Clampless off-pump versus conventional coronary artery revascularization: a propensity score analysis of 788 patients.

Abstract:

BACKGROUND:This study aimed to assess if clampless off-pump coronary artery bypass grafting (CABG) decreases risk-adjusted mortality, stroke rate, and morbidity in unselected patients in comparison to conventional CABG. METHODS AND RESULTS:Between July 2009 and November 2010, data of 1282 consecutive patients undergoing isolated CABG were prospectively recorded. In 30.8% (n=395), clampless off-pump revascularization was used, either with the PAS-Port automated central venous anastomosis system (n=310) or as total arterial revascularization without central anastomoses (n=85). Propensity score (PS) matching was performed based on 15 preoperative risk variables to correct for selection bias. In-hospital mortality and stroke rate as primary end point, as well as major complications and follow-up outcome of clampless off-pump (lessOPCAB) and conventional CABG (cCABG) were compared in 394 matched patient pairs (total: 788 patients). The clampless off-pump technique decreased the in-hospital rate of death (odds ratio, 0.25; 95% confidence interval, 0.05-1.18, P=0.080) and stroke (odds ratio, 0.36; 95% confidence interval, 0.13-0.99, P=0.048) significantly. Complications such as low cardiac output syndrome, prolonged ventilation and rethoracotomy were also reduced by lessOPCAB. Over a 2-year follow-up period overall survival, cerebrovascular and major adverse event rate were significantly lower in the lessOPCAB group, while the repeat revascularization rate was comparable. CONCLUSIONS:In a retrospective PS-matched analysis, clampless off-pump CABG lowers mortality, stroke rate and other morbidity in an unselected group of patients with coronary artery disease.

journal_name

Circulation

journal_title

Circulation

authors

Börgermann J,Hakim K,Renner A,Parsa A,Aboud A,Becker T,Masshoff M,Zittermann A,Gummert JF,Kuss O

doi

10.1161/CIRCULATIONAHA.111.084285

subject

Has Abstract

pub_date

2012-09-11 00:00:00

pages

S176-82

issue

11 Suppl 1

eissn

0009-7322

issn

1524-4539

pii

126/11_suppl_1/S176

journal_volume

126

pub_type

杂志文章
  • Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group.

    abstract::To assess the likelihood of procedural success in patients with multivessel coronary disease undergoing percutaneous coronary angioplasty, 350 consecutive patients (1,100 stenoses) from four clinical sites were evaluated. Eighteen variables characterizing the severity and morphology of each stenosis and 18 patient-rel...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.82.4.1193

    authors: Ellis SG,Vandormael MG,Cowley MJ,DiSciascio G,Deligonul U,Topol EJ,Bulle TM

    更新日期:1990-10-01 00:00:00

  • Exploration of the precision of classifying sudden cardiac death. Implications for the interpretation of clinical trials.

    abstract:BACKGROUND:As cardiovascular clinical trials improve in sophistication and therapies target specific cardiac mechanisms of death, a more objective and precise system to identify specific cause of death is needed. Ideally, sudden cardiac death would describe patients dying of ventricular tachycardia and ventricular fibr...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.93.3.519

    authors: Pratt CM,Greenway PS,Schoenfeld MH,Hibben ML,Reiffel JA

    更新日期:1996-02-01 00:00:00

  • Aminoguanidine prevents the decreased myocardial compliance produced by streptozotocin-induced diabetes mellitus in rats.

    abstract:BACKGROUND:A decreased cardiac compliance is a major feature of the cardiomyopathy of diabetes mellitus. Either an increase in the resistance afterload to the LV or an increase in collagen cross-linking induced by the formation of advanced glycosylation end products (AGEs) of collagen may be responsible for the stiff m...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.93.10.1905

    authors: Norton GR,Candy G,Woodiwiss AJ

    更新日期:1996-05-15 00:00:00

  • Intracoronary beta-irradiation with a liquid (188)re-filled balloon: six-month results from a clinical safety and feasibility study.

    abstract:BACKGROUND:Coronary irradiation is a new concept to reduce restenosis. We evaluated the feasibility and safety of intracoronary irradiation with a balloon catheter filled with (188)Re, a liquid, high-energy beta-emitter. METHODS AND RESULTS:Irradiation with 15 Gy at 0.5-mm tissue depth was performed in 28 lesions afte...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章

    doi:10.1161/01.cir.101.20.2355

    authors: Höher M,Wöhrle J,Wohlfrom M,Hanke H,Voisard R,Osterhues HH,Kochs M,Reske SN,Hombach V,Kotzerke J

    更新日期:2000-05-23 00:00:00

  • Prolonged circulatory arrest in moderate hypothermia with retrograde cerebral perfusion. Is brain ischemic?

    abstract:BACKGROUND:Circulatory arrest (CA), which provides a bloodless field and good visualization without the need of aortic cross-clamp, is commonly used to facilitate repair of aortic lesions. However, extended periods of CA may impair cerebral metabolism and cause ischemic injury. Studies were performed to evaluate the ef...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:

    authors: Lin PJ,Chang CH,Tan PP,Chang CN,Lee ST,Wang CC,Chang JP,Liu DW,Chu JJ,Tsai KT,Kao CL,Hsieh MJ,Hua MS

    更新日期:1996-11-01 00:00:00

  • Evidence Supporting the Existence of a Distinct Obese Phenotype of Heart Failure With Preserved Ejection Fraction.

    abstract:BACKGROUND:Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. Phenotyping patients into pathophysiologically homogeneous groups may enable better targeting of treatment. Obesity is common in HFpEF and has many cardiovascular effects, suggesting that it may be a viable candidate for...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.116.026807

    authors: Obokata M,Reddy YNV,Pislaru SV,Melenovsky V,Borlaug BA

    更新日期:2017-07-04 00:00:00

  • Attenuation of exercise-induced myocardial ischemia in dogs with recruitment of coronary vasodilator reserve by nifedipine.

    abstract::There is now evidence that under resting conditions coronary vasodilator reserve exists even in the presence of myocardial ischemia. Therefore, we tested the hypothesis that a vasodilator reserve may exist during exercise so that during exercise-induced ischemia a reduction in coronary constrictor tone can be produced...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.75.2.482

    authors: Heusch G,Guth BD,Seitelberger R,Ross J Jr

    更新日期:1987-02-01 00:00:00

  • Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study.

    abstract:BACKGROUND:Prior small to modest-sized studies suggest a benefit of intravascular ultrasound (IVUS) guidance in noncomplex lesions. Whether IVUS guidance is associated with improved clinical outcomes after drug-eluting stent (DES) implantation in an unrestricted patient population is unknown. METHODS AND RESULTS:Asses...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1161/CIRCULATIONAHA.113.003942

    authors: Witzenbichler B,Maehara A,Weisz G,Neumann FJ,Rinaldi MJ,Metzger DC,Henry TD,Cox DA,Duffy PL,Brodie BR,Stuckey TD,Mazzaferri EL Jr,Xu K,Parise H,Mehran R,Mintz GS,Stone GW

    更新日期:2014-01-28 00:00:00

  • Incremental value of the preoperative echocardiogram to predict mortality and major morbidity in coronary artery bypass surgery.

    abstract:BACKGROUND:Although echocardiography is commonly performed before coronary artery bypass surgery, there has yet to be a study examining the incremental prognostic value of a complete echocardiogram. METHODS AND RESULTS:Patients undergoing isolated coronary artery bypass surgery at 2 hospitals were divided into derivat...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究

    doi:10.1161/CIRCULATIONAHA.112.127639

    authors: Afilalo J,Flynn AW,Shimony A,Rudski LG,Agnihotri AK,Morin JF,Castrillo C,Shahian DM,Picard MH

    更新日期:2013-01-22 00:00:00

  • Effect of time of day on prehospital care and outcomes after out-of-hospital cardiac arrest.

    abstract:BACKGROUND:More than 300 000 out-of-hospital cardiac arrests (OHCA) occur each year in the United States. The relationship between time of day and OHCA outcomes in the prehospital setting is unknown. Any such association may have important implications for emergency medical services resource allocation. METHODS AND RE...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.113.002058

    authors: Wallace SK,Abella BS,Shofer FS,Leary M,Agarwal AK,Mechem CC,Gaieski DF,Becker LB,Neumar RW,Band RA

    更新日期:2013-04-16 00:00:00

  • Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects.

    abstract::In this study, we tested the hypothesis that the neural control of circulation in humans undergoes continuous but in part predictable changes throughout the day and night. Dynamic 24-hour recordings were obtained in two groups of ambulant subjects. In 18 hospitalized patients free to move, direct high-fidelity arteria...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.81.2.537

    authors: Furlan R,Guzzetti S,Crivellaro W,Dassi S,Tinelli M,Baselli G,Cerutti S,Lombardi F,Pagani M,Malliani A

    更新日期:1990-02-01 00:00:00

  • Discrimination of nonobstructive hypertrophic cardiomyopathy from hypertensive left ventricular hypertrophy on the basis of strain rate imaging by tissue Doppler ultrasonography.

    abstract:BACKGROUND:The differentiation of hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (H-LVH) on the basis of morphological information obtained by conventional echocardiography is occasionally problematic. We investigated whether strain rate (SR) imaging derived from tissue Doppler imaging...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000150334.69355.00

    authors: Kato TS,Noda A,Izawa H,Yamada A,Obata K,Nagata K,Iwase M,Murohara T,Yokota M

    更新日期:2004-12-21 00:00:00

  • The new 99mTc myocardial perfusion imaging agents: 99mTc-sestamibi and 99mTc-teboroxime.

    abstract::The two new 99m (99mTc) labeled myocardial perfusion agents, 99mTc-Sestamibi and 99mTc-Teboroxime, are now available for routine clinical application. Both agents allow assessment of ejection fraction by the first-pass technique at rest or during exercise, thus providing additional information not available with thall...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,多中心研究,评审

    doi:

    authors: Berman DS,Kiat H,Maddahi J

    更新日期:1991-09-01 00:00:00

  • Progesterone regulates cardiac repolarization through a nongenomic pathway: an in vitro patch-clamp and computational modeling study.

    abstract:BACKGROUND:Female sex is an independent risk factor for torsade de pointes in long-QT syndrome. In women, QT interval and torsade de pointes risk fluctuate dynamically during the menstrual cycle and pregnancy. Accumulating clinical evidence suggests a role for progesterone; however, the effect of progesterone on cardia...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.107.702407

    authors: Nakamura H,Kurokawa J,Bai CX,Asada K,Xu J,Oren RV,Zhu ZI,Clancy CE,Isobe M,Furukawa T

    更新日期:2007-12-18 00:00:00

  • Clinical cardiac positron emission tomography: state of the art.

    abstract::Cardiac positron emission tomography (PET) has evolved rapidly from a relatively esoteric research tool into clinical applications providing unique, quantitative information on myocardial perfusion, metabolism, and cell membrane function and having a potentially significant impact on cardiovascular medicine. Although ...

    journal_title:Circulation

    pub_type: 杂志文章,评审

    doi:

    authors: Gould KL

    更新日期:1991-09-01 00:00:00

  • Late complications in patients with Björk-Shiley and St. Jude Medical heart valve replacement.

    abstract::Valve-related complications after Björk-Shiley mitral valve implantation (n = 475), aortic valve implantation (n = 424), or mitral-aortic valve implantation (n = 119) were compared with those after St. Jude Medical mitral valve replacement (n = 173), aortic valve replacement (n = 152), or mitral-aortic valve replaceme...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:

    authors: Horstkotte D,Körfer R,Seipel L,Bircks W,Loogen F

    更新日期:1983-09-01 00:00:00

  • Hypoxia/reoxygenation stimulates intracellular calcium oscillations in human aortic endothelial cells.

    abstract:BACKGROUND:We have previously shown that hydrogen peroxide stimulates endothelial [Ca(2+)](i) oscillations. This study was performed to determine whether posthypoxic reoxygenation stimulates [Ca(2+)](i) oscillations in vascular endothelial cells. METHODS AND RESULTS:Hypoxia (glucose-free 95% N(2)/5% CO(2) bicarbonate ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.102.20.2541

    authors: Hu Q,Ziegelstein RC

    更新日期:2000-11-14 00:00:00

  • Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study.

    abstract:BACKGROUND:Although insulin resistance has been implicated in the pathogenesis of left ventricular (LV) hypertrophy, previous studies have yielded inconsistent results and are limited by referral bias. METHODS AND RESULTS:We examined the relations between echocardiographic LV measurements and glucose tolerance status ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.0000045671.62860.98

    authors: Rutter MK,Parise H,Benjamin EJ,Levy D,Larson MG,Meigs JB,Nesto RW,Wilson PW,Vasan RS

    更新日期:2003-01-28 00:00:00

  • Beneficial effects of pimobendan on exercise tolerance and quality of life in patients with heart failure. Results of a multicenter trial. The Pimobendan Multicenter Research Group.

    abstract:BACKGROUND:This multicenter trial was conducted to determine the efficacy and safety of pimobendan, an inotropic agent with calcium-sensitizing properties and activity as a phosphodiesterase inhibitor, in patients with heart failure. METHODS AND RESULTS:One hundred ninety-eight ambulatory patients with symptoms of mod...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1161/01.cir.85.3.942

    authors: Kubo SH,Gollub S,Bourge R,Rahko P,Cobb F,Jessup M,Brozena S,Brodsky M,Kirlin P,Shanes J

    更新日期:1992-03-01 00:00:00

  • Peroxisome proliferator-activated receptor gamma activators downregulate angiotensin II type 1 receptor in vascular smooth muscle cells.

    abstract:BACKGROUND:Peroxisome proliferator-activated receptor gamma (PPARgamma) activators, such as troglitazone (Tro), not only improve insulin resistance but also suppress the neointimal formation after balloon injury. However, the precise mechanisms have not been determined. Angiotensin II (Ang II) plays crucial roles in th...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.102.15.1834

    authors: Takeda K,Ichiki T,Tokunou T,Funakoshi Y,Iino N,Hirano K,Kanaide H,Takeshita A

    更新日期:2000-10-10 00:00:00

  • Left ventricular function during intra-aortic balloon pumping assessed by multigated cardiac blood pool imaging.

    abstract::The effectiveness of intra-aortic balloon pumping in augmenting ventricular performance during acute myocardial ischemic syndromes was determined by noninvasive multigated cardiac blood pool imaging. Nine patients with unstable angina refractory to medical therapy and nine patients with acute myocardial infarction com...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:

    authors: Nichols AB,Pohost GM,Gold HK,Leinbach RC,Beller GA,McKusick KA,Strauss HW,Buckley MJ

    更新日期:1978-09-01 00:00:00

  • Impact of prolonged cyclooxygenase-2 inhibition on inflammatory markers and endothelial function in patients with ischemic heart disease and raised C-reactive protein: a randomized placebo-controlled study.

    abstract:BACKGROUND:The impact of cyclooxygenase (COX)-2 antagonist treatment on acute coronary risk is controversial. We investigated the effect of prolonged COX-2 inhibition on inflammatory profile and endothelial function in patients with ischemic heart disease and high serum C-reactive protein (CRP) values. METHODS AND RES...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.CIR.0000139338.12464.5F

    authors: Bogaty P,Brophy JM,Noel M,Boyer L,Simard S,Bertrand F,Dagenais GR

    更新日期:2004-08-24 00:00:00

  • Nonselective versus selective beta-adrenergic receptor blockade in congestive heart failure: differential effects on sympathetic activity.

    abstract:BACKGROUND:Activation of the sympathetic nervous system has important prognostic implications in chronic heart failure. Nonselective versus selective beta-adrenergic receptor antagonists may have differential effects on norepinephrine release from nerve terminals mediated by prejunctional beta(2)-adrenergic receptors. ...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/hc4301.098282

    authors: Azevedo ER,Kubo T,Mak S,Al-Hesayen A,Schofield A,Allan R,Kelly S,Newton GE,Floras JS,Parker JD

    更新日期:2001-10-30 00:00:00

  • A new noninvasive method for the estimation of peak dP/dt.

    abstract:BACKGROUND:Peak dP/dt is a good index of ventricular performance that is not influenced by afterload, wall motion abnormalities, or the variations in ventricular anatomy and morphology commonly encountered among patients with congenital heart disease. Unfortunately, the clinical utility of peak dP/dt has been limited b...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.88.6.2693

    authors: Rhodes J,Udelson JE,Marx GR,Schmid CH,Konstam MA,Hijazi ZM,Bova SA,Fulton DR

    更新日期:1993-12-01 00:00:00

  • Molecular magnetic resonance imaging of atrial clots in a swine model.

    abstract:BACKGROUND:The detection and differentiation of intracardiac masses is still challenging and may include neoplasms and thrombi. The aim of this study was the investigation of a targeted, fibrin-specific contrast agent (EP-2104R) for molecular targeted magnetic resonance imaging (MRI) of left atrial clots. METHODS AND ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.104.529941

    authors: Spuentrup E,Fausten B,Kinzel S,Wiethoff AJ,Botnar RM,Graham PB,Haller S,Katoh M,Parsons EC Jr,Manning WJ,Busch T,Günther RW,Buecker A

    更新日期:2005-07-19 00:00:00

  • Assessment of aortic valve stenosis severity: A new index based on the energy loss concept.

    abstract:BACKGROUND:Fluid energy loss across stenotic aortic valves is influenced by factors other than the valve effective orifice area (EOA). We propose a new index that will provide a more accurate estimate of this energy loss. METHODS AND RESULTS:An experimental model was designed to measure EOA and energy loss in 2 fixed ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.101.7.765

    authors: Garcia D,Pibarot P,Dumesnil JG,Sakr F,Durand LG

    更新日期:2000-02-22 00:00:00

  • Comparative effects of nicardipine, a new calcium antagonist, on size of myocardial infarction after coronary artery occlusion in dogs.

    abstract::To examine whether nicardipine, a dihydropyridine derivative, limits size of myocardial infarction, and to compare the protective effects of nicardipine administered before and early and late after coronary artery occlusion, 99mTc-labeled albumin microspheres were injected into the left atrium during 5 min temporary c...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.74.2.420

    authors: Endo T,Nejima J,Fujita S,Kiuchi K,Iida N,Kikuchi K,Hayakawa H,Okumura H

    更新日期:1986-08-01 00:00:00

  • Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block.

    abstract:BACKGROUND:Several authors have reported cases in which 201Tl scintigraphy demonstrated perfusion abnormality in the septum of patients with left bundle branch block (LBBB) and normal coronary arteriogram. The mechanism of this abnormality, however, remains to be clarified. METHODS AND RESULTS:To determine whether LBB...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.85.3.1125

    authors: Ono S,Nohara R,Kambara H,Okuda K,Kawai C

    更新日期:1992-03-01 00:00:00

  • Plasma endothelin in chronic heart failure.

    abstract:BACKGROUND:Endothelins are recently characterized vasoconstrictor peptides. As chronic heart failure (CHF) is characterized by peripheral arteriolar and renal vasoconstriction, we have measured venous plasma endothelin-like immunoreactivity ("endothelin") in patients with this syndrome. METHODS AND RESULTS:Compared wi...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.85.4.1374

    authors: McMurray JJ,Ray SG,Abdullah I,Dargie HJ,Morton JJ

    更新日期:1992-04-01 00:00:00

  • Psychosocial precursors of hypertension: a review of the epidemiologic evidence.

    abstract::This article provides a selective overview of epidemiologic studies on the relationship between psychosocial factors and blood pressure elevation. The review focuses on English-language reports published since 1975 and emphasizes two broad areas of research: changes in mean blood pressures of third world populations u...

    journal_title:Circulation

    pub_type: 杂志文章,评审

    doi:

    authors: James SA

    更新日期:1987-07-01 00:00:00