ABSTRACT
Abstract Objective: We investigated the effects of pedicled and semiskeletonized left internal mammary artery (LIMA) harvesting techniques on postoperative drainage in patients subjected to off-pump CABG, ignoring other advantages or disadvantages of those techniques. Methods: The present study comprises a total of 160 subjects that underwent coronary artery bypass surgery in our clinic. Data were collected consecutively and retrospectively. An attempt was made to have similar groups in terms of demographic characteristics. Patients that underwent off-pump coronary artery bypass surgery by two surgical teams which differed only in LIMA harvesting technique were dichotomized and compared according to these techniques. The first group (Group 1) consisted of patients in whom LIMA was harvested with surrounding tissues using the pedicled technique. The second group (Group 2) consisted of patients in whom LIMA was harvested using the semiskeletonized technique, with the veins separated from surrounding connective tissues. Results: The mean amount of drainage in the first 24 hours was 706.1±234.2 ml vs. 591±258.8 ml (Group 1 vs. Group 2; P=0.005), the mean amount of drainage in the second 24 hours was 270±133.6 ml vs. 189.4±140.4 ml (Group 1 vs. Group 2; P<0.001), and the mean amount of total drainage was determined to be 976.1±306.9 ml vs. 781.2±335.5 ml (Group 1 vs. Group 2; P<0.001). Conclusion: It was observed that semiskeletonized LIMA presents reduced amount of postoperative drainage in the first and second 24-hour periods and total amount of drainage than pedicled LIMA, independent of pleural integrity.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Drainage/methods , Tissue and Organ Harvesting/methods , Coronary Artery Bypass, Off-Pump/methods , Internal Mammary-Coronary Artery Anastomosis/methods , Mammary Arteries/surgery , Postoperative Care/methods , Postoperative Period , Drainage/statistics & numerical data , Retrospective Studies , Age FactorsABSTRACT
ABSTRACT OBJECTIVE: The present study consisted of patients who underwent on-pump coronary artery bypass grafting (CABG) and off-pump CABG and investigated effect of using cardiopulmonary bypass (CPB) on the amount of postoperative drainage and blood products, red blood cell (RBC), free frozen plasma (FFP) given in the intensive care unit in 60-80-year-old patients who underwent CABG. METHODS: The present study comprises a total of 174 patients who have undergone coronary artery bypass graft (off-pump or on-pump CABG) surgery in our clinic in between 2012-2015 year. RESULTS: It was observed that the amount of drainage in the first 24 postoperative hours was lower in the on-pump CABG group (Group 1) when compared to off-pump group (Group 2) (Group 1 vs . Group 2; 703.5±253.8 ml vs . 719.6±209.4 ml;P =0.716). However, the amount of drainage in the second 24 hours was statistically significantly lower in the off-pump CABG group (Group 1 vs . Group 2; 259.8±170.6 mlvs . 190.1±129.1 ml; P =0.016). With regard to the amount of overall drainage, no statistically significant difference was observed between the two groups. Group 1 needed RBC transfusion higher than Group 2 (Group 1 vs . Group 2; 2.2±1.3 bag vs . 1.2±0.9 bag;P <0.001). CONCLUSION: We can say that CPB influences the amount of second 24-hour drainage which indexed body surface area. In addition, CPB decreases hct, hb, thrombocyte count in ICU arrived, after 24 hours in postoperative period. Reduced thrombocyte counting effect can be appeared after 48 hours in the postoperative period of CPB.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Coronary Artery Bypass, Off-Pump , Cardiopulmonary Bypass/methods , Drainage/statistics & numerical data , Erythrocyte Transfusion , Hematocrit , Intensive Care Units , Plasma , Postoperative Period , Retrospective Studies , Time FactorsABSTRACT
AbstractObjective:The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting.Methods:A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden) heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11.Results:The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump) as compared to Group 2 (off-pump). But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893), P>0.05 for bilateral pleural effusion (P=0.780)]. Left pleural effusion was encountered to be lower in Group 2 (off-pump). The difference was found to be statistically significant (P<0.05, P=0.006).Conclusion:Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.
ResumoIntrodução:O presente estudo investigou efeito da utilização de bomba em derrame pleural pós-operatório nos casos de pacientes que se submeteram à cirurgia de revascularização miocárdica.Métodos:Um total de 256 pacientes que foram submetidos à cirurgia de revascularização isolada no ambulatório de Cirurgia Cardiovascular foram incluídos no estudo. Máquina coração-pulmão Jostra-Cobe (Modelo 043213 105, VLC 865, Suécia) foi utilizada em cirurgia de revascularização miocárdica com circulação extracorpórea. Cirurgia de revascularização miocárdica sem circulação extracorpórea foi realizada utilizando Octopus e Starfish. Anastomose proximal na aorta, em ambas as técnicas, foi realizada por grampos laterais. Os pacientes receberam alta do hospital entre os dias 6 e 11 de pós-operatório.Resultados:A incidência de derrame pleural à direita pós-operatória e derrame pleural bilateral encontrada foi mais elevada em contagem do Grupo 1 (com circulação extracorpórea) em relação ao Grupo 2 (sem circulação extracorpórea). Mas a diferença não foi estatisticamente significativa [P>0,05 para derrame pleural à direita (P=0,893), P>0,05 para derrame pleural bilateral (P=0,780)]. O derrame pleural esquerdo encontrado foi menor no Grupo 2 (CEC). A diferença foi estatisticamente significativa (P<0,05, P=0,006).Conclusão:Sob a luz destes resultados, pode-se dizer que derrame pleural esquerdo é menos prevalente nos pacientes que foram submetidos à revascularização do miocárdio sem circulação extracorpórea em comparação com os pacientes que foram submetidos à revascularização do miocárdio com circulação extracorpórea.