Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


The conversion to cardiopulmonary bypass during coronary artery bypassgrafting on the beating heart: causes, predictors and its role in interpretingpublished research

Authors: A.A. Melikulov, V.Yu. Merzlyakov, M.F. Akhmedova

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2017-14-4-193-201

UDC: 616.132.2-089.168

Link: Clinical Physiology of Blood Circulaiton. 2017; 14 (4): 193-201

Quote as: Melikulov A.A., Merzlyakov V.Yu., Akhmedova M.F. The conversion to cardiopulmonary bypass during coronary artery bypass grafting on the beating heart: causes, predictors and its role in interpreting published research. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2017; 14 (4): 193–201 (in Russ.). DOI: 10.24022/1814-6910-2017-14-4-193-201

Received / Accepted:  09.08.2017/04.09.2017

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Abstract

The invention of artificial blood circulation and its application in clinical practice is a revolutionary achievement of the last century that provided the basis for the further progressive development of cardiac surgery. At the present stage, coronary bypassing in conditions of artificial blood circulation and cardioplegic cardiac arrest remains as “the gold standard” and makes up about 80% of the total number of operations performed on vessels. As is known, artificial blood circulation ensures the simplicity of the technical performance of surgical manipulations on the internal structures of the heart and especially on its surface vessels contributing to the qualitative performance of coronary anastomosis.

Off-pump coronary artery bypass (OPCAB) has gained popularity over the past 15–20 years because of the risk of cerebral injury, myocardial injury, renal failure, respiratory complications, and systemic inflammatory response syndrome associated with cardiopulmonary bypass (CPB). Coronary bypass surgery is performed on the working heart in order to eliminate the side effect of artificial circulation and thereby reduces the incidence of complications associated with artificial circulation. However, in some cases, in cases of coronary bypass surgery on a working heart, an artificial circulation is required to safely complete the operation. The presence in the operating room of artificial blood circulation and perfusion is an indispensable condition for the operation on a working heart.

Despite the multiple benefits of OPCAB, its long-term outcomes associated with the patency of grafts have been controversial. Moreover, patients who undergo OPCAB occasionally require conversion to on-pump surgery with CPB. These conversions induce an emergent situation, which significantly increases the risks of morbidity and mortality. Conversion to artificial circulation during coronary bypass surgery on a working heart leads to an increased risk of mortality and postoperative complications, depriving myocardial revascularization by the OPCAB method of all its advantages.

About Authors

  • Melikulov Alisher Almardonovich, Cand. Med. Sc., Cardiovascular Surgeon; orcid.org/0000-0002-5164-9702
  • Merzlyakov Vadim Yur’evich, Dr. Med. Sc., Head of Department of Surgical Treatment of Coronary Heart Disease and Minimally Invasive Coronary Surgery; orcid.org/0000-0001-5638-3723
  • Akhmedova Madina Fatkhullaevna, Cand. Med. Sc., Cardiologist; orcid.org/0000-0002-6184-6742

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