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Background: Linear flow during cardiopulmonary bypass is considered a potential mechanism of lung damage in patients with chronic obstructive pulmonary disease (COPD). We evaluated differences in lung function of patients with COPD undergoing preoperative intraaortic balloon pumping (IABP), between linear flow during cardiopulmonary bypass (IABP-off) and maintenance of pulsatile flow (IABP-on at automatic 80 bpm) during cardioplegic arrest., Methods: Fifty patients with COPD undergoing preoperative IABP were randomized between January 2004 and July 2005 to receive nonpulsatile cardiopulmonary bypass with IABP discontinued during cardioplegic arrest (25 patients; group A), or IABP-induced pulsatile cardiopulmonary bypass (25 patients; group B). Hospital outcome, need for noninvasive ventilation, oxygenation (partial pressure of oxygen, arterial to fraction of inspired oxygen [Pao(2)/Fio(2])), respiratory system compliance, and scoring of chest radiographs were compared., Results: There were no hospital deaths, no IABP-related complications, and no differences in postoperative noninvasive ventilation (group A: 6 of 25, 24.0% vs group B: 5 of 25, 20%; p = not significant [NS]). One patient in both groups developed pneumonia (p = NS). Intensive care and hospital stay were comparable (p = NS). Group B showed lower intubation time (8.3 +/- 5.1 hours versus group A: 13.2 +/- 6.0; p = 0.001), better Pao(2)/Fio(2) at aortic declamping (369.5 +/- 93.7 mm Hg vs 225.7 +/- 99.3; p = 0.001) at admission in intensive care (321.3 +/- 96.9 vs 246.2 +/- 109.7; p = 0.003), and at 24 hours (349.8 +/- 100.4 vs 240.8 +/- 77.3; p = 0.003). The respiratory system compliance was better in group B at the end of surgery (56.4 +/- 8.2 mL/cm H(2)O vs 49.4 +/- 7.0; p = 0.004) and 8 hours postoperatively (76.4 +/- 8.2 vs 59.4 +/- 7.0; p = 0.0001), as well as scoring of chest radiograph at intensive care admission (0.20 +/- 0.41 vs 0.38 +/- 0.56; p = 0.05) and on the first day (0.26 +/- 0.45 vs 0.50 +/- 0.67; p = 0.025)., Conclusions: Automatic 80 bpm IABP during cardioplegic arrest preserves lung function in patients with COPD.

Background: Some concerns have been raised about technical accuracy and quality of distal anastomoses in off-pump myocardial revascularization (OPCAB), which could affect graft patency., Methods: Transit-time flowmetric results and clinical, enzymatic, and echocardiographic findings from 201 consecutive isolated on-pump coronary artery bypass graft cases (cardiopulmonary bypass coronary artery bypass grafting; group A) were compared with 96 consecutive OPCAB (group B) cases performed at our institution between January 2003 and December 2004. Maximum, mean, minimum flow, and pulsatility index were compared, stratifying the two groups according to graft type and coronaries revascularized. Graft flow reserve was evaluated in patients undergoing preoperative intraaortic balloon pump during baseline conditions and at a 1 to 1 ratio of intraaortic balloon pump augmentation., Results: No differences were recorded between the two groups in hospital mortality, perioperative myocardial infarction, postoperative enzymatic leakage, echocardiographic recovery, or hospital stay (p = not significant). Off-pump coronary artery bypass and cardiopulmonary bypass coronary artery bypass grafting demonstrated similar intraoperative maximum (75.8 +/- 10.4 mL/min vs 82.3 +/- 15.8; p = 0.190), mean (50.1 +/- 13.3 vs 46.3 +/- 7.7; p = 0.420), minimum flow (12.7 +/- 5.3 vs 11.9 +/- 5.4; p = 0.811), and pulsatility index (2.9 +/- 0.2 vs 2.6 +/- 0.8; p = 0.360). After stratifying the population according to graft type, no differences were detected between the two groups in transit-time flowmetric results of left internal mammary artery, radial artery, and single and sequential saphenous vein grafts. A one to one ratio of intraaortic balloon pump augmentation did not result in any difference in graft flow reserve when left internal mammary artery (p = 0.699), radial artery (p = 0.066), and saphenous vein graft anastomoses (p = 0.772) were considered., Conclusions: Off-pump coronary artery bypass grafting and cardiopulmonary bypass coronary artery bypass grafting demonstrated similar clinical, biochemical, and transit-time flowmetric results, as well as comparable graft flow reserve. These data exclude a lower anastomotic quality in off-pump coronary artery bypass grafting.

Background: Although accepted worldwide as the first-choice conduit for myocardial revascularization (coronary artery bypass graft surgery), it is still questionable if left internal mammary arteries (LIMAs) do better as pedicled or skeletonized grafts. Recent reports have suggested that the skeletonized technique improves the outcomes. Methods: In all, 516 consecutive isolated coronary artery bypass graft surgery patients admitted between January 2003 and February 2007 were grouped according to the harvesting technique of LIMAs (387 pedicled versus 129 skeletonized). Intraoperative transit time flow results, hospital outcome, perioperative troponin I leakage, and echocardiographic results were analyzed. Maximum, mean, and minimum flows, pulsatility index, and graft flow reserve were stratified according to the type of surgery (on pump and off pump) and subgroups at risk (severe left ventricular hypertrophy). Results: The transit time flow results were unsatisfactory in 4 patients (0.8%), all 4 of whom underwent redo anastomosis. Maximum, mean, and minimum flows and pulsatility index values were comparable between skeletonized and pedicled LIMAs (p = not significant), for both on-pump and off-pump surgeries (p = not significant). Graft flow reserve was comparable between the two groups (p = not significant), as well as transit time flow results in severe ventricular hypertrophy. Troponin leakage, postoperative echocardiographic recovery, and hospital outcome were comparable between the two groups (p = not significant at all time points). Only superficial wound complications proved higher in the pedicled group (2.6% versus skeletonized group: 0%; p = 0.05). Conclusions: Pedicled LIMA carries a higher risk for minor wound complications. Neverthless, the two techniques showed similar in-vivo functional behavior and hospital outcome. Therefore, there is no reason to prefer one technique over the other. [Copyright &y& Elsevier]