Predictors of Increased Length of Hospital Stay in Patients with Severe Cardiomyopathy Undergoing Coronary Artery Bypass Grafting

Objective: Minimal invasive extracorporeal circuits (MiECC) have been associated with a significant reduction in the incidence of postoperative atrial fibrillation (AF). Nevertheless, AF remains one of the most common complications following elective primary coronary artery bypass grafting (CABG). The aim of this study was to identify the predictors of AF persisting beyond the hospital stay in elective primary CABG patients. Methods: We conducted a retrospective analysis for the predictors of AF that persisted beyond discharge between all patients who received an elective isolated CABG in our institution between 2009 and 2014. Patients with a positive history for intermittent or persistent AF were excluded from the analysis. Almost all patients were discharged to a rehabilitation facility where they stayed for 3 to 4 weeks postoperatively. At rehab approximately 91% of them received Holter monitoring at least once prior to their discharge. Results: A total of 770 patients were included in the analysis of which 763 patients survived the in-hospital stay. The incidence of AF at hospital discharge was 4.2% (32/763) while that on Holter monitor at Rehab was 1.5% (10/685). Age and the type of extracorporeal circuit (ECC) utilized were the only significant predictors for both AF at discharge ( p < 0.01 both) and on Holter monitor in rehab ( p < 0.01 and 0.02, respectively). This was also confirmed on multivariate analysis. Conclusion: Our findings show that the benefits of MiECC regarding the incidence of postoperative AF persist beyond hospital discharge. They may thus positively influence the outcomes of patients beyond the early postoperative period.

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Minimally Invasive Coronary Artery Bypass Grafting Decreases Hospital Stay and Cost

Annals of Surgery ◽

10.1097/00000658-199706000-00018 ◽

1997 ◽

Vol 225 (6) ◽

pp. 805-811 ◽

Cited By ~ 34

Author(s):

Robert C. King ◽

T. Brett Reece ◽

Janet L. Hurst ◽

Kimberly S. Shockey ◽

Curtis G. Tribble ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Minimally Invasive ◽

Hospital Stay ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting

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Utility of perioperative B-type natriuretic peptide in off-pump bypass surgery

Nepalese Heart Journal ◽

10.3126/njh.v11i1.10977 ◽

2014 ◽

Vol 11 (1) ◽

pp. 19-25

Author(s):

Dikshya Joshi ◽

Zhi Gang Guo

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Hospital Stay ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Left Ventricular ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Off Pump ◽

Pump Coronary Artery Bypass

Background and Aims: This study was performed to determine clinical relevance of perioperative B-type natriuretic peptide (BNP) in patients undergoing off-pump coronary artery bypass grafting. Methods: 145 consecutive patients undergoing off-pump coronary artery bypass grafting during 8-month period were enrolled in this study. The relationship between the plasma BNP and various clinical parameters was examined. Postoperatively their main clinical endpoints including requirement of mechanical ventilator support, length of intensive care unit stay and hospital stay was closely monitored. Results: Mean preoperative BNP levels were significantly higher in patients whose left ventricular ejection fraction was less than 0.50 (P<0.00083), and New York Heart Association class (III, IV) (P<0.02). The determinants of preoperative higher level of BNP can be related to the advanced age of the patients, r=0.387 (P<0.01) and left ventricular end diastolic diameter, r=0.200 (P<0.05). Postoperative 12-hour BNP correlated significantly with the duration of mechanical ventilation, rho=0.84 (P<0.05), and postoperative hospital stay for 10 days or more, rho=0.202 (P<0.05). Logistic regression analyses showed a significant association between 12-hour BNP and the requirement of mechanical ventilation, Wald=3.956 (P<0.049, 95% CI_1.023- 20.476). Conclusion: Plasma BNP concentration is a valuable biochemical marker, is easy to measure and can effectively predict postoperative outcome in off-pump coronary artery bypass grafting. Baseline BNP had strong correlation with the age and ventricular function of the patient. Postoperatively, elevated 12-hour BNP indicated prolonged ventilation and longer duration of hospital stay. DOI: http://dx.doi.org/10.3126/njh.v11i1.10977 Nepalese Heart Journal 2014;11(1): 19-25

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Retrospective analysis of the impact of a low glycaemic index diet on hospital stay following coronary artery bypass grafting: a hypothesis

Journal of Human Nutrition and Dietetics ◽

10.1111/j.1365-277x.2004.00519.x ◽

2004 ◽

Vol 17 (3) ◽

pp. 241-247 ◽

Cited By ~ 13

Author(s):

V. C. Patel ◽

R. D. Aldridge ◽

A. Leeds ◽

A. Dornhorst ◽

G. S. Frost

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Hospital Stay ◽

Retrospective Analysis ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Glycaemic Index ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

The Impact

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Allogeneic Blood Product Usage in Coronary Artery Bypass Grafting (CABG) with minimalized Extracorporeal Circulation System (MECC) Versus Standard On-Pump Coronary Artery Bypass Grafting

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401610010148 ◽

2016 ◽

Vol 10 (1) ◽

pp. 148-157

Author(s):

M. Lisy ◽

E. Schmid ◽

J. Kozok ◽

P. Rosenberger ◽

U.A. Stock ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Hospital Stay ◽

Coronary Artery Bypass ◽

Extracorporeal Circulation ◽

Blood Product ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Pump Coronary Artery Bypass

Aim:Intraoperative allogeneic blood product transfusion (ABPT) in cardiac surgery is associated with worse overall outcome, including mortality. The objective of this study was to evaluate the ABPTs in minimalized extracorporeal cardiopulmonary (MECCTM) compared with standard open system on-pump coronary revascularization.Methods:Data of 156 patients undergoing myocardial revascularization between September 2008 and September 2010 were reviewed. 83 patients were operated by the MECC technique and 73 were treated by standard extracorporeal circulation (sECC). ABPT and overall early postoperative complications were analyzed.Results:Operative mortality and morbidity were similar in both groups. ABPT in the MECC group was significantly lower than in the sECC group both intraoperatively (7.2vs.60.3% of patients p<0.001) and during the first five postoperative days (19.3vs.57.5%; p<0.001). “Skin to skin”- (214 ± 45vs.232 ± 45 min; p=0.012), cardiopulmonary bypass (CPB) - (82 ± 25vs.95 ± 26 min; p=0.014), and X-clamp- times (50 ± 16vs.56 ± 17 min; p=0.024) were significantly lower in the MECC group than in the sECC group. Length of ICU (intensive care unit) - and hospital stay were also significantly lower in the MECC groupvs.the sECC group (26.7 ± 20.2vs.54.5 ± 68.9 h; p<0.001, and 12.0 ± 4.1vs.14.5 ± 4.6 days; p<0.001).Conclusion:Application of MECC as on-pump coronary artery bypass graft (CABG) results in significantly lower ABPT as well as shorter ICU and in-hospital stay. In order to achieve these benefits of MECC autologous retrograde priming, Bispectral index (BIS) monitoring, intraoperative cell salvage, meticulous hemostasis and strict peri- and postoperative volume management are crucial.

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