title: Off-pump coronary artery bypass grafting: a case-matched comparison of hemodynamic outcome.
abstract: OBJECTIVE
  The objective of this study was to assess improved myocardial protection by performing coronary artery bypass grafting (CABG) on the beating heart. A case-matched study was conducted among patients who underwent CABG either on-pump (group 1), or off-pump (group 2).
  
  
  METHODS
  Forty-five pairs of patients, having a similar clinical profile, were selected on the basis of five variables: age, gender, body surface area, ejection fraction, extent of coronary disease. Operative risk predicted by the The Society of Thoracic Surgeons national database was 1.80+/-0.35% in group 1, and 1.89+/-0.37% in group 2 (NS). Cold blood cardioplegia and 28 degrees C cardiopulmonary bypass were used in group 1. In group 2, beating heart coronary grafting was achieved with the Octopus 1 and 2 stabilizers. The average number of distal anastomoses was 2.8+/-0.1 in group 1 and 2.3+/-0.1 in group 2 (P=0.015).
  
  
  RESULTS
  There was no significant difference among the groups regarding the trend in cardiac index, left and right ventricular stroke work indexes, and systemic and pulmonary vascular resistance indexes. However, heart rate trend was slower in group 2 (P=0.05). Pharmacological support was required in 65% of the patients in group 1, and in 33% in group 2 (P<0.001). The total amount of Dobutamine and/or Dopamine administered during the first 48 h was 3914+/-1306 gamma/kg in group 1 and 1645+/-697 gamma/kg in group 2 (P=0.049). Release of creatine kinase MB mass isoenzyme (CK-MB mass) was markedly reduced in group 2 (P<10(-4)).
  
  
  CONCLUSIONS
  Hemodynamic outcome following off-pump CABG is similar to on-pump CABG but the need for inotropic support is significantly reduced and CPK-MB mass release is markedly lower.
authors.affiliation: Cardiovascular and Thoracic Surgery, University Clinics of Mont Godinne, Université Catholique de Louvain, Mont Yvoir, Belgium. louagie@chir.ucl.ac.be
authors.forename: Yves
authors.initials: Y
authors.lastname: Louagie
authors.forename: Jacques
authors.initials: J
authors.lastname: Jamart
authors.forename: Serge
authors.initials: S
authors.lastname: Broka
authors.forename: Edith
authors.initials: E
authors.lastname: Collard
authors.forename: Vincent
authors.initials: V
authors.lastname: Scavée
authors.forename: Manuel
authors.initials: M
authors.lastname: Gonzalez
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004280:Dobutamine / Q000627:therapeutic use; D006324:Heart Arrest, Induced; D006339:Heart Rate; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D014655:Vascular Resistance
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D007527:Isoenzymes; D004280:Dobutamine; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form