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off-pump coronary artery bypass grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh

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World Journal of Cardiovascular Surgery 2024年第9期14卷 145-156页

作者： Muhit Abdullah Md. Abir Tazim Chowdhury Satyajit Sharma Rehana Akther Munama Magdum Munjerin Refat Synthee Md. Zafar-Al-Nimari Saikat Das Gupta Saleh Ahmed Samir Kumar Biswas M. Quamrul Islam Talukder Farooque Ahmed Department of Cardiac Surgery National Heart Foundation Hospital and Research Institute (NHFH&RI) Dhaka Bangladesh Department of Cardiothoracic and Vascular Surgery Evercare Hospital Dhaka Dhaka Bangladesh Ispahani Islamia Eye Institute & Hospital Khamarbari Dhaka Bangladesh National Institute of Preventive and Social Medicine Dhaka Bangladesh Square Hospital Dhaka Bangladesh

Background: off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk.

关键词： off-pump coronary artery bypass grafting Left Ventricular Dysfunction (LVD) Short-Term Outcomes

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Endoscopic vein harvest in elective off-pump coronary artery bypass grafting

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2009年第10期10卷 748-752页

作者： Nai-kuan CHOU Meng-lin LEE Shoei-shen WANG Division of Cardiovascular Surgery National Taiwan University Hospital College of Medicine National Taiwan University

While traditional open vein harvest was related to postoperative wound complications, endoscopic vein harvest was developed to minimize the morbidity in the greater saphenous vein harvest procedure. In this study, these two procedures were compared for postoperative wound healing and long-term graft patency. We reviewed all consecutive patients undergoing elective off-pump coronary artery bypass grafting from January 2004 to December 2005 and collected data regarding wound complications and coronary events. Wound complications included dehiscence, excessive discharge, edema, altered sensation, cellulitis, hema-toma, pain scale, and superficial and deep wound infection. coronary events were defined as diagnosis of myocardial infarction during the first year's follow-up. A total of 392 patients were included in our series, among whom 44 were excluded from the study due to emergent operation, preoperative intra-aortic balloon pump support, or the greater saphenous vein varicose characteristic, 78 belonged to open vein harvest group, and 270 to endoscopic vein harvest group. Wound complications were significantly less in the endoscopic group (5.2%) compared to the open group (19.2%) (P=0.0002). There was no significant difference on preopera-tive risk factors, total operative time, or hospitalization days. During one-year follow-up, both the early and late graft patency rates were similar between the two groups. Endoscopic vein harvest is safe and effective, which carries less risk for wound complica-tions and is associated with better satisfaction and cosmetic result than the traditional greater saphenous vein harvest procedure. The endoscopic vein harvest also demonstrates a great long-term patency.

关键词： Endoscopic vein harvest (EVH) Open vein harvest (OVH) off-pump coronary artery bypass grafting Greater saphenous vein (GSV) Internal mammary artery (IMA)

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A comparative analysis of intra-aortic balloon pump in off-pump patients undergoing coronary artery bypass grafting at different perioperative stages

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South China Journal of Cardiology 2012年第4期13卷 216-221页

作者：李欣麦明杰吴敏张洪宇陈星权简旭华黄劲松郑少忆 Department of Cardiovascular Surgery Guangdong Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical Sciences

Background Intra-aortic balloon pump （IABP） has been widely used at present. We can use it at different stages of perioperative period in off-pump coronary artery bypass grafting （CABG）. However, when to used it was seldom confirmed. Methods From January 2008 to June 2012, the 89 coronary heart disease （CHD） patients accepted implantation of IABP at different stages of off-pump CABG, preoperative and postoperative ventricular systolic function, left ventricular remodeling situation and the changes of myocardial enzymes were evaluated. Results All the patients had left heart insufficiency and muhivessel disease. Their postoperative left ventricular systolic function and ventricular remodeling were significantly improved while myocardial enzymes decreased with preoperative interventional implantation of IABP. The perioperative mortality was 7.86% （7/89）. No patients had complication of IABP. Conclusion Earlier IABP implantation at preoperation is useful to improve heart function, improve the tolerability of surgery, reduce the incidence of postoperative low cardiac output syndrome （LCOS） and decrease the mortality.

关键词： intra-aortic balloon pump off-pump coronary artery bypass grafting

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Application of intraoperative arterial pressure-based cardiac output monitoring for patients undergoing coronary artery bypass grafting surgery

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Chinese Medical Journal 2012年第12期125卷 2099-2103页

作者： LU Jia-kai ZHU Chen JING He WANG Yi-jun QING En-ming Department of Anesthesiology Beijing Anzhen Hospital CapitalMedical University Beijing 100029 China Department＇-of Anesthesiology China Coal General HospitalBeijing 100029 China

Background For patients undergoing off-pump coronary artery bypass grafting （OPCABG）, it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment. This study aimed to observe the clinical feasibility of arterial pressure-based cardiac output （APCO） for cardiac output （CO） monitoring and to evaluate the correlation between APCO and pulmonary artery catheter （PAC） for CO measurement for patients undergoing OPCABG intraoperatively. Methods Fifty patients of American Society of Anaesthesiologists （ASA） classification Ⅱ-Ⅲ, undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study. All patients were assigned to CO monitoring by PAC and APCO simultaneously. Patients with pacemaker, severe valvular heart disease, left ventricular ejection fraction （EF）〈40%, cardiac arrhythmias, peripheral vascular disease, application of intra-aortic balloon pump （IABP） and emergent diversion to cardiac pulmonary bypass were excluded. The radial artery waveform was analyzed to estimate the stroke volume （SV） and heart rate （HR） continuously. CO was calculated as SV × HR; other derived parameters were cardiac index （CI）, stroke volume index （SVI）, systemic vascular resistance （SVR）, and systemic vascular resistance index （SVRI）. PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms. Continuous cardiac output （CCO）, CI and other hemodynamic parameters were monitored at following 5 time points： immediate after anesthesia induction （baseline value）, anastomosis of left internal mammary artery to left anterior descending artery （LAD）, anastomosis of left circumflex （LCX）, anastomosis of posterior descending artery （PDA） and immediate after sternal closure. Results In the 50 patients, preoperative echocardiography measured left ventricular EF was （52.8±11.5）%, and 35 patients （70%） showed regional wall motion abnormalities. The correlation coeffic

关键词： arterial pressure-based cardiac output pulmonary artery catheter hemodynamics, cardiac output off-pump coronary artery bypass grafting

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off-pump versus on-pump coronary artery bypass surgery for the treatment of left main with triple coronary artery disease

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Journal of Nanjing Medical University 2008年第3期22卷 159-163页

作者： Zhibing Qiu Xin Chen Ming Xu Kaihu Shi Yinshuo Jiang Liqiong Xiao Department of Cardiothoracic Surgery the Nanjing First Hospital Affiliated to Nanjing Medical University Nanjing 210006 Jiangsu Province China

Objective：To obtain early results of off-pump coronarE~ artery bypass grafting（OPCAB） in patients with significant left main coronary artery（LMCA） and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery（CCAB）. Methods：Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demo- graphic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results： The number of distal anastomo- sis and grafts varied from 3 to 6. The average number per patient was similar in the two groups （OPCAB group：3.76 ± 0.98, CCAB group：3.81 ± 1.02）. Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance （P 〉 0.05）. The frequency of atrial fibrillation （AF）, IABP usage, mediastinitis, re-operation for bleeding （or tamponade） were similar in the two groups （P 〉 0.05）. Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group（P 〈 0.05）.Conclusion： Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.

关键词： left main coronary artery triple-vessel stenosis off-pump coronary artery bypass grafting

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coronary artery bypass grafting with concomitant resection for carcinoma of lung

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The Journal of Biomedical Research 2010年第1期24卷 77-80页

作者： Yangyang Zhang,Yanhu Wu ,Biao Yuan,Xiang Liu,Sheng Zhao,Zhi Li,Yu Xia Department of Cardiothoracic Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu Province,China [a] Department of Cardiothoracic Surgery the First Affiliated Hospital of Nanjing Medical University Nanjing 210029 Jiangsu Province China

A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting （CABG） and left lower lobectomy were performed through median sternotomy. This approach avoids complications due to staged operations and cardiopulmonary bypass （CPB）. This report shows that simultaneous off pump CABG and pulmonary operations can be performed safely in patients with coronary artery disease （CAD） associated with lung cancer.

关键词： lung cancer coronary artery disease luo- resection off-pump coronary artery bypass grafting

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