ABSTRACT
Coronary Artery Bypass Grafting (CABG) Surgery is considered the standard treatment for revascularization in Coronary Artery Disease. The Off-Pump Coronary Artery Bypass Graft (OPCAB) which evades the use of Cardiopulmonary Bypass (CPB) became a popular CABG procedure, due to the adverse effect of CPB. Hypothetically, OPCAB may improve the rates of perioperative Myocardial Injury, Neurocognitive Impairment, Stroke and Mortality. However, some studies showed no superior outcomes for OPCAB compared to on-pump CABG. This study aims to evaluate the short-term and long-term outcomes of OPCAB versus On-Pump CABG. The results showed that OPCAB is probably a safe procedure for patients, especially for those with high-risk conditions. OPCAB procedure showed superior short-term outcomes in terms of Myocardial Infarction, Systemic Inflammatory Response, Postoperative Cognitive Dysfunction, Renal Failure, Stroke, Pulmonary Complication, Postoperative Transfusion, Hospital stay length and infection than On-pump CABG. However, regarding long-term outcomes, Off-Pump CABG had a higher rate of incomplete revascularization and repeat revascularization and a higher risk of long-term mortality as well as lower graft patency. Furthermore, the result showed that the higher experience of the surgeons in OPCAB improves the outcome of the Surgery.
ABSTRACT
During off pump coronary artery bypass grafting surgery, it is common to observe mitral or tricuspid regurgitation due to heart displacement. But it's very unusual to notice new onset aortic regurgitation in OPCABG.
ABSTRACT
Objective • To find out the optimal positive end expiratory pressure (PEEP) by electrical impedance tomography (EIT) for better lung recruitment and ventilation distribution in patients undergoing off pump coronary artery bypass grafting surgery (OPCAB). Methods • 105 patients underwent OPCAB from Jan. 2017 to Dec. 2017 were analysed. Patients were randomly divided into two groups, i.e. experiment group (54 cases) and control group (51 cases). Four regions of interest (ROI) were recorded by EIT. PEEP were 3 cmH2O in control group while PEEP were increased stepwise by 2 cmH2O from 0 cmH2O to 14 cmH2O in experiment group. The optimal PEEP for lung recruitment was applied in experiment group. Postoperative oxygenation index (PaO2/FiO2) and pulmonary complication were compared between two groups. Results • The overall mortality was 2 (1.90%). The incidence of postoperative pulmonary complication, pulmonary infection, atelectasis, pleural effusion were 18.10%, 2.86%, 18.10%, 18.10%, respectively. The optimal PEEP zone was 6-9 cmH2O. PaO2/FiO2 was significantly increased with the optimal PEEP in experiment group (P=0.00). There were significant differences in postoperative pulmonary complication between two groups (P=0.02). Conclusion • EIT can directly monitor ventilation distribution and titrate suitable PEEP for better lung recruitment in patients undergoing OPCAB. It can significantly reduce postoperative pulmonary complication, improve oxygenation, and decrease ICU stay and ventilation duration.
ABSTRACT
Objective·To find out the optimal positive end expiratory pressure (PEEP) by electrical impedance tomography (EIT) for better lung recruitment and ventilation distribution in patients undergoing off pump coronary artery bypass grafting surgery (OPCAB). Methods?·?105 patients underwent OPCAB from Jan. 2017 to Dec. 2017 were analysed. Patients were randomly divided into two groups, i.e. experiment group (54 cases) and control group (51 cases). Four regions of interest (ROI) were recorded by EIT. PEEP were 3?cmH2O in control group while PEEP were increased stepwise by 2?cmH2O from 0?cmH2O to 14?cmH2O in experiment group. The optimal PEEP for lung recruitment was applied in experiment group. Postoperative oxygenation index (PaO2/FiO2) and pulmonary complication were compared between two groups. Results?·?The overall mortality was 2 (1.90%). The incidence of postoperative pulmonary complication, pulmonary infection, atelectasis, pleural effusion were 18.10%, 2.86%, 18.10%, 18.10%, respectively. The optimal PEEP zone was 6-9?cmH2O. PaO2/FiO2was significantly increased with the optimal PEEP in experiment group (P=0.00). There were significant differences in postoperative pulmonary complication between two groups (P=0.02). Conclusion?·?EIT can directly monitor ventilation distribution and titrate suitable PEEP for better lung recruitment in patients undergoing OPCAB. It can significantly reduce postoperative pulmonary complication, improve oxygenation, and decrease ICU stay and ventilation duration.
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BACKGROUND: Renal dysfunction is an independent risk factor of cardiac dysfunction and one of common complications after cardiac surgery. This study was designed to evaluate the relationship between serum creatinine (s-Cr) and cardiac troponin I (cTnI) in off-pump coronary artery bypass graft surgery (OPCAB). METHODS: Data, from 13 patients underwent OPCAB, were analyzed in prospective fashion. The levels of s-Cr and cTnI were evaluated before and after OPCAB. The correlations of s-Cr and TnI were analyzed in the patients with cardiac dysfunction assessed by low cardiac output or stroke volume at end of surgery. RESULTS: Patients with preoperatively elevated s-Cr (female, > or =1.2 microg/L; male, > or =1.5microg/L) showed higher incidence of elevated s-Cr and elevated cTnI (> or =0.68microg/L) on arrival at intensive care unit (POD-0), postoperative 12 hours (POD-1) and postoperative 36 hours (POD-2) (P< 0.05). Patients with preoperatively elevated cTnI showed higher incidence of elevated cTnI at POD-0, POD-1 and POD-2 (P< 0.05). In 7 patients with low cardiac index (< 2.0 L/min/m2) or stroke volume index (<40 mL/beat/m2) at end of surgery, the increases of s-Cr and cTnI showed positive correlation at POD-0, POD-1 and POD-2 (correlation coefficient 0.818, 0.864 and 0.785, respectively). CONCLUSIONS: The increases of s-Cr and cTnI showed positive correlation in low cardiac output after OPCAB. The results suggested that elevated s-Cr may be an independent predictor of elevated cTnI representing perioperative myocardial injury.
Subject(s)
Humans , Male , Cardiac Output, Low , Coronary Artery Bypass, Off-Pump , Creatinine , Incidence , Intensive Care Units , Prospective Studies , Risk Factors , Stroke Volume , Thoracic Surgery , Transplants , Troponin , Troponin IABSTRACT
Capnography is monitoring of concentration or partial pressure of CO2 in respiratory gases. It provides information about CO2 production, pulmonary perfusion, alveolar ventilation, respiratory patterns and elimination of CO2 from the anesthesia circuit and ventilator. Thus it gives us a rapid and reliable method to detect life threatening conditions such as malposition of tracheal tube, ventilatory failure, circulatory failure and defective breathing circuits. Authors experienced that change of capnogram during off pump coronary artery bypass grafting surgery helped early detecting ruptured bulla and prevented intraopertive or postoperative pneumothorax.