Comparison of mortality in Off Pump Versus On Pump CABG in patients with significant LMS

Authors

  • Rehan Shahid
  • Haffiz Moazzam Ali Punjab Institute of Cardiology, Lahore
  • Muhammad Ismael University of Health Sciences, Lahore

DOI:

https://doi.org/10.55958/jcvd.v18i3.193

Abstract

INTRODUCTION:  At our institute, we frequently conduct both on pump and off-pump coronary artery bypass surgery (CABG). CABG performed with cardiopulmonary bypass (on-pump surgery) is a treatment that is both safe and successful. In case of on-pump CABG, it is important to note that it is associated with a notable risk of surgical complications. Despite, off-pump CABG has been recommended as a method to reduce surgical complications. So, we designed this study to compare post-operative mortality rates for off-pump versus on-pump coronary artery bypass grafting in patients with severe LMS disease

AIMS & OBJECTIVES: To compare post-operative mortality rates for off-pump versus on-pump coronary artery bypass grafting in patients with severe LMS disease.

MATERIAL & METHODS: This was a cross sectional study in which 200 patients undergoing CABG were enrolled. Nonprobability purposive sampling technique used to select the patients. Patients were divided into two groups 100 patients in each group.

RESULTS: In this study the average age of the cases in Group A was 54.40 ± 8.60 while in Group B 54.20 ± 9.78. There were 68% males and 32% females found in Group A while 63% male and 37% females found in Group B. There were 44% diabetic, 65% hypertensive and 32% smokers found in Group A while 51% diabetic, 61% hypertensive and 28% smokers were found in Group B. The comparison of mortality was found significant (6% vs 1%) with p-value 0.05.

CONCLUSION:  Off pump surgery has been accepted in the management of LMS illness despite reasonable apprehensions and disagreements, as it results in a lower death rate than on pump CABG.

Author Biographies

Haffiz Moazzam Ali, Punjab Institute of Cardiology, Lahore

Associate professor of cardiac surgery

Muhammad Ismael, University of Health Sciences, Lahore

Fellow MS Cardiac Surgery

References

Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ, Choi YH, Wahlers T. Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16 900 patients investigated in randomized controlled trials. European Journal of Cardio-Thoracic Surgery. 2016 Apr 1;49(4):1031-41.

Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA, Almassi GH, Kozora E, Bakaeen F, Cleveland Jr JC, Bishawi M. Five-year outcomes after on-pump and off-pump coronary-artery bypass. New England Journal of Medicine. 2017 Aug 17;377(7):623-32.

Diegeler A, Börgermann J, Kappert U, Hilker M, Doenst T, Böning A, Albert M, Färber G, Holzhey D, Conradi L, Rieß FC. Five-year outcome after off-pump or on-pump coronary artery bypass grafting in elderly patients. Circulation. 2019 Apr 16;139(16):1865-71.

Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z, Piegas LS, Avezum A, Akar AR, Lanas Zanetti F, Jain AR. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. New England journal of medicine. 2016 Dec 15;375(24):2359-68.

Smart NA, Dieberg G, King N. Long-term outcomes of on-versus off-pump coronary artery bypass grafting. Journal of the American College of Cardiology. 2018 Mar 6;71(9):983-91.

Benedetto U, Caputo M, Patel NN, Fiorentino F, Bryan A, Angelini GD. Long-term survival after off-pump versus on-pump coronary artery bypass graft surgery. Does completeness of revascularization play a role?. International Journal of Cardiology. 2017 Nov 1;246:32-6.

Jönsson A, Hammar N, Nordquist T, Ivert T. Left main coronary artery stenosis no longer a risk factor for early and late death after coronary artery bypass surgery—an experience covering three decades. European journal of cardio-thoracic surgery. 2006 Aug 1;30(2):311-7.

Sikder MA, Al-Miraj AK, Ullah MA, Khan MA, Haque MM, Hasan R, Ahammed MS, Zaher MA, Shaha SC. Comparison Of Short Term Outcome Between Two Group Off-Pump And On Pump Coronary Artery Bypass Grafting In Left Main Coronary Artery. British Journal of Medical & Health Sciences (BJMHS). 2021 Jan;3(1).

Mishra M, Shrivastava S, Dhar A, Bapna R, Mishra A, Meharwal ZS, Trehan N. A prospective evaluation of hemodynamic instability during off-pump coronary artery bypass surgery. Journal of cardiothoracic and vascular anesthesia. 2003 Aug 1;17(4):452-8.

Gan HL, Zhang JQ, Xiao W, Zhao S, Huang FJ, Gu CX, Lu CS, Wang PS. Ostial left main coronary artery stenosis as an additional risk factor in off-pump coronary artery bypass grafting. The Journal of thoracic and cardiovascular surgery. 2012 Jan 1;143(1):103-10.

Hlavicka J, Straka Z, Jelinek S, Budera P, Vanek T, Maly M, Widimsky P. Off-pump versus on-pump coronary artery bypass grafting surgery in high-risk patients: PRAGUE-6 trial at 30 days and 1 year. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016 Jun 24;160(2):263-70.

Benedetto U, Puskas J, Kappetein AP, Brown WM, Horkay F, Boonstra PW, Bogáts G, Noiseux N, Dressler O, Angelini GD, Stone GW. Off-pump versus on-pump bypass surgery for left main coronary artery disease. Journal of the American College of Cardiology. 2019 Aug 13;74(6):729-40.

Athanasopoulos LV, Athanasiou T. Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies. Journal of thoracic disease. 2016 Nov;8(Suppl 10):S787.

Murzi M, Caputo M, Aresu G, Duggan S, Miceli A, Glauber M, Angelini GD. On-pump and off-pump coronary artery bypass grafting in patients with left main stem disease: a propensity score analysis. The Journal of Thoracic and Cardiovascular Surgery. 2012 Jun 1;143(6):1382-8.

Lu JC, Grayson AD, Pullan DM. On-pump versus off-pump surgical revascularization for left main stem stenosis: risk adjusted outcomes. The Annals of thoracic surgery. 2005 Jul 1;80(1):136-42.

Published

2025-02-27

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Articles