Off-pump coronary artery surgery.
Cardiopulmonary bypass has several associated deleterious effects that include a systemic inflammatory response, coagulopathy, central nervous system complications and a variable degree of end-organ damage. The recent upsurge in interest in "beating-heart" surgery attempts to avoid these deleterious effects. Advances in surgical technique, such as the use of intracoronary shunts and the Octopus retractor, have made beating-heart surgery a reality. The challenges for the anaesthetist are greater than for coronary artery surgery using cardiopulmonary bypass, and whilst some advantages are proven, such as the lack of the inflammatory response and the decreased need for blood or blood products, others have yet to be proved and there is a need for further research. The advantages and disadvantages need to be evaluated in randomised studies in order to confirm the safety and efficacy of these new techniques in terms of long-term graft patency and decreased morbidity.
Heames
R M
RM
Department of Anaesthetics, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
Gill
R S
RS
Ohri
S K
SK
Hett
D A
DA
D000768:Anesthesia, General / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome