This document discusses off-pump coronary artery bypass grafting (OPCABG) experiences at IGIMS hospital in Patna. It provides background on coronary artery disease and treatments. OPCABG avoids use of cardiopulmonary bypass and its risks. Hardware like tissue stabilizers and shunts help perform anastomoses off-pump. IGIMS data shows 60 off-pump cases with 2 conversions to on-pump. Advantages of OPCABG include avoiding cardiopulmonary bypass risks while disadvantages can include incomplete revascularization and lesser graft patency. The document also discusses the history and pioneers of CABG and provides an overview of conduits, techniques and adjuncts used in OPCAB

1. OFF PUMP CABG –OUR
EXPERIENCE AT IGIMS
DR.MADHAV KUMAR
ASSISTANT PROFESSOR CTVS
IGIMS,PATNA

2. CORONARY ARTERY DISEASE
Cardiovascular disease
is the leading cause of
death worldwide,
accounting for 31% of
all registered deaths
Most common is the
coronary artery disease
Etiology of coronary
artery disease is
atherosclerosis, a
multifactorial, chronic
inflammatory process.
Obstruction of blood
flow - plaques formed
from fatty deposits in
the walls of blood
vessels and
endothelium.
The degree of
obstruction of the
vessel determines the
treatment needed,
either pharmacological
or surgical.

4. Alexis Carrel: Father of Vascular Anastomosis and Organ
Transplantation
Alexis Carrel was a French surgeon and
biologist, a recipient of the coveted Noble prize
in 1912
Pioneering work on triangulation technique of
vascular anastomosis
Criticized for his views on eugenics-humankind
could achieve perfection through selective
reproduction

5. The Vineberg Legacy
The LITA was used in humans as early
as 1945 by Arthur Vineberg, who,
instead of anastomosing the LITA to
LAD implanted it directly in the
myocardium of the left ventricle.

6. Robert H.Goetz

8. Vasilii I.Kolesov
Vasilii I. Kolesov (1904–
1992) was one of the
pioneers of cardiovascular
surgery.
Kolesov was the first to
successfully apply the
suture technique to
clinical coronary artery
bypass surgery

9. THE FATHER OF CABG: Rene` Favaloro
In 1967 Favaloro
reported the use of
the saphenous vein
graft in direct
coronary surgery.

10. FIRST CABG IN INDIA
Worked at southern railway
Hqrs.hospital from 1975 to 1987
Founder of MMM,Chennai
First Coronary Artery Bypass Graft
(CABG) surgery was carried out by Dr.
K.M. Cherian in 1975 at Chennai.

11. HEART TEAM

14. EMERGENCY CABG
Emergency CABG indication
Left main coronary stenosis
Failed PCI
Anatomy unsuitable for PCI
Ongoing ischemia despite
maximal nonsurgical therapy
Angiographic accident
Cardiogenic shock with
unsuitability for PCI

15. CONDUITS
Commonly used
Internal thoracic artery
Saphenous vein
Radial artery
Right gastroepiploic artery
occasionally ulnar artery (UA), splenic artery, and inferior epigastric artery

16. CONDUITS

17. ITA-The permeability of the ITA is superior to that
of all other conduits used in CABG.
The left ITA, when anastomosed with the LAD, has
a permeability of 97% at 10 years and 90% at 20
years.
RADIAL ARTERY -It has a permeability of 72%–84%
at 10 years
SAPHENOUS VEIN -The permeability of the SV is
50%–60% at 10 years and 20% at 20 years

18. CPB MACHINE
The machine for extracorporeal
circulation, and John Gibbon as its
inventor, radically changed cardiac
surgery and the prognosis of patients
with cardiac diseases

19. ON PUMP CABG
Advantages
Leads to more complete
revascularization
Is a better option in emergency
situations
Most surgeons are familiar with
this form of CABG
Disadvantages
Associated inflammatory
cascade activation due to
CPB
Post-surgical cerebral
microemboli

20. OFF PUMP CABG

21. ADJUNCTS-HARDWARE
Octopus Tissue Stabiliser
• In 1994, Borst et al developed
the Octopus Tissue Stabilizer
• Utilises suction(pressure of 400
mmHg) to immobilise the
epicardium
• Used by Jansen etal in 1995 in
OPCABG

22. ADJUNCTS-HARDWARE
STARFISH HEART POSITIONER
• Starfish™ contributes to the
stability of hemodynamics by
maintaining the right
ventricular function.

23. ADJUNCTS-HARDWARE
INTRACORONARY SHUNTS
• Maintains distal perfusion
• provides a bloodless field during
off-pump coronary
revascularization

24. ADJUNCTS-HARDWARE
MISTER-BLOWER
• clear the surgical site for
improved visibility
• controlled delivery of CO2 gas
and saline solution.

26. ADVANTAGES OF OPCABG
• Avoids the adverse events of CPB
• Used in high risk-profile patients(advanced age, CKD,lower LVEF)
• Decreased surgery duration,ICU stay,hospitalization and less blood
transfusion.
• Lower postoperative pulmonary,neurological,gastrointestinal
complications.

27. DISADVANTAGES
• Incomplete revascularization
• Lesser graft patency
• Conversion to ONPUMP CABG

29. IGIMS DATA
• TOTAL CABG-180
• OFFPUMP CABG-60
• CONVERSION TO ONPUMP FROM OFFPUMP-2

30. CABG PCI
HYBRID
CABG

31. HYBRID CABG
Hybrid coronary
revascularization combines the
benefits of both percutaneous
coronary intervention (PCI) and
coronary artery bypass grafting
(CABG).
Benefits of the LIMA-to-LAD
graft and drug eluting stent
(DES) to non-LAD regions.
Patient receives the long-term
benefit of the LIMA graft and
avoids the morbidity of a full
sternotomy and saphenous vein
grafts.

32. THANK YOU