Off-pump versus on-pump CABG: a comparison.

BACKGROUND: The off-pump technique reduces the complications of coronary artery bypass grafting performed with extracorporeal circulatory assistance. This hypothesis was tested by analyzing the results of 53 patients operated with and 48 without cardiopulmonary bypass by a single surgeon (ARR) from February 2001 to September 2001. METHODS AND RESULTS: The angiograms of all the patients scheduled for isolated coronary artery bypass grafting were carefully analyzed and a plan for revascularization made. After sternotomy and inspection of the vessels, a decision was taken to perform the surgery on- or off-pump. All the demographic, operative and postoperative data were prospectively collected and analyzed statistically. Major end-points, such as mortality, perioperative infarction and organ dysfunction, were not different between the two techniques. The incidence of renal and pulmonary dysfunction was similar. There were no neurological problems in either group. In contrast to many reports. bleeding complications and the use of blood products were the same in both groups (1.6+/-2.3 in the on-pump group and 0.8+/-1.7 in off-pump group: p=0.06). The only important difference between the two groups was the incidence of low cardiac output and use of inotropes, being more common in the on-pump group. CONCLUSIONS: Off-pump coronary artery bypass grafting is as safe as that done on-pump. The claims of a lower incidence of organ dysfunction and blood product use in the off-pump group were not substantiated in this study. The incidence of low cardiac output and use of inotropes was significantly lower in the off-pump group.

Surgical repair of left ventricular aneurysms: a comparative evaluation of linear versus Dor's repair.

BACKGROUND: Resection and linear repair of aneurysms of the left ventricle alter its geometry and thereby reduce its performance over the long term. Hence, Dor's circular patch repair was advocated to maintain the geometry of the left ventricle. However, the superiority of this procedure over linear repair is debatable. METHODS AND RESULTS: We retrospectively analyzed 95 cases of left ventricular aneurysm repair--28 cases by Dor's procedure and 67 by linear repair. The age group, symptoms, risk-factor profile and severity of coronary artery disease were comparable in both the groups, but the cardiopulmonary bypass and mean aortic cross-clamp time were longer in those treated with Dor's procedure. The left internal mammary artery could be grafted to the left anterior descending artery or diagonal branch in 13 cases in the group undergoing Dor's procedure (group I) versus 14 cases in the group undergoing linear repair (group II). There was no mortality in group I while there were 7 deaths in group II. Patients in group I were followed up for up to 2 years and those in group II for up to 13 years. During follow-up, 16/2 8 remained in NYHA functional class I or II in group I versus 24/67 in group II. The mean preoperative left ventricular ejection fraction was 34.9% in group I which improved to 39.7% during follow-up. In group II, the mean preoperative left ventricular ejection fraction was 37.2% which improved to 41.5% during follow-up. This difference was not statistically significant. CONCLUSIONS: In our retrospective study, we did not observe any superiority of Dor's repair over linear repair for left ventricular aneurysm as regards NYHA functional class and left ventricular ejection fraction. However, follow-up with Dor's repair was short (up to 2 years). Hence, no definite conclusions can be drawn.