scholarly journals In situ skeletonized bilateral thoracic artery for left coronary circulation: a 20-year experience

2019 ◽  
Vol 57 (1) ◽  
pp. 160-167 ◽  
Author(s):  
Massimo Bonacchi ◽  
Edvin Prifti ◽  
Marco Bugetti ◽  
Francesco Cabrucci ◽  
Michael Cresci ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Circulation ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Adverse Cardiac Events

Abstract OBJECTIVES Our goal was to analyse the outcomes in a patient population using a standardized technique for coronary artery bypass grafting (CABG) consisting of total arterial myocardial revascularization utilizing the in situ skeletonized bilateral thoracic artery for left coronary circulation. We also explored potential predictors of long-time unfavourable outcomes. METHODS Patients undergoing total arterial myocardial revascularization using in situ skeletonized bilateral thoracic artery for left coronary circulation between January 1997 and May 2017 were included prospectively in this study. The median follow-up (100% complete) was 103 months (interquartile range 61–189 months) and ranged from 1 to 245 months. RESULTS A total of 1325 consecutive patients were recruited. During the follow-up period, there were 131 deaths (9.8%), 146 repeat revascularizations (11.0%) and 229 major adverse cardiac events (17.2%). The 18-year freedom from major adverse cardiac events was 62.6 ± 9.3%, 62.5 ± 6.3% and 53.9 ± 11.0%, respectively. Multivariable models showed that a left ventricular ejection fraction ≤35%, chronic obstructive pulmonary disease, peripheral vascular disease (P < 0.001), chronic kidney disease and age ≥80 years (P = 0.002) were independent predictors of diminished long-term survival. Moreover, peripheral vascular disease and off-pump coronary artery bypass (both, P < 0.001) predicted repeat revascularization. Finally, age ≥80 years, peripheral vascular disease, left ventricular ejection fraction ≤35%, off-pump coronary artery bypass and chronic pulmonary obstructive disease were independent predictors of major adverse cardiac events during the long-term follow-up period (all, P < 0.001). CONCLUSIONS Coronary artery bypass using the in situ skeletonized bilateral thoracic artery for left coronary circulation configuration for total arterial myocardial revascularization resulted in satisfactory long-term results with a low incidence of death and late events and may represent a technique of choice in selected patients having CABG. Larger and long-term prospective studies are, however, warranted.

scholarly journals Succinylcholine is Equally Efficient as Rocuronium Bromide in terms of Major Adverse Cardiac Events (MACE)During Off Pump Coronary Artery Bypass Surgery : A Single Centre Study

2021 ◽  
Author(s):  
Nikhil Mudgalkar ◽  
venkata ramana kandi
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Tertiary Care ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Intubation Difficulty ◽  
Adverse Cardiac Events

Introduction: Rapid and safe endotracheal intubation is of paramount importance in the general anaesthesia practices. Safety of such practices while performing surgical procedures in people with critical coronary lesions assumes increased significance.The use of succinylcholine and rocuronium are common but the association with the application of these medications and concomitant haemodynamic changes on major adverse cardiac events (MACE) has not been adequately studied. The aim of this study is to assess the safety and efficacy of succinylcholine in comparison with rocuronium for MACE in cardiac surgical population. Methods: Retrospective analysis of data collected from administrative and surgical databases of a tertiary care centre. The patients were divided in two groups,wherein the Group A constituted patients who belonged to succinylcholine and Group B represents the patients who were treated with rocuronium.The baseline demographic characteristics, MACE including intubation difficulty score and Cormack Lahne grade of intubation were recorded. Results: A total of 134 patients were included in the study. Baseline characters were similar in both the groups. There were 2 deaths in the succinylcholine group while 3 in the rocuronium group. The MACE was not statistically significant (p= 0.0505) in both groups. Cormack Lahane scale and intubation difficulty scale were similar in both groups. Conclusion: Succinylcholine was found to be equally efficient and safe in comparison with rocuronium in terms of MACE during coronary artery bypass surgery.

scholarly journals Impact of body mass index on major adverse cardiac events after coronary artery bypass graft surgery

2016 ◽  
Vol 11 (10-11) ◽  
pp. 458-458
Author(s):  
Josip Vincelj ◽  
Sandra Jakšić Jurinjak ◽  
Mario Udovičić ◽  
Kristina Milevoj Križić ◽  
Ante Lisičić ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Body Mass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Cardiac Events ◽  
Adverse Cardiac Events

Post-Coronary Artery Bypass Medications in Dialysis Patients: Do We Need to Change Strategies?

2019 ◽  
Vol 68 (08) ◽  
pp. 706-713
Author(s):  
Yu-Ning Hu ◽  
Chwan-Yau Luo ◽  
Meng-Ta Tsai ◽  
Ting-Wei Lin ◽  
Chung-Dann Kan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Dialysis Patients ◽  
Cardiac Events ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Adverse Cardiac Events ◽  
Β Blocker

Abstract Background Coronary artery bypass grafting (CABG) is frequently performed in patients with end-stage renal disease (ESRD) together with severe coronary artery disease, after which, patients with ESRD have higher surgical risk and poorer long-term outcomes. We report our experience in patients with ESRD who survived in CABG and identify predictors of long-term outcomes. Methods We retrospectively investigated 93 consecutive patients with ESRD who survived to discharge after isolated CABG between January 2005 and December 2016 at our institution. Long-term outcomes, including all-cause mortality after discharge, readmission due to major adverse cardiac events, and reintervention, were evaluated. Predictors affecting long-term outcomes were also analyzed. Results The rates of freedom from all-cause mortality after discharge in 1, 3, 5, and 10 years were 92.1, 81.3, 71.9, and 34.9%, respectively. The rates of freedom from readmission due to major adverse cardiac events in 1, 3, 5, and 10 years were 90.7, 79.1, 69.9, and 55.6%, respectively. The rates of freedom from reintervention in 1, 3, 5, and 10 years were 95.3, 86.5, 79.0, and 66.6%, respectively. Postoperative β-blocker and statin use significantly improved overall long-term survival (β-blocker, p = 0.013; statin, p = 0.009). After case–control matching, patients who received statins showed better long-term survival than those without statins. The comparison of long-term survival between patients with and without β-blockers showed no significant difference after matching. Conclusions After CABG, dialysis patients who survived to discharge had acceptable long-term overall survival. Post-CABG statin use in dialysis patients is a predictor of better long-term survival.

scholarly journals Calcification markers and long-term outcomes of coronary artery bypass grafting

2021 ◽  
Vol 26 (8) ◽  
pp. 4450
Author(s):  
E. M. Stakhneva ◽  
E. V. Kashtanova ◽  
A. V. Kurguzov ◽  
N. A. Maslatsov ◽  
Ya. V. Polonskaya ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Coronary Atherosclerosis ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Bypass Grafting ◽  
Long Term Outcomes ◽  
Artery Bypass Grafting

Aim. To assess the long-term outcomes of coronary artery bypass grafting (CABG) and their association with calcification biomarkers.Material and methods. The study included 129 men (mean age, 61,5±7,5 years) with coronary atherosclerosis who were admitted for CABG surgery. Patients were divided into 2 groups: with favorable and unfavorable (death, myocardial infarction, stroke, surgery) 5-year prognosis after surgery. Before the surgery, the blood concentrations of calcification biomarkers (osteoprotegerin, osteopontin, osteonectin and osteocalcin) were determined in all patients.Results. Long-term outcomes of myocardial revascularization were studied in 92 patients (71%). An unfavorable long-term 5-year period was identified in 28 men (30,4%). In men with an unfavorable 5-year prognosis, the blood osteocalcin level before CABG was 1,2 times higher than in men with a favorable one. Multivariate linear regression showed that the risk of a 5-year unfavorable prognosis for coronary atherosclerosis after myocardial revascularization was associated with the blood osteocalcin concentration, determined before CABG (B=0,018, R2=0,285, p=0,008).Conclusion. The data obtained indicate the relevance of continuing studies on osteocalcin, including with respect to its contribution to coronary atherosclerosis and calcification.

Effectivity of dexamethasone in patients undergoing off-pump coronary artery bypass surgery

2020 ◽  
pp. 021849232097764
Author(s):  
Dudy Arman Hanafy ◽  
I Komang Adhi Parama Harta ◽  
I Made Indra Prasetya ◽  
Pribadi Wiranda Busroh ◽  
Tri Wisesa Soetisna ◽  
...  
Keyword(s):  
Placebo Group ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Cardiac Events ◽  
Off Pump ◽  
Dexamethasone Group ◽  
Adverse Cardiac Events ◽  
Pump Coronary Artery Bypass

Background Based on our previous pilot study, systemic inflammatory response syndrome is more common in off-pump compared to on-pump coronary artery bypass. Therefore, we conducted a clinical trial of dexamethasone in patients undergoing off-pump coronary artery bypass. Methods Sixty consecutive patients undergoing off-pump coronary artery bypass were enrolled from August 2018 to January 2019 and randomized to a dexamethasone or placebo group of 30 each. Clinical outcomes were analyzed. Results There was a lower incidence of major adverse cardiac events in the dexamethasone group compared to the placebo group (17% versus 43%, p = 0.024). Clinical outcomes in the dexamethasone group were better than those in the placebo group, in terms of duration of mechanical ventilation ( p = 0.029), intensive care unit stay ( p = 0.028), hospital stay ( p = 0.04), and vasoactive-inotropic score ( p = 0.045). There were significant differences in inflammatory markers between the two groups: interleukin-6 ( p = 0.0001), procalcitonin ( p = 0.0001), and C-reactive protein ( p = 0.0001) were lower in the dexamethasone group. There was a significant association between the incidence of major adverse cardiac events and both interleukin-6 ( p = 0.005) and procalcitonin ( p = 0.007). Conclusion Preoperative dexamethasone in patients undergoing off-pump coronary artery bypass is effective in improving clinical outcomes and controlling the postoperative inflammatory reaction.

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