Download PDF
Aktuelle Kardiologie 2014; 3(2): 88-92
DOI: 10.1055/s-0034-1368254
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Koronarchirurgie in Off-Pump-Technik. Wer profitiert davon?

Off-Pump Coronary Artery Surgery. Who Benefits?
Ulrich F. W. Franke
Abteilung für Herz- und Gefäßchirurgie, Robert-Bosch-Krankenhaus, Stuttgart
› Author Affiliations
Further Information

Publication History

Publication Date:
15 April 2014 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Diskussion um die beste operative Strategie der koronaren Bypassoperation wird unter den Herzchirurgen sehr intensiv geführt. Vier prospektiv randomisierte Multicenterstudien der letzten 4 Jahre konnten keine wesentlichen Unterschiede zwischen den konkurrierenden OP-Verfahren feststellen. Demgegenüber weisen Metaanalysen und Datenbankauswertungen tendenziell einen Vorteil der Off-Pump-Koronarrevaskularisation hinsichtlich Mortalität, Schlaganfallrate, Nierenversagen und Nachblutung aus. Die erneute Revaskularisation ist nach On-Pump-Eingriffen seltener. Die Vermeidung einer notfallmäßigen Konversion zum HLM-Eingriff scheint für die erfolgreiche OPCAB-Prozedur entscheidend zu sein. Dafür sind Regelmäßigkeit und Erfahrung essenziell.

Abstract

There is an intensive discussion among cardiac surgeons regarding the best operative strategy for coronary surgery. Four prospective randomized multi-center trials did not detect any differences between the concurrent operative procedures. However, meta-analyses and the evaluation of databases detected an advantage of off-pump coronary revascularization regarding mortality and the incidences for stroke, renal failure and bleeding. The need for repeat revascularization was lower after on-pump procedures. The avoidance of emergent conversion to the on-pump procedure seems to be crucially. For that routine and experience are essential.

Schlüsselwörter

koronare Herzerkrankung - On-Pump-Koronarchirurgie - Off-Pump-Koronarchirurgie

Key words

coronary artery disease - on-pump coronary artery surgery - off-pump coronary artery surgery
 

  • Literatur

  • 1 Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), European Association for Percutaneus Cardiovascular Interventions (EAPTCA), Kohl P, Wijns W, Danchin N et al. Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2010; 38: S1-S52
    CrossrefPubMedGoogle Scholar
  • 2 Shroyer AL, Grover FL, Hattler B et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 2009; 361: 1827-1837
    CrossrefPubMedGoogle Scholar
  • 3 Lamy A, Devereaux PJ, Prabhakaran D et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012; 366: 1489-1497
    CrossrefPubMedGoogle Scholar
  • 4 Houlind K, Kjeldsen BJ, Madsen SN et al. On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. Circulation 2012; 125: 2431-2439
    CrossrefPubMedGoogle Scholar
  • 5 Diegeler A, Börgermann J, Kappert U et al. Off-pump versus on-pump coronary-artery grafting in elderly patients. N Engl J Med 2013; 368: 1189-1198
    CrossrefPubMedGoogle Scholar
  • 6 Kuss O, von Salviati B, Börgermann J. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses. J Thorac Cardiovasc Surg 2010; 140: 829-835
    CrossrefPubMedGoogle Scholar
  • 7 Polomsky M, He X, OʼBrien SM et al. Outcomes of off-pump versus on-pump coronary artery bypass grafting. Impact of preoperative risk. J Thorac Cardiovasc Surg 2013; 145: 1193-1198
    CrossrefPubMedGoogle Scholar
  • 8 Fattouch K, Guccione F, Dioguardi P et al. Off-pump versus on-pump myocardial revascularization in patients with ST-segment elevation myocardial infarction: a randomized trial. J Thorac Cardiovasc Surg 2009; 137: 650-657
    CrossrefPubMedGoogle Scholar
  • 9 Renner A, Zittermann A, Aboud A et al. Coronary revascularization in diabetic patients: off-pump versus on-pump surgery. Ann Thorac Surg 2013; 96: 528-534
    CrossrefPubMedGoogle Scholar
  • 10 Chawla L, Zhao Y, Lough FC et al. Off-pump versus on-pump coronary artery bypass grafting outcomes stratified by preoperative renal function. J Am Soc Nephrol 2012; 23: 1389-1397
    CrossrefPubMedGoogle Scholar
  • 11 Usta E, Elkrinawi R, Ursulescu A et al. Clinical outcome and quality of life after reoperative CABG: off-pump versus on-pump - observational pilot study. J Cardiothorac Surg 2013; 8: 66
    CrossrefPubMedGoogle Scholar
  • 12 Konety SH, Rosenthal GE, Vaughan-Sarrazin MS. Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter?. J Thorac Cardiovasc Surg 2009; 137: 1116-1123
    CrossrefPubMedGoogle Scholar
  • 13 Chowdhury R, White D, Kilgo P et al. Risk factors for conversion to cardiopulmonary bypass during off-pump coronary artery bypass surgery. Ann Thorac Surg 2012; 93: 1936-1941
    CrossrefPubMedGoogle Scholar
  • 14 Novitzky D, Baltz JH, Hattler B et al. Outcomes after conversion in the Veterans Affairs randomized on versus off bypass trial. Ann Thorac Surg 2011; 92: 2147-2154
    CrossrefPubMedGoogle Scholar
  • 15 Emmert MY, Seifert B, Wilhelm M et al. Aortic no-touch technique makes the difference in off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2011; 142: 1499-1506
    CrossrefPubMedGoogle Scholar