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John D. Puskas - One of the best experts on this subject based on the ideXlab platform.
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Evidence base for off-pump Coronary Artery Bypass grafting
State of the Art Surgical Coronary Revascularization, 2021Co-Authors: Emmanuel Moss, Michael E. Halkos, John D. PuskasAbstract:The relative merits of off-pump versus on-pump Coronary Artery Bypass grafting have been compared for almost three decades. Off-pump Coronary Artery Bypass grafting was pioneered in the 1990s on the premise that avoiding the use of the heart–lung machine could minimize the morbidity associated with Coronary Artery Bypass grafting surgery, particularly in high-risk patient subgroups. More recently, the correlation between extent of aortic manipulation and incidence of perioperative stroke has been cited as another potential benefit of off-pump Coronary Artery Bypass grafting surgery when it is performed with a no-aortic-touch technique. The trade-off for avoiding the heart–lung machine is a more technically demanding operation that, according to some reports, may lead to a less complete revascularization and decreased long-term graft patency.
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Off-pump Coronary Artery Bypass grafting
State of the Art Surgical Coronary Revascularization, 2021Co-Authors: Gianluca Torregrossa, David P. Taggart, John D. PuskasAbstract:Off-pump Coronary Artery Bypass grafting is a highly specialized technique with the potential for reduction of in-hospital morbidity and mortality, particularly in high-risk patient populations. When possible, it should be performed as a clampless or no-aortic-touch technique with multiple or all-arterial conduits. By optimizing longevity of graft patency with arterial conduits and minimizing the risk of perioperative stroke by minimizing aortic manipulation, clampless and no-aortic-touch off-pump Coronary Artery Bypass grafting techniques may be considered the ideal form of surgical Coronary revascularization.
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The Choice of Conduits in Coronary Artery Bypass Surgery.
Journal of the American College of Cardiology, 2015Co-Authors: Mario Gaudino, John D. Puskas, David P. Taggart, Hisayoshi Suma, Filippo Crea, Massimo MassettiAbstract:Coronary Artery Bypass grafting is the most common cardiac surgery operation performed worldwide. It is the most effective revascularization method for several categories of patients affected by Coronary Artery disease. Although Coronary Artery Bypass grafting has been performed for more than 40 years, no detailed guidelines on the choice of Coronary Artery Bypass grafting conduits have been published and the choice of the revascularization strategy remains more a matter of art than of science. Moreover, there is a clear contradiction between the proven benefits of arterial grafting and its very limited use in everyday clinical practice. In the hope of encouraging wider diffusion of arterial revascularization and to provide a guide for clinicians, we discuss current evidence for the use of different conduits in Coronary Artery Bypass surgery and propose an evidence-based algorithm for the choice of the second conduit during Coronary Artery Bypass operations.
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Off-pump versus on-pump Coronary Artery Bypass grafting.
The Surgical clinics of North America, 2009Co-Authors: Michael E. Halkos, John D. PuskasAbstract:Off-pump Coronary Artery Bypass is a safe and effective method of Coronary revascularization that avoids the use of cardiopulmonary Bypass. Randomized trials, typically enrolling low-risk patients, have shown comparable mortality and reduced morbidity between off-pump and on-pump Coronary Artery Bypass. Larger retrospective analyses suggest improved mortality and a lower incidence of adverse events in patients undergoing off-pump Coronary Artery Bypass. This article reviews the available literature comparing outcomes of patients undergoing on- and off-pump Coronary Artery Bypass surgery.
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Teaching Off-Pump Coronary Artery Bypass Surgery
Seminars in thoracic and cardiovascular surgery, 2009Co-Authors: Michael E. Halkos, John D. PuskasAbstract:Off-pump Coronary Artery revascularization requires a unique skill set and a different conduct of operation compared with on-pump Coronary Artery Bypass. Not only must the surgeon perform anastomoses on the beating heart, but he/she must understand the hemodynamic consequences of cardiac positioning and stabilization, the effects of regional ischemia on hemodynamic function, contractility, and arrhythmias, and the importance of anesthesia and grafting sequence given variants of anatomy and clinical conditions. Given these differences, the ability to teach off-pump Coronary Artery Bypass to residents and surgeons places unique demands on the teaching surgeon. In this article, we review the available literature about the safety and efficacy of teaching off-pump Coronary Artery Bypass to residents, discuss the fundamentals for training residents, and review the future of simulation and new training paradigms and the impact this will have on current training methods.
Michael J. Mack - One of the best experts on this subject based on the ideXlab platform.
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Influence of diabetes on mortality and morbidity: off-pump Coronary Artery Bypass grafting versus Coronary Artery Bypass grafting with cardiopulmonary Bypass
The Annals of thoracic surgery, 2001Co-Authors: Mitchell J. Magee, Todd M. Dewey, Tea E. Acuff, James R. Edgerton, James F Hebeler, Syma L. Prince, Michael J. MackAbstract:Abstract Background . Myocardial revascularization in diabetic patients is challenging with no established optimum treatment strategy. We reviewed our Coronary Artery Bypass grafting experience to determine the impact of eliminating cardiopulmonary Bypass on outcomes in diabetic patients relative to nondiabetic patients. Methods . From January 1995 through December 1999, 9,965 patients, of whom 2,891 (29%) had diabetes, underwent isolated Coronary Artery Bypass grafting. Diabetic and nondiabetic patients were further divided into groups on the basis of cardiopulmonary Bypass use. Twelve percent (346 of 2,891) of diabetic patients and 12% (829 of 7,074) of nondiabetic patients underwent Coronary Artery Bypass grafting without cardiopulmonary Bypass; the remainder had Coronary Artery Bypass grafting with cardiopulmonary Bypass. Nineteen preoperative variables were compared among treatment groups by univariate analysis. Results . Patients undergoing Coronary Artery Bypass grafting without cardiopulmonary Bypass compared with those having Coronary Artery Bypass grafting with cardiopulmonary Bypass had higher mean predicted mortalities (diabetic, 3.96% versus 3.72%, p = 0.83; nondiabetic, 3.03% versus 2.86%, p = 0.79). In nondiabetic patients, Coronary Artery Bypass grafting without cardiopulmonary Bypass provides an actual and risk-adjusted survival advantage over Coronary Artery Bypass grafting with cardiopulmonary Bypass (1.81% versus 3.44%, p = 0.0127; risk-adjusted mortality, 1.79% versus 3.61%, p = 0.007). This survival benefit of Coronary Artery Bypass grafting without cardiopulmonary Bypass was not seen in diabetic patients (2.89% versus 3.69%, p = 0.452; risk-adjusted mortality, 2.19% versus 2.98%, p = 0.42). Diabetic patients undergoing Coronary Artery Bypass grafting without cardiopulmonary Bypass had fewer complications, including decreased blood product use (34.39% versus 58.4%, p = 0.001), and reduced incidence of prolonged ventilation (6.94% versus 12.10%, p = 0.005), atrial fibrillation (15.90% versus 23.26%, p = 0.002), and renal failure requiring dialysis (0.87% versus 2.75%, p = 0.036). Conclusions . The survival advantage in nondiabetic patients treated with Coronary Artery Bypass grafting without cardiopulmonary Bypass is not apparent in diabetic patients. Coronary Artery Bypass grafting without cardiopulmonary Bypass in diabetic patients is nevertheless associated with a significant reduction in morbidity.
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A Survey on Minimally Invasive Coronary Artery Bypass Grafting
The Annals of thoracic surgery, 1997Co-Authors: Hani Shennib, Michael J. Mack, Allan G.l. LeeAbstract:Abstract Background. There is increasing interest in performing minimally invasive Coronary Artery Bypass grafting. To evaluate the current level of acceptance and utility of this procedure a survey of 162 cardiothoracic surgeons was conducted. Results. Currently only 16% of surveyed surgeons performed more than 10 minimally invasive Coronary Artery Bypass grafting procedures. Most were less than 55 years old and in private practice. The majority predicted that it will be indicated in less than 25% of Coronary Artery Bypass grafting cases and considered minimally invasive Coronary Artery Bypass grafting a modification of existing techniques rather than investigational. Most believed exposure and stabilization of the Coronary arteries on the beating heart to be the most challenging part and expressed concern with quality of the anastomosis. Conclusions. We conclude that minimally invasive Coronary Artery Bypass grafting is rapidly gaining acceptance in younger surgeons as techniques are improved. Despite concerns with adequacy of anastomosis the procedure is not considered investigational and follow-up is not rigorous.
Michael E. Halkos - One of the best experts on this subject based on the ideXlab platform.
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Evidence base for off-pump Coronary Artery Bypass grafting
State of the Art Surgical Coronary Revascularization, 2021Co-Authors: Emmanuel Moss, Michael E. Halkos, John D. PuskasAbstract:The relative merits of off-pump versus on-pump Coronary Artery Bypass grafting have been compared for almost three decades. Off-pump Coronary Artery Bypass grafting was pioneered in the 1990s on the premise that avoiding the use of the heart–lung machine could minimize the morbidity associated with Coronary Artery Bypass grafting surgery, particularly in high-risk patient subgroups. More recently, the correlation between extent of aortic manipulation and incidence of perioperative stroke has been cited as another potential benefit of off-pump Coronary Artery Bypass grafting surgery when it is performed with a no-aortic-touch technique. The trade-off for avoiding the heart–lung machine is a more technically demanding operation that, according to some reports, may lead to a less complete revascularization and decreased long-term graft patency.
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Off-pump versus on-pump Coronary Artery Bypass grafting.
The Surgical clinics of North America, 2009Co-Authors: Michael E. Halkos, John D. PuskasAbstract:Off-pump Coronary Artery Bypass is a safe and effective method of Coronary revascularization that avoids the use of cardiopulmonary Bypass. Randomized trials, typically enrolling low-risk patients, have shown comparable mortality and reduced morbidity between off-pump and on-pump Coronary Artery Bypass. Larger retrospective analyses suggest improved mortality and a lower incidence of adverse events in patients undergoing off-pump Coronary Artery Bypass. This article reviews the available literature comparing outcomes of patients undergoing on- and off-pump Coronary Artery Bypass surgery.
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Teaching Off-Pump Coronary Artery Bypass Surgery
Seminars in thoracic and cardiovascular surgery, 2009Co-Authors: Michael E. Halkos, John D. PuskasAbstract:Off-pump Coronary Artery revascularization requires a unique skill set and a different conduct of operation compared with on-pump Coronary Artery Bypass. Not only must the surgeon perform anastomoses on the beating heart, but he/she must understand the hemodynamic consequences of cardiac positioning and stabilization, the effects of regional ischemia on hemodynamic function, contractility, and arrhythmias, and the importance of anesthesia and grafting sequence given variants of anatomy and clinical conditions. Given these differences, the ability to teach off-pump Coronary Artery Bypass to residents and surgeons places unique demands on the teaching surgeon. In this article, we review the available literature about the safety and efficacy of teaching off-pump Coronary Artery Bypass to residents, discuss the fundamentals for training residents, and review the future of simulation and new training paradigms and the impact this will have on current training methods.
Ellis L. Jones - One of the best experts on this subject based on the ideXlab platform.
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Multiple reoperative Coronary Artery Bypass grafting
The Annals of thoracic surgery, 1991Co-Authors: Kevin D. Accola, Joseph M. Craver, William S. Weintraub, Robert A. Guyton, Ellis L. JonesAbstract:Abstract Initial reoperative Coronary Artery Bypass grafting is being performed commonly, and an increasing number of patients are being referred for subsequent reoperative Coronary Artery Bypass grafting. From January 1980 through June 1990, 53 patients (52 male, 1 female) underwent a third or fourth Coronary Artery Bypass operation and were retrospectively reviewed. This represented 0.3% ( 53 / 17 ,102) of the Coronary Artery Bypass procedures done during that time period. The mean age was 59 ± 8 years. The number of grafts placed ranged from one to four with an average of 2.6 per patient. Internal mammary Artery grafts were used in 30 patients (57%). The mean left ventricular ejection fraction was 0.52 ± 0.13. Intraaortic balloon pump support was necessary in 10 patients postoperatively. There were no intraoperative deaths, although 4 patients died in the postoperative hospitalization period. Perioperative myocardial infarctions were diagnosed in 6 patients, 13 patients had perioperative dysrhythmias, and 2 patients sustained a stroke. Superficial wound infections occurred in 5 patients. Late follow-up in 49 patients revealed that 2 other patients have since died, and no further myocardial infarctions have been reported in the survivors. Postoperative 3-year survival is 85%, whereas 3-year myocardial infarction-free survival is 70%. Although there is increased risk of operative complications and early death after multiple reoperative Coronary Artery Bypass grafting, both in-hospital and long-term results suggest that it is an appropriate therapeutic strategy.
Gianni D. Angelini - One of the best experts on this subject based on the ideXlab platform.
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Off-pump Coronary Artery Bypass grafting: not a flash in the pan
The Annals of thoracic surgery, 2003Co-Authors: Raimondo Ascione, Massimo Caputo, Gianni D. AngeliniAbstract:During the past decade, technical improvements have made off-pump Coronary Artery Bypass operations a routine procedure. During this time, off-pump Coronary Artery Bypass has been audited against conventional techniques by many observational, case-matched, and prospective randomized studies. There is evidence in the literature suggesting that off-pump Coronary Artery Bypass operations reduce postoperative morbidity, organ dysfunction, and costs, without compromising midterm outcome compared with conventional Coronary operations. The available evidence also supports the view that high-risk patients might benefit the most from revascularization on the beating heart. High quality follow-up data are still needed to assess the impact of off-pump Coronary Artery Bypass operations on long-term clinical outcome.
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Minimally invasive Coronary Artery Bypass grafting.
The Annals of thoracic surgery, 1996Co-Authors: Antonio M. Calafiore, Gianni D. Angelini, Jacob Bergsland, Tomas A. SalernoAbstract:Minimally invasive Coronary Artery Bypass grafting has recently been introduced into cardiac surgery. The procedure promises to become an important addition to the surgical treatment of Coronary Artery disease. This current review gives a historical perspective and an overview of this growing field, based on the experience of three international centers with experience with minimally invasive Coronary Artery Bypass grafting. It is predicted that the field will grow, and that future generation of cardiac surgeons will have to become familiar with this new procedure.