Urgent Coronary Artery Bypass Grafting Research Articles

Preoperative intra-aortic balloon pump in patients with ST-elevation myocardial infarction undergoing urgent cardiac bypass surgery.

In patients with ST-elevation myocardial infarction (STEMI), either with or without cardiogenic shock, mechanical circulatory support with an intra-aortic balloon pump (IABP) is not associated with lower mortality. However, in STEMI patients undergoing urgent coronary artery bypass grafting (CABG), preoperative insertion of an IABP has been suggested to reduce mortality. In this study, the effect of preoperative IABP use on mortality in STEMI patients undergoing urgent CABG was investigated. All consecutive STEMI patients undergoing urgent CABG in asingle centre between 2000 and 2018 were studied. The primary outcome, 30-day mortality, was compared between patients with and without apreoperative IABP. Subgroup analysis and multivariable analysis using apropensity score and inverse probability treatment weighting were performed to adjust for potential confounders. Atotal of 246 patients were included, of whom 171 (69.5%) received apreoperative IABP (pIABP group) and 75 (30.5%) did not (non-pIABP group). In the pIABP group, more patients suffered from cardiogenic shock, persistent ischaemia and reduced left ventricular function. Unadjusted 30-day mortality was comparable between the pIABP and the non-pIABP group (13.3% vs 12.3%, p = 0.82). However, after correction for confounders and inverse probability treatment weighting preoperative IABP was associated with reduced 30-day mortality (relative risk 0.52, 95% confidence interval 0.30-0.88). In patients with STEMI undergoing urgent CABG, preoperative insertion of an IABP is associated with reduced mortality.

Intra-aortic balloon pump for ST-elevation myocardial infarction necessitating urgent coronary artery bypass grafting, still avalid indication?

Intra-aortic balloon pump for ST-elevation myocardial infarction necessitating urgent coronary artery bypass grafting, still avalid indication?

Assessment of atherosclerotic plaque morphology using contrast-enhanced ultrasound and its impact on primary cardiovascular events following simultaneous carotid endarterectomy and coronary artery bypass grafting.

The incidence of stroke after on-pump cardiac surgery during the perioperative period can affect up to 2% of patients, and is frequently linked to carotid artery disease. Notably, in patients with significant unilateral carotid artery stenosis of 80%-99%, the risk of stroke reaches 4%. Among individuals undergoing coronary artery bypass grafting (CABG), 3% to 10% exhibit significant carotid artery stenosis. To mitigate the risk of stroke and mortality, patients can undergo either simultaneous or staged carotid endarterectomy and CABG. The aim of this study was to assess whether early postoperative complications, including stroke, following simultaneous CABG/CAE procedures, correlate with morphological attributes of carotid plaque, assessed via contrast-enhanced ultrasound. A single centre retrospective analysis was performed including 62 patients who underwent simultaneous CABG/CEA between 2019 and 2022. Our study excluded patients who underwent staged carotid endarterectomy and CABG procedures, off-pump CABG, or those necessitating urgent CABG. Our analysis focused on patients meeting elective CABG criteria, diagnosed with symptomatic triple-vessel or left main trunk coronary artery disease (CAD), alongside asymptomatic carotid stenosis (a. carotis internae) exceeding 70% or symptomatic ipsilateral carotid stenosis surpassing 50%. The extent of contralateral carotid artery stenosis was not taken into account. Prior to the CEA/CABG procedure, each patient underwent contrast-enhanced ultrasound to assess atherosclerotic lesions, which were classified using Nakamura et al.'s classification. Among the patients, 37.1% exhibited no neovascularisation within the atherosclerotic plaque, 56.5% showed insignificant neovascularisation, and 6.5% displayed notable neovascularization within the plaque. Our study aimed to establish a connection between the degree of plaque vascularisation identified through contrast-enhanced ultrasound and subsequent postoperative complications. Upon evaluating postoperative complications occurring within 30 days after the surgery and the plaque morphology identified through contrast-enhanced ultrasound, a statistically significant correlation was observed between a higher grade of plaque vascularisation and the occurrence of ischaemic stroke (r = 0.329, p = .008). Monte Carlo calculations of the Chi-square test indicated a significant association between a higher grade of plaque vascularisation and the presence of peripheral artery disease (χ2 = 15.175, lls = 2, p = .003). Within 30 days of surgery, a significant correlation exists between the occurrence of ischaemic stroke following carotid endarterectomy subsequent to CABG and the presence of a higher grade plaque vascularisation as identified by contrast-enhanced ultrasound.

Impact of preprocedural left ventricular systolic function on the safety and durability of percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) is considered less safe in patients with reduced ejection fraction (EF), an impression based on older data. Whether the safety and durability of contemporary PCI are different in patients with reduced EF compared with normal EF patients is unknown. Patients from the BIOFLOW II, IV and V clinical trials were grouped as normal EF (≥50%) and reduced EF (30%-50%). Using multivariable logistic regression and cox proportional hazards regression, we determined relations of EF category with procedural safety (a composite of cardiac death, myocardial infarction, stroke and urgent coronary artery bypass grafting within 30 days of PCI) and target lesion failure (TLF; comprising cardiac death, target vessel myocardial infarction, target vessel revascularization within 1 year of PCI) respectively. In sensitivity analyses, we regrouped patients into EF < 45% and ≥55% and repeated the aforementioned analyses. In 1685 patients with normal EF (mean age 65 years; 27% women; mean EF 61%) and 259 with low EF (mean age 64 years; 17% women; mean EF 41%), 101 safety and 148 TLF events occurred. Compared with patients in the normal EF group, those with reduced EF had neither a statistically significant higher proportion of safety events, nor a higher multivariable-adjusted risk for such events. Similarly, patients with reduced EF and normal EF did not differ in terms of TLF event proportions or multivariable-adjusted risk for TLF. The results were similar in sensitivity analyses with EF groups redefined to create a 10% between-group EF separation. PCI safety and durability outcomes are similar in patients with mild-moderately reduced EF and normal EF.

Interpretable machine learning models for predicting in-hospital and 30 days adverse events in acute coronary syndrome patients in Kuwait

The relationships between acute coronary syndromes (ACS) adverse events and the associated risk factors are typically complicated and nonlinear, which poses significant challenges to clinicians' attempts at risk stratification. Here, we aim to explore the implementation of modern risk stratification tools to untangle how these complex factors shape the risk of adverse events in patients with ACS. We used an interpretable multi-algorithm machine learning (ML) approach and clinical features to fit predictive models to 1,976 patients with ACS in Kuwait. We demonstrated that random forest (RF) and extreme gradient boosting (XGB) algorithms, remarkably outperform traditional logistic regression model (AUCs = 0.84 & 0.79 for RF and XGB, respectively). Our in-hospital adverse events model identified left ventricular ejection fraction as the most important predictor with the highest interaction strength with other factors. However, using the 30-days adverse events model, we found that performing an urgent coronary artery bypass graft was the most important predictor, with creatinine levels having the strongest overall interaction with other related factors. Our ML models not only untangled the non-linear relationships that shape the clinical epidemiology of ACS adverse events but also elucidated their risk in individual patients based on their unique features.

Radial artery graft in coronary artery bypass surgery 1 week to 1 year postoperation.

The actual patency rate of the radial artery (RA) grafts 1 week and 1 year after coronary artery bypass grafting (CABG) has not been extensively reported on. We used coronary computed tomography angiography (CCTA) to evaluate the patency rate of RA grafts and compared it with that of saphenous vein (SV) grafts. In this observational cohort study, 80 patients who underwent urgent or elective CABG with RA and SV grafts at Ruijin Hospital from August 2019 to June 2021 were included. Follow-up CCTA scans were completed about 1 year postoperation in the out-patient clinic. We graded the grafts into four classes: A, excellent; B, graft diameter <50% of target coronary artery; O, occluded; and S, string sign. Both S and O were defined as graft failure. The patients' mean age was 58.48±8.06 years, and 87.5% (70/80) of the patients were male. The 1-week patency rate of the left internal mammary artery (LIMA), RA, and SV grafts were 98.7% (75/76), 76.3% (61/80), and 93.8% (75/80), respectively. At 1 year, the patency rate of the LIMA, RA, and SV grafts were 97.4% (74/76), 80.0% (64/80), and 81.3% (65/80), respectively. The RA graft patency rate was lower than was the SV graft patency rate perioperatively [relative risk (RR): 0.918; 95% confidence interval (CI): 0.852-0.990; P=0.007]. Moreover, 63.6% (7/11) of RA grafts graded S and 25.0% (2/8) of RA grafts graded O were defined as patent (graded A or B) at 1 year postoperation. Compared with SV grafts, more RA grafts improved (RA: 12/80, 15.0%; SV: 0%) and fewer RA grafts deteriorated (RV: 10/80, 12.5%; SV: 19/80, 23.8%) from 1 week to 1 year (P=0.001). The patency rate of the 2 types of grafts became similar at 1 year postoperation (RR: 0.560; 95% CI: 0.113-2.781; P>0.99). RA grafts had a lower patency rate than did SV grafts 1 week after operation. However, because of the "revival" phenomena and lower attrition rate, the patency rate of the two kinds of grafts did not show any significant difference at 1 year.

Outcome of patients with cardiogenic shock in acute myocardial infarction treated with Impella CP and a standardized protocol

Abstract Background Recent registry data indicate improved outcome of patients with cardiogenic shock in acute myocardial infarction (AMICS) if treated with Impella CP according to a standardized protocol. Purpose To evaluate in-hospital and 6-months survival of patients with AMICS after implementation of a standardized protocol with early use of Impella CP. Methods The study compared a contemporary cohort of consecutive patients treated in our centre for AMICS with Impella CP according to an established protocol with a historical cohort of consecutive patients treated with IABP without a protocol (admissions during 5/2019 - 5/2022 vs. 1/2007 - 12/2012). The criteria for implantation of Impella included: 1.) ischemia duration of &amp;lt;24 hours, 2.) age &amp;lt;75 years and absence of life-limiting comorbidities, 3.) impaired left ventricular contractility with enddiastolic pressure (LVEDP) of &amp;gt;18 mmHg, and 4.) successful percutaneous coronary intervention (PCI), urgent coronary artery bypass grafting (CABG), or potential candidacy for long-term left ventricular assist device (LVAD) in case of unattainable coronary revascularization. Excluded were patients with out-of-hospital cardiac arrest of &amp;gt;5 minutes, mechanical complications of myocardial infarction, and patients with small diameter of access arteries. The protocol contained recommendations for early identification of AMICS, complex intensive care, pharmacotherapy, and escalation of the mechanical circulatory support. The patients in the historical cohort were retrospectively matched with the contemporary cohort by the same idication criteria except for LVEDP, which was not measured routinely. In-hospital and 6-months survival status were evaluated from collected medical records. Results In total, 21 patients were treated with Impella CP according to the protocol and 23 patients were treated with IABP without a protocol (age: 65 ± 10 vs. 64 ± 10 years; males: 19 [90%] vs. 20 [87%], LVEF: 27 ± 7% vs. 24 ± 6%, median [IQR] lactate: 3.7 [2.1 - 5.7] vs. 4.2 [2.2 – 9.2] mmol/l, all p-values &amp;gt;0.2). Revascularisation was successful in 90% and 91% of the patients, respectively (PCI/CABG: 17/2 vs. 17/4). In 5 (24%) of the patients treated with Impella, the device was implanted before PCI. Subsequent addition of ECMO for refractory shock was needed in 4 (19%) of the patients in the contemporary cohort and 3 (13%) of the patients in the historical cohort. Long-term LVAD was implanted in 3 (14%) patients and 1 patient (4%), respectively. In-hospital survival was 15 (71%) in the contemporary cohort vs. 14 (61%) in the historical cohort, and 6-months survival was 15 (71%) vs. 11 (48%), respectively (p = 0.008 by log-rank test). Conclusions Patients with AMICS who were treated according to a standardized protocol with early implantation of Impella CP had a relatively favourable 6-months survival that was better compared to a historical cohort.

Sex-specific disparities in patients undergoing isolated CABG

Study objectiveExamine sex-specific characteristics in patients undergoing coronary artery bypass grafting (CABG) at our institution. DesignRetrospective chart review was performed utilizing our institutional Society of Thoracic Surgeons (STS) database. SettingAn academic, quaternary care center from 2010 to 2021. Participants3163 females and 9573 males underwent isolated CABG. InterventionsThe institutional STS database was queried for preoperative, intraoperative, and postoperative variables. Main outcome measuresUnivariate comparisons between female and male groups were performed using chi-squared tests or fisher exact tests. Multivariate logistic regression was used to assess risk factors for 30-day mortality. ResultsFemales had more preoperative comorbidities than males, including hypertension, diabetes, peripheral arterial disease, cerebrovascular disease, renal failure, and prior myocardial infarction. Females more frequently underwent urgent (61 % vs. 58 %) or emergent CABG (5.8 % vs. 4.3 %) compared to males (p < 0.0001). Females experienced longer total intensive care unit (ICU) hours (48.3 h vs. 43.5 h) (p < 0.0001), were more frequently discharged to an extended care facility (13 % vs. 6.4 %) (p < 0.0001) and prescribed less aspirin and beta blocker therapy at discharge than males. In-hospital mortality was higher in females (1.9 % vs. 1.2 %, p = 0.002), as was 30-day mortality (2.7 % vs. 1.6 %, p = 0.0001). Female sex was an independent risk factor for 30-day mortality (odds ratio = 1.46, 95 % CI: 1.06, 2.03, p = 0.02). ConclusionOver the past decade, females undergoing CABG had more preoperative comorbidities, urgent and emergent operations, longer postoperative ICU stay and a higher risk of mortality than their male counterparts. Further studies must investigate these disparities to improve outcomes for females undergoing CABG.

The impact of on-site cardiac surgical backup on clinical outcomes of acute coronary syndrome-analysis of the ACSIS national registry.

The availability of advanced technologies for mechanical support in hospitals with on-site cardiac surgery (CS), along with the ability to perform urgent coronary artery bypass graft (CABG) surgery, may result in improved clinical outcomes in patients with acute coronary syndrome (ACS). We conducted a retrospective analysis of the bi-annually Acute Coronary Syndrome Israeli Survey (ACSIS) registry from the year 2000 to 2020, performed in hospitals with and without CS. Mortality rates and major adverse cardiac and cerebrovascular events (MACCE) rates are reported. We evaluated two periods of the study-early (2000-2010) vs. late (2011-2020). Propensity score matching was performed to reduce bias between the two groups. The study included 16,979 patients (52.3% in the on-site CS group). Patients in the on-site CS group were more likely to undergo percutaneous coronary intervention (PCI), (odds ratio [OR], 1.26 [95% CI, 1.18-1.35]; p < 0.001) and CABG [OR, 1.91 (95%CI, 1.63-2.24); P < 0.001], and patients in hospitals without on-site CS had higher 30-day MACCE [OR, 1.17 (95% CI, 1.07-1.27); p < 0.0005]. Overall, there was no difference in 1-year mortality (hazard ratio [HR], 0.98 [95% CI, 0.89-1.08]; p = 0.71) between the groups. During the late period of the study, patients in the group without on-site CS had lower 30-day mortality [OR, 0.69 (95% CI, 0.49-0.97); P = 0.04], yet with no difference in 1-year mortality [HR, 0.81 (95% CI, 0.65-1.01); p = 0.07]. The availability of on-site CS resulted in variations in treatment modality, yet it did not affect the clinical outcomes of ACS. A trend to a better short-term outcomes was noted in hospitals without CS during the late period of the study, which warrants further investigation.

Discussion to: Impact of timing of urgent coronary artery bypass grafting following coronary angiography on acute kidney injury

Discussion to: Impact of timing of urgent coronary artery bypass grafting following coronary angiography on acute kidney injury

436 Total Arterial Revascularisation Complicated by Unexpected Vasoconstrictor Requirements

Abstract Introduction The debate surrounding conduit selection in multi-vessel coronary artery bypass grafting (CABG) persists. Whilst combined arterial and venous conduits remains the gold standard approach, some studies report superior long-term outcomes with total arterial revascularisation (TAR). Case Description A 48-year-old male was admitted with acute coronary syndrome. Investigations demonstrated significant triple vessel coronary artery disease with preserved biventricular systolic function. He had no major comorbidities. He underwent uneventful urgent off-pump CABG x 3 with TAR. Conduits used were a skeletonised left internal mammary artery (LIMA) and a radial artery. They were anastomosed to make a Y configuration. The LIMA was anastomosed end-to-side to the mid-LAD and the radial artery was anastomosed side-to-side to the first obtuse marginal and end-to-side to the posterior descending artery. Post-operatively the patient had significant drain output, resulting in haemodynamic instability and a significant increase in vasoconstrictor requirements. This led to vasoconstrictive spasm of the arterial grafts and cardiac arrest ensued. The patient underwent emergency re-sternotomy and institution of cardiopulmonary bypass. The arterial grafts were removed, and the patient was re-grafted with three saphenous vein grafts. The patient was successfully discharged home in a stable condition on the tenth post-operative day. Discussion Careful management of post-operative complications in patients who underwent TAR is required in order to reduce the risk of arterial graft spasm. Pre-operative planning should include the consideration of alternative conduit strategies in patients where higher post-operative vasoconstrictor requirements are anticipated.

Two Decades of Coronary Artery Bypass Grafting in Women: Has Anything Changed?

BackgroundStudies have shown that women have worse outcomes after coronary artery bypass grafting (CABG); it is unclear whether this knowledge has led to improved outcomes over time. This study sought to examine temporal trends in women undergoing CABG. MethodsFrom 2000 to 2021, 9062 women underwent isolated CABG at a single institution. The institutional Society of Thoracic Surgeons database was queried for preoperative, intraoperative, and postoperative variables. The cohort was stratified by date of operation into 6 groups coinciding with versions of The Society of Thoracic Surgeons database: 2002-2004/version 2.41 (n = 1348 [15%]), 2004-2007/version 2.52 (n = 2413 [27%]), 2008-2011/version 2.61 (n = 2244 [25%]), 2011-2014/version 2.73 (n = 1230 [14%]), 2014-2017/version 2.81 (n = 783 [9%]), and 2017-2021/version 2.9 (n = 1044 [12%]). ResultsThe median age was 66 (interquartile range, 58-74) years. Comorbid conditions including chronic lung disease, cerebrovascular disease, diabetes, hypertension, and heart failure increased over time. The number of urgent CABG procedures increased from 20% in the 2002-2004 group to 66% in the 2017-2021 group, whereas the number of elective CABG procedures decreased from 76% to 32% (P < .001). From 2002-2004 to 2017-2021, internal mammary artery use increased from 85% to 92% (P < .001). Mortality did not improve for women over time, in-hospital mortality was significantly higher for women (3.6%) than for men (1.8%; P < .001), and the gap between women and men remained unchanged over time. ConclusionsMortality of women undergoing CABG at our institution (3.6%) remains higher than the overall national average (∼2%) and that of the male institutional cohort (1.8%). Further studies to understand this disparity and to improve care for women undergoing CABG are needed.

Efficacy of Perioperative Infusion of N(2)-L-alanyl-L-glutamine in Glycemic Control for Patients With Uncontrolled Diabetes Mellitus Presented for Urgent Coronary Artery Bypass Surgery: A Randomized Controlled Trial

To evaluate the efficacy of preoperative glutamine infusion in reducing insulin requirements in patients with uncontrolled type 2 diabetes, defined as glycated hemoglobin (HbA1c) >7%, undergoing urgent coronary artery bypass graft (CABG) surgery. A randomized controlled trial. At Ain Shams University Hospital, Cardiothoracic Academy. Ninety-three patients (of both sexes) with uncontrolled diabetes presenting for urgent CABG were categorized into 2 groups. The dipeptiven group (n=46) was given an infusion of dipeptiven 1.5 mL/kg body weight dissolved in normal saline (200 mL) over 3 hours before surgery. The control group (n=47) received a normal saline infusion (200 mL). The dipeptiven group demonstrated statistically significant lower intraoperative (173.74 ± 19.97 mg/dL v 198.22 ±14.64 mg/dL) and postoperative (162.36 ±13.11 mg/dL v 176.13 ±14.86 mg/dL) mean blood glucose levels. In addition, dipeptiven infusion was found to reduce mean total insulin requirements intraoperatively by 3.64 ± 0.56 units/h and postoperatively by 37.109 ± 4.30 units/24 h in comparison to placebo (50.98 ± 16.55 units/24 h and 5.10 ± 2.28 units/h, respectively). A preoperative infusion of dipeptiven can contribute to ameliorating stress hyperglycemia in uncontrolled diabetic patients undergoing urgent CABG.

Impact of timing of urgent coronary artery bypass grafting following coronary angiography on acute kidney injury

ObjectivesPrior studies have examined the association between timing of cardiac surgery after coronary angiography with risk of acute kidney injury, but this remains controversial. The purpose of this study was to investigate the association between interval from coronary angiography to urgent coronary artery bypass grafting with acute kidney injury, and to examine this possible effect in patients with preexisting kidney disease. MethodsPatients from a single institution undergoing urgent, isolated coronary artery bypass grafting within 7 days of coronary angiography were included. Patients were subdivided by chronic kidney disease stage and angiography-to-surgery interval. Locally estimated scatterplot smoothing was used to evaluate the functional relationship of the probability of acute kidney injury and time interval. Adjusted odds ratios were calculated for each time interval group compared against the Day 0 to 1 interval group, controlling for multiple covariates. Analyses were repeated for each chronic kidney disease subgroup. ResultsA total of 2249 patients were included in this study. There were 271 (12.0%) patients with postoperative acute kidney injury. Plots demonstrated a decreasing risk of kidney injury from Day 0 to 1 to Day 3 following coronary angiography. Adjusted odds ratios also showed a significant decrease in risk of kidney injury on Day 3 compared with Day 0 to 1. Analyses repeated for each chronic kidney disease stage showed similar trends. ConclusionsFor patients undergoing urgent coronary artery bypass grafting, there is a decreased risk of kidney injury in those having surgery on day 3 after coronary angiography compared with those having surgery on Day 0 to 1, regardless of preexisting kidney disease.

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

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

Coronary artery bypass grafting in active or recent COVID-19 infection: a systematic review.

Even though there have been few studies on coronary artery bypass grafting (CABG), data on patients with coronavirus disease-2019 (COVID-19) infection show that cardiac surgery has poor outcomes in this subset. From the available studies in the literature, we conducted a systematic review with the aim of determining the outcome of COVID-19 patients who underwent CABG. Between December 2019 and October 2022, searches were conducted in PubMed, the Directory of Open Access Journals, and Google Scholar to find studies reporting results of COVID-19 patients undergoing CABG. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. The quality of the studies was assessed using a standardised tool. The total sample size across the 12 included studies was 99 patients who underwent CABG in active disease or within 30days of COVID-19 infection. The median and interquartile range (IQR) for the length of time spent on a mechanical ventilator, stay in the intensive care unit (ICU), and the total hospital stay were 0.9 (0.47-2), 4.5 (2.5-8), and 12.5 (8.5-22.5) days respectively. Seventy-six patients developed postoperative complications, and there were eleven deaths. The findings of the present study indicate that mortality risk goes down when the time between COVID-19 diagnosis and surgery increases. When compared to data from other high-risk urgent or emergent CABG patients around the world who were not infected with COVID-19, patients who underwent CABG in the COVID-19 subgroup had similar postoperative outcomes. The online version contains supplementary material available at 10.1007/s12055-023-01495-7.

APPROACH OF WITHHOLDING P2Y12 INHIBITORS FOR URGENT CORONARY ARTERY BYPASS GRAFTING IN DIABETIC PATIENTS WITH ACUTE CORONARY SYNDROME

Objectives: To compare angiographic findings between diabetic and non-diabetic patients with acute coronary syndrome (ACS) along with feasibility of P2Y12 inhibitors withholding approach for urgent coronary artery bypass grafting (CABG) in diabetic (DM) patients with severe lesions. Methodology: Consecutive ACS patients were included. P2Y12 inhibitors was hold in a certain number of diabetic patients with either left main (LM) or multi-vessel disease (MVD) on baseline angiogram, at the discretion of primary physician. Angiographic diseases severity was compared between diabetic and non-diabetics. The clinical management and outcomes of diabetic patients were further compared based on the deferred P2Y12 inhibitors approach. Results: Out of 205 patients, 149 were males and 40.9% were diabetic. Involved vessel was LM in 19.8% vs. 16.6%; p=0.566, left anterior descending artery (LAD) in 62.8% vs. 39.3%; p=0.001, and right coronary artery in 27.3% vs. 45.2%; p=0.008 with MVD in 42.1% vs. 28.6%, p=0.047 of the diabetic and non-diabetic patients, respectively. P2Y12 inhibitors was hold in 59 diabetic patients who undergone urgent CABG with hospital stay of &lt;5 days. In remaining 62 diabetic patients, 50 undergo coronary intervention and 12 undergo delayed CABG with hospital stay of &gt;5 days due to P2Y12 administration. Conclusion: The presence of DM showed a significant association with the involvement of the LAD artery. Most participants showed presence of MVD. By holding P2Y12 inhibitors reduces the perioperative bleeding and hospital stay.

Minimal Extracorporeal Circulation and Microplegia in the Setting of Urgent Coronary Artery Bypass Grafting.

We aimed to analyse the performance of minimal invasive extracorporeal circulation (MiECC) concomitantly with Microplegia, in patients with recent myocardial infarction (MI) undergoing urgent coronary artery bypass grafting (CABG) surgery. We included patients with a recent MI (≤7 days) undergoing isolated CABG surgery using MiECC. The primary endpoint was a major cardiovascular or cerebrovascular event (MACCE). In a secondary analysis, we compared our institutional Microplegia concept with the use of a crystalloid single-shot cardioplegic solution. In total, 139 patients (mean ± standard deviation (SD) age 66 ± 10 years) underwent urgent CABG surgery using Microplegia; 55% (n = 77) of the patients had an acute MI within 1-7 days preoperatively; 20% (n = 28) had an acute MI within 6-24 h; and 24% (n = 34) had an acute MI within &lt;6 h preoperatively. The number of distal anastomoses was a geometric mean of 4 (95% confidence interval 3-4). The MACCE and in-hospital mortality were 7% (n = 10) and 1% (n = 2), respectively. The results were confirmed in a secondary analysis comparing Microplegia with crystalloid cardioplegic solution (n = 271). The use of MiECC with Microplegia in urgent CABG surgery is feasible and safe and provides a straight-forward intraoperative setting. Therefore, it can also be considered to retain the benefits of MiECC in urgent CABG surgery.

Intra-aortic Balloon Pump Securement.

Intra-aortic Balloon Pump Securement.

Staged Hybrid Coronary Revascularization in Acute Coronary Syndrome

BackgroundIn acute coronary syndrome (ACS) with non-ST elevation myocardial infarction, there is a subgroup of patients who are difficult to treat; these are patients with a complex left anterior descending artery (LAD) lesion or a non-LAD culprit lesion but who are not suitable for standard coronary artery bypass grafting (CABG). Staged hybrid coronary revascularization (HCR), combining primary percutaneous coronary intervention on the non-LAD culprit lesion with CABG, represents an attractive solution. MethodsWe conducted a retrospective observational study to compare effectiveness and safety of HCR vs CABG alone. From December 6, 2016, to December 21, 2021, at our institution, 339 patients underwent urgent CABG with or without previous primary percutaneous coronary intervention; 65 received HCR (study group) and 274 received CABG alone (control group). Primary outcomes were major adverse cardiac and cerebrovascular events at 30 days and at long-term follow-up. Secondary outcomes were in-hospital postoperative complications. ResultsSignificant preoperative differences were detected in the mean EuroSCORE II: 3.4 (1.5-7.8) in HCR vs 2.5 (1.1-4.5) in CABG (P < .05). Patients in the CABG group needed more blood transfusions than patients in the HCR group (P = .004). Conversely, no other significant differences were detected for in-hospital postoperative complications. Survival analysis did not show significant differences between HCR and CABG, either to 30 days (hazard ratio, 0.51 [95% CI, 0.03-4.04]; P = .52) or to longer follow-up (maximum 5 years; hazard ratio, 0.40 [95% CI, 0.09-1.68]; P = .21). ConclusionsOur data support the safety and effectiveness of staged HCR in the scenario of ACS.