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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2003 Aprile;44(2):167-72

CARDIAC SECTION 

 CARDIAC SECTION

Off-pump versus on-pump coronary bypass. Comparison of patient characteristics and early outcomes

Järvinen O., Laurikka J., Tarkka M. R.

Depart­ment of Car­di­oth­o­racic Sur­gery Tam­pere Uni­ver­sity Hos­pital, Tam­pere, Fin­land

Aim. ­This clin­ical ­report ­details a com­par­ison ­between the con­ven­tional on-­pump and ­beating ­heart off-­pump tech­niques ­with par­tic­ular atten­tion to ­patient char­ac­ter­is­tics, per­i­op­er­a­tive var­i­ables and ­early out­comes.
­Methods. We col­lected pros­pec­tively a com­pre­hen­sive ­data ­body ­from 1131 con­sec­u­tive ­patients who under­went iso­lated ­CABG in Tam­pere Uni­ver­sity Hos­pital. The mor­bidity, mor­tality and ­length of ­stay ­data ­from the sec­on­dary ­referral hos­pi­tals ­were ­also col­lected. One thou­sand and six­teen (89.8%) ­patients under­went ­bypass ­grafting ­with car­di­o­pul­mo­nary ­bypass (CPB, on-­pump) and 115 (10.2%) ­patients ­without the CPB (off-­pump).
­Results. ­Thirty-day mor­tality ­rates ­were 4.0% (on-­pump) and 2.6% (off-­pump, p=0.5). The ­total post­op­er­a­tive ­length of ­stay was 12 (on-­pump) and 10 (off-­pump) ­days as the ­medians (p<0.001). ­Adverse out­come ­events ­among the on-­pump and off-­pump ­patients ­were as fol­lows: post­op­er­a­tive ­stroke, 2.5% and 0.9% (p=0.3); per­i­op­er­a­tive myo­car­dial infarc­tion, 7.0% and 7.8% (p=0.7); ­impaired ­renal func­tion, 9.5% and 4.3% (p=0.3); re-ster­notomy for ­bleeding or low ­output, 5.3% and 4.3% (p=0.2); new-­onset ­atrial fib­ril­la­tion, 38.9% and 24.6% (p=0.002) and the ­need for red ­cell trans­fu­sions in ICU, 50.3% and 22.6% (p<0.001). ­Eighty-­three percent of the on-­pump and 85.2% of the off-­pump ­patients (p=0.5) had a favor­able out­come ­without a ­major com­pli­ca­tion.
Con­clu­sion. Con­sid­ering the lim­i­ta­tions ­with a non­ran­dom­ized ­study ­design, we con­clude ­that off-­pump ­CABG is a ­safe and com­par­able ­method of myo­car­dial revas­cu­lar­iza­tion in ­terms of ­early out­comes. ­Overall ­length of ­stay ­shorter by 2 ­days, ­over a ­third ­shorter ven­ti­la­tion ­time, ­fewer red ­cell trans­fu­sions and ­lower fre­quency of post­op­er­a­tive ­atrial fib­ril­la­tion ­favor off-­pump sur­gery.

lingua: Inglese


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