Coronary Artery Bypass Grafting Group Research Articles

CABG outcomes in patients with postinfarctional ventricular septal rupture

Aim: Postinfarctional ventricular septal rupture (Post MI VSR) is the most fatal complication of the myocardial infarction. The mortality rate in modern and in-time surgical management is varying between 10 and 40%; the survival rate is 88% in the first year. The issue of CABG (coronary artery by-pass grafting) is still the subject of great discussion. In order to clarify this issue, we decided to analyze the short- and long-term outcomes of CABG in our patients with Post MI VSR. Material and Methods: In our research we analyzed 90 patients with IHD (ischemic heart disease), complicated with Post-MI IVS rupture (Post -MI IVSR). Most of the patients with Post MI VSR were over 60 years old. The Post MI VSR within first days after acute myocardial infarction (AMI) was detected in 10 patients; up to 3 days – in 6 patients; up to 7 days – in 3 patients; from 7 to 29 days – in 4 patients. The time of IVS rupture after AMI was varying from 1 to 29 days (5.5±7.6 дней). All patients were distributed into groups depending on the hospitalization time after AMI. Out of 83 patients underwent reconstruction after Post MI VSR, 79 (95.2%) required CABG. Two- or three-vessel lesions were detected in 67 (80.7%) patients. Cumulative mortality in CABG group was 19.7%, whereas in the group without accompanied CABG – 20%. The long-term outcomes were followed from 1- to 8 years, averagely in 18 patients (28.6%). Results: The decompensation of heart failure and relapse of coronary symptoms during follow-up up to 3 years was observed in 6 (33.3%) patients, during follow-up from 3 to 8 years – in 3 (25%) out of 12 patients. The repeated revascularization was conducted in 5 patients. Conclusion: Our results are showing the benefits of CABG in patients with Post MI VSR, which requires mandatory coronary angiography in pre-op period.

Comparison Between Treatment Strategies of Carotid Stenosis in Patients Undergoing Coronary Artery Bypass Grafting.

IntroductionIn patients undergoing coronary artery bypass grafting (CABG), stroke is a major complication that increases morbidity and mortality. The presence of carotid stenosis (CS) increases risk of stroke, and the optimal treatment remains uncertain due to the lack of randomized clinical trials. The aim of this study is to compare three management approaches to CS in patients submitted to CABG.MethodsFrom 2005 to 2015, 79 consecutive patients with significant CS submitted to CABG were retrospectively evaluated. Patients were divided in three groups, according to CS treatment: 17 underwent staged carotid endarterectomy (CEA)-CABG, 26 underwent synchronous CEA-CABG, and 36 underwent isolated CABG without carotid intervention. The primary outcomes were composed by 30-day postoperative acute myocardial infarction (MI), 30-day postoperative stroke, and death due to all causes during the follow-up.ResultsPatients were evaluated during an average 2.05 years (95% confidence interval = 1.51-2.60) of follow-up. Major adverse cardiac events, including death, postoperative MI, and postoperative stroke, occurred in 76.5% of the staged group, 34.6% of the synchronous group, and 33.3% of the isolated CABG group (P=0.007). As for MI, the rates were 29.4%, 3.85%, and 11.1% (P=0.045), respectively. There was no statistically significant difference in total mortality rates (35.3%, 30.8%, and 25.0%, respectively; P=0,72) and stroke (29.4%, 7.7%, and 8.3%, respectively; P=0,064) between groups.ConclusionStaged CEA-CABG is associated with higher major adverse cardiac events and MI rate when compared to the strategy of synchronous and isolated CABG, but without statistically difference in total mortality during the entire follow-up.

Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta‐analysis

Coronary artery bypass graft (CABG) accelerates the prevalence of native coronary chronic total occlusion (CTO), and this kind of CTO shows extensive challenging and complex atherosclerotic pathology. As a result, the procedural success rate of percutaneous coronary intervention (PCI) is inferior to another kind of lesions. The present meta‐analysis aims to compare the lesion characteristics and procedural complications of CTO‐PCI in patients with or without prior CABG. A total of 8 studies, comprising of 13439 patients, published from inception to August 2021 were included in this meta‐analysis. Results were pooled using random effects model and are presented as odds ratio (OR) with 95% confidence intervals (95% CIs). From the 13439 patients enrolled, 3349 (24.9%) patients had previous CABG and 10090 (75.1%) formed the control group in our analysis. For the clinical characteristic, compared to the non‐CABG patients, prior CABG patients were older (OR, 3.98; 95% CI, 3.19–4.78; p < .001; I 2 = 72%), had more male (OR, 1.30; 95% CI, 1.14–1.49; p < .001; I 2 = 6%), diabetes mellitus (OR, 1.54; 95% CI, 1.36–1.73; p < .001; I 2 = 37%), dyslipidemia (OR, 1.89; 95% CI, 1.33–2.69; p < .001; I 2 = 81%), hypertension (OR, 1.88; 95% CI, 1.46–2.41; p < .001; I 2 = 71%), previous myocardial infarction (OR, 1.94; 95% CI, 1.48–2.56; p < .001; I 2 = 85%), and previous PCI (OR, 1.74; 95% CI, 1.52–1.98; p < .001; I 2 = 22%). Non‐CABG patents had more current smoker (OR, .45; 95% CI, 0.27–0.74; p < .001; I 2 = 91%). BMI (OR, −0.01; 95% CI, −0.07–0.06; p = .85; I 2 = 36%) were similar in both groups. For lesions location, the right coronary artery (RCA) was predominant target vessel in both groups (50.5% vs 48.7%; p＝.49), although, the left circumflex (LCX) was more frequently CTO in the prior CABG group (27.3% vs 18.9%; p＜.01), while left anterior descending artery (LAD) in non‐CABG ones (16.0% vs 29.1%; p＜0.01). For lesions characteristics, prior CABG patients had more blunt stump (OR, 1.71; 95% CI, 1.46–2.00; p < .001; I 2 = 40%), proximal cap ambiguity (OR, 1.45; 95% CI, 1.28–1.64; p < .001; I 2 = 0.0%), severe calcifications (OR, 2.91; 95% CI, 2.19–3.86; p < .001; I 2 = 83%), more bending (OR, 3.07; 95% CI, 2.61–3.62; p < .001; I 2 = 0%), lesion length > 20 mm (OR, 1.59; 95% CI, 1.10–2.29; p = .01; I 2 = 83%), inadequate distal landing zone (OR, 1.95; 95% CI, 1.75–2.18; p＜.001; I 2 = 0.0%), distal cap at bifurcation (OR, 1.65; 95% CI, 1.46–1.88; p < .001; I 2 = 0.0%), and higher J‐CTO score (SMD, 0.52; 95% CI, 0.42–0.63; p < .001; I 2 = 65%). But side branch at proximal entry (OR, 0.88; 95% CI, 0.72–1.07; p = .21; I 2 = 45%), in‐stent CTO (OR, 0.99; 95% CI, 0.86–1.14; p = .88; I 2 = 0.0%), lack of interventional collaterals (OR, 0.80; 95% CI, 0.55–1.15; p = .23; I 2 = 78%), and previously failed attempt (OR, 0.73; 95% CI, 0.48–1.11; p = .14; I 2 = 89%) were similar in both groups. For complication, prior CABG patients had more perforation with need for intervention (OR, 1.91; 95% CI, 1.36–2.69; p < 0.001; I 2 = 34%), contrast‐induced nephropathy (OR, 3.40; 95% CI, 1.31–8.78; p = .01; I 2 = 0.0%). Non‐CABG patents had more tamponade (OR, 0.25; 95% CI, 0.09–0.72; p = .01; I 2 = 0.0%), and the major bleeding complication (OR, 1.18; 95% CI, 0.57–2.44; p = .65; I 2 = 0%) were no significant difference in both groups. In conclusion, Patients with prior CABG undergoing CTO‐PCI have more complex lesion characteristics, though procedural complication rates were comparable.

Postoperative Early Outcomes of Conventional versus Minimally Invasive Multivessel Coronary Artery Bypass Surgery: Retrospective Study

Minimally invasive coronary artery bypass grafting (CABG) is a new technique developed in recent years apart from the conventional method. Our first objective is to compare the postoperative early outcomes of conventional and minimally invasive multivessel (MIM) CABG methods, and second objective is to compare perioperative differences between two surgical techniques. This retrospective, comparative study was conducted at a university hospital with 100 patients, who underwent CABG surgery from November, 1 2019 to June, 1 2020. The data of 50 patients, who underwent MIM CABG (Group M), was certain. Among the patients operated with the conventional method (Group C), 50 patients were randomly selected from the same time period. Examination of early postoperative outcomes revealed that Group C had significantly higher intensive care unit (ICU) stay (p=0.013), significantly higher mechanical ventilation time in ICU (p&lt;0.001), and significantly higher isolated systolic blood pressure (p=0.013). Examination of perioperative variables revealed that Group C had significantly shorter duration of surgery (p&lt;0.001), significantly shorter aortic cross-clamp time (p&lt;0.001), significantly shorter cardiopulmonary bypass (CPB) time (p&lt;0.001), significantly lesser graft numbers (p&lt;0.001), significantly lesser left internal mammary artery use (p&lt;0.05), and significantly lesser inotropic support after CPB was discontinued (p&lt;0.05). In the light of these results, MIM CABG was associated with enhanced postoperative early outcomes with prolonged surgery time compared to conventional method.

“Pleurotomy during CABG on the Clinical Outcome Following Left Internal Mammary Artery (LIMA) Harvesting”

Background: The internal mammary artery (IMA) is the graft of choice for coronary artery bypass grafting (CABG) due to superior patency and enhanced patient survival. Pleurotomy during coronary artery bypass grafting (CABG) may cause post-operative events, mostly pulmonary complications. Objective: To assess the impact of intact pleura during left internal mammary artery harvesting on clinical outcome. Materials and Methods: This Cross sectional observational study was carried out in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2019 to December 2019.101 patients who underwent Department of Cardiac Surgery, BSMMU were enrolled in this study and divided into two groups: group A (n = 48, 36 male and 12 female patients at a mean age of 56.5 ± 11.2 years) underwent routine CABG and pleurotomy and group B (n = 53, 45 male and 8 female patients at a mean age of 55.4 ± 10.3 years) had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events. Results: The Incidence Of Postoperative Pericardial Effusion Was Similar Between The Groups, But The Incidence Of Postoperative Pulmonary Complications Such As Pleural Effusion (Except For Mild Pleural Effusion) On The Second (No: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.1% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) and fifth postoperative days (no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) was significantly lower in group B (p value &lt; 0.001 and p value = 0.007, respectively). Also, the incidence of atelectasis (except for mild atelectasis) on the second (no: 2.1%, mild: 22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%, mild: 59.3%, moderate: 31.5%, and severe: 0 in group B) and fifth postoperative days (no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no: 39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B) was significantly higher in group A (p value &lt; 0.001 and p value = 0.004, respectively). Postoperative partial oxygen pressure and O2 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A (p value = 0.017). Amount of bleeding (p value = 0.008) and duration of hospitalization (p value = 0.002) were significantly higher in group A than those in group B. Conclusion: Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion.

Open-heart surgery in elderly patients: short-term vs. long-term effects

The objective of the study was to analyze in-hospital mortality and long-term survival of elderly patients who underwent open-heart surgery and met the criterion of frailty. Materials and Methods. The study involved 266 patients over 75 years old complying with the frailty criterion (F-index ≤5). A total of 155 operations of coronary artery bypass grafting (CABG), 47 surgeries of aortic valve replacement (AVR), and 64 procedures of CABG in combination with AVR were performed. Study subjects were distributed among the groups depending on the surgery type. Postoperative complications were evaluated, and short-term and long-term outcomes were compared. Results. In-hospital mortality was 5.3% in general group, 9.4% in CABG+AVR group, 3.9% in CABG group, and 4.2% in AVR group. There was no significant difference among the rates of in-hospital mortality between the groups (р&gt;0.05). Long-term survival rates in general group were as follows: 98.3% for 1-year survival, 94.6% for 3-year survival, and 82.1% for 5-year survival. Type of surgery had no significant impact on the outcome (р&gt;0.05). Conclusion. Short- and long-term effects of CABG, AVR, and combination of CABG with AVR in the group of elderly patients who meet the criterion of frailty were characterized by low mortality and low incidence of non-fatal complications. The type of cardiac surgery and old age did not affect significantly the outcome of a surgical treatment.

Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome.

BACKGROUNDGRACE and SYNTAX scores are important tools to assess prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, there have been few studies on their value in patients receiving different types of therapies.AIMTo explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies. METHODSThe data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups. A total of 195 patients who received agents alone comprised the medication group, 156 who received medical therapy combined with stents comprised the stent group, and 35 patients who were given agents and underwent coronary artery bypass grafting (CABG) comprised the CABG group. General information was compared among the three groups. GRACE and SYNTAX scores were calculated. The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events (MACEs) was analyzed. Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS. Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model. RESULTSThe incidence of MACE increased with the elevation of GRACE and SYNTAX scores (all P < 0.05). The incidence of MACE was 18.5%, 36.5%, and 42.9% in the medication group, stent group, and CABG group, respectively. By comparison, the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups (all P < 0.05). The incidence of MACE was 6.2%, 28.0% and 40.0% in patients with a low GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 31.0%, 30.3% and 42.9% in patients with a medium GRACE score in the medication group, stent group, and CABG group, respectively (P > 0.05). The incidence of MACE was 16.9%, 46.2%, and 43.8% in patients with a high GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 16.2%, 35.4% and 60.0% in patients with a low SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 37.5%, 40.9%, and 41.7% in patients with a medium SYNTAX score in the medication group, stent group, and CABG group, respectively (P > 0.05). MACE incidence was 50.0%, 75.0%, and 25.0% in patients with a high SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). Univariate Cox regression analyses showed that both GRACE score (hazard ratio [HR] = 1.212, 95% confidence interval [CI]: 1.083 to 1.176; P < 0.05) and SYNTAX score (HR = 1.160, 95%CI: 1.104 to 1.192; P < 0.05) were factors influencing MACE (all P < 0.05). Multivariate Cox regression analyses showed that GRACE (HR = 1.091, 95%CI: 1.015 to 1.037; P < 0.05) and SYNTAX scores (HR = 1.031, 95%CI: 1.076 to 1.143; P < 0.05) were independent predictors of MACE (all P < 0.05). CONCLUSIONGRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients, and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.

Quality of life in patients with stable coronary artery disease submitted to percutaneous, surgical, and medical therapies: a cohort study

BackgroundClinical, surgical, and percutaneous strategies similarly prevent major cardiovascular events in patients with stable coronary artery disease (CAD). The possibility that these strategies have differential effects on health-related quality of life (HRQoL) has been debated, particularly in patients treated outside clinical trials.MethodsWe assigned 454 patients diagnosed with CAD during an elective diagnostic coronary angiography to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical treatment (OMT), and followed them for an average of 5.2 ± 1.5 years. HRQoL was assessed using a validated Brazilian version of the 12-Item Short-Form Health Survey questionnaire. The association between therapeutic strategies and quality of life scores was tested using variance analysis and adjusted for confounders in a general linear model.ResultsThere were no differences in the mental component summary scores in the follow-up evaluation by therapeutic strategies: 51.4, 53.7, and 52.3 for OMT, PCI, and CABG, respectively. Physical component summary scores were higher in the PCI group than the CABG and OMT groups (46.4 vs. 42.9 and 43.8, respectively); however, these differences were no longer different after adjustment for confounding variables.ConclusionIn a long-term follow-up of patients with stable CAD, HRQoL did not differ in patients treated by medical, percutaneous, or surgical treatments.

Abstract 12607: Long-Term Outcomes of CABG versus Medical Therapy: A Systematic Review and Meta-Analysis of 34350 Patients With Ischemic Heart Diseases

Background/Aim: Medical therapy (MT) and coronary artery bypass graft (CABG) are valuable treatment options for patients with ischemic heart diseases (IHD). However, their negative outcomes in the long-term are poorly investigated. Therefore, we conducted this meta-analysis to determine the long-term effects of both interventions. Methods: Till Nov 27, 2020, nine databases were searched for original articles investigating MT versus CABG in patients with IHD. Primary outcomes included mortality, survival, revascularization/additional treatment, event-free survival (incidence of cardiovascular (CV) mortality, myocardial infarction (MI), or refractory angina), cerebrovascular accidents (CVA), and acute MI. Secondary outcomes included imaging findings, such as left ventricular ejection fraction (LVEF). Cochrane’s revised tool (Version II) and ROBINS-I tool were used to assess the risk of bias of randomized and non-randomized intervention studies, respectively. Results: Fifteen studies were included in the systematic review, while twelve studies (34350 patients) were analyzed. CABG was associated with a significant reduction in all-cause mortality (OR=0.61; 95%CI: 0.45-0.83) and significant improvement in survival (OR=2.45; 95%CI: 1.61-3.73). The risk of acute MI (OR=0.44; 95%CI: 0.23-0.85) and the need for revascularization/additional treatment were significantly lower in the CABG group. No significant differences were noted as regards CV mortality (OR=0.64; 95%CI: 0.34-1.17), CVA (OR=1.45; 95%CI: 0.56-3.75), event-free survival (OR=0.86; 95%CI: 0.22-3.39), and LVEF (OR=-0.21; 95%CI: -1.48-1.6). Eleven studies had low risk, and four studies had a high risk of bias. Conclusions: Compared to medical therapy alone, CABG offers better long-term outcomes in terms of fewer mortality rates, higher survival rates, and limited need for revascularization or additional treatment.

Determining Factors for Independent Walking in Patients Undergoing Cardiovascular Surgery: Differences between Coronary Artery Bypass Grafting, Heart Valve Surgery, and Aortic Surgery.

Physical deconditioning often occurs during the acute phase after cardiovascular surgery, and unassisted walking is required to achieve independence, to manage cardiac diseases, and to prevent recurrences. This study aims to investigate the characteristics of independent walking after cardiovascular surgery. We conducted a retrospective cohort study in patients who underwent cardiovascular surgeries (total of 567 patients): 153 in the coronary artery bypass grafting (CABG) group, 312 in the heart valve surgery group, and 102 in the aortic surgery group. We evaluated the effect of each surgery group on the cardiac rehabilitation (CR) progression. The factors associated with independent walking were age, renal diseases, intensive care unit (ICU) length of stay, and post-operative respiratory complications in the CABG group. In the heart valve surgery group, the factors were New York Heart Association functional classification, renal and respiratory diseases, ICU length of stay, duration of mechanical ventilatory support, and post-operative cardiovascular and respiratory complications. In the aortic surgery group, these were ICU length of stay and acute kidney injury. The CR progression in patients who underwent aortic surgery was significantly longer than those who underwent CABG and heart valve surgery (p < 0.001). New intervention strategies are needed for patients with prolonged ICU stays.

Coronary Stenting versus Bypass Graft Surgery for Management of Left Main Coronary Artery Disease in the Setting of Acute Myocardial Infarction: A Retrospective Cohort Study

Background: There is a lack of published research that compare stenting versus coronary artery bypass grafting (CABG) for patients with left main coronary artery (LMCA) disease. This research compared the safety and efficacy of stents versus CABG for patients with LMCA disease in the setting of acute myocardial infarction. Materials and Methods: A retrospective chart review was conducted to retrieve the records of LMCA who underwent coronary stenting or CABG. We compared both techniques in terms of major adverse cardiovascular and cerebrovascular events (MACCE) and postoperative complications. Results: Sixty patients were included (30 patients in each group). The incidence of periprocedural mortality was equal between PCI and CABG groups (6.7% versus 10%). Likewise, the overall incidence of periprocedural complications was comparable between both groups (13.3% versus 20%). The incidence of immediate post procedural complications was 20% and 30% in PCI and CABG groups, respectively (p =0.37). Likewise, the rate of immediate post procedural mortality was 3.3% and 6.7%, respectively (p =1.0). Both groups exhibited similar rates of late post procedural complications as well (p =0.25). Conclusion: In conclusion, PCI and CABG had comparable postoperative outcomes in LMCA patients in the setting of acute myocardial infarction. Further randomized controlled trials with larger sample size and longer follow-up period are required to evaluate the safety and efficacy of both techniques in such patients.

Impact of cardiopulmonary bypass and surgical complexity on plasma soluble urokinase-type plasminogen activator receptor levels after cardiac surgery

Background Circulating soluble urokinase plasminogen activator receptor (suPAR) is a marker of inflammation with prognostic value for elevated risk of morbidity and mortality. It has not yet been shown how the inflammatory process induced by cardiac surgery affects suPAR concentrations postoperatively Methods In a prospective observational study, plasma suPAR levels were measured in 30 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), pre-, peri, post-operatively, and 3–5 days after surgery. Fifteen patients underwent coronary artery bypass grafting (CABG) and 15 underwent complex procedures with longer CPB duration. Concentrations of suPAR at each time point were compared to the preoperative levels and compared between the two groups. Results In both groups, plasma suPAR concentrations were significantly higher on the first postoperative day (3.27 (interquartile range (IQR) 2.75–3.86) µg/L compared to baseline (2.62 (1.98–3.86)) µg/L, p < .001. There were no significant differences in suPAR concentrations between the groups at any time point. Preoperatively, the median suPAR concentration was 2.57 (2.01–3.60) µg/L in the CABG group versus 2.67 (1.89–3.97) µg/L in the complex group (p = .567). At ICU arrival 2.48 (2.34–3.23) µg/L versus 2.73 (2.28–3.44) µg/L in CABG and complex patients, respectively (p = .914). There was no difference in suPAR concentrations between the groups on postoperative day 1 (3.34 (2.89–3.89) versus 3.19 (2.57–3.62) p = .967) or 3–5 days after surgery (2.72 (1.98–3.16) versus 2.96 (2.39–4.28) p = .085. Conclusions After a transient rise on the first postoperative day, the suPAR levels returned to the preoperative levels by the third postoperative day. There was no significant difference in suPAR levels between the routine CABG and complex group with longer CPB time.

Five-year outcomes after coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with complex coronary artery disease.

We assessed the clinical effectiveness of coronary artery bypass grafting (CABG) in comparison with that of percutaneous coronary intervention (PCI) in octogenarians with triple-vessel disease (TVD) or left main coronary artery (LMCA) disease. From the CREDO-Kyoto registry cohort-2, 527 patients, who were ≥ 80years of age and underwent the first coronary revascularization for TVD or LMCA disease, were divided into the CABG group (N = 151) and the PCI group (N = 376). The median and interquartile range of patient's age was 82 (81-84) in the CABG group and 83 (81-85) in the PCI group (P = 0.10). Patients > = 85years of age accounted for 19% and 31% in the CABG and PCI groups, respectively (P = 0.01). The cumulative 5-year incidence of all-cause death was similar between CABG and PCI groups (35.8% vs. 42.9%, log-rank P = 0.18), while CABG showed a lower rate of the composite of cardiac death/MI than PCI (21.7% vs. 33.9%, log-rank P = 0.005). After adjusting for confounders, the lower risk of CABG relative to PCI was significant for all-cause death (HR 0.61, 95% CI 0.43-0.86, P = 0.005), any coronary revascularization (HR 0.25, 95% CI 0.14-0.43, P < 0.001) and the composite of cardiac death/MI (HR 0.52, 95% CI 0.32-0.85, P = 0.009). CABG compared with PCI was associated with a lower adjusted risk for all-cause death, any coronary revascularization, and a composite of cardiac death/MI in very elderly patients with TVD or LMCA disease. CABG seemed an acceptable option for selected octogenarians with severe coronary artery disease.

THE INFLUENCE OF ANTIPLATELET MEDICATIONS ON INTRAOPERATIVE PATIENT BLOOD MANAGEMENT DURING ADULT CARDIAC SURGERY

Introduction Cardiac surgery is inherently associated with increased bleeding and transfusion requirements. The increased risk of bleeding is due to multiple factors; pharmacological (Intravenous heparin and Dual Antiplatelet Therapy-DAPT), patient (advanced age, preoperative anaemia, and female gender) and surgical (Emergency and redo surgery)1. This study aimed to determine if preoperative antiplatelet medication influenced intraoperative blood and blood products requirements during elective adult Isolated Coronary Artery Bypass Graft (CABG) and valve surgery. Methods Methodology: A Prospective observational study carried out between September to November 2020, MMUH Ethical committee approval ref: CA20-064 on 12/10/2020. Perioperative data were collected from fifty patients. This included demographic data, preoperative laboratories, pre-Cardiopulmonary Bypass (CPB) heparin dose, Activated Clotting Time (ACT) at baseline, post heparin and post protamine, blood products transfused and estimated blood loss (EBL). The inclusion criteria applied was isolated CABG, single valve surgery and elective operation. A one-paired Student t-test performed to detect a statistical difference between the two groups (Isolated CABG Vs Single valve Surgery) Results 31 patients met the inclusion criteria. 19 patients excluded because of the following reasons: emergency surgery n=3, redo surgery n=1, New Oral Anticoagulants (NOACS) medication n= 4, combined CABG & valve surgery/other n=12. 20 patients underwent an isolated CABG, and 11 patients underwent a single valve operation. DAPT was prescribed in 30% n=6/20 and 9% n=1/11 in the CABG and Valve group respectively. There was no statistical difference in the EBL at the end of the procedure between the two groups (CABG-624 ml Vs Valve-507 ml, p= 0.13). Intraoperative red cells transfusion between the two groups were similar, however Octaplasma, fibrinogen and platelets transfusion were higher in the valve group. Discussion DAPT were more frequently prescribed pre-operatively in patients undergoing elective CABG in comparison to single valve surgery. Pre & postoperative haemoglobin and EBL were similar between the two groups. Despite this, in the single valve surgery group (only 1 patient out of 9 received DAPT, n=1/9) received more blood products during the intraoperative period. This was statistically significant for the use of Octaplasma, Platelets and fibrinogen. Blood transfusion was not directed using ROTEM in any patients in either group. We, therefore, recommend the intraoperative use of ROTEM to guide blood transfusion for patients undergoing isolated single valve surgery.

Choice of revascularization method in acute coronary syndrome with non-ST-segment elevation

Aim. To analyze the results of various revascularization techniques in high-risk non – STsegment elevation in acute coronary syndromes performed during the first 24 hours.Methods. As a part of a single-center retrospective study, 45 cases of coronary artery bypass grafting (CABG) were examined in high-risk non – ST-segment elevation in acute coronary syndromes patients during the first 24 hours since their hospitalization for the period from 2017 to 2020. 45 cases of percutaneous coronary intervention (PCI) were selected from a similar group of patients with the help of the copy-pair method.Results. The groups were comparable according to such significant factors as age, gender, postinfarction cardiosclerosis, diabetes mellitus, and multifocal atherosclerosis. However, the severity of coronary atherosclerosis according to the Syntax score was significantly higher in the CABG group (p = 0.0004). The groups were comparable in achieving complete revascularization (p = 0.2). In 8.9% (n = 4) of patients in the PCI group, unscheduled repeated revascularization was required, and in 15.6% (n = 7) of cases stent restenosis/thrombosis was detected during the hospital period and between PCI stages, while in the CABG group, congenital malformations and dysfunction were not found. Mortality in the groups did not differ significantly (4 (8.8%) versus 2 (4.4%), p = 0.4).Conclusion. CABG provides freedom from repeated revascularizations, despite the initially more severe coronary lesion.

The effect of cardiac rehabilitation on anxiety and depression in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) patients

Background/Aim: It is well-known that Cardiac Rehabilitation (CR) brings about a marked improvement in depression and anxiety. As far as we know, there are no studies that research the effect of CR, Percutaneous Coronary Intervention (PCI), and Coronary Artery Bypass Grafting (CABG) on anxiety and depression. This study aimed to investigate the effects of the CR program on anxiety and depression and the change of anxiety and depression symptoms in patients who underwent PCI and CABG. Methods: This cross-sectional study included 27 patients with PCI and 16 patients who had undergone CABG admitted to the CR program. The Beck Depression Inventory (BDI) was used to determine the severity of depression symptoms, and the Situational and Trait Anxiety Inventory (STAI I-II) were used. Results: After CR, the BDI, STAI-1, and STAI-2 significantly decreased in both the PCI (P<0.001, P=0.002, and P=0.006, respectively) and CABG groups (P<0.001, P=0.001, and P=0.015, respectively) compared to before CR. The change in BDI was higher in the CABG group (P=0.033), while there were no significant differences between the changes in STAI-1 and STAI-2 scores (P=0.378 and P=0.361). Conclusion: The results of this study demonstrate the CR benefits for depression and anxiety in patients undergoing CABG and PCI. On the other hand, CABG patients show relatively more benefit in terms of depressive symptoms. Prospective and controlled studies with larger sample sizes are needed to support our findings.

Real-World Outcomes of On- vs Off-pump Coronary Bypass Surgery: Result From Korean Nationwide Cohort

BackgroundAlthough several randomized trials have shown conflicting results regarding the comparative effectiveness of on- and off-pump coronary artery bypass grafting (CABG), research on long-term outcomes in large-scale, real-world clinical settings are limited. The study sought to examine the comparative effectiveness of on- and off-pump CABG in a real-world clinical setting. MethodsUsing the nationwide claims database of the Korean National Health Insurance Service, the study identified patients who underwent isolated CABG from 2004 to 2013. Propensity-score matching with multivariable adjustment was used to assemble a cohort of patients with similar baseline characteristics. ResultsAmong 23 828 patients, 12 639 in the off-pump group (53.0%) and 11 189 in the on-pump group (47.0%) were enrolled. After matching, 6483 pairs were included in the final analysis. At 30 days, there was no significant difference in adjusted mortality between the off- and on-pump groups (hazard ratio [HR], 1.00; 95% CI, 0.87-1.16). During long-term follow-up (100% complete; median, 5.3 years; maximum, 13.2 years), however, off-pump CABG was associated with a higher risk of mortality than on-pump CABG (HR, 1.09; 95% CI, 1.03-1.15). The risks of myocardial infarction (HR, 1.3; 95% CI, 1.16-1.45) and repeat revascularization (HR, 1.50; 95% CI, 1.37-1.63) were also significantly higher in the off-pump CABG group than in the on-pump CABG group, whereas the stroke risk was similar between the groups (HR, 0.99; 95% CI, 0.87-1.13). ConclusionsIn this contemporary, nationwide, clinical practice claim registry, off-pump CABG was associated with higher long-term risks of mortality, myocardial infarction, and repeat revascularization than on-pump CABG.

Comparative analysis of revascularization with percutaneous coronary intervention versus coronary artery bypass surgery for patients with end-stage renal disease: a nationwide inpatient sample database

ABSTRACT Background The role of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) remains unknown. Research design & methods The National Inpatient Sample (NIS) (2002–2017) was queried to identify all cases of CAD and ESRD. The relative merits of PCI vs CABG were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were calculated. Results A total of 350,623 [CABG = 112,099 (32%) and PCI = 238,524 (68%)] hospitalizations were included in the analysis. The overall adjusted odds for major bleeding (aOR 1.28, 95% CI 1.25–1.31, P < 0.0001), post-procedure bleeding (aOR 5.19, 95% CI 4.93–5.47, P < 0.0001), sepsis (aOR 1.29, 95% CI 1.26–1.33, P < 0.0001), cardiogenic shock (aOR 1.23, 95% CI 1.20–1.26, P < 0.0001), and in-hospital mortality (aOR 1.65, 95% CI 1.61–1.69, P < 0.0001) were significantly higher for patients undergoing CABG compared with PCI. The need for intra-aortic balloon pump (IABP) placement (aOR 2.52, 95% CI 2.45–2.59, P < 0.001) was higher in the CABG group, while the adjusted odds of vascular complications were similar between the two groups (aOR 0.99, 95% CI 0.94–1.06, P = 0.82). As expected, patients undergoing CABG had a higher mean length of stay and mean cost of hospitalization. Conclusion CABG in ESRD may be associated with higher in-hospital complications, increased length of stay, and higher resource utilization.

Effect of Heart Failure on Long-Term Clinical Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Severe Coronary Artery Disease.

BackgroundHeart failure might be an important determinant in choosing coronary revascularization modalities. There was no previous study evaluating the effect of heart failure on long‐term clinical outcomes after percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG).Methods and ResultsAmong 14 867 consecutive patients undergoing first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013 in the CREDO‐Kyoto PCI/CABG registry Cohort‐3, we identified the current study population of 3380 patients with three‐vessel or left main coronary artery disease, and compared clinical outcomes between PCI and CABG stratified by the subgroup based on the status of heart failure. There were 827 patients with heart failure (PCI: N=511, and CABG: N=316), and 2553 patients without heart failure (PCI: N=1619, and CABG: N=934). In patients with heart failure, the PCI group compared with the CABG group more often had advanced age, severe frailty, acute and severe heart failure, and elevated inflammatory markers. During a median 5.9 years of follow‐up, there was a significant interaction between heart failure and the mortality risk of PCI relative to CABG (interaction P=0.009), with excess mortality risk of PCI relative to CABG in patients with heart failure (HR, 1.75; 95% CI, 1.28–2.42; P<0.001) and no excess mortality risk in patients without heart failure (HR, 1.04; 95% CI, 0.80–1.34; P=0.77).ConclusionsThere was a significant interaction between heart failure and the mortality risk of PCI relative to CABG with excess risk in patients with heart failure and neutral risk in patients without heart failure.

Comparative efficacy and safety of biatrial versus left atrial ablation in the surgical treatment of long-standing persistent atrial fibrillation with concomitant coronary artery bypass grafting in patients with ischemic heart disease

Purpose. To compare the results of biatrial (BA) and left atrial ablation (LAA) performed in patients with long-standing persistent atrial fibrillation (AF) with concomitant coronary artery disease (CAD) with indication for coronary artery bypass grafting (CABG).Material and Methods. A prospective, randomized, single-center, blinded study was conducted on the basis Meshalkin National Medical Research Center in the period from 2016 to 2019. A total of 116 patients with long-standing persistent AF and CAD were randomized into two groups: BA + CABG group (n = 58) and LAA + CABG group (n = 58). Patients of both groups underwent CABG surgery with the chosen atrial ablation technique (LAA or BA).Results: BA technique proved to be more effective in maintaining sinus rhythm (58%) compared with isolated LAA (31%) at 24 months (p = 0.019) after surgical treatment of long-standing persistent AF with concomitant CABG.Conclusion: BA technique was more effective than isolated LAA in the late postoperative period of 24 months.