| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2003;23:50-55
© 2003 Elsevier Science NL
The National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Harefield Hospital, Harefield, Middlesex UB9 6JH, UK
Received 4 July 2002; received in revised form 17 September 2002; accepted 1 October 2002.
* Corresponding author. Tel.: +44-1895-828-550; fax: +44-1895-828-992
e-mail: mr.amrani{at}rbh.nthames.nhs.uk
 |
Abstract |
|---|
 Top Abstract 1. Introduction2. Patients and methods3. Results4. DiscussionReferences |
|---|
5. Two hundred and eighty-six patients were operated on using the OPCAB technique while 1112 patients were operated on using the conventional CABG technique with CPB. The OPCAB patients were significantly older than the CPB patients (68.1±8.3 vs. 63.7±9.9 years, respectively, P<0.001). The OPCAB group included significantly more patients with poor left ventricular (LV) function (ejection fraction (EF) 
30%) (P<0.001) and more patients with renal problems (P<0.001). Results: There was no significant difference in the number of grafts between the groups. The CPB patients received 2.8±1.2 grafts per patient while OPCAB patients received 2.8±0.5 grafts per patient (P=1). Twenty-one (7.3%) OPCAB patients had one or more major complications, while 158 (14.2%) CPB patients (P=0.008) developed major complications. Thirty-eight (3.4%) CPB patients developed peri-operative myocardial infarction (MI) while only two (0.7%) OPCAB patients developed peri-operative MI (P=0.024). The intensive therapy unit (ITU) stay for OPCAB patients was 29.3±15.4 h while for CPB patients it was 63.6±167.1 h (P<0.001). There were ten (3.5%) deaths in the OPCAB patients compared to 78 (7%) deaths in the CPB patients (P=0.041) within 30 days postoperatively. Conclusions: This retrospective study shows that using the OPCAB technique for multi-vessel myocardial revascularization in high-risk patients significantly reduces the incidence of peri-operative MI and other major complications, ITU stay and mortality. Even though the OPCAB group included a significantly higher proportion of older patients with poor LV function (EF 30%) and renal problems, the beneficial effect of OPCAB was evident.
Key Words: Off-pump coronary artery bypass surgery • Outcome • High-risk patients
|
1. Introduction |
|---|
|
TopAbstract1. Introduction2. Patients and methods3. Results4. DiscussionReferences |
|---|
The prospective randomized trials up to date, probably due to ethical considerations, have been recruiting relatively young cardiac surgical patients with relatively low surgical risk profiles and consequently showing either little or no substantial difference in the early clinical outcomes between OPCAB and CPB [5–7]. Therefore, observational reports, case-matched studies and retrospective series analyses are still useful to highlight the patient groups who would benefit from the avoidance of CPB [8].
The aim of this retrospective study is to assess the efficacy of the OPCAB technique in multi-vessel myocardial revascularization in a large series of high-risk patients.
|
2. Patients and methods |
|---|
|
TopAbstract1. Introduction2. Patients and methods3. Results4. DiscussionReferences |
|---|
5 on admission to the hospital. Registry databases, medical notes and charts were studied for preoperative and postoperative data of the patients. Two hundred and eighty-six patients were operated on using the OPCAB technique while 1112 patients were operated on using the conventional CABG technique with CPB. The selection of the patients for either surgical technique (whether OPCAB or CPB) was done by the individual surgeons, and was completely based on their experience and preference. No randomization was involved in this cohort of patients.
2.2. Operative technique
2.2.1. Anaesthesia
Anaesthesia was induced using propofol 1–2 mg/kg, pancuronium 0.1 mg/kg and fentanyl 8–15 µg/kg, and was maintained by air/oxygen and propofol 2–3 mg/kg per h. Trans-esophageal echocardiography (TEE) was used for additional monitoring as required. For cases performed by the OPCAB technique, normo-thermia was maintained by using warm intravenous fluids, a heating mattress and a humidified airway, in addition to maintaining a warm operating theatre. A standby perfusionest with primed bypass circuit was available for all OPCAB cases.
2.2.2. Approach and exposure
A standard midline sternotomy incision is used to expose the heart. The pericardium is opened using an inverted T-shaped incision following the harvest of the internal thoracic arteries (ITAs). Opening the right pleural space creates a space for the rotated and vertically placed heart to minimize haemodynamic compromise when performing the operation off-pump. This is followed by an evaluation of the status of coronary arteries and the required lengths of the conduits.
2.2.3. The CPB technique
Anticoagulation was achieved using 250 units/kg of heparin. The activated clotting time was maintained above 480 s. Heparin was reversed by protamine at the end of the procedure. CPB was instituted with a single right atrial cannula and an ascending aorta perfusion cannula. Standard bypass management included membrane oxygenators, arterial line filters, non-pulsatile flow of 2.4 l/min per m2, and a mean arterial blood pressure greater than 50 mmHg. Myocardial protection was achieved with intermittent cold blood cardioplegia (4:1 blood to crystalloid ratio).
2.2.4. The OPCAB technique
Anticoagulation was achieved using 150 units/kg of heparin. The activated clotting time was maintained above 250 s. The heart is stabilized using a suction/irrigation tissue stabilization system (Octopus® 3 Medtronic Inc., Minneapolis, MN). One deep pericardial retraction suture is placed at the posterior fibrous pericardium very close and medial to the most proximal part of the inferior vena cava (IVC). It acts as a lever that helps the surgeon manipulate and rotate the heart to vertical and lateral positions along with the Octopus®. Coronary shunts are not routinely used, unless grafting large or non-collateralized coronary arteries.
2.3. Statistical analysis
Numerical variables are presented as the mean±standard deviation for both patient groups and compared using Student's t-test or the Mann–Whitney test where appropriate. Patient characteristics and postoperative complications are compared using the Fisher exact test or the 
2 test where appropriate. Small values of P (<0.05) indicate a significant difference.
|
3. Results |
|---|
|
TopAbstract1. Introduction2. Patients and methods3. Results4. DiscussionReferences |
|---|
30%) (P<0.001) and less patients with good LV function (P=0.009). The OPCAB group also included more patients with renal problems (P<0.001).
|
200 µmol/l) and acute or chronic renal failure. Cerebrovascular disease included transient ischaemic attacks (TIA) and cerebrovascular accidents (CVA). Peripheral arterial disease included acute or chronic ischaemia of the upper or lower limbs. Respiratory problems included asthma and chronic obstructive airway disease (COAD) requiring active treatment at the time of the operation.
3.2. Operative characteristics
There was no significant difference in the number of grafts between the groups. The CPB patients received 2.8±1.2 grafts per patient while OPCAB patients received 2.8±0.5 grafts per patient (P=1). The distribution of distal anastomoses to the various vascular territories of the heart was not significantly different between the two groups and is presented in Table 2. For the CPB patients, the cumulative bypass time was 71.7±38.9 min and the cumulative aortic cross-clamp time was 32.4±25.6 min.
|
We defined the term ‘major complications’ to include peri-operative MI, pulmonary oedema or adult respiratory distress syndrome (ARDS), septicaemia, CVA (permanent stroke), and renal dysfunction requiring haemofiltration or haemodialysis. Twenty-one (7.3%) OPCAB patients had one or more major complications, while 158 (14.2%) CPB patients (P=0.008) developed major complications. Thirty-eight (3.4%) CPB patients developed peri-operative MI while only two (0.7%) OPCAB patients developed peri-operative MI (P=0.024). Twenty-three (8%) OPCAB patients developed low cardiac output (LCO) in the postoperative period compared to 146 (13.1%) CPB patients (P=0.024). There was no statistically significant difference between the two groups with regard to other complications as evident from the data listed in Table 3.
|
3.4. Postoperative mortality
We defined the ‘30-day mortality’ as death within the 30 days following the operation. There were ten (3.5%) deaths in the OPCAB patients compared to 78 (7%) deaths in the CPB patients (P=0.041) within 30 days postoperatively.
The ten OPCAB deaths included two due to cardiac causes, four due to septicaemia, three due to multi-organ failure (MOF) and one due to respiratory failure. The 78 CPB deaths included 32 due to cardiac causes, 19 due to MOF, 13 due to septicaemia, six due to CVA, two due to respiratory failure and six due to gastrointestinal tract (GIT) causes such as pancreatitis, mesenteric infarction and peptic ulcer bleeding/perforation.
3.5. Poor LV function
The sub-group analysis of patients with poor LV function (EF 30%) presented in Table 4 shows that there were significantly less OPCAB patients requiring ventilation for >24 h. The two sub-groups were not different otherwise in the rest of the postoperative outcomes or 30-day mortality.
|
|
4. Discussion |
|---|
|
TopAbstract1. Introduction2. Patients and methods3. Results4. DiscussionReferences |
|---|
30%) and renal problems, the beneficial and protective effects of OPCAB were evident. The initial application of OPCAB in the early nineties was mainly directed to highly selected and relatively low-risk surgical patients [9]. Since then there has been a growing body of evidence suggesting many potential advantages of the OPCAB technique over the conventional CPB technique in different groups of high-risk patients [10,11]. Therefore, it seems that the referral pattern, and consequently, the cardiac surgical practice has come round full circle and the OPCAB technique has become more commonly used in patients presenting with preoperative risk factors and co-morbidities that make them more susceptible to the hazardous effects of the CPB [12].
We have recently shown that conversion to non-selective application of OPCAB does not increase morbidity nor necessitate a change of practice [13]. Furthermore, encouraged by our previous reports on the favourable outcome of the OPCAB technique in elderly and emergency patients [14,15], we have expanded the use of the OPCAB technique to all high-risk cardiac surgical patients with satisfactory clinical and angiographic results. This is presented in Fig. 1 which shows the gradual increase in the OPCAB practice for high-risk cases in relation to CPB practice over the last 5 years, growing from 3.3% in the last 4 months of 1996 to 41.8% in 2001.
|
Indeed, the data from the present study support this concept as we found that OPCAB significantly reduces peri-operative MI, major morbidity, ITU stay and mortality in this group of high-risk patients. These data conform to those of another retrospective study on a series of consecutive high- and low-risk patients where CPB was found to be an independent risk factor for higher mortality, peri-operative MI and major early complications [22].
The difference in concept between the regional ischaemia caused by OPCAB and the global ischaemia caused by CPB with aortic cross-clamping might explain the myocardial protective effect of the OPCAB technique as evident from the low incidence of MI in this study and other previous studies [22]. Undoubtedly, these findings made OPCAB a safe alternative technique for surgical treatment of patients with recent acute MI [23], and also ruled out some theoretical contraindications on the use of OPCAB in patients with critical left main stem disease [24].
Interestingly, in our study there was no difference in the average number of total grafts between the two groups, which rules out the possibility of incomplete revascularization in the OPCAB patients that was previously suggested by others and allows for better matching and comparison of the two patient groups [3,11,25]. Furthermore, the absence of a difference in the distribution of distal anastomoses to the various vascular territories of the heart reduces the possible bias that could be involved in the selection of the procedure. However, the lack of an objective means of graft function assessment, i.e. flow measurement, is considered as a limitation of this study in comparing the two techniques in terms of the patency of the anastomoses.
Indeed, the study is limited by its retrospective non-randomized nature. It would be ideal to have a prospective randomized study design for high-risk patients, restricted only to surgeons who are adequately experienced in both techniques. However, the currently available randomized studies involve relatively low-risk cardiac patients, and therefore are not very likely to show a substantial difference in the outcome especially considering the relatively small numbers of patients that can be recruited [5–7]. For these reasons, retrospective comparative studies are still of some value in high-risk patients who are likely to benefit most from the OPCAB technique and this consequently shows up in terms of saving economic resources [26,27].
|
References |
|---|
|
TopAbstract1. Introduction2. Patients and methods3. Results4. DiscussionReferences |
|---|
This article has been cited by other articles:
|
|
 |
|
  J. D. Puskas, V. H. Thourani, P. Kilgo, W. Cooper, T. Vassiliades, J. D. Vega, C. Morris, E. Chen, B. J. Schmotzer, R. A. Guyton, et al. Off-pump coronary artery bypass disproportionately benefits high-risk patients. Ann. Thorac. Surg., October 1, 2009; 88(4): 1142 - 1147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Haddad, P. Couture, C. Tousignant, and A. Y. Denault The Right Ventricle in Cardiac Surgery, a Perioperative Perspective: II. Pathophysiology, Clinical Importance, and Management Anesth. Analg., February 1, 2009; 108(2): 422 - 433. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Pande, S. K Agarwal, A. Kundu, N. Kale, A. Chaudhary, and U. Dhir Off-Pump Coronary Artery Bypass in Severe Left Ventricular Dysfunction Asian Cardiovasc Thorac Ann, January 1, 2009; 17(1): 54 - 58. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Barandon, P. Richebe, E. Munos, J. Calderon, M. Lafitte, S. Lafitte, T. Couffinhal, and X. Roques Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 789 - 793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. M. Lattouf, V. H. Thourani, P. D. Kilgo, M. E. Halkos, K. T. Baio, R. Myung, W. A. Cooper, R. A. Guyton, and J. D. Puskas Influence of On-Pump Versus Off-Pump Techniques and Completeness of Revascularization on Long-Term Survival After Coronary Artery Bypass Ann. Thorac. Surg., September 1, 2008; 86(3): 797 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D Prabhu, I. E Thazhkuni, S. Rajendran, R. A Thamaran, K. A Vellachamy, and M. P Vettath Mammary Artery Patch Reconstruction of Left Anterior Descending Coronary Artery Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 313 - 317. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Plass, I. Valenta, O. Gaemperli, P. Kaufmann, H. Alkadhi, G. Zund, J. Grunenfelder, and M. Genoni Assessment of coronary sinus anatomy between normal and insufficient mitral valves by multi-slice computertomography for mitral annuloplasty device implantation Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 583 - 589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Rukosujew, S. Klotz, C. Reitz, W. Gogarten, H. Welp, and H. H. Scheld Patients and complication with off-pump vs. on-pump cardiac surgery a single surgeon experience Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 768 - 771. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Y. Etienne, S. Papadatos, D. Glineur, Y. Mairy, E. El Khoury, P. Noirhomme, and G. El Khoury Reduced Mortality in High-Risk Coronary Patients Operated Off Pump With Preoperative Intraaortic Balloon Counterpulsation Ann. Thorac. Surg., August 1, 2007; 84(2): 498 - 502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Ngaage, K. J. Zehr, R. C. Daly, T. M. Sundt III, C. J. Mullany, J. A. Dearani, T. A. Orszulak, and H. V. Schaff Off-Pump Strategy in High-Risk Coronary Artery Bypass Reoperations Mayo Clin. Proc., May 1, 2007; 82(5): 567 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mizutani, A. Matsuura, K. Miyahara, T. Eda, A. Kawamura, T. Yoshioka, and K. Yoshida On-Pump Beating-Heart Coronary Artery Bypass: A Propensity Matched Analysis Ann. Thorac. Surg., April 1, 2007; 83(4): 1368 - 1373. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Natarajan, S. Samadian, and S. Clark Coronary artery bypass surgery in elderly people Postgrad. Med. J., March 1, 2007; 83(977): 154 - 158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y.-Y. Nan, J.-P. Chang, M.-S. Lu, and C.-L. Kao Mediastinal hematoma and left main dissection following blunt chest trauma Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 320 - 321. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Mishra, R. Malhotra, A. Karlekar, Y. Mishra, and N. Trehan Propensity Case-Matched Analysis of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Patients With Atheromatous Aorta Ann. Thorac. Surg., August 1, 2006; 82(2): 608 - 614. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Rastan, J. I. Eckenstein, B. Hentschel, A. K. Funkat, J. F. Gummert, N. Doll, T. Walther, V. Falk, and F. W. Mohr Emergency Coronary Artery Bypass Graft Surgery for Acute Coronary Syndrome: Beating Heart Versus Conventional Cardioplegic Cardiac Arrest Strategies Circulation, July 4, 2006; 114(1_suppl): I-477 - I-485. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Korach, C. T. Hunter, H. L. Lazar, R. J. Shemin, and O. M. Shapira OPCAB for acute LAD dissection due to blunt chest trauma. Ann. Thorac. Surg., July 1, 2006; 82(1): 312 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. O. Jensen, P. Hughes, L. S. Rasmussen, P. U. Pedersen, and D. A. Steinbruchel Cognitive Outcomes in Elderly High-Risk Patients After Off-Pump Versus Conventional Coronary Artery Bypass Grafting: A Randomized Trial Circulation, June 20, 2006; 113(24): 2790 - 2795. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Al-Ruzzeh, S. George, M. Bustami, J. Wray, C. Ilsley, T. Athanasiou, and M. Amrani Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial BMJ, June 10, 2006; 332(7554): 1365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. A. Vohra, R. Kanwar, T. Khan, and W. R. Dimitri Early and late outcome after off-pump coronary artery bypass graft surgery with coronary endarterectomy: a single-center 10-year experience. Ann. Thorac. Surg., May 1, 2006; 81(5): 1691 - 1696. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E Sharoni, H K Song, R J Peterson, R A Guyton, and J D Puskas Off pump coronary artery bypass surgery for significant left ventricular dysfunction: safety, feasibility, and trends in methodology over time--an early experience Heart, April 1, 2006; 92(4): 499 - 502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Buffolo, J. N. R. Branco, L. R. Gerola, L. F. Aguiar, C. A. Teles, J. H. Palma, and R. Catani Off-Pump Myocardial Revascularization: Critical Analysis of 23 Years' Experience in 3,866 Patients Ann. Thorac. Surg., January 1, 2006; 81(1): 85 - 89. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Tomic, S. Russwurm, E. Moller, R.A. Claus, M. Blaess, F. Brunkhorst, M. Bruegel, K. Bode, F. Bloos, J. Wippermann, et al. Transcriptomic and Proteomic Patterns of Systemic Inflammation in On-Pump and Off-Pump Coronary Artery Bypass Grafting Circulation, November 8, 2005; 112(19): 2912 - 2920. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Murphy, C. A. Rogers, M. Caputo, and G. D. Angelini Acquiring Proficiency in Off-Pump Surgery: Traversing the Learning Curve, Reproducibility, and Quality Control Ann. Thorac. Surg., November 1, 2005; 80(5): 1965 - 1970. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Ohata, M. Kaneko, T. Kuratani, H. Ueda, and K. Shimamura Using the EuroSCORE to Assess Changes in the Risk Profiles of the Patients Undergoing Coronary Artery Bypass Grafting Before and After the Introduction of Less Invasive Coronary Surgery Ann. Thorac. Surg., July 1, 2005; 80(1): 131 - 135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C.Y. Lu, A. D. Grayson, and D. M. Pullan On-Pump Versus Off-Pump Surgical Revascularization for Left Main Stem Stenosis: Risk Adjusted Outcomes Ann. Thorac. Surg., July 1, 2005; 80(1): 136 - 142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D.L. Keenan, Y. Abu-Omar, and D. P. Taggart Bypassing the Pump: Changing Practices in Coronary Artery Surgery Chest, July 1, 2005; 128(1): 363 - 369. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Kerendi, J. D. Puskas, J. M. Craver, W. A. Cooper, E. L. Jones, O. M. Lattouf, J. D. Vega, and R. A. Guyton Emergency Coronary Artery Bypass Grafting Can Be Performed Safely Without Cardiopulmonary Bypass in Selected Patients Ann. Thorac. Surg., March 1, 2005; 79(3): 801 - 806. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Staton, W. H. Williams, E. M. Mahoney, J. Hu, H. Chu, P. G. Duke, and J. D. Puskas Pulmonary Outcomes of Off-Pump vs On-Pump Coronary Artery Bypass Surgery in a Randomized Trial Chest, March 1, 2005; 127(3): 892 - 901. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J Murphy, R. Ascione, and G. D Angelini Coronary artery bypass grafting on the beating heart: surgical revascularization for the next decade? Eur. Heart J., December 1, 2004; 25(23): 2077 - 2085. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G Raja, Z. Haider, and H. Zaman Off-Pump Coronary Artery Bypass Surgery: Analysis of 5-Year Experience Asian Cardiovasc Thorac Ann, December 1, 2004; 12(4): 306 - 311. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Athanasiou, O. Aziz, O. Mangoush, S. Al-Ruzzeh, S. Nair, V. Malinovski, R. Casula, and B. Glenville Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited Eur. J. Cardiothorac. Surg., October 1, 2004; 26(4): 701 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G Raja and G. D Dreyfus Will off-pump coronary artery surgery replace conventional coronary artery surgery? J R Soc Med, June 1, 2004; 97(6): 275 - 278. [Full Text] [PDF]
|
|
|
|
|
|
H. K. Shinn, Y. J. Oh, S. H. Kim, J. H. Lee, C. S. Lee, and Y. L. Kwak Evaluation of serial haemodynamic changes during coronary artery anastomoses in patients undergoing off-pump coronary artery bypass graft surgery: initial experiences using two deep pericardial stay sutures and octopus tissue stabilizer Eur. J. Cardiothorac. Surg., June 1, 2004; 25(6): 978 - 984. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Sergeant, P. Wouters, B. Meyns, C. Bert, J. Van Hemelrijck, C. Bogaerts, G. Sergeant, and K. Slabbaert OPCAB versus early mortality and morbidity: an issue between clinical relevance and statistical significance Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 779 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Athanasiou, O. Aziz, O. Mangoush, A. Weerasinghe, S. Al-Ruzzeh, S. Purkayastha, J. Pepper, M. Amrani, B. Glenville, and R. Casula Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting? Ann. Thorac. Surg., May 1, 2004; 77(5): 1567 - 1574. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Verma, P. W.M. Fedak, R. D. Weisel, P. E. Szmitko, M. V. Badiwala, D. Bonneau, D. Latter, L. Errett, and Y. LeClerc Off-Pump Coronary Artery Bypass Surgery: Fundamentals for the Clinical Cardiologist Circulation, March 16, 2004; 109(10): 1206 - 1211. [Full Text] [PDF]
|
|
|
|
|
|
T. Athanasiou, S. Al-Ruzzeh, P. Kumar, M.-C. Crossman, M. Amrani, J. R. Pepper, R. Del Stanbridge, R. Casula, and B. Glenville Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients Ann. Thorac. Surg., February 1, 2004; 77(2): 745 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Sharony, E. A. Grossi, P. C. Saunders, A. C. Galloway, R. Applebaum, G. H. Ribakove, A. T. Culliford, M. Kanchuger, I. Kronzon, and S. B. Colvin Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 406 - 413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Y. Oo, A. D. Grayson, N. C. Patel, D. M. Pullan, W. C. Dihmis, and B. M. Fabri Is off-pump coronary surgery justified in EuroSCORE high-risk cases? A propensity score analysis Interactive CardioVascular and Thoracic Surgery, December 1, 2003; 2(4): 660 - 664. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. T. Reston, S. J. Tregear, and C. M. Turkelson Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting Ann. Thorac. Surg., November 1, 2003; 76(5): 1510 - 1515. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Ngaage Off-pump coronary artery bypass grafting: the myth, the logic and the science Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 557 - 570. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
