Abstract
Coronary revascularization with extracorporeal circulation (ECC) was established in the 1960s; since then, this technique has evolved into a routine clinical tool. In view of typical mortality rates of 2-5%, the method is generally considered safe. Increasing standardization of the surgical approach and enhanced ECC techniques have led to expanded indications, and subsequently to increasing numbers of elderly patients and patients with multiple morbidities undergoing surgery. These expanded indications confronted us with postoperative complications in patients with complex comorbidities, eventually resulting in higher morbidity and mortality rates and therefore in a higher use of resources. There is a variety of surgical complications which can affect several organ systems. In addition to postoperative hypoperfusion with or without myocardial pump failure, neurological, pulmonary, and renal complications are frequently seen. We should aim at developing therapeutic strategies that minimize surgical trauma without compromising the high safety of the standard approach. In more and more patients, preoperative organ function is already at the brink of decompensation, and the response to an invasive surgical procedure may be enough to threaten this fragile equilibrium.
Keywords
- Coronary Artery Bypass
- Cardiopulmonary Bypass
- Myocardial Revascularization
- Cardioplegic Arrest
- Postoperative Stroke
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Akpinar B, Guden M, Sanisoglu I, Sagbas E, Caynak B, Bayramoglu Z et al (2001) Does off-pump coronary artery bypass surgery reduce mortality in high risk patients? Heart Surg Forum 4(3):231–236
Anderson RE, Li TQ, Hindmarsh T, Settergren G, Vaage J (1999) Increased extracellular brain water after coronary artery bypass grafting is avoided by off-pump surgery. J Cardiothorac Vasc Anesth 13(6):698–702
Angelini GD, Taylor FC, Reeves BC, Ascione R (2002) Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 359(9313):1194–1199
Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD (1999) On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 68(2):493–498
Ascione R, Nason G, Al-Ruzzeh S, Ko C, Chilli F, Angelini GD (2001) Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency. Ann Thorac Surg 72(6):2020–2025
Ascione R, Reeves BC, Chamberlain MH, Ghosh AK, Lim KH, Angelini GD (2002) Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study. Ann Thorac Surg 74(2):474–480
Asimakopoulos G, Smith PL, Ratnatunga CP, Taylor KM (1999) Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg 68(3):1107–1115
Bedi HS, Suri A, Kalkat MS, Sengar BS, Mahajan V, Chawla R et al (2000) Global myocardial revascularization without cardiopulmonary bypass using innovative techniques for myocardial stabilization and perfusion. Ann Thorac Surg 69(1): 156–164
Benetti FJ, Mariani MA, Ballester C (1996) Direct coronary surgery without cardiopulmonary bypass in acute myocardial infarction. J Cardiovasc Surg (Torino) 37(4):391–395
Bittner HB, Savitt MA (2002) Off-pump coronary artery bypass grafting decreases morbidity and mortality in a selected group of high-risk patients. Ann Thorac Surg 74(1):115–118
Blauth CI, Cosgrove DM, Webb BW, Ratliff NB, Boylan M, Piedmonte MR et al (1992) Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg 103(6):1104–111; discussion 11-12.
Bouchard D, Cartier R (1998) Off-pump revascularization of multivessel coronary artery disease has a decreased myocardial infarction rate. Eur J Cardiothorac Surg 14(Suppl 1):S20–S24
Bowles BJ, Lee JD, Dang CR, Taoka SN, Johnson EW, Lau EM et al (2001) Coronary artery bypass performed without the use of cardiopulmonary bypass is associated with reduced cerebral microemboli and improved clinical results. Chest 119(1):25–30
Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L (1985) Pulmonary densities during anesthesia with muscular relaxation — a proposal of atelectasis. Anesthesiology 62(4):422–428
Chertow GM, Lazarus JM, Christiansen CL, Cook EF, Hammermeister KE, Grover F et al (1997) Preoperative renal risk stratification. Circulation 95(4):878–884
Contini M, Di Mauro M, Vitolla G, Mazzei V, Iaco AL, Cirmeni S et al (2000) Off-pump myocardial revascularization using arterial conduits without cardiopulmonary bypass. J Card Surg 15(4):251–255
Cox CM, Ascione R, Cohen AM, Davies IM, Ryder IG, Angelini GD (2000) Effect of cardiopulmonary bypass on pulmonary gas exchange: a prospective randomized study. Ann Thorac Surg 69(1):140–145
Craver JM, Murrah CP (2001) Elective intraaortic balloon counterpulsation for high-risk off-pump coronary artery bypass operations. Ann Thorac Surg 71(4):1220–1223
D’Ancona G, Karamanoukian H, Kawaguchi AT, Ricci M, Salerno TA, Bergsland J (2001) Myocardial revascularization of the beating heart in high-risk patients. J Card Surg 16(2):132–139
Diegeler A, Doll N, Rauch T, Haberer D, Walther T, Falk V et al (2000) Humoral immune response during coronary artery bypass grafting: a comparison of limited approach, “off-pump” technique, and conventional cardiopulmonary bypass. Circulation 102(19 Suppl 3):III95–100
Diegeler A, Matin M, Falk V, Battellini R, Walther T, Autschbach R et al (1999) Coronary bypass grafting without cardiopulmonary bypass — technical considerations, clinical results, and follow-up. Thorac Cardiovasc Surg 47(1):14–18
Eryilmaz S, Corapcioglu T, Eren NT, Yazicioglu L, Kaya K, Akalin H (2002) Off-pump coronary artery bypass surgery in the left ventricular dysfunction. Eur J Cardiothorac Surg 21(1):36–40
Gamoso MG, Phillips-Bute B, Landolfo KP, Newman MF, Stafford-Smith M (2000) Off-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction. Anesth Analg 91(5): 1080–1084
Gunther A, Siebert C, Schmidt R, Ziegler S, Grimminger F, Yabut M et al (1996) Surfactant alterations in severe pneumonia, acute respiratory distress syndrome, and cardiogenic lung edema. Am J Respir Crit Care Med 153(1):176–184
Kim KB, Lim C, Ahn H, Yang JK (2001) Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg 71(6):1964–1968
Kim KB, Lim C, Lee C, Chae IH, Oh BH, Lee MM et al (2001) Offpump coronary artery bypass may decrease the patency of saphenous vein grafts. Ann Thorac Surg 72(3):S1033–S1037
Kirali K, Rabus MB, Yakut N, Toker ME, Erdogan HB, Balkanay M et al (2002) Early-and long-term comparison of the on-and off-pump bypass surgery in patients with left ventricular dysfunction. Heart Surg Forum 5(2):177–181
Kobayashi J, Sasako Y, Bando K, Niwaya K, Tagusari O, Nakajima H et al (2002) Multiple off-pump coronary revascularization with “Aorta No-Touch” technique using composite and sequential methods. Heart Surg Forum 5(2):114–118
Lancey RA, Soller BR, Van der Salm TJ (2000) Off-pump versus on-pump coronary artery bypass surgery: a case-matched comparison of clinical outcomes and costs. Heart Surg Forum 3(4):277–281
Lee JH, Abdelhady K, Capdeville M (2000) Clinical outcomes and resource usage in 100 consecutive patients after off-pump coronary bypass procedures. Surgery 128(4):548–555
Mariani MA, Gu YJ, Boonstra PW, Grandjean JG, van Oeveren W, Ebels T (1999) Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate? Ann Thorac Surg 67(5):1370–1375
Massoudy P, Zahler S, Becker BF, Braun SL, Barankay A, Meisner H (2001) Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest 119(1):31–36
Matata BM, Sosnowski AW, Galinanes M (2000) Off-pump bypass graft operation significantly reduces oxidative stress and inflammation. Ann Thorac Surg 69(3):785–791
McKhann GM, Goldsborough MA, Borowicz LM Jr, Mellits ED, Brookmeyer R, Quaskey SA et al (1997) Predictors of stroke risk in coronary artery bypass patients. Ann Thorac Surg 63(2):516–521
Mohr R, Moshkovitch Y, Shapira I, Amir G, Hod H, Gurevitch J (1999) Coronary artery bypass without cardiopulmonary bypass for patients with acute myocardial infarction. J Thorac Cardiovasc Surg 118(1):50–56
Muller-Werdan U, Schumann H, Fuchs R, Reithmann C, Loppnow H, Koch S et al (1997) Tumor necrosis factor alpha (TNF alpha) is cardiodepressant in pathophysiologically relevant concentrations without inducing inducible nitric oxide-(NO)-synthase (iNOS) or triggering serious cytotoxicity. J Mol Cell Cardiol 29(11):2915–2923
Murkin JM (2000) Neurological outcomes after OPCAB: how much better is it? Heart Surg Forum 3(3):207–210
Ng CS, Wan S, Yim AP, Arifi AA (2002) Pulmonary dysfunction after cardiac surgery. Chest 121(4):1269–1277
Omeroglu SN, Kirali K, Guler M, Toker ME, Ipek G, Isik O et al (2000) Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 70(3):844–849; discussion 50
Perrault LP, Menasche P, Peynet J, Faris B, Bel A, de Chaumaray T et al (1997) On-pump, beating-heart coronary artery operations in high-risk patients: an acceptable trade-off? Ann Thorac Surg 64(5): 1368–1373
Pompilio G, Zanobini M, Polvani G, Alamanni F, Bignoli P (2001) Efficacy of off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg 71(5):1750–1751
Puskas JD, Thourani VH, Marshall JJ, Dempsey SJ, Steiner MA, Sammons BH et al (2001) Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Ann Thorac Surg 71(5):1477–1483; discussion 83-84
Puskas JD, Thourani VH, Vinten-Johansen J, Guyton RA (2001) Active perfusion of coronary grafts facilitates complex off-pump coronary artery bypass surgery. Heart Surg Forum 4(1):65–68
Puskas JD, Winston AD, Wright CE, Gott JP, Brown WM 3rd, Craver JM et al (2000) Stroke after coronary artery operation: incidence, correlates, outcome, and cost. Ann Thorac Surg 69(4):1053–1056
Puskas JD, Wright CE, Ronson RS, Brown WM, 3rd, Gott JP, Guyton RA (1998) Off-pump multivessel coronary bypass via sternotomy is safe and effective. Ann Thorac Surg 66(3):1068–1072
Quintilio C, Voci P, Bilotta F, Luzi G, Chiarotti F, Acconcia MC et al (1995) Risk factors of incomplete distribution of cardioplegic solution during coronary artery grafting. J Thorac Cardiovasc Surg 109(3):439–447
Reichenspurner H, Boehm D, Detter C, Schiller W, Reichart B (1999) Economic evaluation of different minimally invasive procedures for the treatment of coronary artery disease. Eur J Cardiothorac Surg 16(Suppl 2):76–79
Ricci M, Karamanoukian HL, Abraham R, Von Fricken K, D’Ancona G, Choi S et al (2000) Stroke in octogenarians undergoing coronary artery surgery with and without cardiopulmonary bypass. Ann Thorac Surg (5):1471–1475
Riess FC, Bader R, Kremer P, Kuhn C, Kormann J, Mathey D et al (2002) Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up. Ann Thorac Surg 73(6):1849–1855
Stamou SC, Dangas G, Dullum MK, Pfister AJ, Boyce SW, Bafi AS et al (2000) Beating heart surgery in octogenarians: perioperative outcome and comparison with younger age groups. Ann Thorac Surg 69(4):1140–1145
Steele M, Palmer-Steele C (2000) Perfusion technique for perfusion-assisted direct coronary artery bypass (PADCAB). J Extra Corpor Technol 32(3):158–161
Taggart DP (2000) Respiratory dysfunction after cardiac surgery: effects of avoiding cardiopulmonary bypass and the use of bilateral internal mammary arteries. Eur J Cardiothorac Surg 18(1):31–37
Tang AT, Knott J, Nanson J, Hsu J, Haw MP, Ohri SK (2002) A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients. Eur J Cardiothorac Surg 22(1):118–123
Tugtekin SM, Gulielmos V, Cichon R, Kappert U, Matschke K, Knaut M et al (2000) Off-pump surgery for anterior vessels in patients with severe dysfunction of the left ventricle. Ann Thorac Surg 0(3):1034–1036
van Dijk D, Nierich AP, Jansen EW, Nathoe HM, Suyker WJ, Diephuis JC et al (2001) Early outcome after off-pump versus onpump coronary bypass surgery: results from a randomized study. Circulation 104(15):1761–1766
Vlassov GP, Deyneka CS, Travine NO, Timerbaev VH, Ermolov AS (2001) Acute myocardial infarction: OPCAB is an alternative approach for treatment. Heart Surg Forum 4(2): 147–150
Vural KM, Tasdemir O, Karagoz H, Emir M, Tarcan O, Bayazit K (1995) Comparison of the early results of coronary artery bypass grafting with and without extracorporeal circulation. Thorac Cardiovasc Surg 43(6):320–325
Wan S, DeSmet JM, Barvais L, Goldstein M, Vincent JL, Le Clerc JL (1996) Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 112(3):806–811
Weimar C, Stausberg J, Kraywinkel K, Wagner M, Busse O, Haberl RL et al (2002) [Diagnosis related groups in stroke treatment. An analysis from the stroke data bank of the German Stroke Foundation]. Dtsch Med Wochenschr 127(31/32):1627–1632
Yau TM, Fedak PW, Weisel RD, Teng C, Ivanov J (1999) Predictors of operative risk for coronary bypass operations in patients with left ventricular dysfunction. J Thorac Cardiovasc Surg 118(6): 1006–1013
Yokoyama T, Baumgartner FJ, Gheissari A, Capouya ER, Panagiotides GP, Declusin RJ (2000) Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg 70(5):1546–1550
Zamvar VY, Khan NU, Madhavan A, Nihal Kulatilake NK, Butchart EG (2002) Clinical outcomes in coronary artery bypass graft surgery: comparison of off-pump and on-pump techniques. Heart Surg Forum 5(2):109–113
Zehr KJ, Handa N, Bonilla LF, Abel MD, Holmes DR, Jr (2000) Pitfalls and results of immediate angiography after off-pump coronary artery bypass grafting. Heart Surg Forum 3(4):293–299
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2004 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Friedrich, I., Börgermann, J. (2004). What do we know about OPCAB surgery?. In: Gulielmos, V. (eds) Beating Heart Bypass Surgery and Minimally Invasive Conduit Harvesting. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-7985-1929-9_2
Download citation
DOI: https://doi.org/10.1007/978-3-7985-1929-9_2
Publisher Name: Steinkopff, Heidelberg
Print ISBN: 978-3-7985-1399-0
Online ISBN: 978-3-7985-1929-9
eBook Packages: Springer Book Archive