Abstract 18855: Outcomes after Coronary Artery Bypass Graft Surgery in Patients Treated with Thoracic Radiotherapy for Cancer

Introduction: Thoracic external beam radiation therapy (XRT) for cancer is associated with a multitude of long-term cardiotoxic side effects. Previous studies have suggested worse outcomes in XRT-treated cancer survivors who undergo revascularization with CABG, but sample sizes have been small. In addition, XRT after CABG is thought to portend decreased patency and survival. We aimed to examine outcomes after CABG in patients with XRT compared with to those without XRT. Methods: We identified all patients who were treated with both CABG (between 1999 and 2013) and curative thoracic XRT for cancer (between 1971 and 2013) (>30 Gray). Baseline clinical characteristics and comorbidities at time of CABG, as well as long-term outcomes after CABG and XRT were compared with propensity matched control cohorts. Results: A total of 38 patients underwent CABG following XRT [Group 1] (mean age 67.9, 63% female) and 43 patients underwent XRT after CABG [Group 2] (mean age 69.3, 63% female). Compared with propensity-matched controls (Group 1: n=141; Group 2: n=167), baseline clinical and demographic characteristics between cases and controls were similar in both groups, except a lower incidence of triple vessel disease in XRT cases in Group 2 (64 vs 80%, p=0.02). For Group 1, there was no significant difference in all-cause survival in long-term follow-up after CABG (Fig. 1, p=0.72). Meanwhile, Group 2 cases had significantly higher all-cause mortality following XRT (Fig. 2, p<0.001). Conclusions: Patients previously treated with thoracic XRT who subsequently undergo CABG for coronary artery disease have a similar overall mortality rate compared to patients without prior XRT. This suggests that CABG is an effective method of revascularization in these patients. The higher mortality rates in CABG patients who subsequently develop disease requiring thoracic XRT is likely due to oncologic rather than cardiovascular causes, but more data are necessary to evaluate this finding.

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The effect of low-dose epsilon-aminocaproic acid on patients following coronary artery bypass surgery

Perfusion ◽

10.1177/026765919601100107 ◽

1996 ◽

Vol 11 (1) ◽

pp. 53-56 ◽

Cited By ~ 14

Author(s):

Ralph M Montesano ◽

Patricia A Gustafson ◽

David A Palanzo ◽

Norman J Manley ◽

Farrokh S Sadr

Keyword(s):

Coronary Artery ◽

Low Dose ◽

Artery Bypass ◽

Aminocaproic Acid ◽

Significant Difference ◽

Antifibrinolytic Drugs ◽

Blood Usage ◽

Group 2 ◽

Epsilon Aminocaproic Acid ◽

Group 1

The effect of low-dose epsilon-aminocaproic acid (EACA) on the postoperative course of 46 patients was studied. Patients undergoing coronary artery bypass grafting were randomly selected in two groups. Group 1 (20 patients) received 5 g EACA upon initiation of cardiopulmonary bypass (CPB). Group 2 (26 patients) received no antifibrinolytic drugs prior to CPB. Neither group received antifibrinolytic drugs after CPB. There was no significant difference between the two groups' blood usage on CPB: 0.65 units in Group 1 and 0.60 units in Group 2. After CPB, blood usage significantly differed: 2.2 ± 1.7 (SD) units in Group 1 and 3.9 ± 3.0 units in Group 2 (p = 0.033). Significant difference was also demonstrated in postoperative blood loss in the first 24 hours: 1610 ± 531 ml in Group 1 versus 2025 ± 804 ml in Group 2 (p = 0.043). Pre-CPB administration of low-dose EACA significantly decreases blood loss and blood usage in the postoperative period.

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Long-term outcomes of patients with stable coronary disease and chronic kidney dysfunction: 10-year follow-up of the Medicine, Angioplasty, or Surgery Study II Trial

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy379 ◽

2018 ◽

Vol 35 (8) ◽

pp. 1369-1376 ◽

Cited By ~ 1

Author(s):

Eduardo Gomes Lima ◽

David M Charytan ◽

Whady Hueb ◽

Diogo Freitas Cardoso de Azevedo ◽

Cibele Larrosa Garzillo ◽

...

Keyword(s):

Coronary Artery ◽

Proportional Hazards ◽

Artery Bypass ◽

Stable Coronary Artery Disease ◽

Bypass Graft ◽

Long Term Outcomes ◽

Clinical Trial Registration ◽

Significant Difference

Abstract Background Chronic kidney disease (CKD) is associated with a worse prognosis in patients with stable coronary artery disease (CAD); however, there is limited randomized data on long-term outcomes of CAD therapies in these patients. We evaluated long-term outcomes of CKD patients with CAD who underwent randomized therapy with medical treatment (MT) alone, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Methods Baseline estimated glomerular filtration rate (eGFR) was obtained in 611 patients randomized to one of three therapeutic strategies in the Medicine, Angioplasty, or Surgery Study II trial. Patients were categorized in preserved renal function and mild or moderate CKD groups depending on their eGFR (≥90, 89–60 and 59–30 mL/min/1.73 m2, respectively). The primary clinical endpoint, a composite of overall death and myocardial infarction, and its individual components were analyzed using proportional hazards regression (Clinical Trial registration information: http://www.controlled-trials.com. Registration number: ISRCTN66068876). Results Of 611 patients, 112 (18%) had preserved eGFR, 349 (57%) mild dysfunction and 150 (25%) moderate dysfunction. The primary endpoint occurred in 29.5, 32.4 and 44.7% (P = 0.02) for preserved eGFR, mild CKD and moderate CKD, respectively. Overall mortality incidence was 18.7, 23.8 and 39.3% for preserved eGFR, mild CKD and moderate CKD, respectively (P = 0.001). For preserved eGFR, there was no significant difference in outcomes between therapies. For mild CKD, the primary event rate was 29.4% for PCI, 29.1% for CABG and 41.1% for MT (P = 0.006) [adjusted hazard ratio (HR) = 0.26, 95% confidence interval (CI) 0.07–0.88; P = 0.03 for PCI versus MT; and adjusted HR = 0.48; 95% CI 0.31–0.76; P = 0.002 for CABG versus MT]. We also observed higher mortality rates in the MT group (28.6%) compared with PCI (24.1%) and CABG (19.0%) groups (P = 0.015) among mild CKD subjects (adjusted HR = 0.44, 95% CI 0.25–0.76; P = 0.003 for CABG versus MT; adjusted HR = 0.56, 95% CI 0.07–4.28; P = 0.58 for PCI versus MT). Results were similar with moderate CKD group but did not achieve significance. Conclusions Coronary interventional therapy, both PCI and CABG, is associated with lower rates of events compared with MT in mild CKD patients >10 years of follow-up. More study is needed to confirm these benefits in moderate CKD.

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The effect of omega-3 polyunsaturated fatty acids in prevention of postoperative atrial fibrillation development in patients undergoing coronary artery bypass graft surgery

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.005 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

O Rubanenko ◽

A Rubanenko

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Postoperative Period ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Omega 3 ◽

Median Level ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Purpose. To estimate the effect of omega-3 polyunsaturated fatty acids (PUFAs) in prevention of postoperative atrial fibrillation (POAF) in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery. Methods. Studied were 306 patients who underwent CABG. All the patients were divided into two groups depending on the prescription of omega-3 PUFAs in the pre- and postoperative period by randomization method: 1 group comprised 158 patients without PUFAs (82.7% men, median age 63.0 (57.0;67.0) years, 2 group - 148 patients with PUFAs (89.3% men, median age 60.0 (57.0;64.0) years). PUFAs were prescribed 2000 mg daily starting with 5 days before CABG and 1000 mg daily after CABG for 21 days. In all the patients, we studied interleukin (IL)-6, IL-8, IL-10, NT-proBNP, troponin, superoxide dismutase (SOD), malondialdehyde (MDA), glutathione and omega-3 index. Results. During the observation period POAF occurred in 29.7% patients of group 1, and in 16.9% patients of group 2 (p = 0.009). In postoperative period patients of group 1 had median IL-6 level 39.3% higher (p = 0.001) and median IL-10 level - 20.2% higher (p = 0.01) comparing with group 2. In patients of group 2 we found SOD median level 78.9% lower (р<0.0001) and MDA median level 33.8% lower compared to the patients of group 1 (р=0.03). In postoperative period in group 2 the median level of docosahexaenoic acid was 55% higher (p = 0.03), and omega-3 index - 43.4% higher (h = 0.04) compared with group 1. Conclusion. We found that patients with PUFAs had less activation of inflammation and oxidative stress after CABG than patients without PUFAs. The patients with PUFAs also had increased levels of docosahexaenoic acids and omega-3 index compared to the patients without PUFAs. We also found a significant decrease of the prevalence of POAF after CABG in patients with PUFAs.

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Comparison of Isolated Primary CABG in Two Successive Decades in Patients Under 40 Years of Age

The Heart Surgery Forum ◽

10.1532/hsf.1448 ◽

2016 ◽

Vol 19 (3) ◽

pp. 139

Author(s):

Przemyslaw Trzeciak ◽

Marian Zembala ◽

Piotr Desperak ◽

Wojtek Karolak ◽

Michal Zembala ◽

...

Keyword(s):

Artery Bypass ◽

Bypass Graft ◽

Young Patients ◽

Coronary Intervention ◽

Off Pump ◽

End Point ◽

Percutaneous Coronary ◽

Significant Difference ◽

Group 2 ◽

Group 1

Background: Coronary artery bypass graft (CABG) surgery is rarely performed in very young patients. The purpose of our study is to compare the characteristics, treatments, in-hospital, and long-term outcomes of two groups of patients less than 40 years of age who had CABG in two successive decades: 1990-2000 and 2001-2011. Methods: We identified 145 consecutive patients who underwent primary isolated CABG. Group 1 consisted of 78 patients operated between 1990-2000 and group 2 consisted of 67 patients operated between 2001-2011. Composite end point assessed at follow-up period involved death or recurrence of symptoms, which we defined as myocardial infarction, a need for percutaneous coronary intervention (PCI), reoperation, or congestive heart failure (CHF). Results: Smoking and hypercholesterolemia before CABG were noted as more frequent in group 1 than in group 2: 96.1% versus 83.6%, P = .011; 88.5% versus 61.2%, P = .0001, respectively. Patients from group 2 more frequently received one graft (29.8% versus 11.5%, P = .0059), were operated with off-pump (41.8% versus 0%, P < .0001) or MIDCAB (28.4% versus 0%, P = .0008) techniques, and had complete arterial revascularization (58.2% versus 23.1%, P < .0001). Group 1 patients had a higher prevalence of composite end point (33.9% versus 17.9%, P = .035), with no significant difference in mortality (11.5% versus 10.4%, P = .83). Conclusion: Patients operated between 1990-2000 had a higher prevalence of smoking and hypercholesterolemia and higher frequency of composite-end point during folow-up period without significant difference in mortality.

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COMPARISON OF THE EFFECT OF ANTEGRADE AND ANTEGRADE/RETROGRADE CARDIOPLEGIA ON THE OUTCOME OF CORONARY ARTERY BYPASS GRAFT SURGERY FOR SEVERE CORONARY ARTERY DISEASE

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70isuppl-4.6026 ◽

2021 ◽

Vol 70 (Suppl-4) ◽

pp. S792-98

Author(s):

Ali Gohar Zamir ◽

Asif Mahmood Janjua ◽

Musfireh Siddiqeh ◽

Farrah Pervaiz ◽

Noor Shah ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Protection ◽

Artery Bypass ◽

Bypass Graft ◽

Vessel Coronary Artery Disease ◽

Group 2 ◽

Artery Disease ◽

Vessel Coronary Artery ◽

Group 1

Objective: To compare the early outcome of Coronary Artery Bypass Graft surgery using a combination of antegrade and retrograde cardipoplegia with that utilizing antegrade cardioplegia alone in triple vessel coronary artery disease. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Adult Cardiac Surgery of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from Sep 2013 to Apr 2019. Methodology: A total of 160 patients with triple vessel coronary artery disease who underwent CABG surgery for 90% or greater stenos is in at least one major vessel in each of the three territories, namely the left anterior descending, the circumflex and the right coronary artery were investigated retrospectively. These were divided into 2 equal groups on the basis of the technique of administration of cardioplegia: in group-1 only ante grade blood cardioplegia was administered for myocardial protection and group-2 was given ante grade and retrograde cardiolplegia. Clinical outcomes like peri-operative mortality and morbidity were recorded, and serum creatine kinase MB, lactate, and mixed venous oxygen saturation levels were monitored. Two dimensional echocardiogram was performed on the 6th post-operative day and follow-up visits were planned 1 week and 4 weeksafter discharge from hospital. Results: There were 2 (2.5%) early deaths in group-1 and no peri-operative mortality in group-2. Five patients in group-1 (6.25%) and 2 (2.5%) in group-2 had non-fatal peri-operative myocardial infarction. However, significant differences included increased incidence of intra-operative ventricular dysrythmias, higher CK-MB levels at 24 hours after surgery, and increased requirement of intra-aortic balloon pump and inotropic support in Group-1. Conclusion: We conclude from this study that the combined delivery of ante grade and retrograde cardioplegia during CABG surgery for triple vessel coronary artery disease provides better myocardial protection and hence better outcome than antegrade cardioplegia alone.Keywords: , , ,

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Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting

The Heart Surgery Forum ◽

10.1532/hsf.1341 ◽

2015 ◽

Vol 18 (6) ◽

pp. 255 ◽

Cited By ~ 7

Author(s):

Hüseyin Şaşkın ◽

Çagrı Düzyol ◽

Kazım Serhan Özcan ◽

Rezan Aksoy ◽

Mustafa Idiz

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Platelet To Lymphocyte Ratio ◽

Artery Bypass Grafting ◽

Lymphocyte Ratio ◽

Group 2 ◽

Group 1

Objective: To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation. Methods: We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142. Results: The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality. Conclusion: In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

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