Predictors for unsuccessful weaning from venoarterial extracorporeal membrane oxygenation in patients undergoing coronary artery bypass grafting

Perfusion ◽  
2020 ◽  
Vol 35 (7) ◽  
pp. 598-607
Author(s):  
Juanjuan Shao ◽  
Liangshan Wang ◽  
Hong Wang ◽  
Xiaotong Hou
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Confidence Interval ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation

Background: Studies reporting risk factors associated with unsuccessful weaning for coronary artery bypass grafting patients on venoarterial extracorporeal membrane oxygenation are scarce. This study was designed to identify factors associated with unsuccessful weaning from venoarterial extracorporeal membrane oxygenation. Methods: Data from 166 coronary artery bypass grafting patients supported with venoarterial extracorporeal membrane oxygenation at the Beijing Anzhen Hospital between February 2004 and March 2017 were retrospectively analyzed. Multivariable logistic regression was performed using bootstrapping methodology to identify factors independently associated with unsuccessful weaning from venoarterial extracorporeal membrane oxygenation. Results: A total of 106 patients (64%) could be weaned from venoarterial extracorporeal membrane oxygenation, and 74 patients (45%) were alive at hospital discharge. The 30-day and 60-day survival rates after ECMO weaning were 72% and 70%, respectively. Pre-existing hypertension (odds ratio, 2.54; 95% confidence interval, 1.16-5.56; p = 0.02), serum creatinine (+1 μmol/L; odds ratio, 1.008; 95% confidence interval, 1.003-1.013; p = 0.001), and serum lactate (+1 mmol/L; odds ratio, 1.17; 95% confidence interval, 1.08-1.26; p = 0.001) were independent risk factors associated with unsuccessful weaning from venoarterial extracorporeal membrane oxygenation. Higher platelet count was protective (+1 × 109/L; odds ratio, 0.992; 95% confidence interval, 0.986-0.998; p = 0.011). The area under the receiver operating characteristic curve 0.81 (95% confidence interval, 0.75-0.88) for the logistic regression model was better than those for the survival after VA-ECMO score (p = 0.002), EuroSCORE (p < 0.001), and the prEdictioN of Cardiogenic shock OUtcome foR Acute myocardial infarction patients salvaGed by VA-ECMO scores (p = 0.02) in this population. The pRedicting mortality in patients undergoing venoarterial Extracorporeal MEMBrane oxygenation after coronary artEry bypass gRafting (0.76; 95% confidence interval, 0.68-0.83; p = 0.29) and sepsis-related organ failure assessment score (0.77; 95% confidence interval, 0.70-0.85; p = 0.46) exhibited good performances similar to the logistic regression model. Conclusion: Pre-existing hypertension, serum creatinine, serum lactate, and low platelet count were independent predictors for unsuccessful weaning from venoarterial extracorporeal membrane oxygenation in patients undergoing coronary artery bypass grafting.

scholarly journals Surgical outcomes in cardiogenic shock patients with preoperative extracorporeal membrane oxygenation (ECMO)

2021 ◽  
Author(s):  
Mahmoud Yousef Ibrahim Abuharb ◽  
Dong Ran ◽  
Zheng Jubing
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Coronary Artery Bypass ◽  
Surgical Outcomes ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Membrane Oxygenation

Abstract Objectives To summarise the surgical outcomes in patients with cardiogenic shock supported by preoperative extracorporeal membrane oxygenation (ECMO). Methods Between May 2012 and August 2017, eight patients with cardiogenic shock patients supported by ECMO underwent emergency surgery; four of them had isolated coronary artery bypass grafting, three had coronary artery bypass grafting with mitral replacement, and one had mitral valve replacement with left ventricular posterior wall repair. Results All eight patients successfully weaned off from ECMO after their surgeries. Postoperative ECOM time ranged from 6.8 to 228 hours, with a median of 68.4 hours. Two patients died postoperatively while another six survived. The follow up time for the six patients was ranged from three to 66 months whereby one of them died in the third month due to septicaemia. The remaining five patients survived with good cardiac function based on the NYHA classification. Conclusion ECMO is a vital bridge in the preparation of critically-ill patients for cardiac surgery. It is associated with acceptable outcomes among the majority of the patients.

scholarly journals Surgical outcomes in cardiogenic shock patients with preoperative extracorporeal membrane oxygenation (ECMO)

2021 ◽  
Author(s):  
Mahmoud Yousef Ibrahim Abuharb ◽  
Dong Ran ◽  
Zheng Jubing
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Coronary Artery Bypass ◽  
Surgical Outcomes ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Membrane Oxygenation

Abstract Objectives To summarise the surgical outcomes in patients with cardiogenic shock supported by preoperative extracorporeal membrane oxygenation (ECMO). Methods Between May 2012 and August 2017, eight patients with cardiogenic shock, who were supported by ECMO, underwent emergency surgery; four of them had isolated coronary artery bypass grafting, three had coronary artery bypass grafting with mitral replacement, and one had mitral valve replacement with left ventricular posterior wall repair. Results All eight patients were successfully weaned off from ECMO after their surgeries. Postoperative ECMO time ranged from 6.8 to 228.0 hours, with a median of 68.4 hours. Two patients died postoperatively while another six survived. The follow up time for the six patients ranged from three to 66 months, whereby one of them died in the third month due to septicaemia. The remaining five patients survived with good cardiac function based on the NYHA classification. Conclusion ECMO is a vital bridge in the preparation of critically-ill patients for cardiac surgery. It is associated with acceptable outcomes among most of the patients.

scholarly journals Surgical outcomes in cardiogenic shock patients with preoperative extracorporeal membrane oxygenation (ECMO)

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mahmoud Yousef Ibrahim Abuharb ◽  
Dong Ran ◽  
Zheng Jubing ◽  
Liu Taoshuai ◽  
Dong Haiming ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Coronary Artery Bypass ◽  
Surgical Outcomes ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Membrane Oxygenation

Abstract Objectives To summarise the surgical outcomes in patients with cardiogenic shock supported by preoperative extracorporeal membrane oxygenation (ECMO). Methods Between May 2012 and August 2017, eight patients with cardiogenic shock, who were supported by ECMO, underwent emergency surgery; four of them had isolated coronary artery bypass grafting, three had coronary artery bypass grafting with mitral replacement, and one had mitral valve replacement with left ventricular posterior wall repair. Results All eight patients were successfully weaned off from ECMO after their surgeries. Postoperative ECMO time ranged from 6.8 to 228.0 h, with a median of 68.4 h. Two patients died postoperatively while another six survived. The follow up time for the six patients ranged from three to 66 months, whereby one of them died in the third month due to septicaemia. The remaining five patients survived with good cardiac function based on the NYHA classification. Conclusion ECMO is a vital bridge in the preparation of critically-ill patients for cardiac surgery. It is associated with acceptable outcomes among most of the patients.

Atrial fibrillation – Can HbA1c levels really predict the risk?

2021 ◽  
pp. 021849232199893
Author(s):  
Pradeep Narayan ◽  
Chandan Kumar Mandal ◽  
Rajlakshmi Das ◽  
Debasis Das ◽  
Paramita Auddya Ghorai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Confidence Interval ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Post Operative Period ◽  
Hba1c Levels

Background Diabetes is associated with higher mortality and worse post-operative outcomes in patients undergoing coronary artery bypass grafting and HbA1c levels have consistently been reported to be associated with adverse post-operative outcomes. However, the role of HbA1c still remains unclear with regards to the occurrence of atrial fibrillation. Method Data for the patients undergoing off-pump coronary artery bypass grafting was analysed in a retrospective fashion. Patients were divided into–those with HbA1c < 6.5% and those with HbA1c ≥ 6.5% and the incidence of atrial fibrillation observed in these two groups. We also compared patient who developed atrial fibrillation in the post-operative period and compared them with those who did not. Results Of the 5259 patients included in the study HbA1c was <6.5 in 2808 (53.4%) patients and was ≥6.5 in 2451 (46.6%) patients; 623 (11.8%) patients in our study developed atrial fibrillation. Onset of atrial fibrillation in the post-operative period was seen most commonly 235 (38.3%) on between 24 and 48 h after the operation with more than half of them 338 (54.2%) occurring within the first 48 h. On multivariate analysis, HbA1c was not a risk factor for atrial fibrillation (odd’s ratio 1.144, 95% confidence interval 0.967–1.354). Only increased age (odd’s ratio 1.08; 95% confidence interval 1.069–1.091); EuroSCORE (odd’s ratio 1.073; 95% confidence interval 1.048–1.099); history of recent MI (odd’s ratio 0.768; 95% confidence interval 0.606–0.971) and peripheral vascular disease (odd’s ratio 1.667; 95% confidence interval 1.091–2.517) were found to be independently associated with increased risk of atrial fibrillation in the post-operative period. Conclusions After adjusting for confounders HbA1c levels do not independently predict risk of atrial fibrillation after off-pump coronary artery bypass grafting.

scholarly journals Sleep apnea and diabetes mellitus are independently associated with cardiovascular events and hospitalization for heart failure after coronary artery bypass grafting

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Aye-Thandar Aung ◽  
Chieh-Yang Koo ◽  
Wilson W. Tam ◽  
Zhengfeng Chen ◽  
William Kristanto ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Coronary Artery ◽  
Sleep Apnea ◽  
Coronary Artery Bypass Grafting ◽  
Confidence Interval ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

AbstractThe relative and combined effects of sleep apnea with diabetes mellitus (DM) on cardiovascular outcomes in patients undergoing coronary artery bypass grafting (CABG) remain unknown. In this secondary analysis of data from the SABOT study, 1007 patients were reclassified into four groups based on their sleep apnea and DM statuses, yielding 295, 218, 278, and 216 patients in the sleep apnea (+) DM (+), sleep apnea (+) DM (−), sleep apnea (−) DM (+), and sleep apnea (−) DM (−) groups, respectively. After a mean follow-up period of 2.1 years, the crude incidence of major adverse cardiac and cerebrovascular event was 18% in the sleep apnea (+) DM (+), 11% in the sleep apnea (+) DM (−), 13% in the sleep apnea (−) DM (+), and 5% in the sleep apnea (−) DM (−) groups. Using sleep apnea (−) DM (−) as the reference group, a Cox regression analysis indicated that sleep apnea (+) and DM (+) independently predicted MACCEs (adjusted hazard ratio, 3.2; 95% confidence interval, 1.7–6.2; p = 0.005) and hospitalization for heart failure (adjusted hazard ratio, 12.6; 95% confidence interval, 3.0–52.3; p < 0.001). Sleep apnea and DM have independent effects on the prognosis of patients undergoing CABG.Clinical trial registration: ClinicalTrials.gov identification no. NCT02701504.

scholarly journals Long-term survival after endoscopic vein harvest for coronary artery bypass grafting

2020 ◽  
Vol 102 (6) ◽  
pp. 422-428
Author(s):  
BH Kirmani ◽  
S Power ◽  
J Zacharias
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Confidence Interval ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Term Survival ◽  
Long Term Survival ◽  
Artery Bypass Grafting

Introduction Endoscopic vein harvest is the technique of choice in North America, where it constitutes 80% of conduit harvest for coronary artery bypass grafting. The UK has much lower rates, despite demonstrable perioperative benefits. Concerns about patency and long-term survival are often cited as reasons for poor uptake and evidence in the literature thus far has only addressed mid-term outcomes. We sought to identify the long-term survival of patients undergoing endoscopic vein harvest compared with a contemporaneous cohort of open vein harvest. Materials and methods This was a retrospective cohort study of all consecutive patients undergoing isolated coronary artery bypass grafting at a single institution between 2007 and 2017. All-cause long-term mortality was compared using Kaplan–Meier curves and log-rank analysis. Results A total of 7,527 patients undergoing coronary artery bypass grafting (1,029 receiving endoscopic vein harvest) were studied. The groups were well matched for preoperative characteristics, except that there were more patients with triple-vessel disease and good left-ventricular function in the endoscopic vein harvest group. There was no statistically significant difference in the long-term survival (p = 0.23). At five years (median follow-up), survival was 86.1% (95% confidence interval 85.3–87.0) in the open vein harvest group compared with 85.5% (95% confidence interval 82.8–88.2) in the endoscopic vein harvest group. Discussion and conclusion Endoscopic vein harvest does not affect long-term survival in an unselected population. The contraindications for minimally invasive vein harvest in coronary artery bypass grafting are increasingly diminishing.

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