Coronary Artery Bypass Graft Surgery Research Articles

Controlled antegrade and retrograde subintimal tracking (CART) for recanalisation of chronic total occlusions.

Controlled antegrade and retrograde subintimal tracking (CART) is rarely performed in contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We aimed to analyse the indications, procedural characteristics, and outcomes of CART at a high-volume CTO programme. We included all patients undergoing a retrograde CTO PCI in which CART was performed at our institution between January 2019 and November 2023. The primary endpoint was technical success. Of 1,582 CTO PCI, the retrograde approach was performed in 603 procedures (38.1%), and CART was used in 45 cases (7.5%). The mean age was 69.1±10.3 years, 93.3% were male, and prior coronary artery bypass graft surgery was present in 68.9%. The most common target CTO vessel was the right coronary artery (48.9%). Anatomical complexity was high (Multicentre CTO Registry of Japan [J-CTO] score of 3.6±0.9). The most common collateral used for CART was a saphenous vein graft (62.2%). Advanced calcium modification was required in 15.6% of cases. CART was successful in 73.3%. Technical and procedural success was 82.2%. Coronary perforation was diagnosed in 4 subjects (8.9%), but only 1 patient (2.2%) suffered tamponade and required pericardiocentesis. No other in-hospital major adverse cardiac events were diagnosed. CART is a useful technique in selected, very complex CTOs tackled with the retrograde approach. Success rates were high, while complication rates were low, considering the high anatomical complexity and baseline patient risk.

Efficacy of POWERbreathe Medic Plus device on maximal inspiratory pressure, functional capacity and quality of life in coronary artery bypass graft patients: A randomized controlled trial protocol

Coronary artery disease (CAD) is a prominent cause of illness and mortality worldwide, with a significant amount of coronary artery bypass graft (CABG) surgeries performed each year. It is a complicated technique that results in several clinical and functional issues. While CABG is an effective treatment, it comes with clinical and functional challenges, including reduced lung volume, maximal inspiratory and expiratory pressure, and thoracic mobility after surgery. Incisional pain has been associated with a decline in postoperative lung function; however, this resolves a month following surgery. There is no documented association between respiratory muscle strength and lung function after heart surgery. The POWERbreathe Medic Plus is intended for patients who have extremely weak breathing muscles as a result of illness, hospitalization, or existing respiratory health disorders such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. To address these challenges, a study will investigate the efficacy of the POWERbreathe Medic Plus device in improving maximal inspiratory pressure, functional capacity, and quality of life in CABG patients. CTRI no. – CTRI/2023/04/052116 Link-https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=ODMxNTA=&Enc=&userName=CTRI/2023/04/052116 CTRI registration date – 28/04/2023

Female Surgeons in Cardiac Surgery: Does the Surgeon's Gender Affect the Outcome of Routine Coronary Artery Bypass Graft and Isolated Aortic Valve Surgery?

The increasing presence of female doctors in the field of cardiac surgery has raised questions about their surgical quality compared to their male colleagues. Despite their success, female surgeons are still underrepresented in leadership positions, and biases and concerns regarding their performance persist. This study aims to examine whether female surgeons perform worse, equally well, or better than their male counterparts in commonly performed procedures that have a significant number of female patients. A retrospective cohort of patients from 2011 to 2020 who underwent isolated coronary artery bypass graft (CABG) and aortic valve surgery was studied. To compare the surgical quality of men and women, a 1:1 propensity score matching (two groups of 680 patients operated by men and women, respectively, factors: age, logarithm of EuroSCORE (ES), elective, urgent or emergent surgery, isolated aortic valve, or isolated CABG) was performed. Procedure time, bypass time, x-clamp time, hospital stay, and early mortality were compared. After propensity score matching between surgeons of both sexes, patients operated by males (PoM) did not differ from patients operated by females (PoF) in mean age (PoM: 66.72 ± 9.33, PoF: 67.24 ± 9.19 years, p = 0.346), log. ES (PoM: 5.58 ± 7.35, PoF: 5.53 ± 7.26, p = 0.507), or urgency of operation (PoM: 43.09% elective, 48.97% urgent, 7.94% emergency, PoF: 40.88% elective, 55.29% urgent, 3.83% emergency, p = 0.556). This was also the case for male and female patients separately. Female surgeons had higher procedure time (PoM: 224.35 ± 110.54 min; PoF: 265.41 ± 53.60 min), bypass time (PoM: 107.46 ± 45.09 min, PoF: 122.42 ± 36.18 min), and x-clamp time (PoM: 61.45 ± 24.77 min; PoF: 72.76 ± 24.43 min). Hospitalization time (PoM: 15.96 ± 8.12, PoF: 15.98 ± 6.91 days, p = 0,172) as well as early mortality (PoM: 2.21%, PoF: 3.09%, p = 0.328) did not differ significantly. This was also the case for male and female patients separately. Our study reveals that in routine heart surgery, the gender of the surgeon does not impact the success of the operation or the early outcome of patients. Despite taking more time to perform procedures, female surgeons demonstrated comparable surgical outcomes to their male counterparts. It is possible that women's inclination for thoroughness contributes to the longer duration of procedures, while male surgeons may prioritize efficiency. Nevertheless, this difference in duration did not translate into significant differences in primary outcomes following routine cardiac surgery. These findings highlight the importance of recognizing the equal competence of female surgeons and dispelling biases regarding their surgical performance.

Should the left internal mammary artery (LIMA) be imaged before radiotherapy in cases of unexpected early acute coronary syndrome?

Abstract Funding Acknowledgements None. Case A 41-year-old male patient presented to the cardiology outpatient clinic with a complaint of exertional chest pain persisting for the past 4 months, along with occasional palpitation attacks. In his medical history, aside from being diagnosed with lymphoma 15 years ago, there were no known additional comorbidities. The electrocardiogram (EKG) revealed sinus rhythm (84 beats/minute), and the blood tests showed creatinine: 0.81 mg/dL, WBC: 11.26 mm^3, LYM: 3.69 mm^3. Transthoracic echocardiography demonstrated an ejection fraction (EF) of 60%, with no additional pathologies except for grade 1 diastolic dysfunction. Considering the presence of typical chest pain, coronary imaging was performed to assess for stable angina. The coronary imaging revealed a lesion extending from the left main coronary artery (LMCA) to the proximal left circumflex artery (CX), with an 80% stenosis in the mid-segment of the LMCA, a 60% stenosis at the narrowest point of the CX proximal segment, and an 80% stenosis in the proximal right coronary artery (RCA). The left circumflex artery obtuse marginal branches (CX OM) appeared thin and extensively diseased (Figure-1) The patient was promptly scheduled for early coronary artery bypass grafting (CABG), transferred to the cardiac surgery intensive care unit, and underwent a successful coronary bypass procedure with LAD-LIMA, Ao-saphenous-IM-saphenous-CxOM1 (sequential) grafting. Throughout the postoperative follow-up period, the patient continued to experience exertional chest pain despite medical treatment. A repeat coronary angiography was performed, revealing that the bypass grafts were opened, but a diffuse 80% stenosis was detected at the mid-segment of the LIMA graft, prior to the anastomosis.(Figure-2) Successful stent placement was performed at the narrowest point of the LIMA mid-segment (Figure-3).The patient had no anginal complaints during post-procedure follow-up and has been stable under observation. Discussion Routine clinical practice does not involve LIMA imaging in patients who have undergone diagnostic coronary angiography with multi-vessel involvement and a CABG decision. However, the use of coronary artery bypass graft surgery (CABG) may entail a risk of rendering the graft unusable due to extensive mediastinal fibrosis and radiation-induced damage to the left or right mammary artery. Therefore, in patients with a history of radiation exposure in the thoracic region and a CABG decision, the visualization of the intermammary artery during coronary angiography and the consideration of alternative grafts, such as the radiation-free radial artery, or the necessity for high-risk percutaneous stent implantation, should be discussed.figure-1figure-2

ASSESSMENT OF LEFT VENTRICULAR FUNCTION AFTER CORONARY ARTERY BYPASS GRAFTING

Coronary artery bypass grafting (CABG) is a commonly performed surgical intervention for coronary artery disease (CAD), aiming to restore blood flow to the myocardium and improve cardiac function. Left ventricular (LV) systolic function is a crucial determinant of postoperative outcomes in CABG patients, yet the predictors of adverse outcomes remain incompletely understood. Objective: This study aimed to evaluate left ventricular function outcomes following CABG and identify predictors of mortality among CABG patients. Methods: A prospective cohort study was conducted at, Ch. Pervaiz Elahi Institute Of Cardiology (CPEIC), Multan, Pakistan, from December 2022 to December 2023. The study included 96 patients undergoing CABG surgery. Preoperative data collection encompassed demographic information, medical history, and baseline clinical characteristics. Left ventricular function was assessed using echocardiography preoperatively and postoperatively. Statistical analysis involved descriptive statistics, univariate analysis, and univariate regression. Results: The study cohort comprised 96 participants, with a mean age of 56.1 years (±12.2) and a male predominance (67.7%). Prevalent comorbidities included diabetes mellitus (78.1%) and hypertension (79.2%). LV systolic dysfunction (30.2%) and old ischemic heart disease (72.9%) were common preexisting conditions. Intraoperative variables included perioperative inotropes (5.2%) and emergent surgeries (3.1%). Postoperative complications included reoperation for bleeding (5.2%) and deterioration of LV ejection fraction (34.4%). The mortality rate was 5.2%. Postoperatively, the mean LVEF increased significantly from 32.00% (±5.219) to 37.00% (±9.801) in isolated CABG patients. Conclusion: This study confirms the significant improvement in LV systolic function following CABG and underscores the high benefit of CABG in patients with reduced EF. However, diabetes mellitus, advanced diastolic dysfunction, and the insertion of IABP were identified as significant predictors of adverse outcomes. Identifying patients with these risk predictors could provide complementary prognostic information and help optimise care, monitoring, and follow-up to improve their expected poor outcomes.

Sleep-Disordered Breathing, Advanced Age, and Diabetes Mellitus Are Associated with De Novo Atrial Fibrillation after Cardiac Surgery

Background: Postoperative de novo atrial fibrillation (POAF) is one of the most frequently encountered complications following cardiac surgery. Despite the identification of several risk factors, the link between sleep-disordered breathing (SDB) and POAF has barely been examined. The objective of this prospective observational study was to determine whether severe SDB is associated with POAF in patients after elective coronary artery bypass grafting (CABG) surgery. Study design and methods: The incidence and preoperative predictors of in-hospital POAF were assessed in 272 patients undergoing CABG surgery at the University Medical Center Regensburg (Germany). In-hospital POAF was detected by continuous telemetry-ECG monitoring and 12-lead resting ECGs within the first seven postoperative days. POAF that occurred after hospital discharge within 60 days post CABG surgery was classified as post-hospital POAF and was ascertained by standardized phone interviews together with the patients’ medical files, including routinely performed Holter-ECG monitoring at 60 days post CABG surgery. The night before surgery, portable SDB monitoring was used to assess the presence and type of severe SDB, defined by an apnea–hypopnea index ≥ 30/h. Results: The incidence of in-hospital POAF was significantly higher in patients with severe SDB compared to those without severe SDB (30% vs. 15%, p = 0.009). Patients with severe SDB suffered significantly more often from POAF at 60 days post CABG surgery compared to patients without severe SDB (14% vs. 5%, p = 0.042). Multivariable logistic regression analysis showed that severe SDB (odds ratio, OR [95% confidence interval, CI]: 2.23 [1.08; 4.61], p = 0.030), age ≥ 65 years (2.17 [1.04; 4.53], p = 0.038), and diabetes mellitus (2.27 [1.15; 4.48], p = 0.018) were significantly associated with in-hospital POAF. After additional adjustment for heart failure, the association between sleep apnea and postoperative atrial fibrillation was attenuated (1.99 [0.92; 4.31], p = 0.081). Conclusions: Amongst established risk factors, severe SDB was significantly associated with in-hospital POAF in patients undergoing CABG surgery. Whether SDB contributes to POAF independently of heart failure and whether risk for POAF may be alleviated by proper treatment of SDB merits further investigation.

Impact of diabetes on short-term outcomes in patients undergoing coronary artery bypass grafting surgery in acute coronary syndrome.

Diabetes mellitus (DM) is associated with concomitant comorbidities, such as atherosclerosis and cardiovascular disease. Coronary artery bypass grafting (CABG) surgery is the optimal therapy in diabetic patients with triple vessel disease. DM is also known to be a relevant risk factor for higher morbidity and mortality in patients who underwent elective CABG procedures. Data regarding outcomes in diabetic patients in acute coronary syndrome (ACS) is heterogeneous. This study aimed to investigate the impact of DM on short-term outcomes in patients who underwent CABG surgery in ACS. A retrospective propensity score matched (PSM) analysis of 1370 patients who underwent bypass surgery for ACS between June 2011 and October 2019 was conducted. All patients were divided into two groups: non-diabetic group (n = 905) and diabetic group (n = 465). In-hospital mortality was the primary outcome. Secondary outcomes were perioperative myocardial infarction, new onset dialysis, reopening for bleeding and duration of intensive care unit (ICU) stay. A subgroup analysis of patients with insulin-dependent and non-insulin dependent DM was also performed. After performing PSM analysis, baseline characteristics and the preoperative risk profile were comparable between both groups. The proportion of patients who underwent total arterial revascularization (p = .048) with the use of both internal thoracic arteries (p < .001) was significantly higher in the non-diabetic group. The incidence of perioperative myocardial infarction (p = .048) and new onset dialysis (p = .008) was significantly higher in the diabetic group. In-hospital mortality was statistically (p = .907) comparable between the two groups. DM was associated with a higher incidence of adverse outcomes, however with comparable in-hospital mortality in patients who underwent CABG procedure for ACS.

Prophylactic Left Atrial Appendage Ligation During Coronary Artery Bypass Graft Surgery Allows Safe Avoidance of Anticoagulation Regardless of Postoperative Atrial Fibrillation

Prophylactic Left Atrial Appendage Ligation During Coronary Artery Bypass Graft Surgery Allows Safe Avoidance of Anticoagulation Regardless of Postoperative Atrial Fibrillation

Spontaneous Coronary Artery Dissection: A Difficult Journey from Emergency Coronary Artery Bypass Grafting to Left Ventricular Assist Device

Spontaneous Coronary Artery Dissection: A Difficult Journey from Emergency Coronary Artery Bypass Grafting to Left Ventricular Assist Device

Rationale and design of a Single-center Randomized Trial to Compare the Graft Patency between the Radial Artery and the No-touch Saphenous Vein in Coronary Artery Bypass Grafting Surgery (GRAFT-CAB Study).

Previous studies suggested only the radial artery and the No-touch (NT) technique were effective in reducing graft occlusion after coronary artery bypass grafting (CABG) surgery. However, there is no randomized trial comparing these two graft conduits. The optimum second conduit for CABG remains undetermined. This study is a prospective, single-center randomized clinical trial, aiming to compare the graft patency between the radial artery and the NT vein graft. All patients undergoing isolated CABG with left internal mammary artery (LIMA) plus at least two additional grafts will be considered eligible. 774 cases (516 in the radial artery group and 258 in the NT vein group) will be enrolled in over 1 to 2 years. Participants will be randomized and allocated to two bypass strategies: the LIMA plus one radial artery and one conventional vein graft, or the LIMA plus two NT vein grafts. The primary outcome is graft occlusion at 1 year after CABG evaluated by CT angiography. The secondary outcomes include graft occlusion at 3 and 5 years and major adverse cardiac or cerebrovascular events at 1, 3 and 5 years follow-ups. This study will define whether or not the NT vein has a lower graft occlusion rate than the radial artery in short and mid-term follow-ups, and provide new evidence for the second conduit choice in CABG surgery. ClinicalTrials.gov NCT06014047. Registered on October 15th, 2023.

Giving up learning from failures? An examination of learning from one's own failures in the context of heart surgeons

AbstractResearch SummaryWe reassess existing theories on individual failure learning and propose an inverted‐U‐shaped relationship between an individual's accumulated failures and learning, based on a theoretical framework that jointly considers the opportunity, motivation, and perceived ability to learn. Using data on 307 California‐based cardiothoracic surgeons who performed coronary artery bypass graft surgeries in 133 hospitals between 2003 and 2018, we find compelling evidence that individuals reach a threshold at which they discontinue learning from their own failures. We also find that this threshold is higher for surgeons who had higher perceived ability to learn. This article aims to shed new light on the relationship between individuals' failure experience and their learning, and advance our understanding of the microfoundations of organizational learning, an important basis of firm performance.Managerial SummaryThis article explores how individuals learn from their own failures. Contrary to prior theories, we propose a non‐monotonic relationship between accumulated failures and learning: as a function of failures, an individual's performance will initially increase, then taper off, and finally decrease. Analyzing data on 307 cardiothoracic surgeons operating coronary artery bypass graft surgeries, we find such an inverted‐U‐shaped pattern. Notably, surgeons with higher perceived ability to learn—those with elite training, certified expertise, and specialization in patient care—reached the tipping point later than their counterparts. Our findings imply that repeated failures can have both beneficial and harmful impacts on individuals' learning processes, and therefore, both impacts must be simultaneously considered for understanding and improving individuals' performance.

Atrial fibrillation incidence after coronary artery bypass graft surgery and percutaneous coronary intervention: the prospective AFAF cohort study

Objectives. Atrial fibrillation is a common arrhythmia in patients with ischemic heart disease. This study aimed to determine the cumulative incidence of new-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting surgery during 30 days of follow-up. Design. This was a prospective multi-center cohort study on atrial fibrillation incidence following percutaneous coronary intervention or coronary artery bypass grafting for stable angina or non-ST-elevation acute coronary syndrome. Heart rhythm was monitored for 30 days postoperatively by in-hospital telemetry and handheld thumb ECG recordings after discharge were performed. The primary endpoint was the cumulative incidence of atrial fibrillation 30 days after the index procedure. Results. In-hospital atrial fibrillation occurred in 60/123 (49%) coronary artery bypass graft and 0/123 percutaneous coronary intervention patients (p < .001). The cumulative incidence of atrial fibrillation after 30 days was 56% (69/123) of patients undergoing coronary artery bypass grafting and 2% (3/123) of patients undergoing percutaneous coronary intervention (p < .001). CABG was a strong predictor for atrial fibrillation compared to PCI (OR 80.2, 95% CI 18.1–354.9, p < .001). Thromboembolic stroke occurred in-hospital in one coronary artery bypass graft patient unrelated to atrial fibrillation, and at 30 days in two additional patients, one in each group. There was no mortality. Conclusion. New-onset atrial fibrillation during 30 days of follow-up was rare after percutaneous coronary intervention but common after coronary artery bypass grafting. A prolonged uninterrupted heart rhythm monitoring strategy identified additional patients in both groups with new-onset atrial fibrillation after discharge.

Perioperative Management and Outcomes in Patients Receiving Low-dose Rivaroxaban and or Aspirin: A Sub-analysis of the COMPASS Trial

BackgroundNo study has investigated the perioperative management and clinical outcomes in patients who are receiving rivaroxaban 2.5 mg bid and ASA 81-100 mg daily. MethodsSub-analysis of the COMPASS trial to assess perioperative management and clinical outcomes in patients with stable coronary or peripheral artery disease who were randomized to receive rivaroxaban 2.5 mg bid plus ASA 100 mg daily, rivaroxaban 5 mg bid, or ASA 100 mg daily. Patients studied required a surgery/procedure during the trial. The study outcomes, which included myocardial infarction, angina, stroke, acute limb ischemia, bleeding, and death, were assessed according to treatment allocation. ResultsThere were 2,632 patients studied (mean age, 68 years; 80% male) who had a surgery/procedure, comprising percutaneous coronary interventions (∼43%), carotid or other arterial angioplasty (∼15%), pacemaker or internal cardiac defibrillator implantation (∼9%), and coronary artery bypass graft surgery (∼7%). Perioperative study drug management varied, with about one-third of patients not interrupting study drug and the remainder interrupting it between 1 and ≥10 days pre-procedure. The incidences of adverse outcomes across treatment groups were 12.7% to 15.3% for myocardial ischemia, 0.8% to 1.2% for stroke, 0.1% to 0.2% for venous thromboembolism, and 3.1% to 4.2% for any bleeding. There was no statistically significant difference in outcome rates across treatment groups. ConclusionIn patients in the COMPASS trial who required a surgery/procedure, there was no significant difference in perioperative adverse outcomes whether patients were receiving rivaroxaban 2.5 mg bid and ASA 100 mg daily, rivaroxaban 5 mg bid or ASA alone.

A-12 | Prognostic Impact of Subclinical Hypothyroidism on Short- and Long-term Outcomes Following Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-Analysis

A-12 | Prognostic Impact of Subclinical Hypothyroidism on Short- and Long-term Outcomes Following Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-Analysis

Inadvertent Suturing of a Left Internal Jugular Vein Catheter into the Innominate Vein during Coronary Artery Bypass Grafting Surgery

Inadvertent Suturing of a Left Internal Jugular Vein Catheter into the Innominate Vein during Coronary Artery Bypass Grafting Surgery

Cardiac Arrhythmias After Coronary Artery Bypass Graft Surgery.

Cardiac Arrhythmias After Coronary Artery Bypass Graft Surgery.

Comparison between propofol and total inhalational anaesthesia on cardiovascular outcomes following on-pump cardiac surgery in higher-risk patients: a randomised controlled pilot and feasibility study

ObjectivesMyocardial revascularisation and cardiopulmonary bypass (CPB) can cause ischaemia-reperfusion injury, leading to myocardial and other end-organ damage. Volatile anaesthetics protect the myocardium in experimental studies. However, there is uncertainty about...

Markedly elevated high-sensitivity troponin and in-hospital mortality after cardiac surgery

BackgroundHigh-sensitivity troponin (hsTnI) is correlated with cardiac mortality; however, studies on the relationship of markedly elevated hsTnI with in-hospital mortality after cardiac surgery are sparse. Therefore, we aimed to define this relationship in order to help guide in-hospital, acute management of post-surgical patients. MethodsWe retrospectively analyzed all cardiac surgeries completed at our institution between January 2020 and June 2022 in which a peak hsTnI was noted to be >35× upper limit of normal (ULN = 34 ng/L). The primary outcome was in-hospital death. Subgroup analysis was performed to assess differences between coronary artery bypass grafting (CABG) and other cardiac surgeries. ResultsA total of 1382 cases met inclusion criteria. The patients' mean age was 64.8 years and 68.2 % were male. Median peak hsTnI after surgery was 4202 ng/L (interquartile ratio: 2427–7654). Univariate analysis of troponin level with mortality found that for every 1000 ng/L increase in hsTnI, odds of in-hospital death increased by 3.8 % (odds ratio [OR]: 1.038; 95 % confidence interval [CI] 1.027–1.050; p < 0.0001). In a multivariate model, troponin (OR 1.02; 95 % CI 1.01–1.04; p = 0.004) maintained a significant association with in-hospital death. CABG had a lower risk of in-hospital death for any given hsTnI level up to 60,000 ng/L compared to other cardiac surgeries. ConclusionIncreasing hsTnI level is associated with increasing probability of in-hospital mortality and, therefore, serves as an additional, objective measure of risk to help guide in-hospital clinical management.

FACTORS AFFECTING MAJOR ADVERSE EFFECTS AFTER CORONARY ARTERY BYPASS SURGERY

OBJECTIVE: The present study aimed to evaluate the patient population who underwent coronary artery bypass grafting (CABG) operation in terms of mortality and major adverse effects (MAE) incidence and examine the factors affecting MAE incidence. MATERIAL AND METHODS: 169 consecutive patients who underwent CABG surgery between January 2017 and December 2019 were retrospectively analyzed. Mortality, myocardial infarction, reoperation, cardiac tamponade, stroke, renal failure, sternal infection, need for extracorporeal membrane oxygenator and cardio pulmonary resuscitation were defined as MAO. RESULTS: The mean age of the patients was 63.19 ±0.72 years, the mean duration of cardiopulmonary bypass (CPB) was 106.95 ±27 minutes, and the mean duration of aortic cross-clamp was 44.87 ±1.05 minutes. Extracorporeal membrane oxygenator support was provided to 11 (6.5%) patients, 7 (4.1%) patients underwent reoperation, 5 (3%) patients experienced a postoperative stroke, 5 (3%) patients required cardiopulmonary resuscitation, and postoperative myocardial infarction was observed in 1 (0.6%) patient. In total, MAE was determined in 28 (16.6%) patients. Mortality occurred in 9 (5.3%) patients. In the univariate analysis, Euroscore, mean arterial pressure during CPB, and ultrafiltration volume were associated with MAE (p=0.004, p=0.026, and p=0.037, respectively). However, in multivariate analysis, only Euroscore (odds ratio: 1.453, 95% CI 1.166-1.811 p=0.001) and ultrafiltration volume (odds ratio:-0.002, 95% CI 0.996-1 p=0.04) were correlated to MAE. CONCLUSIONS: In our study, we observed that high Euroscore levels increased not only mortality but also the incidence of MAO, and increased ultrafiltration volumes reduced the incidence of MAO. We believe that it should be kept in mind during CABG surgery that appropriate ultrafiltration and CPB strategy can reduce the incidence of MAO.

The association between low serum calcium level and new-onset atrial fibrillation after coronary artery bypass grafting.

This study aims to investigate the relationship between serum calcium levels and the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass graft surgery. This retrospective, observational cohort study consecutively enrolled patients undergoing isolated coronary artery bypass grafting in Beijing Anzhen hospital from January 2018 to December 2021. Patients with a previous history of atrial fibrillation or atrial flutter or requiring concomitant cardiac surgery were excluded. A logistic regression model was used to determine predictors of postoperative atrial fibrillation. Multivariable adjustment, inverse probability of treatment weighting, and propensity score matching were used to adjust for confounders. Moreover, we conducted univariable and multivariable logistic regression analyses on preoperative and postoperative serum calcium and ionized serum calcium levels. The analysis encompassed 12,293 patients. The postoperative atrial fibrillation rate was significantly higher in patients with low serum calcium level than those without (1379 [33.9%] versus 2375 [28.9%], P < 0.001). Low serum calcium level was associated with an increased odds ratio of postoperative atrial fibrillation (odds ratio [95% CI]: 1.27 [1.18-1.37], P < 0.001). Inverse probability of treatment weighting and propensity score matching analyses confirmed the results. The increased postoperative atrial fibrillation rate in low serum calcium level group still existed among subgroup analysis based on different age, sex, body mass index, hypertension, hyperlipidemia, CHA2DS2-VASc and magnesium. Low serum calcium level indicates elevated postoperative atrial fibrillation risk in patients undergoing isolated coronary artery bypass graft surgery even after the adjustment for age, sex, cardiovascular risk factors, echocardiographic parameters and laboratory markers.