scholarly journals Intraoperative Mild Hyperoxia May be Associated with Improved Survival After Off-Pump Coronary Artery Bypass Grafting: A Retrospective Observational Study

2021 ◽  
Author(s):  
Jae-Woo Ju ◽  
Hyun Woo Choe ◽  
Jinyoung Bae ◽  
Seohee Lee ◽  
Youn Joung Cho ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Lower Risk ◽  
Artery Bypass ◽  
Arterial Oxygen ◽  
Bypass Grafting ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Coronary Artery Bypass

Abstract Background: The effect of hyperoxia due to supplemental oxygen administration on postoperative outcomes in patients undergoing cardiac surgery remains unclear. This retrospective study aimed to evaluate the relationship between intraoperative oxygen tension and mortality after off-pump coronary artery bypass grafting (OPCAB).Methods: The study included adult patients who underwent isolated OPCAB between July 2010 and June 2020. Patients were categorised into three groups based on their intraoperative time-weighted average arterial oxygen partial pressure (PaO2): normoxia/near-normoxia (<150 mmHg), mild hyperoxia (150–250 mmHg), and severe hyperoxia (>250 mmHg). The risk of in-hospital mortality was compared using weighted logistic regression analysis. Restricted cubic spline analysis was performed to analyse intraoperative PaO2 as a continuous variable. The risk of cumulative all-cause mortality was compared using Cox regression analysis.Results: The normoxia/near-normoxia, mild hyperoxia, and severe hyperoxia groups included 229, 991, and 173 patients (n=1,393), respectively. The mild hyperoxia group had a significantly lower risk of in-hospital mortality than the normoxia/near-normoxia (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.06–0.22) and severe hyperoxia groups (OR, 0.06; 95% CI, 0.03–0.14). Intraoperative PaO2 exhibited a U-shaped relationship with in-hospital mortality in the non-hypoxic range. The risk of cumulative all-cause mortality was significantly lower in the mild hyperoxia group (hazard ratio, 0.72; 95% CI, 0.52–0.99) than in the normoxia/near-normoxia group.Conclusions: Intraoperative mild hyperoxia was associated with a lower risk of mortality after OPCAB than normoxia, near-normoxia, or severe hyperoxia. Mildly increasing arterial oxygen tension during OPCAB may help to optimise postoperative outcomes.Trial registration: Not applicable.

scholarly journals Complications and In-Hospital Mortality After On- Pump Vs Off-Pump Coronary Artery Bypass Grafting

2018 ◽  
Vol 14 (14) ◽  
pp. 53
Author(s):  
Giorgi Janashia ◽  
Zurab Chkaidze ◽  
Merab Nachkepia ◽  
Kakha Beselia ◽  
Iamze Taboridze
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Data Analyses ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Off-pump surgery has involved into the most frequently adopted alternative technique to conventional on-pump coronary artery bypass grafting (CABG) in the treatment of patients with coronary artery disease. Our aim was to compare data analyses of complications and in-hospital mortality after on-pump vs off-pump CABG. Materials and methods: Retrospective data analyses research is based on 402 patients, ranging in 37-75 years of age. Operations CABG were performed in 2009- 2012, at the West Georgian Interventional Medicine National Center Hospital, Kutaisi; Aleksandre Aladashvili Clinic, Tbilisi; and L.T.D. Lancet, Tbilisi. 253 cases were performed off pump and 149 cases were performed on pump. Groups were diversified by the F Fischer’s criteria. Odds ratio (OR) was made using regression analysis. Statistical analysis was made using SPSS 22 program. Results: While on pump during surgery, intraoperative shock occurred in 8(5.37%) cases, Thrombosis – 3(2.01%); Dissection – 3(2.01%), Stroke – 1(0.67%) and Myocardial Infarction – 1(0.67%). These complications were not detected during off pump CABG. Frequency of in-hospital mortality after off pump and on pump CABG are respectively 7(2.77%) and 15(10.07%) - p<0.0018. Totallyperi operative  complications were during off pump CABG – 35(13.83%) and on pump CABG – 41(27.51%)(p<0.0007). In the cases of on pump surgery, odds ratio of complications that arise: bleeding OR=4.48(95CI;1.38-14.54); atrial fibrillation – OR=6.64(95%CI:1.82-24.21); pulmonary complications - OR=2.24(95%CI:1.19-4.21), renal insufficiency - OR=8.75(95%CI:1.01- 75.63); in-hospital mortality – OR=2.365(95%CI:1.425-3.924). Conclusion: Off pump CABG seems to significantly reduce postoperative renal failure, bleeding, atrial fibrillation, and respiratory complications, while perioperative myocardial infarction rates remain significantly unchanged. Considering in-hospital mortality and perioperative complications, off pump CABG has much better results.

scholarly journals A Risk Score for Predicting Long-Term Mortality Following Off-Pump Coronary Artery Bypass Grafting

2021 ◽  
Vol 10 (14) ◽  
pp. 3032
Author(s):  
Tomasz Kamil Urbanowicz ◽  
Michał Michalak ◽  
Aleksandra Gąsecka ◽  
Anna Olasińska-Wiśniewska ◽  
Bartłomiej Perek ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Risk Score ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Coronary Artery Bypass ◽  
Long Term Mortality

Background: Off-pump coronary artery bypass grafting (OPCAB) comprises 15–30% of all bypass grafting surgeries. The currently available perioperative scores such as Euroscore and STS score do not specifically predict long-term mortality after off-pump procedures. The neutrophil-to-lymphocyte ratio (NLR) is one of the new, easily accessible markers of inflammation with proven predictive value in cardiovascular diseases. We aimed to develop the first risk score for long-term mortality after OPCAB and to determine if the perioperative value of NLR predicts long-term mortality in OPCAB patients. Methods: In total, 440 consecutive patients with multivessel stable coronary artery disease undergoing OPCAB were recruited. Differential leukocyte counts were obtained by a routine hematology analyzer. Data regarding mortality during a median follow-up time of 5.3 years were obtained from the Polish National Health Service database. An independent population of 242 patients served as a validation cohort. Results: All-cause mortality was influenced by different clinical risk factors. In multivariate regression analysis, chronic obstructive pulmonary disease, stroke history, post-operative NLR and LVEF were independent predictors of mortality. Combing all independent predictors predicted long-term all-cause mortality with 68.5% sensitivity and 71.5% specificity (AUC = 0.704, p < 0.001). After weighing these variables according to their estimates in a multivariate regression model, we developed a score to predict mortality in patients undergoing OPCAB (PREDICT-OPCAB Score, ranging from 0 to 10). Patients with a high score were at higher risk of mortality within the median 5.3 years of follow-up (score 0–3: 8.3%; 4–6: 27.0%; 7–10: 40.0%; p < 0.001 for score 0–3 vs. 4–6 and 7–10). This association was confirmed in the validation cohort. Conclusions: We developed and validated the first simplified risk score to predict mortality following OPCAB based on easily accessible clinical factors. This risk score can be used when obtaining a patient’s informed consent and as an aid in determining treatment.

Routine Preoperative Insertion of IABP in High-Risk Off-Pump Coronary Artery Bypass Grafting

2005 ◽  
Vol 8 (2) ◽  
pp. 94 ◽  
Author(s):  
Hunaid A. Vohra ◽  
Norman P. Briffa
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
High Risk ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Beneficial Effects ◽  
Pump Coronary Artery Bypass

The beneficial effects of intraaortic balloon pump (IABP) in coronary artery bypass graft surgery with cardiopulmonary bypass have been reported. However, whether preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting (OPCAB) has any beneficial effects remains to be established. We report our experience of preoperative insertion of IABP in OPCAB.

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