Current Trends and Technique in OPCAB Surgery
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Bibliographic record
Abstract
BACKGROUND AND AIM OF THE STUDY: Aging of the population, increased surgical risk, and technical improvement have contributed to the recent revival of off pump coronary artery bypass surgery (OPCAB). We present our experience with the systematic use of this technique. METHODS: Between September 1996 and June 2000, 500 OPCAB procedures were performed at the Montreal Heart Institute (95% of all procedures during time frame, single surgeon). Contraindications were unstable hemodynamics, intramyocardial left anterior descending artery, and reoperation with extensive adhesions. Stabilization was achieved with pericardial sutures and mechanical compression. Surgical strategy was to first bypass the culprit lesion. Anesthetic management consisted of adequate fluid loading and minimal use of alpha-agonist. This cohort was compared to a contemporary cohort of 1,444 patients operated with cardiopulmonary bypass (CPB). RESULTS: Demographics and risk factors were comparable for all. OPCAB patients received more grafts (3.1 +/- 0.9 vs 2.9 +/- 0.7, p = 0.006), conversion rate was low (0.4%), and complete revascularization was achieved in 93%. Operative mortality and perioperative myocardial infarction were comparable in both groups. Transfusion need, CK-MB count, postoperative use of intra-aortic balloon pump, and creatinine increase were less significant in OPCAB. Postoperative hemorrhage, atrial fibrillation, prevalence of cerebrovascular accident, and hospital stay were comparable for both groups. These results are comparable to those currently reported in the literature. CONCLUSION: OPCAB surgery in the current era has established its safety and short-term efficacy although long-term clinical results are still warranted. Considering the changing pattern in surgical practice, OPCAB surgery should remain a therapeutic option in modern cardiac surgery.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.007 |
| Bibliometrics | 0.004 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it