Atherosclerosis Case Study

Andrew Hsia [e-mail] PICO #1

In patients with atherosclerosis, can off-pump CABG compared to on-pump CABG reduce adverse side effects, improve treatment outcome, and reduce complications?

Patient, Population Problem-
Patients with atherosclerosis

Intervention
Off-pump CABG (coronary by-pass graft)

Comparison:
On-pump CABG

Outcome reduction of side effects.
Reduced complications, improved treatment outcome

EBP

Coronary artery bypass grafting is performed in patients who have atherosclerosis (clogged arteries) in arteries supplying the heart. The surgery usually uses the internal mammary artery to create a detour or bypass around the blocked part of the coronary artery. A part of the saphenous vein is removed and
In contrast, we observed better long term survival in the group of patients undergoing on-pump CABG with the use of cardiopulmonary bypass and cardioplegic arrest. Based on the current evidence, on pump CABG should continue to be the standard surgical treatment. However, off-pump CABG may be acceptable when there is contraindication for cannulation of the aorta and cardiopulmonary bypass."

Similarly, a study by Lamy et al. showed no difference between off-pump vs. on pump CABG in death at 30 days, stroke, MI, or new renal failure. However, off-pump had a significantly lower rate of blood product transfusion. In addition, the off-pump group returned to the operating room less for complications such as bleeding, acute kidney injury, and respiratory complications. The off-pump group did have more repeat revascularizations early on. In this study, the surgeons that were familiar with the off-pump technique were involved. The study did not allow primary surgery
. . Zacher, M. (2015). Off-Pump Versus On-Pump Coronary-Artery Bypass Grafting in Elderly Patients. Survey of Anesthesiology, 59(1), 3. doi:10.1097/sa.0000000000000105

Lamy, A., Devereaux, P., Prabhakaran, D., Taggart, D. P., Hu, S., Paolasso, E., . . . Yusuf, S. (2012). Off-Pump or On-Pump Coronary-Artery Bypass Grafting at 30 Days. Survey of Anesthesiology, 56(6), 267-268. doi:10.1097/sa.0b013e3182751ea3

Møller, C. H., Penninga, L., Wetterslev, J., Steinbrüchel, D. A., & Gluud, C. (2012). Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database of Systematic Reviews Reviews. doi:10.1002/14651858.cd007224.pub2

Pepper, J. (2013). Recent data on off-pump coronary artery bypass grafting: The CORONARY and GOPCABE trials. EuroIntervention, 9(1), 29-32. doi:10.4244/eijv9i1a5

Shroyer. (2009). On-pump versus off-pump coronary-artery bypass surgery. New England Journal of Medicine, 5(361), 19th ser.,