scholarly journals Postoperative Tachyarrhythmias: On-Pump versus Off-Pump Coronary Artery Bypass Grafting

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Mohamed Shehata ◽  
Bassem AbdElhalim ◽  
Hany Hanna ◽  
Mervat Nabih
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Categorical Variables ◽  
Off Pump ◽  
Electrocardiographic Monitoring ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective. Tachyarrhythmias, after coronary artery bypass graft (CABG) surgery, develop in 11%–40% of patients. Surgery technique (on-pump or off-pump) might affect incidence of post-CABG tachyarrhythmias. Methods. The study included 60 patients undergoing CABG (≥2 grafts) with left ventricle ejection fraction (LV EF) >40%. Patients were divided into two groups equally: group A (on-pump) and group B (off-pump). Patients were subjected to electrocardiographic monitoring (7 days postoperatively), transthoracic echocardiography, with recording of surgical details and complications. Results. Data collected between December 2012 and May 2013 showed no significant difference between two groups regarding incidence of postoperative tachyarrhythmias with statistically significant higher incidence of supraventricular tachycardia in group B (P<0.05) and a trend towards higher incidence of atrial fibrillation in group A. Patients who developed postoperative tachyarrhythmias in group A showed higher prevalence of family history of coronary artery disease and higher incidence of postoperative chest infections (P<0.05), while those in group B showed higher mean LV EF (pre- and postoperatively) (P<0.05). Data were statistically described in terms of mean ± standard deviation. Comparison of numerical and categorical variables was done using Student’s t- and Chi-square tests, respectively. Conclusion. Adopting off-pump CABG technique is not associated with less incidence of post-operative tachyarrhythmias, as compared to on-pump technique.

scholarly journals Predictors of Atrial Fibrillation following Coronary Artery Bypass Grafting

2011 ◽  
Vol 5 ◽  
pp. CMC.S7170 ◽  
Author(s):  
Feridoun Sabzi ◽  
Abdol Hamid Zokaei ◽  
Abdol Rasoul Moloudi
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
Bypass Graft ◽  
Multivariate Logistic Regression Analysis ◽  
Categorical Variables ◽  
Group A ◽  
Group B

Background Atrial fibrillation (AF) is a frequent and serious complication of coronary artery bypass graft (CABG) surgery. Methods: We undertook a retrospective review of the records of patients undergoing CABG at Imam Ali Hospital between February 1, 2003 and February 1, 2006. The patients were divided in two groups, ie, Group A (AF) and Group B (no AF). The association between the occurrence of AF following CABG and other variables was compared with respect to continuous or categorical variables by t-test and χ2-test. Results Multivariate logistic regression analysis of potentially predictive factors in univariate analysis showed that opium use, type of operation, and crossclamp time were predictors of AF following CABG. Conclusion This study identifies some new predictors of postoperative AF, control of which could lead to a lower incidence of AF and reduced morbidity, mortality, and resource utilization for patients undergoing cardiac surgery.

scholarly journals Bisoprolol Versus Corticosteroid and Bisoprolol Combination for Prevention of Atrial Fibrillation After On-Pump Coronary Artery Bypass Graft Surgery

2019 ◽  
Vol 13 (1) ◽  
pp. 18-24
Author(s):  
Ramy Mahrose ◽  
Ahmed M. Elsayed ◽  
Mohamed S. Elshorbagy
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Group A ◽  
Pump Coronary Artery Bypass ◽  
Group B

Background:The most common cardiac arrhythmia that happens after on-pump Coronary Artery Bypass Graft (CABG) surgery is Atrial Fibrillation (AF). It is combined with several postoperative complications such as increased incidence of stroke, increased hospital stay and increased costs.Objectives:The aim of this study was to look for safe, effective, reliable and well tolerated tools for the prevention of atrial fibrillation after on pump coronary artery bypass surgery.Patients and Methods:The study enclosed 176 patients (the age ranges from 40 to 79 years) and scheduled for elective on-pump CABG operations without concomitant procedures. The patients were selected randomly into two equal groups. Group (A) in which bisoprolol was used to prevent atrial fibrillation after surgery. Group (B) in which bisoprolol and hydrocortisone were used for prevention of atrial fibrillation after surgery. For each patient, the following data were collected: gender, preoperative diseases, cardiopulmonary bypass time, intraoperative cross clamp time, Left internal mammary Artery usage, incidence of postoperative atrial fibrillation, death, myocardial infarction chest infection and C-reactive protein amount in plasma.Results:There was a statistically significant decrease in the occurrence of atrial fibrillation in group (B) when compared to corresponding values in group (A). Also, group (B) showed a statistically significant decrease in length of hospital stay in comparison to group (A). C-reactive protein concentrations on the 1stand 2ndpostoperative days were lower significantly in group (B) than in group (A). There were no statistically significant differences between both groups regarding gender, preoperative diseases, cardiorespiratory bypass time, intraoperative cross clamp time, Left internal mammary artery usage, death, myocardial infarction and chest infection.Conclusion:This study demonstrated that using bisoprolol and hydrocortisone combination showed greater benefit than the use of bisoprolol only for prevention of postoperative AF after on-pump coronary artery bypass graft surgery.

scholarly journals Effect of Pre-operative Amiodarone on Atrial Fibrillation after Off-Pump Coronary Artery Bypass Surgery

2018 ◽  
Vol 33 (1) ◽  
pp. 67-73
Author(s):  
AKM Manzurul Alam ◽  
Istiaq Ahmed ◽  
Manzil Ahmad ◽  
Abdullah Al Mamun Hossain ◽  
Md Mohashin Reza ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Serum Electrolytes ◽  
Off Pump ◽  
Function Test ◽  
Group A ◽  
Pump Coronary Artery Bypass ◽  
Group B

Background: Atrial Fibrillation (AF) is common in early recovery period after cardio-thoracic surgery. There have been several pharmacological and nonpharmacological strategies suggested for prevention against AF after coronary artery bypass grafting. The purpose of this study was to evaluate the effect of oral amiodarone in the prevention of atrial fibrillation in patients who underwent off pump coronary artery bypass graft (OPCAB).Methods: This interventional study was conducted from February 2017 to January 2018 in the department of cardiac surgery, National Institute of Cardiovascular Disease (NICVD) Dhaka, Bangladesh. By purposive sampling a total of 100 patients having sinus rhythm who will undergo OPCAB were selected for the study. Among them 50 patients (Group-A) got amiodarone (600mg/day started 3 days prior to surgery) and 50 patients (Group-B) did not get amiodarone. Two (2) patients of group-A were excluded from the study due to conversion to on pump from off pump during operation. So, finally group A had 48 patients and group- B had 50 patients. Preoperative electrocardiography (ECG), serum electrolytes (e.g. potassium & magnesium), thyroid function test, liver function test and echocardiogram were done in all patients under study. Per-operative occurrence of AF was assessed on operation theatre monitor. Each patient was evaluated by continuous ECG up to 5th post-operative day (POD). Serum potassium & magnesium were measured in every alternative day up to 5th POD. ECG with long lead tracing was done for all patients on the day of hospital discharge & was recorded. Data were analyzed by SPSS 24.0 (Statistical Package for the Social Sciences) and tested by student T-test and Chi-square test. P < 0.05 was considered significant.Results: Pre-operative baseline characteristics were similar in both groups. Per-operative and postoperative AF occurred more frequently in group B than group A. Those were 10(20.83%) and 32(64.0%) peroperative, 9(18.75%) and 31(36.0%) immediate postoperative period respectively in group A and group B. The result was statistically significant (P value<.05). Post-operative amiodarone used in all patients who developed AF irrespective of groups. This also decreased AF significantly. There were statistically no significant difference found in postoperative serum electrolytes and use of inotropes, anti-arrhythmic drugs. All patients recovered well.Conclusion: This study concluded that preoperative oral administration of amiodarone can prevent the occurrence of atrial fibrillation in patients undergone Off Pump Coronary Artery Bypass (OPCAB).Bangladesh Heart Journal 2018; 33(1) : 67-73

Antegrade-Retrograde Cardioplegia for Myocardial Protection during Coronary Artery Bypass Graft Surgery

1998 ◽  
Vol 6 (3) ◽  
pp. 188-194
Author(s):  
Tarek A Abdel Aziz ◽  
Najib Al Khaja ◽  
Mohamed A Ali ◽  
Ali S Maklad ◽  
Mohamed F Bassiouny ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Damage ◽  
Artery Bypass Graft ◽  
Retrograde Cardioplegia ◽  
Group A ◽  
Group B

This prospective randomized clinical study was designed to assess and compare the use of combined antegrade-retrograde cardioplegia versus antegrade cardioplegia in providing adequate myocardial preservation during coronary artery bypass graft surgery. Fifty patients undergoing elective coronary artery bypass grafting were randomly divided into 2 groups according to the route of cardioplegic delivery: group A (25 patients) received antegrade cold crystalloid cardioplegia; group B (25 patients) received combined antegrade-retrograde cold crystalloid cardioplegia. The groups were compared by clinical and electrocardiographic criteria and biochemical markers of ischemic myocardial damage. There was a highly significant statistical difference between the groups in terms of spontaneous recovery of sinus rhythm (40% of patients in group A versus 96% in group B). The use of direct current shock to restore sinus rhythm was higher in group A (60%) compared with group B (4%). Low cardiac output occurred in 20% of patients in group A and in 16% of patients in group B but this difference was not statistically significant. No bundle-branch block was found in group B whereas the incidence was 8% in group A. Significantly higher levels of biochemical markers of myocardial damage were obtained in group A at 10 minutes, 4 hours, and 12 hours after declamping. These results indicate that combined antegrade-retrograde cardioplegia is superior to antegrade cardioplegia for myocardial protection during coronary artery bypass graft surgery.

Incidence and Clinical Implications of Postoperative Atrial Fibrillation in patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Grafting

2021 ◽  
Vol 15 (6) ◽  
pp. 1216-1217
Author(s):  
U. Ullah ◽  
A. Ahmad ◽  
M. A. R. Mirza ◽  
W. Rehman ◽  
M. Mehmood
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Postoperative Atrial Fibrillation ◽  
Clinical Implications ◽  
Off Pump ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Aim: Post-operative incidence and clinical implications of atrial fibrillation in patients having on-pump and off-pump CABG. Place of Study: Department of Cardiovascular & Thoracic Surgery, Shaikh Zayed Hospital, Lahore. Study Duration: 1 year Design of Study: Quasi-experimental study Methodology: 140 cases were selected. Non-probability purposive sampling technique was used. Grouping: Group A (Off-pump) and Group B (On-pump). Results: In group A, cases showed atrial fibrillation and in group B 23(32.9%) cases were noted. The incidence of postoperative atrial fibrillation was low in off-pump CABG as compare to on pump CABG.Clinical implications of postoperative AF such as, length of ICU & hospital stay, cerebrovascular events, wound infections and mortality of the cases are significantly reduced by using off-pump CABG. Conclusion: Incidence of P/O atrial fibrillation is low in off-pump CABG as compare to on pump CABG Keywords: Coronary Artery Bypass Graft (CABG), Atrial Fibrillation, on pump CABG.

Thoracoscopic Transmyocardial Laser Revascularization: Is Prior Coronary Artery Bypass Grafting a Contraindication?

2007 ◽  
Vol 2 (3) ◽  
pp. 112-115 ◽  
Author(s):  
Gary S. Allen ◽  
Jason Budde
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Airway Injury ◽  
Transmyocardial Laser Revascularization ◽  
Port Access ◽  
Group A ◽  
Group B

Objective Recently, thoracoscopic techniques have been used to perform transmyocardial laser revascularization (TMR) in patients who are not suitable candidates for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions. Whether or not prior CABG contraindicates a port access–only approach to TMR is unclear. This study compares patients with and without prior CABG who have undergone thoracoscopic TMR. Methods Between May 2003 and October 2005, 23 consecutive patients (6 without prior CABG, group A; and 17 with prior CABG, group B) underwent thoracoscopic TMR, using a holmium:yttriumaluminum-garnet (Ho:YAG) laser system. Either 3 or 4 port incisions (each ≤2 cm in length) were used, depending on the patient's anatomy. Procedural success was defined as the ability to create all intended channels without conversion to thoracotomy. Results Patient demographics were not significantly different between group A and group B (mean age, 65.8 ± 4.3 years versus 67.4 ± 2.4 years, Canadian Cardiovascular Society angina class 3.7 ± 0.2 versus 3.9 ± 0.1, and Parsonnet score 12.0 ± 3.2 versus 20.5 ± 2.4). Fourteen (82.4%) group B patients had a prior left internal mammary artery to left anterior descending artery graft, of which 12 (85.7%) were patent. One patient in group A had an airway injury at intubation that led to an extended hospital stay of 30 days. One patient in group A (16.7%) and one patient in group B (5.9%) required a blood transfusion (P = NS). Adhesion lysis time in group B ranged from 0 to 68 minutes (mean, 27 ± 5.6 minutes). Neither group had a conversion to thoracotomy or any deaths through a mean combined follow-up of 12 months. Conclusions A port access approach is safe and reproducible for patients who are candidates for sole therapy TMR. Prior CABG, including patent grafts, is not a contraindication to thoracoscopic TMR.

scholarly journals Atrial fibrillation after Coronary Artery Bypass Surgery with and without Cardiopulmonary Bypass

2018 ◽  
Vol 10 (2) ◽  
pp. 171-179
Author(s):  
Md Rezaul Karim ◽  
Tawfiq Ahmed ◽  
Shahriar Moinuddin ◽  
Tariq Ahmed Chowdhury ◽  
Moshfequre Rahman Khan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Off Pump ◽  
Coronary Artery Bypass Operation ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Background:Atrial fibrillation (AF) is the most common postoperative supraventricular arrhythmi. 20% to 40% of patients have AF after coronary artery bypass operation (CABG).Arrhythmia of all grades may occur due to cardiopulmonary bypass (CPB) and injuries inflicted during operativeprocedures. Thus it has been proposed that CABG surgery would be safer if CPB could be avoided.Methods:Total 60 patients who underwentCABG were selected for the study and divided in two groups. Group A: 30 patients with Off-pump CABG (OPCAB) and Group B: 30 patients with On-pump CABG. 12 lead ECG was done at morning on the day of surgery, after surgery & when any arrhythmia are noted for at least 7days. Morbidity of patients like arrhythmia and hospital mortality were recorded and compared during the first week after surgery.Results:Off-pump group (group- A) had less incidence of post-operative AF than on-pump group(group-B) (10% vs 40%). Postoperative blood requirement,total operative time, the period of mechanical ventilation,ICU stay and total postoperative hospital stayis significantly shorter in off-pump than in on-pump group of patients.Conclusion: This study clearly demonstrates that off pump CABG procedure is associated with less incidence of AF. Therefore OPCAB procedure for myocardial revascularization is clearly justified whenever feasible.Cardiovasc. j. 2018; 10(2): 171-179

Minimally Invasive Direct Coronary Artery Bypass Graft Surgery: Experience during the Learning Curve

1997 ◽  
Vol 5 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Kit V Arom ◽  
Robert W Emery
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Length Of Hospital Stay ◽  
Surgical Approaches ◽  
Risk Patients ◽  
Group A ◽  
Group B

This communication briefly details the goals, indications, surgical approaches, and limitations of minimally invasive direct coronary artery bypass surgery. The clinical data of 93 cases performed at our institution were analyzed. These patients were divided into two groups: group A consisted of 70 healthy low-risk patients with single left anterior descending or right coronary artery lesions; group B consisted of 23 high-risk patients who had major contraindications to conventional cardiopulmonary bypass procedures. Using The Society of Thoracic Surgeons' preoperative predicted risk module, group A had a 1% predicted mortality versus 5% in group B. The 30-day mortality was 1% in group A and 13% in group B. The postoperative length of hospital stay averaged 4 days for group A and 9 days for group B. Short-term follow-up is promising and 83% of patients are free of angina.

scholarly journals Comparison of Recovery and Postoperative Analgesia between Thoracic Epidural Anaesthesia (TEA) plus General Anaesthesia and General Anaesthesia alone, in Patients Undergoing Off-Pump Coronary Artery Bypass (OPCAB) Surgery

1970 ◽  
Vol 2 (2) ◽  
pp. 156-162 ◽  
Author(s):  
S Ferdous ◽  
S Hossain ◽  
N Haque ◽  
AYFE Chowdhury
Keyword(s):  
Coronary Artery ◽  
General Anaesthesia ◽  
Coronary Artery Bypass ◽  
Postoperative Analgesia ◽  
Artery Bypass ◽  
Indwelling Catheter ◽  
Off Pump ◽  
Group A ◽  
Pump Coronary Artery Bypass ◽  
Group B

Background: In recent years, high thoracic anaesthesia (HTEA) combined with general anaesthesia has been extensively studied in patients undergoing coronary artery bypass graft surgery with or without cardiopulmonary bypass. Off-pump coronary artery bypass grafting was implemented to reduce trauma of surgical coronary revascularization by avoiding extracorporeal circulation. TEA in combination with GA further reduces intraoperative stress resulting in more rapid extubation and significantly better pain relief in patients undergoing off-pump coronary artery bypass grafting (OPCAB). In addition, common postoperative complications are also decreased. Methodology: 40 male patients aged between 40-65 years with CAD undergoing OPCAB surgery at NICVD from April 2006 to October 2008 were randomly divided in two groups. Group A received epidural analgesic drugs through an indwelling catheter introduced before induction of anesthesia while group B patients received standard general anesthesia (GA) alone. Group A patients received continuous epidural analgesia delivered through the indwelling catheter with a mixture of Lignocaine (2%) 20 ml + Bupivacaine (0.5%) 20 ml + Fentanyl 50 gm 1 ml + normal saline q.v. 50 ml at the rate of 1-2 ml/hour by a syringe pump for up to 72 hours. Group B patients received conventional intermittent narcotics (Morphine)/NSAIDS (Ketorolac/Diclofen) for up to 72 hours. Results: Haemodynamic parameters of all patients in both the groups were within acceptable range throughout operations. Incidence of cardiac dysrhythmias was less in patients of group A. Group A patients showed faster recovery and better analgesia compared to Group B patients. There was also decreased incidence of nausea, vomiting, arrhythmia, O2 desaturation, confusional states, renal failure and requirement of iontropic support in ICU in Group A patients. TEA for postoperative analgesia was safe and well accepted by the patients. There was no complication related to epidural anesthesia in any patient. Conclusion: TEA in general anesthesia provides faster recovery and effective analgesia. Nonetheless, the actual and potential risks of TEA during cardiac surgery should not be underestimated. Keywords: Thoracic epidural anaesthesia; OPCAB; Postoperative analgesia DOI: 10.3329/cardio.v2i2.6632Cardiovasc. j. 2010; 2(2) : 156-162

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