Background and Aim: Coronary artery bypass grafting with CPB is an effective surgical treatment of CAD with low morbidity and mortality. Besides long-term outcomes are excellent. In recent years application of OPCAB (Without CPB) technique is increasing. The aim of this study was clinical evaluation and electocardiographic changes in patient with coronary artery bypass with/without CPB. Materials and Methods: In this quasi-experimental study, from 22 Jun 2002 to 6 mar 2003 primary isolated coronary artery bypass graft was performed in 115 patients (75 patients off - pump and 40 patients on - pump) in Department of cardiac surgery Ghaem Hospital. In two groups, hospital outcome and the level of CK-MB, CTnI, ECG changes (to evaluate myocardial injury) were compared together postoperatively. Data were analyzed by x2, logistic regression and t tests. Results: Two groups were similar in terms of age (off-pump 56.3±9.3 year Vs on-pump 55.6±10.6), sex, Risk factor, Preoperative EF, Extend of coronary disease, functional class, average of grafts (off- pump 4.09±0.9 Vs on-pump 4.02±0.7). Mean postoperative CK-MB level was (off-pump 39.3±36.7 U/lit Vs on-pump 56.68±33 U/lit) significantly less in off-pump group (P=0.03). Similar results were obtained also for CTnI (off-pump had 8% weakly positive and 6.7% positive Vs on-pump 17.5% weakly positive and 15% positive) (P=0.03). Postoperative and Discharge ECGs were similar in the two groups for new Q and ST changes (P=0.62). ICU and Hospital length of stay, intubation time, arrythmia, hemodynamic state, neurologic and perioperative mortality defects were not significant in two groups. Postoperative hemorrhage (P=0.009) and need for allogenic blood transfusion during the first postoperative 24 hours were significantly (0.044) less in off-pump group. Conclusion: Enzymatic changes (Myocardial injury) in off-Pump technique is less than on pump and these changes were more reliable than ECG changes. OPCAB is safe for CAD.

Background: In patients undergoing Cardiopulmonary Bypass (CPB) with extracorporeal circulation, the rapid restoration ofblood flow to the ischemic tissue induces cardiac damage termed as myocardial Ischemic Reperfusion (I/R) injury. Objectives: In the current study, the researchers hypothesized that Dexmedetomidine (DEX) modulates I/R injury in CoronaryArtery Bypass Graft Surgery (CABG) with Cardiopulmonary Bypass (CPB). Methods: This randomized, double-blind, clinical trial took place in a university affiliated Hospital, Gilan, Iran. From April 2016to March 2017, 114 eligible patients undergoing elective and isolated CABG were randomized to receive either DEX infusion 0. 3 to0. 5  g/kg/hour before induction of anesthesia till 12 hours postoperatively (group D) or normal saline as placebo (group C). Theendpoints were used to assess creatinine phosphokinase-MB (CKMB) and cardiac troponin I (CTnI) levels at four measurement timepoints, including baseline (T0) and 6, 12, 24, and 48 hours after the operation (T0-T4). Results: Overall, 114 patients’ data were analyzed; group D (n = 58) and group C (n = 56). No significant differences were foundbetween the two groups, in view of baseline characteristics. Following CPB, a marked increase in CKMB and CTnI plasma levels wasobserved in both groups compared with baseline (P = 0. 0001). Serum CKMB levels increased from 2. 27 0. 59 to 7. 81 1. 39, and 2. 22 0. 64 to 7. 46  1. 25 and CTnI levels from 10. 22  0. 17 to 4. 89  1. 1, and 0. 27  0. 28 to 4. 5  1. 4 in groups C and D, respectively (P= 0. 0001). According to CKMB, there was a significant difference between the two groups at T2 (P = 0. 002) and T3 (P = 0. 0001), andbased on CTnI at T2 (P = 0. 004) and T3 (P = 0. 0001). However, no significant difference was observed at the other measurement pointtimes. No adverse effect was recorded due to this intervention. Conclusions: Perioperative DEX in cardiac surgery appears safe, with properties to alleviate I/R injury. Obviously, future standardtrials are required to find optimal intervention strategies.

Background and Aim: Excessive Bleeding continues to play a key role and an important cause of morbidity and mortality after cardiopulmonary bypass (CPB).The goal of this study was to determine the differences in bleeding and transfusion between OPCAB and on -pump CABG patients.Materials and Methods: In a randomized, double blinded prospective study 300 patient's undergoing coronary revascularization surgery were enrolled, 150 CABG patients were compared with 150 OPCAB patients. The patients were assessed during the first 72 hours to determine the postoperative side effects. The 2 groups were compared using the chi-square test or fisher's exact test and the rank sum test.Results: CABG patients received more intraoperative red blood cells (P<0.0001), more albumin and more fresh- frozen plasma (P<0.0001).Postoperatively, CABG patients were more likely to receive more platelets (29.3% v 70.7%, P<0.007). During the operative and the initial 4-hour postoperative period OPCAB patients exhibited greater blood loss (P<0.0001); however, at 12, 24 and 72 hours postoperatively, CABG patients exhibited greater blood loss. There were4 death in CABG patients (P<0.05) Conclusion: Despite not reversing the heparin at the end of the OPCAB surgery, OPCAB surgery was associated with an overall reduction in platelets, fresh- frozen plasma, Albumin and transfusion requirements.

Background: In patients with coronary artery stenosis, coronary artery bypass graft surgery (CABG) is the most effective strategy to limit infarct size and improving outcomes. However, the rapid restoring of bloodflowto the tissue can paradoxically induce cardiac damage. This phenomenon termed as myocardial ischemic/reperfusion (I/R) injury which is exacerbated under cardiopulmonary bypass (CPB) and is the cause of poor clinical outcomes. Therefore, it is essential to search for novel strategies with further cardio protective effects.Objectives: In the current study, we investigated the effects of selenium (Se) administration on I/R injury in CABG patients.Methods: This randomized double-blind clinical trial was conducted in the department of cardiac surgery of a university hospital in North of Iran from May 2015 to September 2015. One hundred and ten patients undergoing an elective isolated CABG surgery were divided into two groups using randomized fixed quadripartite blocks. They received either intravenous Se before induction of anesthesia, or normal saline as placebo. Cardiac troponin I (CTnI) and creatine kinase-MB (CKMB) were measured as biomarkers at four measurement point times, before the intervention (T0), at 6, 12, 24 and 48 hours after the surgery (T1-T4).Results: Finally, data from 104 patients were analyzed, the Se (n=53) and control (n=51) groups. There was no significant difference between the two groups regarding the baseline characteristics. In both groups CPB caused a markedly increase in CKMB and CTnI plasma concentrations compared to the baseline (P=0.0001). Based on CKMB, there was no significant difference between the two groups at any point times, T0 (P=0.357), T1 (P=0.751), T2 (P=0.46), T3 (P=0.16) and T4 (P=0.053). According to CTnI, there was just a significant difference between the two groups at T1 (P=0.011) but not at T2 (P=0.116), T3 (P=0.09) and T4 (P=0.634). No adverse effect was recorded linked to our intervention.Conclusions: Selenium can alleviate I/R injury in short time. Further well-planned trials are needed to find the optimized administration method to achieve the most beneficial effects to the patients.

Cardiopulmonary bypass and aortic clamping evokes the obligatory global myocardial ischemia and dysfunction with a significant inflammatory response. The discrepancy about cardioprotective effects of erythropoietin still exist. The aim of this study was to assess the clinical immunomodulatory effects of Erythropoietin (EPO) on serum inflammatory biomarkers (YKL40, IL-6) and cardiac biomarkers, (pro-BNP, CK-MB and troponin). In this randomized double blind clinical trial, 132 patients admitted for elective coronary surgery with Cardiopulmonary Bypass (CPB) were randomly assigned in one of three groups: 1-group EPO-A (n = 35) infusion of 300 IU/Kg EPO after anesthesia induction and before undergoing CPB; 2-group EPO-CPB (n = 31) the same intervention during CPB; 3-placebo group (n = 66) saline infusion in the same volume. Cardiac enzymes and serum biomarkers were measured at intervals. There was a sharp increase in serum YKL-40 with a 24 h delay after CPB in all groups without significant difference. The increase in serum IL-6 was significant in EPO-CPB group compared with both other groups (p = 0. 001 and p = 0. 001, respectively). Serum pro-BNP reached maximum level 24 h after operation in all groups; in group A significantly less than others (p = 0. 008). CKMB increased significantly in all groups (p < 0. 001), less prominently in CPB-A group (p = 0. 03). EPO administration before induced ischemia may be cardioprotective in terms of cardiac biomarkers in patients undergoing CABG with CPB.

Introduction: Application of off-pump technique for reoperative coronary artery bypass grafting (Redo CABG) has been limited by technical difficulties, potentiation for embolism of athermanous debris from the involved grafts, resulting in myocardial infarction, and rapid hemodynamic deterioration.Materials and Methods: In this descriptive study from 2002, at Cardiac surgery Department of Emam Reza Hospital, a total of 77 consecutive patients underwent redo CABG (64 ONCAB and 13 OPCAB) The outcomes of off-pump (OPCAB) and on-pump (ONCAB) redo CABG were compared. Surgical technique in 2 patients (%11) was converted from OPCAB to ONCAB due to hemodynamic instability, severe adhesion or graft injury; and in one patient (%7) the conversion from ONCAB to OPCAB was for severe aorta calcification.Conclusion: Propensity matched comparison of the outcome of OPCAB with ONCAB for redo CABG showed that OPCAB was associated with significant reduction in postoperative complications, volume of blood transfusion and hospitalization length. OPCAB can be safely and effectively applied for reoperative CABG, in selected cases.

Bachground: OPCAB, though as old as coronary surgery, simplicity, low cost, better outcome and its unique life saving quality in certain cases has not become the universal operation. The reason might be the original presentation which was technical without adequate science of its own but base on the background of CABG science. Therefore concern about inadequate revascularization was a reality from the beginning. Material & Methods: Our efforts which helped to overcome the above concerns led to the discovery that inspection of the beating heart is an accurate way to diagnose possible local ischemia associated with coronary occlusion, positioning and stabilization during OPCAB. Visible changes in color and contractility were tested& proved to be accurate tools in predicting the need for cardio pulmonary bypass before global mal function and severe hemodynamic deterioration occurs. Results: Practicing such a training protocol resulted in 1: avoidance of “ crash conversion” . 2: created a safe and stress free environment and resulted in a overall mortality<1%. In addition accurate observation of the heart has given new insight into the anatomy and physiology of coronary circulations namely corrugated anatomy and capacitances vessel physiology. Conclusion: Training in visual diagnosis of cardiac changes during OPCAB provides the ability to predict the course of the operation& timely information about the need for cardio pulmonary bypass. The intra operative complication are avoided& presence of safe and stress free environment provides for complete revascularizations. Therefore we recommend this practice to everybody.

According to disadvantages and complications of cardiopulmonary bypass (CPB), cardiothoracic surgeons in world- wide have become interested in off-pump CABG. Generally, coronary artery surgery accomplished in two Method, first routine method, in which CABG is performed with the help of CPB (PUMP MACHINE). In this method, the field of the operation is motionless and free of blood, however the complications of the CPB are still present. Second off- pump method that surgery is performed without using CPB. In this method, the heart is beating during operation, and normal activities of heart and lung are maintained, this method devoid of the disadvantages of the previous one.The first CABG surgery was done on a beating heart in 1960. In Iran cardiac surgery has commenced since 40 years ago, and is developing rapidly, but about operations with off-pump Method and results, there is no documented study. Off-pump CABG not only avoids of disadvantages of CPB but also has economic benefits. The goal of our study was to investigation the results (Ghaem, Javad-al-aemeh, Mosa-ebne-jafar Hospitals) in Mashhad, so that it can be a useful guide for future cardio-thoracic surgeons.

Background and purpose: Recent studies showed that erythropoietin (EPO) despite having role in hematopoiesis, has non-hematopoietic protective effects on ischemia-reperfusion injury. this study evaluates the effects of erythropoietin on reducing ischemia-reperfusion injuries during coronary artery bypass graft surgery (CABG).Materials and methods: in this clinical trial, 60 patients candidate for elective CABG were randomly divided into two groups, EPO and control group. Patients in EPO group received IV infusion of EPO (700 IU/kg), at the start of reperfusion after aorta cross clamp. Cardiac markers including Troponin I and Creatine kinase MB (CKMB) assessed eight hours after CABG surgery. Also echocardiography was performed in all patients six month after surgery. the data was analyzed using t-test chi-square and mann-withney.Results: Troponin I level showed no significant difference in EPO and control group (P=0.30). CKMB level in EPO group was higher than that of the control group (P=0.004). Ejection fraction (EF) was also higher in EPO group after six month but it was not significant (P=0.46). Left ventricle end systolic volume (P=0.017) and also Left ventricle end diastolic volume(P=0.04) in EPO group were significantly less in control group.Conclusion: in this study the administration of erythropoietin caused reduction in ischemia-reperfusion injuries after CABG  by improving ventricular function, and also reduction in myocardial remodeling and Left ventricle end systolic volume and left ventricle end diastolic volume.

Background- Neurocognitive dysfunction after cardiac surgery with cardiopulmonary bypass (CPB or “pump”) is a common complication, reported in up to 53% of patients. In many patients this morbidity is only mild and transient, but in 5% of cases, it is severe.Method-In this prospective study from June 2002 to July 2004,186 cases underwent coronary artery bypass graft surgery (CABG) using CPB or off-pump CABG (OPCAB), and they were evaluated for neurocognitive complications by mini-mental status examination.Results- The average age of the patients was 56±6.2 years, 62% were male and 38% were female. 121 operations were performed with CPB (on-pump) and 65 operations were done off-pump. Mini-mental status test was normal in 50% of off-pump CABGs and in 43% of on-pump CABGs, very mild disturbance was seen in 48% of off-pump CABGs and in 54% of on-pump CABGs (p value=0.192, NS), mild disturbance was seen in 2% of off-pump CABGs and in 3% of on-pump CABGs (p value 0.392, NS), and moderate or severe disturbance was not seen in either group.Conclusion- In our study, there was no significance difference in the frequency of postoperative neurocognitive complications between off-pump and on-pump CABG patients.