scholarly journals Effects of Chronic Kidney Disease on 5-Year Follow-Up Clinical Outcomes After Off-pump Coronary Artery Bypass Grafting-A Retrospective Study

2021 ◽  
Author(s):  
Xihui Li ◽  
Siyu Zhang ◽  
Feng Xiao
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Abstract BackgroudTo investigate the effect of chronic kidney disease (CKD) on mid- and long-term clinical outcomes after off-pump coronary artery bypass grafting (CABG).MethodsThis was a retrospective analysis of data of1141 discharged patients from January 2010 to June 2018 after undergoing off-pump CABG. Follow-up endpoints included stroke, myocardial infarction, heart failure, revascularization, and all-cause death.Patients with preoperative estimated glomerular filtration rate calculated, using the Chronic Kidney Disease Epidemiology equation of≥ 60 mL/min/1.73 m2 and < 60 mL/min/1.73m2, were assigned tonormal Group (1, 910 cases) and CKD group (231 cases), respectively. The effects of CKD on selected endpoint events were compared and analyzed.ResultsThere was a higher proportion of women, more preoperative complications, and a higher incidence of early postoperative complications in patients with CKD than inthose with normal renal function.After 1–9 years of follow-up (mean5.0±2.2 years), the incidences of stroke, myocardial infarction, and all-cause mortality were significantly higher in the CKD than in the normal renal function group, whereas incidences of revascularization and heart failure were not.Logistic regression analysis showed that preoperative CKD was a risk factor for stroke, myocardial infarction, and all-cause death during follow-up. After correctingfor common confounding factors, such as sex, age, and left ventricular ejection fraction, preoperative CKD was a risk factor for myocardial infarction and all-cause death.ConclusionsIn patientsundergoing off-pump CABG, preoperative CKD is associated with increases in the incidences of myocardial infarction and all-cause mortality 5-year postoperation..

scholarly journals Effects of chronic kidney disease on mid- and long-term clinical outcomes after off-pump coronary artery bypass grafting-a retrospective study

2020 ◽  
Author(s):  
Xihui Li ◽  
Bo Song ◽  
Shiyong Dong ◽  
Siyu Zhang
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Off Pump ◽  
All Cause Mortality ◽  
Pump Coronary Artery Bypass ◽  
Fatal Myocardial Infarction

Abstract Backgroud: To investigate the effect of chronic kidney disease (CKD) on mid- and long-term clinical outcomes after off-pump coronary artery bypass grafting (CABG).Methods: This was a retrospective analysis of data of 1141 patients discharged from the Department of Cardiac Surgery, Peking University First Hospital from January 2010 to June 2018 after undergoing off-pump CABG. Preoperative baseline, operative, and follow-up data obtained at regular outpatient visits or by telephone calls were collected. Follow-up endpoints included stroke, nonfatal myocardial infarction, heart failure, revascularization, and all-cause death. Patients with preoperative estimated glomerular filtration rate calculated, using the Chronic Kidney Disease Epidemiology equation of≥ 60 mL/min/1.73 m2 and < 60 mL/min/1.73m2, were assigned to normal Group (1, 910 cases) and CKD group (231 cases), respectively. The effects of CKD on selected endpoint events were compared and analyzed.Results: There was a higher proportion of women, more preoperative complications, and a higher incidence of early postoperative complications in patients with CKD than in those with normal renal function. After 1–9 years of follow-up (mean5.0±2.2 years), the incidences of stroke, non-fatal myocardial infarction, and all-cause mortality were significantly higher in the CKD than in the normal renal function group, whereas incidences of revascularization and heart failure were not. Logistic regression analysis showed that preoperative CKD was a risk factor for stroke, non-fatal myocardial infarction, and all-cause death during follow-up. After correcting for common confounding factors, such as sex, age, and left ventricular ejection fraction, preoperative CKD was a risk factor for non-fatal myocardial infarction (OR 2.675, 95% CI 1.023–6.995, P=0.045) and all-cause death (OR 1.833, 95% CI 1.079–3.114, P=0.025).Conclusions: In patients undergoing off-pump CABG, preoperative CKD is associated with increases in the incidences of mid- and long-term non-fatal myocardial infarction and all-cause mortality.

scholarly journals Influence of chronic kidney disease on early clinical outcomes after off-pump coronary artery bypass grafting

2020 ◽  
Author(s):  
Xihui Li ◽  
Siyu Zhang ◽  
Feng Xiao
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Artery Bypass ◽  
Complication Rates ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Abstract Backgroud: Patients with chronic kidney disease (CKD) have a high incidence of coronary heart disease, which is the leading cause of death in these patients. CABG significantly decreases short-term and long-term mortality in patients with CKD compared with PCI. The effect of CKD on the early outcomes of off-pump CABG has been studied less often. We aimed to investigate the effect of CKD on early postoperative mortality and complications following off-pump coronary artery bypass grafting (CABG). Methods: We retrospectively analyzed preoperative baseline and surgery data for 1173 patients undergoing off-pump CABG from January 2010 to December 2017 in the Department of Cardiac Surgery, Peking University First Hospital. Outpatient follow-up was performed until 30 days postoperatively. Patients with estimated glomerular filtration rates calculated according to the Chronic Kidney Disease Epidemiology Collaboration equation ≥ 60 mL/min/1.73 m2 were assigned to the normal renal function group (normal group, n = 924), and those with a rate < 60 mL/min/1.73 m2 were assigned to the CKD group (CKD group, n = 249). Results: Patients in the CKD group were seriously ill with multiple complications, and postoperative 30-day mortality and complication rates were significantly higher than those in the normal group. In the logistic regression analysis, after correcting for common confounding factors, namely, sex, age, and left ventricular ejection fraction, preoperative CKD was a risk factor for postoperative acute kidney injury, perioperative myocardial infarction, gastrointestinal bleeding, secondary tracheal intubation, stroke, chest wound infection, prolonged mechanical ventilation (≥ 24 h), prolonged intensive care unit stay (≥ 72 h), prolonged length of stay (≥ 14d), dialysis requirement, and postoperative death within 30 days. Conclusions: Patients with CKD had more preoperative complications, and their postoperative 30-day mortality and complication rates after off-pump CABG were significantly higher than those of patients with normal renal function. For CABG patients with CKD, the risk of surgery should be assessed carefully, and comprehensive measures should be taken to strengthen perioperative management, with an aim to reduce complications and mortality and improve surgical outcomes.

scholarly journals Perioperative Outcomes after On- and Off-Pump Coronary Artery Bypass Grafting

2014 ◽  
Vol 41 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Faisal G. Bakaeen ◽  
Danny Chu ◽  
Rosemary F. Kelly ◽  
William L. Holman ◽  
Michael E. Jessen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Perioperative Myocardial Infarction ◽  
Off Pump ◽  
Intention To Treat ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Although numerous reports describe the results of off-pump coronary artery bypass grafting (CABG) at specialized centers and in select patient populations, it remains unclear how off-pump CABG affects real-world patient outcomes. We conducted a large, multicenter observational cohort study of perioperative death and morbidity in on-pump (ON) versus off-pump (OFF) CABG. We reviewed Veterans Affairs Surgical Quality Improvement Program data for all patients (N=65,097) who underwent isolated CABG from October 1997 through April 2011 (intention-to-treat data were available from 2005 onward). The primary outcome was perioperative (30-day or in-hospital) death; the secondary outcomes were perioperative stroke, dialysis dependence, reoperation for bleeding, mechanical circulatory support, myocardial infarction, ventilator support ≥48 hr, and mediastinitis. Propensity scores calculated from age, 17 preoperative risk factors, and year of surgery were used to match 8,911 OFF with 26,733 ON patients. In the complete cohort, compared with the ON patients (n=53,468), the OFF patients (n=11,629) had less perioperative death (2.02% vs 2.53%, P=0.0012) and lower incidences of all morbidities except perioperative myocardial infarction. In the matched cohort, perioperative death did not differ significantly between OFF and ON patients (1.94% vs 2.28%, P=0.06), but the OFF group had lower incidences of all morbidities except for perioperative myocardial infarction and mediastinitis. A subgroup intention-to-treat analysis yielded similar but smaller outcome differences between the ON and OFF groups. Off-pump CABG might be associated with decreased operative morbidity but did not affect operative death, compared with on-pump CABG. Future studies should examine the effect of off-pump CABG on long-term outcomes.

scholarly journals Predictors of perioperative myocardial infarction in patients undergoing off-pump coronary artery bypass grafting

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
Mohamed A. Amr ◽  
Elsayed Fayad
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Perioperative Myocardial Infarction ◽  
Off Pump ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass

Abstract Background Perioperative myocardial infarction (PMI) increases morbidity and mortality after off-pump coronary artery bypass grafting (CABG). The objective of the current study was to characterize patients with PMI after off-pump CABG and identify its predictors. Results We included 1181 patients who had off-pump CABG from 2010 to 2020; 59 patients (5%) had PMI. We compared patients with PMI to those without PMI. Patients with PMI were older (57 (25th–75th percentiles: 51–63) vs. 54 (48–60) years; P = 0.01) and had higher NYHA class (28 (47.46%) vs. 326 (29.06%): P = 0.01). The distal anastomosis time was longer in patients with PMI (28 (23–35) vs. 24 (16–30) min; P ˂ 0.001). Patients with PMI had higher postoperative low cardiac output (10 (18.18%) vs. 1 (0.1%): P ˂ 0.001), prolonged ventilation (12 (8–39) vs. 8 (6–10) h, P ˂ 0.001), ICU (71 (46–138) vs. 24 (23–42) h; P ˂ 0.001), and hospital stay (9 (6–15) vs. 7 (6–8) days; P ˂ 0.001). Mortality was significantly higher in patients with PMI (20 (33.9%) vs. 6 (0.53%); P ˂ 0.001). Older age (OR: 1.05 (95% CI: 1.01–1.1); P = 0.02), increased number of distal anastomoses (OR: 1.74 (95% CI: 1.20–2.50); P = 0.003), preoperative congestive heart failure (OR: 10.27 (95% CI: 2.58–40.95); P = 0.001), and thrombolysis within 24 h of surgery (OR: 15.34 (1.93–121.9); P = 0.01) were associated with increased PMI, while PMI was lower in male patients (OR: 0.42 (95% CI: 0.19–0.93); P = 0.03) and with higher body surface area (BSA) (OR: 0.08 (95% CI: 0.07–0.86); P = 0.04). Conclusions Post-off-pump CABG PMI was associated with increased morbidity and mortality. Risk factors for PMI were older age, lower BSA, females, increased distal anastomoses, preoperative heart failure, and thrombolysis.

Long-Term Follow-up of Off-Pump and On-Pump Coronary Artery Bypass Grafting

2014 ◽  
Vol 9 (2) ◽  
pp. 122-129 ◽  
Author(s):  
Shahzad G. Raja ◽  
Umberto Benedetto ◽  
Dimple Chudasama ◽  
Siobhan Daley ◽  
Mubassher Husain ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Long Term Follow Up ◽  
Pump Cabg ◽  
Pump Coronary Artery Bypass ◽  
Long Term Mortality

Objective Despite increasing recognition of the benefits of off-pump coronary artery bypass grafting (CABG), concerns persist regarding its impact on long-term mortality and freedom from reintervention. In this study, we assessed the impact of off-pump CABG on long-term outcomes. Methods From January 2002 to December 2002, a total of 307 consecutive patients who underwent isolated multivessel off-pump CABG at our institution were compared with a control group of 397 patients who underwent multivessel on-pump CABG during the same period. Perioperative data were prospectively collected and compared. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years. Results After adjusting for clinical covariates, off-pump CABG did not emerge as a significant independent predictor of long-term mortality [hazard ratio (HR), 0.91; 95% confidence interval (CI), 0.70–1.12], readmission to hospital for cardiac cause (HR, 0.96; 95% CI, 0.78–1.10), or the need for reintervention (HR, 0.93; 95% CI, 0.87–1.05). Conclusions At long-term follow-up, off-pump CABG remains a safe and effective myocardial revascularization strategy with no adverse impact on survival or freedom from reintervention.

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.

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