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1.
Ann Thorac Cardiovasc Surg ; 26(5): 276-285, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32893224

RESUMO

PURPOSE: Benefits of off-pump coronary bypass (OPCAB) over on-pump (ONCAB) remain controversial. We aimed to evaluate the early impacts of OPCAB vs ONCAB for varying left ventricular (LV) function baselines by applying the non-invasive myocardial work (MW) analysis, which enables further insights in cardiac mechanics, contractility, and efficacy. METHODS: We retrospectively analyzed 98 patients (55 ONCAB vs 43 OPCAB). Transthoracic echocardiography (TTE) and concurrent arterial blood pressure measurements taken at rest, prior to, and early after surgery were performed. Global myocardial work index (GMWI), global constructive work (GCW), and global work efficiency (GWE), inter alia, were quantified. RESULTS: Preoperatively, OPCAB patients had significantly lower values than ONCAB patients in terms of GMWI (1404.33 ± 585.41 mmHg% vs 1619.07 ± 535.42 mmHg%, p = 0.039), GWE (90% (60%, 96%) vs 93% (74%, 98%), p = 0.028). After surgery, GMWI was reduced in both groups. However, a more significant GMWI impairment occurred early after ONCAB than after OPCAB (-343.14 ± 35.20 mmHg%, p <0.001 vs -224.04 ± 120.91 mmHg%, p = 0.042). CONCLUSION: Despite lower preoperative LV function in OPCAB patients, GMWIs after OPCAB were superior to ONCAB, indicating better preservation of systolic LV function early after OPCAB by means of contractility compared to ONCAB. Further studies should investigate the long-term course of MW response and their clinical impact.


Assuntos
Ponte Cardiopulmonar , Ponte de Artéria Coronária sem Circulação Extracorpórea , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Contração Miocárdica , Função Ventricular Esquerda , Idoso , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
2.
Ann Thorac Cardiovasc Surg ; 26(3): 125-132, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32475890

RESUMO

PURPOSE: Off-pump coronary arterial bypass grafting (OPCAB) has become a common practice for coronary artery bypass grafting (CABG) in Japan, with approximately 65% CABG procedures currently being performed using OPCAB. However, it is unclear whether OPCAB is superior in terms of associated mortality, incidence of complications, graft patency rate, and long-term outcomes compared with conventional CABG (CCABG). METHODS: Literature consideration was performed, mainly based on observational studies involving large samples and randomized controlled trials (RCTs). RESULTS: Many RCTs indicated that the acute-phase and long-term mortality rates were comparable between CCABG and OPCAB or that OPCAB was inferior to CCABG. In contrast, many observational studies indicated that OPCAB was superior to CCABG. CONCLUSION: CABG is a delicate procedure, the outcomes of which vary in accordance with the patient's condition as well as the level of expertise of the associated institution and surgeon. In the future, we hope that reports will emerge with excellent results, including long-term results, from Japanese institutions experienced in performing OPCAB.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , 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 , Humanos , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
3.
Zhonghua Wai Ke Za Zhi ; 58(5): 363-368, 2020 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-32393003

RESUMO

Objective: To examine the safety and efficacy of minimally invasive coronary surgery-coronary artery bypass grafting (MICS-CABG). Methods: From the first case in November 2015 to November 2019, a total of 244 cases of MICS-CABG were performed in Department of Cardiovascular Surgery, Peking University Third Hospital. There were 197 males and 47 females, aging (62.3±8.7)years (range: 36 to 88 years). The operations were performed via the 5(th) intercostal space of left thoracic lateral incision (length: 4 to 5 cm extended for 8 to 10 cm), and were performed under off-pump, with the help of the chest wall suspension device and cardiac fixator. The proximal anastomosis on ascending aorta and the distal anastomosis of left anterior descending branch, circumflex branch and right coronary system were completed according to procedure. In all 244 cases, the proportion of 2 grafts was 53.7% (131 cases), 3 grafts was 36.1% (88 cases), 4 grafts was 9.8% (24 cases) and 5 grafts was 0.4% (1 case). The average of grafts was 2.6±0.7 (range: 2 to 5). The proportion of hybrid was 14.3% (35 cases), sequential bypass procedure was 43.0% (105 cases) and multiple artery grafts was 25.4% (62 cases). The perioperative complications of the patients were collected, the patency rate of the grafts was evaluated by coronary angiography or CT within 7 days after the operation, and main adverse cardiovascular and cerebrovascular events (MACCE) were followed up. The survival curve was drawn by Kaplan-Meier method, and the 1-year MACCE rate was calculated by survival analysis. Results: All cases had no transition to thoracotomy and cardiopulmonary bypass procedure, and no cases needed intra aortic balloon pumping and extracorporeal membrane oxygenation during the operation.There were 2 cases of poor incision healing, and reoperation was performed in 10 cases (6 cases of postoperative bleeding, 2 cases of incision debridement, and 2 cases of grafts problems). The rate of MACCE in 30 days was 2.6% (10 cases), which contained 3 cases of death (2 cases of grafts occlusion, 1 case of serious hemorrhage after thoracic puncture drainage), 3 cases of stroke and 5 cases of non-fatal myocardial infarction. By the re-examination of angiography in 7 days after operation, the overall patency of the grafts was 96.1%, and the patency of the left anterior descending was 98.6%. Kaplan-Meier survival analysis was conducted for 235 patients (96.3%) with 1 to 36 months follow-up results, and the 1-year MACCE rate was 5.6% (95%CI: 4.2% to 7.0%) . There was no significant difference among the incidences of MACCE at each stage of learning curve. Surgeon could reduce the operation time and complete more anastomosis with the accumulation of experience after the early 30 cases. Conclusions: MICS-CABG can safely achieve completed revascularization, which has good operative effects in short and medium-long term. There is no significant risk in the early cases of learning curve.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Angiology ; 71(8): 704-712, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32295386

RESUMO

This retrospective study assessed the risk factors for adverse events following off-pump coronary artery bypass graft (CABG) surgery with dual antiplatelet therapy (DAPT). Records (between 2013 and 2017) were reviewed for patients who discontinued DAPT (clopidogrel 75 mg and aspirin 100 mg) ≤5 days before off-pump CABG. The primary outcome was the incidence of a Bleeding Academic Research Consortium (BARC) type 4 major event. Factors associated with bleeding events and perioperative myocardial ischemia were evaluated using multivariable logistic regression. The incidence of major bleeding events was 17.6% in 2012 patients. Adjusted multiple logistic regression analysis showed that the risk of postoperative bleeding increased when DAPT was discontinued <3 days before surgery (day 2: adjusted odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.09-2.64; day 1: adjusted OR: 2.37, 95% CI: 1.49-3.77; day 0: adjusted OR: 2.45, 95% CI: 1.53-3.92). The adjusted risk of mortality (OR: 13.14, 95% CI: 4.55-37.94) was increased with bleeding complications. In subgroup analysis, perioperative myocardial ischemia was related to increased blood loss (adjusted OR: 1.10, 95% CI: 1.02-1.18). Aspirin and clopidogrel should optimally be discontinued >3 days before CABG to reduce the risk of bleeding complications, myocardial ischemia, and death.


Assuntos
Aspirina/administração & dosagem , Clopidogrel/administração & dosagem , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Hemorragia/epidemiologia , Isquemia Miocárdica/epidemiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Pequim/epidemiologia , Clopidogrel/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Esquema de Medicação , Quimioterapia Combinada , Feminino , Hemorragia/mortalidade , Hemorragia/prevenção & controle , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/prevenção & controle , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Int Heart J ; 61(2): 263-272, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32132317

RESUMO

This study aims to evaluate the effect of dexmedetomidine (DEX) sedation for relieving anxiety and the incidence of atrial fibrillation (AF) after off-pump coronary artery bypass graft (OPCABG).This randomized, double-blind, controlled trial was conducted on 196 patients who underwent OPCABG in Shandong Provincial Hospital from July 2017 to June 2018. The patients were randomly assigned to two groups, intervention of DEX group and Propofol (PROP) group. Episodes of postoperative AF (POAF) were identified within 5 days after OPCABG. Perioperative anxiety status was assessed using Zung's Self-Rating Anxiety Scale (SAS). The baseline demographic and surgical characteristics of the population and other outcome variables were evaluated.We analyzed 62 patients in the DEX group and 61 patients in the PROP group. There was no significant difference in SAS anxiety scores between two groups before surgery (P = 0.104), while SAS had significantly after surgery (P = 0.018). The incidence of POAF in the DEX group was lower than that of the PROP group (16.1% versus 32.8%, P = 0.037), and a total of 30 patients (30/123, 24.4%) manifested POAF after OPCABG. Some univariable predictors of POAF were detected. The conceptual model of mediator analyses showed DEX was not only directly related to POAF but was also indirectly related through the independent effect of anxiety level.The findings indicated that patients receiving DEX were more likely to have less incidence of POAF, also uniquely showed DEX administration and POAF processes as a function of anxiety status.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Ansiedade/prevenção & controle , Fibrilação Atrial/prevenção & controle , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Dexmedetomidina/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Idoso , Ansiedade/etiologia , Fibrilação Atrial/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos
6.
J Cardiovasc Surg (Torino) ; 61(3): 356-368, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31985189

RESUMO

BACKGROUND: The competitive coronary flow is influenced by the severity of the stenosis and may affect graft patency. Transit time flow measurement (TTFM) enables intraoperative graft evaluation and cardiac magnetic resonance (MRI) allows for graft evaluation during follow-up. METHODS: Competitive flow and target vessel diameters were determined in 35 patients undergoing off-pump coronary bypass graft surgery (CABG) and correlated to TTFM. Cardiac function, ischemia, and graft flow were evaluated using cardiac MRI during the follow-up period to determine the impact of above-mentioned parameters on graft patency. RESULTS: Competitive flow led to reduced mean graft flow (MGF) and increased pulsatility index (PI) in arterial grafts. This effect to was not observed in veins. Smaller target coronary arteries (<1.5 mm) were associated with reduced MGF, more pronounced in veins, which presented increased PI and shortened diastolic flow fraction (DF). No death and no re-hospitalization for acute coronary syndrome occurred. Borderline values of TTFM (mean MGF 13±4 mL/min; PI 3.8±1) in left internal mammary artery (LIMA) were mainly observed due to increased native anterior descending artery (LAD) flow. These LAD's collateralized occluded right coronaries (RCA). The corresponding LIMA to LAD grafts showed a bypass flow increase at cardiac MRI follow-up. Two graft occlusions occurred: one in LIMA-to-LAD bypass with borderline TTFM, which did not collateralize the RCA and one in a vein graft with borderline TTFM bypassed on a narrow vascular target. CONCLUSIONS: Competitive flow has an impact on arteries contrary to veins. Veins are at risk for occlusion when grafted to smaller targets. Borderline LIMA flow should be considered as potentially dangerous, if satisfactory explanations are missing, e.g. in the absence of a large coronary target without flow competition.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Circulação Coronária , Estenose Coronária/cirurgia , Vasos Coronários/cirurgia , Imagem por Ressonância Magnética , Imagem de Perfusão , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
7.
BMC Cardiovasc Disord ; 20(1): 3, 2020 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924163

RESUMO

BACKGROUND: Perioperative bleeding during cardiac surgery are known to make patients susceptible to adverse outcomes and several bleeding classifications have been developed to stratify the severity of bleeding events. Further validation of different classifications was needed. The aim of present study was to validate and explore the prognostic value of different bleeding classifications in patients undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS: Data on baseline and operative characteristics of 3988 patients who underwent OPCAB in Beijing Anzhen Hospital from February 2008 to December 2014 were available. The primary endpoint was a composite of in-hospital death and nonfatal postoperative myocardial infarction (MI). The secondary endpoint was postoperative acute kidney injury (AKI). We explored the association of major bleeding defined by the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Bleeding Academic Research Consortium (BARC) classification and Study of Platelet Inhibition and Patient Outcomes (PLATO) with primary endpoints by multivariable logistic regression analysis and investigated their significance of adverse event prediction using goodness-of-fit tests of - 2 log likelihood. RESULTS: In-hospital mortality was 1.23% (n = 49) and postoperative MI was observed in 4.76% (n = 190) of patients, AKI in 24.69% (n = 985). The incidence of the primary outcome was 5.99% (n = 239). Multivariable logistic regression analysis showed that BARC type 4 (OR = 2.64, 95% CI: 1.66-4.19, P < 0.001), UDPB class 4 (OR = 3.52, 95% CI: 2.05-6.02, P < 0.001) and E-CABG class 2-3 (class 2: OR = 2.24, 95% CI: 1.36-3.70, P = 0.001; class 3: OR = 12.65, 95% CI: 2.74-18.43, P = 0.002) bleeding but not PLATO bleeding were associated with an increased risk of in-hospital death and postoperative MI. Major bleeding defined by all the four classifications mentioned above was an independent risk factor of AKI after surgery. Inclusion of major bleeding defined by these four classifications improved the predictive performance of the multivariable model with baseline characteristics. CONCLUSIONS: Bleeding assessed by BARC, E-CABG and UDPB classifications were significantly associated with poorer immediate outcomes. These classifications seemed to be valuable tool in the assessment of prognostic effect of perioperative bleeding.


Assuntos
Perda Sanguínea Cirúrgica , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Hemorragia Pós-Operatória/diagnóstico , Terminologia como Assunto , Lesão Renal Aguda/etiologia , Idoso , Pequim , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Hemorragia Pós-Operatória/classificação , Hemorragia Pós-Operatória/mortalidade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Ann Thorac Surg ; 110(2): 599-607, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31863758

RESUMO

BACKGROUND: Type 2 neurologic complications of coronary artery bypass grafting (CABG) include postoperative cognitive dysfunction and delirium. Although relevant clinically, they are rarely properly recognized outside of dedicated research setting, as their identification is complex and time-consuming. The aim of this study was to examine the diagnostic potential of 4 novel brain-injury biomarkers for predicting these sequelae at the completion of off-pump CABG. METHODS: A total of 100 consecutive patients scheduled for elective isolated off-pump CABG were enrolled. Control group of patients without neurological complications (n = 48) was compared separately to study groups diagnosed with postoperative cognitive dysfunction (n = 39) and delirium (n = 26). Serum concentrations of glial fibrillary acidic protein, neuroserpin, phosphorylated axonal neurofilament subunit H, and visinin-like protein 1 were evaluated at baseline, end of surgery, as well as on postoperative day 1 and 7. RESULTS: Increased end of surgery to baseline ratio of neuroserpin predicted the occurrence of both postoperative cognitive dysfunction (area under the curve = 0.655, 95% confidence interval 0.54-0.77) and delirium (area under curve = 0.643, 95% confidence interval 0.52-0.77). Concentrations of neuroserpin were significantly higher on postoperative day 7 compared with end of surgery and postoperative day 1 in all groups. CONCLUSIONS: Among novel biochemical markers of brain damage, neuroserpin may be a promising predictor of type 2 neurological complications and may express neuroregeneration after off-pump CABG, whereas glial fibrillary acidic protein, phosphorylated axonal neurofilament subunit H, and visinin-like protein 1 may not be suitable for this clinical setting.


Assuntos
Biomarcadores/sangue , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Doenças do Sistema Nervoso/sangue , Complicações Pós-Operatórias/sangue , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Polônia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
9.
Cardiovasc Ther ; 2019: 1582183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772605

RESUMO

Background: Decreased graft patency after off-pump coronary artery bypass grafting (OPCAB) leads to substantial increases in cardiac events. However, there is paucity of data on efficacy and safety of perioperative statin therapy for OPCAB populations. Methods: 582 patients undergoing OPCAB in a single-institution database (October 1, 2009-September 30, 2012) were stratified by perioperative continuation of statin therapy (CS group, n=398) or not (DS group, n=184). Inverse probability weighted propensity adjustment was used to account for treatment assignment bias, resulting in a well-matched cohort. Primary outcomes were graft patency at an average of five days after operation and in-hospital mortality. Secondary outcomes included intraoperative blood loss, liver, and renal functions. Results: No in-hospital death occurred in this study. Early graft patency rates after OPCAB were 98.4% (1255 of 1275 grafts) in the CS group and 98.0% (583 of 595 grafts, P=0.486) in the DS group. Secondary outcomes showed a reduction in blood loss during operation (438.53 mL versus 480.47 mL, P=0.01). Continuation of statin therapy is associated with alanine transaminase (ALT) elevation (49.67 U/L versus 34.52 U/L, P<0.001), as well as aspartate transaminase (33.54 U/L versus 28.10 U/L, P<0.001). Abnormal ALT elevation was observed in 8.9% of the CS group and 3.1% in DS (odds ratio 3.06, 95% confidence interval, 1.77 to 5.29, P<0.001). There was no significant difference in estimated glomerular filtration rate (76.28 mL/min/1.73m2 versus 76.13 mL/min/1.73m2, P=0.90). Subgroup analyses suggested that graft occlusion was less common in CS than in DS group among smoking patients (odds ratio 0.41, 95% confidence interval, 0.20 to 0.86, P=0.026). Conclusions: Perioperative continuation of statin therapy did not improve early graft patency in OPCAB patients. A lower risk of graft occlusion was observed among smoking patients. Continuous statin use correlated with liver function elevation (Clinical Trials.gov number, NCT01268917).


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Assistência Perioperatória , Grau de Desobstrução Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Bases de Dados Factuais , Esquema de Medicação , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/prevenção & controle , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Fígado/efeitos dos fármacos , Fígado/enzimologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Int Heart J ; 60(6): 1276-1283, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31735768

RESUMO

Consensus has yet to emerge among experts as to whether the radial artery (RA) conduit was superior to the saphenous vein (SV) graft for coronary artery bypass grafting (CABG) in terms of long-term patency. This study aimed to evaluate long-term patency of the RA conduit compared to the SV conduit for off-pump CABG, and to screen the independent predictors of long-term RA graft failure.Patients < 80 years of age with graftable triple-vessel disease undergoing non-emergent, primary, isolated off-pump CABG, using both the RA and the SV conduits, were reviewed. Graft patency, all-cause mortality and repeat revascularization were followed-up. The independent predictors of long-term RA graft failure were identified.A total of 296 out of 320 eligible patients (42 females, 61.3 ± 9.9 years old) received follow-up with an observed period of 93.4 ± 16.5 months. All-cause mortality was 14.5%, and repeat revascularization was conducted on 6 RA grafts and 9 SV grafts. Superior patency of the RA grafts compared to the SV grafts was observed (84.4% versus 78.5%, P = 0.035). Independent predictors of long-term RA graft failure included proximal stenosis of target right coronaries < 90% (OR = 2.35, 95%CI 1.41-5.82) and diabetes mellitus (OR = 1.66, 95%CI 1.17-4.26).The RA graft had a superior long-term patency than the SV graft. Long-term patency of the RA graft may be poor in diabetics or in the case of proximal stenosis of target right coronary <90%. (Trial registration: ChiCTR-OCH-1200212).


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/etiologia , Artéria Radial , Veia Safena , Grau de Desobstrução Vascular , Idoso , Estudos de Coortes , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Heart Surg Forum ; 22(5): E416-E422, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31596723

RESUMO

BACKGROUND: Olfactory and taste sensations have a high impact on the quality of life. Impaired olfactory and taste functions may have a negative effect on physical and mental well-being, personal hygiene, and nutritional satisfaction, leading to the occurrence of depressive symptoms and impaired quality of life. Therefore, the recovery period of patients with disturbed olfactory and taste functions may be prolonged, and return to active life may be delayed. We designed this study to determine whether on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have any effects on olfactory and taste functions and compare these functions between the surgical groups. METHODS: A total of 60 patients, who underwent elective isolated first-time CABG, were included in this study. Patients were divided into two groups as Off-Pump and On-Pump CABG groups with 30 patients in each group. In addition to patients' primary clinical and laboratory data, olfactory and taste functions were evaluated pre- and postoperatively in both groups separately, and then these functions were compared between the groups. Olfactory functions were evaluated by the Brief Smell Identification Test, while taste functions by the Burghart Taste test. RESULTS: Olfactory functions significantly were disrupted in the postoperative period in patients undergoing on-pump CABG (P value < .05), while these functions significantly were not affected in patients undergoing off-pump CABG (P value > .05). During the preoperative period, advanced age and smoking were detected to be independent predictors of impaired olfactory function for the study population. During the postoperative period, smoking, amount of postoperative bleeding and serum low-density lipoprotein (LDL) level were found to be independent predictors of impaired olfactory function for just the On-Pump CABG Group. In both groups, no significant deterioration in taste functions occurred during the postoperative period (P value > .05). CONCLUSION: Our study demonstrated that olfactory function was impaired in patients, who underwent on-pump CABG in the postoperative period, and significant impairment in taste function was present in neither off-pump nor on-pump CABG patients. However, the results of our study should be supported by more comprehensive, prospective, randomized controlled trials with more extensive patient series and by further tests.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Transtornos do Olfato/etiologia , Complicações Pós-Operatórias/etiologia , Distúrbios do Paladar/etiologia , Fatores Etários , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Complicações do Diabetes , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Lipoproteínas LDL/sangue , Masculino , Hemorragia Pós-Operatória/complicações , Olfato , Fumar/efeitos adversos , Paladar
13.
J Cardiothorac Surg ; 14(1): 162, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500639

RESUMO

BACKGROUND: Sternal wound complications (SWC) are a rare but potentially life-threatening complication after coronary artery bypass grafting (CABG) surgery. Especially the use of bilateral IMA (BIMA) grafts as opposed to single IMA (SIMA) grafts is associated with an increased risk of SWC. Skeletonised harvesting has been proposed to reduce this risk. The purpose of this study was to retrospectively investigate the effect of skeletonisation on SWC after off-pump coronary artery bypass grafting (OPCAB) in a centre with a high volume of off-pump procedures and high frequencies of BIMA. METHODS: From January 2010 to November 2016, 1900 consecutive patients underwent OPCAB surgery at the University Hospitals of Leuven. The first group (n = 1487) received non-skeletonised IMA grafts, whereas the second group (n = 413) received skeletonised grafts. Optimal wound management was pursued in all patients. A new four-grade classification for SWC was developed. Incidence and grade of SWC as well as overall survival were assessed. RESULTS: Analysis of diabetic patients showed a lower incidence of SWC in the skeletonised (12/141, 8.5%) compared to the non-skeletonised group (82/414, 19.8%) [odds ratio 0.46, 95% confidence interval (0.23;0.88), p = 0.019] as well as a lower grade [0.45 (0.24;0.871), p = 0.018]. There was no significant effect on overall survival [0.67 (0.19;2.32), p = 0.529]. Subanalysis of this population revealed that the observed effects were most prominent in patients receiving BIMA grafts, with 6/56 (10.7%) SWC in the skeletonised and 62/252 (24.6%) in the non-skeletonised group [0.37 (0.15;0.90), p = 0.028 for incidence], as well as a lower grade [0.36 (0.15;0.88), p = 0.025]. These advantages were not significant in diabetic patients receiving SIMA grafts nor in the full study population. CONCLUSIONS: This study, using a more sensitive classification of SWC, shows in a large group of patients that, in combination with optimized wound management, the skeletonisation technique is associated with a clear reduction in the incidence and grade of SWC in diabetic patients receiving BIMA grafts. This encourages the extension of BIMA use in OPCAB to this risk population.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Artéria Torácica Interna/transplante , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Coleta de Tecidos e Órgãos/métodos , Idoso , Bélgica/epidemiologia , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia
14.
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
15.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451466

RESUMO

Marchiafava-Bignami disease (MBD) is a rare complication of chronic alcoholism; however, MBD in a non-alcoholic diabetic patient has rarely been reported. The aetiology or pathophysiology of MBD is still unknown. A 50-year-old man with a history of untreated diabetes mellitus underwent on-pump beating coronary artery bypass graft surgery (CABG) surgery for three-vessel and left main coronary disease. 3 days after the surgery, he developed a fever over 40°C and entered a coma state. MRI revealed multiple lesions, including in the corpus callosum, globus pallidus, brain stem and upper cervical spinal cord, which suggested MBD. The patient did not respond to thiamine therapy, but partly responded to steroid therapy. He ultimately died of respiratory failure. The autopsy revealed MBD and haemophagocytic lymphohistiocytosis. It is rare, but systemic inflammatory response syndrome induced by on-pump beating CABG could develop these complication.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Corpo Caloso/diagnóstico por imagem , Linfo-Histiocitose Hemofagocítica , Doença de Marchiafava-Bignami , Complicações Pós-Operatórias , Autopsia/métodos , Encéfalo/diagnóstico por imagem , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Doença da Artéria Coronariana/cirurgia , Evolução Fatal , Humanos , Linfo-Histiocitose Hemofagocítica/etiologia , Linfo-Histiocitose Hemofagocítica/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Doença de Marchiafava-Bignami/diagnóstico , Doença de Marchiafava-Bignami/etiologia , Doença de Marchiafava-Bignami/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia
16.
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
17.
Interact Cardiovasc Thorac Surg ; 29(6): 852-854, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31408168

RESUMO

There is evidence that, in adult cardiac surgical patients undergoing on-pump procedures, tranexamic acid (TXA) dose-dependently increases the risk of convulsive seizure (CS). We aimed to investigate whether a single TXA bolus of 1 g influences the risk of CS in patients who were operated on without the use of cardiopulmonary bypass. In 2249 propensity-score-matched pairs who underwent off-pump coronary artery bypass grafting with or without TXA administration, the risk of CS was 0.5% and 0.3% in the TXA and non-TXA groups, respectively (P = 0.36). In the subgroups of patients with estimated glomerular filtration rates <30, 30-60 and >60 ml/min/1.73 m2, the risk of CS in the TXA group was 2.8%, 1.2% and 0.4%, respectively (P = 0.002), and in the non-TXA group 0.0%, 0.0% and 0.3%, respectively (P = 0.36). The risk of stroke, in-hospital mortality and 30-day mortality did not differ significantly between study groups (P-value >0.05). Our data indicate that in patients undergoing off-pump coronary artery bypass grafting, a single TXA bolus of 1 g generally does not increase the risk of CS. However, the presence and extent of renal insufficiency have a very significant impact on the incidence of CS even after single-dose TXA.


Assuntos
Antifibrinolíticos/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal/epidemiologia , Convulsões/epidemiologia , Ácido Tranexâmico/efeitos adversos , Adulto , Idoso , Antifibrinolíticos/administração & dosagem , Feminino , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Acidente Vascular Cerebral/epidemiologia , Ácido Tranexâmico/administração & dosagem
18.
J Card Surg ; 34(10): 941-947, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31269312

RESUMO

BACKGROUND AND AIM OF THE STUDY: The possible association of off-pump coronary artery bypass graft (CABG) with reduced risk of postoperative stroke and enhanced benefits in high-risk patients support the hypothesis that patients with a positive history of cerebrovascular disease would benefit from off-pump coronary surgery. This study aims to investigate the impact of off-pump CABG on the incidence of postoperative neurologic events in patients with a previous history of cerebrovascular disease. METHODS: From January 2015 to September 2018, 414 patients underwent isolated CABG with a previous history of transient ischemic attack (TIA) or stroke: 295 patients had on-pump CABG and 119 patients had off-pump CABG. Neurological outcomes of interest are postoperative stroke (transient or permanent), delirium requiring pharmacological treatment or a combination of both, collectively defined "Major Adverse Neurological Events" (MANE). Propensity score (PS) adjusted analysis has been used for regression models. RESULTS: Off-pump CABG carried a lower incidence of postoperative stroke (3.4% vs 9.8%, P = .046, PS-adjusted odds ratio 0.34 with P = .044). Postoperative delirium occurred more than twice as often in the on-pump group (11.5% vs 4.2%, P = .034, PS-adjusted odds ratio 2.78 with P = .043). The composite outcome of MANE occurred in 20.3% in the on-pump group, and in 7.6% in the off-pump group (P = .003). Other complications were similar between groups. CONCLUSIONS: In patients with a previous TIA or stroke, off-pump CABG is associated with a reduced risk of stroke, delirium, and postoperative adverse neurological events, compared to on-pump CABG. Patients with high neurological risk can potentially benefit from off-pump CABG, due to an overall reduction of postoperative neurological complications.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Ataque Isquêmico Transitório/complicações , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Acidente Vascular Cerebral/epidemiologia , Idoso , Doença da Artéria Coronariana/complicações , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Reino Unido/epidemiologia
19.
Curr Opin Cardiol ; 34(5): 552-556, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31219874

RESUMO

PURPOSE OF REVIEW: Coronary artery bypass grafting (CABG) remains the standard of care for patients with complex multivessel coronary artery disease. However, conventional CABG utilizing left internal mammary artery and supplemental vein grafts performed on cardiopulmonary bypass is marred by questionable long-term patency of vein grafts and risk of neurological injury. Total arterial off-pump CABG is a strategy associated with avoidance of neurological injury and vein graft failure. The aim of this review is to summarize recent evidence on safety and effectiveness of total arterial off-pump CABG. RECENT FINDINGS: Two key studies have been published recently. One describes a dual inflow technique that achieves anaortic, off-pump complete revascularization using arterial grafts only. The other is single centre study that reports 10-year survival of 89.33%, rate of freedom from repeat revascularization of 91.33% and early stroke rate of 0.9% after total arterial off-pump CABG. SUMMARY: Total arterial off-pump CABG with its advantages of improved survival, enhanced freedom from repeat revascularization and low stroke rate can be regarded as the Holy Grail of myocardial revascularization. However, the results of a large, multicenter, prospective trial are required to substantiate this status.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Humanos
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