On-pump beating-heart coronary artery bypass grafting: a literature review

Cover Page

Abstract


Coronary artery bypass grafting techniques have been unchangeable for many years, whereas development and enhancement of myocardial protection methods in coronary bypass grafting for patients with ischemic heart disease are still actual issues of current coronary surgery. Coronary artery bypass grafting techniques include the traditional/conventional technique with cardiopulmonary bypass, aortic cross-clamping and cardioplegia, off-pump and on-pump beating heart coronary artery bypass grafting. Coronary artery bypass grafting with cardiopulmonary bypass and cardioplegia remains the most common method of coronary revascularization. However the cardiac arrest inevitably leads to global cardiac ischemia, and current cardioplegias do not prevent ischemic damage to the myocardium in all cases, especially in high-risk surgical patients. Off-pump coronary artery bypass grafting allows preventing global myocardial ischemia (due to the constant native coronary blood-flow) and avoiding possible negative consequences of cardiopulmonary bypass use. The main limitations of this technique are associated with high risk of hemodynamic instability due to low cardiac output and systolic output caused by target arteries exposition. On-pump beating heart technique is a reasonable compromise between conventional on-pump coronary artery bypass grafting, cardioplegia and off-pump procedure. It is a safe and effective technique with outcomes that are equivalent or superior to the outcomes reported for conventional coronary artery bypass grafting in patients with unstable hemodynamics, low left ventricular ejection fraction and in high-risk patients. The literature review presents the results of on-pump beating heart coronary artery bypass grafting.


D V Borisov

Federal Research Clinical Center for Specialized Types of Medical Care and Medical Technologies of FMBA

Author for correspondence.
Email: dan-cer@inbox.ru
Moscow, Russia

A S Zotov

Federal Research Clinical Center for Specialized Types of Medical Care and Medical Technologies of FMBA

Email: dan-cer@inbox.ru
Moscow, Russia

A V Troitskiy

Federal Research Clinical Center for Specialized Types of Medical Care and Medical Technologies of FMBA

Email: dan-cer@inbox.ru
Moscow, Russia

R I Khabazov

Federal Research Clinical Center for Specialized Types of Medical Care and Medical Technologies of FMBA

Email: dan-cer@inbox.ru
Moscow, Russia

  • Samuels L., Samuels M. Pump-Assisted ­Beating-Heart Coronary Artery Bypass Grafting: The Pursuit of Perfection. J. Clin. Exp. Cardiolog. 2017; 8: 540. doi: 10.4172/2155-9880.1000540.
  • Thanikachalam M., Lombardi P., Tehrani H.Y., et al. The history and development of direct coronary surgery without cardiopulmonary bypass. J. Card. Surg. 2004; 19: 516–519. doi: 10.1111/j.0886-0440.2004.04088.x.
  • Fujii T., Watanabe Y., Shiono N., et al. Assessment of on-pump beating coronary artery bypass surgery performed after introduction of off-pump approach. Ann. Thorac. Cardiovasc. Surg. 2006; 12: 324–332. PMID: 17095974.
  • Shroyer A.L., Hattler B., Wagner T.H., et al. Vete­rans Affairs ROOBY-FS Group. Five-year outcomes after on-pump and off-pump coronary-artery bypass. N. Engl. J. Med. 2017; 377: 623–32. doi: 10.1056/NEJMoa1614341.
  • Aydin A., Erkut B. On-Pump beating heart coronary revascularization: Is it valid for emergency revascularization? Ann. Saudi. Med. 2015; 35: 133–137. doi: 10.5144/0256-4947.2015.133.
  • Afrasiabirad A., Safaie N., Montazergaem H. On-pump beating coronary artery bypass in high risk coronary patients. Iran. J. Med. Sci. 2015; 40: 40–41. PMID: 25650152.
  • Izumi Y., Magishi K., Ishikawa N. On-pump beating heart coronary artery bypass grafting for acute myocardial infarction. Ann. Thorac. Surg. 2006; 81: 573–576. doi: 10.1016/j.athoracsur.2005.08.036.
  • Fattouch K., Guccione F., Dioguardi P., et al. Off-pump versus on-pump myocardial revascularization in patients with ST-segment elevation myocardial infarction: a randomized trial. J. Thorac. Cardiovasc. Surg. 2009; 137: 650–656. doi: 10.1016/j.jtcvs.2008.11.033.
  • Darwazah A.K., Bader V., Isleem I., Helwa K. Myocardial revascularization using on-pump beating heart among patients with left ventricular dysfunction. J. Cardiothorac. Surg. 2010; 5: 109. doi: 10.1186/1749-8090-5-109.
  • Erkut B., Dag O., Kaygin M.A., et al. On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction: early outcomes. Can. J. Surg. 2013; 56: 398–404. doi: 10.1503/cjs.018412.
  • Chernyavskiy A.M., Nesmachnyy A.S., Bobosh­ko A.V., et al. Surgical on-pump beating-heart treatment of ischemic patients with low LF ejection fraction: immediate results. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2015; 19 (1): 51–58. (In Russ.)
  • Xia L., Ji Q., Song K., et al. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. J. Cardiothorac. Surg. 2017; 12: 11. doi: 10.1186/s13019-017-0572-x.
  • Yu L., Gu T., Shi E., et al. On-pump with ­beating heart or cardioplegic arrest for emergency conversion to cardiopulmonary bypass during off-pump coronary artery bypass. Ann. Saudi. Med. 2014; 34: 314–319. doi: 10.5144/0256-4947.2014.314.
  • Alwan K., Falcoz P.E., Alwan J., et al. Beating versus arrested heart coronary revascularization: Evaluation by cardiac troponin I release. Ann. Thorac. Surg. 2004; 77: 2051–2055. doi: 10.1016/j.athoracsur.2003.11.004.
  • Sabban M.A., Jalal A., Bakir B.M., et al. Compa­rison of neurological outcomes in patients undergoing conventional coronary artery bypass grafting, on-pump ­beating heart coronary bypass, and off-pump coronary bypass. Neurosciences. 2007; 12: 35–41.
  • Tsai Y.T., Lin F.Y., Lai C.H., et al. On-pump beating heart coronary artery bypass provides efficacious short- and long-term outcomes in hemodialysis patients. Nephrol. Dial. Transplant. 2012; 27: 2059–2065. doi: 10.1093/ndt/gfr536.
  • Antunes P.E., Ferrao de Oliveira J., Prieto D., et al. Coronary artery bypass surgery without cardioplegia: hospital results in 8515 patients. Eur. J. Cardiothorac. Surg. 2016; 49: 918–925. doi: 10.1093/ejcts/ezv177.
  • Ueki C., Sakaguchi G., Akimoto T., et al. On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis. Eur. J. Cardiothorac. Surg. 2016; 50: 813–821. doi: 10.1093/ejcts/ezw129.
  • Sepehripour A.H., Chaudhry U.A., Suliman A., et al. How revascularization on the beating heart with cardiopulmonary bypass compares to off-pump? A meta-analysis of observational studies. Interact. Cardiovasc. Thorac. Surg. 2016; 22: 63–71. doi: 10.1093/icvts/ivv291.

Views

Abstract - 10

PDF (Russian) - 25

PlumX


© 2018 Borisov D.V., Zotov A.S., Troitskiy A.V., Khabazov R.I.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.


Свидетельство о регистрации СМИ ЭЛ № ФС 77-70434 от 20 июля 2017 года выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор)