title: Is off-pump coronary artery bypass surgery superior to on-pump coronary artery bypass surgery on postoperative paradoxical ventricular septal motion?
abstract: BACKGROUND
  The aims of this study were to investigate the appearance of paradoxical ventricular septal motion (PSM) after coronary artery bypass graft (CABG) surgery and to identify factors that might be related to this abnormality.
  
  
  METHODS
  This prospective study included 119 consecutive patients (38 women, 81 men) who underwent CABG. Patients who underwent on-pump surgery (22 women, 45 men) and patients who underwent off-pump surgery (16 women, 36 men) were studied separately. All subjects underwent preoperative angiographic septal perfusion evaluation, pre- and postoperative echocardiography, and standard electrocardiographic and laboratory investigations, including troponin I and CK-MB levels. Multivariate logistic regression analysis was also performed for a variety of related parameters.
  
  
  RESULTS
  Significant differences in EuroSCORE, length of intensive care unit stay, length of hospital stay, PSM (assessed using echocardiography), septal perfusion (observed using preoperative angiography), postoperative pleural effusion, and intensive care unit recidivism were observed between the two groups (P < .05). Moreover, postoperative PSM was correlated with septal perfusion (r = -0.687**, P < .001), type of operation (r = -0.194*, P = .035), diabetes mellitus (r = 0.273**, P = .003), carotid stenosis (r = 0.235*, P = .011), the number of distal anastomoses (r = 0.245**, P = .008), pleural effusion (r = 0.193*, P = .037), and intensive care unit recidivism (r = 0.249**, P = .007). However, multivariate analysis demonstrated that only preoperative septal perfusion (odds ratio: 0.037; 95% confidence interval: 0.011-0.128; P < .05) constitutes an independent risk factor for PSM (P < .05).
  
  
  CONCLUSIONS
  This study demonstrated that preoperative septal perfusion deficiency represents an independent risk factor for postoperative PSM in patients undergoing CABG. Further investigations addressing the timing of the appearance of PSM and the correlation of this finding with perfusion imaging studies may provide new details concerning the mechanisms that underlie this abnormality.
authors.affiliation: Department of Cardiovascular Surgery, Baskent University Faculty of Medicine.
authors.forename: Murat
authors.initials: M
authors.lastname: Günday
authors.affiliation: Department of Cardiology, Baskent University, Ankara, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Alpaslan
authors.affiliation: Department of Cardiology, Baskent University, Ankara, Turkey.
authors.forename: Ozgür
authors.initials: O
authors.lastname: Ciftçi
authors.affiliation: Department of Cardiovascular Surgery, Baskent University Faculty of Medicine.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozülkü
authors.affiliation: Department of Cardiology, Baskent University, Ankara, Turkey.
authors.forename: Gülay
authors.initials: G
authors.lastname: Copur
authors.affiliation: Department of Cardiovascular Surgery, Baskent University Faculty of Medicine.
authors.forename: Sait
authors.initials: S
authors.lastname: Aslamacı
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000517:prevention & control*