Off-pump Coronary Artery Bypass Grafting Research Articles

Serum CIRP increases the risk of acute kidney injury after cardiac surgery.

Acute kidney injury (AKI) is a frequent perioperative complication. The underlying mechanisms of cardiac surgery-associated AKI are still not completely elucidated. Cold-induced RNA-binding protein (CIRP) has been subsequently found to be regulated by various stress conditions. During cardiac surgery and cardiopulmonary bypass (CPB), the host is subjected to hypothermia and inadequate organ perfusion, resulting in an upregulation of CIRP secretion. The aim of this study is to evaluate the role of elevated extracellular CIRP level as a contributing factor in the development of AKI. A total of 292 patients who underwent cardiac surgery were retrospectively enrolled and their serum samples were collected preoperative and postoperative. Demographic data, intraoperative data, in-hospital outcomes, and the occurrence of AKI were also collected for the patients. The correlation between CIRP and intraoperative procedures, as well as its association with postoperative outcomes were analyzed. In multivariable analysis, higher ΔCIRP (p = 0.036) and body mass index (p = 0.015) were independent risk factors for postoperative AKI. Meanwhile, patients with postoperative AKI exhibited lower survival rate in 2-year follow-up (p = 0.008). Compared to off-pump coronary artery bypass grafting surgery, patients who underwent on-pump coronary artery bypass grafting, valve surgery, aortic dissection and other surgery showed higher ΔCIRP, measuring 1,093, 666, 914 and 258 pg/mL, respectively (p < 0.001). The levels of ΔCIRP were significantly higher in patients who underwent CPB compared to those who did not (793.0 ± 648.7 vs. 149.5 ± 289.1 pg/mL, p < 0.001). Correlation analysis revealed a positive correlation between ΔCIRP levels and the duration of CPB (r = 0.502, p < 0.001). Patients with higher CIRP levels are at greater risk of postoperative AKI (OR: 1.67, p = 0.032), especially the stage 2-3 AKI (OR: 2.11, p = 0.037). CIRP secretion increases with prolonged CPB time after cardiac surgery, and CIRP secretion is positively correlated with the duration of CPB. Cardiac surgeries with CPB exhibited significantly higher levels of CIRP compared to non-CPB surgeries. Elevation of CIRP level is an independent risk factor for the incidence of AKI, especially the severe AKI, and were associated with adverse in-hospital outcomes.

A Prospective Clinical Audit to Strengthen the Clinical Practices Affecting the Incidence of New-onset Atrial Fibrillation after Off-pump Coronary Artery Bypass Grafting

Introduction: New-onset Atrial Fibrillation (AF) carries significant morbidity and mortality risk for postoperative patients. Clinical practice guidelines aimed at preventing it are beneficial, with protocols in place to prevent deviations from the standard. Aim: To improve or strengthen the clinical practices that impact the incidence of new-onset AF after off-pump Coronary Artery Bypass Grafting (CABG). Materials and Methods: The present prospective clinical audit was conducted in the Department of Cardiac Anaesthesiology, Bhanubhai Madhuben Patel Cardiac Centre, Bhaikaka University, Anand, Gujarat, India, from January 2021 to June 2021. Study included 50 consecutive patients undergoing off-pump CABG surgery. The monitored standards included the continuation of betablocker therapy in the preoperative period, restarting them in the immediate postoperative period, and maintaining serum potassium (S.K+) within the range of 3.5-5.5 mEq/L. The incidence of AF was also noted. The data were analysed using Microsoft Excel. Results: The audit included a total of 50 patients, with 36 males with a mean age of 58.72 years, and 14 females with a mean age of 60.07 years. Preoperative beta-blocker/Calcium Channel Blocker (CCB) therapy on the day of surgery was administered to 45 (90%) patients, while restarting beta-blockers in the immediate postoperative period was done for 49 (98%) patients. S.K+ levels were maintained within the range in 31 (62%) patients. The last standard was reaudited, and compliance was achieved in 39 (78%) patients. New-onset AF occurred in 4 (8%) and 5 (10%) patients in the audit and reaudit samples, respectively. Conclusion: Clinical audit is a process that helps to identify the lacunae in clinical practices that affect patient outcomes. In the current study, clinical audits have aided in measuring compliance with different clinical practices, as per Institutional protocols. They have also assisted in increasing compliance with clinical practices where measured compliance was below the targeted goal.

Transatlantic analysis of patient profiles and mid-term survival after isolated coronary artery bypass grafting: a head-to-head comparison between the European DuraGraft Registry and the US STS Registry.

Although cardiovascular surgery societies in Europe and the USA constantly strive for the exchange of knowledge and best practices in coronary artery bypass grafting (CABG), the available evidence on whether such efforts result in similar patient outcomes is limited. Therefore, in the present analysis, we sought to compare patient profiles and overall survival outcomes for up to 3 years between large European and US patient cohorts who underwent isolated CABG. Patients from the European DuraGraft Registry (n = 2,522) who underwent isolated CABG at 45 sites in eight different European countries between 2016 and 2019 were compared to randomly selected patients from the US STS database who were operated during the same period (n = 294,725). Free conduits (venous and arterial grafts) from the DuraGraft Registry patients were intraoperatively stored in DuraGraft, an endothelial damage inhibitor, before anastomosis, whereas grafts from the STS Registry patients in standard-of-care solutions (e.g., saline). Propensity score matching (PSM) models were used to account for differences in patient baseline and surgical characteristics, using a primary PSM with 35 variables (2,400 patients matched) and a secondary PSM with 25 variables (2,522 patients matched, sensitivity analysis). The overall survival for up to 3 years after CABG was assessed as the primary endpoint. The comparison of patient profiles showed significant differences between the European and US cohorts. The European patients had more left main disease, underwent more off-pump CABG, and received more arterial grafts together with more complete arterial grafting procedures. In contrast, the US patients received more distal anastomoses with more saphenous vein grafts (SVGs) that were mainly harvested endoscopically. Such differences, however, were well balanced after PSM for the mortality comparison. Mortality comparison at 30 days, 12 months, and 24 months between the European and US patients was 2.38% vs. 1.96%, 4.32% vs. 4.79%, and 5.38% vs. 6.96%, respectively. At 36 months, the mortality was significantly lower in the European patients than that of their US counterparts (7.37% vs. 9.65%; p-value = 0.016). The estimated hazard ratio (HR) was 1.29 (95% CI 1.05-1.59). This large-scale transatlantic comparative analysis shows that there are some significant differences in patient profiles between large cohorts of European and US patients. These differences were adjusted by using PSM for the mortality analysis. No significant difference in mortality was detected between groups through 2 years, but survival was significantly better in the European DuraGraft Registry patients at 3 years post-CABG.

ПРОГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ПОКАЗАТЕЛЕЙ ДИНАМИКИ КОНЦЕНТРАЦИИ ТРОПОНИНА I ПОСЛЕ ВЫПОЛНЕНИЯ КОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ РАБОТАЮЩЕГО СЕРДЦА И ГИБРИДНОЙ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА

Objective. To assess the prognostic significance of dynamic indicators of troponin I concentration after off-pump coronary artery bypass grafting (CABG) and hybrid myocardial revascularization (HMR) and identification of factors influencing the development of postoperative complications. Methods. The prospective single-center randomized comparative study included 180 patients with multifocal coronary artery disease. Group 1 (n = 98) consisted of patients who underwent off-pump CABG. Group 2 (n = 82) included patients who underwent hybrid myocardial revascularization. HMR consisted of two stages. The 1st stage was minimally invasive direct mammary coronary bypass grafting with access through a left minithoracotomy. The 2nd stage, 1–3 days after the open surgery, was percutaneous coronary intervention using drug-eluting stents. Results. The highest concentrations of Tn and AUC Tn after CABG are characteristic of patients with a peak content of the cardiac marker in the bloodstream 24 hours after surgery, which indicates a longer and more intense release of it into the bloodstream after surgery. Prognostically unfavorable for patients who have undergone CABG is an increase in the concentration of Tn by 12 hours after surgery (Tn 12in /Tn in ) by 68 times or more. Patients with Tn 12 /Tn in ≥ 68 have a sharply reduced event-free survival within 12 months after CABG (p = 0.001). Patients with a combination of Tn 12 /Tn in ≥ 68 and a late peak Tn concentration are at high risk of adverse clinical outcomes after CABG. A high level of Tn by 24 hours after breast cancer is associated with impaired carbohydrate metabolism: the presence of type 2 diabetes (r pb = 0.41), BMI (r pb = 0.33), preoperative concentrations of glucose (r pb = 0.35) and glycated hemoglobin (r pb = 0.41). Prognostic criteria for a Tn concentration of more than 0.2 ng/ml by 24 hours after breast cancer are the presence of CKD and the number of stented arteries in patients with elevated levels of glycated hemoglobin. Conclusion. With unidirectional changes in the concentration of highly-sensitive Tn I after CABG and HMR, a less pronounced release of the cardiomarker into the bloodstream in patients after HMR indicates less myocardial trauma during hybrid myocardial revascularization.

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Left main coronary artery disease treated with beating heart surgery: 10-year single center results.

Left main (LM) coronary disease is believed to represent a complex, advanced, and potentially life-threatening atherosclerotic syndrome that can be treated by either percutaneous or surgical interventions. Despite its satisfactory results, the declined number of off-pump coronary artery bypass grafting (OPCAB) is observed. To compare 10-year survival and point out possible mortality risk factors in patients referred for left main and multivessel OPCAB surgery followed by transit time bypass measurements. There were 159 patients (128 (81%) men and 31 (19%) women) in a median age of 66 (60-70) years enrolled in retrospective analysis who were referred to surgical intervention due to left main (51, 32%) and multivessel (108, 68%) disease. The regression analysis for long-term mortality risk and the Kaplan-Meyer survival curve were analyzed. Multivariable analysis pointed female sex (HR = 1.08, 95% CI: 1.03-1.14, p = 0.001) and diabetes mellitus (HR = 6.33, 95% CI: 1.86-21.52, p = 0.003) as possible risk factors for 10-year mortality risk. There was no significant difference in Kaplan-Meyer 10-year mortality comparison between left main and multivessel disease patients treated by off-pump surgical revascularization (HR = 0.93, 95% CI: 0.40-2.13, p = 0.86). Off-pump surgery in the left main disease, compared to multivessel disease, represents a safe surgical technique with satisfactory long-term results. The female sex and diabetes mellitus were found as possible risk factors for 10-year mortality risk in multivariable analysis.

A novel predictor behind conventional risk factors of new-onset atrial fibrillation after off-pump coronary artery bypass graft surgery: The triglyceride-glucose index

A novel predictor behind conventional risk factors of new-onset atrial fibrillation after off-pump coronary artery bypass graft surgery: The triglyceride-glucose index

Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh

Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh

One-year outcomes after off-pump coronary artery bypass grafting in diffuse coronary atherosclerosis

One-year outcomes after off-pump coronary artery bypass grafting in diffuse coronary atherosclerosis

Research on the Effects of Remimazolam on Hemodynamics and Postoperative Cognitive Function during Anesthesia Induction in Off-Pump Coronary Artery Bypass Grafting

Research on the Effects of Remimazolam on Hemodynamics and Postoperative Cognitive Function during Anesthesia Induction in Off-Pump Coronary Artery Bypass Grafting

The effects of on-pump and off-pump coronary artery bypass surgery on oxidative stress and cerebral oxygenation: a prospective observational study.

In this prospective observational study, our goal was to investigate the relationship between serum levels of oxidative stress (OS) parameters and regional cerebral oxygen saturation (rSO2) in addition to evaluating postoperative clinical outcomes among patients undergoing coronary artery bypass graft surgery (CABG). This study comprised 64 adult patients undergoing elective CABG (on-pump [n = 48] and off-pump [n = 16]) procedures. Serum OS levels and rSO2 values were measured intraoperatively at three specific time points: T1 (after induction), T2 (15 min before aortic cross-clamp removal or the final distal anastomosis), and T3 (15 min after aortic cross-clamp removal or the last distal anastomosis). Serum OS and lactate values demonstrated higher levels at T2 and T3 (p < 0.001), while rSO2 values were lower at T2 (p = 0.024) in the on-pump CABG group compared to the off-pump CABG group. The rSO2 values at T2 exhibited a negative correlation with OS parameters, lactate levels at T2 and T3, aortic clamp time, postoperative mechanical ventilation time, and intensive care unit stay length. In the multivariate linear regression analysis (R2 = 0.181, p = 0.001), lactate values at T2 emerged as the sole factor affecting the OS index at T2 (t = 2.843, p = 0.006). In our study, we observed elevated OS values and relatively low rSO2 values during on-pump CABG procedures, with rSO2 showing an association with increased OS parameters. Close monitoring of the OS response level and rSO2 during CABG could potentially enhance postoperative clinical outcomes.

Off-pump coronary artery bypass surgery in patients with multifocal atherosclerosis and inoperable internal carotid artery lesion

Off-pump coronary artery bypass surgery in patients with multifocal atherosclerosis and inoperable internal carotid artery lesion

Simultaneous surgery: Off-pump coronary artery bypass surgery and total pulmonectomy

Coronary artery disease increases the morbidity of surgery in patients with lung tumors. There are still disagreements about whether to perform simultaneous surgery or in different sessions, and which surgical strategy should be chosen in these patients. We presented a 62-year-old elderly patient who underwent simultaneous coronary bypass surgery and lung tumor surgery.

Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh

Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh

Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review.

This systematic review examines the occurrence and implications of resistance to primary antiplatelet agents, aspirin and clopidogrel, often utilised in patients undergoing coronary artery bypass grafting (CABG), alongside the methodologies for assessment of such resistance. An extensive literature search across various databases such as PubMed, MEDLINE via Ovid, Embase, and Cochrane CENTRAL until May 2024 was conducted to identify studies evaluating antiplatelet resistance in on-pump and off-pump CABG patients. Following quality assessment, only high-quality studies were incorporated into this review. This review included 19 studies with 3,915 patients, four of which were randomised controlled trials and 15 were observational studies. Aspirin resistance incidence ranged from 11.0% to 51.5%, while clopidogrel resistance was 22%. Antiplatelet resistance, assessed through a wide variety of methods, was associated with a 13 times increase in the risk of vein graft occlusion and increased rates of mortality, myocardial infarction, and target vessel revascularisation in the case of clopidogrel resistance. The effect of cardiopulmonary bypass on antiplatelet resistance remains ambiguous. The academic literature lacks a standardised definition for antiplatelet resistance. Assessment methodologies greatly vary, leading to noninterchangeable outcomes. While aspirin resistance has a conflicting overall significant impact on adverse outcomes, clopidogrel resistance correlates with poorer clinical outcomes.

PERIOPERATIVE OUTCOMES OF COMBINED HEART SURGERY AND LUNG TUMOR RESECTION : A SYSTEMATIC REVIEW

Background: Cancer and cardiovascular disease are the leading causes of death in both men and women worldwide. There are concerns regarding the potentially increased mortality and complication rates of simultaneous surgery and the adequacy of lung exposure during heart surgery. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of cthe requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 14 articles, whereas the results of our search on SagePub brought up 91 articles. The results of the search conducted for the last year of 2013 yielded a total 9 articles for PubMed and 23 articles for SagePub. In the end, we compiled a total of 5 papers, 4 of which came from PubMed and 1 of which came from SagePub. We included five research that met the criteria. Conclusion: In summary, combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analyses revealed that most patients with lung cancer underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG may reduce the complication rate compared with on-pump CABG. Further researches are still needed to verify these findings.

The Effects of Daytime Variation on Short-term Outcomes of Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Study objectiveTo evaluate the effects of time of operation on short-term outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCAB). DesignRetrospective cohort study. SettingA single large-volume cardiovascular center. PatientsPatients undergoing elective OPCAB between September 2019 and July 2022. InterventionsPatients were divided into two groups according to the start time of surgery: morning (AM group, before 11am) and afternoon (PM group, after 11am). Propensity score matching (PSM) with a 1:1 matching ratio was used to create comparable cohorts. Measurements and Main resultsThe primary endpoint was the composite incidence of mortality and morbidities during hospitalization. Secondary endpoints included postoperative bleeding and transfusion, mechanical ventilation duration (MVD) and length of stay (LOS) in intensive care unit (ICU) and hospital. From a consecutive series of 1,039 patients, PSM yielded 317 well-matched pairs. There was no difference in the composite incidence of in-hospital mortality and morbidities between AM and PM groups (16.4% vs. 17.4%, P=0.832). However, patients in PM group were associated with less postoperative blood loss over the first 24 h (470 ml vs. 540 ml, P=0.002), decreased MVD (14 h vs. 16 h, P<0.001) and shorter LOS in ICU (46 h vs. 68 h, P=0.002) as compared to patients in AM group. ConclusionsThe current study suggested a lack of relevance regarding time of operation with in-hospital mortality and morbidities in patients undergoing OPCAB.

The Effect of Proton-Pump Inhibitors the on Development of Arrhythmia and Hypomagnesemia After Off-Pump Coronary Artery Bypass Surgery

Background: Long-term use of proton-pump inhibitors (PPI) can result in hypomagnesemia and arrhythmia. This study aimed to compare the effect of PPI and histamine 2-receptor antagonists (H2 RA) on the incidence of hypomagnesemia and arrhythmia in patients following off-pump coronary artery bypass surgery (CABG). Method: In this randomized-controlled clinical trial 290 patients admitted to the ICU after off-pump CABG were randomly divided into two groups of H2 RA (n=145) and PPI (n=145). For patients in the H2 RA group, 50 mg intravenous ranitidine was prescribed every 8 hours after the nothing by mouth (NPO) period, followed by 40 mg famotidine tablets after starting the oral regimen (PO). The PPI group received 40 mg pantozol IV injections every 12 hours during the NPO period and 40 mg pantozol tablets once daily after becoming PO. The patients were investigated for the development of hypomagnesemia and associated arrhythmia. Results: In total 271 patients with a mean age of 59.3±10 years completed the study (female/male=32.8%). Hypomagnesemia occurred in 60.1% of the patients, 76 (56.7%) in the H2 RA group and 87 (63.5%) in the PPI group (P=0.245), whereas arrhythmia had a prevalence of 12 (9.6%) and 15 (11.1%) cases, respectively (P=0.690). The mean time of occurrence of hypomagnesemia and arrhythmia was 1.75±1.08 and 3.0±0.9 days after the operation in the H2 RA group (P=0.111) and 1.47±0.7 and 2.9±1.5 days in the PPI group (P=0.897), respectively. Conclusion: Our study revealed that the short-term use of PPIs does not result in higher rates of hypomagnesemia and associated arrhythmia in comparison to H2 RA consumption after off-pump CABG.

Severe Refractory Vasoplegic Shock Syndrome after OPCABG Successfully Treated with Hydroxycobalamin: A Case Report and Review of the Literature.

Vasoplegic shock syndrome (VSS) after an off-pump coronary artery bypass graft (OPCABG) is an extremely rare condition. Inotropic support is usually the first-line therapy, though it can precipitate several complications or be ineffective. We report the first case of severe refractory VSS after OPCABG successfully treated with hydroxycobalamin. A 77-year-old gentleman underwent OPCABG for three vessels coronary artery disease. Preoperative LV ejection fraction was 28%, and the patient before surgery started sacubitril/valsartan titrated, then, at the highest dose. Surgery was uneventful and, by the end of the procedure, TEE showed improved biventricular contractility. The patient was transferred to the ICU without inotropic support, but soon developed hypotension. TEE ruled out pericardial tamponade and confirmed fair contractility. Norepinephrine was titrated to a medium-high dose, vasopressin was started and a Swan-Ganz catheter was placed. SVR was 480 dyn·s·cm-5. Despite aggressive pharmacologic treatment (including methylprednisolone and methylene blue), no improvements were noticed. Ten grams of hydroxycobalamin were administered. One hour later, hemodynamic status re-assessment showed SVR > 800 dyn·s·cm-5. Afterward, vasopressors were gradually reduced. Our case demonstrated the importance of adequate early treatment in VSS after OPCABG. This case report shows, for the first time, that hydroxycobalamin was effectively used to restore homeostasis.

Acute kidney injury as a risk factor for atrial fibrillation after coronary artery bypass grafting — effects of sodium-glucose cotransporter-2 inhibitors

Aim. To identify predictors of paroxysmal atrial fibrillation (pAF) in patients with stable angina after coronary artery bypass grafting (CABG), as well as to evaluate the effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors.Material and methods. We examined 92 patients with stable angina who received CABG, aged 64±7 years (men, 78,3%). Among this cohort, 81,5% of patients had multivessel coronary artery disease, carbohydrate metabolism disorders — 35,6%, hypertension — 96,7%, chronic kidney disease (CKD) — 23,9%, preprocedural pAF — 10,9%, previous myocardial infarction (MI) — 54,3%. Off-pump CABG was performed in 31,5%, including bilateral inthernal thoracic artery grafting — in 50%. Cardiopulmonary bypass time was 68 (55-83) minutes. The number of grafts was 2,7±0,7. In addition, 18,5% of individuals received SGLT-2 inhibitors. Serum creatinine content was determined by the Jaffe method, and CKD was diagnosed with glomerular filtration rate &lt;60 ml/min. Acute kidney injury (AKI) was assessed according to the KDIGO criteria (2012).Results. The number of patients who had pAF after CABG was 29,3%, AKI — 16,3%. There were following parameters associated with pAF after CABG: creatinine (100;82-142 in patients with pAF and 83;69-105 μmol/l — without pAF, p=0,032) and urea (7,8;5,8-9,7 in patients with pAF and 5,9;4,7-9,1 mmol/l — without pAF, p=0,025) one day after the intervention; postoperative AKI was revealed in 33,3% and 9,2% (p=0,004), while the number of patients taking SGLT-2 inhibitors was 3,7% and 24,6% (p=0,019) in those with and without pAF, respectively. The probability of pAF after CABG increased by an average of 5,5 times with AKI. Patients with pAF after CABG compared to patients without pAF have a higher rate of AKI, intraoperative MI, and cardiac death.Conclusion. The number of patients with pAF after CABG was 29,3%, AKI — 16,3%. Post-CABG pAF predictor was postoperative AKI. The use of SGLT-2 inhibitors was associated with a lower incidence of pAF after intervention. Patients with pAF after CABG have a poor inhospital prognosis.