The heart surgery forum
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This study was designed to evaluate the feasibility of beating heart coronary bypass operations on the anterior vessels of the heart through very limited sternotomy (VLS). ⋯ Coronary bypass grafting on the LAD, the RCA, and their tributaries can be safely performed through VLS. Early and midterm results are comparable with those of classic methods of myocardial revascularization. Conversion to full sternotomy is quite easy and safe, should the necessity arise.
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The heart surgery forum · Jan 2003
Improving hemodynamics by atrial pacing during off-pump bypass surgery.
To avoid hemodynamic deterioration during tilting of the heart in off-pump surgery, we perform atrial pacing. We describe hemodynamic evaluation of this simple maneuver. ⋯ Atrial pacing increases intraoperative RRs, RRm, CO, and CI and decreases SV and LAP significantly, thus offering stable hemodynamics during off-pump surgery. In the last 400 consecutive off-pump coronary artery bypass grafting procedures, there was only 1 (0.25%) conversion to cardiopulmonary bypass.
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The heart surgery forum · Jan 2003
Myocardial contractile performance, preload recruitable stroke work relationships, and histomorphometric changes following off-pump and on-pump coronary bypass grafting of the left internal thoracic artery to the left anterior descending artery.
It has been shown that coronary artery bypass grafting without cardiopulmonary bypass (off-pump or OPCABG) preserves better cerebrocognitive, pulmonary, hepatorenal, and blood cell functions compared with onpump surgery because of an attenuated inflammatory response. The degrees of ischemia/reperfusion injury, myocardial protection, and quantitative changes in myocardial contractile performance following OPCABG have not been well documented. ⋯ Compared with most commonly applied myocardial preservation techniques (cardiopulmonary bypass, hypothermic blood cardioplegic arrest), OPCABG provides at least equal myocardial protection, because there were no significant quantitative differences between off-pump and onpump CABG in myocardial contractile performance following LITA-to-LAD revascularization. The more prominent intimal thickening observed in OPCABG procedures is worrisome and deserves further investigation.
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The heart surgery forum · Jan 2003
Clinical Trial Controlled Clinical TrialMarkers of myocardial ischemia in the evaluation of the effect of left anterior descending coronary artery lesion and collateral circulation on myocardial injury in 1-vessel off-pump coronary bypass surgery.
The purpose of this study was to use serum markers for myocardial tissue damage to evaluate the effect of the severity of left anterior descending artery (LAD) lesions after 1-vessel off-pump coronary artery bypass grafting. ⋯ One-vessel off-pump coronary artery bypass grafting can be performed safely in patients with serious LAD stenosis and borderline antegrade blood flow without the need for any coronary collateral circulation support. A short anastomosis time prevents myocardial injury during off-pump coronary surgery.
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The heart surgery forum · Jan 2003
Primary OPCAB as a strategy for acute coronary syndrome and acute myocardial infarction.
Conventional coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB) carries higher mortality and morbidity for patients undergoing surgery during acute coronary syndrome (ACS). The aim of this retrospective study was to evaluate potential benefits of avoiding CPB by instead performing off-pump CAB (OPCAB) during surgery on patients in ACS. ⋯ OPCAB is a valuable treatment strategy in ACS patients; however, it carries significant mortality and morbidity. Careful preselection and timing of intervention are required in order for patients to fully benefit from the OPCAB strategy.