Abstract 4778: Postoperative ST2 Blood Concentrations Predict One Year Mortality in Coronary Artery Bypass Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Michael C Grant ◽  
Robert Christenson ◽  
Jeffrey Gray ◽  
Jeremy S Pollock ◽  
Eric Christenson ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Troponin I ◽  
Strong Predictor ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Blood Concentrations ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death

Soluble ST2 (sST2) is released from myocytes in response to mechanical overload and predicts poor outcome in heart failure and myocardial infarction. We evaluated the capability of early sST2 release after coronary artery bypass surgery (CABG) to predict mortality during the first postoperative year. We prospectively evaluated sST2 baseline prior to CABG (BL), immediately after CABG (post), and 24h and 72h. The primary endpoint of the study was all-cause mortality at 1 year. Of the 210 patients enrolled, death occurred in 3 (1.5%) within 30 days and 20 (9.5%) by 1 year. sST2 levels did not change immediately post-CABG (BL: 0.32±0.42, post: 0.42±0.46) but became significantly elevated at 24h and 72h (3.39±3.08, 0.95±1.04 ng/ml; P<0.001). Compared to survivors, sST2 was significantly elevated in decedents at 24h (7.68±3.15 vs. 2.78±2.56, P<0.001) and 72h (1.56±1.62 vs. 0.88±0.44, P<0.03). On ROC analysis, sST2 at 24h strongly predicted death at 1 yr (AUC 0.868, 95% CI=0.77– 0.96). In multivariate analysis, sST2 level was a more powerful predictor of death (OR 17.0, P<0.0001) than traditional predictors (STS risk score, age, left ventricular ejection fraction) or other biomarkers (OR 1.59, P<0.0001) including troponin I, CPK-MB, and NT-pBNP. Although operative mortality was better than predicted by STS score, the 9.5% risk of death over 1yr highlights the need to better stratify mortality risk in order to guide appropriate follow-up after hospital discharge. As a strong predictor of 1yr mortality, independent of traditional laboratory or clinical variables, the sST2 level at 24 hrs may help advance this goal.

A Comparison of Success Rate in Off-Pump Coronary Artery Bypass Grafting Surgery among Patients with Varying Preoperative Left Ventricular Ejection Fractions: Retrospective Observational Study

2021 ◽  
Vol 104 (8) ◽  
pp. 1309-1316
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Off Pump ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

Background: Off-pump coronary artery bypass grafting (OPCAB) is an alternative to coronary artery revascularization and avoids the complications of cardiopulmonary bypass (CPB). The procedure’s success, however, depends on intraoperative hemodynamic stability. Preoperative cardiac function can predict the tolerance to compromised hemodynamics during cardiac surgery. Inability to manage hypotension and low cardiac output while manipulating the heart is the most frequent cause of intraoperative conversion to CPB. Objective: The authors investigated the effects of the preoperative left ventricular ejection fraction (LVEF) on the success of OPCAB surgery and the relation of intraoperative factors to the success of OPCAB surgery. Material and Methods: Medical records of 284 patients who underwent OPCAB surgery in Ramathibodi Hospital between January 2015 and December 2017 were retrospectively reviewed. Preoperatively, the patients were classified into groups 1 to 4 based on LVEFs of 50% to 70%, 40% to 49%, 30% to 39%, and <30%, respectively. Preoperative characteristics were collected. Intraoperative success of OPCAB surgery, application of inotropes, vasopressor, fluid, and intra-aortic balloon pump (IABP), and post-operative outcomes were analyzed and compared among the four LVEF groups. Results: No significant differences in success of OPCAB surgery emerged among the four groups (p=0.430). Intraoperative requirements of IABP were significantly higher for LVEF <30% patients (p=0.001). In addition, the time to extubation was significantly delayed (p=0.001) and the LVEF <30% patients stayed longer in intensive care unit (ICU) (p=0.002) when compared with the good LVEF patients. There were no significant differences in the operative time, amount of intravenous fluid, blood transfusion requirement, or blood loss among the groups. There were no significant differences in major postoperative morbidities. Conclusion: OPCAB surgery can be performed successfully in patients with severe cardiac dysfunction (LVEF <30%) without significant differences from LVEF ≥30% patients, although the need for an intraoperative IABP device and inotropic drugs for hemodynamic support were greater and the extubation times and ICU stays were longer. Keywords: Coronary artery bypass graft; Left ventricular ejection fraction; Off-pump CABG; OPCAB; Poor cardiac function

scholarly journals Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001027 ◽  
Author(s):  
Davorin Sef ◽  
Janko Szavits-Nossan ◽  
Mladen Predrijevac ◽  
Rajna Golubic ◽  
Tomislav Sipic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Bypass ◽  
Myocardial Ischaemia ◽  
Graft Failure ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

ObjectivesUpdated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome.MethodsAmong 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints.ResultsOverall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op).ConclusionsUrgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.

Minimally Invasive Direct Coronary Artery Bypass as a Primary Strategy for Reoperative Myocardial Revascularization

2010 ◽  
Vol 5 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Lognathen Balacumaraswami ◽  
Nirav C. Patel ◽  
Hagen Gorki ◽  
Joan Jennings ◽  
Konstadinos A. Plestis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Risk Profile ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hospital Outcomes ◽  
Ventricular Ejection Fraction

Objective Conventional reoperative coronary artery bypass grafting is associated with risk of sternal re-entry, injury to patent grafts, and embolization from diseased grafts. Sternal sparing minimally invasive direct coronary artery bypass (MIDCAB) avoids such risks in cases where it is technically feasible. We sought to examine in-hospital outcomes of reoperative MIDCAB surgery. Methods We recorded prospective standardized data from the New York Cardiac Surgical Reporting System database of 369 reoperative MIDCAB cases from 1996 to 2006 and compared with 822 primary MIDCAB patients in the same time period. We compared the preoperative risk profile and postoperative in-hospital outcomes and length of stay for both groups. Results There was a significantly higher risk profile typical of the reoperative patient population (P < 0.001 for stroke, peripheral/cerebrovascular disease, extensive aortic calcification, renal failure, and left ventricular ejection fraction <40%) compared with the primary MIDCAB group. Despite this fact, there was no difference in the in-hospital outcomes and length of hospital stay between the two groups. Conclusions Reoperative MIDCAB provides targeted coronary revascularization and avoids hazards of sternal re-entry, graft injury and manipulation, and deleterious effects of cardiopulmonary bypass. This hastens recovery and provides excellent early outcomes equivalent to primary MIDCAB procedures.

scholarly journals Myocardial Expression of PPARγand Exercise Capacity in Patients after Coronary Artery Bypass Surgery

PPAR Research ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Izabela Wojtkowska ◽  
Tomasz A. Bonda ◽  
Jadwiga Wolszakiewicz ◽  
Jerzy Osak ◽  
Andrzej Tysarowski ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Walking Test ◽  
6Mwt Distance ◽  
The Relationship

Activation of PPARs may be involved in the development of heart failure (HF). We evaluated the relationship between expression of PPARγin the myocardium during coronary artery bypass grafting (CABG) and exercise tolerance initially and during follow-up. 6-minute walking test was performed before CABG, after 1, 12, 24 months. Patients were divided into two groups (HF and non-HF) based on left ventricular ejection fraction and plasma proBNP level. After CABG, 67% of patients developed HF. The mean distance 1 month after CABG in HF was397±85 m versus420±93 m in non-HF. PPARγmRNA expression was similar in both HF and non-HF groups. 6MWT distance 1 month after CABG was inversely correlated with PPARγlevel only in HF group. Higher PPARγexpression was related to smaller LVEF change between 1 month and 1 year (R=0.18,p<0.05), especially in patients with HF. Higher initial levels of IL-6 in HF patients were correlated with longer distance in 6MWT one month after surgery and lower PPARγexpression. PPARγexpression is not related to LVEF before CABG and higher PPARγexpression in the myocardium of patients who are developing HF following CABG may have some protecting effect.

scholarly journals Association between Smoking and In-hospital mortality in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery: A Propensity-matched Study

2021 ◽  
Author(s):  
Hanwei Tang ◽  
Jianfeng Hou ◽  
Kai Chen ◽  
Xiaohong Huang ◽  
Sheng Liu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Hospital Mortality ◽  
Coronary Artery Bypass ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract BackgroundData on the effect of smoking on In-hospital outcome in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery are limited. We sought to determine the influence of smoking on CABG patients with left ventricular dysfunction.MethodsA retrospective study was conducted using data from the China Heart Failure Surgery Registry database. Eligible patients with left ventricular ejection fraction less than 50% underwent isolated CABGS were included. In addition to the use of multivariate regression models, a 1 to 1 propensity scores matched analysis was performed. Our study (n=6,531) consisted of 3,635 smokers and 2896 non-smokers. Smokers were further divided into ex-smokers (n=2373) and current smokers (n=1262).ResultsThe overall in-hospital morality was 3.9%. Interestingly, current smokers have lower in-hospital mortality than non-smokers (2.3% vs 4.9%; adjusted odds ratio [OR], 0.612 [95%CI, 0.395-0.947]). No difference was detected in mortality between ex-smokers and non-smokers (3.6% vs 4.9%; adjusted OR, 0.974 [0.715-1.327]). No significant differences in other clinical end points were observed. Results of propensity-matched analyses were broadly consistent.ConclusionsIt is paradoxically that current smokers had lower in-hospital mortality than non-smokers. Future studies should be performed to further understand the biological mechanisms that may explain this ‘smoker’s paradox’ phenomenon.

Abstract 3040: Coronary Artery Bypass Surgery In 14,956 Patients With Cardiogenic Shock: The Society Of Thoracic Surgeons National Database Experience

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Rajendra H Mehta ◽  
Joshua D Grab ◽  
Sean M O’Brien ◽  
Donald D Glower ◽  
Jeffrey P Jacobs ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
National Database ◽  
Ventricular Ejection Fraction

Background . While only a small minority of patients undergo coronary artery bypass surgery (CABG) in the setting of cardiogenic shock (CS), these patients face a high risk for mortality and morbidity. There exist few studies that characterize clinical features and outcomes in CS patients undergoing CABG in contemporary community practice. Methods . We evaluated data of 14,956 patients with CS in comparison with 693637 without CS undergoing CABG between 2002 and 2005 at hospitals participating in the Society of Thoracic Surgeons National Database. Clinical, angiographic and operative features and in-hospital outcomes were studied in patients with and without CS. Results . Patients with preoperative CS constituted 2.1% of patients undergoing CABG yet accounted for 16% of all CABG deaths. These patients had greater comorbid conditions and left main disease and lower left ventricular ejection fraction. In-hospital events and length of hospital stay (median 96 vs. 36 days) were significantly higher in CS patients. Operative mortality was high (rising from 20% for isolated CABG, to 33% for CABG+ valve surgery, to 58% for CABG+ ventricular septal repair). While mortality for CABG surgery overall has declined significantly overtime (p for trend< .0001), mortality for CS patients have not changed significantly over the 4 year study period (p= .07, Figure ). Conclusions . Patients with CS represents minority of patients undergoing CABG, yet with persistently high operative risks. These patients in fact account for 1 of every 7 deaths in patients undergoing CABG. Ongoing efforts are warranted to continuously develop and evaluate new strategies to improve outcomes of these patients.

Can Surgeons Do Complete Revascularization in Diabetic Patients Using the Off-Pump Technique?

2007 ◽  
Vol 2 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Kitipan V. Arom ◽  
Vibul Jotisakulratana ◽  
Vitoon Pitiguagool ◽  
Sujit Banyatpiyaphod ◽  
Sawat Asawapiyanond ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Complete Revascularization ◽  
Ventricular Ejection Fraction ◽  
Off Pump ◽  
Poor Outcomes

Background The arguments are discussed as to whether or not to proceed with multivessel percutaneous coronary intervention, with or without a drug-eluting stent, in patients with diabetes mellitus (DM), including (1) surgeons unable to complete revascularization because of smaller native arteries; and (2) diabetic patients being sicker and having higher operative mortality rates than nondiabetic patients (non-DM), particularly with the conventional coronary artery bypass surgery (on-pump) technique. To support or dispute the claims, a retrospective review of 480 consecutive patients at a single institution (195 DM and 285 non-DM) was carried out. Observations were made to see whether diabetes is a predictor of poor outcomes. Materials and Methods The preoperative comorbidity, intraoperative measurement of the size of the artery at the site of anastomosis with different gauged probes, and the number of grafts per patient were recorded. Intraoperative and postoperative variables between two groups were compared. The observed number of grafts (O) after surgery was compared with the number of grafts predicted (P) before surgery. The O/P ratio or “completion index” of ≥1 signifies complete revascularization. Logistic regression analysis was used to test the possibility that diabetes is a predictor of poor outcomes. Results Diabetic patients were older, with more comorbidity (congestive heart failure, peripheral vascular diseases, dialysis-dependent). The number of grafts per patient was 4.2 ± 1.3 (DM) and 4.2 ± 1.3 (non-DM). The size of 742 DM and 949 non-DM arteries were gauged. There was no statistical difference in size between DM and non-DM (in millimeters) at each artery. All ratios ranged from 0.9 to 1.2, indicating similarity between DM and non-DM. The only significant risk factor for operative death was low left ventricular ejection fraction (P = 0.001). Conclusions Patients with DM were sicker but tolerated off-pump coronary artery bypass grafting as well as non-DM patients. The number of grafts per patient and O/P ratio signify the ability to perform complete revascularization. We are able to bypass the small target vessels, as anticipated. Diabetes is not a predictor of the outcomes.

scholarly journals Novel approaches to the assessment of cardiorespiratory readiness of patients after coronary artery bypass surgery aimed to the efficient cardiac rehabilitation performance

2021 ◽  
Vol 12 (3) ◽  
pp. 139-146
Author(s):  
Tea T. Kakuchaya ◽  
Tamara G. Dzhitava ◽  
Arjanа M. Kuular ◽  
Nona V. Pachuashvili ◽  
Zarina K. Tokaeva
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Training Programs ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Training Activities

Aim. To develop novel strategies of patients selection and risk stratification after coronary artery bypass surgery before starting aerobic cardiorespiratory training programs. Material and methods. One hundred thirty seven patients 4 weeks after coronary artery bypass surgery were included in our study. RARE scale (risk of activity related events), ergospirometric test, FIT treadmill score and certain laboratory parameters like hemoglobin and alaninaminotransferase were used. Results. Logical interdependence is revealed between certain indicators of cardiorespiratory capacity and risk of developing unfavorable events due to aerobic training activities. Comprehensive protocol is developed based on multifactorial regression analysis, which allows to differentiate patients into low and high class of readiness to physical activities, including aerobic cardiorespiratory training programs. Conclusion. The protocol includes following variables METs, RARE scale, FIT treadmill score, left ventricular ejection fraction, hemoglobin and alaninaminotransferase levels. It is very userfriendly, easy, practical and efficient.

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