Bypass Graft Patients Research Articles

Coronary Artery Bypass Grafting among Patients Undergoing Cardiac Surgery in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Among all cardiac surgeries, coronary artery bypass graft is frequently performed and is expected to improve the quality of life in patients with coronary artery disease. This study aimed to look at the prevalence of the patients undergoing coronary artery bypass grafting among cardiac surgery cases at a tertiary care hospital. This was a descriptive cross-sectional study conducted at the Cardio-Thoracic and Vascular Surgery department of a tertiary care hospital among 92 patients who underwent cardiac surgery. Participants were enrolled after the ethical clearance from the Institutional Review Committee (Reference number: 574/2019). Epidemiological characters, functional New York Heart Association classification, and left ventricular function were evaluated. Data were entered in Microsoft Excel 2010 and analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. The prevalence of coronary artery bypass graft in patients undergoing cardiac surgery was 49 (53.2%) (43.0-63.4 at 95% Confidence Interval). The mean age of 49 patients was 58.87 years. Hypertension 43 (88%), Dyslipidemia 34 (69%) and Type 2 Diabetes Mellitus 25 (51%) were major comorbidities. The mean preoperative and postoperative ejection fraction was 48.2±10.5% and 52.6±6.0% respectively. The preoperative median New York Heart Association class was 3 whereas the post-operative class was 1. Mortality was seen in one (2.04%) patient. The prevalence of coronary artery bypass graft in the patient undergoing cardiac surgery was lower than noted in other studies.

CABG in patients with liver cirrhosis: to pump or not to pump?

ABSTRACT Introduction Coronary artery bypass grafting in patients with established liver cirrhosis is generally associated with poor outcomes. Avoiding cardiopulmonary bypass (CPB) in these patients has not demonstrated any advantage over the use of CPB. We review the current available literature that compared the outcome of both on-pump (ONCABG) and off-pump (OPCAB) techniques in cirrhotic patients in terms of morbidity and mortality. Areas covered A comprehensive search was conducted in the PubMed/MEDLINE and EMBASE databases in January 2021. Articles that reported outcomes of OPCAB and/or ONCABG in cirrhotic patients with no concomitant surgical procedures were included. 829 unique abstracts were retrieved with title and abstract screening completed independently by two reviewers. Two case studies and six retrospective cohort studies were included. The largest study comprised more than 98% of the total population, showing some survival benefit for OPCAB over ONCABG. However, it was population-based and did not report the severity of liver. The remaining studies reported no clear difference in outcome between the two techniques. Expert opinion Surgical myocardial revascularisation carries high perioperative risk in patients with liver cirrhosis irrespective of the surgical technique. There is a lack of evidence to suggest that avoiding CPB in these patients may be beneficial.

Trend, predictors, and outcomes of combined mitral valve replacement and coronary artery bypass graft in patients with concomitant mitral valve and coronary artery disease: a National Inpatient Sample database analysis.

AimsCombined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) procedures have been the norm for patients with concomitant mitral valve disease (MVD) and coronary artery disease (CAD) with no large-scale data on their safety and efficacy.Methods and resultsThe National Inpatient Sample database (2002–18) was queried to identify patients undergoing MVR and CABG. The major adverse cardiovascular events (MACE) and its components were compared using a propensity score-matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 6 145 694 patients (CABG only 3 971 045, MVR only 1 933 459, MVR + CABG 241 190) were included in crude analysis, while a matched cohort of 724 237 (CABG only 241 436, MVR only 241 611 vs. MVR + CABG 241 190) was selected in PSM analysis. The combined MVR + CABG procedure had significantly higher adjusted odds of MACE [OR 1.13, 95% confidence interval (CI) 1.11–1.14 and OR 1.96, 95% CI 1.93–1.99] and in-hospital mortality (OR 1.29, 95% CI 1.27–1.31 and OR 2.1, 95% CI 2.05–2.14) compared with CABG alone and MVR alone, respectively. Similarly, the risk of post-procedure bleeding, major bleeding, acute kidney injury, cardiogenic shock, sepsis, need for intra-aortic balloon pump, mean length of stay, and total charges per hospitalization were significantly higher for patients undergoing the combined procedure. These findings remained consistent on yearly trend analysis favouring the isolated CABG and MVR groups.ConclusionCombined procedure (MVR + CABG) in patients with MVD and CAD appears to be associated with worse in-hospital outcomes, increased mortality, and higher resource utilization compared with isolated CABG and MVR procedures. Randomized controlled trials are needed to determine the relative safety of these procedures in the full spectrum of baseline valvular and angiographic characteristics.

Early and annual outcomes of coronary artery bypass grafting in patients with coronary arteries less than 1.5 mm and their comparison with postoperative outcomes in patients with larger coronary arteries

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить эффективность коронарного шунтирования (КШ) у больных с диаметром коронарных артерий (КА) менее 1,5 мм по сравнению с результатами шунтирования у пациентов с более крупными сосудами. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Проанализированы ранние и годичные результаты КШ в двух псевдорандомизированных группах больных: в исследуемой 1-й группе — 100 пациентов со множественными поражениями КА диаметром менее 1,5 мм в зоне микрохирургических анастомозов и во 2-й группе сравнения, в которой КШ выполнялось с КА диаметром более 1,5 мм (тоже 100 наблюдений). 1-я группа разделена на 2 подгруппы — пациенты с КА ≤1,5 мм (<i>n</i>=61) и с КА ≤1 мм (<i>n</i>=39). Пациентам с подозрением на клинику ишемической болезни сердца при годичном наблюдении были проведены клинические обследования с контрольной мультиспиральной компьютерной томографией или прямой шунтографией. <h3>РЕЗУЛЬТАТЫ</h3> При исследовании госпитальных результатов единственный случай периоперационного инфаркта миокарда с последующим летальным исходом отмечен в группе с КА ≤1 мм. Через год зафиксировано 6 (11,3%) случаев рецидива стенокардии выше I функционального класса у пациентов с КА ≤1,5 мм, 11 (30,6%) случаев с шунтированием КА ≤1 мм и 8 (9,2%) случаев у больных после шунтирования КА &gt;1,5 мм. В группе с КА ≤1,5 мм умерло 2 (3,8%) пациента, в группе с КА ≤1 мм — 1 (2,7%) пациент, в контрольной группе летальные случаи не зарегистрированы. Частота повторных реваскуляризаций примерно одинаковая и статистически не различалась — по 1 случаю в каждой из исследуемых подгрупп (1,9% у пациентов с КА ≤1,5 мм и 2,9% — с КА ≤1 мм соответственно) и 2 (2,3%) случая в группе сравнения. По данным шунтографии в течение года после операции в исследуемой группе было 8 случаев несостоятельных аутовенозных шунтов к КА ≤1,5 мм и 9 случаев — к КА ≤1 мм, из которых в 2 наблюдениях выявлено поражение маммарных шунтов. В контрольной группе неудовлетворительные результаты к КА &gt;1,5 мм зарегистрированы в 7 случаях и 1 случай окклюзии аутовенозного шунта к ветви КА ≤1 мм. <h3>ЗАКЛЮЧЕНИЕ</h3> Наше исследование свидетельствует о высокой эффективности выполнения полной реваскуляризации миокарда у больных с КА ≤1,5 мм. В группе с КА ≤1 мм в госпитальном периоде отмечалась тенденция к развитию периоперационного инфаркта миокарда с летальным исходом и большая частота окклюзий шунтов у пациентов через год, в связи с чем необходима дальнейшая разработка техники и тактики шунтирования артерий ≤1 мм в зоне анастомозов.

Does the previous stenting affects the outcome of coronary artery bypass grafting in patients with multivessel disease

BackgroundDuring the past decade, the number of percutaneous coronary interventions (PCI) performed before coronary artery bypass grafting (CABG) has risen significantly. Patients with more serious coronary pathology are referred for CABG, which can affect the postoperative outcome.Patients and methodsOutcomes of 60 CABG patients, who were recruited in a prospective comparative study, were compared. Group A (n = 30) underwent primary CABG and group B (n = 30), had prior PCI before CABG.ResultsTotal morbidity was substantially higher in the second group than in the first, with six patients in group A (nonstent group) and 19 patients in group B being affected (stent group). Inotropes and intraaortic balloon pump were used more in the previous PCI community than in group A. Group B had a longer ICU stay (50.45 ± 33.49 h in group A vs. 79.56 ± 60.44 h in group B).ConclusionPrevious PCI can have a detrimental effect on the morbidity outcome of the subsequent CABG. However, postoperative mortality has not been affected significantly. Thus, percutaneous coronary revascularization should be carefully weighed against the increased risk of CABG afterward. The guidelines for intervention should be strictly followed, particularly in patients with complex coronary lesions who are more likely to be referred for CABG.

Analysis of Changes in “Mitral Valve Reserve” after Coronary Artery Bypass Grafts in Patients with Functional Mitral Regurgitation

Analysis of Changes in “Mitral Valve Reserve” after Coronary Artery Bypass Grafts in Patients with Functional Mitral Regurgitation

Safety and Efficacy of PCI Versus Coronary Artery Bypass Graft in Patients with STEMI and Unprotected Left Main Stem Disease: A Systematic Review&amp;nbsp;&amp;amp; Meta-Analysis

Safety and Efficacy of PCI Versus Coronary Artery Bypass Graft in Patients with STEMI and Unprotected Left Main Stem Disease: A Systematic Review&amp;nbsp;&amp;amp; Meta-Analysis

In-hospital outcomes of coronary artery bypass grafting in patients with coronary artery diameter less than 1.5 mm and in patients with larger vessels

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Сравнение ранних результатов коронарного шунтирования (КШ) у больных с диаметром коронарных артерий (КА) менее 1,5 мм и у больных с более крупными сосудами. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Изучены результаты КШ в период с января 2018 г. по декабрь 2020 г. в двух группах больных. Основная группа включала 100 больных с множественными поражениями КА диаметром менее 1,5 мм, которым в послеоперационном периоде была выполнена контрольная КТ-шунтография. Группа сравнения включала 100 пациентов с диаметром КА более 1,5 мм. Группы сформированы методом псевдорандомизации. <h3>РЕЗУЛЬТАТЫ</h3> В исследуемой группе достоверно чаще использовали сложные реконструктивные методики, что обусловило увеличение продолжительности ишемии миокарда и искусственного кровообращения (ИК). Диагностирован 1 случай периоперационного инфаркта миокарда у пациента с диаметром КА ≤1 мм с последующим летальным исходом. Кроме того, отмечено, что время ишемии, ИК и восполняемая кровопотеря у таких больных также были достоверно выше как по сравнению с пациентами с диаметром КА ≤1,5 мм, так и по сравнению с контрольной группой. По данным выполненной в исследуемой группе КТ-шунтографии зарегистрировано 10 случаев окклюзии шунтов к КА диаметром ≤1,5 мм, из которых в 8 случаях отмечали дисфункцию шунтов к КА диаметром ≤1 мм. <h3>ВЫВОД</h3> Наше исследование свидетельствует о целесообразности полной реваскуляризации миокарда у больных с диаметром КА ≤1,5 мм. Шунтирование КА диаметром ≤1 мм показало худшие результаты и большее количество ранних окклюзий шунтов. Для окончательных выводов требуется дальнейшее изучение проблемы в отдаленном периоде.

Early Outcomes of Coronary Artery Bypass Grafting in Patients with Preoperative Renal Dysfunction

Background: Chronic kidney disease combined with coronary artery disease is a growing public health issue. Preoperative renal dysfunction is one of the major risk factors for perioperative morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG). This study aimed to analyze the early clinical outcomes of CABG in patients with preoperative renal impairment.&#x0D; Methods: The study was conducted from July 2017 to July 2019. We included 100 patients who underwent CABG. Group A (n= 50) included patients with preoperative renal impairment and group B (n= 50) had patients with normal renal functions.&#x0D; Results: The mean age was 63.3±9.1 years in Group A and 57.1±8.5 years in Group B (P&lt;0.001). There were 35 males in Group A and 47 in Group B (P&lt;0.001). Blood transfusion was more in Group A (47 (94%) vs. 32 (64%) patients; P=0.001). There was no difference in mortality between both groups.&#x0D; Conclusion: Preoperative renal impairment in patients undergoing CABG is more common in elder females. Patients undergoing CABG with preoperative renal impairment could have a higher risk for blood transfusion.

On-pump and off-pump coronary artery bypass grafting in patients with diffuse coronary artery disease

<h3></h3> Диффузное поражение коронарного русла обусловливает сложность инвазивного лечения и худший прогноз в структуре заболевания ишемической болезнью сердца. Предшествующие чрескожные коронарные вмешательства, повышение среднего возраста, уровня коморбидности оперируемых пациентов с сопутствующим сахарным диабетом и дислипидемией ведут к увеличению встречаемости диффузного поражения коронарных артерий. В настоящее время не существует единого алгортима выбора тактики реваскуляризации у таких больных, которые нуждаются в сложных реконструктивных вмешательствах с эндартерэктомией и шунтопластикой, что усложняет оценку результатов оперативного лечения. В обзоре представлены различные технические особенности прямой реваскуляризации миокарда у больных с диффузным поражением коронарных артерий с применением эндартерэктомии и шунтопластики. Проанализирован опыт проведения коронарного шунтирования на работающем сердце и в условиях искусственного кровообращения.

Left Ventricular Structure is Associated with Postoperative Death After Coronary Artery Bypass Grafting in Patients with Heart Failure with Reduced Ejection Fraction

BackgroundThe relationship between abnormal left ventricular (LV) structure and adverse outcomes has been confirmed in diverse patient groups in previous studies. However, it remains uncertain whether LV structure has predictive implications in heart failure with reduced ejection fraction (HFrEF) patients with coronary artery bypass grafting (CABG).MethodsThis study retrospectively enrolled patients who had HFrEF and underwent CABG between January 2013 and July 2019. According to LV hypertrophy (LVH) and LV enlargement (LVE) assessed by echocardiography, patients were classified into four LV structure types: (-)LVH/(-)LVE, (+)LVH/(-)LVE, (-)LVH/(+)LVE, and (+)LVH/(+)LVE.ResultsA total of 435 consecutive patients (mean age: 59.4 ± 9.6 years; 14.9% female) were enrolled in the present study. Examined independently, either LVH (p < 0.001) or LVE (p < 0.001) was independently associated with postoperative mortality in multivariate analysis. When LVH and LVE were analyzed in combination, the risk of mortality after CABG was lowest in (-)LVH/(-)LVE and increased with (+)LVH/(-)LVE (odds ratio [OR]: 7.525; 95% confidence interval [CI]: 1.827–30.679, p = 0.004), (-)LVH/(+)LVE (OR: 7.253; 95% CI: 1.950–27.185, p = 0.003), and (+)LVH/(+)LVE (OR: 9.547; 95% CI: 2.726–34.805, p < 0.001), independent of other risk factors. Adding LV structural types to the baseline model gained an incremental effect on the predictive value for postoperative mortality (AUC: baseline model, 0.838 vs baseline model + LV structural types, 0.901, p for comparison = 0.010; category‐free net reclassification improvement (NRI): 0.764, p < 0.001; integrated discrimination improvement (IDI): 0.061, p = 0.007).ConclusionLVH and LVE were associated with an increased risk of postoperative mortality after CABG in patients with HFrEF. Categorizing LV structural patterns with LVH and LVE contributes to risk stratification and provides incremental predictive ability. Routine echocardiographic assessment of LVH and LVE is needed in clinical practice.

The Effect of Off-Pump Coronary Artery Bypass Grafting in Patients on Aspirin Therapy until Surgery Day.

Coronary artery bypass grafting (CABG) is widely used to treat coronary artery disease, and intraoperative and postoperative bleeding is one of the major factors affecting the efficacy and mortality of CABG. To overcome the adverse effects of extracorporeal circulation (CPB), nonextracorporeal coronary artery bypass grafting (OPCABG) has become the main modality of CABG but is still prone to thromboembolic events. Whether antiplatelet agents should be clinically applied before CABG, especially OPCABG, remains controversial. Aspirin is currently the most important perioperative oral antiplatelet agent for coronary artery bypass graft surgery. In this study, we evaluated the effect of continuing aspirin therapy before OPCABG and observed perioperative performance and physiological indicators to find evidence for continuing aspirin therapy before surgery in China. The study showed that preoperative aspirin application had a positive effect on enhancing early postoperative platelet inhibition without increasing the incidence of adverse effects such as cardiovascular events. This provides an important clinical reference for whether antiplatelet agents should be applied before CABG, especially OPCABG.

Off-pump coronary artery bypass grafting in patients with coronary artery disease and concomitant aortic valve lesion

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценка результатов хирургического лечения больных с сочетанным поражением коронарных артерий и аортального клапана путем реваскуляризации миокарда на работающем сердце и в условиях кардиоплегического ареста. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование вошли больные (<i>n</i>=41) с сочетанным поражением коронарных артерий и аортального клапана, которым выполняли одномоментную реваскуляризацию миокарда с коррекцией порока аортального клапана. В 1-й группе (<i>n</i>=22) больным выполнено аортокоронарное шунтирование в условиях кардиоплегического ареста, во 2-й группе (<i>n</i>=19) — реваскуляризация на работающем сердце. <h3>РЕЗУЛЬТАТЫ</h3> <i></i> В группе больных с реваскуляризацией миокарда без использования искусственного кровообращения (ИК) или на параллельном ИК выявлено значимое сокращение времени пережатия аорты (189,9±27,6 и 89,2±23,3 мин, <i>p</i>&lt;0,05), ИК (149±30,5 и 128,9±27,4 мин, <i>p</i>&lt;0,05) и общей длительности операции (327,5±62,8 и 274,5±30,8 мин, <i>p</i>&lt;0,05). Также отмечено статистически значимое сокращение объема необходимой гемотрансфузии (3,5±1,5 и 1,9±1,0 дозы свежезамороженной плазмы, <i>p</i>&lt;0,05; 2,1±0,6 и 1,3±0,7 дозы эритроцитарной взвеси, <i>p</i>&lt;0,05) и длительности госпитализации (17,1±6,4 и 13,6±4,5 сут, <i>p</i>&lt;0,05). <h3>ВЫВОД</h3> <i></i> Реваскуляризация миокарда на работающем сердце у больных с сочетанной патологией позволяет достоверно сократить время пережатия аорты, длительность ИК, продолжительность операции, а также снизить объем гемотрансфузии и сократить длительность лечения.

One-Stop Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease.

Background: Data on one-stop hybrid coronary revascularization (HCR) are limited. This study aimed to compare the early and midterm outcomes of one-stop HCR with off-pump coronary artery bypass grafting (OPCAB) in patients with multivessel coronary artery disease.Methods: From April 2018 to May 2021, 752 patients with multivessel coronary artery disease who underwent isolated one-stop HCR or OPCAB were retrospectively included in this analysis. After exclusion and propensity score matching, 151 patients who underwent HCR were matched with 151 patients who underwent OPCAB. The primary endpoints were midterm major adverse cardiovascular and cerebrovascular events (MACCE) after the procedure. The secondary endpoints were in-hospital complications and outcomes.Results: The preprocedural characteristics were well balanced between the two groups after matching. The HCR group was associated with a lower rate of perioperative transfusion (23.8 vs. 53.0%, p < 0.001) and new-onset atrial fibrillation (AF) (5.3 vs. 15.2%, p = 0.004), shorter time of mechanical ventilation (h) [15 (16, 17) vs. 17 (16, 20), p < 0.001], and shorter length of stay (LOS) in the hospital (days) [19 (16, 24) vs. 22 (18, 27), p = 0.001]. Cumulated MACCE rates were similar between the two groups (15.9 vs. 14.0%, p = 0.59) during a median follow-up of 20 months.Conclusions: One-stop HCR is safe and efficacious with less invasiveness and faster postoperative recovery in selected patients with multivessel coronary artery disease. Randomized controlled trials with larger sample sizes and long-term follow-up are warranted to confirm these findings.

Ejection Fraction Recovery after Coronary Artery Bypass Grafting for Ischemic Cardiomyopathy.

Controversy exists about left ventricular systolic function recovery after coronary artery bypass grafting in patients with ischemic cardiomyopathy. The aim of this study is to evaluate the temporal evolvement of left ventricular systolic function after coronary artery bypass surgery in patients with ischemic cardiomyopathy. A total of 50 patients with coronary artery disease and left ventricular ejection fraction (LVEF) ≤35% underwent isolated coronary artery bypass grafting in a single center in the period 2017 to 2019. We performed a retrospective analysis of the echocardiographic and clinical follow-up data at 3 months and 1 year postoperatively. Median LVEF preoperatively was 25% (20-33%), mean patient age was 66 ± 8.2 years, 33 (66%) patients were operated off-pump, and 22 (44%) procedures were non-elective. There was no in-hospital myocardial infarction, stroke, and repeat revascularization. Three (6%) patients underwent re-exploration for bleeding or tamponade. In-hospital mortality was 8% and 1-year mortality was 12%. At 1 year postoperatively, there was no repeat revascularization, no myocardial infarction, 1 (2.6%) patient had a transient ischemic attack, and 10 (20%) patients required an implantable defibrillator. There was a statistically significant median ejection fraction increase at 3 months (15% [5-22%], p < 0.0001) and 1 year (23% [13-25%], p < 0.0001) postoperatively, with an absolute increase ≥10% in 32 (74.4%) and 30 (78.9%) patients at 3 months and 1 year, respectively. Patients with ischemic cardiomyopathy undergoing coronary artery bypass surgery show continuous recovery of left ventricular systolic function in the first postoperative year.

Developing and verifying a multivariate model to predict the survival probability after coronary artery bypass grafting in patients with coronary atherosclerosis based on the MIMIC-III database

BackgroundCoronary atherosclerosis is one of the main cardiovascular diseases affecting the global population. Coronary artery bypass grafting (CABG) is commonly used to improve the survival probability of patients with coronary atherosclerosis. However, the prognosis of patients after CABG remains unclear. ObjectivesWe aimed to construct a novel nomogram comprising readily available indicators to predict the 1-, 2-, and 3-year survival rates after CABG in patients with coronary atherosclerosis. MethodsWe utilized the Medical Information Mart for Intensive Care III (MIMIC-III) database for the study. The calibration plot, concordance index (C-index), net reclassification index (NRI), integrated discrimination improvement (IDI), and area under the receiver operating characteristic curve (AUROC) were used to evaluate the performance of the model, and to compare the nomogram with the Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology Score II (SAPS II) in order to illustrate the clinical effectiveness of the model. ResultsThe multivariate Cox regression model showed that age, marital status, body mass index, creatinine, platelet count, red cell distribution width, heart rate, intensive-care unit stay time, and Elixhauser Comorbidity Index were risk factors. The C-indexes of the nomogram exceeded 0.75, and its NRI and IDI were both higher than 0. The AUROCs were larger for the nomogram than for the SAPS II and SOFA score. ConclusionOur new nomogram is a personalized tool that helps clinicians choose treatment options and predict the long-term prognosis of patients.

Dual antiplatelet therapy before coronary artery bypass grafting in patients with myocardial infarction: a prospective cohort study

BackgroundDual antiplatelet therapy (DAPT) in patients with MI who are candidates for early coronary artery bypass grafting (CABG) can affect intraoperative and postoperative outcomes. Therefore, the aim of this study was to evaluate the effect of DAPT up to the day before CABG on the outcomes during and after surgery in patients with MI.MethodsIn this prospective cohort study, 224 CABG candidate patients with and without MI were divided into two groups: (A) patients without MI who were treated with aspirin 80 mg/day before surgery (noMI-aspirin group; n = 124) and (B) patients with MI who were treated with aspirin 80 mg/day before surgery and clopidogrel (Plavix brand) at a dose of 75 mg/day (MI-DAPT group; n = 120). Dual or mono-antiplatelet therapy continued until the day before surgery. Patients were followed to assess in-hospital and 6-months outcomes.ResultsThe in-hospital mortality in MI-DAPT group was similar with noMI-aspirin group (OR 4.2; 95% CI 0.9–20.5; p = 0.071). The prevalence of CVA (p = 0.098), duration of hospital stay (p = 0.109), postoperative ejection fraction level (p = 0.693), diastolic dysfunction grade (p = 0.651) and postoperative PAP level (p = 0.0364) did not show difference between two groups. No mild or severe bleeding was observed in the patients. Six-month follow up showed that number of readmissions (p = 0.801), number of cases requiring angiography (p = 0.100), cases requiring re-PCI (p = 0.156), need for re-CABG (p > 0.999) and CVA (p > 0.999) did not differ between the two groups. During the 6-month follow-up, out-hospital mortality did not differ significantly between the two groups (p = 0.446).ConclusionsA 6-month follow-up showed that DAPT with aspirin and clopidogrel before CABG in patients with MI has no effect on postoperative outcomes more than mono-APT with aspirin. Therefore, DAPT is recommended in the preoperative period for these patients.

Intraoperative transit time flow measurement in patients with diffuse coronary artery disease in the prevention of aortocoronary bypass graft occlusion

Aim. To study the parameters of transit time flow measurement (TTFM) for coronary bypass grafts in patients with diffuse lesions with different diameter of target coronary arteries.Material and methods. The study included 150 patients with diffuse coronary artery disease. All patients underwent microscope-assisted coronary artery bypass grafting (CABG), during which the TTFM parameters were evaluated. Depending on the diameter of target coronary arteries, patients were divided into 3 groups: group 1 included grafts to arteries ≤1 mm (n=101), group 2 — 1-1,5 mm (n=138), group 3 — ≥1,5 mm (n=308). Comparative analysis of TTFM parameters was performed.Results. Mostly participants were male (76%); mean age was 62,9±7,6 years. During hospitalization, we recorded 1 death, 2 perioperative myocardial infarctions (1,3%) and 1 cerebrovascular accident (0,7%). TTFM analysis showed the worst hemodynamic parameters and a higher rate of suboptimal function in group 1; blood flow parameters were comparable in groups 2 and 3. The additional analysis in group 1 and combined groups 2 and 3 allows us to make an opinion about the negative impact of coronary artery diameter less than 1 mm on optimal blood flow through the grafts (odds ratio=2,1, 95% confidence interval, 1,2-3,8, p=0,011).Conclusion. Diffuse coronary atherosclerosis with a diameter of target coronary arteries less than 1 mm significantly increase the risk of suboptimal graft function that requires considering more aggressive secondary prevention. TTFM demonstrate high effectiveness of microscope-assisted CABG in target coronary artery diameter of 1-1,5 mm and higher.

Comparative characteristics of a pacemaker implantation after biatrial or left atrial ablation of atrial fibrillation in combination with coronary artery bypass grafting in patients with ischemic heart disease and long-standing persistent atrial fibrillation.

Aim To compare the incidence of a permanent pacemaker (PP) implantation based on the chosen treatment technology (biatrial ablation, BA, or left atrial ablation (LAA) for long-standing persistent atrial fibrillation (AF) with simultaneous coronary bypass (CB).Material and methods The study included 116 patients with long-standing persistent AF and indications for CB. Patients were randomized to two equal groups (58 patients in each). Group 1 underwent BA in combination with CB; group 2 patients underwent isolated LAA with simultaneous CB under the conditions of artificial circulation. Incidence of PP implantation was assessed during the early (to 30 days) and late (to 60 months) postoperative periods.Results For the observation period, a total of 9 PPs was implanted in both groups, 6 in the BA group and 3 in the LAA group (odds ratio, OR, 0.5; 95 % confidence interval, CI, 0.1-2.4; р=0.490). During the early postoperative period, 5 patients in the BA group and 2 patients in the LAA group were implanted with PP (OR, 0.4; 95 % CI. 0-2.5; р=0.438). During the late postoperative period, one (2%) patient of the BA group was implanted with a permanent PP at 30 months of follow-up due to the development of sick sinus syndrome (SSS); also, one (2%) patient of the LAA group required PP implantation at 54 months of follow-up due to the development of SSS. The causes for PP implantation in the BA group included the development of complete atrioventricular (AV) block in 9 % of cases (95 % CI, 4-19 %); sinus node dysfunction and junctional rhythm in 2 % of cases (95 % CI, 0-9 %). Compared to this group, the LAA group showed a statistically significant difference in the incidence of AV block (0 cases, р=0.047). The major cause for PP implantation in the LAA group was the development of sinus node dysfunction in 3 (5 %) patients (95 % CI, 2-14 %).Conclusion The use of BA in surgical treatment of long-standing persistent AF with simultaneous myocardial revascularization is associated with a high risk of AV block, which requires permanent PP implantation in the postoperative period. Total incidence of permanent PP implantation for dysfunction of the cardiac conduction system following the combination surgical treatment of long-standing persistent AF and IHD, either CB and LAA or BA, did not differ between the treatment groups both in early and late postoperative periods.

624 Twenty Years' Experience of Coronary Artery Bypass Grafting in Patients with Reduced Left Ventricular Ejection Fraction

Abstract Aim Reduced Left Ventricular Ejection Fraction (LVEF) is a risk factor for patients undergoing Coronary Artery Bypass Grafting (CABG). The aim of our study was to compare short term outcomes and long-term (20 years) survival rates of patients with reduced LVEF undergoing CABG. Method Between 1996 and 2015, 5016 patients with reduced LVEF underwent CABG: 1024 (20.4%) had poor LVEF (&amp;lt; 30%) and 3992 (79.6%) had moderate LVEF dysfunction (30-49%). After excluding reoperations and combined procedures, the final sample consisted of 3867 patients. Our primary outcomes were early in-hospital mortality and complications and long-term survivals. Results In-hospital mortality rate was 4.4%, stroke rate 1.4% and renal failure 2.9%. Survival rates at 1, 5, 10 and 20 years were 91.1%, 76.7%, 55.1% and 22.1% respectively. Additive Euroscore and Logistic Euroscore (AUC 0.78) is less reliable compared to normal LV patients. Complete revascularization was an independent factor affecting long term survival (HR: 0.85). No difference between OPCABG and ONCABG were found. Conclusions CABG is still safe and most likely the best treatment option for patients with reduced LVEF. Completeness of revascularization plays an important role in long term outcomes while OPCABG has no significant advantages. Euroscore has a reduced predicting ability in this group of patients.