title: The Effects of On-Pump and Off-Pump Coronary Artery Bypass Surgery on Metabolic Profiles in the Early Postoperative Period.
abstract: OBJECTIVE
  Hyperlactatemia and base deficit (BD) are markers of adverse outcome after cardiac surgery, and their derangement can be influenced by the use of extracorporeal circulation. The authors hypothesized a better postoperative metabolic profile in off-pump coronary artery bypass grafting (OPCABG) compared with "on-pump" coronary artery bypass grafting (ONCABG).
  
  
  METHODS
  This was a retrospective study, with consecutive data collected for 1 year from electronic medical records.
  
  
  METHODS
  Cardiothoracic intensive care unit at a tertiary university hospital.
  
  
  METHODS
  The study comprised 339 patients who underwent elective coronary artery bypass grafting (ONCABG [n = 215], OPCABG [n = 124]).
  
  
  METHODS
  None.
  
  
  RESULTS
  The metabolic (arterial lactatemia, pH, and BD) and hemodynamic (inotropic/vasopressor support) parameters of OPCABG and ONCABG patients were compared at 7 predefined time points (intensive care admission and the 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). For each output of interest, mixed-effects linear regression models were used (with time as random-effect to allow for clustering of repeated measures) and adjusted for a predetermined set of covariates. Arterial lactatemia and pH were comparable at all time points; BD was worse in the ONCABG group overall (p = 0.01) and at most time points (except at the 1st and 24th postoperative hours). For the whole period, inotropic support was more common in ONCABG patients (p<0.05), whereas vasopressor use was more frequent in the OPCABG group (p< 0.05).
  
  
  CONCLUSIONS
  Improved postoperative BD values were demonstrated in the OPCABG group, although pH and lactatemia were similar between groups. Inotropic support was less common in the OPCABG group at the expense of more frequent vasopressor support.
authors.affiliation: Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy. Electronic address: filipposanfi@yahoo.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Sanfilippo
authors.affiliation: Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Chiarenza
authors.affiliation: Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cassisi
authors.affiliation: Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Santonocito
authors.affiliation: Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Tsoutsouras
authors.affiliation: Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.
authors.forename: Marialena
authors.initials: M
authors.lastname: Trivella
authors.affiliation: Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gerry
authors.affiliation: School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Astuto
authors.affiliation: Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Shane
authors.initials: S
authors.lastname: George
authors.affiliation: Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; Nuffield Department of Surgery, John Radcliffe Hospital-University of Oxford,Oxford, United Kingdom.
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
mesh_terms: D000138:Acidosis / Q000209:etiology; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007773:Lactates / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008659:Metabolic Diseases / Q000209:etiology*; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D002316:Cardiotonic Agents; D007773:Lactates; D014662:Vasoconstrictor Agents
keywords: acidosis; base excess; cardiac surgery; intensive care; lactates