The choice of whether or not to stop beating after conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHAO Tiefu , WANG Shengyu , ZHANG Chunxiao , ZHANG Ming , ZENG Wen , WANG Jiangang , ZHENG Shuai , CHEN Hong

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding author：

ZHAO Tiefu, Email: tiefuzhao@163.com

Keywords：

Coronary artery bypass grafting; cardiopulmonary bypass; beat-heart; surgical conversion

DOI：

10.7507/1007-4848.202003138

Video：

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Objective To explore the effect of whether or not to stop beating after conversion to cardiopulmonary bypass (CPB) in off-pump coronary artery bypass grafting.Methods From 2016 to 2018, 177 patients with off-pump coronary artery bypass grafting in Beijing Anzhen Hospital were transferred to CPB. According to whether they stopped beating after conversion to CPB during the operation, they were divided into two groups. A non-stop beating group: there were 76 patients with 45 males, 31 females. aged 63.53±6.98 years, who were not to stop beating after conversion to CPB. A stop beating group: there were 101 patients with 66 males and 35 females, aged 63.98 ± 8.37 years, who were to stop beating and underwent the modified perfusion and application of papaverine in perfusion after conversion to CPB. The clinical effect of the two groups was compared.Results There were 14 deaths in the perioperative period. The mean graft flow (MGF) in the stop beating group was higher (P=0.033), and the pulse index (PI) was lower (P=0.001) than those in the non-stop beating group. Intra-aortic balloon counter pulsation (P=0.036), extracorporeal membrane oxygenation (P=0.038), continuous renal replacement therapy (P=0.014), ventilator-assisted time (P=0.021), ICU monitoring time (P=0.012), perioperative mortality (P=0.025) and the ejcetion fraction value (P=0.023) were significantly different between the groups.Conclusion Compared with not to stop beating, those to stop beating can get better perioperative clinical effect after conversion to CPB, which is worthy of recommendation.

Citation： ZHAO Tiefu, WANG Shengyu, ZHANG Chunxiao, ZHANG Ming, ZENG Wen, WANG Jiangang, ZHENG Shuai, CHEN Hong. The choice of whether or not to stop beating after conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 954-958. doi: 10.7507/1007-4848.202003138 Copy

1.	陈彧, 万峰, 江龙, 等. 312 例非体外循环 CABG 的危险因素评价. 中华心血管病杂志, 2002, 30(3): 161-164.
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6.	Sarin EL, Kayatta MO, Kilgo P, et al. Short-and long-term outcomes in octogenarian patients undergoing OPCAB coronary artery bypass grafting compared with on-pump coronary artery bypass grafting. Innovations (Phila), 2011, 6(2): 110-115.
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11.	赵铁夫, 王盛宇, 陈宏, 等. 体外循环下 CABG 中应用罂粟碱灌注的疗效分析. 中国胸心血管外科临床杂志, 2016, 23(12): 1150-1153.
12.	周明阳, 张健群, 毛斌, 等. 非体外循环 CABG 术式改变 156 例分析. 心肺血管疾病杂志, 2016, 5(11): 868-870.
13.	李京倖, 顾承雄, 韦华, 等. 心功能不全冠心病患者非体外循环 CABG 的疗效分析. 中国胸心血管外科临床杂志, 2011, 18(2): 157-159.
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15.	张梅, 张运, 李贵双, 等. 经皮冠状动脉内多普勒超声技术对冠状动脉血液动力学的研究. 中国循环杂志, 2000, 15(4): 216-217.
16.	杨柏松, 齐国先, 杨满光, 等. 冠状动脉造影正常的胸痛患者冠状动脉血流储备功能研究. 临床心血管病杂志, 2003, 19(5): 270-272.
17.	王妍军. 罂粟碱和硝酸甘油对乳内动脉血流量和血管内膜影响的对比研究. 首都医科大学, 2006.

1. 陈彧, 万峰, 江龙, 等. 312 例非体外循环 CABG 的危险因素评价. 中华心血管病杂志, 2002, 30(3): 161-164.
2. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—Summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol, 2002, 40(7): 1366-1374.
3. Soltoski P, Salerno T, Levinsky L, et al. Conversion to cardiopulmonary bypass in off-pump coronary bypass grafting: Its effect on outcome. J Card Surg, 1998, 13(9): 328-334.
4. Shaefi S, Mittel A, Loberman D, et al. Off-pump versus on-pump coronary artery bypass grafting—A systematic review and analysis of clinical outcomes. J Cardiothor Vasc AN, 2019, 33(1): 232-244.
5. Diegeler A, Borgermann J, Kappert U, et al. OPCAB versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med, 2013, 368(13): 1189-1198.
6. Sarin EL, Kayatta MO, Kilgo P, et al. Short-and long-term outcomes in octogenarian patients undergoing OPCAB coronary artery bypass grafting compared with on-pump coronary artery bypass grafting. Innovations (Phila), 2011, 6(2): 110-115.
7. Siegfried MR, Erhardt J, Rider T, et al. Cardioprotection and attenuation of endothelial dysfunction by organic nitric oxide donors in myocardial ischemia reperfusion. J Pharmacol exp Ther, 1991, 260(2): 668-675.
8. Toombs CF, McGee S, Johnston WE, et al. Myocardial protective effects of adenosine. Circulation, 1992, 86(4): 986-994.
9. 夏利民, 刘欢, 宋凯, 等. 合并缺血性左心室功能不全的冠心病患者的 OPCAB 治疗. 中华胸心血管外科杂志, 2014, 30(2): 96-97.
10. 沈金强, 季强, 丁文军, 等. 心肺转流不停跳与非体外循环 CABG 治疗射血分数≤35% 的冠心病的早期效果比较. 中华外科杂志, 2018, 56(4): 294-298.
11. 赵铁夫, 王盛宇, 陈宏, 等. 体外循环下 CABG 中应用罂粟碱灌注的疗效分析. 中国胸心血管外科临床杂志, 2016, 23(12): 1150-1153.
12. 周明阳, 张健群, 毛斌, 等. 非体外循环 CABG 术式改变 156 例分析. 心肺血管疾病杂志, 2016, 5(11): 868-870.
13. 李京倖, 顾承雄, 韦华, 等. 心功能不全冠心病患者非体外循环 CABG 的疗效分析. 中国胸心血管外科临床杂志, 2011, 18(2): 157-159.
14. 房勤, 谷天祥, 刘波, 等. 左心室射血分数低下患者行 CABG. 中国胸心血管外科临床杂志, 2012, 19(4): 433-434.
15. 张梅, 张运, 李贵双, 等. 经皮冠状动脉内多普勒超声技术对冠状动脉血液动力学的研究. 中国循环杂志, 2000, 15(4): 216-217.
16. 杨柏松, 齐国先, 杨满光, 等. 冠状动脉造影正常的胸痛患者冠状动脉血流储备功能研究. 临床心血管病杂志, 2003, 19(5): 270-272.
17. 王妍军. 罂粟碱和硝酸甘油对乳内动脉血流量和血管内膜影响的对比研究. 首都医科大学, 2006.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The choice of whether or not to stop beating after conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting

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