Comparison of pulmonary gas exchange in OPCAB versus conventional CABG.
BACKGROUND
Cardiopulmonary bypass has been implicated as a cause of acute lung injury in cardiac surgical patients. This could be avoided with off-pump coronary artery bypass surgery. Aim. To ascertain the possible benefit of OPCAB surgery on pulmonary gas exchange.


METHODS
We randomized 75 consecutive patients (mean age 57 years) into two groups: Group 1 off-pump coronary artery bypass surgery (OPCAB), n=37, Group 2 conventional coronary artery bypass grafting (con CABG), n=38. Alveolar-arterial oxygen difference (A-aO(2) difference) was calculated pre-operatively, then 2 and 4h post-operatively. PaO(2)/FiO(2) ratio and respiratory index (RI) were calculated 2 and 4h post-operatively.


RESULTS
Alveolar-arterial O(2) gradient sharply increased in the immediate post-operative period, from 27mmHg pre-operatively, to 227mmHg 2h post-operatively, then declined to 152mmHg 4h post-operatively. PaO(2)/FiO(2) ratio and RI also showed severe worsening 2h post-operatively, with marked improvement at 4h. The pattern of physiological deterioration of gas exchange was similar in both the groups.


CONCLUSIONS
In terms of pulmonary gas exchange, similar degree of deterioration is noticed in CABG patients with or without cardiopulmonary bypass. OPCAB seems to provide no physiological benefit of gas exchange at the alveolar capillary membrane when compared to conventional CABG.
Syed
Aitizaz
A
Cardiac Services Department, North West Armed Forces Hospital, P.O. Box 100, Tabuk, Saudi Arabia. aitizaz@hotmail.com
Fawzy
Hosam
H
Farag
Atef
A
Nemlander
Arto
A