الفهرس 
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Abstract
Coronary artery bypass grafting remains the standard treatment for patients with extensive coronary artery disease. Coronary surgery without use of cardiopulmonary bypass avoids the deleterious systemic inflammatory effects of the extracorporeal circuit. However there is an ongoing debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass (ONCAB versus OPCAB) grafting surgery.
Despite a large body of evidence, there is an ongoing, controversial debate whether coronary artery bypass graft surgery should be performed with or without extracorporeal circulation. This intense debate is held between two schools of thought: the “pure”, off-pump surgeons and the on- pump surgeons. Historically, the shift towards off-pump coronary artery bypass (OPCAB) grafting was proposed both to reduce the operation cost in developing countries but also to avoid the deleterious effects of the contact of blood with the artificial extracorporeal circuit (i.e., mainly the systemic inflammatory response and coagulopathy).
In coronary artery bypass graft surgery (CABG), derangements in hemostasis and an integrated systemic inflammatory responses (SIRs) contribute to bleeding, transfusion requirements, and adverse postoperative complications. The cardiopulmonary bypass (CPB) pump in coronary artery bypass grafting (CABG) has been identified as the culprit of the insult in CABG surgery. Therefore, off-pump CABG has recently gained popularity as an alternative operative technique to conventional CPB to reduce derangements in hemostasis and SIRs.
This prospective cohort, observational analytical study was conducted in post open heart ICU in cardio thoracic academy unit in Ain-Shams University hospitals.
Study period: 9 months October 2017-June 2018.
We enrolled sixty consecutive adult patients scheduled for isolated CABG surgery (with a median sternotomy) with or without cardiopulmonary bypass pump. The patients are allocated in two groups where thirty patients in each group (group A – On pump – ONCAB- conventional surgery) and (group B – Off pump – OPCAB – beating heart) after obtaining their written informed consent.
A standard record of perioperative data was applied at the following categories:
1. Bleeding time, ACT (control, heparinzed and protaminated values).
2. CBC (Hb, HCT and platelet count) and coagulation profile (INR, PT, PTT) intraopratively, one hour postopratively and twenty four hours postopratively.
3. Amount of blood in chest tube drains after twenty four hrs admission to ICU.
4. Type and amount of blood products (Packed RBCs, FFP and platelet concentrate) transfused to both groups.
5. number of patients had reexplorated
The clinical outcome measure was the incidence of bleeding in group B less than group A.
In our study there was highly significant increase in the amount of blood in drains, transfusion requirements and need for re-exploration within twenty four hours after surgery in group A than group B.
We concluded that off pump cardiac surgery is better than on pump procedure in decreasing risk of bleeding, post-operative transfusion requirements and risk of re-exploration.
Lastly, Off-pump CABG is an attractive strategy for treating high-risk patients and next generation of cardiac surgeons must receive structured training to perform off-pump CABG so as to deal with increasing numbers of high-risk patients that are being referred for surgical myocardial revascularization.