journal of Cardio-Thoracic Surgery 11/2003; 24(4):557-70. · 2.67 Impact Factor
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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. · 0.46 Impact Factor


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