The choice of whether or not to stop beating after conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHAO Tiefu , WANG Shengyu , ZHANG Chunxiao , ZHANG Ming , ZENG Wen , WANG Jiangang , ZHENG Shuai , CHEN Hong

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding?author：

ZHAO Tiefu, Email: tiefuzhao@163.com

Keywords：

Coronary artery bypass grafting; cardiopulmonary bypass; beat-heart; surgical conversion

DOI：

10.7507/1007-4848.202003138

Video：

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Objective To explore the effect of whether or not to stop beating after conversion to cardiopulmonary bypass (CPB) in off-pump coronary artery bypass grafting.Methods From 2016 to 2018, 177 patients with off-pump coronary artery bypass grafting in Beijing Anzhen Hospital were transferred to CPB. According to whether they stopped beating after conversion to CPB during the operation, they were divided into two groups. A non-stop beating group: there were 76 patients with 45 males, 31 females. aged 63.53±6.98 years, who were not to stop beating after conversion to CPB. A stop beating group: there were 101 patients with 66 males and 35 females, aged 63.98 ± 8.37 years, who were to stop beating and underwent the modified perfusion and application of papaverine in perfusion after conversion to CPB. The clinical effect of the two groups was compared.Results There were 14 deaths in the perioperative period. The mean graft flow (MGF) in the stop beating group was higher (P=0.033), and the pulse index (PI) was lower (P=0.001) than those in the non-stop beating group. Intra-aortic balloon counter pulsation (P=0.036), extracorporeal membrane oxygenation (P=0.038), continuous renal replacement therapy (P=0.014), ventilator-assisted time (P=0.021), ICU monitoring time (P=0.012), perioperative mortality (P=0.025) and the ejcetion fraction value (P=0.023) were significantly different between the groups.Conclusion Compared with not to stop beating, those to stop beating can get better perioperative clinical effect after conversion to CPB, which is worthy of recommendation.

Citation： ZHAO Tiefu, WANG Shengyu, ZHANG Chunxiao, ZHANG Ming, ZENG Wen, WANG Jiangang, ZHENG Shuai, CHEN Hong. The choice of whether or not to stop beating after conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 954-958. doi: 10.7507/1007-4848.202003138 Copy

1.	陳彧, 萬峰, 江龍, 等. 312 例非體外循環 CABG 的危險因素評價. 中華心血管病雜志, 2002, 30(3): 161-164.
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3.	Soltoski P, Salerno T, Levinsky L, et al. Conversion to cardiopulmonary bypass in off-pump coronary bypass grafting: Its effect on outcome. J Card Surg, 1998, 13(9): 328-334.
4.	Shaefi S, Mittel A, Loberman D, et al. Off-pump versus on-pump coronary artery bypass grafting—A systematic review and analysis of clinical outcomes. J Cardiothor Vasc AN, 2019, 33(1): 232-244.
5.	Diegeler A, Borgermann J, Kappert U, et al. OPCAB versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med, 2013, 368(13): 1189-1198.
6.	Sarin EL, Kayatta MO, Kilgo P, et al. Short-and long-term outcomes in octogenarian patients undergoing OPCAB coronary artery bypass grafting compared with on-pump coronary artery bypass grafting. Innovations (Phila), 2011, 6(2): 110-115.
7.	Siegfried MR, Erhardt J, Rider T, et al. Cardioprotection and attenuation of endothelial dysfunction by organic nitric oxide donors in myocardial ischemia reperfusion. J Pharmacol exp Ther, 1991, 260(2): 668-675.
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10.	沈金強, 季強, 丁文軍, 等. 心肺轉流不停跳與非體外循環 CABG 治療射血分數≤35% 的冠心病的早期效果比較. 中華外科雜志, 2018, 56(4): 294-298.
11.	趙鐵夫, 王盛宇, 陳宏, 等. 體外循環下 CABG 中應用罌粟堿灌注的療效分析. 中國胸心血管外科臨床雜志, 2016, 23(12): 1150-1153.
12.	周明陽, 張健群, 毛斌, 等. 非體外循環 CABG 術式改變 156 例分析. 心肺血管疾病雜志, 2016, 5(11): 868-870.
13.	李京倖, 顧承雄, 韋華, 等. 心功能不全冠心病患者非體外循環 CABG 的療效分析. 中國胸心血管外科臨床雜志, 2011, 18(2): 157-159.
14.	房勤, 谷天祥, 劉波, 等. 左心室射血分數低下患者行 CABG. 中國胸心血管外科臨床雜志, 2012, 19(4): 433-434.
15.	張梅, 張運, 李貴雙, 等. 經皮冠狀動脈內多普勒超聲技術對冠狀動脈血液動力學的研究. 中國循環雜志, 2000, 15(4): 216-217.
16.	楊柏松, 齊國先, 楊滿光, 等. 冠狀動脈造影正常的胸痛患者冠狀動脈血流儲備功能研究. 臨床心血管病雜志, 2003, 19(5): 270-272.
17.	王妍軍. 罌粟堿和硝酸甘油對乳內動脈血流量和血管內膜影響的對比研究. 首都醫科大學, 2006.

1. 陳彧, 萬峰, 江龍, 等. 312 例非體外循環 CABG 的危險因素評價. 中華心血管病雜志, 2002, 30(3): 161-164.
2. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—Summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol, 2002, 40(7): 1366-1374.
3. Soltoski P, Salerno T, Levinsky L, et al. Conversion to cardiopulmonary bypass in off-pump coronary bypass grafting: Its effect on outcome. J Card Surg, 1998, 13(9): 328-334.
4. Shaefi S, Mittel A, Loberman D, et al. Off-pump versus on-pump coronary artery bypass grafting—A systematic review and analysis of clinical outcomes. J Cardiothor Vasc AN, 2019, 33(1): 232-244.
5. Diegeler A, Borgermann J, Kappert U, et al. OPCAB versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med, 2013, 368(13): 1189-1198.
6. Sarin EL, Kayatta MO, Kilgo P, et al. Short-and long-term outcomes in octogenarian patients undergoing OPCAB coronary artery bypass grafting compared with on-pump coronary artery bypass grafting. Innovations (Phila), 2011, 6(2): 110-115.
7. Siegfried MR, Erhardt J, Rider T, et al. Cardioprotection and attenuation of endothelial dysfunction by organic nitric oxide donors in myocardial ischemia reperfusion. J Pharmacol exp Ther, 1991, 260(2): 668-675.
8. Toombs CF, McGee S, Johnston WE, et al. Myocardial protective effects of adenosine. Circulation, 1992, 86(4): 986-994.
9. 夏利民, 劉歡, 宋凱, 等. 合并缺血性左心室功能不全的冠心病患者的 OPCAB 治療. 中華胸心血管外科雜志, 2014, 30(2): 96-97.
10. 沈金強, 季強, 丁文軍, 等. 心肺轉流不停跳與非體外循環 CABG 治療射血分數≤35% 的冠心病的早期效果比較. 中華外科雜志, 2018, 56(4): 294-298.
11. 趙鐵夫, 王盛宇, 陳宏, 等. 體外循環下 CABG 中應用罌粟堿灌注的療效分析. 中國胸心血管外科臨床雜志, 2016, 23(12): 1150-1153.
12. 周明陽, 張健群, 毛斌, 等. 非體外循環 CABG 術式改變 156 例分析. 心肺血管疾病雜志, 2016, 5(11): 868-870.
13. 李京倖, 顧承雄, 韋華, 等. 心功能不全冠心病患者非體外循環 CABG 的療效分析. 中國胸心血管外科臨床雜志, 2011, 18(2): 157-159.
14. 房勤, 谷天祥, 劉波, 等. 左心室射血分數低下患者行 CABG. 中國胸心血管外科臨床雜志, 2012, 19(4): 433-434.
15. 張梅, 張運, 李貴雙, 等. 經皮冠狀動脈內多普勒超聲技術對冠狀動脈血液動力學的研究. 中國循環雜志, 2000, 15(4): 216-217.
16. 楊柏松, 齊國先, 楊滿光, 等. 冠狀動脈造影正常的胸痛患者冠狀動脈血流儲備功能研究. 臨床心血管病雜志, 2003, 19(5): 270-272.
17. 王妍軍. 罌粟堿和硝酸甘油對乳內動脈血流量和血管內膜影響的對比研究. 首都醫科大學, 2006.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The choice of whether or not to stop beating after conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting

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