Conducting CABG without a heart-lung machine can reduce the incidence of these problems, but at a price: Some studies have reported that within five years after CABG, patients who undergo off-pump surgery
are more likely to die or need another revascularization procedure than patients who have CABG with a heart-lung machine.
Concomitant surgical procedures, off-pump surgery
, presence of the history of antithrombotic agent usage during 2 weeks preoperatively, presence of accompanying acute infection, presence of chronic infection, presence of preoperative advanced liver or pulmonary insufficiency, and preexisting renal failure were considered among the exclusion criteria.
Patients with emergency surgery, urgent referral for operation, patients who underwent redo-coronary artery bypass surgery, off-pump surgery
and CABG with valve surgery were excluded.
decreases postoperative complications and resource utilization in the elderly.
(A) Off-Pump Surgery
. Coronary artery bypass surgery on a beating heart precludes multiple of the previously mentioned risk factors for the development of postoperative neurological complications, that is, aortic cannulation, aortic cross-clamping, and antegrade cardioplegia, as well as the possible cerebral inflammatory response to CPB [27, 28].
For off-pump surgery
, various stabilization devices were used to provide a motionless surgical field.
Vaage, "Increased extracellular brain water after coronary artery bypass grafting is avoided by off-pump surgery
," Journal of Cardiothoracic and Vascular Anesthesia, vol.
However, despite some evidence for their efficacy, off-pump surgery
and multiple arterial grafts have not become widespread (see below).
Notably, mucosal lactate levels were significantly lower during off-pump surgery
when compared with on-pump surgery (51).
In the case of CABG, while off-pump surgery
is feasible, sewing a graft onto a moving blood vessel is technically difficult.
In the 1990s, surgeons began doing off-pump surgery
-- without the machine but with devices that stabilize the beating heart.
has not become the standard of care.