Effect of on-Pump and Off-Pump Coronary Artery Bypass Graft on Length of Icu Stay among Low Ejection Fraction Patients Going through Cardiac Revascularization

Main Article Content

Muhammad Gibran Khan
Ajab Khan
⁠Imran Khan ⁠Khalil
Shahzad Khan
Hussain Shah
Haider Ali Khan

Abstract

Background Coronary artery bypass grafting (CABG) remains a cornerstone in the management of coronary artery disease, especially for patients with severe left ventricular dysfunction. The debate between on-pump and off-pump CABG techniques centers on their impact on postoperative outcomes, particularly the length of ICU stay, which has significant implications for patient recovery and healthcare resources.


Objective This study aimed to compare the effects of on-pump and off-pump coronary artery bypass grafting on the length of ICU stay among patients with severe left ventricular dysfunction undergoing cardiac revascularization, with a view to optimizing postoperative outcomes and resource utilization in this high-risk patient population.


Methods A longitudinal cross-sectional study was conducted, enrolling 78 participants scheduled for CABG at a single center over one year. Participants were divided into two groups: those undergoing on-pump CABG (n=44) and those undergoing off-pump CABG (n=34). Data collection focused on demographic information, clinical characteristics, and the length of ICU stay. Statistical analysis employed SPSS v25, utilizing means, standard deviations, and Independent t-tests to compare outcomes between the two groups.


Results The study revealed that patients undergoing on-pump CABG had a significantly shorter mean ICU stay (4 ± 3.9 days) compared to the off-pump CABG group (5 ± 4.4 days), with a P value of 0.01. Further stratification showed that older patients and those with comorbidities such as diabetes and hypertension experienced longer ICU stays, irrespective of the surgical technique used.


Conclusion On-pump CABG is associated with shorter ICU stays compared to off-pump CABG in patients with severe left ventricular dysfunction, suggesting that the on-pump technique may be preferable for optimizing postoperative recovery and resource allocation in this patient cohort.

Article Details

How to Cite
Khan, M. G., Khan, A., ⁠Khalil, ⁠Imran K., Khan, S., Shah , H., & Khan, H. A. (2024). Effect of on-Pump and Off-Pump Coronary Artery Bypass Graft on Length of Icu Stay among Low Ejection Fraction Patients Going through Cardiac Revascularization. Journal of Health and Rehabilitation Research, 4(1), 1484–1489. https://doi.org/10.61919/jhrr.v4i1.575
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Articles
Author Biographies

Muhammad Gibran Khan, Peshawar General Hospital Hayatabad Pakistan.

Assistant Professor, Peshawar General Hospital Hayatabad, Pakistan.

Ajab Khan, Afridi Medical Complex and Teaching Hospital Pakistan.

Assistant Professor, Afridi Medical Complex and Teaching Hospital, Pakistan.

⁠Imran Khan ⁠Khalil, MMC General Hospital Pakistan.

Consultant Cardiac Surgeon, MMC General Hospital, Pakistan.

Shahzad Khan, Afridi Medical Complex and Teaching Hospital Pakistan.

Registrar, Afridi Medical Complex and Teaching Hospital, Pakistan.

Hussain Shah , Afridi Medical Complex and Teaching Hospital Pakistan.

Registrar, Afridi Medical Complex and Teaching Hospital, Pakistan.

Haider Ali Khan, Afridi Medical Complex Peshawar Pakistan.

Consultant Physiotherapist Physiotherapy Department, Afridi Medical Complex Peshawar, Pakistan.

References

Sheikhy A, Fallahzadeh A, Forouzannia K, Pashang M, Tajdini M, Momtahen S, Mansourian S, Shirzad M, Sadeghian S, Hosseini K. Off-pump versus on-pump coronary artery bypass graft surgery outcomes in patients with severe left ventricle dysfunction: inverse probability weighted study. BMC Cardiovasc Disord. 2022 Dec;22(1):1-8.

Kowalewski M, Pawliszak W, Malvindi PG, Bokszanski MP, Perlinski D, Raffa GM, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: meta-analysis. J Thorac Cardiovasc Surg. 2016 Jan;151(1):60–77.

Deppe A-C, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ, et al. Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16,900 patients investigated in randomized controlled trials. Eur J Cardiothorac Surg. 2016 Apr;49(4):1031–41.

Takagi H, Umemoto T. Worse long-term survival after off-pump than on-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2014 Nov;148(5):1820-9.

Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA, et al. Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. N Engl J Med. 2017 Aug 17;377(7):623-632.

Mahesh B, Choong CK, Goldsmith K, Gerrard C, Nashef SA, Vuylsteke A. Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations. Ann Thorac Surg. 2012 Jul;94(1):109-16.

Bardakci H, Cheema FH, Topkara VK, Dang NC, Martens TP, Mercando ML, et al. Discharge to home rates are significantly lower for octogenarians undergoing coronary artery bypass graft surgery. Ann Thorac Surg. 2007 Feb;83(2):483–9.

Toumpoulis IK, Anagnostopoulos CE, Chamogeorgakis TP, Angouras DC. Impact of early and delayed stroke on in-hospital and long-term mortality after isolated coronary artery bypass grafting. Am J Cardiol. 2008 Aug 15;102(4):411–7.

Gilman S. Cerebral disorders after open heart operations. N Engl J Med. 1965 Mar 4;272(9):489–98.

Gupta M, Mishra PK, Shoeb M, Agarwal A, Prasad J. A comparison of clinical outcomes of LVEF ≤35% versus LVEF>35% in off-pump coronary artery bypass graft surgery. Int Surg J. 2017 Jun;4(6):1908-1912.

Ahmadi SH, Karimi A, Movahedi N, Shirzad M. Is severely left ventricular dysfunction a predictor of early outcomes in patients with coronary artery bypass graft? Heart Asia. 2010;2(1):62-66.

Paparella D, Guida P, Scrascia G, Fanelli V, Contini M. On-pump versus off-pump coronary artery bypass surgery in patients with preoperative anemia.

Wijeysundera DN, Beattie WS, Djaiani G, Rao V, Borger MA, Karkouti K, Cusimano RJ. Off-pump coronary artery surgery for reducing mortality and morbidity: meta-analysis of randomized and observational studies. J Am Coll Cardiol. 2005 Sep;46(5):872–882.

Cheng DC, Bainbridge D, Martin JE, Novick RJ. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology. 2005 Sep;103(3):188–203.

Parolari A, Alamanni F, Polvani G, Agrifoglio M, Kassem S, Veglia F, Tremoli E, Biglioli P. Meta-analysis of randomized trials comparing off-pump with on-pump coronary artery bypass graft patency. Ann Thorac Surg. 2005 Dec;80(6):2121–2125.

Ercan A, Toker ME, Uçar HI, Fırat A, Gürbüz A. A comparison of off-pump and on-pump coronary bypass surgery in patients with low Euroscore. J Cardiothorac Surg. 2014;9:105. doi:10.1186/1749-8090-9-105.

Rustenbach CJ, Reichert S, Radwan M, Doll I, Mustafi M, Nemeth A, Marinos SL, Berger R, Baumbach H, Zdanyte M, Haeberle H. On-vs. Off-Pump CABG in Heart Failure Patients with Reduced Ejection Fraction (HFrEF): A Multicenter Analysis. Biomedicines. 2023 Nov 14;11(11):3043.

Ahsan K, Uddin MJ, Ali MA, Kamruzzaman M, Mahato GN. A Comparative Study of Post-Operative Outcomes for Off-Pump and On-Pump Coronary Artery Bypass Grafting. SAS J Surg. 2023 May;5:402-6.

Abd Raboh AM, Elshihy EM, Fouad AS, Habib MW, Zayed MA. The short outcome of patients undergoing off-pump CABG using remote versus regional ischemic preconditioning.

Mottahedi B, Kahrom M, Mottahedi M, Azimzadeh M, Hoseinikhah H. On-pump Arrest Versus On-pump Beating Coronary Artery Bypass Surgery.

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