pump cabg
Recently Published Documents


TOTAL DOCUMENTS

321
(FIVE YEARS 82)

H-INDEX

17
(FIVE YEARS 3)

2022 ◽  
Author(s):  
Xiaopeng Zhang ◽  
Yirui Hu ◽  
Michael Friscia ◽  
Xianren Wu ◽  
Li Zhang ◽  
...  

Abstract Diltiazem is frequently applied during the perioperative period of coronary artery bypass grafting with cardiopulmonary bypass (on-pump CABG) to prevent arterial graft spasm; however, the short- and long-term outcome effects are unclear. In this retrospective cohort study, from October 2008 to October 2018, adult patients who underwent isolated CABG with cardiopulmonary bypass (CPB) were identified. Patients in the perioperative diltiazem (DILT) and non-intervention (non-DILT) cohorts were matched based on propensity scores. Logistic regression was fitted to evaluate the impact on short-term outcomes. Long-term outcome was investigated by survival analyses. Total of 1004 patients were included. There were no statistically significant differences between the cohorts in perioperative outcomes, although at 24 hours postoperatively, patients in DILT were more likely to be on hemodynamic support from inotropic and/or vasoactive agents. The overall long-term survival was similar between the cohorts; however, in the subgroup of patients who received more than one arterial graft, perioperative diltiazem may be associated with higher long-term all-cause mortality. Based on these data, the perioperative and long-term outcome benefits of continuous iv infusion of diltiazem in patients who underwent on-pump CABG.


2022 ◽  
Vol 30 (1) ◽  
Author(s):  
Mohamed A. Amr ◽  
Elsayed Fayad

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.


2021 ◽  
Vol 8 (3) ◽  
pp. 109
Author(s):  
Septa Ariany ◽  
Ivan Joalsen Mangara Tua ◽  
Danial Danial ◽  
Nataniel Tandirogang

Acute Kidney Injury (AKI) adalah sindrom kompleks yang ditandai dengan penurunan fungsi ginjal. Pada penelitian ini, rasio neutrofil-limfosit (RNL) yang tinggi dikaitkan dengan perkembangan AKI setelah Coronary Artery Bypass Grafting On-Pump (CABG on-pump). Penggunaan RNL sebagai parameter yang tersedia dengan mudah untuk mendeteksi pasien yang berisiko terkena AKI. Tujuan penelitian untuk mengetahui perbedaan nilai RNL pasca operasi CABG on-pump terhadap kejadian AKI dan Non-AKI. Penelitian ini merupakan penelitian analitik dengan pendekatan cross sectional. Semua data klinis preoperative dan postoperative diambil sebagai data sekunder dari rekam medik pasien yang menjalani CABG di Rumah Sakit Umum Daerah Abdul Wahab Sjahranie (RSUD AWS) Samarinda periode Januari 2017-Desember 2020. Penelitian menggunakan uji statistik dengan Mann-Whitney dan Uji Regresi. Hasil penelitian ini ditemukan 41,1% dari 56 sampel mengalami AKI. Hasil didapatkan bahwa terdapat perbedaan nilai RNL pasca operasi pada sampel AKI dan Non-AKI dengan nilai p=0,008. Peningkatan RNL ≥ 10 kali risiko sebesar 6,352 kali lipat.


2021 ◽  
Vol 15 (11) ◽  
pp. 3098-3100
Author(s):  
Mati Ur Rahman ◽  
Ajwad Farogh ◽  
Sadaf Iftikhar ◽  
Naseem Ahmad ◽  
Gohar Bashir ◽  
...  

Objective: The aim of this study is to compare in hospital morbidity and mortality in on pump versus off pump CABG. Methodology: All the patients undergoing CABG surgery were enrolled after taking informed consent. Demographic and postoperative variables were entered in the predesigned questionnaire and patients were followed for early outcomes after surgical procedure. Results: A total of 470 patients wasdivided in two groups 235 (on pump and off pump).The mean age of patients was 54.85 ± 9.57 (23-85).There were 400(85.1%) males and 70(14.9%) females. The total data of 470 patients was divided in two groups 235 in on Pump and 235 in off pump CABG.The mean age of patients was 54.85 ± 9.57 (23-85). There were 400(85.1%) males and 70(14.9%) females. Different clinical outcomes were compared in both groups (On-Pump versus Off-Pump CABG) by using Euro Score, we found Peripheral Disease in On-Pump CABG group compared with Off-Pump CABG as 11(4.68% vs 12(5.11%) with p-value=0.831 which was statistically insignificant, current data assessed lung disease in both groups as 11(4.68%) vs 13(5.53%) with statistically insignificant p-value (0.675). and unstable angina were 12(5.11%, p-value 1.00) patients founded and Peri and post myocardial infarction also assessed in both groups with p-value (0.74 & 1.20). respectively.Data regarding in hospital mortality was analyzed and found that 7(2.98%) in on pump group compare with off pump group was According to our research mean number of grafts placed in On-Pump CABG were 9(3.83%) with statistically insignificant p-value (0.611). Conclusion:Proof is presented that surgery on beating heart (Off-Pump) is as safe and effective as Conventional CABG, and cheaper than conventional surgery. However, it is uncertain whether the cost savings are sustained over a longer period of time. Keywords: Coronary artery Bypass grafting surgery, On Pump Off Pump


2021 ◽  
pp. 2899-2900
Author(s):  
Hadiqa Fatima ◽  
Shoaib Waqas ◽  
Asifa Javaid ◽  
Aadil Ameer Ali ◽  
Muhammad Tariq

Aim: To describe the quality of life six months following on-pump coronary artery bypass grafting in people aged 61 to 70. Methods: An analytical cross-sectional survey was conducted on 119 cardiovascular patients who have undergone On Pump CABG procedure. The data was collected from Punjab Institute of Cardiology and Omer Hospital Lahore. 70 patients were taken from Punjab Institute of Cardiology Lahore and 49 from Omer Hospital. Non-probability convenient sampling was used as a sampling approach. From August 2018 until January 2019, the research was conducted. The Medical Outcomes Study short form 36 (SF-36) questionnaires were used to determine the quality of life. Results: The mean age of the 119 patients was 65.23 + 3.35, with a standard deviation of 3.35. Three patients (2.5%) had energy fatigue, three (2.5%) had role limitations due to physical health, fifteen (12.6%) had role limitations due to emotional problems, 96 (80.7%) had physical functioning and two (1.7%) had emotional well-being, four (3.4%) had social functioning, three (2.5%) had pain, and three (2.5%) had general health problems. Conclusion: The quality of life of on-pump CABG patients aged 61-70 years after six months of cardiac rehabilitation was reported to be satisfactory, with improved activities of daily living. Keywords: Quality of life, on pump coronary artery bypasses grafting, cardiac rehabilitation


2021 ◽  
Vol 6 (5) ◽  
pp. 222-229
Author(s):  
V. A. Podkamenniy ◽  
A. A. Sharavin ◽  
D. I. Likhandi ◽  
Yu. V. Zheltovsky ◽  
A. V. Vyrupaev

Coronary heart disease (CHD) ranks first among the causes of death from cardiac events. Patients who have previously undergone surgical treatment – coronary artery bypass grafting (CABG) – are not immune from the return of angina due to the progression of atherosclerosis in the native coronary arteries or degenerative changes in the shunts. Therefore, the issue of redo surgery in this group of patients is debatable.The aim of the research is to show that the use of alternative sternotomy approaches and the rejection of artificial blood circulation (ABC) are considered as possible measures to improve the results of redo CABGs.Materials and methods. In the Cardiac Surgery Unit No. 1 of the Irkutsk Regional Clinical Hospital from 2003 to 2020, 6773 off-pump CABG surgeries were performed. Of these, 6338  (93.6  %) surgeries were performed using median sternotomy and  435  (6.4  %) surgeries were performed using minitoracotomy or subxyphoid access. Of the 6338 CABG surgeries performed using sternotomy, 58 (0.9 %) were performed repeatedly. All redo surgeries during the period under review were performed by minithoracotomy or subxyphoid access. The indication for redo surgery was the return of angina of III or IV functional class, which did not respond to optimal drug therapy. When performing 54 redo surgeries, the access was leftsided mini-thoracotomy. In 3 patients, CABG was performed by subxyphoid access and in 1 patient – from right-sided mini-thoracotomy.Results. 58 redo CABG surgeries were performed. There was no damage to the access of the heart or functioning shunts. Complications were noted in 5 (8.6 %) patients. In 1 case, a second operation was required due to bleeding from the intercostal artery. In other cases, there were rhythm disturbances, or the need for inotropic support.Conclusion. Performing redo off-pump CABG surgeries using mini-accesses reduces the risk of damage to the heart and functioning shunts, eliminates manipulations on the ascending aorta, and avoids difficulties with cardioplegic protection of the myocardium with a functioning mammarocoronary graft. 


Author(s):  
Muhammed Gerçek ◽  
Mina Ghabrial ◽  
Lina Glaubitz ◽  
Oliver Kuss ◽  
Anas Aboud ◽  
...  

Abstract Objectives Left atrial appendage (LAA) amputation concomitant to coronary artery bypass grafting (CABG) has become an increasingly performed technique in patients with atrial fibrillation (AF) or with sinus rhythm and a CHA2DS2-VASc score ≥2. However, LAA amputation has come under suspicion to cause postoperative atrial fibrillation (POAF) due to left atrial (LA) dilation. This study aims to assess this assumption in patients undergoing CABG in off-pump technique with and without amputation of the LAA. Methods Patients who underwent isolated CABG in off-pump technique without history of AF were retrospectively examined. Cohorts were divided according to the concomitant execution of LAA amputation. LA volume was measured by transthoracic echocardiography and rhythm was analyzed by electrocardiography, medication protocol, and visit documentation. Propensity score (PS) matching was performed based on 20 preoperative risk variables to correct for selection bias. Results A total of 1,522 patients were enrolled, with 1,267 in the control group and 255 in the LAA amputation group. Occurrence of POAF was compared in 243 PS-matched patient pairs. Neither the unmatched cohort (odds ratio [OR] 0.82; 95% confidence interval or CI [0.61; 1.11], p = 0.19) nor the PS-matched cohort (OR 0.94; 95% CI [0.62; 1.41], p = 0.75) showed significant differences in POAF occurrence. Subgroup analysis of sex, use of β-blockers, pulmonary disease, ejection fraction, and CHA2DS2-VASc-Score also showed no tendencies. LA volume did not change significantly (p = 0.18, 95% CI [−0.29; 1.51]). Conclusion Surgical amputation of the LAA concomitant to CABG did not lead to LA dilation and has no significant impact on the occurrence of POAF.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Rosler ◽  
G Constantin ◽  
P Nectoux ◽  
B S Holz ◽  
D Cardoso ◽  
...  

Abstract Background The results of coronary artery bypass graft surgery (CABG) performed with and without the support of cardiopulmonary bypass have already been widely discussed and studied, including through a few large randomized clinical trials. Despite the efforts, the findings of these studies still generate controversy and doubts about the outcomes achieved by the two techniques. One of the contested points is the heterogeneity of the degree of specialization in the off-pump technique in relation to the surgical groups that participated in the studies. Purpose To compare the results in 30 days of on-pump and off-pump CABG. Methods A single centre cohort with 1,767 patients undergoing isolated CABG was initially evaluated (January 2013 – December 2018). 397 patients undergoing off-pump CABG and 1,370 patients undergoing on-pump surgery were identified. To obtain two completely homogeneous study groups, a propensity score matching was applied. For this, a logistic regression model was built with the variable use of CPB support as dependent variable. In the group of independent variables, 14 baseline and operative characteristics were included. The probabilities generated for each patient were used as scores to establish the match. To establish a pair, it was necessary to have three squares after the comma, with the fourth decimal place being the tiebreaker criterion in the pairing. In this way it was possible to obtain 332 pairs (N=664). The paired groups, on and off-pump, were compared by descriptive and univariate analysis and later a logistic regression model was applied to identify possible risk predictors and to verify the impact of CPB support on 30-day mortality. The level of significance was 5% and the analysis was performed using Python 3.0. Results None of the 29 baseline and operative characteristics showed a significant difference between the groups, demonstrating a high degree of homogeneity obtained from the propensity score matching, which enabled a solid comparison between the incidences of outcomes in 30 days. None of the analysed outcomes showed any difference between the groups on and off-pump, including AMI, stroke, major reoperation and death (1.5% vs 2.4%; p=0.401). Through regression analysis it was possible to establish that the use of CPB was not an independent predictor of risk for the occurrence of death (p=0.246). Conclusion After matching by propensity score, patients who underwent surgery with and without CPB had similar incidences of 30-day mortality. In addition, it was possible to verify that the use of CPB was not an independent predictor of risk for the occurrence of death in 30 days. FUNDunding Acknowledgement Type of funding sources: None. Propensity score adjustment by group 30-day outcomes vs CABG technique


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Omar M.T El safty ◽  
Manal M Kamal ◽  
Maha S Hussein ◽  
Mohammed S.M Mohammed

Abstract Background Coronary artery diseases are one of the leading causes of death around the world. Great efforts to diagnose, evaluate, prevent and decreasing morbidity and mortality had been done. CABG is one of the most effective ways for treatment of CAD when compared to PCI or medical treatment. On pump CABG is the basic and gold standard technique for CABG surgery. Yet there are some burdensome complications from the use of CPB so surgeons developed off pump technique to decrease these complications. Objective In this study we compared the early results of isolated CABG, using onpump and off-pump, in patients with preoperative mild to moderate elevation of serum creatinine. We examined if off-pump coronary revascularization offers a superior renal protection and less in post-operative complications when compared with conventional coronary revascularization with cardiopulmonary bypass. Methods This study was prospective cohort, observational study, conducted in post open heart ICU at Ain Shams university hospitals, 6th October insurance hospital and National Heart Institute during the period between October 2018 and April 2019. We enrolled 1st 100 consecutive adult patients scheduled for isolated CABG surgery (with a median sternotomy) with or without cardiopulmonary bypass pump. The patients are allocated in 2 groups where 50 patients in each group (group A – On pump – ONCAB- conventional surgery) and (group B – Off pump –OPCAB – beating heart) after obtaining their written informed consent without cross over between both groups. Results In this study, we found that postoperative AKI among both study group was relatively common defined by AKIN criteria and there was significant difference between the incidences of postoperative AKI among both study groups. It was higher in ONCAB group than OPCAB group (52%, 30% respectively) with (p-value = 0.025). According to AKIN classification for complicated cases with postoperative renal impairment; there were 32% among ONCAB group had AKIN stage 1 renal impairment versus 22% among OPCAB group had the same stage. While, there were 6% versus 2% had AKIN stage 2 renal impairment among ONCAB group versus OPCAB group respectively. Also there were 14% versus 6% had AKIN stage 3 renal impairment among ONCAB group versus OPCAB group respectively. The need for dialysis was much greater in the ONCAB group 20% versus 8% in the OPCAB group with significant p-value (0.029). Early mortality was significantly higher in ONCAB group about 11 cases (22%) VS 4 cases (8%) in OPCAB group with p-value 0.033. Also there was statistically significant difference between ONCAB group and OPCAB group according to drainage amount (p-value 0.028), re-exploration for bleeding (p-value 0.018), mean ICU stay (p-value 0.027) and mean hospital stay (p-value 0.009). Conclusion The off pump CABG is superior and gives more renal protection in patients with preoperative mild to moderate renal impairment. It is also reducing the early mortality and morbidity in these patients.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Rosler ◽  
P Nectoux ◽  
G Constantin ◽  
B S Holz ◽  
D Cardoso ◽  
...  

Abstract Background Coronary artery bypass graft surgery (CABG) is the most common cardiac surgery performed in the world and a significant part of these surgeries are performed without cardiopulmonary bypass (off pump). Although none of the main surgical risk scores include pump use in their prediction model, the scores are widely used in risk stratification, including for patients who will be submitted to off pump CABG. Purpose To analyse and compare the predictive accuracy of EuroScore I, EuroScore II and STS Score for 30-day mortality after off pump CABG. Methods Single-centre cohort with 943 patients consecutively submitted to off pump CABG between January 2010 and December 2020. 31 baseline and operative variables were analysed. The primary outcome was the occurrence of death in the first 30 days after the surgery. Descriptive analysis, normality for quantitative data and univariate inference were performed to compare proportions and means between the survival group (n=930) and death group (n=13). Next, three logistic regression models were performed. Each of them had 30-day mortality as a dependent variable and one of the scores as an independent variable. The probabilities generated by the three models were saved and analysed by ROC curves. Thus, it was possible to assess the predictive accuracy of each of the scores. Finally, the values of the areas under the curves were compared using the DeLong test. The level of significance was 5% and the analysis was performed using the Python 3.0 programming language. Results The mean age of the general group was 63 years old and there was a predominance of male patients (68.4%). The means of the three evaluated risk scores were significantly higher in the Death group (p<0,05). This pattern confirmed the findings of higher prevalence of several comorbidities in the death group. The 30-day mortality rate was 1.37%. Through the analysis of regressions and the probabilities generated through them, it was possible to verify that the predictive accuracy of EuroScore II was significantly higher than that of the other two scores. While the predictive accuracy of EuroScore II was 77.3%, the accuracy of two other scores was in the range of 69% (AUC EsI: 0.697; AUC EsII: 0.773; AUC STS: 0.695; p=0.029). Conclusion EuroScore II seems to be the most adequate surgical risk score for the assessment of mortality risk of patients who will undergoing to off pump CABG. The score had a predictive accuracy of 77.3%, almost 8% more than the other two scores. Therefore, although EuroScore II does not include in its model the use of cardiopulmonary bypass, it has a satisfactory accuracy to be used in clinical-surgical practice. On the other hand, the EuroScore I and the STS Score showed predictive accuracy not adequate for this type of surgery. FUNDunding Acknowledgement Type of funding sources: None. Predictive accuracies of risk scores


Sign in / Sign up

Export Citation Format

Share Document