Trainees operating on high-risk patients without cardiopulmonary bypass: a high-risk strategy?

2004 ◽  
Vol 78 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Raimondo Ascione ◽  
Barnaby C Reeves ◽  
Marco Pano ◽  
Gianni D Angelini
Keyword(s):  
Cardiopulmonary Bypass ◽  
High Risk ◽  
High Risk Patients ◽  
Risk Patients

Coronary Revascularization Without Cardiopulmonary Bypass Versus the Conventional Approach in High-Risk Patients

2005 ◽  
Vol 79 (2) ◽  
pp. 552-557 ◽  
Author(s):  
Sotiris C. Stamou ◽  
Kathleen A. Jablonski ◽  
Peter C. Hill ◽  
Ammar S. Bafi ◽  
Steven W. Boyce ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Coronary Revascularization ◽  
Conventional Approach ◽  
High Risk Patients ◽  
Risk Patients

Miniaturized versus conventional cardiopulmonary bypass in high-risk patients undergoing coronary artery bypass surgery

Perfusion ◽  
2010 ◽  
Vol 25 (2) ◽  
pp. 65-70 ◽  
Author(s):  
Simo-Pekka Koivisto ◽  
Jan-Ola Wistbacka ◽  
Riikka Rimpiläinen ◽  
Juha Nissinen ◽  
Pertti Loponen ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
High Risk Patients ◽  
Risk Patients

Use of Cardiopulmonary Bypass in High-Risk Patients Is a Predictor of Adverse Outcome

2000 ◽  
Vol 4 (2) ◽  
pp. 86-91 ◽  
Author(s):  
W. Douglas Boyd ◽  
Nimesh D. Desai ◽  
Richard J. Novick ◽  
F. Neil McKenzie ◽  
Dario F. DelRizzo ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Artery Bypass ◽  
Major Complication ◽  
Protective Effects ◽  
Off Pump ◽  
High Risk Patients ◽  
Popula Tions ◽  
Repeat Operation ◽  
Risk Patients

High-risk patients experience substantially more compli cations after coronary artery bypass grafting (CABG). We hypothesized that these patients are uniquely vulner able to cardiopulmonary bypass and compared postop erative outcomes between high-risk patients undergo ing off-pump CAB (OPCAB) and conventional CABG. Prospective provincial cardiac care registry and retro spective chart data were reviewed for 1,850 consecutive patients at our institution between January 1996 and January 1999. From this, 235 patients, 36 OPCAB and 199 CABG, were identified as high risk (modified Parson net score ≥15). Risk factor analysis showed the popula tions were equivalent in perioperative risk with mean modified Parsonnet scores of 18.1 ± 3.4 (OPCAB) and 18.7 ± 4.2 (CABG) (P = .4). In total, 6% of OPCAB and 40% of CABG patients suffered major complications leading to extended hospital/intensive care unit (ICU) stay or death ( P ≤ .001). Mean hospital stays were 7.0 ± 4.0 days (OPCAB) and 10.6 ± 10.2 days (CABG) ( P ≤ .001). Mean ICU stays were 23.9 ± 9.7 hours (OPCAB) and 64.9 ± 128.3 hours (CABG) ( P ≤ .001). Mortality was 0% in the OPCAB group and 6% in the CABG group (P = .2). Multivariate predictors of experiencing a major complication were: use of cardiopulmonary bypass (OR 5.1, 95 Cl 2.1-12.1), age > 80 (OR 2.5, 95 Cl 1.7-7.5), female (OR 3.0, 95 Cl 1.6-5.4), repeat operation (OR 2.5, 95 Cl 1.2-5.4), and ejection fraction <40% (OR 2.4, 95 Cl 1.2-4.7). Extracorporeal circulation is the most impor tant predictor of postoperative complications after CABG in high-risk patients. Off-pump surgery substantially reduces morbidity in this group, and further study of the protective effects of this emerging modality are war ranted.

scholarly journals A Comparation of Coronary Artery Bypass Grafting with and without Cardiopulmonary Bypass in Euroscore High Risk Patients

2007 ◽  
Vol 7 (1) ◽  
pp. 48-51
Author(s):  
Emir Kabil ◽  
Emir Mujanović ◽  
Jacob Bergsland
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
High Risk ◽  
Hospital Stay ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
High Risk Patients ◽  
Risk Patients

Angiotensin converting enzyme (ACE) and nitric oxide (NO) have been suggested to be in - The objective of this study is to compare outcomes of coronary artery bypass grafting (CABG) in high-risk patients performed with- (ONCAB) and without -(OPCAB) use of cardiopulmonary bypass. From October 2001 till October 2005, 210 high-risk patients classified according to European System for Cardiac Operative Risk Evaluation (EuroSCORE) (score =or> 5) underwent CABG in Cardiovascular Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina. 138 patients operated as OPCAB were compared to 72 patients operated as ONCAB. All data were entered in a patient database (DATACOR) and analyzed in SPSS. OPCAB patients received insignificantly less number of grafts than those treated by ONCAB (3,0 vs. 3,2) (p=0,071). Stroke was significantly more common in ONCAB group (2,9 vs. 11,1%) (p=0,034) while the incidence of other postoperative complications and mortality were similar. The ventilation time (4,3 vs. 6,7 hours) (p=0,007), retransfusion volume (392,7 vs. 633,7 ml) (p=0,041) and hospital stay (8,2 vs. 10,1 days) (p=0,031) was significantly less in OPCAB group. OPCAB is safe and effective in treatment of high-risk patients. Avoidance of cardiopulmonary bypass is associated with reduced incidence of neurologic complications, lower intubation time, retransfusion rate and shorter hospital stay, and in our experience the preferred operative method in such patients.

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