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1.
Rev Med Chil ; 151(1): 32-41, 2023 Feb.
Artículo en Español | MEDLINE | ID: mdl-37906744

RESUMEN

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Humanos , Estudios Retrospectivos , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente de Arteria Coronaria , Puente Cardiopulmonar/efectos adversos , Chile/epidemiología , Resultado del Tratamiento
2.
Braz J Cardiovasc Surg ; 38(4): e20210607, 2023 07 04.
Artículo en Inglés | MEDLINE | ID: mdl-37402236

RESUMEN

INTRODUCTION: Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). We observed the role of routine use of BITA and off-pump coronary artery bypass grafting (OPCABG) in the incidence of DSWI and associated risk factors. METHODS: Between January 2010 and December 2020, 1,207 patients were treated with isolated coronary artery bypass grafting. In all cases, OPCABG was attempted, and BITA was used whenever there was a need for a second arterial graft for the left coronary artery. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple linear regression analysis was employed to model the risk of DSWI. RESULTS: The incidence of DSWI was 0.58%. Mortality rate was higher in DSWI group than in no-DSWI group (28.57% vs. 1.25%; P<0.001). No significant difference in DSWI incidence was observed when BITA (70.6%) or single internal thoracic artery (29.4%) were used (P=0.680). The prevalence of diabetes (100% vs. 40.7%; P=0.001), hyperlipidemia (100% vs. 85.9%; P=0.045), and obesity (71.4% vs. 26.8%; P-0.017) was significantly elevated in DSWI group, when compared with no-DSWI group. Diabetes (P=0.0001), unstable angina (P=0.0064), previous myocardial infarction > 30 days (P=0.0009), left ventricular ejection fraction < 50% (P=0.0074), and emergency surgery (P=0.0002) were independent risk factors. CONCLUSION: The results of routine use of skeletonized BITA after OPCABG were satisfactory regarding DSWI incidence and operative mortality in a single-center experience.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Enfermedad de la Arteria Coronaria , Diabetes Mellitus , Arterias Mamarias , Humanos , Arterias Mamarias/trasplante , Puente de Arteria Coronaria Off-Pump/efectos adversos , Infección de la Herida Quirúrgica/etiología , Volumen Sistólico , Resultado del Tratamiento , Estudios Retrospectivos , Función Ventricular Izquierda , Factores de Riesgo , Enfermedad de la Arteria Coronaria/complicaciones
3.
Rev. méd. Chile ; 151(1): 32-41, feb. 2023. ilus, tab
Artículo en Español | LILACS | ID: biblio-1515419

RESUMEN

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente Cardiopulmonar/efectos adversos , Análisis de Supervivencia , Chile/epidemiología , Puente de Arteria Coronaria , Estudios Retrospectivos , Resultado del Tratamiento , Puntaje de Propensión
4.
Braz J Cardiovasc Surg ; 38(1): 110-123, 2023 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-35895983

RESUMEN

INTRODUCTION: According to the American Heart Association guideline for coronary artery bypass grafting (CABG), female patients undergoing on-pump CABG (ONCAB) are at higher risk of short-term adverse outcomes than male patients. However, whether off-pump CABG (OPCAB) can improve the short-term outcome of female patients compared to ONCAB remains unclear. METHODS: We conducted a meta-analysis to study the effect of the female sex on short-term outcomes of OPCAB vs. ONCAB. A total of 31,115 patients were enrolled in 12 studies, including 20,245 females who underwent ONCAB and 10,910 females who underwent OPCAB. RESULTS: The in-hospital mortality in female patients who underwent OPCAB was significantly lower than in those in the ONCAB group with (2.7% vs. 3.4%; odds ratio [OR] 0.76; 95% confidence interval [CI] 0.65-0.89) and without (OR 0.68; 95% CI 0.52-0.89) adjustment for cardiovascular risk factor. The incidence of postoperative stroke in female patients who underwent OPCAB was lower than in those in the ONCAB group (1.2% vs. 2.1%; OR 0.59; 95% CI 0.48-0.73) before cardiovascular risk factor adjustment but was not significant (OR 0.87; 95% CI 0,66-1.16) after adjustment. There was no significant difference in the incidence of postoperative myocardial infarction between women who underwent OPCAB and those in the ONCAB group (1.3% vs. 2.3%; OR 0.88; 95% CI 0.54-1.43). CONCLUSION: In contrast to the American Heart Association CABG guideline, female patients who had OPCAB don't have unfavorable outcomes compared with the ONCAB group.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Infarto del Miocardio , Humanos , Masculino , Femenino , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria Off-Pump/efectos adversos , Infarto del Miocardio/complicaciones , Complicaciones Posoperatorias/etiología , Mortalidad Hospitalaria , Resultado del Tratamiento
5.
Rev Assoc Med Bras (1992) ; 68(12): 1747-1752, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36449805

RESUMEN

OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Enfermedad de la Arteria Coronaria , Hipertensión Pulmonar , Humanos , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente de Arteria Coronaria , Hipertensión Pulmonar/complicaciones , Estudios Retrospectivos , Volumen Sistólico , Función Ventricular Izquierda , Complicaciones Posoperatorias , Resultado del Tratamiento , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/cirugía
6.
Rev Assoc Med Bras (1992) ; 68(9): 1240-1246, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36228255

RESUMEN

OBJECTIVE: This study aims to examine the predictive role of systemic immune-inflammation index on postoperative new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. METHODS: A total of 722 patients undergoing elective off-pump coronary artery bypass grafting between January 2017 and September 2021 were included in this study and divided into two groups as the atrial fibrillation group (n=172) and the non-atrial fibrillation group (n=550). Both groups were compared in terms of patients' baseline clinical features, operative and postoperative variables, and preoperative hematological indices derived from the complete blood count analysis. Multivariate logistic regression and receiver-operating characteristic curve analyses were performed to detect the independent predictors of postoperative new-onset atrial fibrillation. RESULTS: The median age and length of hospital stay in the atrial fibrillation group were significantly higher than those in the non-atrial fibrillation group. The median values of white blood cell, platelet, neutrophil, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune-inflammation in the atrial fibrillation group were significantly greater than in those in the non- atrial fibrillation group. Logistic regression analysis demonstrated that age, platelet, platelet/lymphocyte ratio, and systemic immune-inflammation were independent predictors of postoperative new-onset atrial fibrillation. receiver-operating characteristic curve analysis revealed that systemic immune-inflammation of 706.7×103/mm3 constituted cut-off value to predict the occurrence of new-onset atrial fibrillation with 86.6% sensitivity and 29.3% specificity. CONCLUSION: Our study revealed for the first time that systemic immune-inflammation predicted new-onset atrial fibrillation after off-pump coronary artery bypass grafting.


Asunto(s)
Fibrilación Atrial , Puente de Arteria Coronaria Off-Pump , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Puente de Arteria Coronaria , Puente de Arteria Coronaria Off-Pump/efectos adversos , Humanos , Inflamación/etiología , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Factores de Riesgo
7.
Braz J Cardiovasc Surg ; 37(6): 848-856, 2022 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-35244371

RESUMEN

INTRODUCTION: Postoperative atrial fibrillation (poAF) is a common complication of coronary artery bypass grafting, and its reasons are still the subject of research. The aim of this study was to evaluate whether QT interval is related to new onset of poAF occurrence. METHODS: This study included 167 patients undergoing elective isolated off-pump coronary artery bypass grafting (OPCAB) surgery. Patients were divided into two groups as poAF (+) and poAF (-), according to the development of poAF, and the results of the measurements were compared between the groups. RESULTS: PoAF was detected in 37 (22.1%) of 167 patients who underwent OPCAB surgery. When QT interval measurements were compared, preoperative and postoperative QT and corrected QT interval (QTc) values were significantly longer in the group with atrial fibrillation. Mean values of preoperative QT were 407.5±27.1 in the poAF (-) group vs. 438.5±48.5 in the poAF (+) group (P<0.001). Mean values of preoperative QTc were 419.1±14.5 in the poAF (-) group vs. 448.5±26.6 in the poAF (+) group (P<0.001). Mean values of postoperative QT were 416.3±48.3 in the poAF (-) group vs. 439.2±45.8 in the poAF (+) group (P=0.005). And mean values of postoperative QTc were 419.8±12.5 in the poAF (-) group vs. 452.0±23.3 in the poAF (+) group (P<0.001). CONCLUSION: QT interval measurement may be a new parameter in predicting poAF development after OPCAB surgery.


Asunto(s)
Fibrilación Atrial , Puente de Arteria Coronaria Off-Pump , Humanos , Puente de Arteria Coronaria Off-Pump/efectos adversos , Fibrilación Atrial/etiología , Complicaciones Posoperatorias/etiología , Puente de Arteria Coronaria/efectos adversos , Periodo Posoperatorio , Factores de Riesgo , Estudios Retrospectivos
8.
Braz J Cardiovasc Surg ; 37(5): 663-673, 2022 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-35244374

RESUMEN

INTRODUCTION: The objective of this single-center study it to retrospectively analyze the relationship between transfusion and 30-day postoperative outcomes in patients undergoing isolated off-pump coronary artery bypass grafting. METHODS: Perioperative data of 2,178 patients who underwent isolated off-pump coronary artery bypass grafting from 2018 to 2019 were collected. A 1:1 propensity score matching was performed to control for potential biases between patients who received blood transfusion and those who did not. After propensity score matching, we analyzed the clinical outcomes of transfusion and non-transfusion patients. Postoperative complications and the survival of patients within 30 days after surgery in both groups were analyzed. Kaplan-Meier survival curve and log-rank test were used for survival analysis. RESULTS: The total blood transfusion rate of all patients was 29%, including red blood cell (27.6%), plasma (7.3%), and platelet (1.9%). Four hundred and forty patients in each group were compared after propensity score matching. There were no significant differences in the incidence of stroke, myocardial infarction, atrial fibrillation, acute kidney function injury, and sternal wound infection of both groups (P>0.05). However, higher incidence of postoperative pulmonary infection and more mechanical ventilation time and days of stay in the intensive care unit and postoperative in-hospital stay were associated with blood transfusion (P<0.05). The 30-day cumulative survival rate of the transfusion group was lower than that of the control group (P<0.05). CONCLUSION: Perioperative blood transfusion increases the risks of postoperative pulmonary infection and short-term mortality in off-pump coronary artery bypass grafting patients.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Puente de Arteria Coronaria , Humanos , Estudios Retrospectivos , Puente de Arteria Coronaria/efectos adversos , Resultado del Tratamiento , Puente de Arteria Coronaria Off-Pump/efectos adversos , Transfusión Sanguínea , Complicaciones Posoperatorias/etiología , Factores de Riesgo
9.
Braz J Cardiovasc Surg ; 37(1): 13-19, 2022 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-34673508

RESUMEN

INTRODUCTION: The objective of this study was to identify risk factors for deep sternal wound infection (DSWI) after off-pump coronary artery bypass (OPCAB) grafting surgery. METHODS: A total of 8,442 patients undergoing OPCAB from April 1, 2009 to December 31, 2018 were retrospectively analyzed. A total of 956 were eventually enrolled on this study based on our exclusion criteria. All subjects were divided into two groups: group 1 (n=63) - DSWI; group 2 (n=893) - without DSWI. Patients were excluded if they had one of the following: acute coronary syndrome, conversion to OPCAB grafting surgery, redo procedure, concomitant cardiac surgery procedures. RESULTS: The prevalence of body mass index (BMI) ≥40 kg/m2 (7.9% vs. 1.9%, respectively; P=0.01), lower extremity atherosclerotic artery disease (23.8% vs. 7.2%, respectively; P=0.001) and use of bilateral internal thoracic artery (19.5% vs. 2.5%, respectively; P=0.008) was significantly higher in patients with DSWI. The incidence of morbidities, including reoperation for bleeding (26.4% vs. 2.1%, respectively; P<0.001), stroke (4.8% vs. 0.8%, respectively; P=0.02), acute renal failure (7.9% vs. 0.8%, respectively; P=0.001), delirium (7.9% vs. 1.7%, respectively; P=0.008) and blood transfusion (30.6% vs. 9.8%, respectively; P<0.001) was significantly higher in patients with DSWI. CONCLUSIONS: A BMI of >40 kg/m2, lower extremity artery disease, use of bilateral internal thoracic artery (BITA) graft, postoperative stroke, sepsis, reoperation due to postoperative complications and blood product requirement significantly increased the risk of sternal infection after OPCAB.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Enfermedad de la Arteria Coronaria , Estudios de Casos y Controles , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria Off-Pump/efectos adversos , Enfermedad de la Arteria Coronaria/etiología , Humanos , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento
10.
Rev. méd. Chile ; 149(10): 1412-1422, oct. 2021. graf, tab
Artículo en Español | LILACS | ID: biblio-1389365

RESUMEN

BACKGROUND: The benefits of off-pump coronary artery bypass graft (OPCAB) compared with conventional on-pump coronary artery bypass graft are not well established although several studies show excellent long-term results. AIM: To assess and report the long-term results of OPCAB surgery in a 20-year period in a Chilean Regional Cardiac Surgery Center. PATIENTS AND METHODS: Retrospective analysis of the medical records and surgical protocols of 1353 patients aged 61.3 ± 6.5 years, (69% males) subjected to OPCAB between June 1999 and December 2019. RESULTS: Thirty-four percent of patients presented with unstable angina. On angiography, the left main coronary artery had a proximal obstruction in 15% of patients. Thirty five percent presented with a myocardial infarction of different territories. Thirty percent of patients were managed previously with angioplasty. Preoperative left ventricular function was 45.3% (30-65%). The mean surgical risk Euroscore was 2.84. The mean number of bypasses was 2.7 ± 0.63. 2.6%. Conversion to on pump technique was required in 2.6% of patients. Operative mortality was 2%, myocardial infarction occurred in 3.4%, a new revascularization procedure was required in 2.3% and 2.4% of patients had a stroke. Long term follow up was complete in most patients and 93% are in NHYA functional capacity I. Actuarial survival was 100, 98, 89, 75 and 66% at 1, 5, 10, 15 and 20 years. Actuarial combined cardiovascular events free survival was 100, 98, 87, 68 and 51% at 1,5,10, 15 and 20 years. CONCLUSIONS: OPCAB surgery is a safe surgical technique, with an excellent bypass durability and permeability. It also provides a prolonged time free from cardiac events such as mortality, angina, myocardial infarction, and freedom from a new coronary procedure.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente de Arteria Coronaria Off-Pump/métodos , Infarto del Miocardio , Chile/epidemiología , Estudios Retrospectivos
11.
Rev Med Chil ; 149(10): 1412-1422, 2021 Oct.
Artículo en Español | MEDLINE | ID: mdl-35319630

RESUMEN

BACKGROUND: The benefits of off-pump coronary artery bypass graft (OPCAB) compared with conventional on-pump coronary artery bypass graft are not well established although several studies show excellent long-term results. AIM: To assess and report the long-term results of OPCAB surgery in a 20-year period in a Chilean Regional Cardiac Surgery Center. PATIENTS AND METHODS: Retrospective analysis of the medical records and surgical protocols of 1353 patients aged 61.3 ± 6.5 years, (69% males) subjected to OPCAB between June 1999 and December 2019. RESULTS: Thirty-four percent of patients presented with unstable angina. On angiography, the left main coronary artery had a proximal obstruction in 15% of patients. Thirty five percent presented with a myocardial infarction of different territories. Thirty percent of patients were managed previously with angioplasty. Preoperative left ventricular function was 45.3% (30-65%). The mean surgical risk Euroscore was 2.84. The mean number of bypasses was 2.7 ± 0.63. 2.6%. Conversion to on pump technique was required in 2.6% of patients. Operative mortality was 2%, myocardial infarction occurred in 3.4%, a new revascularization procedure was required in 2.3% and 2.4% of patients had a stroke. Long term follow up was complete in most patients and 93% are in NHYA functional capacity I. Actuarial survival was 100, 98, 89, 75 and 66% at 1, 5, 10, 15 and 20 years. Actuarial combined cardiovascular events free survival was 100, 98, 87, 68 and 51% at 1,5,10, 15 and 20 years. CONCLUSIONS: OPCAB surgery is a safe surgical technique, with an excellent bypass durability and permeability. It also provides a prolonged time free from cardiac events such as mortality, angina, myocardial infarction, and freedom from a new coronary procedure.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Infarto del Miocardio , Anciano , Chile/epidemiología , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente de Arteria Coronaria Off-Pump/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
12.
Artículo en Inglés | MEDLINE | ID: mdl-33155774

RESUMEN

Numerous coronary revascularization studies have documented superior results associated with bilateral internal thoracic artery grafting compared with single internal thoracic artery grafting. However, concerns about perioperative complications and the technical challenges inherent in bilateral grafting limit its broad utilization. In this video tutorial we show our routine technique for off-pump bilateral internal thoracic artery grafting, and also discuss the experience of our department and the evolving process of how we have performed myocardial revascularization over the past two decades.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Enfermedad de la Arteria Coronaria/cirugía , Complicaciones Intraoperatorias/prevención & control , Arterias Mamarias/trasplante , Revascularización Miocárdica/métodos , Complicaciones Posoperatorias/prevención & control , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente de Arteria Coronaria Off-Pump/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
13.
Braz J Cardiovasc Surg ; 35(5): 797-814, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33118746

RESUMEN

OBJECTIVE: There is currently much debate about which patients would benefit more after on- or off-pump coronary artery bypass grafting (CABG). The aim of this meta-analysis and meta-regression is to investigate the effect of age on short-term clinical outcomes after these approaches. METHODS: To identify potential studies, systematic searches were carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy included the key concepts of "cardiopulmonary bypass" AND "coronary artery bypass grafting" AND "off pump" OR "on pump". This was followed by a meta-analysis and meta-regression investigating the effect of age on the incidences of stroke, myocardial infarction (MI), and mortality. RESULTS: Thirty-seven studies including 15,324 participants were analysed. Overall, there was a significant odds reduction for patients receiving off-pump CABG suffering a stroke (odds ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P=0.048); however, when patients were subdivided according to different age bands, this difference disappeared. There were also no significant differences in the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P=0.241) or MI (OR 0.937, 95% CI 0.795, 1.105, P=0.439). Meta-regression analysis revealed no significant relationship between age and stroke (P=0.652), age and mortality (P=548), and age and MI (P=0.464). CONCLUSION: Patients undergoing CABG are becoming older and may suffer from multiple comorbidities increasing their risk profile. However, with respect to short-term clinical outcomes, the patient's age does not help in determining whether off- or on-pump is superior.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Infarto del Miocardio , Accidente Cerebrovascular , Puente de Arteria Coronaria , Puente de Arteria Coronaria Off-Pump/efectos adversos , Humanos , Masculino , Complicaciones Posoperatorias , Calidad de Vida , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Resultado del Tratamiento
14.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;35(5): 797-814, Sept.-Oct. 2020. tab, graf
Artículo en Inglés | LILACS, Sec. Est. Saúde SP | ID: biblio-1137348

RESUMEN

Abstract Objective: There is currently much debate about which patients would benefit more after on- or off-pump coronary artery bypass grafting (CABG). The aim of this meta-analysis and meta-regression is to investigate the effect of age on short-term clinical outcomes after these approaches. Methods: To identify potential studies, systematic searches were carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy included the key concepts of "cardiopulmonary bypass" AND "coronary artery bypass grafting" AND "off pump" OR "on pump". This was followed by a meta-analysis and meta-regression investigating the effect of age on the incidences of stroke, myocardial infarction (MI), and mortality. Results: Thirty-seven studies including 15,324 participants were analysed. Overall, there was a significant odds reduction for patients receiving off-pump CABG suffering a stroke (odds ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P=0.048); however, when patients were subdivided according to different age bands, this difference disappeared. There were also no significant differences in the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P=0.241) or MI (OR 0.937, 95% CI 0.795, 1.105, P=0.439). Meta-regression analysis revealed no significant relationship between age and stroke (P=0.652), age and mortality (P=548), and age and MI (P=0.464). Conclusion: Patients undergoing CABG are becoming older and may suffer from multiple comorbidities increasing their risk profile. However, with respect to short-term clinical outcomes, the patient's age does not help in determining whether off- or on-pump is superior.


Asunto(s)
Humanos , Masculino , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/epidemiología , Puente de Arteria Coronaria Off-Pump/efectos adversos , Infarto del Miocardio , Complicaciones Posoperatorias , Calidad de Vida , Puente de Arteria Coronaria , Resultado del Tratamiento
15.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;35(3): 396-398, May-June 2020. tab, graf
Artículo en Inglés | LILACS, Sec. Est. Saúde SP | ID: biblio-1137278

RESUMEN

Abstract Coronary artery bypass grafting is a commonly performed procedure for coronary revascularization. We describe the successful management of left ventricular dissecting hematoma, caused by the tissue stabilizer, while performing off-pump coronary artery bypass graft procedure.


Asunto(s)
Humanos , Puente de Arteria Coronaria Off-Pump/efectos adversos , Ventrículos Cardíacos/cirugía , Resultado del Tratamiento , Hematoma/cirugía , Hematoma/etiología , Hematoma/diagnóstico por imagen
16.
Braz J Cardiovasc Surg ; 35(3): 396-398, 2020 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-31478366

RESUMEN

Coronary artery bypass grafting is a commonly performed procedure for coronary revascularization. We describe the successful management of left ventricular dissecting hematoma, caused by the tissue stabilizer, while performing off-pump coronary artery bypass graft procedure.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Ventrículos Cardíacos/cirugía , Puente de Arteria Coronaria Off-Pump/efectos adversos , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/cirugía , Humanos , Resultado del Tratamiento
17.
Eur J Cardiothorac Surg ; 57(2): 271-276, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31209460

RESUMEN

OBJECTIVES: Our goal was to describe the experience at 2 centres with off-pump coronary artery bypass grafting using a left thoracotomy. METHODS: From January 2002 to December 2017, a total of 2528 consecutive patients (578 women, mean age 62.3 ± 9.1 years) were operated on using this technique. Data were collected prospectively and analysed retrospectively. RESULTS: There were no conversions to median sternotomy and 6 patients (0.2%) were converted to on-pump CABG. The mean number of grafts per patient was 2.8 ± 0. 9. The 30-day mortality rate was 1.0% (25 patients). Most patients were extubated in the operating theatre (97.3%), and 47 patients (1.9%) needed re-exploration for bleeding. Seven patients (0.3%) experienced a cerebrovascular event; 4 (0.3%) had a postoperative myocardial infarction; and 84 (3.4%) had new-onset atrial fibrillation. A total of 1510 patients (61.1%) were discharged from the hospital in the first 48 h after surgery. Long-term survival rates were 98.8%, 93.6% and 69.1% at 1, 5 and 10 years, respectively (central image). During the follow-up period, 60 patients (2.9%) were re-examined for recurrence of angina with a new coronary angiogram; of those, 24 (1.2%) required percutaneous coronary intervention and 11 (0.5%) had redo surgery. CONCLUSIONS: A left thoracotomy is a safe alternative to a median sternotomy for coronary artery bypass grafting on the beating heart, with low early complications and good mid- and long-term results.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Toracotomía , Anciano , Puente de Arteria Coronaria , Puente de Arteria Coronaria Off-Pump/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Retrospectivos , Toracotomía/efectos adversos , Resultado del Tratamiento
18.
Braz J Cardiovasc Surg ; 34(4): 412-419, 2019 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-31454195

RESUMEN

OBJECTIVE: To investigate whether low bleeding influences the early outcomes after off-pump coronary artery bypass grafting (CABG). METHODS: Retrospective analysis of ischemic heart disease patients who underwent off-pump CABG from January 2013 to December 2017. Patients were divided into low-bleeding group (n=659) and bleeding group (n=270), according to total drainage from chest tube during the first postoperative 12 hours. Clinical material and early outcomes were compared between the groups. RESULTS: Baseline was similar in the two groups. Operation time was 270±51 min in the low-bleeding group and 235±46 min in the bleeding group (P<0.0001). The low-bleeding group presented smaller drainage during the first 12 h (237±47 ml) and shorter mechanical ventilation time (6.86±3.78 h) than the bleeding group (557±169 ml and 10.66±5.19 h, respectively) (P<0.0001). Hemodynamic status was more stable in the low-bleeding group (P<0.0001) and usage rate of more than two vasoactive agents in this group was lower than in the bleeding group (P<0.0001). Number of distal anastomosis, reoperation for bleeding, suddenly increase in chest tube output, intensive care unit (ICU) stay, hospital stay, and other early outcomes had no statistical significance between the groups (P>0.05). CONCLUSION: Postoperative bleeding < 300 ml/12 h in off-pump CABG patients did not require blood product transfusion and reoperation and that would contribute to reduction in mechanical ventilation time and maintaining hemodynamic stability. Bleeding < 800 ml during the first postoperative 12 h did not increase infection rates and ICU length of stay.


Asunto(s)
Puente de Arteria Coronaria Off-Pump/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Hemorragia Posoperatoria/sangre , Anciano , Transfusión Sanguínea , Femenino , Hemodinámica , Hemostasis , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Reoperación , Respiración Artificial , Estudios Retrospectivos , Factores de Tiempo
19.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;34(4): 412-419, July-Aug. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1020504

RESUMEN

Abstract Objective: To investigate whether low bleeding influences the early outcomes after off-pump coronary artery bypass grafting (CABG). Methods: Retrospective analysis of ischemic heart disease patients who underwent off-pump CABG from January 2013 to December 2017. Patients were divided into low-bleeding group (n=659) and bleeding group (n=270), according to total drainage from chest tube during the first postoperative 12 hours. Clinical material and early outcomes were compared between the groups. Results: Baseline was similar in the two groups. Operation time was 270±51 min in the low-bleeding group and 235±46 min in the bleeding group (P<0.0001). The low-bleeding group presented smaller drainage during the first 12 h (237±47 ml) and shorter mechanical ventilation time (6.86±3.78 h) than the bleeding group (557±169 ml and 10.66±5.19 h, respectively) (P<0.0001). Hemodynamic status was more stable in the low-bleeding group (P<0.0001) and usage rate of more than two vasoactive agents in this group was lower than in the bleeding group (P<0.0001). Number of distal anastomosis, reoperation for bleeding, suddenly increase in chest tube output, intensive care unit (ICU) stay, hospital stay, and other early outcomes had no statistical significance between the groups (P>0.05). Conclusion: Postoperative bleeding < 300 ml/12 h in off-pump CABG patients did not require blood product transfusion and reoperation and that would contribute to reduction in mechanical ventilation time and maintaining hemodynamic stability. Bleeding < 800 ml during the first postoperative 12 h did not increase infection rates and ICU length of stay.


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad de la Arteria Coronaria/cirugía , Hemorragia Posoperatoria/sangre , Puente de Arteria Coronaria Off-Pump/efectos adversos , Periodo Posoperatorio , Reoperación , Respiración Artificial , Factores de Tiempo , Transfusión Sanguínea , Estudios Retrospectivos , Mortalidad Hospitalaria , Hemodinámica , Hemostasis , Unidades de Cuidados Intensivos , Tiempo de Internación
20.
Angiology ; 70(4): 337-344, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30286625

RESUMEN

It was a randomized trial, and 308 patients undergoing revascularization were randomly assigned: 155 to off-pump coronary artery bypass (OPCAB) and 153 to on-pump coronary artery bypass (ONCAB). End points were freedom from death, myocardial infarction, revascularization, and cerebrovascular accidents. The rates for 10-year, event-free survival for ONCAB versus OPCAB were 69.6% and 64%, (hazard ratio [HR]: 0.88; 95% confidence interval [CI] 0.86-1.02; P = .41), respectively. Adjusted Cox proportional hazard ratio was similar (HR: 0.92; 95% CI 0.61-1.38, P = .68). A difference occurred between the duration of OPCAB and ONCAB, respectively (4.9 ± 1.5 vs 6.6 ± 1.1 h, P < .001). Statistical differences occurred between OPCAB and ONCAB in the length of intensive care unit (ICU) stay (20 ± 2.5 vs 48 ± 10 hours, P < .001), time to extubation (5.5 ± 4.2 vs 10.2 ± 3.5 hours, P < .001), hospital stay (6.7 ± 1.4 vs 9.2 ± 1.3 days, P < .001), higher incidence of atrial fibrillation (AF; 33 vs 5 patients, P < .001), and blood requirements (46 vs 64 patients, P < .001). Grafts per patient was higher in ONCAB (3.15 vs 2.55 grafts, P < .001). No difference existed between the groups in primary composite end points at 10-year follow-up. Although OPCAB surgery was related to a lower number of grafts and higher incidence of AF, it had no effects related to long-term outcomes.


Asunto(s)
Puente Cardiopulmonar , Puente de Arteria Coronaria Off-Pump , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Estenosis Coronaria/cirugía , Anciano , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/mortalidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Puente de Arteria Coronaria Off-Pump/efectos adversos , Puente de Arteria Coronaria Off-Pump/mortalidad , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Supervivencia sin Progresión , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
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