On-pump Coronary Bypass Grafting Research Articles

The effect of ultrasound-guided bilateral single shot pecto-intercostal plane block on recovery after on-pump coronary bypass graft surgery, randomized controlled trial

The effect of ultrasound-guided bilateral single shot pecto-intercostal plane block on recovery after on-pump coronary bypass graft surgery, randomized controlled trial

The effect of ultrasound-guided bilateral single-shot erector spinae plane block on recovery after on-pump coronary bypass graft surgery: a randomized controlled study

BackgroundFast-track and ultra-fast-track anesthesia techniques can be facilitated with opioid requirements’ reduction and multi-modal analgesia techniques that include the regional anesthesia techniques. The study aimed to assess the preoperative effect of single-shot bilateral ultrasound-guided erector spinae plane block (ESPB) on the extubation time and postoperative pain of patients undergoing on-pump CABG surgery.ResultsThe ESPB group was statistically significant decreased regarding the extubation time, ICU length stay, intraoperative fentanyl, and postoperative morphine consumption than the control group (p < 0.0001 for all the previous measurement). The 1st time of rescue analgesia of the ESPB group was longer than the control group (p < 0.0001). The numerical rating score (NRS) after extubation of the ESPB group was lower at 2 and 4 h after extubation (P = ˂ 0.0001 and 0.0006 respectively) than the control group. The number of patients who required rescue analgesia after extubation was significantly decreased in the ESPB group in comparison to the control group, 2 and 4 h after extubation (P = < 0.0001 and 0.004 respectively).ConclusionsThe preoperative single-shot ultrasound-guided ESPB in patients scheduled for on-pump CABG surgery shortened the extubation time and the length of ICU, decreased intraoperative fentanyl and postoperative morphine consumption and postoperative pain scores, and prolonged 1st time of rescue analgesia without significant effect on the incidence of complications, re-intubation, or mortality.Trial registrationApproval was obtained from the Research Ethics Committee of the Faculty of Medicine (approval code of 33702/02/20) registered at February 2, 2020, and written informed consent was obtained from the patients. The trial was registered at 17 March 2020 in the Pan African Clinical Trial Registry with a unique identification number for the registry which is PACTR202003822626676.

Risk of acute kidney injury in patients with ischemic heart disease and concomitant metabolic syndrome after on-pump coronary bypass grafting

Risk of acute kidney injury in patients with ischemic heart disease and concomitant metabolic syndrome after on-pump coronary bypass grafting

Changes in pentraxin 3 and oxidative parameters during coronary bypass grafting and factors affecting postoperative atrial fibrillation.

ObjectiveThe performance of coronary bypass grafting (CBG) induces a type of subclinical systemic inflammatory response syndrome. The present study was performed to examine the changes in pentraxin 3 (PTX3) and oxidative parameters during cross-clamping in patients undergoing CBG. We also examined factors affecting the development of postoperative atrial fibrillation (POAF).MethodThis study involved 40 patients who underwent elective on-pump CBG (33 men, 7 women; mean age, 60.8 ± 8.0 years). Blood specimens were drawn before anaesthesia and after aortic cross-clamping. POAF was detected by analysing the rhythm records of telemetry units for 96 hours postoperatively.ResultsThe mean PTX3 concentration prior to surgery was 176.3 ± 148.4 pg/mL. After cross-clamping, it increased to 947.7 ± 377.2 pg/mL. The increase was statistically significant. Twelve patients had POAF. The leucocyte count and change in the oxidative stress index were significantly higher in patients without than with POAF. Although the increase in PTX3 was higher in patients without POAF, the difference was not statistically significant.ConclusionThe PTX3 concentration significantly increases during CBG. A significant change in the oxidative stress index and a more intense increase in the PTX3 concentration were seen in patients without POAF.

Effect of Preoperative Creatinine Levels on Mortality after Coronary Artery Bypass Grafting Surgery: an Observational Study.

IntroductionRenal function is an independent risk factor for mortality among on-pump coronary bypass grafting (ONCABG) patients. This association is well known in the international literature, but there is a lack of knowledge of how admission creatinine (AC) levels modulate each cardiovascular risk factor.ObjectiveThe aim of this paper was to assess the effect of different AC levels on mortality among ONCABG patients.Methods1,599 patients who underwent ONCABG between December 1999 and February 2006 at Hospital de Base in São José do Rio Preto/SP-Brazil were included. They were divided into quartiles according to their AC levels (QI: 0.2 ≤AC < 1.0 mg/dL; QII: 1.0 ≤ AC < 1.2 mg/dL; QIII: 1.2 ≤ AC < 1.4 mg/dL; and QIV: 1.4 ≤ AC ≤ 2.6 mg/dL). Seven risk factors were then evaluated in each stratum.ResultsMortality was higher in the QIV group than QI or QII groups. Factors such as age (≥ 65 years) and cardiopulmonary bypass (CPB) time (≥ 115 minutes) in QIV, as well preoperative hospital stay (≥ 5 days) in QIII, were associated with higher mortality rates. Creatinine variation greater than or equal to 0.4 mg/dL increased mortality rates in all groups. The use of intra-aortic balloon pump and dialysis increased mortality rates in all groups except for QII. Type I neurological dysfunction increased the mortality rate in the QII and III groups.ConclusionCreatinine levels play an important role in ONCABG mortality. The combination of selected risk factors and higher AC values leads to a worse prognosis. On the other hand, lower AC values were associated with a protective effect, even among elderly patients and those with a high CPB time.

Mid- and long-term prognosis of off- vs. on-pump coronary artery bypass graft in patients with multisite artery disease

Among patients with coronary artery disease (CAD), around 25% have multisite artery disease (MSAD). Patients with CAD and MSAD are at higher risk of peri-operative and long-term cardiovascular events. Whether off-pump coronary bypass grafting (CABG) can improve their prognosis is unknown. We aimed to assess the benefits of off- vs. on-pump cardiac surgery in patients undergoing CABG, according to coexistence of extra-cardiac artery disease. Between April 1998 and September 2008, 1221 patients undergoing CABG without any other intervention were enrolled. Overall death and major cardiovascular events were recorded at 1-month and during long-term follow-up. A propensity score (PS), derived from all relevant variables (P<0.25) associated with on-pump as compared to off-pump CABG, and representing the likelihood for each individual patient to receive off-pump CABG, was calculated. MSAD was observed in 279 patients (23%). Off-pump CABG was performed in 208 (17%) patients. The median follow-up was 7.6 years. The 10-year mortality was significantly lower in off- vs. on-pump CABG group (74±4% vs. 68±2%, P=0.024). In patients with MSAD, there was a trend for better survival for off- vs. on-pump CABG (63±8% vs. 50±4%, P=0.078). After adjustment for PS, we found no further difference between on- and off-pump CABG both in the whole cohort (HR=1.30, P=0.10), as well as in MSAD patients (HR=1.51, P=0.14). Patients with MSAD receiving CABG are at worst prognostic than those with isolated CAD. In these patients, we found no significant difference in the long-term mortality and cardiovascular events between on- and off-pump CABG.

RENAL FUNCTION AFTER CORONARY BYPASS SURGERY IN PATIENTS WITH PRE-DIABETES

Aim. To reveal the predictors of renal dysfunction due to surgical revascularization of myocardium in stable angina patients with prediabetes. Material and methods. Totally, 48 patients with prediabetes studied, having indications for coronary bypass grafting (CBG) at the age 60±7,4 years with coronary heart disease (CHD) anamnesis 6±5,4 years. Multivessel disease of coronary vessels had 68,8% of patients, LCA stem stenosis >50 % had 10,9% of patients. On-pump CBG was done in 87,5% of patients, off-pump — 12,5%. Duration of on-pump period was 95±23 min., number of distal anastomoses for one patient — 2,8±0,8. Baseline, on the first and second days post-CBG, and if needed later, the creatinin concentration was measured in the blood, as glomerular filtration rate (GFR) by CKD-EPI equation. Of the development of renal dysfunction in CBG we decided if GFR decreased below 60 mL/min/1,73 m2 . In statistics we took continuous variables as М±SD and as Me (25%–75%) depending on the type of distribution. Renal dysfunction predictors were defined with the method of staged regression. Results. In patients with stable angina and prediabetes we found moderate transient decrease of GFR after CBG comparing to the baseline level with Me 89,4 (78-105) to Ме 77,8 (59-96) mL/min/1,73 m2 (р<0,01). Significant decrease of GFR after CBG had the patients with in-hospital complications (introperational myocardial infarction, acute heart failure, atrial fibrillation paroxysm) — Ме 92 (82-107) and Ме 72,4 (56-89) mL/min/1,73 m2 , р=0,000 differ from the patients groups not having complications, р=0,797. The part of persons developing CBG related renal dysfunction was 21,7%. Decrease of GFR <60 mL/min/1,73 m2 after CBG is associated with older age, lower baseline GFR and longer on-pump period. Conclusion. Among patients with stable angina and pre-diabetes the part of those developing CBG related renal dysfunction was 21,7%. The increase of on-pump time more than Me 105 (86-136) minutes significantly increased the relative risk of renal dysfunction development after CBG.

PREDICTORS OF PERSISTANT POST-OPERATION COGNITIVE DYSFUNCTION IN 2 TYPE DIABETES PATIENTS AFTER CORONARY BYPASS GRAFTING

Aim. To study predictors of long-term post-operation cognitive dysfunction (POCD) in patients with diabetes mellitus 2 type (DM), underwent coronary bypass grafting (CBG) under on-pump conditions. Material and methods. Totally, 54 men included, with DM 2 type, underwent scheduled on-pump CBG, at the age 45-69 y.o. All patients, together with standard clinical assessment, were neurophysiologically tested on the 3-5th day after operation, on 7-14th day and in 1 year after CBG. As factors, suggestively significant for persistent POCD development, were selected: integral parameter of patents adherence to treatment, moderate cognition disorders (MCD) before operation, anxiety level (AL) and progression of carotid arteries (CA) stenoses, measured in 1 year before the operation. Results. In DM2 patients after on-pump CBG, the following most significant factors were identified as predictors for POCD: CA stenoses progression, high AL, low integral parameter of adherence; this allows for high probability level of prediction of POCD in 1 year after CBG. Conclusion. The obtained data demonstrated significance of the factors as CA stenoses progression, high LA and low adherence to treatment for development of persistent POCD in DM2 patients after on-pump CBG.

KIDNEY FUNCTION AFTER CORONARY BYPASS IN PREDIABETES PATIENTS

Aim. To reveal the predictors of renal dysfunction due to surgical revascularization of myocardium in stable angina patients with prediabetes. Material and methods. Totally, 48 patients with prediabetes studied, having indications for coronary bypass grafting (CBG) at the age 60±7,4 y.o. with CHD anamnesis 6±5,4 y. Multivessel disease of coronary vessels had 68,8% of patients, LCA stem stenosis >50% had 10,9% of patients. On-pump CBG was done in 87,5% of patients, off-pump — 12,5%. Duration of on-pump period was 95±23 min., number of distal anastomoses for one patient — 2,8±0,8. Baseline, on the first and second days post-CBG, and if needed later, the creatinin concentration was measured in the blood, as glomerular filtration rate (GFR) by CKD-EPI equation. Of the development of renal dysfunction in CBG we decided if GFR decreased below 60 mL/min/1,73 m2 . In statistics we took continuous variables as М±SD and as Me (25- 75%) depending on the type of distribution. Kidney dysfunction predictors were defined with the method of staged regression. Results. In patients with stable angina and prediabetes we found moderate transient decrease of GFR after CBG comparing to the baseline level with Me 89,4 (78-105) to Ме 77,8 (59-96) mL/min/1,73 m2 (р<0,01). Significant decrease of GFR after CBG had the patients with in-hospital complications (introperational myocardial infarction, acute heart failure, atrial fibrillation paroxysm) — Ме 92 (82- 107) and Ме 72,4 (56-89) mL/min/1,73 m2 , р=0,000 differ from the patients groups not having complications, р=0,797. The part of persons developing CBG related renal dysfunction was 21,7%. Decrease of GFR <60 mL/min/1,73 m2 after CBG is associated with older age, higher baseline GFR and longer on-pump period. Conclusion. Among patients with stable angina and prediabetes the part of those developing CBG related renal dysfunction was 21,7%. The increase of on-pump time more than Me 105 (86-136) minutes significantly increased the relative risk of renal dysfunction development after CBG.

912Nanoparticle Enhanced CMR – A Novel Method Of Investigating Myocardial Inflammation &amp; Dysfunction

Purpose: Myocardial inflammation following infarction or coronary bypass graft (CABG) surgery exerts detrimental effects on ventricular remodelling and function. “Ultrasmall superparamagnetic particles of iron-oxide” (USPIOs) are internalised by inflammatory cells, and shorten T2* decay times during magnetic resonance imaging (MRI). The aim of the study was to assess whether USPIOs could be used to measure in vivo myocardial cellular inflammation after ST-elevation myocardial infarction (STEMI) or CABG surgery. Methods: Patients underwent MRI 2-4 days post STEMI (baseline), and 24-hours after intravenous USPIO infusion (4 mg/kg Ferumoxytol; n = 10) or no infusion (n = 6). The same protocol was performed in 47 patients 5-28 days following on-pump CABG and 10 healthy volunteers, with all subjects receiving USPIO. Standard Cardiac MRI was performed at 3T. USPIO imaging was performed using T2*-weighted multi-gradient-echo sequences. Four echoes (TE = 2.13, 4.27, 6.41, 8.55 ms) were combined to create R2* (1/T2*) maps, that were used to evaluate USPIO uptake (Figure 1). Plasma troponin I concentrations were determined by high sensitivity assay in patients undergoing CABG surgery. Results (Figure 2): Following USPIO administration, R2* values increased in the liver and spleen consistent with uptake by the reticuloendothelial system. In patients with STEMI, there was a large increase in R2* in infarcted myocardium (41 ± 12 to 155 ± 45 s−1; p<0.001) indicative of macrophage accumulation in this region. There was only a small increase in R2* in the myocardium remote from the infarct (39 ± 3 to 80 ± 15 s−1; p<0.001), similar to the increase observed in the myocardium of healthy volunteers (44 ± 6 to 88 ± 12 s−1). This represented USPIO laden blood pooling. In contrast, R2* signal increased further in the myocardium of CABG surgery patients (44 ± 6 to 114 ± 21 s−1; p<0001) and this was greater than in the myocardium of healthy volunteers (p<0.05), but lower than the infarcted myocardium (p<0.001). High sensitivity troponin I increased 1340 fold from baseline (8 ± 9 pg/ml) to a peak at 6 hours (4809 ± 6176 pg/ml), and correlated with R2* increase (r = 0.34, p = 0.03). R2* map Results

Hemodynamic effects of peri-operative statin therapy in on-pump cardiac surgery patients

BackgroundPeri-operative statin therapy in cardiac surgery cases is reported to reduce the rate of mortality, stroke, postoperative atrial fibrillation, and systemic inflammation. Systemic inflammation could affect the hemodynamic parameters and stability. We set out to study the effect of statin therapy on perioperative hemodynamic parameters and its clinical outcome.MethodsIn a single center study from 2006 to 2007, peri-operative hemodynamic parameters of 478 patients, who underwent cardiac surgery with cardiopulmonary bypass, were measured. Patients were divided into those who received perioperative statin therapy (n = 276; statin group) and those who did not receive statin therapy (n = 202; no-statin group). The two groups were compared together using Kolmogorov-Smirnov-Test, Fisher’s-Exact-Test, and Student’s-T-test. A p value < 0.05 was considered as significant.ResultsThere was no significant difference in the preoperative risk factors. Onset of postoperative atrial fibrillation was not affected by statin therapy. Extended hemodynamic measurements revealed no significant difference between the two groups, apart from Systemic Vascular Resistance Index (SVRI) . The no-statin group had a significantly higher SVRI (882 ± 206 vs. 1050 ± 501 dyn s/cm5/m2, p = 0.022). Inotropic support was the same in both groups and no significant difference in the mortality rate was noticed. Also, hemodynamic parameters were not affected by different types and doses of statins.ConclusionsPerioperative statin therapy for patients undergoing on-pump coronary bypass grafting or valvular surgery, does not affect the hemodynamic parameters and its clinical outcome.

Functional Evaluation of Platelet Aspirin Resistance after On-Pump Coronary Bypass Grafting Using Multiple Aggregation Tests

The predominant mechanism of early graft failure after coronary artery bypass grafting (CABG) is associated with antiplatelet treatment using drugs such as acetylsalicylic acid (ASA). Impaired hemostasis of multiple etiologies is often present in patients undergoing on-pump cardiac surgery. We investigated the impact of intravenous ASA administration on platelet function in this setting. Forty-two patients were enrolled in the study. Patients received 100 mg oral ASA once daily, beginning in the early postoperative period. Noncompliance was eliminated by the administration of 300 mg ASA intravenously at 6-8 days post-operation. Blood was drawn immediately before, 1 h and 24 h after ASA administration. A platelet function analyzer (PFA-100™) was used to evaluate closure time (CT), turbidimetric platelet aggregation (TPA) and impedance platelet aggregation (IPA) induced by arachidonic acid (AA), collagen and ADP and results were compared with the respective values from 120 healthy individuals. At 1 h and 24 h after administration, we found that intravenous ASA caused CEPI-CT to be significantly prolonged with a reduction of AA and collagen-induced IPA. Despite postoperative oral ASA administration for 6-8 days, PFA-100™ CEPI and CADP-CT were significantly shorter and ADP-TPA and IPA values induced by any agonist were significantly greater in patients than in controls. Intravenous ASA had no significant influence on CADP-CT or ADP-induced IPA (ADP-IPA). Platelet tests for diagnosing patients as aspirin responders (ASA-R) or aspirin non-responders (ASA-NR) were found to be not comparable. Patients after CABG show augmented platelet dysfunction. Intravenous ASA administration may indicate a promising approach to reduce laboratory resistance after CABG procedure. The reason for this is not clear and requires additional clinical studies.

Minimally Invasive Coronary Artery Bypass Grafting

Limited access, off-pump coronary artery bypass grafting for revascularization of all the various coronary arteries is an acceptable alternative to standard on-pump coronary bypass grafting through sternotomy. A variety of small, targeted incisions are used to approach various coronary locations. Technical advances in conduit harvesting, stabilization, cardiac positioning devices, and anastomotic connectors have made these procedures more standardized and replicable. This has resulted in reduced morbidity as a consequence of less invasive approaches. These efforts have paved the way for the ultimate goal of same day surgical coronary revascularization.

Off-pump coronary artery bypass sacrifices graft patency: Meta-analysis of randomized trials

Off-pump coronary artery bypass sacrifices graft patency: Meta-analysis of randomized trials

New Prospects in Myocardial Surgical Revascularization

Myocardial revascularization with coronary bypass graft surgery or angioplasty is the conventional treatment for ischaemic heart disease. The progressive refinement of both techniques (eg, use of arterial grafts and drug eluting stents) has improved clinical outcomes but the elucidation of which of the two treatments is more effective would require well designed randomised studies. While the utility of off-pump as compared to on-pump coronary bypass graft surgery is still debated, the evidence for the exclusive use of arterial conduits for surgical revascularization is compelling. Patients with diffuse coronary artery disease that cannot be treated by conventional revascularization treatments remain a challenge for the control of angina and a variety of alternative treatments, including transmyocardial laser revascularization and cardiac denervation, have been applied. However, these treatments do not eliminate angina and the benefit obtained is transient. The angiogenic therapy using stem cells and modification of gene expression is a new treatment which potential, in spite of the promising animal studies and the initial clinical trials, is still unclear. The introduction of less invasive surgical techniques and robotics could play an important role for the delivery of these treatments in the future.

Aborted Off-Pump Coronary Artery Bypass Patients Have Much Worse Outcomes Than On-Pump or Successful Off-Pump Patients

Off-pump coronary artery bypass graft (CABG) surgery is purported to reduce perioperative mortality and morbidity compared with on-pump coronary bypass graft surgery. However, the outcomes of patients for whom an off-pump strategy must be changed to an on-pump procedure during surgery have not been extensively studied. The Merged Cardiac Registry (Health Data Research, Inc) contains 70 514 isolated CABG performed from January 1998 to March 2004 in 40 facilities. Among them, 62 634 patients begun and completed on-pump bypass (CPB); 7880 patients begun off-pump, of which 7424 (94.2%) completed off-pump coronary artery bypass (OPCAB), whereas 456 (5.8%) were converted to on-pump (CONVERT). CONVERT patients were more severely ill. The observed mortality of CONVERT, CPB, and OPCAB was 9.9%, 3.0%, and 1.6%, respectively, and the observed-to-predicted ratio was 2.77, 1.20, and 0.74, respectively. CONVERT also had more morbidity than either OPCAB or CPB. Finally, a risk model was created to identify patients who might be at risk for conversion from off-pump to on-pump CABG. Patients who are intended for an off-pump strategy and then require conversion to on-pump have significantly higher operative mortality and morbidity than either completed OPCAB or CPB patients. In addition, the operative mortality and morbidity are far in excess of that predicted preoperatively. Based on these results, strong consideration should be given for a planned strategy of CPB for those patients with preoperative hemodynamic instability requiring a salvage CABG operation, left ventricular hypertrophy, or previous CABG.

The effect off-pump coronary artery bypass surgery on in-hospital mortality and morbidity.

Off-pump coronary artery bypass (OPCAB) surgery is being increasingly reported to show better outcomes compared to conventional on bypass grafting. We examined the effect of OPCAB on in-hospital mortality and morbidity, while adjusting for patient and disease characteristics, in four institutions in the North West of England. Between April 1997 and March 2001, 10,941 consecutive patients underwent isolated coronary artery bypass surgery at these four institutions. Of these, 7.7% were performed off-pump. We used logistic regression to examine the effect of OPCAB on in-hospital mortality and morbidity after adjusting for potentially confounding variables. The crude odds ratio (OR) for death (off-pump versus on-pump coronary bypass grafting) was 0.48 (95% confidence interval, CI 0.26-0.92; P=0.023). After adjustment for all major risk factors, the OR for death was 0.59 (95% CI 0.31-1.12; P=0.105). Off-pump patients had a substantially reduced risk of post-operative stroke (0.6 versus 2.3%, respectively; adjusted OR 0.26 (95% CI 0.09-0.70; P=0.008) and a significant reduction in post-operative hospital stay. Other morbidity outcomes were similar in both groups. Off-pump coronary artery bypass incurs no increased risk of in-hospital mortality. In contrast, there is a significant reduction in morbidity in patients undergoing off-pump coronary bypass grafting when compared to that performed on cardiopulmonary bypass.