Concurrent Coronary Artery Bypass Research Articles

Analysis of Risk Factors and Intervention Strategies for Acute Kidney Injury After Cardiac Valve Replacement.

To investigate the risk factors and intervention strategies for the development of acute kidney injury (AKI) after cardiac valve replacement with extracorporeal circulation. Retrospective analysis of the clinical data of a total of 106 patients diagnosed with heart valve disease and undergoing extracorporeal circulation heart valve replacement surgery from January 2021 to December 2021 in the Department of Cardiac and Major Vascular Surgery of our hospital. The two groups were divided into AKI and non-AKI groups according to whether acute kidney injury occurred after surgery, and the preoperative, intraoperative and postoperative clinical data were compared. Single-factor analysis and multi-factor logistic regression analysis were used to explore the risk factors for acute kidney injury after extracorporeal heart valve replacement, and to improve the prognosis by giving kidney function protection strategies as early as possible. Univariate analysis showed that age, preoperative blood creatinine >130umol/L, LVEF <45%, presence of subacute infective endocarditis (SIE), concurrent coronary artery bypass grafting (CABG), time to extracorporeal circulation, time to surgery, MAP <70mmHg, urine output <0.5mL/(kg-h), pulmonary infection, low cardiac output, and bacteraemia were risk factors for postoperative AKI. Multi-factor regression analysis showed that preoperative blood creatinine >130umol/l, LVEF <45%, combined infective endocarditis, extracorporeal circulation time >2h, intraoperative and postoperative hypotension, low cardiac output, and postoperative bacteremia were independent risk factors for postoperative AKI. Active intervention strategies in the perioperative period can reduce the occurrence of postoperative AKI and improve patient prognosis.

Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting.

Patients with severe ischemic mitral regurgitation (IMR) may receive concurrent coronary artery bypass graft (CABG) with surgical mitral valve repair (SMVr) or percutaneous coronary stent implantation (PCI) with transcatheter edge-to-edge mitral valve repair (TMVr). However, there is no consensus on the management of severe IMR in this setting. We aimed to compare the outcomes of combined SMVr with CABG to concurrent TMVr with PCI among patients with IMR in the National Inpatient Sample (NIS) database. The National Inpatient Sample was queried for all patients diagnosed with IMR who underwent SMVr with CABG or TMVr with PCI during the years 2016-2018. Study outcomes included all-cause in-hospital mortality, periprocedural complications, and resources used. A total of 1,360 potentially eligible patients were included in the study. After 1:5 propensity score matching, 133 patients were classified in the SMVr + CABG group and 29 patients in the TMVr + PCI group. Adjusted mortality was higher in the TMVr + PCI group compared with the SMVr + CABG group (13.8% vs. 4.5%, P = 0.034). Perioperative complications were higher among patients who underwent SMVr + CABG including blood transfusions (29.3% vs. 6.9%, P = 0.01) and post-procedural cardiogenic shock (11.3% vs. 0%, P = 0.044). The cost of care was higher (USD$783548.80 vs. USD$331846.523, P = 0.001) and the length of stay was longer (17.9 vs. 15.44 days, P < 0.001) in the TMVr + PCI group. On multivariable analysis, age (OR, 1.039 [95% CI, 1.006-1.072]; P = 0.032), renal failure (OR, 3.465 [95% CI, 1.867-6.433]; P < 0.001), and liver disease (OR, 5.012 [95% CI, 2.578-9.686]; P < 0.001) were associated with in-hospital mortality. TMVr + PCI was associated with higher resource use and in-hospital mortality but with improved perioperative complications compared with SMVr + CABG.

Concurrent Aortic Valve Replacement and Coronary Artery Bypass Grafting: Early Outcome and Predictors of Mortality

Concurrent Aortic Valve Replacement and Coronary Artery Bypass Grafting: Early Outcome and Predictors of Mortality

Nephrectomy and Tumor Thrombectomy with Concurrent Coronary Artery Bypass Graft for an HMB-45-Negative Giant Classical Renal Angiomyolipoma with Venous Extension

Nephrectomy and Tumor Thrombectomy with Concurrent Coronary Artery Bypass Graft for an HMB-45-Negative Giant Classical Renal Angiomyolipoma with Venous Extension

Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report

IntroductionLeft ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement.Case presentationA 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus. Additional investigation revealed a moderately stenosed bicispid aortic valve, two vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent early surgery to reduce the risk of further embolic episodes. A trans-aortic approach was utilized with videoscopy and single shafted instrumentation to aide in removal of the thrombus. The patient then underwent aortic valve replacement and coronary artery bypass grafting.ConclusionWe report an alternative technique for the removal of a left ventricular thrombus in a patient undergoing concurrent coronary and aortic valve surgery. The transaortic video-assisted approach provided excellent visualisation of the apex and near complete removal of the thrombus without damaging the surrounding trabeculae. The main benefit of this technique is sparing of LV tissue, thereby preserving left ventricular function.

Early outcome of concurrent mitral valve replacement and coronary artery bypass grafting

Concomitant coronary artery bypass surgery (CABG) in patients undergoing mitral valve replacement (MVR) has been shown to be an important risk factor for hospital mortality. We evaluated preoperative characteristics, postoperative complications, in-hospital mortality rate, and length of stay in hospital for patients undergoing concurrent CABG with MVR. Preoperative and postoperative clinical data from 175 patients undergoing concurrent CABG with MVR operation at BSMMC (Bangabandhu Sheikh Mujibur Rahman Medical College), Dhaka, Bangladesh from January to December 2019 were collected and entered into a database. Information was obtained by clinical and case note review as well as detailed questionnaires to physicians and patients. Mean age of patients was 57.95 ± 10.54 years and 51.4% were male. Among studied patients, 18.3% and 2.9% underwent aortic and tricuspid valve replacement, respectively. In-hospital mortality was 6.9% and 96.0% of patients were hospitalized ≥14 days. History of congestive heart failure (P=0.027) and postoperative brain stroke (P=0.004) were independent predictors for in-hospital mortality. Exact considering of congestive heart failure and postoperative brain stroke related to in-hospital mortality in concurrent CABG with MVR operation are necessary.

The effect of combining coronary bypass with carotid endarterectomy in patients with unrevascularized severe coronary disease

ObjectiveManagement of significant carotid stenosis in those with symptomatic coronary disease remains controversial. Staged and combined carotid endarterectomy (CEA) with coronary artery bypass grafting has been described. Yet, an understanding of the additive risks of these approaches is poor. This study sought to assess outcomes in patients with clinically relevant coronary disease undergoing either isolated CEA (ICEA) or combined CEA and coronary artery bypass (concurrent coronary artery bypass [CCAB]). MethodsAll CEAs in the Vascular Quality Initiative from 2003 to 2017 were reviewed. CCABs were identified, as were ICEAs in patients with unrevascularized stable angina, unstable angina, or myocardial infarction (MI) within 6 months of operation. CCABs were compared with ICEAs as well as with a risk-matched cohort of ICEAs. Primary outcomes included perioperative stroke, all-cause death, MI, and these as composite (SDM). Univariate analysis and logistic regression were performed. ResultsThere were 4042 patients identified, including 2582 ICEA patients (64%) and 1460 CCAB patients (36%); 61% were male, 91% were white, and 39% had symptomatic carotid disease. Overall stroke was 3.5%, death 1.8%, and SDM 6.0%. ICEA had higher rates of postoperative MI (1.9% vs 0.9%; P = .01) but lower rates of stroke (2.8% vs 4.7%; P = .002), death (1.0% vs 3.0%; P < .001), and SDM (5.1% vs 7.5%; P = .002). After regression, predictors of SDM were congestive heart failure (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3-2.4; P < .001), urgent operation (OR, 1.6; 95% CI, 1.2-2.2; P = .001), and CCAB (OR, 1.3; 95% CI, 1.01-1.7; P = .04). After propensity matching, ICEA continued to have higher rates of perioperative MI (2.6% vs 1.0%; P = .01) and lower rates of death (1.0% vs 3.0%; P = .001). However, there were no longer differences in stroke (3.2% vs 4.6%; P = .10) or SDM (6.3% vs 7.8%; P = .18). Within the matched cohort, predictors of SDM included chronic obstructive pulmonary disease (OR, 1.6; 95% CI, 1.1-2.2; P = .01), congestive heart failure (OR, 1.7; 95% CI, 1.1-2.5; P = .01), and symptomatic carotid disease (OR, 1.5; 95% CI, 1.03-2.1; P = .03). CCAB was not significant (OR, 1.3; 95% CI, 0.9-1.8; P = .18). ConclusionsIn patients with unrevascularized, clinically relevant coronary disease, CCAB reduces operative MI but increases risk of stroke and death. After risk adjustment, MI remains higher in ICEA, but differences in 30-day stroke and SDM between ICEA and CCAB are no longer appreciated. These data suggest that CEA risk undertaken in patients with unrevascularized coronary disease is not inconsequential, and outcomes are similar to those of CCAB.

Reinforcement of suture lines with aortic eversion in aortic replacement

SummaryBackgroundIn this study, we describe the technique of eversion of the native aortic tissue to prevent suture line complications, and report on our results with this technique.MethodsA total of 42 patients who were operated on due to aortic aneurysm were retrospectively assessed. In all patients, an aortic segment of approximately 2 cm, which was left both distally and proximally, was everted to form a doublelayer lumen and the grafts were anastomosed. Postoperative outcomes and long-term follow-up results were assessed.ResultsAortic root replacement was done in 14 cases and eight subjects underwent concurrent coronary artery bypass surgery. Postoperatively, the average volume of the drainage was 375 ± 75 ml, and there were no re-operations. Twentyseven patients required blood transfusion.ConclusionReinforcement of the anastomosis line via eversion of the native aortic tissue reduced peri-operative blood loss and pseudo-aneurysm and infection, with the advantage of using viable tissue.

Mitral Valve Surgery with or without Concurrent Coronary Artery Bypass Grafting: 8-year Comparative Cohort Study

Mitral Valve Surgery with or without Concurrent Coronary Artery Bypass Grafting: 8-year Comparative Cohort Study

Comparison of Surgical Options in the Management of Ischaemic Mitral Regurgitation With Concurrent Coronary Artery Bypass Grafting

Comparison of Surgical Options in the Management of Ischaemic Mitral Regurgitation With Concurrent Coronary Artery Bypass Grafting

Predictors of survival, functional survival, and hospital readmission in octogenarians after surgical aortic valve replacement

ObjectiveTo analyze outcomes and predictors of functional survival (personal care home admission and mortality) and hospital readmission in patients aged ≥80 years who underwent surgical aortic valve replacement (SAVR) in a Manitoba hospital. MethodsThis was a retrospective cohort study of patients aged ≥80 years who underwent SAVR with or without coronary artery bypass grafting in Manitoba between 1995 and 2014. Data from the Manitoba Adult Cardiac Surgery database and the Manitoba Centre for Health Policy were used. Kaplan–Meier estimates of outcomes and Cox multivariate regression analysis of risk factors were performed. Survival was compared with that of age- and sex-matched life expectancy. ResultsA total of 1872 patients were aged ≥50 years and 378 were aged ≥80 years, 55% of whom (n = 208) underwent concurrent coronary artery bypass grafting. Compared with younger patients, octogenarians had higher in-hospital mortality (8.5%; P <.001), longer median intensive care unit stay (47.2 hours; P <.001), and longer median in-hospital stay (13 days; P <.001). The median follow-up was 5.2 years. Functional survival was 82.4% at 1 year and 56.5% at 5 years, and freedom from hospital readmission was 61.5% at 1 year and 28.4% at 5 years. Survival approximated the age- and sex-matched life expectancy at 1 year (83.8%) and 5 years (60.8%). Preoperative atrial fibrillation, peripheral vascular disease, female sex, postoperative acute kidney injury, and blood transfusion were associated with adverse outcomes. ConclusionsIn eligible octogenarians, SAVR has acceptable 1- and 5-year functional survival and hospital readmission rates, but significant perioperative mortality and morbidity.

Comparison of Trends and In-Hospital Outcomes of Concurrent Carotid Artery Revascularization and Coronary Artery Bypass Graft Surgery: The United States Experience 2004 to 2012

ObjectivesThe aim of this study was to compare trends and outcomes of 3 approaches to carotid revascularization in the coronary artery bypass graft (CABG) population when performed during the same hospitalization. BackgroundThe optimal approach to managing coexisting severe carotid and coronary disease remains controversial. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) are used to decrease the risk of stroke in patients with carotid disease undergoing CABG surgery. MethodsThe authors conducted a serial, cross-sectional study with time trends of 3 revascularization groups during the same hospital admission: 1) combined CEA+CABG; 2) staged CEA+CABG; and 3) staged CAS+CABG from the Nationwide Inpatient Sample database 2004 to 2012. The primary composite endpoints were in-hospital all-cause death, stroke, and death/stroke. ResultsDuring the 9-year period, 22,501 concurrent carotid revascularizations and CABG surgeries during the same hospitalization were performed. Of these, 15,402 (68.4%) underwent combined CEA+CABG, 6,297 (28.0%) underwent staged CEA+CABG, and 802 (3.6%) underwent staged CAS+CABG. The overall rate of CEA+CABG decreased by 16.1% (ptrend = 0.03) from 2004 to 2012, whereas the rate of CAS+CABG did not significantly change during these years (ptrend = 0.10). The adjusted risk of death was greater, whereas risk of stroke was lower with both combined CEA+CABG (death odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.08 to 3.97; p = 0.03; stroke OR: 0.65, 95% CI: 0.42 to 1.01; p = 0.06) and staged CEA+CABG (death OR: 2.40, 95% CI: 1.43 to 4.05; p = 0.001; stroke OR: 0.50, 95% CI: 0.31 to 0.80; p = 0.004) approaches compared with CAS+CABG. The adjusted risk of death or stroke was similar in the 3 groups. ConclusionsIn patients with concomitant carotid and coronary disease undergoing combined revascularization, combined CEA+CABG is utilized most frequently, followed by staged CEA+CABG and staged CAS+CABG strategies. The staged CAS+CABG strategy was associated with lower risk of mortality, but higher risk of stroke. Future studies are needed to examine the risks/benefits of different carotid revascularization strategies for high-risk patients requiring concurrent CABG.

Aortic Valve Replacement With or Without Concurrent Coronary Artery Bypass Grafting in Octogenarians: Eight-Year Cohort Study.

With the introduction of transcatheter aortic valve implantation (TAVI), there is increasing interest in evaluating outcomes of aortic valve replacement (AVR) with or without (+/-) concurrent coronary artery bypass grafting (CABG) particularly in high-risk patients. We reviewed the characteristics and outcomes of octogenarians undergoing isolated AVR and AVR+CABG. All patients 80 years of age or older undergoing AVR+/-CABG at Auckland City Hospital during 2005-2012 were included, and their characteristics and outcomes analysed. There were 93 and 104 octogenarians respectively undergoing isolated AVR and AVR+CABG with mean follow-up of 4.4+/-2.2 years and 4.1+/-2.3 years. Significant differences in baseline and operative characteristics contributed to higher EuroSCORE II (5.9 vs 6.4%, P=0.016) and STS Score (4.9 vs 6.9%, P<0.001) for AVR+CABG patients. They also had a significantly higher rate of 30-day mortality (0.0% vs 6.7%, P=0.015) and prolonged ventilation>24hours (10.7% vs 23.1%, P<0.001), but not composite morbidity (P=0.248) or stroke (P=0.709). Long-term survival was similar at one, three and five years; 94.6%, 82.6% and 73.0% for AVR and 91.3%, 86.1% and 67.6% for AVR+CABG. Independent predictors of 30-day mortality included reduced creatinine clearance and history of myocardial infarction. AVR+CABG had significantly higher but acceptable 30-day mortality in octogenarians than AVR. We have identified prognostic factors important in the decision-making of treatment modality, where age alone should not preclude surgery.

Eight-year cohort study of octogenarians undergoing aortic valve replacement with or without concurrent coronary artery bypass grafting

Background: Given the introduction of transcatheter aortic valve implantation (TAVI), there is significant interest in evaluating outcomes of aortic valve replacement (AVR) with or without(+/-) concurrent coronary artery bypass grafting (CABG) especially in high-risk patients. We reviewed the characteristics and outcomes of octogenarians undergoing isolated AVR and AVR+CABG. Methods: All patients 80 years of age or older undergoing AVR+/-CABG at Auckland City Hospital during 2005-2012 were included, and their characteristics and outcomes analysed. Results: There were 93 and 104 octogenarians respectively undergoing isolated AVR and AVR+CABG with mean follow-up of 4.4+/-2.2 years and 4.1+/-2.3 years. On average 10 more cases of AVR+/-CABG per year were performed since 2010 when TAVI was started at our centre. AVR+CABG patients have significantly higher proportion with history of myocardial infarction, left main and three vessel disease (all P<0.005), higher average CCS and NYHA class (both P<0.001), impaired renal function (P=0.019), higher STS score (6.9% vs 4.9%, <0.001) and longer cardiopulmonary bypass and cross-clamp time (both P<0.001) compared to AVR. They also had significantly higher rate of operative mortality (6.7% vs 0.0%, P=0.015) and prolonged ventilation>24 hours (23.1% vs 10.7%, P<0.001), but similar late mortality (P=0.195). Survival at 1, 3 and 5 years were 94.6%, 82.6% and 73.0% for AVR and 91.3%, 86.1% and 67.6% for AVR+CABG. Conclusion: AVR+CABG had significantly higher but acceptable operative mortality in octogenarians than AVR. These factors are important for the consideration of patients undergoing AVR+/-CABG or TAVI+/-percutaneous coronary intervention, where age alone should not exclude someone from surgery.

Eight-year cohort study of octogenarians undergoing aortic valve replacement with or without concurrent coronary artery bypass grafting

Eight-year cohort study of octogenarians undergoing aortic valve replacement with or without concurrent coronary artery bypass grafting

Aortic valve replacement with or without coronary artery bypass grafting: stroke outcomes and predictors

Background: Stroke is arguably the most important and devastating non-mortality complication after cardiac surgery, including comparisons between aortic valve replacement (AVR) and transcatheter aortic valve implantation. We analysed the rates and predictors of stroke after AVR with or without concurrent coronary artery bypass grafting (CABG). Methods: All patients undergoing AVR+/-CABG at Auckland City Hospital during 2005-2012 were included, and analyses conducted to identify predictors for post-operative stroke, defined as in-hospital new neurological deficits lasting more than 24 hours after surgery. Results: There were 620 isolated AVR and 450 AVR+CABG patients studied. Rates of stroke was significantly higher for AVR+CABG 3.3% (15) compared to AVR alone 1.3% (8), P=0.031. Independent predictors of stroke (odds ratio and 95% confidence interval) for isolated AVR included age (1.02, 1.00-1.04), syncope (6.07, 1.03-35.8), critical pre-operative state (6.07, 2.08-25.6) and history of stroke (7.23, 1.20-43.6), while the only independent predictor identified for AVR+CABG was diabetes on insulin (6.19, 1.63-23.5). Receiver-operative characteristics analysis found the original EuroSCORE having the highest C-statistic for detecting stroke after isolated AVR 0.845 (0.783-0.907), while the Society of Thoracic Surgeon's Score had the highest though moderate C-statistic after AVR+CABG 0.642 (0.508-0.776). Conclusion: Although rates of stroke are low at our centre, performing CABG concurrently with AVR was associated with significantly higher risk. We have identified a number of conventional cardiovascular risk factors that independently predict stroke in aortic valve surgery which should be taken into consideration when deciding for modality of aortic valve intervention.

Coronary Revascularization in Lung Transplant Recipients With Concomitant Coronary Artery Disease

Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single-center series have suggested that short-term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate-term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible.

Concurrent Carotid Endarterectomy and Coronary Artery Bypass Grafting / Valve Replacement in Asymptomatic Patients with Severe Carotid Stenosis: A Five Year Single Center Experience

Concurrent Carotid Endarterectomy and Coronary Artery Bypass Grafting / Valve Replacement in Asymptomatic Patients with Severe Carotid Stenosis: A Five Year Single Center Experience

Aortic Valve Replacement and Concomitant Coronary Artery Bypass Grafting in a Patient with Infective Endocarditis and Anomalous Origin of the Right Coronary Artery from the Opposite Sinus of Valsalva

A 69-yrs-old woman with anomalous origin of the right coronary artery from the opposite sinus of Valsalva (ACAOS) was diagnosed as having infective endocarditis affecting the aortic valve. Transthoracic echocardiography showed severe aortic stenosis and vegetations on the cusp of the aortic valve, which necessitated aortic valve replacement. Before the operation, computed tomography showed a right-ACAOS, with the artery running an interarterial course between the aorta and pulmonary artery. ACAOS running an interarterial course has been reported to be associated with an increased risk of ischemic cardiac events and sudden death. The patient was treated successfully by the aortic valve replacement with concurrent coronary artery bypass grafting using a saphenous vein graft for the right coronary artery.

Advantages of Sutureless Aortic Valve in a Patient with Unsuspected Pheochromocytoma

We describe a 60-year-old man who underwent elective aortic valve replacement and concurrent single graft coronary artery bypass surgery with acute intraoperative hypertension. The early suspicion of a pheochromocytoma and immediate aggressive pharmacologic intervention are discussed. Expeditious surgery contributed to the good outcome. It is possible that the short implant time of the sutureless valve may have been beneficial, but this is speculative. The management of an undiagnosed pheochromocytoma presenting during general anesthesia is reviewed.