الفهرس 
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Abstract
Conventional bypass grafting using cardioplegic arrest
continues to be associated with some complications that may negate
an otherwise successful procedure. Interest in off-pump bypass
grafting (OPCABG) in the mid-1990s presented surgeons with the
option of revascularization without the potential complications of
extracorporeal support if CPB can be avoided; a reduction in perioperative
morbidity and mortality is anticipated.
The aim of our study is to compare both techniques regarding
mortality, morbidity, complications and brain injury in both groups
of patients with ischemic heart disease.
Patients and methods: Eighty patients (pts) were subjected to
CABGs, 40 with off pump (group I) and the other 40 pts with on
pump (group II) techniques. Patients in both groups were matching
as regards age, sex, risk factors, and number of bypassed coronaries.
Pre-operatively and postoperatively all patients were subjected to
clinical examination, ECG, chest X-ray, trans echocardiography,
routine laboratory tests and serum S100 B protein as well as Neuron
Serum Enolase (NSE). Brain injury will be evaluated by using
Glasgow Coma Scale and the neuromediators.
Results: Intra-operatively, group I pts had statistically
significant shorter operative time (3.6 ± 0.6 vs. 4.1± 0.7 hours in
group II, p < 0.001), less intra-operative bleeding –of medical causes
- with lower intra-operative use of blood products (55% of pts in
group I vs. 100% of group II) & lower incidence of arrhythmias
(25% vs. 60% of group II). Post-operatively, group I showed
statistically significant shorter stay in intensive care unit (2.8 ± 0.7
vs. 3.8 ± 1.3 days in group II; p < 0.001), earlier extubation (9.4 ± 4
vs 15.5 ± 11.6 hours in group II; p < 0.002), lower pulmonary
complications as regard atelectasis, chest infection (5% vs 22.5% in
group II; p < 0.02), lower cardiac complications as regard atrial
fibrillation , low cardiac output & need for use of inotropic support
(55% vs 82.5% in group II; p < .007), less hypothermic with lower
incidence of postoperative bleeding with less need for use of blood
products & reopening. Group I showed significantly less renal
(22.5% vs 52.5% in group II; p < 0.05) and less hepatic impairment
than in pts of group II (20% vs 55% in group II, p < 0.05). No
statistically difference between both groups as regards cardiac
ischemia, cardiac arrest, ECG changes, trans-thoracic
echocardiographic findings, hematemesis, and sternal wound
infection. Finally, group I showed lower incidence of neurological
deficits (whether reversible or permanent) (5% vs 27.5% in group II;
p<0.006).
Despite the latter, postoperative values of neuromediators
S100B protein & NSE showed a significant increase in both groups
compared to preoperative serum level denoting some brain ischemia
(as regard S100B protein, 60 vs 20 pg/ml preoperatively in group I;
p < 0.05 and 100 vs 35 pg/ml preoperatively in group II; p < 0.05),
(NSE, 22 vs 6 ug/L preoperatively in group I; p < 0.05 and 20 vs 7
ug/L preoperatively in group II; p<0.05). However; there is no
statistically significant difference between both groups regarding the
percent of increase of both mediators postoperatively (1.88% in
group I vs 1.7% in group II; P value: non significant).
Conclusions: 1. In the view of S100B and NSE serum levels
in both groups, no significant difference between both groups
regarding cerebral ischemia 2. Off-pump Coronary artery bypass
grafting is effective with success rate comparable to On-pump
CABG. 3. Off-pump technique is safer in patients with preoperative
bleeding disorders, renal/hepatic impairment, pulmonary disorders,
or high risk for stroke e.g. calcific aortic roots. 4. Off-pump
technique saves expenses due to fewer complications and less
postoperative stay in intensive care unit.
Key word: Postoperative, CABG, on-pump, off-pump