醫學筆記匯整 ED Notes

• Off pump V.S. On pump
• No aortic cannulation -> less risk of dissection, embolism
• No atrial cannulation -> less atrial injury, arrhythmias
• No cross-clamping -> less risk of plaque embolism, CVA, MI
   
• No activation of coagulation, kallikrein, inflammation caused by tubing
  -> less coagulopathy, less bleeding, less transfusion
   
• No cardioplegia -> no K+ load, fluid load, coronary air embolism
   
• No risk of bypass machine failure -> air embolism
• Less cost
• Less equipment
• Less staff
  
  
  - 不用 CPB 少了 SIRS
    減少輸血, Coagulopathy
  
  - 不用去動到 aorta 減少 stroke, dissection
  
  - 不用 cardioplegia 心臟不會停
    減少 kidney, brain injury

* Off pump 特別適合

1. Old age
2. Stroke history
3. Aortic problem ( 嚴重鈣化, 有過 dissection )
4. LV dysfunction
5. Impaired renal function
    

In general, indications for OPCAB include:

• Coronary artery disease requiring surgical revascularisation
• High risk or contraindications for cardiopulmonary bypass and aortic cross-clamping:
• Severely atheromatous or heavily calcified aorta
• Aortic disease with risk of dissection, rupture or embolisation

• Poor quality target vessels including intramyocardial vessels,
  diffusely diseased vessels and calcified coronary vessels

• Hemodynamic instability
• Impaired left ventricular function
• Recent myocardial infarction
• History of transient ischemic attacks or cerebrovascular accidents
• Impaired renal function or need for dialysis in patients with chronic renal failure
• Patients who refuse blood transfusions 
• Elderly patients, patients with respiratory problems
   or other systemic disease considered high risk surgical patients
   because of their reduced functional capacity and the presence of co-morbidities.