Pump Coronary Artery Bypass Grafting Research Articles

Left Atrial Strain to Predict Postoperative Atrial Fibrillation in Patients Undergoing Off-pump Coronary Artery Bypass Graft

ObjectivePostoperative atrial fibrillation (POAF) is associated with increased morbidity, mortality, and length of stay. The objective of this study was to assess the utility of left atrial strain (LAS) to predict POAF in patients undergoing off pump coronary artery bypass grafting (OPCABG). DesignRetrospective Observational Study. SettingTertiary Care Level Hospital. Participants103 undergoing OPCABG. InterventionsNone. Measurements and ResultsIn addition to comprehensive TTE, LAS was measured for reservoir (R), conduction (CD), and contraction (CT) components. The POAF was defined as new electrocardiography evidence of AF requiring treatment. Logistic regression was done to assess the factors associated with POAF. The diagnostic accuracy of variables in predicting POAF was assessed by ROC analysis.POAF was documented in 24 (23.3%) patients. There was no difference in EF, average GLS and proportion of LVDD grades between patients with POAF and patients without POAF. All the three components of LAS: LAS R (19.2 ± 4.7 vs 23.5 ± 4.8; p<0.001), LAS CD (8.9 ± 3.7 vs 12.3 ± 4.8; p=0.1) and LAS CT (10.3 ± 3.9 vs 12.1 ± 4.1; p=0.04) were significantly lower among patients with POAF as compared to patients without POAF respectively. According to univariate analysis, all components of LAS were found to be statistically significant predictors of POAF. On multivariate analysis, only age (OR=1.08; p=0.025) and LAS R (OR=0.84; p=0.004) were independently associated with POAF. The LAS R was a better predictor of POAF with AUC of 0.758, than LAS CD (AUC=0.67) and LAS CT (AUC=0.62). The LAS R had optimal cut-off of 23% with sensitivity of 95.8% (C.I. 78.9%- 99.9%) and specificity of 49.4% (37.9%- 60.9%) to predict POAF. ConclusionsLAS R is significant predictor of POAF and its use can be recommended for screening of OPCABG patients at high risk of POAF.

Pre-operative anaemia-does it influence post-operative outcomes after isolated coronary artery bypass grafting?

Preoperative anaemia is prevalent in a number of patients undergoing coronary artery bypass grafting. Studies provide conflicting results due to several reasons including variation in the threshold of haematocrit used to define anaemia. We aimed to assess the independent effect of preoperative anaemia on outcomes in patients undergoing off pump coronary artery bypass grafting (OPCAB). In this retrospective study, patients with a hemoglobin level less than 11g/dl (haematocrit <33%) were considered to have moderate-to-severe anaemia as per the recommendations of the World Health Organization. Association between haematocrit <33% and mortality as well as adverse post-operative outcomes was assessed. Multivariable logistic regression (MLR) was carried out to assess the independent effect of haematocrit<33% on 30-day mortality and other outcomes. The study included 4957 consecutive patients undergoing isolated OPCAB surgery between 2015 and 2020. Out of 4957, 635 (12.8%) had haematocrit <33% and 4322 (81.2%) had haematocrit ≥33%. Patients with haematocrit < 33% had a 30-day mortality of 13 (2%) compared to 38 (0.9%) in patients without anaemia and had a greater requirement for blood transfusion (p<0.0001). It was also associated with an increased incidence of renal failure (p<0.0001), tracheostomy (p=.0.012) and risk of re-intubation (p=0.006). On multiple linear regression (MLR), haematocrit < 33% was not an independent predictor of 30-day mortality odds ratio (OR) 1.47, 95% confidence interval (CI) 0.745-2.917; p=0.26. It was however an important independent risk factor for blood transfusion (OR 1.80, 95% CI 1.29-2.50, p<0.001) and renal failure (OR 3.06, 95% CI 1.338-7.012, p=0.008). The receiver operating characteristic (ROC)-area under the curve (AUC) was 0.63 suggesting moderate discriminatory value of haematocrit < 33% for 30-day mortality. Haematocrit < 33% is an important risk factor for adverse outcomes following isolated, primary, elective OPCAB. The online version contains supplementary material available at 10.1007/s12055-024-01746-1.

Pre-Operative Serum Uric Acid Level is a Predictor of Acute Kidney Injury Subsequent off Pump Coronary Artery Bypass Grafting

Pre-Operative Serum Uric Acid Level is a Predictor of Acute Kidney Injury Subsequent off Pump Coronary Artery Bypass Grafting

Effects of stellate ganglion block on the perioperative hemodynamics for coronary artery bypass grafting surgery

ABSTRACT Background Stellate ganglion block (SGB) is a successful technique that can potentially maintain hemodynamics and terminate fatal arrhythmia. We aimed to study the efficacy of SGB on hemodynamic changes after on pump coronary artery bypass grafting (CABG) surgery. Methods Forty patients who underwent CABG surgery at the Cardiac Surgical Academy Ain Shams University Hospital were randomly allocated to receive SGB or placebo between June 2020 and February 2021. After fulfilling the inclusion criteria, patients were classified as American Society of Anesthesiologists III and IV. Patients were randomly assigned to one of two groups utilizing a computer-generated block number in a sealed envelope. Group S (20 patients) received SGB, and Group C (20 patients) included matched controls who received a placebo solution in the SGB. Primary outcome was perioperative changes in heart rate and systolic and diastolic blood pressures. Secondary outcomes included the incidence of atrial and ventricular fibrillation, and myocardial ischemia in addition to the times from ICU admission to extubation, ICU stay, and hospital stay. Results A statistically substantial increase in systolic and diastolic blood pressure as well as increased incidence of AF and VF was found in the control group compared to the SGB group with p values <0.001, <0.001, 0.037, and 0.028, respectively. Conclusion SGB can reduce the hemodynamic responses to surgery and anesthesia, intraoperative tachyarrhythmias, and ICU and hospital stays.

Early life threatening constrictive pericarditis following off-pump CABG

Abstract We present a unique case of aggressive symptomatic constrictive pericarditis within one month following off pump coronary artery bypass grafting surgery. The patient had a medical history of Hodgkin’s lymphoma treated with radiotherapy and chemotherapy 20 years ago. Investigations confirmed constrictive pericardium with patent grafts and good biventricular function. Pericardiectomy was successful with remarkable recovery of symptoms.

Remimazolam anesthesia for off pump coronary artery bypass grafting and transfemoral transcatheter aortic valve implantation combined surgery in patients with angina pectoris with low flow, low gradient aortic stenosis

Remimazolam anesthesia for off pump coronary artery bypass grafting and transfemoral transcatheter aortic valve implantation combined surgery in patients with angina pectoris with low flow, low gradient aortic stenosis

High Thoracic Epidural Anesthesia and Dexmedetomidine for Awake Off-Pump Coronary Artery Bypass Grafting: A Feasible Option for Patients with Severe Pulmonary Disease.

High thoracic epidural anesthesia in cardiac surgery as the sole anesthetic technique is used in a select groups of patients having severe pulmonary co morbidities. We describe a case series of three patients at high risk for post operative pulmonary complications where this technique was used along with dexmedetomidine infusion for conscious sedation in off pump coronary artery bypass grafting. Proper selection of patients, proper placement of the epidural catheter at the appropriate level and timing of catheter insertion and removal are of paramount importance.

Improvement in cerebral oxygen saturation with sinus conversion during off pump coronary artery bypass graft: A case report.

Near-infrared spectroscopy (NIRS) is a noninvasive bedside tool for monitoring regional cerebral oxygen saturation (rSO2). The sinus conversion of atrial fibrillation (AF) was shown to be responsible for increasing rSO2. However, the reason for this improvement has not yet been clearly explained. We report the case of a 73-year-old woman who underwent cardioversion during an off-pump coronary artery bypass under NIRS and live hemodynamic monitoring. Unlike previous studies that failed to control and compare all conditions during procedures, this case showed real-time fluctuating hemodynamic and hematological values, such as hemoglobin (Hgb), central venous pressure (CVP), mean arterial pressure (MAP), cardiac index (CI), left ventricular end-diastolic pressure (LVEDP), and SVO2. The rSO2 increased immediately after cardioversion and decreased during the obtuse marginal (OM) graft and after AF was obtained. However, no other hemodynamic data showed the same or opposite directional changes in the rSO2. Significant instantaneous changes were observed in rSO2 using NIRS after sinus conversion, without obvious hemodynamic alterations in the systemic circulation or other monitoring values.

Blood Urea Level After on Pump and Off Pump Coronary Artery Bypass Grafting

CABG being one of the most common types of cardiac surgery, lowers the risk of Myocardial Infarctions and patients can remain symptom free for as long as 10-15 years. Though this surgery became more common, there are 2 methods of performing CABG, and they are On-pump and Off-pump techniques. Recent studies reveals several advantages for Off-pump technique than performing On-pump technique. So the intention of this study was to analyze if there is anyphysiological significance of doing On-pump over Off-pump technique. The physiological parameter being considered in this study includes Blood urea level. Post CABG results of blood urea level showed almost similar outcomes among both the techniques of performing CABG surgery. Thus, renal function is unaffected by the technique if CABG, whether with or without cardiopulmonary bypass, in spite of the theoretical advantage of off-pump surgery.

Effect of Use of Entropy Monitoring on Consumption of Sevoflurane Inhalational Agent in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: A Randomized, Double Blinded, Controlled Study

Background: Monitoring the depth of Anesthesia using Entropy modality is essential and resourceful as it allows for more accurate hypnotic drug administration and decreased anesthetic drug consumption and shortens the recovery time. This study was performed to evaluate the effect of entropy monitoring on Sevoflurane consumption in patients undergoing Off Pump Coronary Artery Bypass Graft Surgery.&#x0D; Methods: A total of 60 patients of ages between 40 – 70 years and of either sex with American Society of Anesthesiologist (ASA) grade 2 and 3, planned for Off Pump Coronary Artery Bypass Graft Surgery were randomly allocated to two groups in this Randomized Controlled Trial. In the control group i.e. Group B, Sevoflurane was titrated according to changes in clinical parameters (Heart Rate (HR) and Blood Pressure (BP) changes within 20% of baseline values) and in the study group i.e. Group A, Sevoflurane was titrated to maintain State Entropy (SE) values between 40-60 accordingly. Response Entropy (RE) and State Entropy (SE) values were continuously recorded in both the groups but were displayed on the monitor only in the study group and were not displayed to the anesthesiologist in the control group. The entropy values, Sevoflurane Consumption and recovery times were compared amongst the two groups. Patients in both the groups were ventilated on Volume Control Mode of ventilator with 100% oxygen @ 2L/min.&#x0D; Results: There were no significant results in terms of age, sex, ASA Grade and NYHA Grade amongst the two groups. Sevoflurane consumption and time of recovery were significantly reduced in the study group i.e. Group A than the Control group i.e. Group B (p value &lt;0.001; Sevoflurane consumption: 7.03±0.67 ml/hr vs 12.42±0.68 ml/hr; Recovery Time 6.47±0.65 hr vs 12.05±1.11 hr). Response and State Entropy values were lower in the control group than the study group (p &lt; 0.001) during the maintenance phase of anesthesia. Systolic Blood Pressure values during skin incision, sternotomy and at the time of completion of all grafts were significantly lower in study group as compared to the control group.&#x0D; Conclusion: Monitoring the Depth of Anesthesia using Entropy Monitoring leads to significant reduction in Sevoflurane consumption and significant faster recovery rate from surgery.

The effects of differing anticoagulant regimes on blood quality after cell salvage in coronary artery bypass grafting (CABG): a pilot study

BackgroundCell salvage reduces allogenic blood transfusion requirements in surgery. We present a pilot study exploring the impact of anticoagulant choice, citrate or heparin, on the quality of cell salvaged blood in adults undergoing coronary artery bypass grafting (CABG).Materials and methodsElective on pump CABG patients were randomly allocated to citrate or heparin anticoagulation. We measured red blood cell characteristics and inflammation in both the blood collection reservoir and the washed red blood cell concentrate. Postoperatively, the level of biomarkers and the coagulation profile in the peripheral blood as well as the transfusion requirements of allogenic blood products were studied.ResultsThirty eight patients were included, 19 in the citrate group and 19 in the heparin group. Baseline characteristics were similar. In the washed red blood cell concentrate, Mean Hb (g/dl) and Ht (%) were lower in the citrate group [Hb: 18.1 g/dL (SD 1.3) vs. 21.1 (1.6), p < 0.001; Ht: 59.9% (54.7–60.9) vs. 63.7% (62.3–64.8); p < 0.001]; Mean corpuscular volume (MCV, μm 3) was higher [99.1fL (9.4) vs. 88 (4.2), p < 0.001] and mean corpuscular hemoglobin concentration (MCHC, g/dl) lower in the citrate group [31.9 g/dl (29.6–32.4) vs. 33.6 (33.1–34.0) p < 0.001]. Thrombocyte count (1000/μl) was higher in the citrate group [31.0 (26.0–77.0) vs. 13.0 (10.0–39.0); p = 0.006]. There were no differences in the requirement for allogenic blood products’ transfusion (intraoperatively and postoperatively) or in the coagulation parameters after washed red blood cell concentrate infusion. Higher IL-10 was found in the citrate group in the blood collection reservoir, higher neutrophil-derived myeloperoxidase (MPO) in the heparin group after washed red blood cell concentrate infusion.ConclusionThough red blood cells in washed red blood cell concentrate were more swollen and diluted in the citrate group with more residual thrombocytes, published quality guidelines were met in both groups. Our pilot study suggests that differences in inflammatory markers in the blood collection reservoir and after infusion of washed red blood cell concentrate indicate a possible pro-inflammatory effect of heparin compared to citrate. A larger study is warranted to confirm these results and their possible clinical consequences.Trial registrationClinicalTrials.gov: NCT02674906. Registered 5 February 2016.

Use of pre-operative hemoglobin a1c to predict early post-operative renal failure and infection risks in patients who are not diabetics and undergoing elective off pump coronary artery bypass graft surgery.

Recent studies have indicated that patients, both with and without diabetes with an increased HbA1c, have a higher rate of adverse outcomes following cardiac surgeries. Our study is focused on to evaluate the prognostic impact of admission value of HbA1c in non-diabetic patients for postoperative renal failure and infections. Plasma HbA1c levels were collected from 200 consecutive nondiabetic patients who got admitted for elective off pump coronary artery bypass graft (CABG) procedure over a 2-year period under two groups, Group A whose HbA1c was < 6% at admission and Group B whose HbA1c was ≥6% and ≤6.4% at admission. After surgery, patients were followed up to see if they have got infection or renal failure as postoperative complication. Student's unpaired t test was used to test the significance of difference between the quantitative variables, Yate's and Fisher's chi square tests were used for qualitative variables. We found early postoperative renal failure in 14 (3/96 in Group A and 11/104 in Group B) out of 200 patients (7%) and infection in 21 (8/96 in Group A and 13/104 in Group B) out of 200 patients (10.5%). After data analysis, it was noted that there is a positive correlation between HbA1c and postoperative renal failure (P = 0.0213) whereas no association was found between HbA1c and postoperative infections (P = 0.175) in patients undergoing off-pump CABG surgery. In patients without diabetes, a plasma HbA1c ≥6% was a significant independent predictor for early postoperative renal failure.

A study of the effects of intravenous magnesium sulphate on post-operative atrial fibrillation in patients undergoing off pump coronary artery bypass grafting (CABG)

Atrial fibrillation (AF) occurs in almost 30% of patients undergoing coronary artery bypass grafting (CABG). Around 80% of these patients have decreased levels of total and ionized serum magnesium postoperatively. The association between magnesium deficiency and post CABG AF is still undetermined. Therefore, a large variety of prophylactic strategies have been assessed including perioperative magnesium administration. However, the efficacy is still questionable. The aim of this study was to find out any correlation of serum magnesium levels with the incidence of post-operative atrial fibrillation in patients undergoing off pump CABG and whether magnesium supplementation modifies the incidence. One hundred fifty patients undergoing CABG were selected and divided into treatment and control groups. Perioperative serum magnesium assays were done, and patients were monitored in the postoperative period for occurrence of Atrial Fibrillation. The risk of post CABG atrial fibrillation was more among females, obese patients, patients with EF &amp;#60; 50% and RWMA. Post-operative AF occurred in 5 patients in the treatment group (n = 75) and 11 patients in the control group (n = 75). : The proportion of patients with post-operative atrial fibrillation among cases (6.7%) was lower than that of controls (14.7%) which may indicate an important role of magnesium in prevention of AF following cardiac surgeries. The results however didn’t reach a statistical significance which could be due to sample size, the duration and design of the study and the period of post-operative AF monitoring.

Off pump Versus On pump Coronary Artery Bypass Grafting: Short-term Outcomes.

Coronary artery disease (CAD) is a major public health issue and a leading cause of death globally. It is one of the most common indications for surgical intervention. There are a lot of different techniques, including CABG, which consists of two approaches: sternotomy and mini-thoracotomy. Different techniques have been developed to improve surgical outcomes, including the use of machine for extracorporal circulation (on-pump) or without it (off-pump). The objective of this study was to assess whether off-pump CABG offers superior short-term outcomes compared to traditional on-pump CABG in patients undergoing isolated CABG.. In period between 2022 - 2023, we performed CABG operation in 80 patients. CABG was performed either on- pump or off-pump. The results have shown advantages and disadvantages of one or another type of CABG. We were comparing the duration of surgical procedure, time on mechanical ventilation, drainage volume, neurological incidents, time to discharge, indication for repeat revascularization and mortality between two groups. The choice of surgical technique should be based on individual patient factors, including comorbidities and surgical risks. It is important to say that OPCABG is more challenging than ONCABG, and it is very important that OPCABG is done by skilled, experienced and confident surgeon, which contributes to better outcome and survival.

Assessment of regional wall motion abnormality using transesophageal echocardiography in patient undergoing off pump coronary artery bypass grafting – An observational study

Context: Transesophageal echocardiography (TOE) has been widely used intraoperatively in cardiovascular surgeries. Its influence on perioperative decision-making in both surgical and pharmacological planning has been well recognized. A study was undertaken to establish the fact that the routine use of TOE not only reduces the complications of Coronary artery bypass grafting procedures, but also helps in better surgical decision-making. Aims: To compare the regional wall motion abnormality (RWMA) using TOE at pre and postgrafting Off-pump coronary artery bypass (OPCAB) procedure. Settings and Design: The study design involves institutional setting and observational study. Subjects and Methods: Seventy-two adult patients undergoing elective OPCAB procedures were included between January 2019 and June 2020. RWMA and ejection fraction (EF) were assessed before grafting and postgrafting using intraoperative TOE (IOTOE) to quantify the improvement of wall motion, if no improvement then the need for graft revision or additional grafting was suggested. Statistical Analysis Used: Quantitative outcomes were compared using paired t-tests. SPSS 20.0 was used to analyze the data collected. P < 0.05 was considered to be statistically significant. Results: Sixty-five (90%) patients had RWMA and EF improvement after the grafting and 3 (4%) patients had improvement after graft revision as suggested by IOTOE. So, 68 (94%) patients out of 72 had good surgical outcomes. The comparison between pre and postgrafting EF showed a statistically significant difference i.e., P < 0.05. Conclusions: IOTOE can be used routinely as a definitive mandatory monitoring tool to help in appropriate intra-operative surgical decision-making in patients undergoing OPCAB to enable better surgical outcomes and thereby reduce the morbidity and mortality associated with the procedure.

Difference in GFAP Levels in POCD and Non-POCD Patients After on Pump CABG.

On-pump, coronary artery bypass grafting (CABG) is the most common cause of postoperative cognitive dysfunction (POCD) after cardiac surgery. Previous studies showed that the incidence of POCD after cardiac surgery was 60%, higher than non-cardiac surgery with 11.7%. Glial fibrillary acid protein (GFAP) is one of the sensitive biomarkers of brain damage. Previous studies have found that elevated GFAP serum is associated with cognitive impairment. This study aims to measure the difference in GFAP levels in POCD and non-POCD patients after CABG on-pump surgery. This study is a retrospective cohort design study. The data were obtained from 56 subjects undergoing elective CABG on the pump surgery enrolled into two groups consisting of 28 POCD as a case group and 28 non-POCD as a control group. In this study, the ELISA method measured the levels of GFAP biomarkers within 24 hours after surgery. After 72 hours, the patient received a MoCA-INA examination to determine cognitive impairment. Data analysis was carried out by SPSS 23.00 software. The mean age of patients in both groups was 60 years and was dominated by males (>85%). POCD patients were found to have a significantly longer duration of cardiopulmonary bypass (CPB) and cross-clamp surgery than non-POCD patients (p = 0.002 and p = 0.004). Postoperative GFAP levels in POCD patients were significantly higher than in non-POCD patients (12.95 ± 7.47 vs 3.80 ± 2.77, p < 0.001). There was a significant increase in GFAP levels compared with non-POCD (8.28 ± 7.24 vs -1.5 ± 3.03, p < 0.001). The area under the curve (AUC) value of GFAP against POCD was 0.887, cut-off GFAP 4.750 with a sensitivity of 92.9% and a specificity of 71.4%. POCD patients had higher GFAP levels than non-POCD patients. There are differences in GFAP levels in patients with POCD and non-POCD post-CABG surgery.

Incidence and Predictors of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery

Objective: To study the incidence of postoperative atrial fibrillation (POAF) and its predictors after coronary artery bypass grafting (CABG) in an Asian cohort.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: The study was conducted at the department of Cardiothoracic Surgery, Almana Hospital, Al Khobar, Saudi Arabia, which is a tertiary care hospital. The study duration was form Oct 2019 to Dec 2021. &#x0D; Methodology: All the male and female consecutive patients with coronary artery disease undergoing coronary artery bypass grafting (CABG) were included in the study. All the surgeries were performed through median sternotomy using cardiopulmonary bypass. Patients with emergency CABG, off pump CABG and those undergoing multiple procedures were excluded from the study. A total of 220 consecutive patients were included in the study. Patients were followed in the perioperative period. Various variables were recorded on a preformed proforma. Patients were divided into two groups, those who had atrial fibrillation (AF) and those who did not have AF. Data was analyzed using SPPS version 23 (SPSS, Inc., Chicago,IL).&#x0D; Results: The mean age of the patients was 51.50±11 years in the AF group and 49.38±9 years in the no AF group. The incidence of atrial fibrillation postoperatively in our cohort was (n=52, 25%). There was no statistically significant difference between the groups with respect to hypertension and diabetes (p=0.408 and p=0.054) respectively).&#x0D; Conclusion: In spite of a younger population, the incidence of AF in our cohort undergoing CABG is comparable to the international literature. Lack of preoperative β-blockers, statins and low ejection fraction are predictors of new onset POAF.

The Effect of Body Mass Index on Bleeding After on Pump Coronary Artery Bypass Grafting

Objective: To study the relationship of body mass index (BMI) and postoperative bleeding in patients undergoing isolated coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB).&#x0D; Study Design: Analytical cross sectional study&#x0D; Place and Duration of Study: Cardiothoracic services, Almana General Hospital, Al Khobar, Saudi Arabia, from Oct 2019 to Oct 2021.&#x0D; Methodology: Two hundred and twenty (220) consecutive patients who underwent CABG using cardiopulmonary bypass were included in the study. Patients who had additional procedures, those who were operated in emergency and those with significant comorbidities like hepatic and liver dysfunction were excluded from the final analysis. Patients were divided into three groups according to their BMI, healthy weight (BMI 18.5 to &lt;25), overweight (BMI 25 to &lt;30) and obese (BMI &gt;30). The world health organization (WHO) definition was used to define different categories of BMI. Various perioperative variables were recorded for all the patients. Only the immediate postoperative follow up period was included in the study. Data was analyzed using IBM SPSS-statistics 23.0 (IBM, SPSS Inc., Chicago, IL).&#x0D; Results: Of the 220 patients included in the study, 184(83%) were male patients and 36(16%) female patients. There was no significant difference in the mean age of the patients in the three groups (p=0.481). There were significantly more hypertensive patients 46(45%) in the overweight group compared to other two groups (p=0.025). Baseline diabetic status was not significantly different among the three categories (p=0.978). Total mediastinal drainage in the first 24 hours was significantly less in the obese group (3.7±4.45 ml) compared to overweight (4.4±2.7 ml) and healthy weight (7.35±8.5 ml) patients (p=0.001). There was no mortality in the studied cohort.&#x0D; Conclusion: Bleeding after isolated coronary artery bypass grafting is inversely related to BMI. Patients with healthy and overweight BMI are at higher risk of bleeding compared to obese patients.

Off-pump versus on-pump coronary artery bypass graft surgery outcomes in patients with severe left ventricle dysfunction: inverse probability weighted study

ObjectiveIn this study we aimed to compare on-pump and off-pump coronary artery bypass grafting (CABG) outcomes in patients presented with low left ventricular ejection fraction (EF) as a high-risk group of patients.MethodsIn this registry-based study from 2014 and 2016, all patients with severe left ventricular dysfunction (EF less than 35%) were included and followed until 2020. The median follow-up period was 47.83 [38.41, 55.19] months. Off pump CABG (OPCABG) was compared with on-pump CABG (ONCABG) in terms of mid-term non-fatal cardiovascular events (CVEs) and all-cause mortality. Propensity score method (with inverse probability weighting technique) was used to compare these two groups.ResultsFrom 14,237 patients who underwent isolated CABG, 2055 patients with EF ≤ 35% were included; 1705 in ONCABG and 350 patients in OPCABG groups. Although OPCABG was associated with lower risk of 30-days mortality (Odds Ratio [OR]: 0.021; Confidence Interval [CI] 95% [0.01, 0.05], P < 0.001); there was no significant difference between OPCABG and ONCABG in term of mid-term mortality and non-fatal CVEs ((Hazard ratio [HR]: 0.822; 95%CI [0.605, 1.112], p = 0.208) and (HR: 1.246; 95%CI [0.805, 1.929], p = 0.324), respectively). Patients with more than three traditional coronary artery disease risk factors, had more favorable outcomes (in terms of mid-term mortality) if underwent OPCABG (HR: 0.420; 95%CI [0.178, 0.992], p = 0.048).ConclusionOPCABG was associated with lower risk of 30-days mortality; however, mid-term outcomes were comparable in both OPCABG and ONCABG techniques.

Association of Low Cardiac Output Syndrome with in Hospital Outcomes after on Pump Coronary Artery Bypass Grafting Surgery

Objective: The main objective of current study was to explore the frequency of Low Cardiac Output Syndrome (LCOS) in patients underwent on-pump CABG. Study design and place: The study was carried out in Cardiac Care Center, Bahawalpur From March 15, 2019, to October 31, 2020, Materials and Methods: This prospective, descriptive study was conducted in the Cardiac Surgery, Cardiac Center Bahawalpur, Punjab. Total 250 patients were enrolled in this prospective, comparative study and divided into two groups. Group A (LVEF ≥40% ) and Group B LVEF &lt;40%) the frequency of LCOS postoperatively was compared. the study was conducted. This study employed the non-probability, purposive sampling method. SPSS 22 was used to analyze data. Significant data was used as P-value 0.05. Results: The average age of the participants was 50 ± 4.67 in Group A as compare with Group B (53.44 ± 3.24) years with p-value 0.034. Total 144(57.6%) Male and 106(42.4%) were female patients. The frequency of LCOS was 19(15.2%) versus 25(20%) (P=0.021). Findings showed that the significant difference in outcomes in terms of Renal Dysfunction, Prior CVA, Stroke, ICU stay(days), Recent MI and mortality between the groups without LCOS and with LCOS. The findings of current study can be helpful for management in patients with low Ejection Fraction undergoing CABG which has been shown a higher perioperative risk and a better survival after myocardial revascularization. In this setting the long-term benefits clearly overcome an increased peri-operative mortality Conclusion: Those with pre-operative LVEF less than 40% had a significantly different frequency of LCOS than patients with LVEF greater than 40%. In comparison to patients without LCOS, individuals with LCOS had considerably worse outcomes in terms of stroke, respiratory failure, renal failure, ICU stay, hospital stay, and death. Keywords: CABG, LCOS, LVEF, CVA, MI, ICU