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Background: For diabetic patients undergoing coronary artery bypass grafting (CABG), there is still a debate about whether an off-pump or on-pump approach is advantageous. Methods: A retrospective review of 1269 consecutive diabetic patients undergoing isolated, primary CABG surgery from January 1, 2013 to December 31, 2015 was conducted. Among them, 614 received non-cardiopulmonary bypass treatment during their operation (off-pump group), and 655 received cardiopulmonary bypass treatment (on-pump group). The hospitalization outcomes were compared by multiple logistic regression models with patient characteristics and operative variables as independent variables. Kaplan-Meier curves and Cox proportional-hazard regression models for mid-term (2-year) and long-term (5-year) clinical survival analyses were used to determine the effect on survival after CABG surgery. In order to further verify the reliability of the results, propensity-score matching (PSM) was also performed between the two groups. Results: Five-year all-cause death rates were 4.23% off-pump vs. 5.95% on-pump (p = 0.044), and off-pump was associated with reduced postoperative stroke and atrial fibrillation. Conclusions: These findings suggest that off-pump procedures may have benefits for diabetic patients in CABG. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a common complication after on-pump cardiac surgery, and previous studies have suggested that blood glucose is associated with postoperative AKI. However, limited evidence is available regarding intraoperative glycemic thresholds in cardiac surgery. The aim of this study was to explore the association between peak intraoperative blood glucose and postoperative AKI, and determine the cut-off values for intraoperative glucose concentration associated with an increased risk of AKI. The study was retrospective and single-centered. Adult patients in West China Hospital of Sichuan University who underwent on-pump cardiac surgery (n = 3375) were included. The primary outcome was the incidence of AKI. Multivariable logistic analysis using restricted cubic spline was performed to explore the association between intraoperative blood glucose and postoperative AKI. The incidence of AKI in the study population was 18.0% (607 of 3375). Patients who developed AKI had a significantly higher peak intraoperative glucose during the surgery compared to those without AKI. After adjustment for confounders, the incidence of AKI increased with peak intraoperative blood glucose (adjusted odds ratio, 1.08, 95% confidence interval 1.03, 1.12). Furthermore, it was demonstrated that the possibility of AKI was relatively flat till 127.8 mg/dL (7.1 mmol/L) glucose levels which started to rapidly increase afterward. Increased intraoperative blood glucose was associated with an increased risk of AKI. Among patients undergoing on-pump cardiac surgery, avoiding a high glucose peak (i.e., below 127.8 mg/dL [7.1 mmol/L]) may reduce the risk of postoperative AKI. [ABSTRACT FROM AUTHOR]

Background: The ongoing debate regarding off-pump coronary artery bypass grafting (CABG) and on-pump CABG has endured for over three decades. Although numerous randomized controlled trials (RCTs) and meta-analyses have been reported, new evidence has emerged. Therefore, an updated and comprehensive meta-analysis to guide clinical practice is essential. Background: The ongoing debate regarding off-pump coronary artery bypass grafting (CABG) and on-pump CABG has endured for over three decades. Although numerous randomized controlled trials (RCTs) and meta-analyses have been reported, new evidence has emerged. Therefore, an updated and comprehensive meta-analysis to guide clinical practice is essential. Results: After thorough screening, 39 articles were included, consisting of 28 RCTs and involving a total of 16 090 patients. Offpump CABG significantly reduced the incidence of short-term stroke (1.27 vs. 1.78%, OR: 0.74, P= 0.03, high certainty). However, it was observed to be associated with increased mid-term coronary reintervention (2.77 vs. 1.85%, RR: 1.49, P<0.01, high certainty) and long-term mortality (21.8 vs. 21.0%, RR: 1.09, P =0.02, moderate certainty). Conclusions: Off-pump CABG significantly reduces the short-term incidence of stroke, but it also increases the incidence of midterm coronary reintervention. Moreover, it may increase long-term mortality. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the effect of coronary artery bypass grafting surgery performed using either the on-pump or off-pump technique on the levels of postoperative anxiety, depression, somatization, and somatosensory amplification in patients. Methods: There were 100 participants in this cross-sectional study who completed the “Sociodemographic Data Form”, the “Hospital Anxiety and Depression Scale”, the “Somatization Scale (SS)”, and the “Somatosensory Amplification Scale”. Results: Compared with the off-pump group, the on-pump group had a higher mean SS score. Conclusion: Because the mean SS score was lower in patients after off-pump surgery, it may be more advantageous to perform offpump surgeries in the future. Before the superiority of the off-pump over the on-pump can be definitively established, however, data from large, randomized trials are required.

Background Elderly patients are at increased risk of perioperative morbidity and mortality after conventional on-pump coronary artery bypass grafting (ONCABG). This study was to determine whether such high-risk population would benefit from off-pump coronary artery bypass grafting (OPCABG). Methods A retrospective analysis was performed on patients aged 65 years or older who underwent isolated coronary artery bypass grafting for the first time in Wuhan Union Hospital from January 2015 to January 2021. We used propensity score matching to adjust for differences in baseline characteristics between the ONCABG and OPCABG groups. Morbidity and mortality within 30 days after surgery were compared between the two groups. All operations were performed by experienced cardiac surgeons. Results A total of 511 patients (ONCABG 202, OPCABG 309) were included. After 1:1 matching, the baseline characteristics of the two groups were comparable (ONCABG 173, OPCABG 173). The OPCABG group had higher rate of incomplete revascularization (13.9% vs. 6.9%; P  = .035) than the ONCABG group. However, OPCABG reduced the risk of postoperative renal insufficiency (15.0% vs. 30.1%; P  = .001) and reoperation for bleeding (0.0% vs. 3.5%; P  = .030). There were no significant differences in early postoperative mortality, myocardial infarction, stroke, and other outcomes between the two groups. Conclusions OPCABG is an alternative revascularization method for elderly patients. It reduces the risk of early postoperative renal insufficiency and reoperation for bleeding. What is already known on this topic   Elderly patients are at increased risk of perioperative morbidity and mortality after conventional on-pump coronary artery bypass grafting. What this study adds   Off-pump coronary artery bypass grafting reduced the risk of early postoperative renal insufficiency and reoperation for bleeding in elderly patients. How this study might affect research, practice or policy   The study showed that off-pump coronary artery bypass grafting is an alternative surgical method for revascularization in elderly patients with coronary heart disease. It can provide data support for clinicians to select off-pump procedure for elderly patients and facilitate clinical decision-making, outcome assessment, and quality improvement. [ABSTRACT FROM AUTHOR]

Objective: The decision to perform on-pump or off-pump coronary bypass surgery (CABG) depends on various parameters such as myocardial contractility, thickness of the myocardium and overall surgeon preference. There are very few studies analyzing the same. Hence, the aim of the study is to investigate the distribution of different risk factors, angiographic patterns and short-term mortality in patients undergoing between on -pump CABG and off- pump CABG groups and compare short-term outcomes among different subgroups of patients with coronary artery disease. Methods: The present study is a retrospective observational study with data from August 2016 to December 2021 undertaken in government general hospital Kurnool, India. A total of 108 patients were taken of whom 36 constituted on-pump CABG group and 72 – off- pump CABG group, were present eligible as per inclusion criteria and exclusion criteria. The data considered includes the age, risk factors, echocardiographic reports, angiographic data, surgery details and post-surgery status. Results: The mean age of patients was 56.21 (10.2) years with maximum age of 85 years and minimum age of 35 years. The distribution of population by sex: male - 90 (83.3%) and female – 18 (16.7%). The smoking as a risk factor was found in 60(55.6%) patients, alcohol - 36 (33.3%) patients, diabetes -28 (25.9 %) patients, and hypertension - 19 (17.6%) patients. Some of them have more than one risk factor. The mean ejection fraction (EF) of the patients was 43 .66 (6.2%) with the highest EF noted 63% and lowest 30%. The patients with single- vessel disease were 26 (24.1%), double -vessel disease - 35 (32.4%), triple vessel disease - 47 (43.5%). Of all patients, 36 undergone on pump CABG of whom 12 patients (33.3%) died and 72 patients undergone off pump CABG, of whom 6 (8.3%) succumbed after the surgery (p<0.05). Conclusion: The on-pump group had significantly more often mortality rate than off- pump group. Increasing age group above 60 years, reduced EF, involvement of left main coronary artery, smoking and alcoholism were associated with morbidity and mortality in on-pump CABG than off-pump CABG. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the effect of coronary artery bypass grafting surgery performed using either the on-pump or off-pump technique on the levels of postoperative anxiety, depression, somatization, and somatosensory amplification in patients. Methods: There were 100 participants in this cross-sectional study who completed the "Sociodemographic Data Form", the "Hospital Anxiety and Depression Scale", the "Somatization Scale (SS)", and the "Somatosensory Amplification Scale". Results: Compared with the off-pump group, the on-pump group had a higher mean SS score. Conclusion: Because the mean SS score was lower in patients after off-pump surgery, it may be more advantageous to perform off-pump surgeries in the future. Before the superiority of the off-pump over the on-pump can be definitively established, however, data from large, randomized trials are required. [ABSTRACT FROM AUTHOR]

Objective: We performed a post hoc analysis of the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial to determine the effect an on-versus off-pump strategy had on outcomes when compared with percutaneous coronary intervention. Methods: All randomized patients in EXCEL (n = 1905) were included. The outcomes of interest were the primary end point composite of death from any cause, stroke, or myocardial infarction; the composite study end point or ischemia-driven revascularization; and the rate of death from any cause at 5 years. Event rates were based on Kaplan–Meier estimates in time-to-first-event analyses. Results: Propensity matching resulted in groups of 1142 patients (571 each) for on-pump coronary artery bypass grafting versus percutaneous coronary intervention and 472 patients (236 each) for off-pump coronary artery bypass grafting versus percutaneous coronary intervention. In the on-pump coronary artery bypass grafting versus percutaneous coronary intervention matched groups, the composite end point was similar (18.0% vs 22.1%, P = .19) and the composite end point or ischemia-driven revascularization (23.3% vs 31.0%, P = .01) was lower, and mortality (7.6% vs 11.8%, P = .025) was lower in the on-pump coronary artery bypass grafting group at 5 years. In the off-pump coronary artery bypass grafting versus percutaneous coronary intervention matched groups, the composite end point (19.4% vs 22.2%, P = .47), composite end point or ischemia-driven revascularization (25.9% vs 34.2%, P = .07), and mortality (12.5% vs 14.2%, P = .59) were similar at 5 years. Conclusions: In the EXCEL trial, on-pump coronary artery bypass grafting was associated with a decreased 5-year rate of the composite outcome of death, stroke, myocardial infarction, or ischemia-driven revascularization, and decreased mortality when compared with percutaneous coronary intervention, whereas outcomes of off-pump coronary artery bypass grafting were similar to percutaneous coronary intervention.

Introduction: although there is the increase in the number of percutaneous procedures, coronary artery bypass grafting (CABG) remains the standard treatment for patients with extensive coronary artery disease. Coronary artery bypass graft surgery should be performed with or without extracorporeal circulation (CPB), therefore there is on-pump and off-pump CABG procedures. There is an ongoing, debate over the superiority of onpump vs. off-pump CABG methods. Both techniques have their pros and cons, and cardiac surgery units around the world have different approaches and opinio ns on the subject. Aim: to show whether there was a difference in early postoperative recovery in patients in whom cardiac bypass surgery was performed using the on-pump or off-pump CABG method and whether one type of operation was superior to the other. Material and methods: in the period from September 2021 to May 2023 isolated CABG was performed on 230 patients, divided into two groups at the Clinic of Cardiovascular Surgery of the Clinical Center University of Sarajevo. One group with 80 patients had on-pump CABG operation (with CPB), and other was with 150 patients was treated with off-pump CABG technique. Data were collected during preoperative, intraoperative and postoperative period. All patients were elective cases. Results: our study showed that there were more male patients in both group with an average age 63 years which was similar in both groups. There was statistically significant difference in number of grafts implanted in favor of on -pump CABG group. Comparing the comorbidities presented in patients in both groups, there was no significant difference, but a statistically significant difference was in the presence of anemia in favor of patients from the off -pump group, 36.7% versus 11.3%, p 0.0001. There was a statistically significant difference in mean number of blood transfusions units (1.03±1.26:0.53±1.02 units) and fresh frozen plasma (FFP) (1.96±1.35:1.37±1.39 units) in favor of on - pump group during operation. In early postoperative period, in intensive care unit (ICU), data showed significantly higher number of patients on vasopressors in off -pump group, 50.0% compared to 35.0% of cases in the on-pump group. Comparison of blood products transfusions during ICU stay indicate that there was a statistically significant difference in mean number of blood transfusions units (1.5±1.99:0.51±1.06 units) and FFP (1.0±1.41:0.51±1.06 units) in favor of on -pump group. The stay in the ICU was statistically significantly longer for the patients in the on-pump group, 3.56±1.93 days (range 2-18 days) compared to the patients in the off-pump group, 2.74±0.82 days (range 1-7 days). Other observed parameters such as the occurrence of atrial fibrillation, the amount of drainage during 48 hours, the duration of mechanical ventilation, the use of platelets and the recorded fatal outcome did not show a significant difference between the observed groups. Conclusion: the study showed that the intra- and post-operative consumption of blood and fresh frozen plasma is significantly lower if the patient underwent off -pump CABG, avoiding possible complications of transfusion use. Also, patients from the off -pump group had a shorter stay in ICU, which favors faster recovery and lower treatment costs. [ABSTRACT FROM AUTHOR]

Postinfarction left ventricular (LV) aneurysm develops as a result of untimely restoration of blood flow in the infarct-dependent artery and is associated with an increase in cardiac mortality. The presence of several postinfarction LV aneurysms of different localizations in one patient is a rare and casuistic case. Case description. Patient B., 53 years old, was urgently hospitalized in the National Amosov Institute with complaints of shortness of breath, pain behind the sternum with radiation to the left arm, occurring with minimal physical exertion. Electrocardiography showed scar changes in the anterior-apical-lateral area of the LV with a thrombosed aneurysm of the LV lateral wall. Echocardiography revealed a severe decrease in the global contractility of the LV with ejection fraction of 24% and aneurysms of the septal-apical and posterior-lateral segments of LV. Pericarditis was found, with a layer of fluid of 1.7 cm on the LV posterior wall and 2.0 cm on the LV apex. Emergency coronary angiography revealed an occlusion of the middle third of the left anterior descending artery and the middle third of the left circumflex coronary artery, 50-70% stenosis of the right coronary artery and confirmed widespread LV aneurysm. Cardiac magnetic resonance imaging with intravenous contrast confirmed the change in configuration and significant dilatation of the LV due to the formation of two LV aneurysms with mural thrombus in the cavity of the posterior-lateral LV aneurysm. After discussing the patient’s data, the cardiac team performed emergency on-pump coronary bypass surgery, resection of the LV aneurysm with thrombectomy. The operation took 5 hours, aorta cross-clamp time was 75 min, perfusion time was 117 min, intraoperative blood loss was 300 ml. The patient was extubated in 2 hours after the end of the operation, the length of intensive care unit stay was 2 days. On the 9th day after the operation, the patient was discharged from the Institute with positive clinical, electrocardiographic and echocardiographic (LV ejection fraction 38%) dynamics. Conclusions. This clinical case demonstrates successful surgical treatment of two LV aneurysms, a rare complication of acute myocardial infarction. Preoperative detailed diagnosis and discussion of the patient’s data by the heart team, selection of the optimal term and volume of the operation allowed to quickly stabilize the patient’s condition and achieve a positive immediate result.

Objective: The decision to perform on-pump or off-pump coronary bypass surgery (CABG) depends on various parameters such as myocardial contractility, thickness of the myocardium and overall surgeon preference. There are very few studies analyzing the same. Hence, the aim of the study is to investigate the distribution of different risk factors, angiographic patterns and short-term mortality in patients undergoing between on -pump CABG and off- pump CABG groups and compare short-term outcomes among different subgroups of patients with coronary artery disease. Methods: The present study is a retrospective observational study with data from August 2016 to December 2021 undertaken in government general hospital Kurnool, India. A total of 108 patients were taken of whom 36 constituted on-pump CABG group and 72 – off- pump CABG group, were present eligible as per inclusion criteria and exclusion criteria. The data considered includes the age, risk factors, echocardiographic reports, angiographic data, surgery details and post-surgery status. Results: The mean age of patients was 56.21 (10.2) years with maximum age of 85 years and minimum age of 35 years. The distribution of population by sex: male - 90 (83.3%) and female – 18 (16.7%). The smoking as a risk factor was found in 60(55.6%) patients, alcohol - 36 (33.3%) patients, diabetes -28 (25.9 %) patients, and hypertension - 19 (17.6%) patients. Some of them have more than one risk factor. The mean ejection fraction (EF) of the patients was 43 .66 (6.2%) with the highest EF noted 63% and lowest 30%. The patients with single- vessel disease were 26 (24.1%), double -vessel disease - 35 (32.4%), triple vessel disease - 47 (43.5%). Of all patients, 36 undergone on pump CABG of whom 12 patients (33.3%) died and 72 patients undergone off pump CABG, of whom 6 (8.3%) succumbed after the surgery (p

BackgroundControversy exists regarding the advantages and risks of off-pump vs. on-pump coronary artery bypass grafting (CABG) for patients with diabetes. We therefore compare the early clinical outcomes of off-pump vs. on-pump procedures for diabetic patients with three-vessel disease.Materials and methodsWe conducted a retrospective analysis of clinical data obtained from 548 diabetic patients with three-vessel coronary artery disease who underwent isolated CABG between January 2016 and June 2020. To adjust the differences of baseline characteristics between the off-pump CABG (OPCAB) and on-pump CABG (ONCAB) groups, propensity score matching (PSM) was used. Following 1:1 matching, we selected 187 pairs of patients for further comparison of outcomes within the first 30 days after surgery.ResultsThe preoperative characteristics of the patients between the two groups were clinically comparable after PSM. The OPCAB group exhibited a significantly higher incidence of incomplete revascularization (27.3% vs. 14.4%; P = 0.002) compared with the ONCAB group. No differences were seen in mortality within 30 days between the matched groups (1.1% vs. 3.7%; P = 0.174). Notably, the OPCAB group had a lower risk of respiratory failure or infection (2.1% vs. 7.0%; P = 0.025), less postoperative stroke (1.1% vs. 4.8%; P = 0.032), and reduced postoperative ventilator assistance time (35.8 ± 33.7 vs. 50.9 ± 64.8; P = 0.005).ConclusionOPCAB in diabetic patients with three-vessel disease is a safe procedure with reduced early stroke and respiratory complications and similar mortality rate, myocardial infarction, and renal failure requiring dialysis to conventional on-pump revascularization.

Abstract Background Systemic deleterious effects of cardiopulmonary bypass have been observed in the postprocedural period. Long-term assessment, including ventricular function (VF), is unclear. The objective of this study was to compare the change of left ventricular ejection fractions (LVEFs) during a long-term follow-up of coronary artery disease (CAD) patients who underwent off-pump (OPCAB) or on-pump coronary artery bypass grafting (ONCAB). Methods This study is a prespecified analysis of the MASS III trial, which was a single-center and prospective study that enrolled stable CAD patients with preserved VF. The CAD patients in our study were randomized to OPCAB or ONCAB. A transthoracic echocardiogram was performed during follow-up and a LVEF value was obtained. The primary endpoint was the difference between the final LVEF and the baseline LVEF. Results Of the 308 randomized patients, ventricular function were observed in 225 over a mean of 5.9 years of follow-up: 113 in the ONCAB group and 112 in the OPCAB group. Baseline characteristics were similar between the two groups, but there was a larger proportion of subjects with 3-vessel disease in the ONCAB group. There was no difference in the LVEF at the beginning (P = 0.08), but there was a slight decrease in the LVEF in the ONCAB and OPCAB groups (P

Aim. To determine the incidence and predictors of cardiovascular events in onpump cardiac operations in modern practice.Material and methods. The study included 200 patients who underwent various elective cardiac surgical interventions. Cardiovascular events (CVEs) were determined within 30 days from the operation, according to medical records and autopsy protocols. We identified major CVEs (cardiovascular death, stroke, myocardial infarction) and minor CVEs (angina pectoris, significant ventricular arrhythmias, atrial fibrillation or flutter episodes, AV conduction disorders, etc.). A comprehensive preoperative examination was performed, including an extended echocardiography protocol and coronary angiography.Results. In 101 patients (50,05%), various CVEs were identified: 4,0% had major CVEs and 46,05% had minor CVEs and various non-cardiac complications, while perioperative mortality was 2,0%. Most ischemic CVEs, as well as most intracardiac conduction disorders, were registered during the first 3 days after surgery. In contrast, episodes of atrial fibrillation/flutter occurred 2-7 days after the intervention. There were following preoperative examination parameters with the highest prognostic value: history of heart failure, age >65 years, history of myocardial infarction, occlusion of at least one coronary artery, and diabetes.Conclusion. The data obtained indicate the high efficiency of current surgical and anesthetic technologies, which lead to relatively low risk of severe and fatal events. The parameters of the preoperative examination, which determine the increased risk of intervention, are highlighted.

The first part of the article was dedicated to the problem of comorbidities in cardiac surgery patients with coronary artery disease (CAD), considered modern literary sources discussing endocrinopathies, connective tissue diseases, COVID-19-associated autoimmune processes, chronic kidney disease and diseases of the gastrointestinal tract. The aim. To continue the analysis of current literature data on comorbidities in patients hospitalized for surgical myocardial revascularization. Results. When assessing the preoperative status of a cardiac surgery patient with CAD, not only their cardiological status and the percentage of stenotic lesion of the coronary arteries are important, but also the presence of concomitant diseases and the degree of their compensation. According to the modern literary sources, 4-20.5% of patients undergoing coronary artery bypass grafting (CABG) have chronic pulmonary disease (COPD). In order to avoid bronchopulmonary complications in the postoperative period, high-quality preoperative diagnosis based on spirometric research is important. When verifying COPD, even of a moderate degree, a course of preventive therapy is required, and in the case of a severe course of COPD with a forced expiratory volume

Reperfusion ventricular fibrillation (VF) is a common arrhythmia after cardiac surgery. Predictors of reperfusion VF and its relationships with the adverse prognosis are still unclear. This study aimed to identify a risk score model to predict reperfusion VF and its effect on in-hospital outcomes. The authors enrolled 1,024 consecutive patients undergoing cardiac surgery, and a total of 823 patients were included in the study. A novel risk score model was developed following logistic regression analysis of the predictors of reperfusion VF. The receiver operating characteristic curve was used to validate this model, and the effect of VF on prognosis was later identified in multivariate or Kaplan–Meier analyses. Risk factors for reperfusion VF occurrence included weight >55 kg, preoperative left ventricular ejection fraction <50%, prior stroke, hypertension, aortic valve replacement, HTK solution, and the use of ≥3 grafts in coronary artery bypass grafting. A novel risk score model was developed using the abovementioned variables, and points were assigned to each risk factor according to its odds ratio. A high score (>6) predicted greater than 65% of patients with VF occurrence. Reperfusion VF increased the risk of in-hospital cardiovascular death (p = 0.03) and renal replacement therapy postoperatively (p = 0.022). More attention should be given to reperfusion VF due to an adverse postoperative prognosis, and the developed risk score model may predict this risk. [ABSTRACT FROM AUTHOR]

Background: Systemic deleterious effects of cardiopulmonary bypass have been observed in the postprocedural period. Long-term assessment, including ventricular function (VF), is unclear. The objective of this study was to compare the change of left ventricular ejection fractions (LVEFs) during a long-term follow-up of coronary artery disease (CAD) patients who underwent off-pump (OPCAB) or on-pump coronary artery bypass grafting (ONCAB). Methods: This study is a prespecified analysis of the MASS III trial, which was a single-center and prospective study that enrolled stable CAD patients with preserved VF. The CAD patients in our study were randomized to OPCAB or ONCAB. A transthoracic echocardiogram was performed during follow-up and a LVEF value was obtained. The primary endpoint was the difference between the final LVEF and the baseline LVEF. Results: Of the 308 randomized patients, ventricular function were observed in 225 over a mean of 5.9 years of follow-up: 113 in the ONCAB group and 112 in the OPCAB group. Baseline characteristics were similar between the two groups, but there was a larger proportion of subjects with 3-vessel disease in the ONCAB group. There was no difference in the LVEF at the beginning (P = 0.08), but there was a slight decrease in the LVEF in the ONCAB and OPCAB groups (P < 0.001 in both groups) at 5.9 years. The decline was not significantly different between the two groups (delta of -6% for ONCAB and -5% for OPCAB; P = 0.78). In a multivariate analysis, myocardial infarction in the follow-up was a predictor of an LVEF < 40%. Conclusions: There was no difference in the long-term development of ventricular function between the surgical techniques, despite a decline in the LVEF in both groups. Trial registration Clinical Trial Registration Information—URL: http://www.controlled-trials.com. Registration number: ISRCTN59539154. Date of first registration: 10/03/2008. [ABSTRACT FROM AUTHOR]

Endothelin-1 (ET-1) is a powerful physiological vasoconstrictor release in response to endothelial injury. Increased synthesis of endothelin is associated with myocardial ischemia and reperfusion injury. The normal level varies between 0.2 and 18.5 pg/mL that maintains normal vascular homeostasis. We hypothesized that there exists a correlation between ET-1 and clinical outcome in patient undergoing elective coronary artery bypass grafting (CABG) surgery under cardiopulmonary bypass. Fifty-eight patients undergoing elective on-pump CABG were enrolled in the study. Blood sample for plasma ET-1 was taken before anesthesia induction. The median ET-1 level was 5 pg/mL (range: 0.6–30.33 pg/mL). The inotropic and intraaortic balloon pump requirement was significantly higher among patients having baseline ET-1 level more than 14.24pg/mL (p  = 0.001in each case). A similar finding was observed in the duration of mechanical ventilation, intensive care unit stay, and duration of hospital stay (r  = 0.68, p  = 0.000; r  = 0.58, p  = 0.000; and r  = 0.61, p  = 0.000 respectively). The occurrence of complications was also more in individuals with higher baseline ET-1 level. The p -value was significant for occurrence infection, arrhythmia, renal and respiratory problems as observed in postoperative period by using Mann–Whitney U test. This study concludes that higher level of preoperative ET-1 levels correlates well to adverse clinical outcome in patients undergoing on-pump CABG surgery, so herein it can be used as a single independent parameter to predict postoperative outcome. [ABSTRACT FROM AUTHOR]

IntroductionThis study was to determine whether coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG, OPCAB) could reduce early postoperative mortality and major complications compared with conventional coronary artery bypass grafting with cardiopulmonary bypass (on-pump CABG, ONCAB) by experienced surgeons.Material and methodsFrom January 2016 to June 2020, isolated CABG was performed in 1200 patients (ONCAB 429, OPCAB 771) in Wuhan Union Hospital. The propensity score matching was used to adjust for differences in baseline characteristics between the ONCABG and OPCABG groups. After 1:1 matching, 404 pairs for each group were selected to compare outcomes within 30 days after surgery. All the operations were completed by experienced surgeons that had completed more than 500 on-pump and 200 off-pump CABG, respectively.ResultsAfter propensity matching, the two groups were comparable in terms of preoperative characteristics. The OPCAB group had less vein graft (2.5 ± 1.0 vs. 2.7 ± 0.9; P < 0.001) and a higher rate of incomplete revascularization (12.4 vs. 8.2%; P < 0.049) than the ONCAB group. There was no significant difference in early postoperative mortality between ONCAB and OPCAB groups (2.2 vs. 2.2%; P = 1.00). However, patients in the OPCAB group had a lower risk of postoperative stroke (1.5 vs. 4.7%; P = 0.008), new-onset renal insufficiency (8.9 vs. 18.8%; P < 0.001), respiratory failure (2.2 vs. 7.2%; P = 0.001), reoperation for bleeding (0.5 vs. 2.7%; P = 0.001), and required less ventilator assistance time (33.4 ± 37.9 h vs. 51.0 ± 66.1 h; P < 0.001) and intensive care unit (ICU) time (3.7 ± 2.7 days vs. 4.8 ± 4.3 days; P < 0.001).ConclusionsIn our study, patients undergoing OPCAB had fewer postoperative complications and a faster recovery. It is a feasible and safe surgical approach to achieve revascularization when performed by experienced surgeons.

In 2017, the European Society of Cardiology outlined the importance of the problem of diagnosing myocardial ischemia-reperfusion injury following coronary artery bypass grafting. Myocardial injury can be accompanied by a critical decline in the cardiac index and an increase in cardiac troponin I plasma levels. The prognostic value troponin I elevation after coronary artery bypass grafting is poorly understood. Objective: to determine the prognostic value of troponin I plasma levels in relation to a fall in the cardiac index after coronary artery bypass grafting (CABG). Task: To determine the probability the cardiac index falling below 2.2 for troponin I levels in the first hours, and on days 1, 2, 3, 4 after CABG. Materials and methods. The single-center, non-randomized prospective study, running from 2016 to 2019, included 336 patients admitted for elective surgical treatment of coronary artery disease. The CABG patients were divided into three observation groups: off-pump (n = 175), on-pump (n = 128), and pump-assisted (n = 33). Troponin I levels were measured in the first hours, and on days 1, 2, 3, 4 after surgery using the Pathfast Compact immunoassay analyzer. Cardiac index was measured by invasive method. Results. In patients with a cardiac index higher than 2.2, troponin I level did not exceed 0.5 ng/mL in the off-pump group, 6 ng/mL in the on-pump group, and 3.5 ng/mL in the pump-assisted group. Patients with cardiac index lower than 2.2 have comparable troponin I levels in all groups - 21 ng/mL. Troponin I thresholds on day 1 after surgery, which, when exceeded, was associated with the likelihood of the cardiac index falling below 2.2, was 3.78 ng/mL in the off-pump group, 9.67 ng/mL in the on-pump group and 17.06 ng/mL in the pump-assisted group. Conclusion. After off-pump CABG, clinically significant myocardial injury should be expected at lower troponin I levels (3.78 ng/mL) than after on-pump CABG (9.67 ng/mL) and pump-assisted CABG (14.7 ng/mL).

Background: There is an increase in the number of patients with severely impaired left ventricle function who referred for CABG. Many studies showed that surgical intervention for those high-risk patients has high survival and wonderful outcome compared to medical treatment. Aim of work: This study aimed to evaluate our experience with coronary artery bypass surgery in patients with EF [ 25% up to 40%] either to perform surgery using off or on-pump technique and try to conclude which technique may be safer regarding cardiac function. Patients and Methods: This prospective observational patient cohort study from August 2017 to July 2019 enclosed forty consecutive patients divided into 2 teams every 20 patients either off or on pump technique according to surgeons' expertise. Pre-, intra- and post-operative data were collected for all patients. All survivors were subjected to a 6-months follow-up clinically and by Echocardiograghy assessment. Results: Improvement of ejection fraction [EF] was encountered in our study; the mean 6-months operative EF improved for each team by [36% versus 37%] for off-pump and on-pump interventions, respectively. There was no statistically important difference in the information collected for each technique [p-value>0.05] regarding most points of comparison. Conclusion: Results of CABG in high-risk patients were acceptable with on-pump and off-pump techniques with nearly comparable results in our study, at least in the early 6-months after intervention. Intra-aortic balloon usage is valuable when indicated.

We aimed to compare the early, mid-term, and long-term mortality between on-pump vs. off-pump redo coronary artery bypass grafting (CABG). We conducted a systematic search for studies comparing clinical outcomes of patients who underwent on-pump vs. off-pump redo CABG. We pooled the relevant studies quantitatively to compare the early (perioperative period, whether in hospital or within 30 days after discharge), mid-term (≥1 year and 50%) between studies. Otherwise, a fixed-effect model was utilized. After systematic literature searching, 22 studies incorporating 5,197 individuals (3,215 in the on-pump group and 1,982 in the off-pump group) were identified. A pooled analysis demonstrated that compared with off-pump redo CABG, on-pump redo CABG was associated with higher early mortality (OR 2.11, 95%CI: 1.54–2.89, P < 0.00001). However, no significant difference was noted in mid-term mortality (OR 1.12, 95%CI: 0.57–2.22, P = 0.74) and long-term mortality (OR 1.12, 95%CI: 0.41–3.02, P = 0.83) between the two groups. In addition, the complete revascularization rate was higher in the on-pump group than the off-pump group (OR 2.61, 95%CI: 1.22–5.60, P = 0.01). In conclusion, the off-pump technique is a safe and efficient alternative to the on-pump technique, with early survival advantage and similar long-term mortality to the on-pump technique in the setting of redo CABG, especially in high-risk patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021244721.

Aim. To present our experience in the international, multicenter, randomized clinical trial CORONARY (CABG Off or On Pump Revascularization Study) in which on-pump and off-pump CABG was compared. Materials and methods. Eleven patients who signed informed consent and matched at least 1 inclusion criterion according to the CORONARY study protocol were randomized in Institute site. All the patients completed the EuroQol-5D questionnaire and underwent neurocognitive tests (MOCA, DSS, Trial Making test). Results. The mean age of the enrolled patients was 62.9 ± 6.2 years. All the patients (100%) had myocardial infarction (MI) in anamnesis, 4 (36.35%) patients had cerebrovascular disease (CVD), 5 (45.4%) patients had chronic kidney disease (CKD), and 4 (36.35%) had diabetes mellitus (DM). The average number of hemodynamically marked coronary artery stenoses was 2.45 ± 0.78, the left main lesion was diagnosed in 2 (18.18%) cases. The severity of the patients’ condition according to the ES II scale averaged 4.9 ± 1.23%. Five (45.5%) patients underwent on-pump CABG, and offpump CABG was performed in 6 (54.5%) cases. The average on-pump time was 122.8 ± 23.5 minutes; the aortic clamp time was 68.4 ± 9.6 minutes. The average number of grafts was 3.5 ± 0.78. In the postoperative period, paroxysm of atrial fibrillation occurred in 4 (36.35%) patients. One (9.09%) patient had fatal ischemic stroke on day 5 after CABG. The patients were discharged on average within 8.5 ± 2.7 days. According to the study protocol, the condition of patients was monitored annually by telephone; 8 (72.7%) patients completed all visits. In 1 (9.09%) patient with recurrence of angina pectoris in 4 years after CABG we performed repeat CABG. Conclusions. According to the Institute experience of participation in the CORONARY study, there was 1 (9.09%) death due fatal ischemic stroke in the on-pump CABG group. One (9.09%) patient from the off-pump CABG group had repeated CABG. These results of small studies are generating debates in terms of the effectiveness of CABG technique. In multicenter CORONARY trial the rate of mortality, stroke, myocardial infarction, kidney failure, repeated revascularization of myocardium during 5 years of follow-up was similar in on-pump and off-pump CABG patients groups.

Objective: To compare cardiac troponin-I levels in post-operative period of on-pump (ONCAB) versus off-pump coronary artery bypass surgery. Study Design: Prospective Observational Study. Place and Duration of Study: Armed Forces Institute of Cardiology, from Jan 2019 to Dec 2019. Methodology: This prospective observational study was done at Armed Forces Institute of Cardiology from 1st January 2019 to 31st December 2019. Eighty six (43 in each on-pump and off-pump) patients admitted for elective coronary artery bypass grafting, aged 30-80 years were included in the study. Baseline data and cardiac troponin-I levels preoperatively as well as at 6, 12, 18 and 24 hours after the surgery in both groups were recorded and analyzed. Results: Out of 100 patients, mean age of the patients was 57.59 ± 10.24 years and 85% were males. All the base line characteristics, comorbid conditions and intra-operative findings were identical in both groups. There was marked rise in CK-MB levels postoperatively in overall participants. There was significant rise in Troponin I levels postoperatively in overall participants. Compared to OPCAB, postoperative Troponin I at 6hours and 12-hours was significantly higher in ONCAB. Conclusion: Compared to OPCAB, postoperative Troponin I at 6 hours and 12-hours was significantly high in ONCAB. However, there was no gross discrepancy in postoperative Troponin I levels between OPCAB and ONCAB at 18- & 24-hours after surgery.

Abstract Objectives Does the manipulation of the off-pump CABG (OPCAB) in patient with depressed left ventricular function is better than on-pump CABG (ONCAB) approach in in-hospital mortality and morbidities? Here we undertook a meta-analysis of the best evidence available on the comparison of primary and second clinical outcomes of the off-pump and on-pump CABG. Design Systematic literature reviewer and meta-analysis. Data sources PubMed, EMBASE, Web of science and Cochrane Center Registry of Controlled Trials were searched the studies which comparing the use of the off-pump CABG(OPCAB) and on-pump CABG (ONCAB) for patients with LVD during January 1990.1 to January 2018. Eligibility criteria All observation studies and randomized controlled trials comparing on-pump and off-pump as main technique for multi-vessel coronary artery disease (defined as severe stenosis (>70%) in at least 2 major diseased coronary arteries) with left ventricular dysfunction(defined as ejection fraction (EF) 40% or less) were included. Data extraction and synthesis Authors will screen and select the studies extract the following data, first author, year of publication, trial characters, study design, inclusion and exclusion criteria, graft type, clinical outcome, assess the risk of bias and heterogeneity. Study-specific estimates will pool through the modification of the Newcastle-Ottawa scale for the quality of study and while leave-one-out analysis will be used to detect the impact of individual studies on the robustness of outcomes. Results Among the 987 screened articles, a total of 16 studies (32,354 patients) were included. A significant relationship between patient risk profile and benefits from OPCAB was found in terms of the 30-day mortality (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73–0.97; P = 0.02), stroke (OR, 0.69; 95% CI, 0.55–0.86; P = 0.00), myocardial infarction (MI) (OR, 0.71; 95% CI, 0.53–0.96; P = 0.02), renal failure (OR, 0.71; 95% CI, 0.55–0.93; P = 0.01), pulmonary complication (OR, 0.68; 95% CI, 0.52–0.90; P = 0.01), infection (OR, 0.67; 95% CI, 0.49–0.91; P = 0.00),postoperative transfusion (OR, 0.25; 95% CI, 0.08–0.84; P = 0.02) and reoperation for bleeding (OR, 0.56; 95% CI, 0.41–0.75; P = 0.00). There was no significant difference in atrial fibrillation (AF) (OR, 0.96;95%; CI, 0.78–1.41; P = 0.56) and neurological dysfunction (OR, 0.88; 95% CI, 0.49–1.57; P = 0.65). Conclusions Compared with the on-pump CABG with LVD, using the off-pump CABG is a better choice for patients with lower mortality, stroke, MI, RF, pulmonary complication, infection, postoperative transfusion and reoperation for bleeding. Further randomized studies are warranted to corroborate these observational data.

Background: For diabetic patients undergoing coronary artery bypass grafting (CABG), there is still a debate about whether an off-pump or on-pump approach is advantageous., Methods: A retrospective review of 1269 consecutive diabetic patients undergoing isolated, primary CABG surgery from January 1, 2013 to December 31, 2015 was conducted. Among them, 614 received non-cardiopulmonary bypass treatment during their operation (off-pump group), and 655 received cardiopulmonary bypass treatment (on-pump group). The hospitalization outcomes were compared by multiple logistic regression models with patient characteristics and operative variables as independent variables. Kaplan-Meier curves and Cox proportional-hazard regression models for mid-term (2-year) and long-term (5-year) clinical survival analyses were used to determine the effect on survival after CABG surgery. In order to further verify the reliability of the results, propensity-score matching (PSM) was also performed between the two groups., Results: Five-year all-cause death rates were 4.23% off-pump vs. 5.95% on-pump ( p = 0.044), and off-pump was associated with reduced postoperative stroke and atrial fibrillation., Conclusions: These findings suggest that off-pump procedures may have benefits for diabetic patients in CABG., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 The Author(s). Published by IMR Press.)

Coronary artery bypass grafting (CABG) surgery with two methods (on‐pump or off‐pump) can be used to rescue individuals with severe coronary artery disease (CAD). Each method might cause an inflammatory response, which can lead to some complications. The aim of this study was to compare the changes in serum concentrations of IFN‐γ, tumor necrosis factor (TNF)‐α, interleukin (IL)‐1α, IL‐1β, IL‐2, IL‐4, IL‐6, IL‐8, IL‐10, VEGF, MCP‐1, and epidermal growth factor between the two CABG surgery methods. Forty‐eight patients (22 = on‐pump, 26 = off‐pump) who underwent on‐pump or off‐pump CABG surgery were enrolled in this study. Serum cytokines levels were measured in two blood samples, the first sample was taken from each patient in the morning of the day of surgery after a 12‐hr fasting and the second sample on the first postoperative day at 24‐hr after surgery. In baseline, comparisons between the two groups of on‐pump/off‐pump surgery did not show any significant difference in demographic data, anthropometric parameters, lipid profile indices, and high‐sensitivity C‐reactive protein levels (p >.05). There was a significant difference between the serum levels of IL‐4, IL‐6, IL‐10, vascular endothelial growth factor (VEGF), IFN‐γ, and MCP‐1 in patients with on‐pump surgery and a significant increase in serum IL‐6 (p <.001), IL8 (p <.05), VEGF (p <.001), and IFN‐γ (p <.01) levels in patients with off‐pump surgery in post‐operation stage compared to pre‐operation. Cardiopulmonary pump in patients under CABG surgery can activate systemic inflammation and the changes of serum cytokines levels in off‐pump CABG were lower compared with on‐pump CABG. [ABSTRACT FROM AUTHOR]

Background: Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG. Methods: Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays. Results: The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = −8.21 h, 95% CI = −11.74 to −4.68, p < 0.00001; MD = −0.77 d, 95% CI = −0.81 to −0.73, p < 0.00001; MD = −2.24 d, 95% CI = −3.17 to −1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization. Conclusion: In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump. [ABSTRACT FROM AUTHOR]

Background: Redo coronary artery bypass grafting (CABG) can be performed with either the off-pump (OPCAB) or the on-pump (ONCAB) technique.Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), this meta-analysis compared the safety and efficacy of OPCAB versus ONCAB redo CABG.Results: Twenty-three (23) eligible studies were included (OPCAB, n=2,085; ONCAB, n=3,245). Off-pump CABG significantly reduced the risk of perioperative death (defined as in-hospital or 30-day death rate), myocardial infarction, atrial fibrillation, and acute kidney injury. The two treatment approaches were comparable regarding 30-day stroke and late all-cause mortality.Conclusions: Off-pump redo CABG resulted in lower perioperative death and periprocedural complication rates. No difference was observed in perioperative stroke rates and long-term survival between the two techniques. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmanın amacı on-pump ve off-pump koroner arter baypass greftleme (KABG) yapılan hastaların klinik sonuçlarını retrospektif olarak güncel literatür ışığında değerlendirmektir.Gereç ve Yöntemler: Çalışmaya Ekim 2014 ile Ağustos 2016 tarihleri arasında KABG uygulanan ve postoperatif sinüs ritmi olan toplam 1672 hasta dahil edildi. KABG yanında ek bir işlem uygulanmış ve KABG dışında açık kalp ameliyatı geçiren hastalar çalışma dışı bırakıldı. Toplam 1672 hastadan 783'üne off-pump KABG ve 889'una on-pump KABG uygulandı.Bulgular: Operasyonel verilerin karşılaştırılmasında, operasyon süresi (p

Introduction: No previous studies comparing the outcomes between off-pump coronary artery bypass grafting (off-pump CABG, OPCAB) and on-pump CABG (ONCAB) have been performed in patients with severe left ventricular dysfunction (LVD) and a giant left ventricle. We aimed to investigate whether such patients could benefit from OPCAB. Methods: From January 2011 to January 2021, a total of 98 patients with severe LVD and a giant left ventricle underwent isolated CABG (ONCAB 46, OPCAB 52) in Wuhan Union Hospital. The clinical data were collected retrospectively and propensity score matching was performed to adjust baseline characteristics. Results: After propensity matching, the two groups were comparable in baseline variables. The OPCAB group had a higher rate of incomplete revascularization than the ONCAB group (25.0% vs. 9.1%; p = 0.047). The 30-day mortality was similar between the matched groups (4.5% vs. 4.5%; p = 1.000) but the OPCAB group had a lower risk of postoperative IABP usage (9.1% vs. 25.0%; p = 0.047) and renal insufficiency (11.4% vs. 29.5%; p = 0.034). The long-term probability of survival (log-rank test, p = 0.450) was similar between the two groups but the OPCAB group had a lower probability of major adverse cardiovascular events (log-rank test, p = 0.038). Conclusions: For patients with severe LVD and a giant left ventricle, OPCAB reduced early postoperative complications while sacrificing long-term quality of life compared to those having ONCAB.

Objective: To compare cardiac troponin-I levels in post-operative period of on-pump (ONCAB) versus off-pump coronary artery bypass surgery. Study Design: Prospective Observational Study. Place and Duration of Study: Armed Forces Institute of Cardiology, from Jan 2019 to Dec 2019. Methodology: This prospective observational study was done at Armed Forces Institute of Cardiology from 1st January 2019 to 31st December 2019. Eighty six (43 in each on-pump and off-pump) patients admitted for elective coronary artery bypass grafting, aged 30-80 years were included in the study. Baseline data and cardiac troponin- I levels preoperatively as well as at 6, 12, 18 and 24 hours after the surgery in both groups were recorded and analyzed. Results: Out of 100 patients, mean age of the patients was 57.59 ± 10.24 years and 85% were males. All the base line characteristics, comorbid conditions and intra-operative findings were identical in both groups. There was marked rise in CK-MB levels postoperatively in overall participants. There was significant rise in Troponin I levels postoperatively in overall participants. Compared to OPCAB, postoperative Troponin I at 6hours and 12- hours was significantly higher in ONCAB. Conclusion: Compared to OPCAB, postoperative Troponin I at 6 hours and 12-hours was significantly high in ONCAB. However, there was no gross discrepancy in postoperative Troponin I levels between OPCAB and ONCAB at 18- & 24-hours after surgery. [ABSTRACT FROM AUTHOR]

Objectives: Does the manipulation of the off-pump CABG (OPCAB) in patient with depressed left ventricular function is better than on-pump CABG (ONCAB) approach in in-hospital mortality and morbidities? Here we undertook a meta-analysis of the best evidence available on the comparison of primary and second clinical outcomes of the off-pump and on-pump CABG.Design: Systematic literature reviewer and meta-analysis.Data Sources: PubMed, EMBASE, Web of science and Cochrane Center Registry of Controlled Trials were searched the studies which comparing the use of the off-pump CABG(OPCAB) and on-pump CABG (ONCAB) for patients with LVD during January 1990.1 to January 2018.Eligibility Criteria: All observation studies and randomized controlled trials comparing on-pump and off-pump as main technique for multi-vessel coronary artery disease (defined as severe stenosis (>70%) in at least 2 major diseased coronary arteries) with left ventricular dysfunction(defined as ejection fraction (EF) 40% or less) were included.Data Extraction and Synthesis: Authors will screen and select the studies extract the following data, first author, year of publication, trial characters, study design, inclusion and exclusion criteria, graft type, clinical outcome, assess the risk of bias and heterogeneity. Study-specific estimates will pool through the modification of the Newcastle-Ottawa scale for the quality of study and while leave-one-out analysis will be used to detect the impact of individual studies on the robustness of outcomes.Results: Among the 987 screened articles, a total of 16 studies (32,354 patients) were included. A significant relationship between patient risk profile and benefits from OPCAB was found in terms of the 30-day mortality (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73-0.97; P = 0.02), stroke (OR, 0.69; 95% CI, 0.55-0.86; P = 0.00), myocardial infarction (MI) (OR, 0.71; 95% CI, 0.53-0.96; P = 0.02), renal failure (OR, 0.71; 95% CI, 0.55-0.93; P = 0.01), pulmonary complication (OR, 0.68; 95% CI, 0.52-0.90; P = 0.01), infection (OR, 0.67; 95% CI, 0.49-0.91; P = 0.00),postoperative transfusion (OR, 0.25; 95% CI, 0.08-0.84; P = 0.02) and reoperation for bleeding (OR, 0.56; 95% CI, 0.41-0.75; P = 0.00). There was no significant difference in atrial fibrillation (AF) (OR, 0.96;95%; CI, 0.78-1.41; P = 0.56) and neurological dysfunction (OR, 0.88; 95% CI, 0.49-1.57; P = 0.65).Conclusions: Compared with the on-pump CABG with LVD, using the off-pump CABG is a better choice for patients with lower mortality, stroke, MI, RF, pulmonary complication, infection, postoperative transfusion and reoperation for bleeding. Further randomized studies are warranted to corroborate these observational data. [ABSTRACT FROM AUTHOR]

Background: Stroke is a devastating complication of coronary artery bypass grafting (CABG). In our study, postoperative neurological complications were assessed after on pump CABG versus off pump CABG. Methodology: This prospective retrospective comparative study included 200 patients who had CABG divided equally into two groups: group A (on pump) CABG and group B (off pump CABG). Preoperative, operative and postoperative data are analyzed to compare neurological outcomes of the two groups. Results: Incidence of early postoperative neurological complications after on pump CABG is higher that after off pump CABG but without statistically significant difference. However, operative time, incidence of AF and ICU stay are significantly more after on pump CABG. While, EF is increased significantly after off pump CABG. Conclusion: Postoperative neurological insults especially stroke are more after on pump than off pump CABG but that failed to reach statistically significant difference. [ABSTRACT FROM AUTHOR]

Background: Off-pump coronary artery bypass grafting (CABG) negates the requirement for extracorporeal circulation used with the traditional on-pump approach. However, off-pump CABG is technically more challenging and may theoretically lead to less complete revascularisation. Recent data suggests a prognostic benefit for traditional on-pump CABG, but the mechanism for this remains unclear. We hypothesised that the inferior outcomes with off-pump CABG could be driven by the need for repeat revascularisation, with this benefit only becoming clear at long-term follow-up. We therefore evaluated short, medium and long-term outcomes of patients undergoing revascularisation with on vs. off-pump CABG.Methods: Electronic databases were searched to identify suitable randomised controlled trials enrolling ≥100 patients in each arm. Clinical outcomes were extracted at 30-days, 12-months or >4years. The primary outcome was long-term all-cause death, while secondary outcomes included 30-day, 12-month and >4-year cardiac death, stroke, myocardial infarction or revascularisation.Results: Thirteen (13) studies comprising 13,234 patients were included. Off-pump CABG was associated with an increased risk of all-cause death (Odds Ratio [OR] 1.18, 95% confidence interval [CI] 1.02-1.32, p=0.01) and repeat bypass surgery (OR 2.57, 95%CI 1.23-5.39, p=0.01) at long-term follow-up. A significant, increased requirement for revascularisation in off-pump was seen at 12-month follow-up (OR 1.59, 95%CI 1.09-2.33, p=0.02). No differences were noted between groups at 30-days, 12-months and >4years for myocardial infarction or stroke.Conclusions: Off-pump CABG is associated with significantly higher rates of all-cause mortality rate at long-term follow-up. These outcomes demonstrate a temporal relationship that may be driven by a greater requirement for repeat revascularisation at 1- and 5-year follow-up.Study Registration: CRD42018102019 (PROSPERO). [ABSTRACT FROM AUTHOR]

Extracorporeal circulation has led to a great development in cardiovascular surgery during the last five decades. Its time-proven efficacy and safety have made on-pump coronary artery bypass grafting (CABG) the gold standard method of surgical revascularization. However, coronary revascularization on cardiopulmonary bypass and the accompanying aortic manipulation are related to plenty of deleterious complications. Therefore, off-pump CABG surgery was established to avoid complications. Nevertheless, despite the initial enthusiasm on this technique, only 20% of myocardial revascularization procedures worldwide are performed off-pump. Not only are off-pump cardiac procedures more technically difficult but also they do not provide better results in terms of graft patency, completeness of revascularization, repeat revascularization requirement, cost, and quality of life. Completeness of revascularization and anastomotic quality should not be compromised to avoid cardiopulmonary bypass.

Background The impact of the coronary artery bypass grafting (CABG) technique (on‐ versus off‐pump, single versus multiple aortic clamping) on postoperative neurological outcome remains a matter of controversy. The aim of this study was to assess the association between the incidence of postoperative stroke and the degree of aortic manipulation in one of the largest contemporary CABG series. Methods and Results A retrospective, multicenter, international study was conducted in 25 388 patients undergoing isolated CABG procedures with on‐pump CABG (ONCAB) or off‐pump CABG (OPCAB) technique including single or multiple aortic clamping. Postoperative stroke was defined as a postoperative neurological deficit lasting more than 24 hours and associated with evidence of a brain lesion on computed tomography. The degree of aortic manipulation was assumed to be higher for on‐pump versus off‐pump surgery and for multiple versus single or no aortic clamping. Logistic regression and propensity matching were used. ONCAB procedures were performed in 17 231 cases and OPCAB in 8157. The incidence of postoperative stroke was significantly lower in the OPCAB group even after propensity matching (0.4% OPCAB versus 1.2% ONCAB, P=0.02). In the ONCAB group (but not in the OPCAB arm) the use of single aortic clamping was associated with significantly reduced postoperative stroke rate (odds ratio, 0.05; 95% CI, 0.008 to 0.07 [P

The purpose of this study was to compare the renal function in patients undergoing coronary artery bypass grafting in off-pump and on-pump having pre-operative impaired renal function. In the on-pump, the serum creatinine and urea levels were significantly increased on post-operative day 1, 3 and 7. On day 1, it was maximum, then gradually decreased but not reached to pre-operative level. In case of off-pump, serum creatinine and urea levels were significantly increased on post-operative day 1 and 3. On day 1, it was maximum. Then decreased and the serum creatinine reached below pre-operative level on day 7. In case of on-pump, the creatinine clearance rate was significantly decreased on post-operative day 1, 3 and 7. On day 1, it was minimum. Then gradually increased but not reached the pre-operative level. In case off-pump, the creatinine clearance rate was significantly decreased on day 1 and 3. On day 1, it was minimum, then gradually increased and reached above the pre-operative level. A significant low level creatinine clearance rate was observed in on-pump group. Renal function was better preserved in patients undergoing off-pump in comparison to on-pump coronary artery bypass grafting.

Background: Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction (AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring urgent or emergency revascularisation in the setting of AMI. We evaluated the early and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS National Cardiac Surgery Database.Methods: Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7 days of AMI. Of these, 77 patients (1.3%) underwent ONBEAT and 5774 (98.7%) underwent ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed for risk adjustment. Survival data were obtained from the National Death Index.Results: Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7%) vs. ONSTOP: 256/5,774 (4.4%), p<0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery and single-vessel disease. After propensity-score matching, 30-day mortality was similar (ONBEAT: 9/77 (11.7%) vs. ONSTOP: 16/154 (10.4%), p=0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT: 17/77 (22.1%) vs. ONSTOP: 38/154 (24.7%), p=0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have incomplete revascularisation (ONBEAT: 15/77 (19.5%) vs. ONSTOP: 15/154, (9.7%), p=0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8% (95% CI 39.4-82.4%) vs. ONSTOP: 63.6% (95% CI 50.5, 74.3%), p=0.89).Conclusions: ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI with similar short and long-term survival compared to ONSTOP. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate the clinical results of the patients undergoing offpump and on-pump coronary artery bypass grafting (CABG) retrospectively in consideration of current literature. Material and Methods: A total of 1672 patients undergoing CABG between October 2014 and August 2016 and having a postoperative sinus rhythm were enrolled in the study. Patients who underwent an additional procedure in addition to CABG and underwent open heart surgery except CABG were excluded from the study. Off-pump CABG was applied to 783 and on-pump CABG to 889 of 1672 patients. Results: In comparison of operative data, duration of operation (p<0.001), number of bypasses to the coronary arteries (p<0.001), number of bypasses of the right coronary artery to the posterior descending artery (p<0.001), and diffuse coronary artery disease (p<0.001) were less in the off-pump CABG group and there was a statistically significant difference. In comparison of postoperative data, postoperative atrial fibrillation development (p<0.001), intubation time (p<0.001), intensive care unit stay (p<0.001), length of hospital stay (p<0.001), reexploration (p=0.006), vasopressor drug usage (p<0.001), positive inotropic drug usage (p<0.001), total drainage (p<0.001), blood and blood product used (p<0.001), and mortality rate (p=0.001) were less in the off-pump CABG group and statistically significant difference was found between groups. Conclusion: In this study, we found that off-pump CABG has many advantages. In a selected group of patients having a coronary artery disease performing CABG in beating heart would avoid the patient from morbid and mortal negative effects of cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Aim. To study predictors of long-term post-operation cognitive dysfunction (POCD) in patients with diabetes mellitus 2 type (DM), underwent coronary bypass grafting (CBG) under on-pump conditions.Material and methods. Totally, 54 men included, with DM 2 type, underwent scheduled on-pump CBG, at the age 45-69 y.o. All patients, together with standard clinical assessment, were neurophysiologically tested on the 3-5th day after operation, on 7-14th day and in 1 year after CBG. As factors, suggestively significant for persistent POCD development, were selected: integral parameter of patents adherence to treatment, moderate cognition disorders (MCD) before operation, anxiety level (AL) and progression of carotid arteries (CA) stenoses, measured in 1 year before the operation.Results. In DM2 patients after on-pump CBG, the following most significant factors were identified as predictors for POCD: CA stenoses progression, high AL, low integral parameter of adherence; this allows for high probability level of prediction of POCD in 1 year after CBG.Conclusion. The obtained data demonstrated significance of the factors as CA stenoses progression, high LA and low adherence to treatment for development of persistent POCD in DM2 patients after on-pump CBG.