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1.
Kyobu Geka ; 72(9): 702-705, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31506413

RESUMO

The patient a 75-year-old man who was treated for diabetes and angina pectoris. He relapsed with an angina attack. Coronary angiography revealed three-vessel disease. We performed coronary artery bypass grafting (CABG). During surgery, we converted from off-pump CABG to on-pump beating CABG because of hemodynamic instability. After surgery, severe circulatory failure occurred with uncontrollable hyperglycemia and hyperlactatemia, which did not improve with catecholamine administration and insulin infusion. However, after continuous hemodiafiltration( CHDF) was initiated, in addition to aortic balloon pumping, his arterial blood pressure increased, and blood glucose and lactate levels decreased. Postoperative hyperinflammatory condition might have induced severe circulatory failure, hyperglycemia, and hyperlactatemia. CHDF might have contributed to improving the condition.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Hiperglicemia , Hiperlactatemia , Idoso , Angina Pectoris , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Humanos , Hiperglicemia/etiologia , Hiperlactatemia/etiologia , Masculino
2.
Braz J Cardiovasc Surg ; 34(4): 412-419, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454195

RESUMO

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.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Hemorragia Pós-Operatória/sangue , Idoso , Transfusão de Sangue , Feminino , Hemodinâmica , Hemostasia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Reoperação , Respiração Artificial , Estudos Retrospectivos , Fatores de Tempo
4.
Int Heart J ; 60(3): 593-600, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019167

RESUMO

Severe aortic atherosclerosis is a risk factor for stroke during coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the incidence of postoperative neurologic complications after off-pump CABG (OPCAB) with a proximal seal system (Heartstring).From January 2011 to December 2014, 729 patients underwent isolated OPCAB. The cohort was divided into two groups (Heartstring [HS] and aortic no-touch [NT]). The severity of aortic atherosclerosis (Katz grade) was evaluated by intraoperative epiaortic ultrasonography (EUS). The primary endpoints were postoperative neurologic complications (early stroke and minor events (delirium, transient ischemic attack, and syncope) ), and the secondary endpoints were late major adverse cardiac and cerebrovascular events (MACCEs) and death.The mean age of all patients was 65.1 ± 9.5 years, and a severe Katz grade (IV or V) was demonstrated to be an independent risk factor of long-term mortality (HR 3.53; 95% CI 1.06-11.75; P = 0.04) and MACCEs (HR 2.41; 95% CI 1.19-4.92; P = 0.02), but no significant differences were found for early stroke (0.9% versus 1.7%; P = 0.53) and minor neurologic complications (14.6% versus 9.9%; P = 0.05) between the groups regardless of the Katz grade. The 5-year overall survival rate did not differ significantly between the groups (90.9% versus 87.6%; P = 0.61).Although a higher Katz grade was identified as an independent risk factor of death and MACCEs, the HS group was not inferior in terms of neurologic complications regardless of the Katz grade. Therefore, the Heartstring system might be safely and efficiently used with EUS to decrease the incidence of neurologic complications.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Transtornos Neurocognitivos/etiologia , Complicações Pós-Operatórias/epidemiologia , Acidente Vascular Cerebral/etiologia , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transtornos Neurocognitivos/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
5.
Med Sci Monit ; 25: 3077-3089, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31025657

RESUMO

BACKGROUND The incidence of early postoperative pneumonia (EPOP) after off-pump coronary artery bypass grafting surgery (CABG) is relatively high, but its diagnosis by traditional methods remains difficult, which could be deleterious to the prognosis. Moreover, few data exist regarding procalcitonin (PCT) in early diagnosis of pneumonia after off-pump CABG. Thus, this study was performed to evaluate the value of PCT in diagnosing EPOP after off-pump CABG. MATERIAL AND METHODS A total of 402 consecutive patients undergoing off-pump CABG were retrospectively enrolled. Forty-four patients were diagnosed with EPOP and 112 patients were diagnosed with systemic inflammatory response syndrome (SIRS). Chest roentgenogram, serum PCT, white blood cells, neutral granulocyte ratio, and daily maximum body temperature were recorded. The ability of PCT to diagnose EPOP was evaluated by receiver operating characteristic (ROC) analyses in comparison with traditional methods. Clinical net benefits were estimated via decision curve analysis (DCA). RESULTS PCT presented satisfying accuracy in diagnosing EPOP with a cutoff value of 1.585 ng/mL (area under the curve [AUC] 0.808, 95% confidence interval [CI] 0.724-0.891, sensitivity 73%, specificity 86%). PCT performed better in diagnosing EPOP among SIRS patients (AUC 0.868, 95% CI 0.748-0.988, sensitivity 85%, specificity 89%). DCA showed valuable clinical net benefits of PCT in diagnosing EPOP after off-pump CABG regardless of threshold selected. CONCLUSIONS PCT could be a diagnostic marker for EPOP after off-pump CABG. The optimal cutoff value for diagnosing EPOP was 1.585 ng/mL. The application of PCT in diagnosing EPOP in SIRS patients was also satisfying with a cutoff value of 1.775 ng/mL.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Pneumonia/sangue , Pró-Calcitonina/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Calcitonina/sangue , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/etiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
6.
Thorac Cardiovasc Surg ; 67(7): 546-553, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30836396

RESUMO

BACKGROUND: The current study analyzed and compared early-term outcomes of off-pump versus on-pump beating heart coronary artery bypass surgery. METHODS: From January 2011 to January 2018, a total of 736 patients underwent isolated first-time elective beating-heart coronary artery bypass surgery without the use of aortic cross-clamping and cardioplegic arrest at our institution, and they were included in this study. Data of patients were collected and retrospectively analyzed. Patients were divided into two groups according to the use of cardiopulmonary bypass during the operation, as off-pump group (n = 399) and on-pump beating-heart group (n = 337). Both groups were compared with each other in terms of preoperative, intraoperative, and postoperative data. RESULTS: Groups were statistically similar with regard to baseline clinical characteristics and demographics. When compared with off-pump group, on-pump beating-heart group had a greater number of distal bypass, longer length of hospital stay, and lower postoperative hematocrit level, and received more blood product transfusion. No statistically significant differences were detected between the groups with respect to mortality and postoperative complications except for atrial fibrillation. Atrial fibrillation was significantly frequent in on-pump beating-heart group. CONCLUSION: Our study suggested that off-pump and on-pump beating-heart coronary artery bypass procedures had similar early mortality and major complication rates except for atrial fibrillation. However, it seemed that off-pump procedure was superior to on-pump beating-heart procedure with regard to length of hospital stay, blood product transfusion, and atrial fibrillation development. Further prospective randomized studies with larger patient series are needed to support our research and attain more accurate data.


Assuntos
Ponte Cardiopulmonar , Ponte de Artéria Coronária sem Circulação Extracorpórea , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Idoso , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Cardiovasc J Afr ; 30(1): 57-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30720843

RESUMO

OBJECTIVE: The rate of patients with diffuse left anterior descending artery (LAD) disease being referred for surgery has increased as a result of advances in endovascular techniques. In surgery of diffuse or multisegment LAD disease, surgical procedures with or without endarterectomy can be performed. In this article, we report our results of longsegment onlay patchplasty of the LAD with a left internal thoracic artery (LITA) graft without endarterectomy, on the beating heart, in patients with multisegment LAD disease. METHODS: We retrospectively analysed patients who underwent coronary artery bypass grafting surgery in our hospital between 1 January 2015 and 31 July 2017. We included LITA onlay patchplasty patients with multisegment LAD disease who had been operated on the beating heart. We excluded patients who underwent coronary endarterectomy and were operated on under cardiopulmonary bypass. RESULTS: In this period, 54 patients with multisegment LAD disease were treated with LITA patchplasty on the beating heart. The mean length of the arteriotomy was 42.8 ± 13.3 mm (25-75 mm). There were two postoperative myocardial infarctions (3.7%) and three deaths (5.5%). In the remaining patients, there was no haemodynamic instability that needed long-term (> 24 hour) inotropic support. Patients were discharged from hospital on postoperative 9.3 ± 7.1 days with dual antiplatalet therapy. CONCLUSIONS: Bypass grafting of the LAD with long-segment LITA onlay patchplasty can safely be performed in patients with multisegment LAD disease, with acceptable early-term results. In this procedure, proximal and distal segments of the diseased LAD are revascularised with LITA grafts, which may improve long-term survival and quality of life.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/métodos , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Anastomose de Artéria Torácica Interna-Coronária/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Asian Cardiovasc Thorac Ann ; 27(4): 256-264, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30798611

RESUMO

AIM: The primary goal of the study was to perform retrospective analysis of fast-track coronary artery bypass grafting at our institute to identify risk factors for prolonged hospital stay. A secondary goal was to identify and compare survival statistics with those published in literature. METHOD: We performed a retrospective analysis of patients enrolled in our fast-track coronary artery bypass protocol. There were 709 patients with a mean age of 58.85 ± 8.9 years; 572 were men. The mean EuroSCORE II was 2.02% ± 2.64%. Of these 709 patients, 538 (76%) met the requirements for discharge within 100 hours. RESULTS: Prolonged ventilation or reintubation, major pulmonary complications, gastrointestinal and neurological complications were the strongest predictors of fast-track failure. Persistent atrial fibrillation, postoperative transient renal impairment, requirement for noninvasive ventilation > 3 times, sternal wound infection, insulin-dependent diabetes mellitus, preoperative intraaortic balloon pump for chest pain or ST changes, preoperative severe left ventricular dysfunction, preoperative severe renal impairment, and peripheral arterial disease were also found to be significant risk factors for fast-track failure. Cumulative survival at 66 months of follow-up was 90.2% ± 0.02%. CONCLUSION: The risk factors listed above were associated with fast-track failure. Smoking cessation helps to nullify the factor of chronic obstructive pulmonary disease. Intraoperative elective insertion of a balloon pump does not affect the fast-track protocol. Survival was comparable to that described in the literature.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Tempo de Internação , Alta do Paciente , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Nível de Saúde , Humanos , Índia , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Interact Cardiovasc Thorac Surg ; 28(6): 893-899, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30649484

RESUMO

OBJECTIVES: Our goal was to investigate risk factors for acute kidney injury (AKI) after coronary artery bypass grafting (CABG) and the impact of AKI on short-term outcomes. METHODS: Data on 1395 patients (1261 who had isolated CABG and 134 with other operations) who underwent non-emergent CABG from January 2013 to March 2016 were retrospectively collected from a single centre. Logistic regression was performed to analyse risk factors. Cox regression was used to analyse the impact of AKI on the postoperative 30-day death rate. A 1:1 propensity score matching was performed to balance the baseline characteristics. RESULTS: The incidence of AKI with on-pump and off-pump coronary artery bypass was 10.4% and 3.5%, respectively. With logistic regression, duration of surgery was a risk factor for AKI (stage ≥2); previous hypertension, preoperative renal function insufficiency and the presence of cardiopulmonary bypass (CPB) were risk factors for mild AKI (stage ≥1). CPB time >207.5 min could be used to predict AKI (sensitivity 79.2%, specificity 78.6%) in the combined group. After adjusting for the duration of the operation, postoperative AKI (stage ≥1) was a risk factor for 30-day death and there was no difference in the 30-day death rate between on-pump and off-pump CABG. CONCLUSIONS: The use of CPB was a risk factor for mild AKI that did not affect the 30-day death rate of CABG whereas moderate to severe AKI caused by prolonged CPB time associated with surgical complexity affected the 30-day death rate. AKI may indicate surgical injury. The decision to use the on- or off-pump technique does not affect the 30-day death rate of CABG.


Assuntos
Lesão Renal Aguda/epidemiologia , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Lesão Renal Aguda/etiologia , China/epidemiologia , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
10.
Med Sci Monit ; 25: 598-604, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30662058

RESUMO

BACKGROUND To evaluate perioperative and mid-term outcomes of saphenous vein Y-grafts in patients with multi-vessel coronary artery disease. MATERIAL AND METHODS Sixty patients who underwent off-pump coronary surgery with Y-graft between 2005 and 2016 were enrolled, including 38 patients with natural Y-graft. Sixty patients with multi-vessel lesions in the same period were randomly selected as a control group. RESULTS A total of 484 conduits were employed. The intraoperative variables were insignificantly different between groups, but Y-graft group compared with control group had more grafts (4.2±0.84 vs. 3.87±0.85) and anastomoses (6.30±1.39 vs. 5.62±1.15). No patient died during coronary artery bypass grafting and no episode of perioperative myocardial infarction was found. Follow-up duration lasted from 1 to 137 (40.0±27.7) months. No significant difference between Y-graft group and control group was found in Kaplan-Meier 3-year survival rate (93.4% vs. 88.0%) or 5-year survival rate (81.4% vs. 88.0%). CONCLUSIONS Saphenous vein Y-graft is a feasible and safe revascularization strategy for multi-vessel coronary artery disease patients and brings about satisfactory outcomes.


Assuntos
Ponte de Artéria Coronária/métodos , Revascularização Miocárdica/métodos , Veia Safena/cirurgia , Idoso , Idoso de 80 Anos ou mais , China , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Período Perioperatório , Estudos Retrospectivos , Taxa de Sobrevida , Transplantes/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
Angiology ; 70(4): 337-344, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30286625

RESUMO

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.


Assuntos
Ponte Cardiopulmonar , Ponte de Artéria Coronária sem Circulação Extracorpórea , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Estenose Coronária/cirurgia , Idoso , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Intervalo Livre de Progressão , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
12.
J Intensive Care Med ; 34(2): 126-132, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29112468

RESUMO

BACKGROUND:: Respiratory complications are common after cardiac surgery and the use of extracorporeal circulation is one of the main causes of lung injury. We hypothesized a better postoperative respiratory function in off-pump coronary artery bypass grafting (OPCABG) as compared with "on-pump coronary artery bypass grafting" (ONCABG). METHODS:: This is a retrospective, single-center study at a cardiothoracic intensive care unit (ICU) in a tertiary university hospital. Consecutive data on 339 patients undergoing elective CABG (n = 215 ONCABG, n = 124 OPCABG) were collected for 1 year from the ICU electronic medical records. We compared respiratory variables (Pao2, Pao2/Fio2 ratio, Sao2, and Paco2) at 7 predefined time points (ICU admission, postoperative hours 1, 3, 6, 12, 18, and 24). We also evaluated time to extubation, rates of reintubation, and use of noninvasive ventilation (NIV). We used mixed-effects linear regression models (with time as random effect for clustering of repeated measures) adjusted for a predetermined set of covariates. RESULTS:: The values of Pao2 and Pao2/Fio2 were significantly higher in the OPCABG group only at ICU admission (mean differences: 9.7 mm Hg, 95% confidence interval [CI] 3.1-16.2; and 27, 95% CI 6.1-47.7, respectively). The OPCABG group showed higher Paco2, overall ( P = .02) and at ICU admission (mean difference 1.8 mm Hg, 95% CI: 0.6-3), although mean values were always within normal range in both groups. No differences were seen in Sao2 values, time to extubation, rate of reintubation rate, and use of postoperative NIV. Extubation rate was higher in OPCABG only at postoperative hour 12 (92% vs ONCABG 82%, P = .02). CONCLUSION:: The OPCABG showed only marginal improvements of unlikely clinical meaning in oxygenation as compared to ONCABG in elective low-risk patients.


Assuntos
Gasometria , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Troca Gasosa Pulmonar , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Transtornos Respiratórios/fisiopatologia , Estudos Retrospectivos
13.
J Cardiovasc Surg (Torino) ; 60(3): 388-395, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30465418

RESUMO

BACKGROUND: Among patients with coronary artery disease (CAD), around 25% have multisite artery disease (MSAD). Patients with CAD and MSAD are at higher risk of peri-operative and long-term cardiovascular events. Whether off-pump coronary bypass grafting (CABG) can improve their prognosis is unknown. We aimed to assess the benefits of off- vs. on-pump cardiac surgery in patients undergoing CABG, according to coexistence of extra-cardiac artery disease. METHODS: Between April 1998 and September 2008, 1221 patients undergoing CABG without any other intervention were enrolled. Overall death and major cardiovascular events were recorded at 1-month and during long-term follow-up. A propensity score (PS), derived from all relevant variables (P<0.25) associated with on-pump as compared to off-pump CABG, and representing the likelihood for each individual patient to receive off-pump CABG, was calculated. RESULTS: MSAD was observed in 279 patients (23%). Off-pump CABG was performed in 208 (17%) patients. The median follow-up was 7.6 years. The 10-year mortality was significantly lower in off- vs. on-pump CABG group (74±4% vs. 68±2%, P=0.024). In patients with MSAD, there was a trend for better survival for off- vs. on-pump CABG (63±8% vs. 50±4%, P=0.078). After adjustment for PS, we found no further difference between on- and off-pump CABG both in the whole cohort (HR=1.30, P=0.10), as well as in MSAD patients (HR=1.51, P=0.14). CONCLUSIONS: Patients with MSAD receiving CABG are at worst prognostic than those with isolated CAD. In these patients, we found no significant difference in the long-term mortality and cardiovascular events between on- and off-pump CABG.


Assuntos
Ponte Cardiopulmonar , Ponte de Artéria Coronária sem Circulação Extracorpórea , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Idoso , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Ann Thorac Surg ; 107(1): 92-98, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30273568

RESUMO

BACKGROUND: For diabetic patients who require coronary artery bypass graft (CABG) operation, controversy persists whether an off-pump or an on-pump approach may be advantageous. This US-based, multicenter, randomized, controlled trial, Department of Veterans Affairs Randomization On versus Off Bypass Follow-up Study, compared diabetic patients' 5-year clinical outcomes for off-pump versus on-pump procedures. METHODS: From 2002 to 2008, 835 medically treated (ie, oral hypoglycemic agent or insulin) diabetic patients underwent either off-pump (n = 402) or on-pump (n = 433) CABG. Five-year primary end points included all-cause death and major adverse cardiovascular events (MACE; composite included all-cause death, myocardial infarction, or repeat revascularization). Secondary 5-year end points included cardiac death and MACE-related components. With baseline risk factors balanced, outcomes were evaluated by using a p value less than or equal to 0.01; nonsignificant trends were reported for p values greater than 0.01 and less than or equal to 0.15. RESULTS: Five-year all-cause death rates were 20.2% off pump versus 14.1% on pump (p = 0.0198). No differences were seen in MACE (32.6% off-pump approach versus 28.6% on-pump approach, p = 0.216), repeat revascularization (12.4% off-pump approach versus 11.8% on-pump approach, p = 0.770), and nonfatal myocardial infarction (12.7% off-pump approach versus 10.4% on-pump approach, p = 0.299). Cardiac death trended worse with off-pump CABG (9.0%) than with on-pump CABG (6.25%, p = 0.137). Sensitivity analyses that removed conversions confirmed these findings. CONCLUSIONS: With a 6.1% absolute difference, a strong trend toward improved 5-year survival was observed with on-pump CABG for medically treated diabetic patients. No off-pump advantage was found for any 5-year end points. A future clinical trial now appears warranted to rigorously compare off-pump versus on-pump longer term outcomes for diabetic patients.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Complicações do Diabetes/complicações , Complicações Pós-Operatórias/epidemiologia , Idoso , Doença da Artéria Coronariana/mortalidade , Complicações do Diabetes/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida
15.
Ann Thorac Surg ; 107(1): 99-105, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30273569

RESUMO

BACKGROUND: Coronary artery bypass grafting (CABG) is a common surgical treatment for ischemic heart disease. Little is known about the long-term costs of conducting the surgery on-pump or off-pump. METHODS: As part of the Randomized On/Off Bypass follow-up study, we followed 2,203 participants randomized to on-pump (n = 1,099) and off-pump (n = 1,104) CABG for 5 years using Department of Veterans Affairs and Medicare administrative data. We examined annual costs through 5 years, standardized to 2016 dollars, using multivariate regression models, controlling for site and baseline patient factors. RESULTS: In the first year, including the CABG surgery, annual average costs were $66,599 (SE, $1,946) for the on-pump group and $70,552 (SE, $1,954) for the off-pump group. In years 2 to 5, average costs ranged from $15,000 to $20,000 per year. There was no significant difference between on-pump and off-pump across the 5 years. We explored differences among high-risk subgroups (diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular disease, renal dysfunction, ejection fraction < 35%, over age 70 years), and found no treatment assignment by time interactions, except for a nonsignificant trend in patients with diabetes. CONCLUSIONS: At 5 years, the average costs of off-pump and on-pump CABG patients did not statistically differ. Costs do not favor one approach and the decision should be based on clinical risks, especially in subgroups. Future research is warranted to examine post-CABG costs and outcomes for diabetic patients over time.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/economia , Doença da Artéria Coronariana/economia , Doença da Artéria Coronariana/cirurgia , Custos de Cuidados de Saúde , Complicações Pós-Operatórias/economia , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo
16.
J Zhejiang Univ Sci B ; 19(9): 735-738, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30178640

RESUMO

Neurological injury is a frequent and important complication of coronary artery bypass grafting (CABG). Several risk factors for this type of sequela have been identified, among them aortic arch atherosclerosis. Our previous study indicated that atherosclerotic burden in coronary arteries may likewise predict postoperative neurological complications (Pawliszak et al., 2016b). We assessed the severity of this condition by using the SYNTAX score calculator. However, diagnosing angiographic three-vessel coronary artery disease (3VD) could be an even simpler method of achieving this goal.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Proteína Glial Fibrilar Ácida/sangue , Proteínas de Neurofilamentos/sangue , Neuropeptídeos/sangue , Serpinas/sangue , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosforilação , Estudos Prospectivos
17.
Medicine (Baltimore) ; 97(35): e12146, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30170456

RESUMO

BACKGROUND: We aimed to compare off-pump technique with on-pump technique on renal function in patients with nondialysis-dependent renal dysfunction who underwent coronary artery bypass grafting. METHODS: The 94 patients with renal dysfunction undergoing isolated coronary artery bypass grafting were retrospectively analyzed. No patient was receiving dialysis. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass and beating heart. Both groups were compared in terms of renal dysfunction parameters and dialysis requirement. The logistic regression models were constructed to identify risk factors associated with dialysis requirement. RESULTS: Renal dysfunction requiring dialysis developed in 9 patients in the on-pump group. The measures analysis of variance was performed on the data that showed worsening of renal function in the on-pump group compared with the off-pump group. Cardiopulmonary bypass is significant as independent predictor for the development of postoperative dialysis. CONCLUSION: These results suggest that off-pump coronary revascularization offers a superior renal protection and has a significantly lower risk for renal complications in patients with nondialysis-dependent renal dysfunction when compared with conventional coronary revascularization with cardiopulmonary bypass.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Complicações Pós-Operatórias/etiologia , Insuficiência Renal Crônica/fisiopatologia , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Rim/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/cirurgia , Estudos Retrospectivos , Fatores de Risco
18.
BMC Cardiovasc Disord ; 18(1): 157, 2018 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-30064376

RESUMO

BACKGROUND: The aim of the study was to investigate the high-sensitivity troponin T (hs-TnT) release profile in off-pump coronary artery bypass grafting (OPCABG) patients with normal postoperative course. METHODS: From January 2015 to October 2016, 398 consecutive OPCABG patients who had normal postoperative courses were enrolled. Blood samples for hs-TnT were collected at several time points and the comparisons among different time points grouped by various factors were further analyzed. RESULTS: There were 317 male and 81 female patients, with a median age of 64. For 66.1% of the patients, peak hs-TnT occurred at the 24th hour after OPCABG, regardless of the groups divided by different factors. In total, the hs-TnT values were much higher in male group (P = 0.035), in patients who need 5 or more bypass grafts (P = 0.035) and in patients with high-risk EuroSCORE II assessment (P = 0.013). However, we failed to find any significant differences between different age groups (P = 0.129) or among different coronary heart disease classifications (P = 0.191). CONCLUSIONS: The hs-TnT values were affected by various factors and culminated around the first 24 h following OPCABG. It may provide some useful information for future clinical studies of myocardial biomarkers after OPCABG.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Troponina T/sangue , Biomarcadores/sangue , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
19.
Ann Card Anaesth ; 21(3): 300-303, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30052221

RESUMO

Chylothorax is a rare complication after cardiac surgery but is associated with morbidity and mortality. The most common cause of chylothorax is damage to or avulsion of thoracic duct by electrocautery during left internal thoracic artery harvesting for coronary artery bypass graft (CABG) surgery. We describe a case of chylothorax after off-pump CABG, which was successfully treated with thoracostomy tube drainage, withholding of oral intake, total parenteral nutrition and subcutaneous octreotide, a somatostatin analog, and chemical pleurodesis.


Assuntos
Quilotórax/etiologia , Quilotórax/terapia , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Complicações Pós-Operatórias/terapia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Gerenciamento Clínico , Drenagem , Fármacos Gastrointestinais/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Nutrição Parenteral Total
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