Readmission destination following cardiac surgery and its association with mortality outcomes: a population-based retrospective study.

Background: It is unclear how pre-surgery transfer relates to readmission destination among patients undergoing cardiac surgery and whether readmission to a hospital other than the operating hospital is associated with increased mortality. Methods: We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years who had an emergency readmission within 30 days following coronary artery bypass graft (CABG) or surgical aortic valve replacement (SAVR) in 2003-2022. Mixed-effect multi-level modelling was used to evaluate associations of readmission destination with 30-day mortality, overall and stratified by pre-surgery transfer. Findings: Of 102,540 patients undergoing cardiac surgery (isolated CABG = 63,000, SAVR = 27,482, combined = 12,058), 28.7% (n = 29,398) had pre-surgery transfer, while the 30-day readmission rate was 14.7% (n = 14,708). During readmission, 35.7% (3499/9795) of those without pre-surgery transfer and 12.0% (590/4913) of those with pre-surgery transfer returned to the operating hospital. Among readmitted patients, 30-day mortality did not differ significantly for those who were readmitted to a non-index hospital, both overall (adjusted odds ratio [aOR] = 1.03 95% CI 0.75-1.41), and in analyses stratified by pre-surgery transfer (no transfer: aOR = 1.07, 95% CI 0.75-1.52; transfer: aOR = 0.88, 95% CI 0.45-1.72). Among patients who had pre-surgery transfer, 30-day mortality was similar among patients who were readmitted to the index operating hospital (reference), the initial admitting hospital (aOR = 1.00, 95% CI 0.50-2.00) or a third, different, hospital (aOR = 0.70, 95% CI 0.33-1.48). Interpretation: Although many Australian patients who are readmitted following cardiac surgery are readmitted to hospitals different to the operating or initial admitting hospital, such readmissions are not associated with increased mortality. Funding: This study was funded by a National Health and Medical Research Foundation of Australia (NHMRC) Project Grant (#1162833).

Outcomes of nonemergency cardiac surgery after overnight operative workload: A statewide experience.

Objective: Cardiac surgeons experience unpredictable overnight operative responsibilities, with variable rest before same-day, first-start scheduled cases. This study evaluated the frequency and associated impact of a surgeon's overnight operative workload on the outcomes of their same-day, first-start operations. Methods: A statewide cardiac surgery quality database was queried for adult cardiac surgical operations between July 1, 2011, and March 1, 2021. Nonemergency, first-start, Society of Thoracic Surgeons predicted risk of mortality operations were stratified by whether or not the surgeon performed an overnight operation that ended after midnight. A generalized mixed effect model was used to evaluate the effect of overnight operations on a Society of Thoracic Surgeons composite outcome (5 major morbidities or operative mortality) of the first-start operation. Results: Of all first-start operations, 0.4% (239/56,272) had a preceding operation ending after midnight. The Society of Thoracic Surgeons predicted risk of morbidity and mortality was similar for first-start operations whether preceded by an overnight operation or not (overnight operation: 11.3%; no overnight operation: 11.7%, P = .42). Unadjusted rates of the primary outcome were not significantly different after an overnight operation (overnight operation: 13.4%; no overnight operation: 12.3%, P = .59). After adjustment, overnight operations did not significantly impact the risk of major morbidity or mortality for first-start operations (adjusted odds ratio, 1.1, P = .70). Conclusions: First-start cardiac operations performed after an overnight operation represent a small subset of all first-start Society of Thoracic Surgeons predicted risk operations. Overnight operations do not significantly influence the risk of major morbidity or mortality of first-start operations, which suggests that surgeons exercise proper judgment in determining appropriate workloads.

Persistent income-based disparities in clinical outcomes of cardiac surgery across the United States: A contemporary appraisal.

Objective: Although national efforts have aimed to improve the safety of inpatient operations, income-based inequities in surgical outcomes persist, and the evolution of such disparities has not been examined in the contemporary setting. We sought to examine the association of community-level household income with acute outcomes of cardiac procedures over the past decade. Methods: All adult hospitalizations for elective coronary artery bypass grafting/valve operations were tabulated from the 2010-2020 Nationwide Readmissions Database. Patients were stratified into quartiles of income, with records in the 76th to 100th percentile designated as highest and those in the 0 to 25th percentile as lowest. To evaluate the change in adjusted risk of in-hospital mortality, complications, and readmission over the study period, estimates were generated for each income level and year. Results: Of approximately 1,848,755 hospitalizations, 406,216 patients (22.0%) were classified as highest income and 451,988 patients (24.4%) were classified as lowest income. After risk adjustment, lowest income remained associated with greater likelihood of in-hospital mortality (adjusted odds ratio, 1.61, 95% CI, 1.51-1.72), any postoperative complication (adjusted odds ratio, 1.19, CI, 1.15-1.22), and nonelective readmission within 30 days (adjusted odds ratio, 1.07, CI, 1.05-1.10). Overall adjusted risk of mortality, complications, and nonelective readmission decreased for both groups from 2010 to 2020 (P < .001). Further, the difference in risk of mortality between patients of lowest and highest income decreased by 0.2%, whereas the difference in risk of major complications declined by 0.5% (both P < .001). Conclusions: Although overall in-hospital mortality and complication rates have declined, low-income patients continue to face greater postoperative risk. Novel interventions are needed to address continued income-based disparities and ensure equitable surgical outcomes.

Comparing the Effectiveness of Open and Minimally Invasive Approaches in Coronary Artery Bypass Grafting: A Systematic Review.

Coronary artery bypass grafting (CABG) is an essential operation for patients who have severe coronary artery disease (CAD). Both open and minimally invasive CABG methods are used to treat CAD. This in-depth review looks at the latest research on the effectiveness of open versus minimally invasive CABG. The goal is to develop evidence-based guidelines that will improve surgical outcomes. This systematic review used databases such as PubMed, MEDLINE, and Web of Science for a full electronic search. We adhered to the PRISMA guidelines and registered the results in the PROSPERO. The search method used MeSH phrases and many different study types to find papers. After removing duplicate publications and conducting a screening process, we collaboratively evaluated the full texts to determine their inclusion. We then extracted data, including diagnosis, the total number of patients in the study, clinical recommendations from the studies, surgical complications, angina recurrence, hospital stay duration, and mortality rates. Many studies that investigate open and minimally invasive CABG methods have shown that the type of surgery can have a large effect on how well the patient recovers and how well the surgery works overall. While there are limited data on the possible advantages of minimally invasive CABG, a conclusive comparison with open CABG is still dubious. Additional clinical trials are required to examine a wider spectrum of patient results.

Renal Outcome in Patients Undergoing Minimally Invasive Total Coronary Revascularization via Anterior Minithoracotomy Compared to Full Median Sternotomy Coronary Artery Bypass Grafting.

Objective: Renal dysfunction and acute renal failure after coronary artery bypass grafting (CABG) are among the main causes of increased mortality and morbidity. A sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced with promising early and midterm outcomes in multivessel coronary artery disease. There are limited data regarding renal complications in patients undergoing the TCRAT technique. The present study analyzed renal outcomes in TCRAT compared to CABG via full median sternotomy (FS). Methods: We analyzed the records of 227 consecutive TCRAT patients (from September 2021 to June 2023) and 228 consecutive FS patients (from January 2017 to December 2018) who underwent nonemergent CABG. Following propensity score matching, preoperative baseline characteristics-including age, sex, diabetes mellitus, arterial hypertension, left ventricular ejection fraction, EuroSCORE II, preoperative serum creatinine, estimated glomerular filtration rate (eGFR), serum urea, and pre-existing chronic renal insufficiency-were comparable between the TCRAT (n = 170) and the FS group (n = 170). The examined postoperative renal parameters and complications were serum creatinine, eGFR, and serum urea on the first postoperative day. Moreover, serum creatinine, eGFR and serum urea at the time of discharge, postoperative ARF, and hemodialysis were investigated. Additionally, the duration of operation, CPB time, aortic cross-clamp time, ICU and hospital stay, ECMO support, rethoracotomy and in-hospital mortality were analyzed. The parameters were compared between groups using a Student's t-test or Mann-Whitney U test. Results: The duration of operation (332 ± 66 vs. 257 ± 61 min; p < 0.05), CPB time (161 ± 40 vs. 116 ± 38 min; p < 0.05), and aortic cross-clamp time (100 ± 31 vs. 76 ± 26; p < 0.05) were longer in the TCRAT group. ICU (1.8 ± 2.2 vs. 2.9 ± 3.6 days; p < 0.05) and hospital (10.4 ± 7.6 vs. 12.4 ± 7.5 days; p < 0.05) stays were shorter in the TCRAT group. There were no differences between groups with regard to the renal parameters examined. Conclusions: Despite a prolonged duration of operation, CPB time, and aortic cross-clamp time when using the TCRAT technique, no increase in renal complications were found. In addition, ICU and hospital stays in the TCRAT group were shorter compared to CABG via full median sternotomy.

Management of Myocardial Infarction and the Role of Cardiothoracic Surgery.

Myocardial infarction (MI) is a leading cause of mortality globally and is predominantly attributed to coronary artery disease (CAD). MI is categorized as ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI), each with distinct etiologies and treatment pathways. The goal in treatment for both is restoring blood flow back to the myocardium. STEMI, characterized by complete occlusion of a coronary artery, is managed urgently with reperfusion therapy, typically percutaneous coronary intervention (PCI). In contrast, NSTEMI involves a partial occlusion of a coronary artery and is treated with medical management, PCI, or coronary artery bypass grafting (CABG) depending on risk scores and clinical judgment. The Heart Team approach can assist in deciding which reperfusion technique would provide the greatest benefit to the patient and is especially useful in complicated cases. Despite advances in treatment, complications such as cardiogenic shock (CS) and ischemic heart failure (HF) remain significant. While percutaneous coronary intervention (PCI) is considered the primary treatment for MI, it is important to recognize the significance of cardiac surgery in treatment, especially when there is complex disease or MI-related complications. This comprehensive review analyzes the role of cardiac surgery in MI management, recognizing when it is useful, or not.

Comparison of routine del Nido cardioplegia vs two types of modified del Nido cardioplegias for myocardial protection among patients undergoing coronary artery bypass grafting (CABG) surgeries: A randomized double-blind clinical trial.

BACKGROUND: The del Nido cardioplegia solution is a widely used method for myocardial protection in various settings. However, there is limited evidence of its effectiveness in adult cardiac surgery, and the baseline solution, Plasma Lyte A, is not readily available, leading to the use of alternative baseline solutions. This study aims to investigate the effectiveness of routine del Nido cardioplegia in adult cardiac surgery and the impact of different baseline solutions on myocardial protection and other perioperative outcomes. METHODS: This study was a prospective, double-blind randomized parallel group clinical trial conducted at a single tertiary care hospital in Iran. A total of 187 adult patients were evaluated for eligibility, of which 120 met the inclusion criteria for elective isolated CABG surgery. The patients were randomly assigned to three groups, with each group consisting of 40 patients. The control group received a normal saline-based routine del Nido cardioplegia, Intervention Group A received Ringer lactate-based del Nido cardioplegia, and Intervention Group B received plain Ringer-based del Nido cardioplegia. The levels of Creatine Kinase-MB (CK-MB), Troponin T, Troponin I, and lactate were primarily assessed at four different times: after anesthesia induction (Baseline), 2 h, 12 h, and 24 h. RESULTS: Preoperative demographic and clinical characteristics were the same among groups with insignificant differences (p > 0.05). There was no significant difference among groups based on CK-MB, Troponin T, Troponin I, and lactate levels (p = 0.078, 0.143, 0.311, and 0.129 respectively). However, there was a significant difference in the time effect of Troponin T and Lactate (p = 0.034, p = <0.001). CONCLUSION: Normal saline, Ringer lactate, and plain Ringer provide comparable myocardial protection in adult-isolated CABG surgery with modified del Nido cardioplegia. Larger studies are needed to identify the best alternative to Plasma Lyte A while maintaining del Nido cardioplegia as the control.

Association between preoperative right heart catheterization parameters and outcomes in patients undergoing isolated coronary artery bypass grafting.

Right ventricular catheterization may capture information that can help define prognosis before coronary artery bypass grafting (CABG). In this study, we evaluate the association between preoperative right heart catheterization parameters and outcomes of patients undergoing isolated CABG. All patients undergoing isolated CABG at our institution from 2013 to 2021 who also underwent preoperative right heart catheterization <14 days prior to isolated CABG were retrospectively queried. A total of 2343 patients underwent isolated CABG of whom 78 patients [20 (25.6%) female] were included in the final analysis. On multivariable regression, central venous pressure was significantly associated with operative mortality (odds ratio 1.14, 95% confidence interval 1.02-1.27, P = 0.024). Preoperative cardiac index was significantly inversely associated with intensive care unit length of stay (odds ratio 0.72, 95% confidence interval 0.62-0.84, P < 0.001) and duration of inotropic support (odds ratio 0.76, 95% confidence interval 0.63-0.92, P < 0.01). Assessment of preoperative cardiac function by right heart catheterization should be considered in high-risk patient populations, particularly those who have significant left ventricular dysfunction on preoperative echocardiography that would make them candidate for percutaneous coronary intervention, left ventricular assist device or heart transplantation. Further, right heart catheterization can help to guide preoperative optimization and intra-/postoperative decision-making.

Cost Analysis of Robot-Assisted Versus On-Pump and Off-Pump Coronary Artery Bypass Grafting: A Single-Center Surgical and 30-Day Outcomes Comparison.

OBJECTIVE: Throughout Europe, the interest in implementing robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) has been growing. However, concerns about additional costs have emerged concurrently. In this analysis, we aim to provide a comparison of the cumulative perioperative costs of RA-MIDCAB, on-pump coronary artery bypass grafting (CABG), and off-pump CABG (OPCAB). METHODS: We conducted a propensity score-matched analysis comparing patients undergoing RA-MIDCAB with those undergoing CABG or OPCAB at our institution from January 2016 to December 2021. After matching, we analyzed the combined intraoperative surgical costs and 30-day postoperative costs. We first compared RA-MIDCAB costs to CABG and then to OPCAB separately. Violin plots illustrated the cost distribution among individual patients. Total cost uncertainty was estimated using 1,000 bootstrapping iterations. RESULTS: Seventy-nine RA-MIDCAB patients were matched to 158 CABG patients, and 80 RA-MIDCAB patients were matched to 149 OPCAB patients. Considering both surgical and clinical outcomes, RA-MIDCAB yielded an average cost of €17,121 per patient (€16,781 to €33,294), CABG was €16,571 per patient (€16,664 to €41,860), and OPCAB was €15,463 per patient (€10,895 to €57,867). After bootstrap iterations, RA-MIDCAB was found to be €472 (2.8%) and €1,599 (10.3%) more expensive per patient than CABG and OPCAB, respectively. CONCLUSIONS: In The Netherlands, the adoption of RA-MIDCAB did not show a significant economic impact on hospital resources. The additional robotic costs for the surgery were almost entirely offset by the cost savings during the postoperative hospital stay. However, these comparisons may differ when considering hybrid coronary revascularization with its additional percutaneous coronary intervention costs.

Transatlantic analysis of patient profiles and mid-term survival after isolated coronary artery bypass grafting: a head-to-head comparison between the European DuraGraft Registry and the US STS Registry.

Introduction: Although cardiovascular surgery societies in Europe and the USA constantly strive for the exchange of knowledge and best practices in coronary artery bypass grafting (CABG), the available evidence on whether such efforts result in similar patient outcomes is limited. Therefore, in the present analysis, we sought to compare patient profiles and overall survival outcomes for up to 3 years between large European and US patient cohorts who underwent isolated CABG. Methods: Patients from the European DuraGraft Registry (n = 2,522) who underwent isolated CABG at 45 sites in eight different European countries between 2016 and 2019 were compared to randomly selected patients from the US STS database who were operated during the same period (n = 294,725). Free conduits (venous and arterial grafts) from the DuraGraft Registry patients were intraoperatively stored in DuraGraft, an endothelial damage inhibitor, before anastomosis, whereas grafts from the STS Registry patients in standard-of-care solutions (e.g., saline). Propensity score matching (PSM) models were used to account for differences in patient baseline and surgical characteristics, using a primary PSM with 35 variables (2,400 patients matched) and a secondary PSM with 25 variables (2,522 patients matched, sensitivity analysis). The overall survival for up to 3 years after CABG was assessed as the primary endpoint. Results: The comparison of patient profiles showed significant differences between the European and US cohorts. The European patients had more left main disease, underwent more off-pump CABG, and received more arterial grafts together with more complete arterial grafting procedures. In contrast, the US patients received more distal anastomoses with more saphenous vein grafts (SVGs) that were mainly harvested endoscopically. Such differences, however, were well balanced after PSM for the mortality comparison. Mortality comparison at 30 days, 12 months, and 24 months between the European and US patients was 2.38% vs. 1.96%, 4.32% vs. 4.79%, and 5.38% vs. 6.96%, respectively. At 36 months, the mortality was significantly lower in the European patients than that of their US counterparts (7.37% vs. 9.65%; p-value = 0.016). The estimated hazard ratio (HR) was 1.29 (95% CI 1.05-1.59). Conclusion: This large-scale transatlantic comparative analysis shows that there are some significant differences in patient profiles between large cohorts of European and US patients. These differences were adjusted by using PSM for the mortality analysis. No significant difference in mortality was detected between groups through 2 years, but survival was significantly better in the European DuraGraft Registry patients at 3 years post-CABG.

Effectiveness of Osteopathic Manipulative Treatment on Hemodynamic and Pulmonary Response in Coronary Artery Bypass Graft Patients: A Meta-Analysis.

In the realm of cardiovascular care, the quest for innovative and holistic approaches to enhance patient outcomes persists. This study analyzes osteopathic manipulative treatment (OMT) and its potential impact on pain intensity, length of hospitalization, respiratory function, and hemodynamic response in patients undergoing coronary artery bypass grafting (CABG). OMT, with its emphasis on physical manipulation of the body's muscles and tissues, presents a potential treatment beyond the realms of conventional post-operative care. Google Scholar was used to identify four relevant articles for further review. RevMan 5.4 was utilized for meta-analytic evaluation in order to produce forest plots with associated standardized mean difference (SMD), confidence interval (CI), and heterogeneity (I²). Output from collection and analysis revealed statistically significant decreases in negatively viewed outcomes, including length of stay (SMD 0.39; 95% CI -0.02,-0.76; I² ≤ 0%) and pain control (SMD 1.67; 95% CI -1.34,-0.67; I² ≤ 94%). Parameters for respiratory function and hemodynamic response, including vital capacity (SMD 0.91; 95% CI 0.57,1.24; I² ≤ 96%) and maximal aerobic capacity (SMD 0.50; 95% CI 0.19, 0.82; I² ≤ 0%), showed a statistically significant increase. These findings suggest the incorporation of OMT as a viable adjunct for postoperative management in CABG patients, yielding favorable reductions in adverse outcomes such as length of hospitalization and pain. Moreover, it has demonstrated enhancement in maximal aerobic and vital capacity. This study suggests that the addition of osteopathic management to post-bypass standards can ultimately prevent certain morbidities associated with this specific patient population.

Imaging-guided PCI improves outcomes in patients with multivessel disease a meta-analysis of randomized and observational trials comparing treatment of ACS.

OBJECTIVE: This meta-analysis sought to investigate if IVUS-guided PCI (IVUS-PCI) can improve outcomes compared to standard PCI and CABG in patients with multivessel CAD. BACKGROUND: Coronary artery disease (CAD) is traditionally revascularized by either percutaneous coronary intervention (PCI) or coronary artery bypass (CABG) with a historical benefit of CABG over PCI in multivessel CAD. Intravascular ultrasound-guided PCI (IVUS-PCI) may improve outcomes compared to angiography alone. METHODS: We undertook a systematic search using PubMed, MEDLINE, EMBASE, Web of Science, and Ovid from 2017 through 2022. We included randomized controlled trials and observational trials comparing PCI vs CABG for multivessel CAD evaluated by two independent reviewers. We extracted baseline data and major adverse cardiovascular events (MACE; death from any cause, MI, stroke, or repeat revascularization) at one year. Three trials were selected based on study arm criteria: FAME 3, BEST, and Syntax II. RESULTS: IVUS-PCI significantly reduced death from any cause (OR 0.45, CI 0.272-0.733, p = 0.001), repeat revascularization (OR 0.62, CI 0.41-0.95, p = 0.03), and showed a non-significant reduction in MACE (OR 0.74, CI 0.54-1.01, p = 0.054) when compared to CABG. IVUS-PCI significantly reduced MACE (OR 0.52, CI 0.38-0.72, p < 0.001) and showed a non-significant reduction in death (OR 0.66, CI 0.36-1.18, p = 0.16) and numerically reduced repeat revascularization (OR 0.66, CI95 0.431-1.02, p = 0.06) when compared to PCI without IVUS. CONCLUSION: IVUS-PCI reduces cardiovascular outcomes in patients with multivessel disease compared to CABG and angiographically-guided PCI at one year. These results reinforce the importance of IVUS-PCI in complex CAD and provide evidence for improved PCI outcomes compared to CABG for multivessel CAD.

A Signature of Pre-Operative Biomarkers of Cellular Senescence to Predict Risk of Cardiac and Kidney Adverse Events after Cardiac Surgery.

Importance: Improved pre-operative risk stratification methods are needed for targeted risk mitigation and optimization of care pathways for cardiac patients. This is the first report demonstrating pre-operative, aging-related biomarkers of cellular senescence and immune system function can predict risk of common and serious cardiac surgery-related adverse events. Design: Multi-center 331-patient cohort study that enrolled patients undergoing coronary artery bypass grafing (CABG) surgery with 30-day follow-up. Included a quaternary care center and two community-based hospitals. Primary outcome was KDIGO-defined acute kidney injury (AKI). Secondary outcomes: decline in eGFR ≥25% at 30d and a composite of major adverse cardiac and kidney events at 30d (MACKE30). Biomarkers were assessed in blood samples collected prior to surgery. Results: A multivariate regression model of six senescence biomarkers (p16, p14, LAG3, CD244, CD28 and suPAR) identified patients at risk for AKI (NPV 86.6%, accuracy 78.6%), decline in eGFR (NPV 93.5%, accuracy 85.2%), and MACKE30 (NPV 91.4%, accuracy 79.9%). Patients in the top risk tertile had 7.8 (3.3-18.4) higher odds of developing AKI, 4.5 (1.6-12.6) higher odds of developing renal decline at 30d follow-up, and 5.7 (2.1-15.6) higher odds of developing MACKE30 versus patients in the bottom tertile. All models remained significant when adjusted for clinical variables. Conclusions: A network of senescence biomarkers, a fundamental mechanism of aging, can identify patients at risk for adverse kidney and cardiac events when measured pre-operatively. These findings lay the foundation to improve pre-surgical risk assessment with measures that capture heterogeneity of aging, thereby improving clinical outcomes and resource utilization in cardiac surgery.

A Comparative Analysis of Single Versus Multiple Arterial Grafts in Coronary Arterial Bypass Grafting: Initial Experience in Iraq.

INTRODUCTION: The global recognition of multiple arterial grafting (MAG) and total arterial grafting (TAG) in coronary artery bypass grafting (CABG) is increasing. However, many centers have not yet adopted these procedures. Our study aims to examine the intraoperative, early postoperative, and two-year follow-up outcomes associated with MAG and TAG in candidates for CABG. The goal is to provide valuable insights into the role of these procedures. METHODS: A prospective comparative study was conducted at Sulaimani Cardiac Hospital to analyze a cohort of 300 patients who underwent CABG surgery between January 2021 and April 2022. Convenience sampling was used to select participants. Prior to surgery, patients underwent comprehensive pre-operative evaluations, with certain CABG types being excluded. The patients were then categorized into three groups based on their surgical approach: single arterial conduit (SA), two arterial conduits (MA), and total arterial revascularization (TA). The standard bypass procedure was performed for all patients, and they were monitored for 30 days, six months, and two years after the surgery. A range of variables, including bypass and cross-clamp times, as well as postoperative complications such as bleeding and stroke, were recorded and analyzed. Statistical Product and Service Solutions (SPSS, version 25; IBM Corp., Armonk, NY) was used for this analysis, with a predetermined significance threshold of p ≤ 0.05. RESULTS: The study included 300 participants who underwent CABG. The participants had an average age of 61.19 ± 4.67 years (95% CI: 36-81) and an average BMI of 27.40 ± 8.4 kg/m² (95% CI: 18-45). Diabetes was present in 40.3% of the patients, and the majority of the participants were male (77.7%). The number of vessels involved in the bypass varied, with two vessels in 21% of cases, three vessels in 65%, and four vessels in 14%. The left internal thoracic artery (LITA) was primarily used for arterial revascularization, and additional arterial conduits were used in 30.3% of cases. Statistical analysis showed significant differences in the number of grafts among patient groups (P = 0.042). However, there were no significant differences in bypass duration, cross-clamp duration, stroke incidence, or in-hospital mortality rates among the groups (P > 0.05). The rates of myocardial infarction (MI) approached significance (P = 0.05), and the mortality rates were comparable over a two-year period after CABG (4.7%) and at shorter intervals. These findings highlight the importance of age and the number of grafts in determining outcomes in CABG patients. CONCLUSION: In a developing nation, the lack of a specialized center for MAG does not hinder the implementation of MAG or TAG. The overall occurrence of complications after CABG is similar across all groups, except for MI. Patients who undergo MAG have higher rates of overall survival compared to those who receive SA and TAG.

Effects of an e-Media-Supported, Exercise-Based Phase II Cardiac Rehabilitation in Coronary Artery Bypass Grafting Surgery Patients: A Randomized Controlled Trial.

Background and objective Coronary artery bypass grafting (CABG) surgery patients undergo cardiac rehabilitation (CR) programs postoperatively to improve their course of recovery. The effectiveness of traditional CR programs is hampered by time constraints, financial burdens, transportation issues, and geographic restrictions. The coronavirus 2019 (COVID-19) pandemic and technological advances have led to the emergence of home-based CR programs using e-media, thereby improving accessibility. This study aimed to analyze the effects of e-media-supported, exercise-based phase II CR in post-CABG patients. Methods A single assessor-blinded randomized controlled trial (RCT) was conducted at a tertiary care hospital to analyze the effectiveness of a validated e-media-supported, exercise-based phase II cardiac rehabilitation in CABG Patients. A total of 40 subjects were included in the study based on the inclusion and exclusion criteria. The subjects were then randomly assigned to two groups: the experimental group received e-media-supported exercise and the control group received routine care. The duration of the intervention was three months. The outcome measures used were functional capacity, left ventricular ejection fraction (LVEF), quality of life, and physical activity (PA). Statistical analysis was conducted using SPSS Statistics v. 22.0 (IBM Corp., Armonk, NY). Results After three months of intervention, the mean distance covered during the six-minute walk test (6MWT) showed a significant increase in both the control and experimental groups. The experimental group demonstrated a statistically significant improvement compared to the control group (p<0.001). Furthermore, the experimental group showed significant improvements in the rate of perceived exertion (RPE), LVEF, and World Health Organization Quality of Life Brief Version (WHOQOL-BREF) and Global Physical Activity Questionnaire (GPAQ) scores compared to the control group (all p<0.001). Conclusions Based on our findings, the e-media-supported, exercise-based phase II cardiac rehabilitation is feasible and safe, and significantly improved functional capacity and enhanced quality of life. The PA level of the experimental group was higher than controls at the 12-week follow-up after CABG.

Left Atrial Strain to Predict Postoperative Atrial Fibrillation in Patients Undergoing Off-pump Coronary Artery Bypass Graft.

OBJECTIVE: Postoperative atrial fibrillation (POAF) is associated with increased morbidity, mortality, and length of hospital stay. The objective of this study was to assess the utility of left atrial strain (LAS) to predict POAF in patients undergoing off-pump coronary artery bypass grafting (OPCABG). DESIGN: Retrospective observational study. SETTING: Tertiary care hospital. PARTICIPANTS: 103 patients undergoing OPCABG. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: In addition to comprehensive transthoracic echocardiography, LAS was measured for reservoir (R), conduction (CD), and contraction (CT) components. POAF was defined as new electrocardiographic evidence of AF requiring treatment. Logistic regression was done to assess factors associated with POAF. The diagnostic accuracy of variables in predicting POAF was assessed by receiver operating characteristic analysis. POAF was documented in 24 (23.3%) patients. There was no difference in ejection fraction, average global longitudinal strain, or proportion of left ventricular diastolic dysfunction grades between patients with POAF and patients without POAF. All three components of LAS: LAS R (19.2 ± 4.7 v 23.5 ± 4.8, p < 0.001), LAS CD (8.9 ± 3.7 v 12.3 ± 4.8, p = 0.1), and LAS CT (10.3 ± 3.9 v 12.1 ± 4.1, p = 0.04), were significantly lower among patients with POAF compared with patients without POAF, respectively. According to univariate analysis, all components of LAS were statistically significant predictors of POAF. In multivariate analysis, only age (odds ratio = 1.08, p = 0.025) and LAS R (odds ratio = 0.84, p = 0.004) were independently associated with POAF. LAS R was a better predictor of POAF, with an area under the curve (AUC) of 0.758, than LAS CD (AUC = 0.67) and LAS CT (AUC = 0.62). LAS R had an optimal cutoff of 23% with sensitivity of 95.8% (confidence interval: 78.9-99.9%) and specificity of 49.4% (37.9-60.9%) to predict POAF. CONCLUSIONS: LAS R is a significant predictor of POAF, and its use can be recommended for screening of OPCABG patients at high risk of POAF.

Perioperative outcome of left atrial appendage amputation in coronary artery bypass grafting.

BACKGROUND: Left atrial appendage (LAA) amputation performed alongside cardiac surgery has become an increasingly established procedure to reduce stroke risk in patients with atrial fibrillation. As the recommendation levels for LAA amputation continue to rise, ample evidence assessing its perioperative safety and risk factors is of utmost interest. METHODS: All patients who underwent isolated coronary artery bypass grafting (CABG) between 2018 and 2021 at two high-volume centers were retrospectively included in the study. Patients were divided into two groups-the CABG and CABG + LAA groups-based on whether they underwent concomitant LAA amputation. Propensity score matching (PS matching) was applied to ensure comparability between the groups. The primary endpoint was defined as a composite outcome comprising of all-cause mortality, stroke, and reoperation. Secondary endpoints included the components of the primary endpoint, perioperative outcome parameters, transfusion rates, and laboratory parameters. RESULTS: A total of 3904 patients were included with 3038 and 866 in the CABG and CABG + LAA group, respectively. After PS matching each group consisted of 856 patients. The primary endpoint showed no significant differences between the CABG and CABG + LAA group (7.0% vs. 6.5% (OR 0.9 95% CI [0.64; 1.35], p = 0.70)). Similarly, there were no notable differences in the individual components of the composite endpoint: all-cause mortality (p = 0.84), stroke (p = 0.74), and reoperation (p = 0.50). Subgroup results did not show any relevant dissimilarity. CONCLUSION: The concomitant performance of LAA amputation is not associated with worse in-hospital outcomes, as measured by the composite endpoint of all-cause mortality, stroke, and reoperation.

Influence of Previous Coronary Artery Bypass Grafting on Clinical Outcomes After Percutaneous Coronary Intervention: A Meta-Analysis of 250 684 Patients.

Background: Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is the preferred strategy for treating obstructive coronary artery disease. Existing literature suggests the worsening of clinical outcomes in patients with previous coronary artery bypass grafting (CABG) history. In light of this, a comprehensive systematic review and meta-analysis was performed. Methods: Databases including PubMed, Cochrane Library, and ScienceDirect were utilized for the inclusive systematic search dating from inception to September 01, 2023. The risk of bias assessment was performed using the Newcastle-Ottawa scale for cohort studies, and the Cochrane Risk of Bias Tool for randomized controlled trials. Results: Ultimately, there were 16 eligible studies pooled together, involving a total of 250 684 patients, including 231 552 CABG-naïve patients, and 19 132 patients with a prior history of CABG. Overall, patients with CABG history were associated with significantly greater short-term mortality (P = .004), long-term mortality (P = .005), myocardial infarction (P < .00001), major adverse cardiovascular events (P = .0001), and procedural perforation (P < .00001). Contrastingly, CABG-naïve patients were associated with significantly greater risk of cardiac tamponade (P = .02) and repeat CABG (P = .03). No significant differences in stroke, bleeding, revascularization, or repeat PCI were observed. Conclusion: Comparatively worsened clinical outcomes were observed, as patients with prior CABG history typically exhibit complex coronary anatomy, and have higher rates of comorbidities in comparison to their CABG-naïve counterparts. The refinement of current procedural and surgical techniques, in conjunction with continued research endeavors, are needed in order to effectively address this trend.

Coronary artery bypass grafting vs. drug-eluting stent implantation: the probabilities of reintervention, transition to severe care-need, nursing home, and death in patients with coronary artery disease within the first three years: evaluations based on health claims data in Germany.

Background: Coronary artery bypass grafting (CABG) and drug-eluting stent implantation (DES) are established as central methods of revascularization for patients with coronary artery disease. This study aims to analyse the health trajectories of patients after first CABG or first, second or third DES within the first three years, with a focus on follow-up interventions, severe care need, transition into a nursing home, and death. Methods: Based on health claims data (n=11,581), we estimated age-and sex standardized probabilities of reintervention, and of transition to severe care need, nursing home and death following initial CABG (n=2,008) or DES (n=9,573) for patients aged 50 years and older using logistic regression models and direct standardization. Up to three follow-up DES interventions and one follow-up CABG were considered. Results: There was a fairly high probability of reintervention, particularly after a DES and within the first year. Follow-up interventions were more likely to involve DES than CABG. The probability of death was notably higher for CABG patients. The probabilities of severe care need and moving to a nursing home were slightly lower and similar across the revascularization methods and over time. Conclusions: DES and CABG are often associated with a need for follow-up interventions. Depending on the procedure, however, the risk of repeat surgery or adverse health outcomes varies. DES is associated with a relatively high probability of follow-up revascularization and a nearly constant probability of negative health outcomes in the short and medium term. In contrast, within three years after a CABG, follow-up reinterventions are rather rare. However, this procedure is particularly associated with an increased risk of mortality and short-term transition into a nursing home.

Age- and sex-related differences in risk factors for perioperative intra-aortic balloon pump application in patients undergoing coronary artery bypass grafting.

Background: An intra-aortic balloon pump (IABP) is a mechanical circulatory device frequently used in patients undergoing coronary artery bypass grafting (CABG). As a treatment for perioperative haemodynamic instability, IABP insertion often implicates an adverse outcome. This study aimed to investigate the age- and sex-related disparity in risk factors for perioperative IABP insertion in CABG patients. Methods: A total of 2,460 CABG patients were included and divided into subgroups by age (elderly subgroup, ≥65 years; young subgroup, <65 years) and sex. Basic characteristics were compared between IABP and non-IABP patients in the overall patient group and the subgroups. Multivariate logistic analysis was used to investigate the significant risk factors for perioperative IABP application, and interaction effects among the potential risk factors were analysed. Combined receiver operating characteristic analysis was used to evaluate the prediction value of combined risk factors. Results: The overall patient group had a mean age of 61.5 years. The application rate of perioperative IABP was 8.0%. A left ventricular ejection fraction (LVEF) <50% significantly correlated with perioperative IABP application in the overall patient group and the subgroups. Traditional factors such as myocardial infarction history, atrial fibrillation history, and intraoperative estimated blood loss were significant risk factors in certain subgroups. Small dense low-density lipoprotein levels were significantly associated with IABP insertion in the male subgroup and young subgroup. The area under the curve of combined risk factors was significantly higher than that of LVEF <50% alone in the overall patient group and subgroups. Conclusion: Age- and sex-related differences were present in the risk factor distribution for perioperative IABP insertion in CABG patients.