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General Thoracic and Cardiovascular Surgery
Erschienen in: General Thoracic and Cardiovascular Surgery 11/2014

01.11.2014 | Review Article

Off-pump coronary surgery: current justifications

verfasst von: Haralabos Parissis, B. C. Ramesh, Bassel Al-Alao

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 11/2014

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Abstract

Although the literature has failed to project an overall superiority of off-pump vs. on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies have concluded that the incidence of a stroke is less than 1 % when anaortic off-pump techniques are advocated in patients with diseased ascending aorta. Furthermore, off-pump techniques or their combination with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities. However, despite this, controversy still exists among the cardiac surgery community in terms of the benefit of this technique and its safety; hence, off-pump is becoming out of fashion. In this review paper, by looking at a “marginal group of patients” (elderly, high risks, atherosclerotic aortas) we attempt to re-establish and justify this technique and re-invent its usage.
Literatur
1.
Shapira OM, Badhwar V, Shahian D, Jacobs JP, Izhar U, Bao Y, Korach A, Lattouf OM, Grover FL, Puskas JD. International participation in the society of thoracic surgeons national database. Ann Thorac Surg. 2014;97(4):1127–30.
2.
De Raet JM, Desimone JP, Sergeant PT. Off-pump coronary artery bypass grafting: Anno 2011. Multimed Man Cardiothorac Surg. 2011;(713).
3.
Patel NN, Akowuah E, Hutter JA. Patient preference for coronary artery bypass graft surgery performed on the arrested or beating heart: a questionnaire study. Eur J Cardiothorac Surg. 2011;40:1282–4.PubMed
4.
Letsou GV, Wu YX, Grunkemeier G, Rampurwala MM, Kaiser L, Salaskar AL. Off-pump coronary artery bypass and avoidance of hypothermic cardiac arrest improves early left ventricular function in patients with systolic dysfunction. Eur J Cardiothorac Surg. 2011;40:227–32.PubMedCrossRef
5.
Rastan AJ, Bittner HB, Gummert JF, Walther T, Schewick CV, Girdauskas E, et al. On-pump beating heart versus off-pump coronary artery bypass surgery—evidence of pump-induced myocardial injury. Eur J Cardiothorac Surg. 2005;27:1057–64.PubMedCrossRef
6.
Yeatman M, Caputo M, Narayan P, Ghosh AK, Ascione R, Ryder I, et al. Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations. Ann Thorac Surg. 2002;73:1411–7.PubMedCrossRef
7.
Grundeman PF, Verlaan CW, van Boven WJ, Borst C. Ninety-degree anterior cardiac displacement in off-pump coronary artery bypass grafting: the Starfish cardiac positioner preserves stroke volume and arterial pressure. Ann Thorac Surg. 2004;78:679–84 (discussion 7–8).PubMedCrossRef
8.
Grundeman PF, Borst C, Verlaan CW, Meijburg H, Moues CM, Jansen EW. Exposure of circumflex branches in the tilted, beating porcine heart: echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass. J Thorac Cardiovasc Surg. 1999;118:316–23.PubMedCrossRef
9.
Saleh HZ, Pullan DM. Monitoring cardiac output trends with end-tidal carbon dioxide pressures in off-pump coronary bypass. Ann Thorac Surg. 2011;91:e81–2.PubMedCrossRef
10.
Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med. 2004;350:21–8.PubMedCrossRef
11.
Muneretto C, Bisleri G, Negri A, Manfredi J, Metra M, Nodari S, et al. Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study. Ann Thorac Surg. 2003;76:778–82 (discussion 83).PubMedCrossRef
12.
Arom KV, Flavin TF, Emery RW, Kshettry VR, Petersen RJ, Janey PA. Is low ejection fraction safe for off-pump coronary bypass operation? Ann Thorac Surg. 2000;70:1021–5.PubMedCrossRef
13.
Vaccarino V, Abramson JL, Veledar E, Weintraub WS. Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women. Circulation. 2002;105:1176–81.PubMedCrossRef
14.
Puskas JD, Kilgo PD, Kutner M, Pusca SV, Lattouf O, Guyton RA. Off-pump techniques disproportionately benefit women and narrow the gender disparity in outcomes after coronary artery bypass surgery. Circulation. 2007;116:I192–9.PubMedCrossRef
15.
Ascione R, Caputo M, Calori G, Lloyd CT, Underwood MJ, Angelini GD. Predictors of atrial fibrillation after conventional and beating heart coronary surgery: a prospective, randomized study. Circulation. 2000;102:1530–5.PubMedCrossRef
16.
Athanasiou T, Aziz O, Mangoush O, Al-Ruzzeh S, Nair S, Malinovski V, et al. Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited. Eur J Cardiothorac Surg. 2004;26:701–10.PubMedCrossRef
17.
Raja SG, Behranwala AA, Dunning J. Does off-pump coronary artery surgery reduce the incidence of postoperative atrial fibrillation? Interact CardioVasc Thorac Surg. 2004;3:647–52.PubMedCrossRef
18.
Misfeld M, Brereton RJ, Sweetman EA, Doig GS. Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation: meta-analysis of 11,398 cases from 8 studies. J Thorac Cardiovasc Surg. 2011;142:e11–7.PubMedCrossRef
19.
Misfeld M, Potger K, Ross DE, McMillan D, Brady PW, Marshman D, et al. “Anaortic” off-pump coronary artery bypass grafting significantly reduces neurological complications compared to off-pump and conventional on-pump surgery with aortic manipulation. Thorac Cardiovasc Surg. 2010;58:408–14.PubMedCrossRef
20.
Vallely MP, Potger K, McMillan D, Hemli JM, Brady PW, Brereton RJ, et al. Anaortic techniques reduce neurological morbidity after off-pump coronary artery bypass surgery. Heart Lung Circ. 2008;17:299–304.PubMedCrossRef
21.
Edelman JJ, Yan TD, Bannon PG, Wilson MK, Vallely MP. Coronary artery bypass grafting with and without manipulation of the ascending aorta—a meta-analysis. Heart Lung Circ. 2011;20:318–24.PubMedCrossRef
22.
Asai T, Suzuki T, Nota H, Kuroyanagi S, Kinoshita T, Takashima N, Hayakawa M, Naito S. Off-pump coronary artery bypass grafting using skeletonized in situ arterial grafts. Ann Cardiothorac Surg. 2013;2(4):552–6.PubMedPubMedCentral
23.
Athanasiou T, Al-Ruzzeh S, Kumar P, Crossman MC, Amrani M, Pepper JR, et al. Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients. Ann Thorac Surg. 2004;77:745–53.PubMedCrossRef
24.
Sedrakyan A, Wu AW, Parashar A, Bass EB, Treasure T. Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting: a meta-analysis of systematically reviewed trials. Stroke. 2006;37:2759–69.PubMedCrossRef
25.
Li Z, Denton T, Yeo KK, Parker JP, White R, Young JN, et al. Off-pump bypass surgery and postoperative stroke: California coronary bypass outcomes reporting program. Ann Thorac Surg. 2010;90:753–9.PubMedCrossRef
26.
Afilalo J, Rasti M, Ohayon SM, Shimony A, Eisenberg MJ. Off-pump vs. on-pump coronary artery bypass surgery: an updated meta-analysis and meta-regression of randomized trials. Eur Heart J. 2012;33:1257–67.PubMedCrossRef
27.
Puskas JD, Thourani VH, Kilgo P, Cooper W, Vassiliades T, Vega JD, et al. Off-pump coronary artery bypass disproportionately benefits high-risk patients. Ann Thorac Surg. 2009;88:1142–7.PubMedCrossRef
28.
Barandon L, Richebe P, Munos E, Calderon J, Lafitte M, Lafitte S, et al. Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results. Interact CardioVasc Thorac Surg. 2008;7:789–93.PubMedCrossRef
29.
Kerendi F, Morris CD, Puskas JD. Off-pump coronary bypass surgery for high-risk patients: only in expert centers? Curr Opin Cardiol. 2008;23:573–8.PubMedCrossRef
30.
Rastan AJ, Walther T, Falk V, Lehmann S, Kempfert J, Mohr FW. Coronary artery bypass grafting on the beating heart in high-risk patients. Herz. 2007;32:483–90.PubMedCrossRef
31.
Lemma MG, Coscioni E, Tritto FP, Centofanti P, Fondacone C, Salica A, et al. On-pump versus off-pump coronary artery bypass surgery in high-risk patients: operative results of a prospective randomized trial (on–off study). J Thorac Cardiovasc Surg. 2012;143:625–31.PubMedCrossRef
32.
Jarral OA, Saso S, Athanasiou T. Off-pump coronary artery bypass in patients with left ventricular dysfunction: a meta-analysis. Ann Thorac Surg. 2011;92:1686–94.PubMedCrossRef
33.
Kunadian V, Zaman A, Qiu W. Revascularization among patients with severe left ventricular dysfunction: a meta-analysis of observational studies. Eur J Heart Fail. 2011;13:773–84.PubMedCrossRefPubMedCentral
34.
Kuss O, von Salviati B, Borgermann J. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses. J Thorac Cardiovasc Surg. 2010;140:829–35, 35 e1–13.
35.
Polomsky M, He X, O’Brien SM, Puskas JD. Outcomes of off-pump versus on-pump coronary artery bypass grafting: impact of preoperative risk. J Thorac Cardiovasc Surg. 2013;145(5):1193–8.PubMedCrossRef
36.
Kinoshita T, Asai T, Suzuki T, Kambara A, Matsubayashi K. Off-pump bilateral versus single skeletonized internal thoracic artery grafting in high-risk patients. Circulation. 2011;124(11):130–4.CrossRef
37.
Panesar SS, Athanasiou T, Nair S, Rao C, Jones C, Nicolaou M, et al. Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass grafting—comparison between off-pump and on-pump techniques. Heart. 2006;92:1808–16.PubMedCrossRefPubMedCentral
38.
LaPar DJ, Bhamidipati CM, Reece TB, Cleveland JC, Kron IL, Ailawadi G. Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians? J Thorac Cardiovasc Surg. 2011;141:81–90.PubMedCrossRefPubMedCentral
39.
Saleh HZ, Shaw M, Fabri BM, Chalmers JA. Does avoidance of cardiopulmonary bypass confer any benefits in octogenarians undergoing coronary surgery? Interact CardioVasc Thorac Surg. 2011;12:435–9.PubMedCrossRef
40.
Kinoshita T, Asai T, Suzuki T, Kuroyanagi S, Hosoba S, Takashima N. Off-pump bilateral skeletonized internal thoracic artery grafting in elderly patients. Ann Thorac Surg. 2012;93(2):531–6.PubMedCrossRef
41.
Ben-Gal Y, Stone GW, Smith CR, Williams MR, Weisz G, Stewart AS, et al. On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. J Thorac Cardiovasc Surg. 2011;142:e33–9.PubMedCrossRef
42.
Moscarelli M, Harling L, Ashrafian H, Athanasiou T. Should we consider off-pump coronary artery bypass grafting in patients with acute coronary syndrome? Interact Cardiovasc Thorac Surg. 2013;16(3):350–5.PubMedCrossRefPubMedCentral
43.
Novitzky D, Baltz JH, Hattler B, Collins JF, Kozora E, Shroyer AL, et al. Outcomes after conversion in the Veterans Affairs randomized on versus off bypass trial. Ann Thorac Surg. 2011;92:2147–54.PubMedCrossRef
44.
Mukherjee D, Ahmed K, Baig K, Patel VM, Darzi A, Athanasiou T. Conversion and safety in off-pump coronary artery bypass: a system failure that needs re-emphasis. Ann Thorac Surg. 2011;91:630–9.PubMedCrossRef
45.
Urso S, Sadaba JR, Pettinari M. Impact of off-pump to on-pump conversion rate on post-operative results in patients undergoing off-pump coronary artery bypass. Interact CardioVasc Thorac Surg. 2012;14:188–93.PubMedCrossRefPubMedCentral
46.
Konety SH, Rosenthal GE, Vaughan-Sarrazin MS. Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: does it matter? J Thorac Cardiovasc Surg. 2009;137(1116–23):e1.PubMed
47.
Lapar DJ, Mery CM, Kozower BD, Kern JA, Kron IL, Stukenborg GJ, et al. The effect of surgeon volume on mortality for off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2012;143:854–63.PubMedCrossRef
48.
Sepehripour AH, Athanasiou T. Is there a surgeon or hospital volume-outcome relationship in off-pump coronary artery bypass surgery? Interact Cardiovasc Thorac Surg. 2013;16(2):202–7.PubMedCrossRefPubMedCentral
49.
50.
Locker C, Schaff HV, Dearani JA, Joyce LD, Park SJ, Burkhart HM, Suri RM, Greason KL, Stulak JM, Li Z, Daly RC. Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: analysis of 8622 patients with multivessel disease. Circulation. 2012;126(9):1023–30.PubMedCrossRef
51.
Emmert MY, Salzberg SP, Cetina Biefer HR, Sundermann SH, Seifert B, Grunenfelder J, et al. Total arterial off-pump surgery provides excellent outcomes and does not compromise complete revascularization. Eur J Cardiothorac Surg. 2012;41:e25–31.PubMedCrossRef
52.
Nakajima H, Kobayashi J, Toda K, Fujita T, Shimahara Y, Kasahara Y, et al. Angiographic evaluation of flow distribution in sequential and composite arterial grafts for three vessel disease. Eur J Cardiothorac Surg. 2012;41:763–9.PubMedCrossRef
53.
Navia D, Vrancic M, Piccinini F, Camporrotondo M, Thierer J, Gil C, Benzadon M. Is the second internal thoracic artery better than the radial artery in total arterial off-pump coronary artery bypass grafting? A propensity score-matched follow-up study. J Thorac Cardiovasc Surg. 2014;147(2):632–8.PubMedCrossRef
54.
Hwang HY, Cho KR, Kim KB. Equivalency of right internal thoracic artery and right gastroepiploic artery composite grafts: five-year outcomes. Ann Thorac Surg. 2013;96(6):2061–8.PubMedCrossRef
55.
Jeong DS, Kim YH, Lee YT, Chung SR, Sung K, Kim WS, Park PW. Revascularization for the right coronary artery territory in off-pump coronary artery bypass surgery. Ann Thorac Surg. 2013;96(3):778–85 (discussion 785).PubMedCrossRef
56.
Kim WS, Lee J, Lee YT, Sung K, Yang JH, Jun TG, Park PW. Total arterial revascularization in triple-vessel disease with off-pump and aortic no-touch technique. Ann Thorac Surg. 2008;86(6):1861–5.PubMedCrossRef
57.
Al-Ruzzeh S, Epstein D, George S, Bustami M, Wray J, Ilsley C, et al. Economic evaluation of coronary artery bypass grafting surgery with and without cardiopulmonary bypass: cost-effectiveness and quality-adjusted life years in a randomized controlled trial. Artif Organs. 2008;32:891–7.PubMedCrossRef
58.
Hu S, Zheng Z, Yuan X, Wang W, Song Y, Sun H, et al. Increasing long-term major vascular events and resource consumption in patients receiving off-pump coronary artery bypass: a single-center prospective observational study. Circulation. 2010;121:1800–8.PubMedCrossRef
59.
Filardo G, Grayburn PA, Hamilton C, Hebeler RF Jr, Cooksey WB, Hamman B. Comparing long-term survival between patients undergoing off-pump and on-pump coronary artery bypass graft operations. Ann Thorac Surg. 2011;92:571–7 (discussion 7–8).PubMedCrossRef
60.
Wu C, Camacho FT, Culliford AT, Gold JP, Wechsler AS, Higgins RS, et al. A comparison of long-term mortality for off-pump and on-pump coronary artery bypass graft surgery. Circ Cardiovasc Qual Outcomes. 2012;5:76–84.PubMedCrossRefPubMedCentral
61.
Alston RP. Brain damage and cardiopulmonary bypass: is there really any association? Perfusion. 2011;26(Suppl 1):20–6.PubMedCrossRef
62.
Cheng DC, Bainbridge D, Martin JE, Novick RJ, Evidence-Based Perioperative Clinical Outcomes Research Group. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology. 2005;102:188–203.PubMedCrossRef
63.
Lamy A, Devereaux PJ, Prabhakaran D, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med. 2012;366:1489–97.PubMedCrossRef
64.
Diegeler A, Börgermann J, Kappert U, et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med. 2013;368:1189–98.PubMedCrossRef
Metadaten
Titel
Off-pump coronary surgery: current justifications
verfasst von
Haralabos Parissis
B. C. Ramesh
Bassel Al-Alao
Publikationsdatum
01.11.2014
Verlag
Springer Japan
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 11/2014
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-014-0470-2

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