Original articlesOff-pump versus on-pump coronary artery bypass surgery and postoperative pulmonary dysfunction
Section snippets
Methods
After approval by the local ethics committee and obtaining written informed consent from each individual, 40 consecutive patients with >2 vessel coronary artery disease were enrolled in the study. Exclusion criteria were emergency surgery, associated significant valvular heart disease requiring surgical repair, previous CABG, poor left ventricular function (ejection fraction <35%), poor preoperative pulmonary function (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] <70%
Results
In all 40 patients, the internal mammary artery was used. One patient in the off-pump group presented persistent hemodynamic instability during the vessel grafting and required urgent conversion to CPB; this patient was analyzed as belonging to the on-pump group. One patient in the on-pump group required ventricular aneurysmectomy and new intra-aortic balloon pump support; this patient died 3 days after surgery in the ICU without extubation and he was excluded from the analysis. Therefore, 20
Discussion
The desire to reduce pulmonary risk and associated morbidity is a major factor that may influence the decision to perform CABG without CPB. However, the findings of the present study do not indicate that avoidance of CPB by using current off-pump techniques significantly reduces the risk for postoperative pulmonary dysfunction after CABG.
Much of the postoperative morbidity after CABG has been attributed to a systemic inflammatory response induced by CPB. CABG procedures performed without CPB
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