POSTOPERATIVE ARRHYTHMIAS AFTER CORONARY ARTERY BYPASS GRAFTING A COMPARISON BETWEEN '˜OFF PUMP' AND '˜ON PUMP' CABG
Abstract
Background: Coronary artery bypass without cardiopulmonary bypass (CPB) has gained popularityrecently with the development of devices that allow for improved exposure and standardization in off
pump coronary artery bypass surgery. Off pump coronary artery bypass surgery reduces some of the
morbidities traditionally attributed to CPB. The primary goal of off pump coronary artery bypass
surgery is to provide an equally comprehensive operational result as the conventional operation. The
purpose of the study was to compare intra operative and postoperative arrhythmias in off pump
coronary artery bypass (OPCAB) verses conventional CABG. Methods: This study was a sub-group as
part of a randomised control trial and was conducted from January 2006 to March 2007 at Punjab
Institute of Cardiology. One hundred patients were included in '˜on pump' group-A, and 100 patients in
'˜off pump' group-B. Results: Thirty-three patients in group-A and 22 in group-B developed
arrhythmias. Twenty-six patients developed atrial fibrillation in group-A and 16 patients in group-B.
Mortality due to arrhythmias was 5, three were in on pump group, and 2 were in off pump group.
Conclusion: There is non-significant tendency towards less frequency of postoperative arrhythmias in
the off pump patients as compared to on pump coronary artery bypass surgery patients.
Keyword: CABG, Coronary Artery Bypass Grafting, off pump, on pump, cardiopulmonary bypass
References
Adams DH, Filsoufi F, Antman EM. Medical management of the
patient undergoing cardiac surgery. In: Zies DP, Libby P, Borow
RO, Braun Wald E, editors. Braun Wald's Heart Disease. A text
book of cardiovascular medicine Philadelphia: Elsevier Saunders;
p.1993-2019
Subodh V, Paul WM, Fedak RD, Wiesel PE, Szmitko MV,
Badiwala DB. Off pump Coronary Artery bypass Surgery.
Fundamentals for the clinical cardiologist. Circulation
;109:1206-11.
Duminda NW, Beatie WS, Djaiani G, Rao V, Michael AB,
Keyvan K., et al. Off Pump Coronary Artery Surgery for
reducing mortality and morbidity. J Am Col Cardiol
;46:872-82.
Kobayashi J, Tashiro T, Ochi M, Yaku H, Watanabe G, Satoh T,
et al. Japanese Off-Pump Coronary Revascularization
Investigation (JOCRI) Study Group. Early outcome of a
randomized comparison of off-pump and on-pump multiple
arterial coronary revascularization. Circulation 2005;112(9
Suppl):I338-43.
Salzberg SP, Adams DH, Filsoufi F. Coronary artery surgery:
conventional coronary artery bypass grafting versus off-pump
coronary artery bypass grafting. Curr Opin Cardiol
;20:509-16.
Wildhirt SM, Schulze C, Conrad N, Sreejayan N, Reichenspurner
H, von Ritter C, et al. Reduced myocardial cellular damage and
lipid per oxidation in off pump versus conventional coronary
artery bypass grafting. Eu J Med Res 2000;5:222-3.
Hanan EL, Wu C, Smith CR, Higgins RS, Carlson RE, Culliford
AT, et al. Off pump versus on pump coronary artery bypass graft
surgery. Differences in short term outcome and in long term
mortality and need for subsequent revascularization Circulation
;116:1145-52.
Oo AY, Grayson AD, Patel NC, Pullan DM, Dihmis WC, Falri
BM. Is off pump coronary surgery justified in Euro score highrisk cases? A propensity score analysis. Interact Cardiovasc
Thorac Surg 2003;2:660-4.
Darwazah AK, Abu shama'a RA, Hussain E, Hawari MH, Ismail
H. Myocardial revascularization in patients with low EF
=35%: effect of pump techniques on early morbidity and
mortality. J Card Surg 2006;21(1):22-7.
Rastan AJ, Eckenstein JI, Hent Schel B, Funkat AK, Gummert
JF, Doll N, et al. Emergency Coronary artery bypass graft
surgery for acute coronary artery syndrome: Beating heart versus
conventional cardioplegia cardiac arrest strategies. Circulation
;114(I Supp):1477-85.
Lahhnen J, Brancari F, Rimpilanen J, Kytökorpi R, Mosorin
M, Rainio P, et al. Off pump versus on pump coronary artery
bypass surgery in high risk patients (Euro Score ‰¥6). Thoracic
Cardiovasc Surg 2007;55;13-8.
Aranki SF, Shaw DP, Adam DH, Rizzo RJ, Couper
GS, VanderVliet M. Predictors of atrial fibrillation after coronary
artery surgery. Current trend and impact on hospital resources.
Circulation 1996;94:390-7.
Yau TM, Ikonomidis JS, Weisel RD, Mickle DA, Hayashida N,
Ivanov J, et al. Which techniques of cardioplegia prevent
Ischemia? Ann Thoracic Surg 1993;56;1020-8.
Bouchard D, Cartier R. off pump revascularization of multi
vessel coronary artery disease has a decreased myocardial
infarction rate Eur J Cardiothoracic Surgery 1998;14:S20-4.
Koh TW, Carr White GS, De Souze AC, Ferdinand FD, Hooper
J, Kemp M, et al. Intraoperative cardiac Troponin release and
lactic acid metabolism during Coronary artery surgery:
Comparison of beating heart with coronary artery surgery on
conventional bypass. Heart 1999;81;495-500.
J Ayub Med Coll Abbottabad 2010;22(3)
http://www.ayubmed.edu.pk/JAMC/PAST/22-3/Javed.pdf 53
Saatvedt K, Flane AE, Sellevold O, Novdstrand K. Is atrial
fibrillation caused by extra corporeal circulation? Ann Thorac
Surg 1999;68:93-3.
Piren ZA, Wayshal AB, Lancey R, Hung SC. Arrhythmias and
conduction disturbances after coronary artery bypass graft
surgery: Epidemiology, management and prognosis. Am Heart J
;129:799-808.
Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after
Cardiac Surgery. Ann Intern Med 2001;13J:1061-73.
Widimsky P, Straka Z, Stros P, Jirasek K, Dvorak J, Votava J, et
al. One year coronary bypass graft patency a randomized
comparison between off pump and on pump surgery
angiographic results of the PRAGUE-4 trial. Circulation
;110:3418-23.
Karolak W, Hirsh G, Buth R, Legare JF. Medium term out come
of coronary artery bypass graft surgery on pump versus off
pump: Results from a randomized controlled trial. Am Heart J
;153:689-95.
Buffalo E, Gerola LR. Coronary artery bypass grafting without
cardio-pulmonary bypass through sternotomy and minimally
invasive procedure. Int J Cardiol 1997;62( Suppl 1):589-93.
Puskas JD, Williams WH, Mahoney EM, Huber PR, Block
PC, Duke PG, et al. Off pump versus conventional coronary
artery bypass grafting: early and 1 year graft patency, Cast and
quality of life outcome: a randomized trial. JAMA
;291:1841-9.
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-years
Survival. Am Thorac Surg 2008;86:1139-46.
Van Dij KD, Nierich AP, Jansen EWL, Nathoe HM, Suyker WJ,
Diephuis JC, et al. Early outcome after off pump versus on pump
coronary by pass surgery. Results from a randomized study.
Circulation 2001;104:1761-6.
Al Ruzzeh S, Nakamura K, Athanasiou T, Modine T, George
S, Yacoub M, et al. Does off pump coronary artery bypass
(OPCAB) surgery improves the outcome in high risk patients? A
comparative study of 1398 high risk patients. Eur J Cardiothorac
Surg 2003;23:50-5.
Cleveland JC, Shroyer AL, Chen AT, Peterson E, Grover FL. Off
pump coronary artery dypass grafting decreases risk adjusted
mortality and morbidity. Ann Thorac Surg 2001;72:1282-8.
Mack MJ, Brown PP, Kugelmass AD, Battaglia SL, Tarkington
LG, Simon AW, et al. Current status and outcome of coronary
revascularization 1999 to 2002: 148, 396 Surgical and
percutaneous procedures. Am Thorac Surg 2004;77:761-6.
Czerny M, Baumer H, Kilo J. Zuckermann A, Grubhofer G,
Chevtchik O. Complete revascularization in coronary artery
bypass grafting with and without cardio pulmonary bypass. Ann
Thorac Surg 2001;71:165-9.
Angelini DG, Taylor FC, Reeves BC, Ascione R. Early and mid
term outcome after on pump and off pump surgery in beating
heart against cardioplegic arrest studies (BHACAS, 1 and 2): a
pooled analysis of randomized control trial. Lancet
;359:1194-9.
Zamvar V, William D, Hall J, Payne N, Cann C, Young K, et al.
Assesment of neurocognitive impairment after off pump and on
pump techniques for coronary artery bypass graft surgery: a
prospective randomized controlled trial. BMJ 2002;325:1268.
Legare JF, Buth KJ, King S, Wood J, Sullivan JA, Hancock
Friesen C, et al. Coronary bypass surgery performed off pump
may not result in lower in hospital morbidity than coronary
artery bypass grafting performed on pump. Circulation
;109:887-92.
Van Belleghem Y, Caes F, Van Overbeke H, Moerman A, Van
Nooten G. Off pump coronary surgery: Surgical strategy for high
risk patient. Cardio Vasc Surg 2003;11:75-9.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
