No abstract available.
Coronary Artery Bypass, Off-Pump* ; Endarterectomy, Carotid* ; Hematoma* ; Transplants*

BACKGROUND: Clopidogrel is widely used just before coronary artery bypass surgery, yet its pharmacological effect can cause postoperative bleeding-related complications. The purpose of this study was to find the effect of preoperative clopidogrel exposure on the blood transfusion requirement and on the rate of reexploration for bleeding control and the rate of readmission caused by bleeding in patients who undergo off-pump coronary artery bypass surgery (OPCAB). MATERIAL AND METHOD: This study included 103 patients who had been on clopidogrel preoperatively and they underwent OPCAB by one surgeon from January, 2005 to November, 2007. We divided the patients into two groups. Group 1 consisted of 45 patients who stopped cloidogrel 5 days before surgery and group 2 consisted of 58 patients who were taking clopidogrel within 5 days before surgery. Two groups were compared in terms of the bleeding related reoperation rate and the readmission rate, the amount of postoperative bleeding and the required amount of transfusion. RESULT: There were no significant differences between the two groups concerning the demographic, echocardiographic and hematologic features. There were no significant differences in the postoperative bleeding amount, but the amount of required transfusion was greater in group 2 (p=0.018). While group 1 showed a 0% reoperation rate for hemostasis and a 0% readmission rate as related to postoperative bleeding, group 2 showed a 6.9% reoperation rate and a 5.2% readmission rate, but there were no statistically significant differences between the two groups. CONCLUSION: Continuous use of clopidogrel did not cause postoperative major bleeding, but it can increase the amount of bleeding and the amount of required transfusion postoperatively. We think that discontinuation of clopidogrel for a while before elective OPCAB can help the patient's postoperative recovery.
Blood Transfusion ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Hemorrhage ; Hemostasis ; Humans ; Reoperation ; Ticlopidine

OBJECTIVETo compare the short-term outcomes in selected high-risk patients underwent off-pump coronary artery bypass grafting (OPCAB) or on-pump conventional coronary artery bypass grafting (CCABG).

METHODSComparative analysis was made between 318 high-risk patients underwent OPCAB between January 1999 to December 2005 and 197 high-risk patients underwent CCABG between January 1999 to December 2003 and EuroSCORE was > or = 5 in all patients.

RESULTSEuroSCORE was similar between the two groups (6.1 +/- 1.2 vs. 6.3 +/- 1.4 per patient). The patients in OPCAB group were significantly older [(71.1 +/- 6.0) years vs. (60.2 +/- 8.5) years, P < 0.01] and had more peripheral vascular diseases (47.8% vs. 23.4%, P < 0.01) than that in CCABG group. The OPCAB group included more patients with left ventricular ejection fraction (LVEF) > or = 50% (84% vs. 60.4%, P < 0.01) compared to CCABG group. Mean grafts per patient was 3.0 +/- 0.8 in OPCAB group and 3.6 +/- 0.9 in CCABG group (P < 0.01). Operative mortality was 1.6% (5/318) in OPCAB group and 6.1% (12/197) (P < 0.01). The total Intensive Care Unit (ICU) time was (90 +/- 169) hours for OPCAB patients and (126 +/- 187) hours for CCABG patients (P < 0.05). The total ventilator support time was (21 +/- 45) hours for OPCAB and (54 +/- 170) hours for CCABG patients (P < 0.01). Intro-Aortic Balloon Pump (IABP) rate (2.5% vs. 10.2%, P < 0.01), rate of re-operation for cardiac reasons (1.9% vs. 5.6%, P < 0.01), rate of cerebral vascular accident (CVA) (0.3% vs. 2.5%, P < 0.05) and cardiac arrest rate (2.8% vs. 6.6%, P < 0.05) were all less in OPCAB group compared to CCABG group.

CONCLUSIONCompared to CCABG, OPCAB significantly reduces post operation ICU time, ventilator support time, operative mortality and operative morbidity in selected high-risk patients.

BACKGROUND: Constrictive pericarditis after coronary artery bypass surgery has been known to affect cardiac output by limiting diastolic ventricular filling. We aimed to assess the influence of postoperative constrictive physiology on the early outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCAB). MATERIALS AND METHODS: Between January 2008 and July 2011, 903 patients underwent an isolated OPCAB and postoperative transthoracic-echocardiography. The patient cohort was classified into two groups: group A, constrictive physiology and group B, control group without constrictive physiology. Early outcomes were analyzed between the two groups. RESULTS: Of the total 903 patients, group A consisted of 153 patients (16.9%). The amount of blood loss in group A during the postoperative 24 hours was greater than that of group B, but this was not statistically significant (p=0.20). No significant differences were found in the mortality rates (group A, 0.6%; group B, 1.4%; p=0.40) and 30-day major adverse cardiac and cerebrovascular events (MACCEs; group A, 3.3%; group B, 6.1%; p=0.42). CONCLUSION: Postoperative constrictive physiology does not affect 30-day MACCEs or other major complications after OPCAB. The results of this study suggest that patients with early postoperative constrictive physiology do not need medical or surgical treatment, and that conservative care is sufficient.
Cardiac Output ; Cohort Studies ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Humans ; Pericarditis, Constrictive ; Transplants

OBJECTIVETo evaluate the changes of circulating hematopoietic progenitor cells (cHPCs) in patients undergoing coronary artery bypass graft (CABG) surgery.

METHODSFifty-one patients scheduled to undergo elective CABG surgery were prospectively enrolled in this study. Blood samples were collected at baseline and at 1, 3, and 5 days after the surgery. CD34⁺ CD45dim, CD133⁺ CD45dim, and CD34⁺ CD133⁺ CD45dim cells were measured by flow cytometry. The functionality of the circulating progenitor cells were studied in vitro using clonogenic and migration assays.

RESULTSAll the elective patients showed a significant postoperative increase of CD34⁺ CD45dim (1.51 ± 1.26 vs 2.02 ± 1.16, P=0.036) and CD133⁺ CD45dim cells (1.16 ± 0.85 vs 1.65 ± 0.99, P=0.008) irrespective of on-pump or off-pump CABG. The perioperative changes of the cHPCs was more significant in patients undergoing on-pump surgery than those having off-pump surgery.

CONCLUSIONIn patients undergoing elective cardiac surgery, cHPC level increased early after the surgery but recovers the normal level over time.

There have been several reports of gas embolism occurring during off-pump coronary artery bypass graft (OPCAB) surgery. However, all these cases of air embolism were associated with the repair of venous circulation, using a CO2 blower. In this report, we describe a rare case of air embolism in the coronary arteries associated with the use of a CO2 blower during OPCAB. There was no injury to the veins during OPCAB. The air embolism was treated successfully with cardiopulmonary bypass.
Cardiopulmonary Bypass ; Catheterization ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Embolism, Air ; Transplants ; Veins

Coronary artery disease has historically been a contraindication to lung transplantation. We report a successful combined bilateral lung transplantation and off-pump coronary artery bypass in a 62-year-old man. The patient had a progressive decline in lung function due to idiopathic pulmonary fibrosis and a history of severe occlusive coronary artery disease.
Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Artery Disease ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Transplantation* ; Lung* ; Middle Aged

It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD.
Aged ; Aneurysm ; Aortic Aneurysm, Abdominal ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; Humans ; Transplants

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) has shown better outcome in chronic renal failure (CRF) patients by avoiding the effects of cardiopulmonary bypass. We evaluated renal function after OPCAB in CRF patients. MATERIAL AND METHOD: 656 patients underwent OPCAB between January, 2001 and December, 2004. Data were collected in 26 CRF patients (Cr>1.7 mg/dL). Preoperative/postoperative creatinine (Cr) levels, creatinine clearance and postoperative data were evaluated. We divided the patients into group 1 (Cr<3 mg/dL) and group 2 (Cr> or =3 mg/dL). RESULT: Three patients started dialysis after surgery. Preoperative mean creatinine level (4.19+/-3.4 mg/dL) was elevated to 4.36+/-2.7 mg/dL at the third postoperative day and decreased below preoperative level at the fifth postoperative day. In group 1 (mean Cr level=1.87+/-0.25 mg/dL), Cr level reached its peak level of 2.19+/-0.52 mg/dL at the fourth postoperative day (p=0.017), with subsequent decrease. Patients without pre- or postoperative dialysis (n=15) showed peak Cr elevation on postoperative day four (p=0.017) and subsequent decrease (p=0.01). Postoperative creatinine clearance showed reverse correlation with creatinine level. CONCLUSION: Creatinine level was elevated at third/fourth postoperative day, but decreased 5 days after surgery. Thus, if urgent dialysis is not indicated, postoperative renal replacement therapy in CRF patients may be better to be considered after four days observation.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Creatinine ; Dialysis ; Humans ; Kidney Failure, Chronic* ; Renal Replacement Therapy ; Transplants*

BACKGROUND: Renal dysfunction is a serious complication that sometimes occurs after on-pump coronary artery bypass grafting. Recently, the off-pump coronary artery bypass (OPCAB) is used. We investigated whether this practice can reduce renal compromise. METHODS: Eighty patients underwent CABG surgery between March 2001 and March 2002. Among these, 50 patients received CABG with cardiopulmonary bypass (CPB) and 30 patients received OPCAB. The data collected included age, gender, history of diabetes, history of hypertension, history of congestive heart failuere, preoperative serum creatinine (PreCr) level, peak postoperative serum creatinine (Peak PostCr) level, preoperative and postoperative left ventriclular ejection fraction, preoperative ACE inhibitor use, perioperative angiography with contrast dye. Perioperative changes in creatinine clearance (DCrCl) were calculated using changes in the pre and postoperative serum creatinine values. Moderate postoperative renal dysfuntion was defined as a peak postoperative creatinine value of greater than 1.5 times and below 2.0 times the preoperative creatinine value. Severe postoperative renal dysfunction was defined as a peak postoperative creatinine of more than twice the preoperative creatinine value. RESULTS: Moderate renal dysfunction was observed in 10% of patients in the on-pump group and in 17.6% of the patients in the off-pump group. Severe renal dysfunction was observed in 6.7% of patients in the on-pump group and in 5.9% of the patients in the 0ff-pump group. Multivariate liner regression analysis showed that the preoperative and immediate postoperative creatinine clearance are associated with postoperative renal dysfuntion in both groups. CONCLUSIONS: In this retrospective study, we could not confirm that OPCAB reduces perioperative renal dysfunction more so than CABG with CPB. Diabetes was found to be significantly associated with postoperative renal dysfunction in CABG with CPB.
Angiography ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Creatinine ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Hypertension ; Retrospective Studies