Pro: All Off-Pump Coronary Artery Bypass Graft Surgeries Should Include Intraoperative Transesophageal Echocardiography Assessment

摘要

Historically, the cardiopulmonary bypass machine was necessary for cardiac surgeons to perform complex operations on the heart. Cardiopulmonary bypass (CPB) allows for a stable operative site and a bloodless field while ensuring end-organ perfusion and cooling of the patient during cardiorespiratory arrest. CPB has been implicated as the cause of many adverse effects of cardiac surgery including a systemic inflammatory response and end-organ damage, especially neurologic injury and cognitive decline. In recent years, it has become possible to safely perform coronary artery bypass graft (CABG) surgery without the use of CPB. It was initially postulated that avoidance of cannulation and CPB wouid decrease the incidence of end-organ damage in all patients. Several clinical studies have not confirmed this, but off-pump CABG (OPCAB) surgery has been shown to be beneficial in a subset of patients that are at higher risk for developing neurologic complications.