| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2001;71:165-169
© 2001 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
b Department of Cardiothoracic and Vascular Anesthesia, University of Vienna Medical School, Vienna, Austria
Accepted for publication July 19, 2000.
Address reprint requests to Dr Grimm, Währinger Gürtel 18-20, A-1090 Vienna, Austria
e-mail: michael.grimm{at}akh-wien.ac.at
 |
Abstract |
|---|
 Top Abstract IntroductionPatients and methodsResultsCommentReferences |
|---|
Methods. Eighty selected low-risk patients were enrolled. In preoperative study with coronary angiography, the decision was made whether complete revascularization without CPB could be performed. Patients were randomly assigned to receive CABG either with (n = 40) or without CPB (n = 40). Randomization criteria were age, sex, and left ventricular ejection fraction. Completeness of revascularization as well as short- and mid-term clinical outcome in a 13.4 ± 6.5 month follow-up period were monitored.
Results. Twenty-six of 40 (65%) patients undergoing CABG without CPB underwent complete revascularization. In 5 of these patients (12.5%) suitable vessels were discarded for technical reasons and 9 patients (22.5%) were switched to CABG with CPB owing to the deeply intramyocardial course of target vessels (n = 5) or to hemodynamic instability (n = 4). In the group of patients operated on with CPB, 34 of 40 patients (85%) received complete revascularization. In 6 patients (15%) suitable vessels were discarded for technical reasons. Mean number of bypass grafts was 3.1 ± 0.8 with CPB and 2.6 ± 0.5 without CPB (p = 0.043). Clinical outcome and hospital stay were comparable in both groups. No patient died during the study period. No myocardial infarction was observed. Three patients undergoing CABG without CPB underwent successful PTCA 3 months after surgery.
Conclusions. CABG without the use of CPB is effective for complete revascularization in the majority of selected low-risk patients. Nevertheless, it has to be stated that the rate of incomplete revascularization in this early series of CABG without CPB is higher, and compromises the basic principle of complete revascularization.
|
Introduction |
|---|
|
TopAbstractIntroductionPatients and methodsResultsCommentReferences |
|---|
CABG with CPB is a routine and safe procedure in selected low-risk patients [5] and complete revascularization with CPB is the surgical standard, improving symptomatic outcome and survival [4]. The beneficial effects of complete revascularization, as defined as grafts to three or more vessels, on event-free survival were shown in the early 1980s and confirmed by others later on [4, 6, 7]. Although complete revascularization on the beating heart provides long-term results comparable with complete revascularization with CPB, a threefold increase of reinterventions has been found after an observation period of 7 years as compared with CABG with CPB [8].
The aim of this study was to evaluate the feasibility of CABG without CPB to achieve complete revascularization as compared with the standard operation with CPB in selected low-risk patients. We studied a series of 80 patients with multivessel coronary artery disease and normal left ventricular ejection fraction undergoing CABG either with or without CPB.
|
Patients and methods |
|---|
|
TopAbstractIntroductionPatients and methodsResultsCommentReferences |
|---|
|
CABG with CPB
In all patients surgical access was gained through a median sternotomy. After harvesting the arterial and venous bypass grafts the patients received heparin (300 U/kg). In patients undergoing CABG with CPB a standard technique was used. We performed normothermic CPB in all patients. Core temperature was assessed by a nasopharyngeal probe.
Myocardial preservation during aortic cross clamping was achieved by 4°C cold intermittent antegrade and retrograde blood cardioplegia. Heparin was antagonized with protaminsulfate. The cardiopulmonary bypass circuit consisted of a hollow-fiber oxygenator (Bard HF 5701; C. R. Bard Inc, Haverhill, PA) primed with Ringer’s lactate solution 2,000 mL, mannitol 20 g, heparin 8,000 IU (Immuno, Vienna, Austria), and aprotinin 1,000,000 IU (Trasylol Bayer, Leverkusen, Germany). Flow during CPB was maintained at 2.5 L · min-1 · m-2. Blood cardioplegia in a 4:1 ratio was used. Hematocrit level was kept higher than 20% with donor blood if necessary. After weaning from CPB, mean arterial pressure was maintained above 60 mm Hg with fluid loading and appropriate vasoactive drugs. Treatment in the intensive care unit (ICU) was defined by institutional standards.
CABG without CPB
A myocardial coronary artery stabilizer system (Cardio Thoracic Systems, Cupertino, CA) was used in all cases. In the majority of cases the LAD was revascularized first. The vessel was stabilized, surrounded distally and proximally to the chosen anastomotic site by two 5-0 polypropylene sutures and was snared. No test of the tolerance for regional ischemia was performed. Afterwards the left internal mammary artery (LIMA)–LAD anastomosis was performed on the beating heart. Thereafter, further distal anastomoses were performed using the same myocardial coronary artery stabilizer system. If venous bypass grafts had been used, proximal anastomoses were performed on the partially clamped ascending aorta. Heparin was antagonized with protaminsulfate.
Completeness of revascularization and parameters of clinical outcome
Revascularization was considered incomplete when a territory was judged surgically nonreconstructable or when a suitable vessel was discarded for technical reasons. In-hospital death, myocardial infarction, and stroke were defined as major adverse outcome. Minor adverse outcome was defined as wound infections and postoperative atrial fibrillation. We also recorded the number of bypass grafts, requirement for blood units, intubation time, in-ICU stay, and in-hospital stay. Mean follow-up was 13.4 ± 6.5 months with regard to major and minor adverse outcome as well as to recurrence of angina. Completion coronary angiography was performed in 9 patients 3 months after surgery.
Statistical analysis
Demographic, medical, angiographic, operative, and postoperative data were collected on all patients. All clinical data are expressed as mean and standard deviation. Data processing and statistical analysis were performed using SAS statistical software (Cary, NC). The nonparametric Mann-Whitney U test was used to calculate differences between the two groups. The 
2 test was used to compare categorical variables. A p value less than 0.05 was considered significant.
|
Results |
|---|
|
TopAbstractIntroductionPatients and methodsResultsCommentReferences |
|---|
|
|
|
|
Follow-up and need for reintervention
The mean follow-up period was 13.4 ± 6.5 months. Death was not observed. Nine patients undergoing CABG without CPB underwent completion coronary angiography 3 months after surgery. All grafts were patent except in 1 patient a vein graft to RCA was occluded. In 2 patients hemodynamically significant anastomotic stenoses were revealed in postoperative completion angiography (LIMA–LAD and vein-marginal circumflex branch). All 3 patients underwent successful percutaneous transluminal coronary angioplasty. No patient in either group experienced early or late recurrence of angina.
|
Comment |
|---|
|
TopAbstractIntroductionPatients and methodsResultsCommentReferences |
|---|
CABG without CPB has gained increasing acceptance for selected patients with single-vessel disease. Introduction of stabilizers made complete revascularization feasible even in multivessel disease [9]. Complete revascularization in multivessel disease without CPB can be performed with low morbidity and mortality and excellent early angiographic results even in high-risk patients [3]. However, so far not all patients seem to be eligible for this procedure. In a certain group of patients with multivessel disease, the intramyocardial course of vessels or hemodynamic instability due to nonuniformal myocardial perfusion during the exposure of the posterior wall will prevent complete revascularization on the beating heart without CPB.
The rate of complete revascularization in patients without CPB in our series is lower and the rate of conversion to CPB is higher when compared with recent reports from other groups [9, 23]. Cartier and coworkers [9] reported a rate of complete revascularization greater than 90% in the group without CPB and a conversion rate to CPB of less than 1%. Bedi and coworkers [23] achieved complete revascularization in all patients undergoing CABG without CPB, with a conversion rate to CPB of 1%.
This series represents our initial experience with off-pump surgery in patients with multivessel disease. In more recent cases the success rate of complete revascularization in patients undergoing CABG without CPB steadily increased and has now reached more than 90%. The procedures at our institution were performed by five different surgeons and not by only one surgeon as in the other mentioned series. Therefore the learning curve of each surgeon may to some extent affect our results. Additionally in the series of Cartier and associates [9], patients with a deeply intramyocardial LAD artery were primarily not considered for the procedure. If we would have excluded this patient group from analysis, our rate of complete revascularization would rise to 78%.
Patients who undergo CABG without CPB are considered to have a smoother early postoperative period and a shorter hospital stay as compared with patients undergoing conventional CABG with CPB [9, 10]. Gundry and coworkers [8] found that multivessel CABG without CPB appears capable of producing similar longevity and symptomatic status even years after surgery as compared with a matched group of patients receiving CABG with CPB. However, twice as many repeat coronary angiographies and three times as many reinterventions predominantly at distal snare sites were required in patients having undergone CABG without CPB [8]. Our 3-month reintervention rate of 10% in patients after CABG without CPB is well in line with reported reintervention rates of other series [8, 9, 23]. Nevertheless, our concept of surrounding the artery distally and proximally to the chosen anastomotic site by two 5-0 polypropylene sutures and snaring has changed, although our completion angiograms did not reveal any late stenoses at distal snare sites. We now surround coronary vessels with smooth silicone elastomer tapes and then snare the artery extremely careful in a stepwise procedure.
It is widely accepted that complete revascularization with the use of CPB remains the surgical gold standard [4, 6, 7]. Interestingly in the Coronary Artery Surgery Study (CASS) registry in patients with CCS class I and II there was no difference in major event-free survival nor in freedom from angina irrespective of the number of vessels bypassed after 5 years [4]. However, patients with complete revascularization were more likely to be free from severe angina than patients with incomplete revascularization, especially patients with CCS class III and IV. From the recent surgical experience, it seems likely that differences in clinical and neurologic outcome—with or without CPB—will only be seen in high-risk patients, eg, the very elderly in whom in-hospital mortality rates after conventional CABG with CPB may be as high as 11.5% and postoperative cognitive brain dysfunction may be as high as 79% [11, 12, 19–21]. Morphologic evidence for cognitive brain dysfunction was provided by Harris and associates [22] who observed significant brain swelling in the first hours after CABG with CPB.
Cardioplegic cardiac arrest is safe and effective for protecting the myocardium during CABG with CPB and the clinical relevance of myocardial injury related to cardioplegic cardiac arrest is acceptably low [13]. Nevertheless, a certain number of patients will suffer from postoperative myocardial injury undergoing CABG with CPB [14]. This ischemic injury may be caused by incomplete distribution of cardioplegia in the heart and by unexpected aortic regurgitation, which results in nonuniform myocardial perfusion [16–18]. For patients undergoing CABG without CPB, recent data suggest that temporary coronary occlusion on the beating heart causes less myocardial injury than cardioplegic cardiac arrest in CABG with CPB [17, 18]. Nevertheless it is known that hemodynamic intolerability during the exposure of the posterior wall is the result of nonuniform myocardial perfusion. Avoidance of ischemia by using an intraluminal shunt or by retrograde coronary sinus perfusion by arterial blood from the ascending aorta may enable complete revascularization to a greater extent than without these techniques [23, 24]. In our early series we did not use any of these techniques. This may contribute to the 10% conversion rate due to hemodynamic intolerability in our series.
Limitations of the study
The primary limitation of our study is that this study was probably done at a too-early stage of performing CABG without CPB for multivessel disease. As is the rest of the surgical community, we are continuously gaining experience in patient selection and intraoperative hemodynamic management—in none of the patients in this series were pericardial stay sutures used for the exposure of the posterior wall, which certainly affected outcome. And finally, data from this study may not be extrapolated to patients with depressed ventricular function, diffuse coronary artery disease, and ventricular hypertrophy.
Despite the several limitations of our early experience with multivessel off-pump grafting, CABG without the use of CPB is effective for achieving complete revascularization in the majority of selected low-risk patients. Nevertheless, it has to be stated that patients undergoing CABG without CPB have a higher rate of incomplete revascularization. Deeply intramyocardial vessel course and hemodynamic intolerability during exposure of the posterior wall were the main limiting factors of this early study [15].
|
References |
|---|
|
TopAbstractIntroductionPatients and methodsResultsCommentReferences |
|---|
This article has been cited by other articles:
|
|
 |
|
  A. Anselmi, G. Possati, and M. Gaudino Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation? Ann. Thorac. Surg., July 1, 2009; 88(1): 326 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Magee, E. Hebert, M. A. Herbert, S. L. Prince, T. M. Dewey, D. V. Culica, and M. J. Mack Fewer Grafts Performed in Off-Pump Bypass Surgery: Patient Selection or Incomplete Revascularization? Ann. Thorac. Surg., April 1, 2009; 87(4): 1113 - 1118. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Angouras eComment: Valid comparisons between off-pump and on-pump coronary artery surgery can only be based on strict study design Interactive CardioVascular and Thoracic Surgery, March 1, 2009; 8(3): 329 - 329. [Full Text] [PDF]
|
|
|
|
|
|
Z.-Z. Feng, J. Shi, X.-W. Zhao, and Z.-F. Xu Meta-analysis of on-pump and off-pump coronary arterial revascularization. Ann. Thorac. Surg., March 1, 2009; 87(3): 757 - 765. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Gao, Z. Liu, B. Li, C. Xiao, Y. Wu, G. Wang, L. Yang, and G. Liu Comparison of graft patency for off-pump and conventional coronary arterial bypass grafting using 64-slice multidetector spiral computed tomography angiography Interactive CardioVascular and Thoracic Surgery, March 1, 2009; 8(3): 325 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Moller, L. Penninga, J. Wetterslev, D. A. Steinbruchel, and C. Gluud Clinical outcomes in randomized trials of off- vs. on-pump coronary artery bypass surgery: systematic review with meta-analyses and trial sequential analyses Eur. Heart J., November 1, 2008; 29(21): 2601 - 2616. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Bednar, P. Osmancik, T. Vanek, H. Mocikova, M. Jares, Z. Straka, and P. Widimsky Platelet activity and aspirin efficacy after off-pump compared with on-pump coronary artery bypass surgery: results from the prospective randomized trial PRAGUE 11-Coronary Artery Bypass and REactivity of Thrombocytes (CABARET). J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 1054 - 1060. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Sistino Using decision-analysis and meta-analysis to predict coronary artery bypass surgical outcomes - a model for comparing off-pump surgery to miniaturized cardiopulmonary bypass circuits Perfusion, September 1, 2008; 23(5): 255 - 260. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Hovakimyan, V. Manukyan, S. Ghazaryan, M. Saghatelyan, L. Abrahamyan, and H. Hovaguimian Predictors of Emergency Conversion to On-Pump During Off-Pump Coronary Surgery Asian Cardiovasc Thorac Ann, June 1, 2008; 16(3): 226 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G Raja and G. D Dreyfus Current Status of Off-pump Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 164 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Dewey and M. J. Mack Myocardial Revascularization without Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2008; 3(2008): 633 - 654. [Full Text]
|
|
|
|
|
|
V. Falk and F. W. Mohr Minimally Invasive Myocardial Revascularization Card. Surg. Adult, January 1, 2008; 3(2008): 697 - 710. [Full Text]
|
|
|
|
|
|
A. Ballotta, H. Z. Saleh, H. W. El Baghdady, M. Gomaa, F. Belloli, H. Kandil, Y. Balbaa, F. Bettini, E. Bossone, L. Menicanti, et al. Comparison of early platelet activation in patients undergoing on-pump versus off-pump coronary artery bypass surgery J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 132 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Fukui, S. Takanashi, Y. Hosoda, and S. Suehiro Early and Midterm Results of Off-Pump Coronary Artery Bypass Grafting Ann. Thorac. Surg., January 1, 2007; 83(1): 115 - 119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Lim, A. Drain, W. Davies, L. Edmonds, and B. R. Rosengard A systematic review of randomized trials comparing revascularization rate and graft patency of off-pump and conventional coronary surgery J. Thorac. Cardiovasc. Surg., December 1, 2006; 132(6): 1409 - 1413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Burgess, M. J. Kilborn, and A. C. Keech Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis Eur. Heart J., December 1, 2006; 27(23): 2846 - 2857. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Sedrakyan, A. W. Wu, A. Parashar, E. B. Bass, and T. Treasure Off-Pump Surgery Is Associated With Reduced Occurrence of Stroke and Other Morbidity as Compared With Traditional Coronary Artery Bypass Grafting: A Meta-Analysis of Systematically Reviewed Trials * Supplemental Appendix I Stroke, November 1, 2006; 37(11): 2759 - 2769. [Full Text] [PDF]
|
|
|
|
 |
|
 P. S. Shekar On-Pump and Off-Pump Coronary Artery Bypass Grafting Circulation, January 31, 2006; 113(4): e51 - e52. [Full Text] [PDF]
|
|
|
|
|
|
A. Chukwuemeka, A. Weisel, M. Maganti, A. F. Nette, D. N. Wijeysundera, W. S. Beattie, and M. A. Borger Renal Dysfunction in High-Risk Patients After On-Pump and Off-Pump Coronary Artery Bypass Surgery: A Propensity Score Analysis Ann. Thorac. Surg., December 1, 2005; 80(6): 2148 - 2153. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. N. Wijeysundera, W. S. Beattie, G. Djaiani, V. Rao, M. A. Borger, K. Karkouti, and R. J. Cusimano Off-Pump Coronary Artery Surgery for Reducing Mortality and Morbidity: Meta-Analysis of Randomized and Observational Studies J. Am. Coll. Cardiol., September 6, 2005; 46(5): 872 - 882. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Fukui, S. Takanashi, Y. Hosoda, and S. Suehiro Total Arterial Myocardial Revascularization Using Composite and Sequential Grafting With the Off-Pump Technique Ann. Thorac. Surg., August 1, 2005; 80(2): 579 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Novitzky Reducing the Risk of Myocardial Revascularization: Relevance of Multimodal Brain Monitoring Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2005; 9(2): 131 - 137. [Abstract] [PDF]
|
|
|
|
 |
|
 A. J. Rastan, H. B. Bittner, J. F. Gummert, T. Walther, C. V. Schewick, E. Girdauskas, and F. W. Mohr On-pump beating heart versus off-pump coronary artery bypass surgery--evidence of pump-induced myocardial injury Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1057 - 1064. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Bainbridge, J. Martin, and D. Cheng Off Pump Coronary Artery Bypass Graft Surgery Versus Conventional Coronary Artery Bypass Graft Surgery: A Systematic Review of the Literature Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 105 - 111. [Abstract] [PDF]
|
|
|
|
|
|
F. Onorati, M. De Feo, P. Mastroroberto, L. Cristodoro, F. Pezzo, A. Renzulli, and M. Cotrufo Determinants and Prognosis of Myocardial Damage After Coronary Artery Bypass Grafting Ann. Thorac. Surg., March 1, 2005; 79(3): 837 - 845. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Pepper Controversies in Off-pump Coronary Artery Surgery Clin. Med. Res., February 1, 2005; 3(1): 27 - 33. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. C. Patel, N. U. Patel, D. F. Loulmet, J. C. McCabe, and V. A. Subramanian Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 655 - 661. [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]
|
|
|
|
|
|
L. Aklog and D. H. Adams Invited commentary Ann. Thorac. Surg., August 1, 2004; 78(2): 684 - 685. [Full Text] [PDF]
|
|
|
|
|
|
G. J.M.G. van der Heijden, H. M. Nathoe, E. W.L. Jansen, and D. E. Grobbee Meta-analysis on the effect of off-pump coronary bypass surgery Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 81 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Puskas, W. H. Williams, E. M. Mahoney, P. R. Huber, P. C. Block, P. G. Duke, J. R. Staples, K. E. Glas, J. J. Marshall, M. E. Leimbach, et al. Off-Pump vs Conventional Coronary Artery Bypass Grafting: Early and 1-Year Graft Patency, Cost, and Quality-of-Life Outcomes: A Randomized Trial JAMA, April 21, 2004; 291(15): 1841 - 1849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. D. Peterson and D. B. Mark Off-Pump Bypass Surgery--Ready for the Big Dance? JAMA, April 21, 2004; 291(15): 1897 - 1899. [Full Text] [PDF]
|
|
|
|
|
|
L. R. Gerola, E. Buffolo, W. Jasbik, B. Botelho, J. Bosco, L. A. Brasil, and J. N. R. Branco Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial Ann. Thorac. Surg., February 1, 2004; 77(2): 569 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Pocar and F. Donatelli Abdominal tumors with cavoatrial extension J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 301 - 302. [Full Text] [PDF]
|
|
|
|
|
|
A. Boening, C. Friedrich, J. Hedderich, J. Schoettler, S. Fraund, and J. T. Cremer Early and medium-term results after on-pump and off-pump coronary artery surgery: a propensity score analysis Ann. Thorac. Surg., December 1, 2003; 76(6): 2000 - 2006. [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]
|
|
|
|
 |
|
 R A Archbold and N P Curzen Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation Heart, October 1, 2003; 89(10): 1134 - 1137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Parolari, F. Alamanni, A. Cannata, M. Naliato, L. Bonati, P. Rubini, F. Veglia, E. Tremoli, and P. Biglioli Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials Ann. Thorac. Surg., July 1, 2003; 76(1): 37 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Puskas, W. H. Williams, P. G. Duke, J. R. Staples, K. E. Glas, J. J. Marshall, M. Leimbach, P. Huber, S. Garas, B. H. Sammons, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: A prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 797 - 808. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Athanasiou, S. Al-Ruzzeh, R. D. Stanbridge, R. P. Casula, B. E. Glenville, and M. Amrani Is the female gender an independent predictor of adverse outcome after off-pump coronary artery bypass grafting? Ann. Thorac. Surg., April 1, 2003; 75(4): 1153 - 1160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Sabik Does Off-Pump Coronary Surgery Reduce Morbidity and Mortality? A Review of the Recent Literature Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 313 - 317. [Abstract] [PDF]
|
|
|
|
|
|
Y. Louagie, J. Jamart, S. Broka, E. Collard, V. Scavee, and M. Gonzalez Off-pump coronary artery bypass grafting: a case-matched comparison of hemodynamic outcome Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 552 - 558. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Sabik, A. M. Gillinov, E. H. Blackstone, C. Vacha, P. L. Houghtaling, J. Navia, N. G. Smedira, P. M. McCarthy, D. M. Cosgrove, and B. W. Lytle Does off-pump coronary surgery reduce morbidity and mortality? J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 698 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N.C. Patel, A.D. Grayson, M. Jackson, J. Au, N. Yonan, R. Hasan, and B.M. Fabri The effect off-pump coronary artery bypass surgery on in-hospital mortality and morbidity Eur. J. Cardiothorac. Surg., August 1, 2002; 22(2): 255 - 260. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. W. Jansen Invited Commentary Asian Cardiovasc Thorac Ann, June 1, 2002; 10(2): 158 - 159. [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 |
