Discussion on the influencing factors of beating heart coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Yun , PIAO Hulin , LI Bo , WANG Yong , XIE Chulong , WEI Shibo , XU Jian , GAO Xinghao , DU Yu ,  LIU Kexiang

Department of Cardiac Surgery, The Second Affiliated Hospital of Jilin University, Changchun, 130041, P. R. China;

Corresponding author：

LIU Kexiang, Email: 852705025@qq.com

Keywords：

Off-pump coronary artery bypass grafting; on-pump beating heart coronary artery bypass grafting; coronary artery bypass grafting; coronary heart disease

DOI：

10.7507/1007-4848.201804044

Video：

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Objective To explore the factors affecting the operation of coronary artery bypass grafting with heart beating and improve the effect of the operation. Methods From January 2012 to June 2016, 898 patients with coronary heart disease who received cardiovascular surgery in the Second Affiliated Hospital of Jilin University were analyzed retrospectively. All patients only underwent coronary artery bypass grafting with beating heart. Among them, 797 patients underwent the off-pump coronary artery bypass grafting (an OPCABG group, 592 males and 205 females, with an average age of 60.5±8.4 years); another 101 patients received on-pump beating heart coronary artery bypass grafting (an OPBH group, 77 males and 24 females, with an average age of 61.5±8.2 years). Results The average number of grafts in the OPCABG group was 3.36±0.74, and in the OPBH group was 3.71±0.69 (P<0.05). The postoperative ventilation time (10.8±9.5 h vs. 20.6±12.3 h), ICU stay (28.8±15.5 h vs. 37.4±30.8 h), hospital stay (10.9±4.8 d vs. 14.8±8.6 d), mortality (1.1% vs. 3.0%), the utilization rate of intra-aortic balloon pump (2.4% vs. 8.9%) and extracorporeal membrane oxygenation (0.5% vs. 5.0%) were significantly different between the OPCABG group and OPBH group (all P<0.05). Twelve patients died after surgery, and the total bloodless operation ratio was 91.3%. Conclusion The results show that most patients can achieve good results with the help of apical fixation and myocardial fixator, improved surgical techniques and methods, good anesthesia management as well as flexible and accurate use of vasoactive drugs. But extracorporeal circulation is necessary in the patients with large left ventricle, low ejection fraction and hemodynamic instability after intraoperatively moving the heart.

Citation： LIU Yun, PIAO Hulin, LI Bo, WANG Yong, XIE Chulong, WEI Shibo, XU Jian, GAO Xinghao, DU Yu, LIU Kexiang. Discussion on the influencing factors of beating heart coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(1): 73-77. doi: 10.7507/1007-4848.201804044 Copy

1.	Jansen EW, Borst C, Lahpor JR, et al. Coronary artery bypass grafting without cardiopulmonary bypass using the octopus method: results in the first one hundred patients. J Thorac Cardiovasc Surg, 1998, 116(1): 60-67.
2.	Athanasiou T, Al-Ruzzeh S, Kumar P, et al. Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients. Ann Thorac Surg, 2004, 77(2): 745-753.
3.	Kshettry VR, Flavin TF, Emery RW, et al. Does multivessel, off-pump coronary artery bypass reduce postoperative morbidity? Ann Thorac Surg, 2000, 69(6): 1725-1730.
4.	Lee JD, Dang CR, Taoka S, et al. Coronary artery bypass grafting performed with or without a bypass pump: early results. Hawaii Med J, 2000, 59(2): 54-56.
5.	Arom KV, Emery RW, Flavin TF, et al. Cost-effectiveness of minimally invasive coronary artery bypass surgery. Ann Thorac Surg, 1999, 68(4): 1562-1566.
6.	Boyd WD, Desai ND, Del Rizzo DF, et al. Off-pump surgery decreases postoperative complications and resource utilization in the elderly. Ann Thorac Surg, 1999, 68(4): 1490-1493.
7.	Buffolo E, de Andrade CS, Branco JN, et al. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg, 1996, 61(1): 63-66.
8.	Reichenspurner H, Boehm D, Detter C, et al. Economic evaluation of different minimally invasive procedures for the treatment of coronary artery disease. Eur J Cardiothorac Surg, 1999, 16(Suppl 2): S76-S79.
9.	陈长城, 尤斌, 王盛宇, 等. 非体外循环冠状动脉旁路移植术中转体外循环后的临床转归. 心肺血管病杂志, 2013, 32(6): 738-741.
10.	喻磊, 谷天祥, 师恩祎, 等. 70 岁以下多支冠状动脉病变患者体外与非体外循环冠状动脉旁路移植术的比较. 中国胸心血管外科临床杂志, 2010, 17(4): 292-296.
11.	Cheng DC, Bainbridge D, Martin JE, et al. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology, 2005, 102(1): 188-203.
12.	Athanasiou T, Aziz O, Mangoush O, et al. Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting? Ann Thorac Surg, 2004, 77(5): 1567-1574.
13.	伍育旗, 张郁林, 周波, 等. 92 例非体外循环冠状动脉旁路移植术的临床分析. 中国胸心血管外科临床杂志, 2013, 20(6): 725-727.
14.	Wang J, Xiao F, Ren J, et al. Risk factors for mortality after coronary artery bypass grafting in patients with low left ventricular ejection fraction. Chin Med J (Engl), 2007, 120(4): 317-322.
15.	顾松, 苏丕雄, 刘岩, 等. 左心室射血分数与缩短分数对冠状动脉旁路移植术后室性心律失常的预测. 中国胸心血管外科临床杂志, 2002, 9(3): 168-171.
16.	Bouchart F, Tabley A, Litzler PY, et al. Myocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long term follow-up in 141 patients. Eur J Cardiothorac Surg, 2001, 20(6): 1157-1162.
17.	Reston JT, Tregear SJ, Turkelson CM. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg, 2003, 76(5): 1510-1515.
18.	Ezhov MV, Safarova MS, Afanasieva OI, et al. Lipoprotein(a) level and apolipoprotein(a) phenotype as predictors of long-term cardiovascular outcomes after coronary artery bypass grafting. Atherosclerosis, 2014, 235(2): 477-482.

1. Jansen EW, Borst C, Lahpor JR, et al. Coronary artery bypass grafting without cardiopulmonary bypass using the octopus method: results in the first one hundred patients. J Thorac Cardiovasc Surg, 1998, 116(1): 60-67.
2. Athanasiou T, Al-Ruzzeh S, Kumar P, et al. Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients. Ann Thorac Surg, 2004, 77(2): 745-753.
3. Kshettry VR, Flavin TF, Emery RW, et al. Does multivessel, off-pump coronary artery bypass reduce postoperative morbidity? Ann Thorac Surg, 2000, 69(6): 1725-1730.
4. Lee JD, Dang CR, Taoka S, et al. Coronary artery bypass grafting performed with or without a bypass pump: early results. Hawaii Med J, 2000, 59(2): 54-56.
5. Arom KV, Emery RW, Flavin TF, et al. Cost-effectiveness of minimally invasive coronary artery bypass surgery. Ann Thorac Surg, 1999, 68(4): 1562-1566.
6. Boyd WD, Desai ND, Del Rizzo DF, et al. Off-pump surgery decreases postoperative complications and resource utilization in the elderly. Ann Thorac Surg, 1999, 68(4): 1490-1493.
7. Buffolo E, de Andrade CS, Branco JN, et al. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg, 1996, 61(1): 63-66.
8. Reichenspurner H, Boehm D, Detter C, et al. Economic evaluation of different minimally invasive procedures for the treatment of coronary artery disease. Eur J Cardiothorac Surg, 1999, 16(Suppl 2): S76-S79.
9. 陈长城, 尤斌, 王盛宇, 等. 非体外循环冠状动脉旁路移植术中转体外循环后的临床转归. 心肺血管病杂志, 2013, 32(6): 738-741.
10. 喻磊, 谷天祥, 师恩祎, 等. 70 岁以下多支冠状动脉病变患者体外与非体外循环冠状动脉旁路移植术的比较. 中国胸心血管外科临床杂志, 2010, 17(4): 292-296.
11. Cheng DC, Bainbridge D, Martin JE, et al. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology, 2005, 102(1): 188-203.
12. Athanasiou T, Aziz O, Mangoush O, et al. Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting? Ann Thorac Surg, 2004, 77(5): 1567-1574.
13. 伍育旗, 张郁林, 周波, 等. 92 例非体外循环冠状动脉旁路移植术的临床分析. 中国胸心血管外科临床杂志, 2013, 20(6): 725-727.
14. Wang J, Xiao F, Ren J, et al. Risk factors for mortality after coronary artery bypass grafting in patients with low left ventricular ejection fraction. Chin Med J (Engl), 2007, 120(4): 317-322.
15. 顾松, 苏丕雄, 刘岩, 等. 左心室射血分数与缩短分数对冠状动脉旁路移植术后室性心律失常的预测. 中国胸心血管外科临床杂志, 2002, 9(3): 168-171.
16. Bouchart F, Tabley A, Litzler PY, et al. Myocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long term follow-up in 141 patients. Eur J Cardiothorac Surg, 2001, 20(6): 1157-1162.
17. Reston JT, Tregear SJ, Turkelson CM. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg, 2003, 76(5): 1510-1515.
18. Ezhov MV, Safarova MS, Afanasieva OI, et al. Lipoprotein(a) level and apolipoprotein(a) phenotype as predictors of long-term cardiovascular outcomes after coronary artery bypass grafting. Atherosclerosis, 2014, 235(2): 477-482.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Discussion on the influencing factors of beating heart coronary artery bypass grafting

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