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Download fileOff-Pump Coronary Artery Bypass I- and T-Graft Technique With "No-Touch" Aorta
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posted on 2020-12-08, 22:27 authored by Valentin Pavlov, Vladimir Plechev, Alexey Pavlov, Vladimir Ishmetov, Albert Tekeev, Timur YagudinOff-pump coronary artery bypass grafting (OPCAB) has some high ground in
reduction of postoperative complications, including systematic
inflammatory response, myocardial injury, renal injury, and cerebral
injury, compared to on-pump coronary artery bypass grafting.
It is important to reduce myocardial oxygen consumption during
anesthesia for OPCAB (1). The anesthesiologists should collaborate with
the cardiac surgeons and plan the best perioperative strategy for rapid
recovery. The anesthesiologists should pay attention to hemodynamic
instability and myocardial ischemia during anastomosis. Fast-track
anesthesia offers many benefits which lead to earlier ambulation,
earlier discharge, and earlier rehabilitation (2). Further fast-track
anesthesia including extubation after OPCAB in the operating room is
needed but can only be performed in selected patients. Detection of
severe atherosclerotic ascending aorta during coronary artery bypass
grafting requires alterations in the standard surgical technique to
reduce the probability of stroke-related atheroembolization (3). OPCAB
confers the benefits of avoiding aortic cannulation and clamping and may
therefore attenuate this risk. Advances in surgical techniques and
retractor-stabilizer devices allowing access to all coronary segments
have resulted in increased interest in off-pump coronary artery bypass
(4). Atherosclerotic or calcified ascending aorta is an important
predictor of adverse cerebrovascular events. Using OPCAB with composite
and in situ arterial grafting to avoid aortic manipulation and clamping
may reduce the risk of stroke related to aortic atheroembolism (5, 6).
When the aorta is calcified and cannot serve as a safe place for
proximal anastomosis, this anastomosis can be performed using I-graft
and T-graft technique (7, 8). However, residual movement at the site of
the anastomosis and potential hemodynamic disturbances make this
operation technically more difficult. Therefore, the level of skill of
the cardiac surgeon should be on top.
References
- Rocha R V, Yanagawa B, Hussain MA, Tu J V, Fang J, Ouzounian M, et al. Off-pump versus on-pump coronary artery bypass grafting in moderate renal failure. J Thorac Cardiovasc Surg. 2020 April;159(4):1297-1304.e2.
- Cetin
E, Can T, Unal CS, Keskin A, Kubat E. Cardiovascular topics OPCAB
surgery with an alternative retraction method : a single-centre
experience. July 2019;:1–5.
- Cartier R. Current trends and technique in OPCAB surgery. J Card Surg. 2000;(514):32–46.
- Szwed K, Pawliszak W, Szwed M, Tomaszewska M, Anisimowicz L, Borkowska A. Reducing delirium and cognitive dysfunction after off-pump coronary bypass : A randomized trial. J Thorac Cardiovasc Surg. 2019 Oct;1;S0022-5223(19)32091-4.
- Aklog L. Future technology for off-pump coronary artery bypass (OPCAB). Semin Thorac Cardiovasc Surg. 2003 Jan;15(1):92-102.
- Polomsky M, Puskas JD, Mortality I. Off-pump coronary artery bypass grafting. Circ J. 2012;76(4):784-790.
- Arrigoni
SC, Mecozzi G, Grandjean JG, Hillege JL, Kappetein AP, Mariani MA.
Off-pump no-touch technique : 3-year results compared with the SYNTAX
trial. Interact Cardiovasc Thorac Surg. 2015 May;20(5):601-604.
- Raja SG. Two decades of off-pump coronary artery bypass surgery : Harefield experience. J Thorac Dis. 2016 Nov;8(Suppl 10):S824-S828.