Off pump CABG has been performed for the first time 40 years ago.Although conventional CABG is considered both safe and effective, the use of CBP is associated with several adverse effects.Improved survival and freedom from adverse cardiac events after CABG for patients with CAD have already been established.

Perioperative myocardial infarction is the most important postoperative complications after coronary bypass grafting. Biochemical markers (CK, CK-MB and troponin) are used for assessment of myocardial injury postoperatively.

PMI can be diagnosed if there is ECG changes (new Q wave) or CK-MB elevation with CK/CK-MB ratio more than 0.1

• To determine the incidence of PMI of both conventional CABG and off-pump surgery.

• To determine the risk factors in these cases and how to reach the most safe and effective surgery.

Type of the study This is a prospective descriptive study

including 60 patients undergoing coronary artery bypass grafting either on-pump or off-pump .

Sixty patients with coronary artery disease subjected to coronary artery bypass grafting either on pump or off pump with the following inclusion and exclusion criteria.

Inclusion criteria:

Patients with coronary artery disease indicated for coronary artery bypass grafting operation for the first time either on-pump or off-pump

Exclusion criteria: Poor left ventricular function. Patients with deep intramyocardial coronaries. Patients require endarterectomy or vein patch. Patients who were planned to be off pump but

it was changed to on pump intraoperatively. Redo coronary artery bypass graft. Emergency cases. Patients with other concomitant valve surgery

Group A30 patients underwent

coronary artery bypass grafting on beating heart.

Group B30 patients underwent

coronary artery bypass grafting using CPB

Preoperative assessment Clinical assessment ECG Echocardiography Coronary angiography Carotid duplex for all patients over 60 Complete blood picture, liver function,

kidney function tests.

Operative assessment Number, types of grafts and targets. The ratio between the numbers of the

performed grafts over the number of the intended grafts, incomplete revascularization.

The use of inotropic drugs, intra aortic balloon.

Number of blood unit transfused. Duration of the operation

Postoperative assessment Every patient was subjected to: Clinical assessment for post operative

morbidity. Mechanical ventilation with the assessment of

the time of ventilation The use of inotropic drugs or intra-aortic

balloon. Occurrence of arrhythmias. Amount of postoperative blood drainage

ECG for detection of perioperative myocardial infarction if occurred.

Echocardiogram at the first day postoperative.

Total blood unit transfused. Total ICU stay in hours. Total hospital stay in days

Laboratory assessment:ACT and coagulation profiles on arrival of

the patient.CK-MB at 4h, 12h, 24h, 48h

postoperatively.Cardiac troponin T at 4h, 12h, 24h, 48h

postoperatively. Liver and kidney function tests every 24 h

for 3 days postoperatively.Complete blood picture every 24 h.

Most of the cases were in the age group between 51-60 yrs old.

Mean operation time was longer in group B than A (219.8 ± 26vs.167.4±28.5min; P-value< 0.05).

Number of grafts per patients was significantly higher in group B (2.7±.83) than group A (1.4±.73); P < 0.05.

Single-vessel grafting is significantly higher in the off-pump group, while three-vessel grafting is significantly higher in on-pump group.

On-pump group included more patients with ( OM, RCA and PDA) grafting.

Incomplete revascularization was higher in the off-pump group, but non-significant.

Patients on the On-pump group show a higher incidence(36.7%-46.7%0) respectively for blood and fresh frozen plasma transfusion intra-operatively (significant).

The On-pump group shows a higher incidence of pulmonary and neurological complication, but non-significant.

Non-significant difference was found between the two groups as regard to creatinine level post-operatively.

Non-significant difference was found between the two groups as regard to bilirubin level post-operatively.

More patients in the On-pump group

were re-explored for bleeding.

Superficial and harvest site infection occurred less in the Off-pump group however, non-significant.

The on-pump group showed a higher duration of mechanical ventilation( statistically significant P < 0.05 ), otherwise patients in the off-pump group had less ICU and hospital stay but (non-significant).

Cardiac TnT concentrations were significantly higher in the on pump group than in the off pump group at hours 4, 12, 24, and 48.

The release of CK-MB was significantly higher in the on pump group however, it does not indicate MI.

0

5

10

15

20

25

30

35

40

45

50

CK-MB after 4 hours CK-MB after 12 hours CK-MB after 24 hours CK-MB after 48 hours

CK

-MB

leve

ls

Off pump On pump

Incidence of peri-operative MI

10%

6.7%

Off pump On pump

• There was no statistically significant difference between both groups as regard the occurrence of perioperative MI.

Perioperative effectiveness outcomes were similar for both OPCAB and on-pump with the exception of the number of grafts performed per patient, which was significantly lower during OPCAB

No technique was found to be superior over the other for less incidence of occurrence of perioperative myocardial infarction

Surgeons must consider achieving complete revascularization on the beating heart with only minor alterations in hemodynamics.

OPCAB should be used appropriately in indicated patients to achieve effective and safe revascularization

Thank You

Thank You