On PUMP Versus Off PUMP Coronary Bypass Grafting Post-Operative Clinical and Laboratory Focus on Neurological Outcome
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On PUMP Versus Off PUMP Coronary Bypass Grafting Post-Operative Clinical and Laboratory Focus on Neurological Outcome,ASHRAF W. ANDRAOS, OSAMA TAYEH, MAHMOUD EL-BADRY, SANAA ABD EL-SHAFY, ASHRAF HUSSEIN, INAS ABD EL-LATIF, TAREK HELMY and CLAUDIO MUNERETTO
Abstract
Conventional bypass grafting using cardioplegic arrest continues to be associated with some complications that may negate an otherwise successful procedure. Interest in off-pump bypass grafting (OPCABG) in the mid-1990s presented surgeons with the option of revascularization without the potential complications of extracorporeal support if CPB can be avoided; a reduction in peri-operative morbidity and mortality is anticipated.
The Aim of our Study: Is to compare both techniques regarding mortality, morbidity, complications and brain injury in both groups of patients with ischemic heart disease.
Patients and Methods: Eighty patients (pts) were subjected to CABGs, 40 with off pump (group I-gpI) and the other 40 pts with on pump (group II-gpII) techniques. Patients in both groups were matching as regards age, sex, risk factors, and number of bypassed coronaries. Pre-operatively and postop-eratively all patients were subjected to clinical examination, ECG, chest X-ray, transthoracic echocardiography, routine laboratory tests and serum S 100 B protein as well as Neuron Serum Enolase (NSE). Brain injury will be evaluated by using Glasgow Coma Scale and the neuromediators.
Results: Intra-operatively, group I pts had statistically significant shorter operative time (3.6±0.6 Vs. 4.1±0.7 hours in group II, p<0.001), less intra-operative bleeding-of medical causes-with lower intra-operative use of blood products (55% of pts in group I Vs. 100% of group II) and lower incidence of arrhythmias (25% Vs. 60% of group II). Post-operatively, group I showed statistically significant shorter stay in intensive care unit (2.8±0.7 Vs. 3.8±1.3 days in group II; p<0.001), earlier extubation (9.4±4 Vs. 15.5±11.6 hours in group II; p<0.002), lower pulmonary complications as regard atelectasis, chest infection (5% Vs. 22.5% in group II; p<0.02), lower cardiac complications as regard atrial fibrillation, low cardiac output and need for use of inotropic support (55% Vs. 82.5% in group II; p<0.007), less hypothermia with lower incidence of postoperative bleeding with less need for use of blood products and reopening. Group I showed significantly less renal (22.5% Vs. 52.5% in group II; p<0.05) and less hepatic impairment than in pts of group II (20% Vs. 55% in group II, p<0.05). No statistically difference between both groups as regards cardiac ischemia, cardiac arrest, ECG changes, trans-thoracic echocardiographic findings, hematemesis, and sternal wound infection. Finally, group I showed lower incidence of neurological deficits (whether reversible or permanent) (5% Vs. 27.5% in group II; p<0.006). Despite the latter, postoper-ative values of neuromediators S 100B protein and NSE showed a significant increase in both groups compared to preoperative serum level denoting some brain ischemia (as regard S 100B protein, 60 Vs. 20pg/ml preoperatively in group I; p<0.05 and 100 Vs. 35pg/ml preoperatively in group II; p<0.05), (NSE, 22 Vs. 6ug/L preoperatively in group I; p<0.05 and 20 Vs. 7ug/L preoperatively in group II; p<0.05). However; there is no statistically significant difference between both groups regarding the percent of increase of both mediators postoper-atively (1.88% in group I Vs. 1.7% in group II; p-value: Non significant).
Conclusions:
1-In the view of S 100B and NSE serum levels in both groups, no significant difference between both groups regarding cerebral ischemia.
2-Off-pump Coronary artery bypass grafting is effective with success rate comparable to On-pump CABGs.
3-Off-pump technique is safer in patients with preoperative bleeding disorders, renal/hepatic impairment, pulmonary disorders, or high risk for stroke e.g. calcific aortic roots.
4-Off-pump technique saves expenses due to fewer compli-cations and less postoperative stay in intensive care unit.