1. On and Off Pump Coronary Artery Bypass Grafting (CABG) David Kim Independent Research GT

2. About Me My name is David Kim and I am currently a junior at Oakland Mills High School undertaking the Independent Research GT program. Some things about me: I am a track runner, a tennis player, a member of the Alpha Achievers, Math Team, National Honor Society, MESA, and the Oakland Mills High School newspaper. I enjoy tutoring other people at Oakland Mills. I always want to learn more about other students, and Physics GT and Biology AP are my favorite classes. Currently, I am researching the effects of different heart surgeries and to provide a solution which I will talk later in this presentation. So why the heart? I want to become a professional heart surgeon. The heart is intriguing; I want to research more about cardiac surgery, but most importantly I want to not only treats patients but gives back to the community.

3. Abstract  My main area of interest is cardiac and cardiothoracic surgery. I am researching the effects of on pump cardiac surgery and off pump cardiac surgery to see if one or the other is more effective. I have gathered up some sources--some of which are penchant towards one or the other type of cardiac surgery. I want to support my research with data and statistics provided from my sources. I also want to know why one or the other is more beneficial or detrimental to the patient's heart; and if both of them are used, what the use of both of them are.  Potentially, this will lead me to design a more efficient type of surgical procedure and thus publish it in an academic journal.

4. My Advisor Dr. Woods is my advisor, a retired cardiothoracic surgeon. I was able to contact Mrs. Creed in trying to find an appropriate advisor (who would be Dr. Woods), and she so happened to know an experienced surgeon that I could possibly talk with via email or phone. So far, all conversations have been made on email. Advisor’s Contact: michaelkwood@yahoo.commichaelkwood@yahoo.com

5. CABG There are 2 different methods of doing CABG: the traditional way, which is called the on-pump CABG, and the newer way, which is called the off-pump CABG. Opinion is still divided on which is the better way as each has low mortality rates. Most CABGs are performed by the midline sternotomy approach (down the middle through the breast bone). On-pump uses a machine to pump blood hence the phrase “on-pump,” and off-pump does not. Picture is of a sternum incision procedure.

6. Off-pump CABG Surgery Off-pump CABG is: widely performed safe effective and there are numerous techniques available patients with aortic disease precluding bypass

7. Cont. ADVANTAGES avoids bypass less bleeding, less transfusion no K+ load, fluid load, coronary air embolism no risk of bypass machine failure -> air embolism less cost less equipment less staff DISADVANTAGES needs skilled staff technically more difficult (increased risk of anastomotic bleeding) not all coronary arteries well reached by technique more graft failure neuropsychological benefit not shown in trial more difficult with disease or small artery disease

8. On-pump CABG Surgery On-pump CABG is: performed while the heart is stopped blood supply must be provided to the rest of the body when the heart is stopped surgeons use the cardiopulmonary bypass machine (also known as the heart-lung machine or the pump) pipes (cannulas) are placed in the heart to drain impure blood to the pump, where it is purified and pumped back into the patient Keep it stopped but also nourish it when it is still. The bypass grafts are then constructed. At the end of the procedure, the heart is restarted. On-pump CABG today is a safe procedure that has a small risk of death and/or complications. average risk of this procedure to a low-risk patient is 1% to 2% Development of new technology has made the heart-lung machine very safe. Surgeons have understood the various reasons for complications and have learned to identify them and to take necessary precautions.

9. Cont. Advantages On-pump CABG today is a safe procedure that has a small risk of death and/or complications. The average risk of this procedure to a low-risk patient is 1% to 2%. The patient’s other health-threatening conditions increase these risks. Some of the important complications that can occur with this technique are stroke, kidney or liver failure, decrease in higher mental function, and bleeding. Development of new technology has made the heart-lung machine very safe. Surgeons have understood the various reasons for complications and have learned to identify them and to take necessary precautions. Disadvantages The patient’s other health-threatening conditions increase these risks. Some of the important complications that can occur with this technique are stroke, kidney or liver failure, decrease in higher mental function, and bleeding.

10. On and Off Pump Rate of Encephalopathy, Dialysis, Sternal Wound Infection, Need for Red Blood Cell Transfusions/On and Off Pump Rates of Death, Stroke, Heart Attack during Surgery Graph 1: Off-pump surgery had a significantly lower rate of encephalopathy, dialysis, sternal wound infection (SWI) & need for red blood cell transfusions (PRBC). Graph 2: Both on-pump and off-pump surgery had low rates of death, stroke, or heart attack (MI) during surgery.

11. Picture URL Links http://babyheartblog.org/tag/international/ http://www.123rf.com/photo_15915115_illustr ation-of-a-human-heart-cross-section.html http://www.123rf.com/photo_15915115_illustr ation-of-a-human-heart-cross-section.html http://my.clevelandclinic.org/heart/disorders/ cad/offpump.aspxhttp://my.clevelandclinic.org/heart/disorders/ cad/offpump.aspx http://www.webmd.com/heart-disease/heart- failure/aortic-valve-replacement-final http://www.webmd.com/heart-disease/heart- failure/aortic-valve-replacement-final