الفهرس 
Patient selection For Off Pump CABGOnly 14 pages are availabe for public view
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Abstract
Each year, coronary artery disease is diagnosed in more than 1 million persons. Of this group, approximately 300,000 will undergo coronary artery bypass graft (CABG) surgery.
The magnitude of the disease raised the comparative studies between different lines of treatment as between medical Vs surgical /interventional and between surgical Vs interventional and also between different types of surgical techniques i.e. Off-pump Vs on-pump.
Also the concept of co-morbidities and risk factors among this huge segment of patients opened a great window of opportunity on how to deal with such risk factors and co-morbidities to improve the outcome.
The identification of preoperative risk factors for adverse outcomes after cardiac surgery is an important component of perioperative care. It helps clinicians provide better informed consent to patients by bringing up specific considerations that could influence outcome. It identifies higher risk patients requiring special care and in whom new interventions can be developed to improve outcome. Finally, it allows risk-adjusted evaluation of outcome and quality of care.
Preoperative renal dysfunction is an important risk factor in cardiac surgery.
In this study we compared the early results of isolated CABG, using on-pump and off-pump, in 60 patients with preoperative mild to moderate elevation of serum creatinine (1.6 to 2.5 mg/dl) level whom do not require maintenance dialysis to support renal function. We examined if off-pump coronary revascularization offers a superior renal protection when compared with conventional coronary revascularization with cardiopulmonary bypass.
The sample was selected according to preoperative serum creatinine and there were no statistical significant difference in the demographic characteristics (age/gender) or in preoperative risk factors as hypertension, diabetes, smoking, dyslipidemia and previous myocardial infarction or in preoperative laboratory investigations.
• Regarding the operative time the results was in favor of on-pump group.
• Regarding the number of distal anastomses there was no difference between both groups.
• Regarding post operative complications such as post operative MI there was no difference between both groups.
• Regarding arrhythmia, reopening for bleeding results were in favor of on-pump technique.
• Regarding dialysis and postoperative renal dysfunction results were in favor of off-pump technique.
• Regarding need for inotropes and IABP results were in favor of off-pump technique.
• Regarding ICU stay results were in favor of off-pump technique.
We concluded that:
Off-pump CABG appears to be a better technique in patients with preoperative renal dysfunction, CPB is associated with a high risk for PRD, and this injury is associated further with substantial morbidity and mortality.
The pathogenesis of kidney injury during CPB is complex and involves hemodynamic, inflammatory, and other mechanisms that interact at a cellular level.
At present, no pharmacologic interventions have demonstrated conclusively efficacy in the prevention of renal dysfunction after cardiac surgery.
Ultimately, a successful therapy will utilize strategies that target these multiple pathways. This integrated strategy would target hemodynamic, inflammatory, and oxidative pathways and act both at the points of proximal cellular injury and at later downstream events, such as tubular regeneration.
CPB offers an attractive model to study these pathways, because the timing of the insult is known and potentially modifiable.