Publications (20)24.69 Total impact
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Article: Does dual antiplatelet therapy affect blood loss and transfusion requirements in robotic-assisted coronary artery surgery?
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ABSTRACT: Patients who present for coronary surgery often receive preoperative dual antiplatelet therapy with aspirin and a thienopyridine derivative (clopidogrel or prasugrel), especially after a recent acute coronary syndrome. Studies have shown that patients on aspirin and clopidogrel are at increased risk for perioperative bleeding and related events. We sought to examine the impact of dual antiplatelet therapy on bleeding and transfusion requirements in patients undergoing robotic-assisted minimally invasive coronary artery bypass grafting. From January 2010 to November 2011, a total of 110 patients underwent robotic-assisted off-pump coronary surgery at our institution. All patients underwent robotic-assisted harvest of the left internal mammary artery from the chest wall. Some patients then underwent direct coronary anastomosis to the left anterior descending coronary artery via a left minithoracotomy, whereas others had a complete robotic endoscopic procedure within the closed chest. The patients were divided into two groups for outcome analysis on the basis of preoperative antiplatelet therapy: group 1 (either aspirin alone or no antiplatelet agents at all; n = 53) and group 2 (aspirin plus clopidogrel or prasugrel; n = 57). Perioperative chest tube drainage was not significantly different between the patient groups, irrespective of the preoperative antiplatelet agents used. Transfusion requirements and other morbidities were also similar in both groups of patients. Preoperative dual antiplatelet therapy does not result in significantly increased bleeding or perioperative transfusion requirements. If clinically indicated, it is reasonable to continue preoperative combination antiplatelet therapy in patients undergoing robotic-assisted coronary surgery.Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 11/2012; 7(6):399-402. -
Article: Does body mass index affect outcomes in robotic-assisted coronary artery bypass procedures?
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ABSTRACT: Obese patients pose unique technical challenges for minimal-access cardiac surgery. We sought to examine the effect of body mass index on short-term outcomes in robotic-assisted coronary surgery. From January 2010 to November 2011, a total of 110 consecutive patients underwent robotic-assisted coronary surgery at our institution. All patients had robotic-assisted mobilization of the left internal mammary artery. Some patients then underwent direct coronary anastomosis to the left anterior descending coronary artery via a left mini thoracotomy, whereas others had a complete robotic endoscopic procedure within the closed chest. The short-term outcomes of obese patients (n = 39), defined as body mass index greater than 30 kg/m, were compared with those of nonobese patients (n = 71). Mean left internal mammary artery harvest time was longer in obese patients than in nonobese patients (51.03 vs 39.94 minutes; P = 0.007), as was overall operative time (218.15 vs 186.72 minutes; P = 0.034). There were no significant differences in mortality or major morbidity between obese and nonobese patients. Obesity does not adversely affect short-term outcomes in robotic-assisted coronary surgery, although operative times are somewhat longer for these patients. Robotic-assisted coronary techniques can be safely pursued in obese patients.Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 09/2012; 7(5):350-3. -
Article: A step toward nonrobotic total endoscopic coronary bypass grafting: 40 coronary anastomoses in a biomechanical beating heart model.
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ABSTRACT: Nonrobotic total endoscopic coronary bypass grafting is commonly considered as technically too difficult. After endoscopic practicing in a simple box model, we questioned this statement in a more sophisticated training model. In a handmade chest model containing a mechanically actuated porcine heart, anastomoses between homologous vein and shunted anterior coronary artery were performed using Prolene 7-0 sutures or U-clips in 20 anastomoses each. Commercially available endoscopic instruments and exclusive two-dimensional endoscopic vision were used. As quality control, the procedures were recorded, flow was measured, indocyanine green dye angiograms were performed, vinylpolysiloxane endocasts were produced, and finally the anastomoses were assessed from the endothelial side. Three-dimensional computed tomographic reconstruction was explored for cast measuring. All anastomoses were completed successfully in a time of 51 ± 14 minutes (Prolene) and 48 ± 10 minutes (U-clips). Despite suboptimal equipment, a reproducible sequence of the procedure was established and documented. Improving surgical performance was reflected in a reduction in anastomotic leakage and time requirement. The quality assessment protocol showed a learning curve and problems itself, which are briefly discussed. A beating heart model is an adamant requirement of training for the technically demanding procedure of nonrobotic total endoscopic coronary bypass grafting. Refinement of the model and quality assessment as well as expansion of training to other regions of the heart should prepare for a cost-effective, broad-based clinical application of nonrobotic endoscopic techniques in coronary surgery. Available high-definition three-dimensional vision systems and the development of appropriate (articulating) instruments will make the procedure safer and quicker and will cut the learning curve.Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 09/2012; 7(5):359-67. -
Article: Increasing surgical experience with off-pump coronary surgery does not mitigate the morbidity of emergency conversion to cardiopulmonary bypass.
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ABSTRACT: Emergency conversion during off-pump coronary artery bypass (OPCAB) confers significant morbidity. We sought to determine whether the outcomes in these patients have changed as our experience with off-pump techniques has increased. Between January 1999 and December 2010, 4763 patients underwent coronary artery surgery. An off-pump strategy was attempted in 4415 cases (92.7%). The results of the most recent 50 patients who required emergency conversion were compared with the preceding 50 conversions and with patients who underwent either OPCAB (n = 2737) or on-pump coronary surgery (coronary artery bypass grafting) (n = 268) during the same time frame. The emergency conversion rate was 2.27% (n = 100), being 2.97% for the first 50 cases and 1.77% for the subsequent 50 patients. The two sequential groups of emergency conversions had similar indications and timing of conversion and comparable outcomes. When compared with patients who underwent OPCAB, the more recent 50 conversions had higher mortality (P = 0.002) and more frequent sternal wound infection (P = 0.036), hemorrhage requiring reoperation (P = 0.003), respiratory failure (P < 0.0001), and all-cause sepsis (P = 0.001). Compared with the on-pump group, the more recent conversions had higher mortality (P = 0.055) and a greater rate of postoperative sepsis (P = 0.002). The incidence of emergency conversion during OPCAB has decreased with increasing surgical experience; however, the morbidity in these patients remains essentially unchanged. The outcomes in these patients remain worse than those in nonconverted patients. Safer bailout strategies during OPCAB are still warranted.Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 07/2012; 7(4):259-65. -
Article: Hybrid minimally invasive extraction of atrial clot avoids redo sternotomy in Jehovah's Witness.
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ABSTRACT: We report the novel use of the AngioVac device in a percutaneous hybrid approach to remove a large right atrial clot as an effective and potentially lifesaving alternative to a very high-risk redo-sternotomy in a Jehovah's Witness patient.Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 01/2012; 7(1):59-61. -
Article: Long-Term Survival After Minimal Invasive Direct Coronary Artery Bypass (MIDCAB) Surgery in Patients With Low Ejection Fraction.
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ABSTRACT: : The long-term survival after minimal invasive direct coronary artery bypass (MIDCAB) surgery to any coronary territory in patients with ejection fraction of ≤30% was investigated for the first time in literature. : Seventy-three patients with primary MIDCAB and 89 patients with reoperative MIDCAB were studied including preoperative risk factors, operative details, early postoperative complications, and survival up to 10 years postoperatively. : Despite the high-risk profile of the patients, the MIDCAB approach for targeted revascularization resulted in excellent short-term results. Ventricular arrhythmia contributed to four of six early deaths. Survival at 5 years postoperatively was 62.5% for primary MIDCAB and 43.2% for reoperative MIDCAB and at 10 years was 36.9% and 29.5%, respectively. Functionally complete vascularization correlates with significantly better long-term survival particularly in primary MIDCAB procedures. : MIDCAB is a valuable option for targeted revascularization in high-risk patients with low ejection fraction and reoperation.Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 11/2010; 5(6):400-6. -
Article: Off-pump Coronary Bypass Surgery in Patients With Low Ejection Fraction: Is There a Long-Term Survival Advantage?
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ABSTRACT: : Long-term survival after off-pump surgery in patients with low ejection fraction was investigated. : Three hundred forty-six patients with ejection fraction 30% or less with isolated off-pump coronary artery bypass surgery (OPCAB) were compared with a propensity matched historical group operated on-pump (ONCAB) and with data from literature after percutaneous coronary intervention and OPCAB surgery. : The lower invasiveness of OPCAB contributed to a significantly better 30-day survival, shorter postoperative length of stay, and fewer in-hospital complications. Incomplete revascularization of the posterior and lateral territories of the heart correlated with higher 1-year mortality. The probability of survival for 8 years after OPCAB was 50.1% (n = 76) versus 49.7% (n = 82) for ONCAB without comparable data from literature for OPCAB or percutaneous coronary intervention in these high-risk patients. : OPCAB surgery in patients with low ejection fraction is a viable alternative but so far without demonstrable long-term survival advantage to ONCAB.Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 01/2010; 5(1):33-41. -
Article: Minimally invasive direct coronary artery bypass as a primary strategy for reoperative myocardial revascularization.
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ABSTRACT: : Conventional reoperative coronary artery bypass grafting is associated with risk of sternal re-entry, injury to patent grafts, and embolization from diseased grafts. Sternal sparing minimally invasive direct coronary artery bypass (MIDCAB) avoids such risks in cases where it is technically feasible. We sought to examine in-hospital outcomes of reoperative MIDCAB surgery. : We recorded prospective standardized data from the New York Cardiac Surgical Reporting System database of 369 reoperative MIDCAB cases from 1996 to 2006 and compared with 822 primary MIDCAB patients in the same time period. We compared the preoperative risk profile and postoperative in-hospital outcomes and length of stay for both groups. : There was a significantly higher risk profile typical of the reoperative patient population (P < 0.001 for stroke, peripheral/cerebrovascular disease, extensive aortic calcification, renal failure, and left ventricular ejection fraction <40%) compared with the primary MIDCAB group. Despite this fact, there was no difference in the in-hospital outcomes and length of hospital stay between the two groups. : Reoperative MIDCAB provides targeted coronary revascularization and avoids hazards of sternal re-entry, graft injury and manipulation, and deleterious effects of cardiopulmonary bypass. This hastens recovery and provides excellent early outcomes equivalent to primary MIDCAB procedures.Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 01/2010; 5(1):22-7. -
Article: Non-typhoid Salmonellae and prosthetic valve endocarditis: more than a rare coincidence? A review of the literature.
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ABSTRACT: Non-typhoid Salmonellae (NTS) commonly cause gastroenteritis but are rarely found pathogens in prosthetic heart valve endocarditis. The details of two patients from the authors' institution and 15 published cases are reviewed in terms of their risk factors, clinical findings and outcomes. Only two of eight patients with paravalvular leakage or abscess--the most serious local complications--survived, both with surgery. It appears that NTS bacteremia in patients with prosthetic valves and concomitant risk factors should be treated early with high-dose antimicrobials for up to six weeks in order to minimize the risk of endocarditis.The Journal of heart valve disease 07/2009; 18(4):401-10. · 0.81 Impact Factor -
Article: Less invasive intracardiac surgery performed without aortic clamping.
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ABSTRACT: Aortic clamping and cardioplegia delivery add complexity to performing intracardiac procedures through a right minithoracotomy. Recent publications have shown excellent patient outcomes after mitral valve (MV) procedures undertaken through thoracotomy on the fibrillating heart. We reviewed our experience with this approach. From March 2000 to September 2006, 100 patients underwent MV repair (n = 42), MV annuloplasty (n = 28), MV replacement (n = 18), atrial septal defect closure (n = 10), tricuspid valve repair (n = 1), and left atrial myxoma excision (n = 1). A modified maze procedure (n = 4) or left minimally invasive direct coronary bypass grafting (MIDCABG) (n = 2) was combined in six cases. The mean age was 57 +/- 11 years (range, 22 to 89); 27 patients were in New York Heart Association (NYHA) class III or IV; 24 cases were first or second time reoperations; 20 patients had a left ventricular ejection fraction of less than 0.3. All the operations were carried out on the fibrillating heart without cross-clamping the aorta through a right minithoracotomy using peripheral cannulation. Mean fibrillation time was 73 +/- 31 minutes (range, 10 to 198 minutes). There was no conversion to sternotomy. Postoperative inotropic support was needed in 20 cases. One patient who underwent a third time reoperation died within 30 days of mesenteric ischemia (hospital mortality = 1%). Complications were the following: four reoperations for bleeding (4%); two strokes (2%). Postoperative median hospital length of stay was five days (range, 2 to 58 days). None of the patients has required MV reoperation after hospital discharge. Follow-up was complete. All survivors were in NYHA class I or II. Ventricular fibrillation simplifies less invasive intracardiac procedures and carries lower complication rates and perioperative mortality compared with conventional surgery.The Annals of thoracic surgery 06/2008; 85(5):1551-5. · 3.74 Impact Factor -
Article: Minimally invasive coronary artery bypass grafting.
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ABSTRACT: Limited access, off-pump coronary artery bypass grafting for revascularization of all the various coronary arteries is an acceptable alternative to standard on-pump coronary bypass grafting through sternotomy. A variety of small, targeted incisions are used to approach various coronary locations. Technical advances in conduit harvesting, stabilization, cardiac positioning devices, and anastomotic connectors have made these procedures more standardized and replicable. This has resulted in reduced morbidity as a consequence of less invasive approaches. These efforts have paved the way for the ultimate goal of same day surgical coronary revascularization.Seminars in Thoracic and Cardiovascular Surgery 02/2007; 19(4):281-8. -
Article: Robotic assisted multivessel minimally invasive direct coronary artery bypass with port-access stabilization and cardiac positioning: paving the way for outpatient coronary surgery?
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ABSTRACT: Minimimal access multivessel coronary artery bypass grafting with same day hospital discharge remains the ultimate goal. We evaluated the feasibility for achieving multivessel coronary bypass through minimal access. From January to July 2003, 30 patients under went off-pump minimally invasive multivessel coronary bypass. Internal mammary arteries were harvested with robotic telemanipulation with three ports. A 2-inch to 3-inch incision with soft tissue retractor was used to perform coronary anastomosis. Robotic ports were used to introduce stabilization and cardiac positioning devices. Endoscopic harvesting of radial artery was done when necessary. Twenty-three patients (77%) had anterior throracotomy approach and 7 (23%) had transabdominal approach. Average number of bypass grafts was 2.6 (range 2-4). There was no mortality in hospital or on 30-day follow-up. Twenty-nine patients (97%) were extubated on the operating table. Two patients required reoperation for bleeding and 1 of those patients needed conversion to sternotomy for additional bypass grafting. Within 24 hours of surgery 50% of patients (n = 15) were discharged, 10% (n = 3) were discharged in 24 to 36 hours, 17% (n = 5) were discharged in 36 to 48 hours, 17% (n = 5) were discharged in 48 to 72 hours, and 2 patients stayed more than 3 days in the hospital. Two patients needed readmission to hospital within 30 days; 1 for pleural effusion and 1 for wound infection. Robotic harvesting of internal mammary arteries and port access stabilization and cardiac positioning allows multivessel coronary bypass to be performed through a small incision. Currently, the majority of the patients can be safely discharged within 36 hours of operation.The Annals of thoracic surgery 06/2005; 79(5):1590-6; discussion 1590-6. · 3.74 Impact Factor -
Article: Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality.
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ABSTRACT: We sought to evaluate outcomes and predictors of emergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery. From January 1999 through July 2002, 1678 consecutive isolated coronary artery bypass operations were performed at Lenox Hill Hospital, with the intention to treat all patients with off-pump coronary bypass surgery. Fifty (2.97%) patients required urgent conversion to cardiopulmonary bypass. All the preoperative, intraoperative, and postoperative variables were collected and analyzed in accordance with the New York State Cardiac Surgery Reporting System. Multivariate regression analysis was performed to determine predictors for conversion. In-hospital mortality and major morbidity were significantly lower in the nonconverted group compared with the converted patients (mortality: 1.47% [n = 24] vs 12% [n = 6], P = .001; stroke: 1.1% [n = 18] vs 6% [n = 3], P = .02; renal failure: 1.23% [n = 20] vs 6% [n = 3], P = .02; deep sternal wound infection: 1.54% [n = 25] vs 8% [n = 4], P = .009; respiratory failure: 3.75% [n = 61] vs 28% [n = 14], P < .0001; nonconverted vs converted patients, respectively). The annual incidence of conversion decreased during the study period. There was a significant reduction in the incidence of conversion after routine use of a cardiac positioning device to performing lateral and inferior wall grafts (4.2% [n = 27] vs 2.3% [n = 23], P = .04). None of the preoperative variables were independent predictors of conversion on multivariate regression analysis. Because emergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery results in significantly higher morbidity and mortality, studies comparing off-pump coronary bypass surgery with conventional coronary artery surgery should include converted patients in the off-pump group. In our experience, emergency conversion is an unpredictable event. The incidence of conversion decreases with increasing experience of surgeons in performing off-pump coronary surgery and use of a cardiac positioning device.Journal of Thoracic and Cardiovascular Surgery 12/2004; 128(5):655-61. · 3.41 Impact Factor -
Article: First robotic endoscopic epicardial isolation of the pulmonary veins with microwave energy in a patient in chronic atrial fibrillation.
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ABSTRACT: The pulmonary veins have been demonstrated to play an important role in generating atrial fibrillation. We report the first successful endoscopic epicardial isolation of the pulmonary veins in a patient with permanent atrial fibrillation, along with a 1-year follow-up. The procedure consisted of making a conduction block around the pulmonary veins with a flexible microwave energy delivery probe. The probe was placed endoscopically on the left atrial epicardium with the aid of robotic instruments.The Annals of thoracic surgery 09/2004; 78(2):e24-5. · 3.74 Impact Factor -
Article: Is off-pump coronary surgery justified in EuroSCORE high-risk cases? A propensity score analysis.
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ABSTRACT: We aimed to quantify the effect of avoiding cardiopulmonary bypass on outcomes in high-risk patients. Of the 2079 consecutive CABG's performed by three surgeons between April 1997 and September 2002, 389 were classified as high-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification, with a score of >5. The off-pump group had 196 patients and the on-pump group had 193 patients. Multivariate logistic regression was used to assess the effect of off-pump on in-hospital outcomes, while adjusting for treatment selection bias with a propensity score. The incidence of hypertension, hypercholesterolaemia, and renal dysfunction were higher in the off-pump group. The median EuroSCORE for off-pump patients was 7 (6-8), while for the on-pump patients was 7 (6-8; P=0.31). After adjusting for the propensity score, off-pump patients were less likely to have stroke (OR 0.17; P=0.041), renal failure (OR 0.35; P=0.029), blood transfusion (OR 0.12; P<0.001), prolonged mechanical ventilation (OR 0.36; P=0.021), and inotrope support (OR 0.35; P<0.001). Off-pump patients also had significantly shorter post-operative hospital stays. There was no significant difference between off-pump and on-pump patients in terms of in-hospital and mid-term mortality. Off-pump CABG is justified in EuroSCORE high-risk cases.Interactive cardiovascular and thoracic surgery 12/2003; 2(4):660-4. -
Article: Off-pump coronary artery bypass surgery does not reduce gastrointestinal complications.
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ABSTRACT: Gastrointestinal (GI) complications following on-pump coronary artery bypass grafting (CABG) are rare, but carry a high mortality rate. Prolonged cardiopulmonary bypass (CPB) has been associated with a higher incidence of such complications. Little is known about the effect of avoiding CPB on GI complications. Our hypothesis was that off-pump CABG might reduce such complications. A total of 2327 consecutive cases undergoing isolated CABG between April 1997 and May 2001 were identified from four consultants' practice at the two cardiothoracic centres involved in this study. We performed a multivariable logistic regression analysis to identify the risk factors for development of post-operative GI complications. Potential risk factors considered in the logistic model were age, sex, angina, ejection fraction, peripheral vascular disease, renal dysfunction, redo operations, previous GI complications, priority of surgery and the use of CPB. A total of 1210 cases were performed on CPB, compared to 1117 off-pump. The incidence of GI complications was 1.2% (n = 14) in the on-pump group and 1.6% (n = 18) in the off-pump group (P = 0.347). The incidence of in-hospital mortality, in the patients who had a GI complication, was 28.6% (n = 4) and 22.2% (n = 4), respectively (P = 0.681). The results of the logistic regression analysis showed that renal dysfunction, advancing age and previous history of GI surgery are significant risk factors for GI complications after coronary bypass surgery whether CPB is used or not. Our study suggests that off-pump and on-pump techniques are similar in the rates of GI complications. We suggest that a properly designed randomized control trial is needed to verify our findings.European Journal of Cardio-Thoracic Surgery 03/2003; 23(2):170-4. · 2.55 Impact Factor -
Article: Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass.
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ABSTRACT: Recent studies examining neuroprotective effects of off-pump coronary artery bypass grafting (CABG) have shown inconsistent results. We examined our database to quantify the independent effects of avoidance of cardiopulmonary bypass (CPB) and aortic manipulation on neurologic outcomes after CABG. A total of 2,327 consecutive cases undergoing isolated CABG between April 1997 and May 2001 were identified at our two institutions. Patients were divided into three groups: on CPB, off-pump with aortic manipulation, and off-pump without aortic manipulation. To control for the confounding effects of other risk factors, we performed a multivariate logistic regression analysis. Potential covariates considered in the logistic model included age, sex, redo operations, diabetes, chronic obstructive pulmonary disease, neurologic disease, peripheral vascular disease, ejection fraction, and priority of operation. A total of 1,210 cases were performed on CPB, compared with 520 off-pump with aortic manipulation, and 597 off-pump without aortic manipulation. The incidence of focal neurologic deficit was 1.6% (n = 19) in the on-pump group, 0.4% (n = 2) in the off-pump with aortic manipulation group, and 0.5% (n = 3) for the off-pump without aortic manipulation group (p for trend = 0.027). The results of the multivariate logistic regression analysis demonstrated that use of CPB was a risk factor for focal neurologic deficit, with an odds ratio of 3.82 (95% confidence interval, 1.41 to 10.34; p = 0.005). Aortic manipulation did not significantly influence neurologic outcome in off-pump patients. Off-pump operation, with or without aortic manipulation, reduces adverse neurologic outcomes compared with on-pump procedures.The Annals of Thoracic Surgery 09/2002; 74(2):400-5; discussion 405-6. · 3.74 Impact Factor -
Article: 'Shunt shuffle'-a simple technique of introducing intracoronary shunts for off-pump coronary artery bypass.
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ABSTRACT: Intracoronary shunting is a useful method for maintaining distal perfusion as well as providing a bloodless field during off-pump coronary revascularization. Intracoronary shunts require insertion of both ends through a limited arteriotomy, which sometimes can be troublesome. We describe the 'shunt shuffle' as a simple technique, which allows rapid, atraumatic and easy insertion of intracoronary shunts.European Journal of Cardio-Thoracic Surgery 07/2002; 21(6):1121-2. · 2.55 Impact Factor -
Article: Does off-pump total arterial revascularization without aortic manipulation influence neurological outcome? A study of 226 consecutive, unselected cases.
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ABSTRACT: Off-pump coronary artery bypass (OPCAB) is increasingly reported to have better post-operative outcomes than on-pump coronary artery bypass (ONCAB). Most series report OPCAB in selected cases and therefore the results of such studies are affected by selection bias. We report our series of consecutive, unselected OPCAB cases representing an entire coronary revascularization practice and its effect on neurological outcome. Between January and December 2000, 226 consecutive OPCAB cases were performed. These were compared with 258 consecutive ONCAB cases performed by same surgeons historically. There were no significant differences in major demographic characteristics between the two groups. Postoperative outcomes including operation time, ventilation time, inotrope requirement, focal strokes, peak CKMB, length of hospital stay and mortality formed the basis of this study. All OPCAB patients had a median sternotomy approach. Left and right internal mammary arteries and radial arteries were used in varying combinations using composite and sequential grafting techniques to achieve revascularization and completely avoid aortic manipulation. ONCAB cases were performed employing conventional cardiopulmonary bypass techniques and using the left internal mammary artery and saphenous vein grafts as appropriate. OPCAB cases had significantly lower peak CKMB levels, operative time, length of hospital stay and number of grafts. There was a significantly lower incidence of permanent focal neurological events in OPCAB patients (0.4%, n = 1) compared to the ONCAB group (3.9%, n = 10, p = 0.012). This study documents the safety of off pump total arterial revascularization without aortic manipulation as the routine technique for coronary bypass surgery. It also demonstrates a significant reduction in the incidence of focal strokes. We conclude that avoidance of both cardiopulmonary bypass and aortic manipulation are important factors in reducing the occurrence of neurological deficits.The Heart Surgery Forum 02/2002; 5(1):28-32. · 0.42 Impact Factor -
Article: Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass
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ABSTRACT: Background. Recent studies examining neuroprotective effects of off-pump coronary artery bypass grafting (CABG) have shown inconsistent results. We examined our database to quantify the independent effects of avoidance of cardiopulmonary bypass (CPB) and aortic manipulation on neurologic outcomes after CABG.Methods. A total of 2,327 consecutive cases undergoing isolated CABG between April 1997 and May 2001 were identified at our two institutions. Patients were divided into three groups: on CPB, off-pump with aortic manipulation, and off-pump without aortic manipulation. To control for the confounding effects of other risk factors, we performed a multivariate logistic regression analysis. Potential covariates considered in the logistic model included age, sex, redo operations, diabetes, chronic obstructive pulmonary disease, neurologic disease, peripheral vascular disease, ejection fraction, and priority of operation.Results. A total of 1,210 cases were performed on CPB, compared with 520 off-pump with aortic manipulation, and 597 off-pump without aortic manipulation. The incidence of focal neurologic deficit was 1.6% (n = 19) in the on-pump group, 0.4% (n = 2) in the off-pump with aortic manipulation group, and 0.5% (n = 3) for the off-pump without aortic manipulation group (p for trend = 0.027). The results of the multivariate logistic regression analysis demonstrated that use of CPB was a risk factor for focal neurologic deficit, with an odds ratio of 3.82 (95% confidence interval, 1.41 to 10.34; p = 0.005). Aortic manipulation did not significantly influence neurologic outcome in off-pump patients.Conclusions. Off-pump operation, with or without aortic manipulation, reduces adverse neurologic outcomes compared with on-pump procedures.The Annals of Thoracic Surgery.
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2004–2012
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Lenox Hill Hospital
New York City, NY, USA
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