Results Of Bypass Grafting Research Articles

Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States.

BackgroundThere are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction.Methods and ResultsAdult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) Inpatient Sample (2000–2017) and classified by tertiles of admission year. Outcomes of interest included temporal trends of CABG use; age‐, sex‐, and race‐stratified trends in CABG use; in‐hospital mortality; hospitalization costs; and hospital length of stay. Of the 11 622 528 acute myocardial infarction admissions, emergent CABG was performed in 1 071 156 (9.2%). CABG utilization decreased overall (10.5% [2000] to 8.7% [2017]; adjusted odds ratio [OR], 0.98 [95% CI, 0.98–0.98]; P<0.001), in ST‐segment–elevation myocardial infarction (10.2% [2000] to 5.2% [2017]; adjusted OR, 0.95 [95% CI, 0.95–0.95]; P<0.001) and non–ST‐segment–elevation myocardial infarction (10.8% [2000] to 10.0% [2017]; adjusted OR, 0.99 [95% CI, 0.99–0.99]; P<0.001), with consistent age, sex, and race trends. In 2012 to 2017, compared with 2000 to 2005, admissions receiving emergent CABG were more likely to have non–ST‐segment–elevation myocardial infarction (80.5% versus 56.1%), higher rates of noncardiac multiorgan failure (26.1% versus 8.4%), cardiogenic shock (11.5% versus 6.4%), and use of mechanical circulatory support (19.8% versus 18.7%). In‐hospital mortality in CABG admissions decreased from 5.3% (2000) to 3.6% (2017) (adjusted OR, 0.89; 95% CI, 0.88–0.89 [P<0.001]) in the overall cohort, with similar temporal trends in patients with ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction. An increase in lengths of hospital stay and hospitalization costs was seen over time.ConclusionsUtilization of CABG has decreased substantially in acute myocardial infarction admissions, especially in patients with ST‐segment–elevation myocardial infarction. Despite an increase in acuity and multiorgan failure, in‐hospital mortality consistently decreased in this population.

Long-term clinical outcomes of coronary artery bypass grafting in young children with Kawasaki disease.

Although coronary artery bypass grafting is not frequently performed in children, Kawasaki disease is one of the most common indications for coronary artery bypass grafting in children. Here, we reviewed the long-term clinical outcomes including graft patency after coronary artery bypass grafting. Between March 2004 and March 2013, six patients with Kawasaki disease underwent coronary artery bypass grafting. All patients were male. Their median age was 13.0 years (interquartile range, 7.8-17.8 years) at the timing of coronary artery bypass grafting, and the median age at the onset of Kawasaki disease was 3.3 years (interquartile range, 1.0-7.0 years). Four patients presented with multiple lesions including aneurysms. The median follow-up duration was 12.1 years (interquartile range, 9.5-13.1 years), and there were no operative complications or overall mortality. One patient had pre-operative symptoms such as exertional chest pain and dyspnoea on exertion, whereas one patient had ventricular tachyarrhythmia. There was an improvement in subjective symptoms after surgery in two patients. The left internal thoracic artery, right internal thoracic artery, and saphenous vein were used in five (83.3%), one (16.7%), and two (33.3%) cases, respectively. In all six patients, post-operative single-photon emission CT findings showed improved perfusion compared with pre-operative single-photon emission CT. All grafts were patent as confirmed by coronary angiography or CT angiography. Coronary artery bypass grafting could be a good surgical option in children with coronary lesions caused by Kawasaki disease in terms of graft patency and myocardial perfusion.

Pontage coronaire chez les patients en dysfonction systolique sévère du ventricule gauche : résultats à court et à long terme

BackgroundIschemic heart disease with severe left ventricular systolic dysfunction is a poor prognosis. Coronary artery bypass grafting is the gold treatment in this population, despite high surgical risk. AimThe aim of our study is to evaluate the short- and long-term outcomes of coronary artery bypass grafting in patients with ischemic heart disease and severe left ventricular systolic dysfunction (LVEF≤35%). MethodsBetween May 1995 and December 2010, 171 patients with ischemic heart disease and severe left ventricular systolic dysfunction (LVEF≤35%) underwent isolated coronary artery bypass grafting. Hospital mortality, postoperative morbidity, all-cause death, cardiovascular death, and major adverse cardiovascular events (heart failure, recurrent angina, myocardial infarction, stroke) were evaluated. The mean follow-up was 9.3±5 years. ResultsHospital mortality was 9.9%. Postoperative morbidity was 36.9%. Overall survival at 1-, 5- and 10-years was 97.4%, 90.5% and 43.4%, respectively. Freedom from cardiovascular death at 1-, 5- and 10-years was 98.1%, 91.8% and 55.4%, respectively. Freedom from recurrent angina at 1-, 5- and 10-years was 95.5%, 84.8% and 44.9%, respectively. Freedom from heart failure at 1-, 5- and 10-years was 89.9%, 86,8% and 53.3%, respectively. Freedom from major adverse cardiovascular events at 1-, 5- and 10-years was 88%, 82.1% and 38.2%, respectively. ConclusionBased on our findings, coronary artery bypass grafting can be performed in patients with ischemic heart disease and severe left ventricular systolic dysfunction with acceptable hospital morbidity and mortality and long-term survival.

Preoperative troponin levels and outcomes of coronary surgery following myocardial infarction.

This study evaluates the impact of peak preoperative troponin level on outcomes of coronary artery bypass grafting (CABG) for non-ST-elevation myocardial infarction (NSTEMI). This was a retrospective review of patients undergoing isolated CABG from 2011 to 2018 with the presentation of NSTEMI. Patients were stratified into low- and high-risk groups based on median preoperative peak troponin (1.95 ng/dl). Major adverse cardiac and cerebrovascular events (MACCE) and mortality were compared. Multivariable analysis was performed to model risk factors for MACCE and mortality. This study included 1211 patients, 607 low-risk (≤1.95 ng/dl) and 604 high-risk (>1.95 ng/dl). Patients were well-matched with respect to age and comorbidity. High-risk patients had lower median preoperative ejection fraction (46.5% [interquartile range {IQR}: 35.0%-55.0%] vs. 53.0% [IQR: 40.0%-58.0%]) and higher incidence of preoperative intra-aortic balloon pump (15.9% vs. 8.73%). Intensive care unit and hospital length of stay were longer in the high-risk group, but increasing troponin level was not associated with prolonged intensive care or hospital length of stay (>4 and >14 days, respectively) after risk adjustment. Postoperative complications and 30-day, 1- and 5-year rates of both MACCE and survival were similar between groups. Peak troponin greater than 1.95 ng/dl was not associated with increased hazards for MACCE, mortality, or readmission in multivariable modeling. In subanalysis, neither increasing troponin as a continuous variable nor peak troponin greater than 10.00 ng/ml were associated with increased hazards for these outcomes. Preoperative troponin levels do not appear to be predictive of short- or long-term outcomes following CABG, and clinical decisions regarding surgical revascularization should not be dictated by these measurements.

Influence of incomplete revascularisation on the outcomes of coronary artery bypass grafting in patients with ischaemic heart disease

Background. At the present time there is no agreement regarding effect of revascularisation volume on long-term results of coronary artery bypass grafting. According to some reports, incomplete revascularisation, compared with complete revascularisation, affects survival and increases the frequency of adverse cardiovascular events. Other researchers do not find such differences.Aim. This study aimed to assess the influence of incomplete revascularisation on the long-term results of coronary bypass surgery and to determine its predictors.Methods. A total of 243 patients with coronary artery disease who underwent microscope-assisted coronary artery bypass surgery were categorised into two groups. Group I included those with complete revascularisation (n = 152), while group II included those with incomplete revascularisation (n = 91). When assigning patients to groups, the volume of achieved myocardial revascularisation was determined according to the patency of grafts. The groups were compared by the late survival and by the frequency of major cardiovascular events. Logistic regression was used to analyse predictors of incomplete revascularisation.Results. The median of follow-up (interquartile range) was 802 days (426–1487 days). Survival in group 1 at 1, 3 and 5 years after surgery was 98%, 98% and 89%, respectively, while in group 2, it was 90%, 86%, and 86%, respectively (p = 0.024). Freedom from major cardiovascular events (death, myocardial infarction, repeated revascularisation, stroke) in group 1 after 1, 3 and 5 years was 91%, 89% and 77%, respectively, and in group 2, it was 78%, 68% and 68%, respectively (p = 0.005). It was revealed that diabetes mellitus (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.01–2.09), arteriosclerosis of arteries of two or more localisations (OR = 1.63, CI = 1.15–2.31), number of lesions in circumflex artery system (OR = 2.48, CI = 1.86–3.31), number of lesions in anterior descending artery system (OR = 1.61, CI = 1.14–2.28) and the diameter of the target coronary artery is less than 1.5 mm (OR = 1.3, CI = 1.22–2.38) are independent predictors of incomplete myocardial revascularisation during coronary artery bypass grafting. Male gender (OR = 0.61, CI = 0.41–0.91) and increased body mass index were associated with a reduced risk of incomplete revascularisation (OR = 0.96, CI = 0.93–0.99).Conclusion. Incomplete revascularisation worsens the prognosis after coronary bypass surgery, and is accompanied by an increase in the frequency of adverse cardiovascular events and a decrease in long-term survival. The risk of incomplete revascularisation increases in patients with diabetes mellitus, common manifestations of atherosclerosis, number of lesions in the left coronary system, as well as with a small diameter of the target coronary arteries. Male gender and increased body mass index were associated with a reduced risk of incomplete revascularisation. Received 15 June 2020. Revised 23 July 2020. Accepted 24 July 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Clinical outcomes of radial artery as the second arterial conduit in coronary artery bypass

Objective: To examine the clinical experience and outcomes of coronary artery bypass grafting (CABG) using radial artery as the second arterial graft. Methods: Totally 585 patients in whom both left internal thoracic artery and radial artery as arterial conduits were used in CABG in Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University from April 2008 to August 2019 were consecutively enrolled. There were 436 males and 149 females, aging (63±10) years (range: 36 to 86 years). There were 40.7% (238/585) of patients had diabetes and 75.6% (442/585) of them had multivessel disease (two-vessel or three-vessel diseases). From January 2017, transit time flow measurement was performed on every patient. Demographic and perioperative data were retrospectively collected, as well as follow-up data for patients who underwent CABG from January 2014 to August 2019. Analysis were made on their early and late outcomes. Results: 81.9%(479/585) Most patients in this cohort (81.9%) received on-pump CABG and 11 patients had intraoperative intro-aortic balloon counterpulsation (prior to CABG) support. Forty-three patients had concomitant valve procedures. The number of distal anastomosis was 3.6±0.9 (range: 2 to 6) and number of arterial distal anastomosis was 2.1±0.3. Radial artery was anastomosed to left obtuse marginal artery in 95.8% (560/585) patients. All target vessels for radial artery conduit had significant proximal stenosis (>70%) and 72.5% (424/585) of target vessels had proximal stenosis which was >90%. Intraoperative transit-time flow measurement of 151 cases showed that radial artery conduits had a flow of (29.8±10.2) ml/minutes (range: 10 to 150 ml/min), and pulsatility index of 2.5±1.4 (range: 0.7 to 5.0). There was no operative death. Two in-hospital death occurred more than 30 days after index surgery. There was no perioperative myocardial infarction. There were 188 patients who received CABG from January 2014 to August 2019 followed-up for a median duration of 3.2 years. There were two noncardiac death. No patient had myocardial infarction or to receive myocardial revascularization. Conclusions: Radial artery as the second arterial conduit is a safe and effective strategy for CABG. Good selection of target vessel and intraoperative transit-time flow measurement may help achieve good patency, as well as the short and mid-term outcome.

Coronary artery bypass grafting after acute ST-elevation myocardial infarction

ObjectivesThe study objectives were to describe the trends and outcomes of isolated coronary artery bypass grafting after ST-elevation myocardial infarction using a nationwide database. MethodsWe queried the 2002-2016 National Inpatient Sample database for hospitalized patients with ST-elevation myocardial infarction who underwent isolated coronary artery bypass grafting. We report temporal trends, predictors, and outcomes of coronary artery bypass grafting in the early (2002-2010) and recent (2011-2016) cohorts. ResultsOf 3,347,470 patients hospitalized for ST-elevation myocardial infarction, 7.7% underwent isolated coronary artery bypass grafting. The incidence of isolated coronary artery bypass grafting after ST-elevation myocardial infarction decreased over time (9.2% in 2002 vs 5.5% in 2016, Ptrend < .001), whereas perioperative crude in-hospital mortality did not change (5.1% in 2002 vs 4.2% in 2016, Ptrend = .66), coinciding with an increase in the burden of comorbidities. There was an increase in performing isolated coronary artery bypass grafting on hospitalization day 3 or more, as well as an increase in the use of mechanical support devices and precoronary artery bypass grafting percutaneous coronary intervention. In the early cohort, isolated coronary artery bypass grafting on days 1 and 2 was associated with higher in-hospital mortality. In the recent cohort, coronary artery bypass grafting on day 2 had similar in-hospital mortality compared with day 3 or more and lower rates of acute kidney injury, ischemic stroke, ventricular arrhythmia, and length of hospital stay. ConclusionsIn this nationwide analysis, there has been a decline in the use of isolated coronary artery bypass grafting after ST-elevation myocardial infarction. Isolated coronary artery bypass grafting on day 1 was performed in sicker patients and was associated with higher in-hospital mortality than coronary artery bypass grafting performed on day 3 or more. In the recent cohort, isolated coronary artery bypass grafting on day 2 had similar in-hospital mortality compared with day 3 or more.

Predictors and Outcomes of Coronary Artery Bypass Grafting: A Systematic and Untargeted Analysis of More Than 120,000 Individuals and 1,300 Disease Traits

To perform an untargeted data-driven analysis on the correlates and outcomes of coronary artery bypass grafting (CABG). FinnGen cohort study. The authors collected information on up to 1,327 disease traits before and after CABG from nationwide healthcare registers. A mixed population and patient sample of 127,911 individuals including 3,784 CABG patients. The authors assessed the association between (1) traits and incident CABG and (2) CABG and incident traits using multivariate-adjusted Cox models. Patients who underwent CABG and were in the fourth quartile of a risk score based on the top predictors of mortality had 12.2-fold increased risk of dying (95% confidence interval [CI], 10.3-14.5) compared with those in the first quartile. Cardiovascular disease (CVD) and CVD risk factors were most strongly associated with incident CABG. However, CABG was associated with death due to cardiac causes (hazard ratio [HR], 3.7; 95% CI, 3.5-4.0) or other causes (HR, 2.5; 95% CI, 2.4-2.7). CABG also was related to increased risk of several non-CVD traits, including anemia (HR, 3.4; 95% CI, 2.8-4.1), gastrointestinal disorders (HR, 2.2; 95% CI, 1.8-2.6), acute renal failure (HR, 4.2; 95% CI, 3.5-5.1), septicemia (HR, 3.6; 95% CI, 3.1-4.1), lung cancer (HR, 2.3; 95% CI, 1.9-2.8), Alzheimer's disease (HR, 2.5; 95% CI, 2.2-2.7), and chronic obstuctive pulmonary disease (HR, 2.5; 95% CI, 2.2-2.9). Known CVD risk factors associate most strongly with incident CABG. However, CABG is associated with increased risk of several, somewhat unexpected, non-CVD traits. More detailed study of these links is warranted to establish potential causality and pathogenesis.

Outcomes of off-pump coronary artery bypass grafting in non-dialysis-dependent patients with stage 2 and stage 3 chronic kidney disease.

To assess the short-term outcomes in non-dialysis-dependent patients with stage 2 and stage 3 chronic kidney disease (CKD), undergoing off-pump coronary artery bypass (OPCAB). To examine whether there was a difference in mortality between stage 2 and stage 3 CKD patients and whether mortality in diabetics was different compared to non-diabetics. Outcomes would be judged on the basis of possible cardiovascular, pulmonary, infective, neurological and renal complications, duration of stay at the intensive therapy unit (ITU), and overall duration of stay at the hospital. A comparative study of outcomes between stage 2 and stage 3 CKD would be undertaken. Also, given the impact of diabetes mellitus in this patient population, a comparative study of outcomes would be made between diabetics and non-diabetics. Three hundred fifteen consecutive patients undergoing OPCAB were included in this observational prospective study. Of them, 201 (64%) had stage 3 CKD and 114 (36%) had stage 2 CKD. Nearly half of the study group (49.52%) were diabetics. Data was collected from patients' files, patient observation charts at the ITU, and patient interviews. Continuous variables were expressed as mean ± standard deviation or median (Q1, Q3) as appropriate and qualitative variables presented with the frequency and corresponding percentage. Comparison between diabetic and non-diabetic patients was performed by the Student's t test or chi-square test as appropriate. And when assumptions of parametric test failed, then an appropriate non-parametric test was performed. Repeated measures ANOVA (analysis of variance) was used to see the trend of estimated glomerular filtration rate (eGFR) values. Statistical analysis was done by using SPSS version 19.0 (SPSS Inc., Chicago, IL, USA). All p values <0.05 were considered statistically significant. The eGFR was measured pre-operatively, on the day following OPCAB and at the time of discharge and the mean eGFR, remained more or less the same throughout (mean of 55.86 ml/min/1.73 m2 pre-operatively, 58.39 ml/min/1.73 m2 on the day following OPCAB and 58.39 ml/min/1.73 m2 at discharge). One patient with stage 2 CKD (0.9%) required hemodialysis post-operatively while 3 patients (1.5%) required the same in the stage 3 CKD group, which was not statistically significant. Nineteen patients (6.03%) required re-intubation for hypoxia in the post-operative period. Post-operative myocardial infarction developed in 12 patients (3.81%). Twenty patients (6.35%) patients needed an intra-aortic balloon pump (IABP) insertion in the peri-operative period owing to hemodynamic compromise. Fifteen patients (4.76%) were re-explored for bleeding following surgery and fifteen patients (4.76%) had a deep sternal wound infection in the post-operative period. New-onset atrial fibrillation was found to be present in 42 stage 3 CKD patients (11%) while it occurred in 21 stage 2 CKD patients (9.6%) (p value = 0.014), which was statistically significant. The mean duration of ITU stay was 84 ± 6.22 h in the stage 2 CKD group and 92.9 ± 8.18 h in the stage 3 CKD group (p value = 0.01), which was statistically significant. Mean duration of ITU stay was 94 ± 10.12 h in the diabetic group while it was 86.7 ± 11.08 h in the non-diabetic group (p value = 0.008) which was statistically significant. Duration of post-operative hospital stay was a mean of 8 ±0.08 days in the diabetic group whereas it was 7 ± 0.04 days in the non-diabetic group (p value = 0.012), which was statistically significant. Surgical mortality was 6 out of 315 patients (1.9%). OPCAB is a safe and effective revascularization strategy in patients with stage 2 and stage 3 CKD. Short-term outcomes of OPCAB have been good in the patient population in this study, in terms of both surgical morbidity and mortality. Surgical mortality was 1.9%. New-onset atrial fibrillation was found in eleven patients (9.6%) in the stage 2 CKD group and 42 patients (21%) in the stage 3 CKD group (p value =0.014) which was statistically significant. The results of this study reflect the reno-protective nature of OPCAB. The duration of ITU stay and the post-operative duration of stay at the hospital were found to be significantly more in diabetics than in non-diabetics.

Ten-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Patients with Type2 Diabetes Mellitus Suffering from Left Main Coronary Disease: A Meta-Analysis.

IntroductionIn this meta-analysis, we aimed to systematically compare the 10-year outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with type 2 diabetes mellitus (T2DM) suffering from left main coronary artery disease (LMCD).MethodsMedical Literature Analysis and Retrieval System Online (MEDLINE), http://www.ClinicalTrials.gov, Excerpta Medica dataBASE (EMBASE), Cochrane Central, Web of Science, and Google scholar were searched for publications comparing 10-year outcomes of PCI versus CABG in patients with T2DM suffering from LMCD. Cardiovascular outcomes were considered as the clinical endpoints. Statistical analysis was carried out using RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after analysis.ResultsEight studies (three randomized trials and five observational studies) with a total number of 3835 participants with T2DM were included in this analysis; 2340 participants were assigned to the PCI group and 1495 participants were assigned to the CABG group. Results of this analysis showed that mortality (RR 0.85, 95% CI 0.73–1.00; P = 0.05), myocardial infarction (RR 0.53, 95% CI 0.35–0.80; P = 0.002), repeated revascularization (RR 0.34, 95% CI 0.26–0.46; P = 0.00001), and target vessel revascularization (RR 0.26, 95% CI 0.18–0.38; P = 0.00001) were significantly higher with PCI when compared to CABG in these patients with diabetes and LMCD. Major adverse cardiac and cerebrovascular events were also significantly higher with PCI at 10 years (RR 0.67, 95% CI 0.49–0.92; P = 0.01). However, CABG was associated with a significantly higher risk of stroke (RR 2.16, 95% CI 1.39–3.37; P = 0.0007).ConclusionsDuring a long-term follow-up time period of 10 years, PCI was associated with worse clinical outcomes compared to CABG in these patients with T2DM suffering from LMCD. However, a significantly higher risk of stroke was observed with CABG. This piece of information might be vital in order to carefully choose and prevent complications following revascularization in such patients.

Mid-term outcomes of coronary artery bypass grafting in patients with mild left ventricular systolic dysfunction: a multicentre retrospective cohort study.

Left ventricular systolic dysfunction (LVSD) is common and associated with adverse events in patients receiving coronary artery bypass grafting (CABG). However, the prognosis of mild LVSD has not been clearly described. We aimed to evaluate the mid-term outcomes of patients with mild LVSD following CABG. This multicentre cohort study using propensity score matching took place from December 2012 to October 2019 in Jiangsu Province, China, with a mean and maximum follow-up of 3.2 and 7.2 years, respectively. Patients were classified to normal left ventricular systolic function (left ventricular ejection fraction ≥53%) and mild LVSD (left ventricular ejection fraction >40%/<53%). The primary outcomes were death from all causes and death from cardiovascular causes. The secondary outcomes were heart failure, myocardial infarction, repeat revascularization and a composite of all mentioned outcomes, including death from all causes (major adverse events). A total of 581 pairs were formed after matching. In-hospital death (1.5% vs 2.1%, P = 0.51) did not differ between 2 cohorts. Throughout 7 years, mild LVSD was associated with higher rates of death from all causes [hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.39-0.89; P = 0.012], death from cardiovascular causes (HR 0.55, 95% CI 0.36-0.90; P = 0.017), heart failure (HR 0.60, 95% CI 0.37-0.93; P = 0.023) and major adverse events (HR 0.66, 95% CI 0.49-0.91; P = 0.009). There was no difference in the rates of myocardial infarction and repeat revascularization. Mild LVSD was associated with a worse mid-term prognosis in patients following CABG.

Improved outcomes in CABG patients with atrial fibrillation associated with surgical left atrial appendage exclusion.

We sought to determine the impact of left atrial appendage clip exclusion (LAACE) on coronary artery bypass grafting (CABG) outcomes among patients with pre-existing atrial fibrillation (AF). From October 1, 2015 to October 1, 2017, 4210 Medicare beneficiaries with pre-existing AF underwent isolated CABG (i.e., without ablation) with (n = 931) or without (n = 3279) LAACE. Inverse probability of treatment weighting was used to evaluate the effect of concomitant LAACE on short- and long-term outcomes after CABG. Long term risks of thromboembolism and mortality were assessed using competing-risk regression and Cox proportional hazard models. Operative mortality, length of stay, and 30-day readmission did not differ between groups. Thromboembolism risk was 26% lower for the CABG + LAACE group compared with isolated CABG over a 2-year time-to-event analysis (sub hazard ratio [sHR] 0.74, 95% confidence interval [CI] 0.54-1.00, p = .049). There were no differences in ischemic stroke rates. All-cause mortality risk was 45% lower for CABG + LAACE during the late follow-up period (91-730 days; HR 0.55, 95% CI 0.32-0.95, p = .031). The late period annual absolute all-cause mortality rate was 3.7% for CABG + LAACE and 6.9% for isolated CABG. There were lower readmission rates (31% vs. 43%, p < .001) and total inpatient days (4.0 days vs. 7.2 days, p < .01.) for the CABG + LAACE during follow-up. Total hospital in and out-patient treatment costs were similar between groups through one year. Concomitant LAA exclusion via an epicardial closure device is associated with reduced CABG mortality, thromboembolic events, and readmissions in patients with pre-existing atrial fibrillation.

Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction

BackgroundCoronary artery bypass grafting (CABG) improves survival in patients with heart failure and severely reduced left ventricular systolic function (LVEF). Limited data exist regarding adverse cardiovascular event rates after CABG in patients with heart failure with midrange ejection fraction (HFmrEF; LVEF > 40% and < 55%). MethodsWe analyzed data on isolated CABG patients from the Veterans Affairs national database (2010-2019). We stratified patients into control (normal LVEF and no heart failure), HFmrEF, and heart failure with reduced LVEF (HFrEF) groups. We compared all-cause mortality and heart failure hospitalization rates between groups with a Cox model and recurrent events analysis, respectively. ResultsIn 6533 veterans, HFmrEF and HFrEF was present in 1715 (26.3%) and 566 (8.6%) respectively; the control group had 4252 (65.1%) patients. HFrEF patients were more likely to have diabetes mellitus (59%), insulin therapy (36%), and previous myocardial infarction (31%). Anemia was more prevalent in patients with HFrEF (49%) as was a lower serum albumin (mean, 3.6 mg/dL). Compared with the control group, a higher risk of death was observed in the HFmrEF (hazard ratio [HR], 1.3 [1.2-1.5)] and HFrEF (HR, 1.5 [1.2-1.7]) groups. HFmrEF patients had the higher risk of myocardial infarction (subdistribution HR, 1.2 [1-1.6]; P = .04). Risk of heart failure hospitalization was higher in patients with HFmrEF (HR, 4.1 [3.5-4.7]) and patients with HFrEF (HR, 7.2 [6.2-8.5]). ConclusionsHeart failure with midrange ejection fraction negatively affects survival after CABG. These patients also experience higher rates myocardial infarction and heart failure hospitalization.

Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3)

There is a scarcity of data comparing long-term clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel coronary artery disease (3VD) in the new-generation drug-eluting stents era. CREDO-Kyoto PCI/CABG registry Cohort-3 enrolled 14927 consecutive patients who had undergone first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013. We identified 2525 patients with 3VD (PCI: n = 1747 [69%], and CABG: n = 778 [31%]). The primary outcome measure was all-cause death. Median follow-up duration was 5.7 (interquartile range: 4.4 to 6.6) years. The cumulative 5-year incidence of all-cause death was significantly higher in the PCI group than in the CABG group (19.8% vs 13.2%, log-rank p = 0.001). After adjusting confounders, the excess risk of PCI relative to CABG for all-cause death remained significant (HR, 1.45; 95% CI, 1.14 to 1.86; p = 0.003), which was mainly driven by the excess risk for non-cardiovascular death (HR, 1.88; 95% CI, 1.30 to 2.79; p = 0.001), while there was no excess risk for cardiovascular death between PCI and CABG (HR, 1.19; 95% CI, 0.87 to 1.64; p = 0.29). There was significant excess risk of PCI relative to CABG for myocardial infarction (HR, 1.77; 95% CI, 1.19 to 2.69; p = 0.006), whereas there was no excess risk of PCI relative to CABG for stroke (HR, 1.24; 95% CI, 0.83 to 1.88; p = 0.30). In conclusion, in the present study population reflecting real-world clinical practice in Japan, PCI compared with CABG was associated with significantly higher risk for all-cause death, while there was no excess risk for cardiovascular death between PCI and CABG.

In-hospital outcomes of endarterectomy and coronary artery bypass grafting in multiple diffuse lesions of coronary arteries

According to a series of studies, performing coronary endarterectomy in direct myocardial revascularization increases the risk of myocardial infarction and in-hospital mortality. There are no commonly accepted indications for carrying out endarterectomy, and in clinical practice this technique is used in severe diffuse lesions of coronary arteries. The study was aimed at assessing in-hospital clinical outcomes of coronary artery bypass grafting (CABG) with the use of endarterectomy in patients with severe multiple diffuse lesions of coronary arteries. This was a single-centre retrospective study enrolling a total of 205 patients presenting with multiple diffuse lesions and subjected to CABG procedures. Of these, after excluding those with severe concomitant pathology (n=28), 177 were enrolled and divided into 2 groups: 76 patients during formation of a coronary anastomosis were subjected to forced endarterectomy from the native channel (Group 1, n=76) and the remaining patients to prolonged anastomosis and/or bypass grafting of distal branches of the diffusely damaged artery (Group 2, n=101). In-hospital outcomes were analysed in both groups. The demographic and clinical characteristics were comparable by all parameters except for age: Group 1 patients were older (66.3±8.4 vs 63.0±8.5, p<0.05). The groups were comparable by severity of coronary lesions by both the SYNTAX Score and diffuse lesion index. The incidence of perioperative myocardial infarction during coronary endarterectomy (Group 1) amounted to 9.2% (7/71) and in the group without endarterectomy (Group 2) to 0. There were no cases of in-hospital mortality in either group. In severe diffuse coronary lesions, endarterectomy combined with CABG makes it possible to perform adequate myocardial revascularization. Performing endarterectomy from coronary arteries is associated with an increased risk for the development of myocardial infarction, but its use is justified if it is impossible to create an anastomosis by means of other techniques.

Annual outcomes of coronary artery bypass grafting in patients with diffuse lesion of coronary arteries

Annual outcomes of coronary artery bypass grafting in patients with diffuse lesion of coronary arteries

Coronary artery bypass grafting in myocardial infarction and unstable angina pectoris: in-hospital outcomes. Part 2

To assess in-hospital outcomes of coronary artery bypass grafting in patients with acute coronary syndrome, depending on the presence or absence of myocardial infarction. Over the period from 2017 to 2018 within the framework of a single-centre register, the study enrolled a total of 166 consecutive patients admitted with non-ST segment elevation acute coronary syndrome and subjected to coronary artery bypass grafting. Depending on the outcome of acute coronary syndrome, the patients were divided into 2 groups: Group One included 98 (59%) patients with unstable angina pectoris and Group Two comprised 68 (41%) patients with myocardial infarction, who underwent surgery at an average of 16 (11; 20) days after manifestation of the clinical signs of myocardial infarction. The endpoints of the study were major adverse cardiovascular events during the in-hospital period: death, myocardial infarction, acute cerebral circulation impairment/transitory ischaemic attack, repeat revascularization, septic complications, multiple organ failure syndrome, wound infectious complications, requirement for repeated surgical debridement, remediastinotomy due to haemorrhage, the frequency of extracorporeal membrane oxygenation and renal replacement therapy. The mortality rate in the compared groups was similar: 3% (n=3) and 3% (n=2), respectively. Perioperative myocardial infarction occurred in 1 (1%) patient of the first group, with no cases of this complication observed in the second group. The frequency of reoperations due to haemorrhage in the early postoperative period in the group of unstable angina pectoris amounted to 3% (n=3) and was associated with administration of dual antithrombotic therapy, with no cases of this complication in the group of myocardial infarction. Wound complication in the second group were observed in 7.6% (n=5) and in the first group in 4% (n=4) (p=0.33). The differences turned out to be statistically insignificant for such postoperative complications as multiple organ failure syndrome, requirement for repeated surgical debridement, renal replacement therapy, and extracorporeal membrane oxygenation. The residual SYNTAX Score in the group of myocardial infarction amounted to 2.3±2.8, whereas in the group of unstable angina pectoris to 2.3±3, thus suggesting complete revascularization in the total sample of patients with acute coronary syndrome. The average length of hospital stay (including the postoperative period) in the first group amounted to 26.3±6.6 days and in the second group to 27.4±7.2 days (p=0.53). The postoperative bed-day in the group with unstable angina pectoris was 12.6±3.2 and in the myocardial infarction group - 14.9±5.3 (p=0.06). The obtained in-hospital outcomes suggest that coronary artery bypass grafting may be an efficient and safe method of complete revascularization for patients with non-ST-elevation acute coronary syndrome, including that resulting in myocardial infarction, performed averagely on day 16 (11; 20) after the onset of clinical manifestations of myocardial infarction.

КОРОНАРНОЕ ШУНТИРОВАНИЕ НА РАБОТАЮЩЕМ СЕРДЦЕ БЕЗ МАНИПУЛЯЦИЙ НА ВОСХОДЯЩЕМ ОТДЕЛЕ АОРТЫ С ИСПОЛЬЗОВАНИЕМ НЕСКЕЛЕТИРОВАННОЙ БОЛЬШОЙ ПОДКОЖНОЙ ВЕНЫ У ПАЦИЕНТОВ С МНОГОСОСУДИСТЫМ АТЕРОСКЛЕРОТИЧЕСКИМ ПОРАЖЕНИЕМ КОРОНАРНЫХ АРТЕРИЙ

Objective. To compare early postoperative hospital and one-year outcomes of coronary artery bypass grafting on a "working heart" (OPCABG) and coronary bypass grafting without manipulation of the ascending aorta (anCABG) in patients with multivessel atherosclerotic coronary artery disease. Methods. The object of the prospective, single-center, randomized study was 80 patients with multivessel atherosclerotic coronary artery lesions who underwent myocardial revascularization at Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology in 2018-2020. One group consisted of the patients (38 people) who underwent anCABG using composite grafts and great saphenous vein harvested "with surrounding tissue". The second group (42 patients) consisted of the patients who underwent OPCABG. Results. Two observation groups did not differ significantly according to the main initial variables. The severity of coronary lesions according to SYNTAX Score was 25.1±6.15 in the anCABG group and 24.3±7.47 in the OPCABG group (p&gt;0.05). All patients underwent complete myocardial revascularization. The number of distal anastomoses was 2.66±0.68 in the anCABG group and 2.36±0.48 in the OPCABG group (p&gt;0.05). There was no in-hospital mortality in either group. Perioperative myocardial infarction occurred in two patients in the OPCABG group and one patient in the anCABG group. One patient in the OPCABG group had an atherothrombotic stroke and another patient developed a transient ischemic attack. Time of stay both in the intensive care unit after the operation and in the cardiac surgery inpatient department was significantly longer in the OPCABG group (p&lt;0.05). Conclusion. The anCABG method showed advantages in comparison with OPCABG at the early postoperative inpatient stage in patients with multivessel atherosclerotic lesions of the coronary arteries. It was expressed in lower frequency of neurological complications and perioperative myocardial infarction and statistically shorter time of stay in intensive care unit and cardiac surgical inpatient department (p&lt;0.05). In the long-term period there was lower incidence of venous graft dysfunction in the anCABG group using large saphenous vein harvested "with surrounding tissue", it being expressed in the reduced frequency of major adverse cardiovascular events.

Bilateral internal mammary grafting: Are the advantages obvious?

Background. The use of one internal thoracic artery has long been considered a gold standard for coronary artery bypass grafting. However, despite the benefits, the frequency of using both internal mammary arteries remains low. The relationship between improving coronary artery bypass grafting results and the risk of complications after surgery using two internal thoracic arteries are yet to be resolved.Aim. We compared immediate and mid-term outcomes of coronary artery bypass grafting using one and two mammary arteries.Methods. Two hundred and thirty-one (231) patients with coronary artery disease, after microscope-assisted coronary artery bypass surgery, were categorised into two groups: group I — patients had received one internal mammary artery during surgery (n = 177), and group II — patients had received two internal mammary arteries during surgery (n = 54). Propensity-score matching was applied to reduce differences between groups, therefore two groups of 50 patients were obtained after matching.Results. Operations with bilateral internal mammary grafting in comparison to single internal mammary grafting were associated with longer operating times (group I: 167.5 [150-190] min., group II: 205 [190–220] min., p &lt; 0.001) and increased aortic cross-clamp times (group I: 37.5 [32–45] min., group II: 44 [39–48] min., p = 0.012), but cardiopulmonary bypass duration was similar (group I: 65.5 [56–78] min. and group II: 69 [58–78] min., p = 0.95). No differences were observed for adverse event frequencies (i.e. death, myocardial infarction, acute cerebrovascular accidents and repeated revascularisation) and sternal wound complications in the early- and long-term post-operation. The grafts patency in groups I and II before discharge was 98.0 vs. 92.5 % (p = 0.195) and 94.6 vs. 92.5 % (p = 0.582) for mammary and venous grafts, respectively. At follow-up time (29.5 ± 18.7 months), group I was associated with significantly improved actuarial overall survival (p = 0.021) and were composite survival free from cardiac-related mortality, myocardial infarction, repeat revascularisation and stroke (p = 0.008). Complete revascularisation was associated with a reduced risk of major cardiac events (OR, 0.41; 95% CI: 0.20–0.85).Conclusion. Bilateral internal mammary artery coronary artery bypass grafting in comparison with single internal mammary grafting was associated with increased operation times, similar grafts patency, early and late outcomes, but no overall improved survival and composite freedom from major adverse cardiac events in the mid-term. Complete revascularisation may be considered an independent prognostic factor after coronary bypass surgery and may be more clinically relevant than both internal thoracic arteries. Received 29 April 2020. Revised 8 September 2020. Accepted 9 September 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Comparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting.

IntroductionPercutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are two common treatment options used in patients suffering from coronary artery disease. Selection and favorability of one over the other depend on individual clinical scenarios. The purpose of this study is to compare outcomes after treatment with PCI and CABG.MethodsThis longitudinal observational study was conducted from April 2018 to July 2019 in a cardiovascular unit of a tertiary care hospital. Participants who were eligible for revascularization were randomized either to receive stent (PCI) or surgery (CABG). Patients were then followed up for 12 months for the development of all-cause mortality and major adverse cardiovascular events (MACEs).ResultsAt 12 months, patients randomized to the PCI group had an increased risk of repeat revascularization (21.3% vs. 7.4%; p = 0.007), whereas a similar number of patients in both groups died (3.8% vs. 3.7%), suffered myocardial infarction (7.6% vs. 5.6%), or had a cerebrovascular accident (3.8% vs. 2.8%).ConclusionsThis study showed that PCI had an increased risk of repeat revascularization compared to CABG. However, both had comparable significance in the development of MACEs. Nevertheless, there is a need for further study to better assess the outcomes of either, especially in the long run.