Long Term Changes in Echocardiography Findings After On-Pump and OffPump Coronary Artery Bypass Grafting; A Historical Cohort Study

Document Type : Original Article

Authors

1 Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

2 Atherosclerosis Research Center, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

3 Trauma Research Center, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

Abstract

Background: Coronary artery bypass grafting (CABG) is a revascularization method for coronary artery disease (CAD), which is done with and without cardiopulmonary bypass (CPB). CABG without CPB (off-pump) has been prevalent due to CPB related complications but a number of studies have not demonstrated superiority between these two methods. Objectives: This study designed to evaluate changes in patients’ echocardiography findings during 4 years after CABG with and without CPB. Patients and Methods: 118 patients who underwent CABG were included in this historical cohort study. Demographic data echocardiographs, serum creatinine and hemoglobin before and after surgery extracted from patients’ medical records. In the next visits, history taking, cardiovascular events, physical examination, and echocardiography considered in all patients. Data compared in Off-Pump and On-Pump CABG groups. Results: One hundred eighteen patients with the mean age of 59.47 ± 9.68 years were included (81 male and 37 female). On-pump CABG was done on 84 patients and off-pump on 34 patients. The mean age was significantly more and numbers of atherosclerotic vessels were less in off-pump patients. Left ventricle ejection fraction (EF) was significantly decreased in on-pump group and increased in off-pump group. Right ventricle EF was significantly decreased in both groups, with significant decrease in on-pump patients. Mitral and tricuspid valves regurgitation were significantly more in on-pump patients (P < 0.05). Conclusions: Our study showed superiority of off-pump CABG regarding LVEF, RVEF and valves regurgitations. Future studies with prospective structure, accurate randomization, longer follow up duration, and larger sample size are needed.

Keywords

References

  1. 1.Bergmann A, Struck J, Morgenthaler NG, Papassotiriou J, Blan- Karimi-Sari H et al. 6 Razavi Int J Med. 2015;3(1):e25054 kenberg S, Lackner K, et al. Method for risk stratification in stable coronary artery disease 2014.

    1. Task Force M, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013; 34 (38):2949–3003.
    2. Gyberg V, Kotseva K, Dallongeville J, Backer GD, Mellbin L, Ryden L, et al. Does pharmacologic treatment in patients with established coronary artery disease and diabetes fulfil guideline recommended targets? A report from the EUROASPIRE III crosssectional study. Eur J Prev Cardiol. 2014.
    3. Prakash N, Choudhury KD, Kazmi A, Gupta A, Grover V, Gupta V. A single-centre experience of coronary revascularisation in young patients. Indian J Thorac Cardiovascular Surg. 2014; 30 (2):134–9.
    4. Mohr FW, Morice MC, Kappetein AP, Feldman TE, Stahle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013; 381 (9867):629–38.
    5. Kirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1983; 86 (6):845–57.
    6. Ben-Gal Y, Stone GW, Smith CR, Williams MR, Weisz G, Stewart AS, et al. On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. J Thorac Cardiovasc Surg. 2011; 142 (2):e33–9.
    7. Wallace A, Lam HW, Nose PS, Bellows W, Mangano DT. Changes in systolic and diastolic ventricular function with cold cardioplegic arrest in man. The Multicenter Study of Perioperative Ischemia (McSPI) Research Group. J Card Surg. 1994; 9 (3 Suppl):497–502.
    8. Cleveland JJ, Shroyer AL, Chen AY, Peterson E, Grover FL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg. 2001; 72 (4):1282–8.
    9. Puskas JD, Kilgo PD, Lattouf OM, Thourani VH, Cooper WA, Vassiliades TA, et al. Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. Ann Thorac Surg. 2008; 86 (4):1139–46.
    10. Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009; 361 (19):1827–37.
    11. Chu D, Bakaeen FG, Dao TK, LeMaire SA, Coselli JS, Huh J. On-pump versus off-pump coronary artery bypass grafting in a cohort of 63,000 patients. Ann Thorac Surg. 2009; 87 (6):1820–6.
    12. Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med. 2004; 350 (1):21–8.
    13. Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C. Off-pump versus on-pump coronary artery by-pass grafting for ischaemic heart disease. Cochrane Libr. 2012(4).
    14. Bull DA, Neumayer LA, Stringham JC, Meldrum P, Affleck DG, Karwande SV. Coronary artery bypass grafting with cardiopulmonary bypass versus off-pump cardiopulmonary bypass grafting: does eliminating the pump reduce morbidity and cost? Ann Thorac Surg. 2001; 71 (1):170–3.
    15. Diller GP, Wasan BS, Kyriacou A, Patel N, Casula RP, Athanasiou T, et al. Effect of coronary artery bypass surgery on myocardial function as assessed by tissue Doppler echocardiography. Eur J Cardiothorac Surg. 2008; 34 (5):995–9.
    16. Michaux I, Filipovic M, Skarvan K, Schneiter S, Schumann R, Zerkowski HR, et al. Effects of on-pump versus off-pump coronary artery bypass graft surgery on right ventricular function. J Thorac Cardiovasc Surg. 2006; 131 (6):1281–8.
    17. Sochon K, Sobkowicz B, Lewczuk A, Tycinska A, Juszczyk G, Sawicki R, et al. Effect of on-pump versus off-pump coronary bypass surgery on cardiac function assessed by intraoperative transesophageal echocardiography. Adv Med Sci. 2013; 58 (1):58–66.
    18. Moller CH, Steinbruchel DA. Off-pump versus on-pump coronary artery bypass grafting. Curr Cardiol Rep. 2014; 16 (3):455.
    19. Bakaeen FG, Chu D, Kelly RF, Holman WL, Jessen ME, Ward HB. Perioperative outcomes after on- and off-pump coronary artery bypass grafting. Tex Heart Inst J. 2014; 41 (2):144–51.
    20. de Waal EE, De Boeck BW, Kruitwagen CL, Cramer MJ, Buhre WF. Effects of on-pump and off-pump coronary artery bypass grafting on left ventricular relaxation and compliance: a comprehensive perioperative echocardiography study. Eur J Echocardiogr. 2010; 11 (9):732–7.
    21. Filardo G, Grayburn PA, Hamilton C, Hebeler RJ, Cooksey WB, Hamman B. Comparing long-term survival between patients undergoing off-pump and on-pump coronary artery bypass graft operations. Ann Thorac Surg. 2011; 92 (2):571–7.
    22. Bakaeen FG, Shroyer AL, Gammie JS, Sabik JF, Cornwell LD, Coselli JS, et al. Trends in use of off-pump coronary artery bypass grafting: Results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg. 2014; 148 (3):856-3.
Razavi International Journal of Medicine
Volume 3, Issue 1
January 2015
Pages 1-6

Files

Share

How to cite

Statistics