On-pump Coronary Artery Bypass Grafting Research Articles

Off-pump CABG surgery in left main coronary artery disease: a single-center prospective registry.

The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Patients with left main multi-vessel coronary artery disease (LM CAD) have concerns regarding incomplete revascularization and reduced survival with off-pump (OPCAB) when compared with on-pump (ONCAB) coronary bypass surgery. To evaluate outcomes among high-risk LM CAD patients undergoing OPCAB, we performed a registry-based prospective study. We performed 4868 coronary artery bypass graft (CABG) surgeries from Jan 2013 to Jun 2019 with 4662 (95.8%) OPCAB. In OPCAB cohort, we had 1323 patients (28.4%) with significant LM (> 50%) triple vessel CAD. Data regarding clinical features, extent of CAD, operative details, in-hospital outcomes, and 3-year follow-up were obtained. Descriptive statistics are reported. The study cohort (n = 1323) was aged 63 ± 9years with men 88.4%. Tobacco use was in 328 (24.8%), diabetes 598 (45.2%), previous myocardial infarction 463 (35.0%), previous coronary intervention 40 (3.0%), and congestive heart failure in 54 (4.1%). All patients had LM (100.0%) with triple vessel disease in 99.4% (LAD, left anterior descending 100.0%; LCX, left circumflex 99.4%; RCA, right coronary artery 78.7%). Vessels bypassed/patient were 2.7 ± 0.4 with 3.2 ± 0.7 total grafts and 2.1 ± 0.8 venous grafts. In total, 1278 (96.5%) patients received left internal mammary artery (LIMA), 63(4.7%) bilateral internal mammary artery (BIMA), and 74 (5.6%) radial artery grafts. There was no patient with conversion from OPCAB to ONCAB. In-hospital major adverse cardiovascular events (MACE: all-cause deaths, myocardial infarction, and stroke) were in 21 (1.6%). At 3-year follow-up (n = 1041), MACE rates were in 84 (8.1%) and cardiovascular deaths in 28 (2.7%). This study shows that off-pump CABG surgery is safe in patients with LM CAD. There is low in-hospital mortality and MACE and 3-year outcomes are similar to the published data of LM CAD patients who undergo on-pump CABG. The online version contains supplementary material available at 10.1007/s12055-023-01526-3.

Intensive care unit length of stay and mortality comparison between on-pump and off-pump coronary artery bypass graft: a retrospective study

BackgroundRecently, coronary artery bypass graft (CABG) techniques, both on-pump (ONCABG) and off-pump (OPCABG), were compared to seek the most effective approach to reduce the cost of prolonged intensive care unit length of stay (ICU LOS) and mortality. This study aims to compare ICU LOS and mortality in ONCABG and OPCABG.ResultsDemographic data of 1569 patients show the variance of characteristics. The analysis shows significant and longer ICU LOS in OPCABG than ONCABG (2.151 ± 0.100 vs. 1.573 ± 0.246 days; p = 0.028). Similar results were demonstrated after adjustment of covariates effects (3.146 ± 0.281 vs. 2.548 ± 0.245 days; p = 0,022). Logistic regression shows no significant difference in mortality in OPCABG and ONCABG, both in the unadjusted (OR [CI 95%] 1.133 [0.485–2.800]; p = 0.733) and the adjusted models (OR [CI 95%] 1.133 [0.482–2.817]; p = 0,735).ConclusionICU LOS was significantly longer in OPCABG patients than in ONCABG patients in the author's centre. There was no significant difference in mortality between the two groups. This finding highlights a discrepancy between recently published theories and the practices observed in the author's centre.

Intraoperative Augmented Rotation and Circumferential Strain Compensate for Reduction of Left Ventricular Longitudinal Function After On-Pump CABG Surgery

Left ventricular (LV) longitudinal function is reduced after on-pump coronary artery bypass grafting (CABG), while global LV function often is preserved. There are only limited data on the underlying compensatory mechanism. Therefore, the authors aimed to describe intraoperative changes of LV contractile pattern by myocardial strain analysis. A prospective observational study. At a single university hospital. A total of 30 patients scheduled for isolated on-pump CABG with an uneventful intraoperative course and preoperative preserved LV and RV function, sinus rhythm, without more-than-mild heart valve disease, or elevated pulmonary pressure. Transesophageal echocardiography was performed after induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). Echocardiographic evaluation was performed under stable hemodynamics, in sinus rhythm or atrial pacing, and vasopressor support with norepinephrine ≤0.1 µg/kg/min. EchoPAC v204 software (GE Vingmed Ultrasound AS, Norway) was used for analysis of 2-dimensional (2D) and 3-dimensional (3D) LV ejection fraction (EF), LV global longitudinal strain (GLS), LV global circumferential strain (GCS), LV global radial strain (GRS), LV apical rotation (aRot), LV basal rotation (bRot), and LV twist. Strain analysis was feasible in all included patients after termination of cardiopulmonary bypass (T2). Although there were no significant differences in the values of conventional echocardiographic parameters during the intraoperative interval, GLS deteriorated significantly after CABG compared to pre-bypass assessment (T1 v T2, -13.4% ± 2.9 v -11.8% ± 2.9; p=0.007). GCS improved significantly after surgery (T1 v T2, -19.4% (IQR -17.1% to -21.2%) v -22.8% (IQR -21.1% to -24.7%); p < 0.001) as well as aRot (T1 v T2, -9.7° (IQR -7.1° to -14.1°) v -14.5° (IQR -12.1° to -17.1°); p < 0.001), bRot (T1 v T2, 5.1° (IQR 3.8°-6.7°) v 7.2° (IQR 5.6°-8.2°); p=0.02), and twist (T1 v T2, 15.8° (IQR 11.7°-19.4°) v 21.6° (IQR 19.2°-25.1°); p < 0.001), while GRS remained unchanged. There were no significant changes in the values of GLS, GCS, GRS, aRot, bRot, or twist, as well as in the values of 2D and 3D LV EF before and after sternal closure (T2 v T3). Beyond evaluation of longitudinal LV strain, measurements of circumferential and radial strain, as well as LV rotation and twist mechanics, were feasible in the intraoperative course of this study. Reduction of longitudinal function after on-pump CABG was compensated intraoperatively by improvement of GCS and rotation in the authors' group of patients. Perioperative assessment of GCS, GRS, as well as rotation and twist, might provide deeper insight into perioperative changes of cardiac mechanics.

Myocardial microstructure assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting.

The correlation between the release of cardiac biomarkers after revascularization, in the absence of late gadolinium enhancement (LGE) or myocardial edema, and the development of myocardial tissue damage remains unclear. This study sought to identify whether the release of biomarkers is associated with cardiac damage by assessing myocardial microstructure on T1 mapping after on-pump (ONCAB) and off-pump coronary artery bypass grafting (OPCAB). Seventy-six patients with stable multivessel coronary artery disease (CAD) and preserved systolic ventricular function were included. T1 mapping, high-sensitive cardiac troponin I (cTnI), creatine kinase myocardial band (CK-MB) mass, and ventricular dimensions and function were measured before and after procedures. Of the 76 patients, 44 underwent OPCAB, and 32 ONCAB; 52 were men (68.4%), and the mean age was 63±8.5 years. In both OPCAB and ONCAB the native T1 values were similar before and after surgeries. An increase in extracellular volume (ECV) values after the procedures was observed, due to the decrease in hematocrit levels during the second cardiac resonance. However, the lambda partition coefficient showed no significant difference after the surgeries. The median peak release of cTnI and CK-MB were higher after ONCAB than after OPCAB [3.55 (2.12-4.9) vs. 2.19 (0.69-3.4) ng/mL, P=0.009 and 28.7 (18.2-55.4) vs. 14.3 (9.3-29.2) ng/mL, P=0.009, respectively]. Left ventricular ejection fraction (LVEF) was similar in both groups before and after surgery. In the absence of documented myocardial infarction, T1 mapping did not identify structural tissue damage after surgical revascularization with or without cardiopulmonary bypass (CPB), despite the excessive release of cardiac biomarkers.

EE560 Nationwide Cost-Effectiveness Analysis of Off-Pump and On-Pump Coronary Artery Bypass Grafting

Off-pump CABG (OPCAB) has been shown to be as safe and effective as on-pump CABG (ONCAB). Despite recent evidence demonstrating that OPCAB carries multiple patient-centered benefits, the volume of OPCAB surgeries over the last decade has decreased, and there are few studies estimating the cost-effectiveness of OPCAB. The purpose of this study was to determine whether OPCAB was cost-effective relative to ONCAB using a national sample.

Long-Term Survival Associated With Multiple Arterial Grafting in Off-Pump and On-Pump Coronary Bypass Surgery

There is a paucity of evidence on whether the survival advantage of multiple arterial revascularisation (MAG) would have an association with off-pump (OPCAB) or on-pump coronary artery bypass grafting (ONCAB). Therefore, this study sought to evaluate the long-term survival of using multi aterial grafting (MAG) vs single arterial grafting (SAG) in OPCAB and ONCAB cohorts.

Coronary Artery Bypass Surgery for Acute Coronary Syndrome: A Network Meta-Analysis of On-Pump Cardioplegic Arrest, Off-Pump and On-Pump Beating Heart Strategies

Coronary artery bypass grafting (CABG) in the setting of an acute coronary syndrome is a high-risk procedure, and the best strategy for myocardial revascularisation remains debated. This study aimed to compare the 30-day mortality benefit of on-pump CABG (ONCAB), off-pump CABG (OPCAB), and on-pump beating heart CABG (OnBHCAB) strategies.

ISCHEMIC STROKE AFTER CORONARY BYPASS SURGERY IN PATIENTS WITH TYPE 2 DIABETES, HYPERTENSION, AND TRIPLE VESSEL DISEASE

Objective: We want to investigate this case, what are the various Risk factors for Ischaemic stroke as a major complication, and how to reduce this life-threatening complication in high-risk patients with diabetes, hypertension, and triple vessel disease. Design and method: A 55-year-old patient with TVD Tripple vessel disease without acute MI (myocardial infarction) needed CABG. His angiographic score and uncontrolled diabetes suggested open heart surgery. He did not have carotid or aortic plaque or other issues during the pre-op examination. He underwent on-pump CABG, cardiac aortic bypass with two saphenous veins (on the RCA and OM1), and anastomosis of the left internal thoracic artery on the LAD. The pumping duration was 150 minutes. The patient was weaned from the pump, the surgery was completed, the sternum was closed, and the patient was transferred to the intensive care unit. When we decided to extubate the patient after 12 hours, we noticed his limb movement was not symmetrical. He was paralyzed on the left side. There was significant left hemisphere ischemia on brain CT, which was consistent with CVA. Once brain hemorrhage was excluded, the neurologists started administering heparin to treat the ischemic stroke. Results: Patients with severe stenosis and 3VD require intervention or CABG treatment; however, in this instance, the areas of stenosis were not appropriate for stenting, and the patient's uncontrolled diabetes was another reason suggestive of open-heart surgery. Three crucial aspects have shocked us and that all surgeons may find challenging. Uncontrolled diabetes can significantly contribute to the damage of medium and small blood vessels, and chronic hypertension can cause micro tears and blood clots in the vessels. These three variables can result in tiny damage. Long pump time and these two variables contributed to blood stagnation in the patient. In addition, the patient may have been more vulnerable to ischemic attacks. Conclusions: We may have avoided this complication by administering the following measures

Use of cardiopulmonary bypass is associated with chronic postsurgical pain among patients undergoing coronary artery bypass graft surgery: follow-up of a randomized, clinical trial.

Chronic postsurgical pain (CPSP) worsens patients' mortality, morbidity, and quality of life. Cardiopulmonary bypass is mandatory for cardiac surgery, but it induces intense inflammation. The presence of inflammation is a crucial part of pain sensitization. An extreme inflammatory response due to cardiopulmonary bypass might cause a high prevalence of CPSP after cardiac surgery. We hypothesized that the prevalence and severity of CPSP are higher in patients after on-pump coronary artery bypass graft (CABG) surgery than in those after off-pump CABG surgery. This prospective, observational study was performed on a cohort from a randomized trial (on-pump CABG: 81 patients, off-pump CABG: 86 patients). A questionnaire about the severity of surgical wound pain that evaluated pain with the numerical rating scale (NRS) was filled out by the patients. NRS responses for current pain, peak pain in the last 4weeks, and average pain in the last 4weeks were evaluated. The main outcomes were the severity of CPSP as evaluated using the NRS and the prevalence of CPSP. CPSP was defined as pain with an NRS score > 0. Differences in severity between groups were analyzed using multivariate ordinal logistic regression models adjusted for age and sex, and differences in prevalence between groups were analyzed using multivariate logistic regression models adjusted for age and sex. The questionnaire return rate was 77.0%. During a median follow-up of 17years, 26 patients complained of CPSP (on-pump CABG: 20 patients, off-pump CABG: 6 patients). Ordinal logistic regression showed that the NRS response for current pain (odds ratio [OR] 2.34; 95% CI 1.12-4.92; P = 0.024) and the NRS response for peak pain in the last 4weeks (OR 2.71; 95% CI 1.35-5.42; P = 0.005) were significantly higher in patients who underwent on-pump CABG surgery than in those who underwent off-pump CABG. Logistic regression showed that on-pump CABG surgery was an independent predictor of CPSP (OR 2.59; 95% CI 1.06-6.31; P = 0.036). The prevalence and severity of CPSP are higher in patients with on-pump CABG surgery than in those with off-pump CABG surgery.

Normal range of intraoperative three-dimensionally derived right ventricular free-wall strain in coronary artery bypass surgery patients.

Data on intraoperative three-dimensionally derived right ventricular free-wall strain (3D-RV FWS) is sparse. We sought to evaluate the normal range of intraoperative 3D-RV FWS in patients scheduled for coronary artery bypass graft (CABG) surgery and compared to conventional echocardiographic parameters. Prospective observational study. A total of 150 patients with preserved left and right ventricular (RV) function and sinus rhythm, without significant heart valve disease or pulmonary hypertension undergoing isolated on-pump CABG surgery, with an uneventful, complication-free intraoperative course. 3D-RV FWS analysis and conventional echocardiographic assessment of RV function were performed intraoperatively in anesthetized and ventilated patients using transesophageal echocardiography (TEE). TomTec 4D RV-Function 2.0 software for assessment of 3D-RV FWS and three-dimensional right ventricular ejection fraction (3D-RV EF). Philips QLAB 10.8 was used to evaluate tissue velocity of the tricuspid annulus (RV S´), tricuspid annular systolic excursion (TAPSE), and RV fractional area change (FAC). All echocardiographic measurements were performed under stable hemodynamic conditions and predefined fluid management without any vasoactive support or pacing. The prospective observational study was performed in a single university hospital setting. Assessment of 3D-RV FWS was feasible in 95% of patients. No included patient experienced any serious perioperative complication. In our group of patients, median values with interquartile range (IQR) for 3D-RV FWS and 3D-RV EF were -25.2 (IQR -29.9 to -21.8) and 46.3% (IQR 41.0%-50.1%), respectively. RV FAC, RV S´, and TAPSE accounted for 39.7% (IQR 34.5%-44.4%), 14.8cm/s (IQR 11.8-19.0cm/s), and 22mm (IQR 20-25mm). The normal range (2.5% to 97.5% percentile) for 3D-RV FWS was -37.1 to -12.8. There was no relevant correlation of 3D-RV FWS to postoperative outcome in this group of CABG patients. We present distribution values for intraoperative 3D-RV FWS and conventional parameters of RV function assessment in a healthy on-pump CABG patient population without serious perioperative complications. We observed no correlations of these parameters with any of the outcome parameters considered. Therefore, we consider these values to be intraoperative TEE-assessed normal values, which can be expected in on-pump CABG patients.

Off-Pump Versus On-Pump Coronary Artery Bypass Grafting In Patients With Left Main Coronary Artery Disease: A Randomized Controlled Trial.

To compare the outcome of off-pump and on-pump coronary artery bypass graftsurgery in patients with left main coronary artery disease. The randomised, controlled, prospective, multicentric study was conducted in 2020 during the period from January 2020 to December 2020 at Kafrelsheikh University Hospital, International Cardiac Centre and Alexandria New Medical Centre, Egypt, and comprised patients with left main coronary artery disease who underwent coronary artery bypass graftsurgery. The patients were randomised to on-pump surgery group I (Control Group) and off-pump surgery group II(Interventional Group). All patients were assessed pre-operatively for the presence of comorbid conditions and post-operatively for myocardial infarction, acute kidney injury, pneumonia, sternal dehiscence and 3-month mortality. Data was analysed using SPSS 20. Of the 60 patients, 44(73.3%) were men and 16(26.6%) were women. The overall mean age was 66.4±9.2 years. There were 30(50%) patients in each of the two groups. There were 2(6.7%) cases of myocardial infarction in group I and 1(3.3%) in group II. There was 1(3.3%) case of acute kidney injury in group I and none in group II. There were 3(10%) cases of pneumonia in group 1 compared to 1(3.3%) in group II. There was 1(3.3%) case of sternal dehiscence in group I and none in group II. Mortality at 3 months was 2(6.7%) in group I and 1(3.3%) in group II. There was no significant difference with respect to outcome between the groups (p>0.05). Off-pump coronary artery bypass graft surgery was found to be efficient and non-inferior to on-pump procedure in patients with left main coronary artery disease. The RCT was registered retrospectively at the Pan African Clinical Trials Registry (PACTR) (Trial #: PACTR202301506140749 Date of Approval: 06/01/2023). Link: https://pactr.samrc.ac.za/Search.aspx.

Evaluation of the Effect of Acute Normovolemic Hemodilution on Bleeding Rate and Short-Term Post-Operative Complication of Patient Who Underwent on-Pump Coronary Artery Bypass Graft Surgery

Evaluation of the Effect of Acute Normovolemic Hemodilution on Bleeding Rate and Short-Term Post-Operative Complication of Patient Who Underwent on-Pump Coronary Artery Bypass Graft Surgery

A Comparative Study of Post-Operative Outcomes for Off-Pump and On-Pump Coronary Artery Bypass Grafting

Introduction: Coronary artery bypass grafting (CABG) is a common surgical procedure for the management of coronary artery disease. Off-pump (OPCAB) and on-pump (ONCAB) CABG have been compared in various studies, but limited data exists for the Bangladeshi population. The present study was conducted to shed further light on the topic relative to the Bangladeshi demographic. Methods: This retrospective observational study conducted at the Department of Cardiac Surgery, National Institute of Cardiovascular Disease, Dhaka, Bangladesh, over a 1.5-year period from April 2019 to September 2020 compared the outcomes of OPCAB and ONCAB in a Bangladeshi population, analyzing the demographic and clinical characteristics, operative characteristics, early postoperative outcomes, and recovery parameters of 34 patients undergoing either OPCAB (n=17) or ONCAB (n=17). Result: The two groups were well-matched in terms of demographic and clinical characteristics, with no significant differences in age, gender, BMI, or comorbidities. The OPCAB group had a significantly shorter total operative time (180.4 ± 26.8 min vs. 195.3 ± 31.2 min, P &lt; 0.05). Early postoperative outcomes were similar between the two groups (P &gt; 0.05 for all comparisons), while the OPCAB group had a significantly shorter hospital stay (7.8 ± 1.8 days vs. 9.2 ± 2.1 days, P &lt; 0.05), mechanical ventilation time (9.1 ± 3.8 hours vs. 12.6 ± 4.5 hours, P &lt; 0.05), and time to ambulation (3.8 ± 0.9 days vs. 4.5 ± 1.0 days, P &lt; 0.05). Conclusion: Our study suggests that OPCAB may be a viable alternative to ONCAB for selected patients in the Bangladeshi population, offering potential benefits in terms of reduced recovery times and resource utilization. Further large-scale, randomized controlled trials are needed to confirm these findings and assess the long-term outcomes and cost-effectiveness of OPCAB compared to ONCAB.

Association of Preoperative Hba1c Level with Incidence of New-Onset Atrial Fibrillation during Early Postoperative Period after On-Pump Coronary Artery Bypass Grafting Surgery in Diabetic Patients

Introduction: Atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG) surgery, particularly in diabetic patients. Elevated preoperative HbA1c levels have been suggested as a potential risk factor for postoperative AF; however, the association remains unclear. This study aimed to investigate the association between preoperative HbA1c levels and the incidence of new-onset atrial fibrillation during the early postoperative period in diabetic patients undergoing on-pump CABG surgery in Bangladesh. Methods: This observational cross-sectional study was conducted at the Department of Cardiac Surgery, National Institute of Cardiovascular Disease, Dhaka, Bangladesh. A total of 60 diabetic patients undergoing on-pump CABG were included and divided into two groups: Group-1 (HbA1c &lt;7%, n=30) and Group-2 (HbA1c ≥7%, n=30). Data were collected using a preformed data collection sheet, and statistical analysis was performed using the chi-square test, Fisher's test, and student's t-test. Result: In this study, Group-1 (HbA1c &lt;7%) consisted of 30 patients, while Group-2 (HbA1c ≥7%) also comprised 30 patients. The mean age of Group-1 was 58.50±6.80 years, and that of Group-2 was 50.53±6.01 years (p &lt; 0.001). The distribution of preoperative variables such as single, double, and triple vessel disease, hypertension, history of antiarrhythmic drug use, and NYHA class III and IV showed no significant differences between the groups (p &gt; 0.05). However, preoperative HbA1c levels were significantly different between the two groups (6.11±0.44 in Group-1 vs. 7.98±0.55 in Group-2, p &lt; 0.001). The incidence of new-onset atrial fibrillation during the early postoperative period was significantly higher in Group-2 (63.33%) than in Group-1 (30.00%, p &lt; 0.05). A significant association was also observed between postoperative atrial fibrillation and hypertension (p &lt; 0.05). Patients in Group-2 experienced a higher rate of postoperative complications, .......

Intraoperative ticagrelor removal via hemoadsorption during on-pump coronary artery bypass grafting

ObjectivesPatients on ticagrelor undergoing urgent cardiac surgery are at high risk for perioperative bleeding complications. We sought to determine whether intraoperative hemoadsorption could remove ticagrelor and lower circulating drug concentrations. MethodsThe hemoadsorption device was incorporated in the cardiopulmonary bypass (CPB) circuit and remained active for the duration of the pump run. Blood samples were collected before and after CPB. The main objective of the current analysis was to compare mean total plasma ticagrelor levels (ng/mL) at baseline with ticagrelor levels obtained at the end of CPB. Plasma ticagrelor levels were measured at a certified outside laboratory (LabConnect). Data are presented as mean ± standard deviation. ResultsA total of 11 patients undergoing urgent coronary artery bypass grafting at 3 institutions were included (mean age, 67.9 ± 9.9 years; 91% male; mean European System for Cardiac Operative Risk Evaluation II of 3.0 ± 3.3%; range, 0.7%-12.4%). Mean intraoperative hemoadsorption duration was 97.1 ± 43.4 minutes with a mean flow rate through the device of 422.9 ± 40.3 mL/min. Mean ticagrelor levels pre-CPB were 103.5 ± 63.8 ng/mL compared with mean post-CPB levels of 34.0 ± 17.5 ng/mL, representing a significant 67.1% reduction (P < .001). Intraoperative integration of the device was simple and safe without any device-related adverse events reported. ConclusionsThis is the first in vivo report demonstrating that intraoperative hemoadsorption can efficiently remove ticagrelor and significantly reduce circulating drug levels. Whether active ticagrelor removal can reduce serious perioperative bleeding in patients undergoing urgent cardiac surgery is currently being evaluated in the double-blinded, randomized Safe and Timely Antithrombotic Removal–Ticagrelor (STAR-T) trial.

Detecting the Change in Total Circulatory Flow with a Wireless, Wearable Doppler Ultrasound Patch: A Pilot Study.

Prospective observational pilot study. Patients undergoing elective, on-pump coronary artery bypass grafting (CABG) surgery. Fourteen patients were referred for elective coronary artery bypass grafting surgery. Cardiopulmonary bypass (CPB) pump flow changes during surgery, as chosen by the perfusionist. A hands-free, wearable Doppler patch was used for CCA velocity measurements with the aim of preventing user errors in ultrasound measurements. Maximum CCA velocity was determined from the spectrogram acquired by the Doppler patch. CPB flow rates were recorded as displayed on the CPB console, and further measured from the peristaltic pulsation frequency visible on the recorded Doppler spectrograms. Changes in CCA maximum velocity tracked well with changes in CPB flow. On average, a 13.6% change in CCA maximum velocity was found to correspond to a 10% change in CPB flow rate. Changes in CCA velocity may be a useful surrogate for determining fluid responsiveness when user error can be mitigated.

Survival and Independent Predictors of Mortality Following Coronary Artery Bypass Graft Surgery in a Single-Unit Practice in the United Kingdom Over 20 Years

The types of graft conduits and surgical techniques may impact the long-term outcomes of patients after coronary artery bypass graft (CABG) revascularization. This study observed a long-term survival rate following CABG surgery over 20 years in the United Kingdom. A total of 2979 isolated CABG patients were studied from 1999 to 2020, and postoperative data were obtained from the hospital-recorded mortality by the data quality team of the information department. Postdischarge survival was estimated using the Kaplan-Meier method, and statistical significance was obtained with log-rank tests and the Gehan-Breslow test, and the Holm-Sidak method was used for multiple pairwise comparisons. The study observed male predominance (80%), and the median age was statistically significant (P <0.001) among the groups, 66 years (interquartile range 58-73) and 72 years (interquartile range 66-78) in survivor and non-survivor groups, respectively. In the Holm-Sidak method analysis, the best survival rate (mean 18.7 years) was observed in the total arterial group with significantly decreased survival for the mixed arterial and venous group (mean 16.12 years) and only the vein group (10.44 years). The Cox regression model observed that the New York Heart Association (NYHA) class III-IV (HR 1.57), chest re-exploration (HR 2.14), preoperative dialysis (HR 3.13), and redo surgery (HR 3.04) were potential predictors of the postoperative mortality (P ≤0.05). In our series over 20 years, albeit off-pump and on-pump CABG observed similar survival rates, the total arterial myocardial revascularization population has significantly better long-term survival benefits.

Effect of the machine learning-derived Hypotension Prediction Index (HPI) combined with diagnostic guidance versus standard care on depth and duration of intraoperative and postoperative hypotension in elective cardiac surgery patients: HYPE-2 – study protocol of a randomised clinical trial

IntroductionHypotension is common during cardiac surgery and often persists postoperatively in the intensive care unit (ICU). Still, treatment is mainly reactive, causing a delay in its management. The Hypotension Prediction...

Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis

ObjectivesTo compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients.MethodsThe present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or coronary artery bypass graft (CABG). DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analyzed between the two groups.ResultsThe DNC group had a similar mortality (3.4% vs. 5.6%, OR = 0.79, P = 0.720) and extracorporeal membrane oxygenation (ECMO) implantation rate (1.1% vs. 2.2%, OR = 0.75, P = 1.000) to the CBC group, a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs. 9.0%, OR = 0.54, P = 0.034) and a higher left ventricular ejection fraction (LVEF) at discharge (60 (56–64) % vs. 57 (51–62)%, P = 0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (79.4 (65.0-94.3) ml/min/1.73m2 vs. 77.2 (59.8–88.7) ml/min/1.73m2, P = 0.014), but no significant differences were identified after 24 h. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0 h: 2.7 (2.0-3.2) vs. 3.2 (2.4–4.4), P = 0.001; 3 h: 3.2 (2.0-4.8) vs. 4.8 (2.8–6.6), P < 0.001; 6 h: 3.5 (2.2–5.4) vs. 5.8 (3.4–8.4), P < 0.001; 9 h: 3.4 (2.0–7.0) vs. 5.5 (2.9–8.3), P = 0.005). There were no differences between the two groups in respect of lactate levels at 12 h and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups.ConclusionsDel-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.

Landiolol: An Ultra-Short-Acting β-Blocker.

Landiolol is an ultra-short-acting, highly cardio-selective, β-blocker, that is currently approved for clinical use in Japan and the European Union, for the treatment of tachyarrhythmias. Landiolol is highly cardio-selective with high β1 selectivity and receptor affinity, resulting in a more potent chronotropic effect and less potent hypotensive effect compared with other β-blockers such as esmolol and propranolol. Based on the recent randomized controlled trials, low-dose landiolol may have a beneficial role in the prevention and management of postoperative atrial fibrillation following noncardiac and cardiac surgeries, including on-pump and off-pump coronary artery bypass grafting and valve surgery. Additionally, landiolol may have potential utility for myocardial salvage and prevention of postpercutaneous coronary intervention myocardial infarction. Furthermore, the use of landiolol may also have a therapeutic effect for rate control of sepsis-related tachyarrhythmias. Positive results of recent randomized controlled trials should continue to inspire clinicians to conduct further, larger studies, to find new potential clinical applications for this novel drug.