1
|
Salikhanov I, Koechlin L, Gahl B, Zellweger MJ, Haaf P, Müller C, Berdajs D. In-Hospital Graft Occlusion in Post-Coronary Artery Bypass Grafting Patients in the Early Postoperative Period: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:5514. [PMID: 39337001 PMCID: PMC11432121 DOI: 10.3390/jcm13185514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Objectives: The objectives of this paper are to evaluate the incidence of early graft occlusion during hospital stays following coronary bypass surgery (CABG) and to assess the factors influencing the odds of in-hospital early graft occlusion. Methods: Reports evaluating the early in-hospital occlusion of coronary bypass grafts were identified through PubMed, Embase, and Cochrane databases. The primary endpoint was to determine the incidence of early graft occlusion following CABG before discharge and to identify and quantify the impact of demographic, clinical, and procedural risk factors on the occurrence of early graft occlusion. The meta-analysis was conducted using a random-effects inverse-variance model with the DerSimonian-Laird estimator, assessing incidence rates, risk factors, and study heterogeneity, with statistical analysis performed using Stata. Results: A total of 22 studies with 35,798 patients were included in the analysis. The overall incidence of in-hospital early graft occlusion was 5% (95% CI: 3% to 7%). In studies using symptom-driven patency assessment, the incidence of occlusion was 2%, whereas in those employing systematic graft patency assessment, it was 6%. Only the presence of a vein graft OR 2.13 (95% CI: 1.19-3.82) was significantly associated with in-hospital graft occlusion. Conclusions: The incidence of in-hospital early graft occlusion seems substantially underestimated if imaging is restricted only to symptomatic patients. Moreover, female gender, increased PI, and the presence of a composite graft could also be potential risk factors for this complication.
Collapse
Affiliation(s)
- Islam Salikhanov
- Department of Cardiac, Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac, Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac, Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Christian Müller
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Denis Berdajs
- Department of Cardiac, Surgery, University Hospital Basel, 4031 Basel, Switzerland
| |
Collapse
|
2
|
Semagin AA, Lukin OP, Fokin AA. [Comparative analysis of in-hospital and long-term results of patients with acute dysfunction of coronary bypass grafts depending on treatment tactics]. Khirurgiia (Mosk) 2024:50-57. [PMID: 38258688 DOI: 10.17116/hirurgia202401150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Comparative analysis of in-hospital and long-term mortality of patients in whom acute dysfunction of coronary bypass grafts was detected in the early postoperative period depending on conservative or surgical tactics. MATERIAL AND METHODS The study is a retrospective analysis of data from 8801 patients who underwent elective coronary artery bypass grafting (CABG) between 2011 and 2022 at the Federal Center for Cardiovascular Surgery (Russia, Chelyabinsk). Among them, 196 patients underwent emergency coronary artery bypass grafting due to suspected perioperative myocardial infarction in the early postoperative period. In 119 patients, dysfunction of coronary bypass grafts was detected, in 77 patients no pathological changes were found. The criteria for inclusion in the study were patients with dysfunction of coronary bypass grafts (n=119). The 1st group included patients who underwent conservative therapy (n=33), the 2nd group (n=86) included those who underwent repeated myocardial revascularization. The primary endpoint was hospital mortality, secondary endpoints were long-term mortality and adverse cardiovascular events (myocardial infarction, stroke, repeat myocardial revascularization). Patients were surveyed via telephone. RESULTS In-hospital mortality in the group of surgical reintervention was 8.1%, in the group of conservative treatment - 9.1% (p=0.867). According to the results of multivariate analysis, predictors of hospital mortality in patients of both groups were extracorporeal membrane oxygenation (p=0.014), time of artificial circulation (p=0.031), duration of artificial ventilation (p=0.001), number of days in intensive care (p<0.001). When analyzing long-term mortality using the Kaplan-Meier method in group 1 and group 2, no statistically significant differences were found; in the group of conservative therapy - 85±9.6 [66.2-103.7] months versus 108.2±4.8 [98.8-117.6] months in the surgery group (log-rank p=0.06). When analyzing long-term mortality from cardiovascular causes and the occurrence of adverse cardiovascular events, statistically significant differences were determined: in the group of conservative therapy - 92.5±9.3 [74.2-110.7] months versus 117.8±3.3 [111.2-124.3] months in the surgical treatment group (log-rank p=0.007) and 78.1±9.2 [60-96.3] months versus 98.9±3.9 [91.3-106.5] months (log-rank p=0.008), respectively. CONCLUSION In-hospital mortality was comparable between groups. Long-term mortality from cardiovascular causes and the number of adverse cardiovascular events were significantly higher in the conservative therapy group. With timely detection of acute dysfunction of coronary bypass grafts, an active surgical approach has an advantage over conservative tactics and can improve the long-term prognosis of patients.
Collapse
Affiliation(s)
- A A Semagin
- Federal Center for Cardiovascular Surgery, Ministry of Health of Russia, Chelyabinsk, Russia
| | - O P Lukin
- Federal Center for Cardiovascular Surgery, Ministry of Health of Russia, Chelyabinsk, Russia
- Federal State Budgetary Educational Institution of Higher Professional Education «South Ural State Medical University» of the Ministry of Health of Russia, Chelyabinsk, Russia
| | - A A Fokin
- Federal State Budgetary Educational Institution of Higher Professional Education «South Ural State Medical University» of the Ministry of Health of Russia, Chelyabinsk, Russia
| |
Collapse
|
3
|
Gaudino M, Dangas GD, Angiolillo DJ, Brodt J, Chikwe J, DeAnda A, Hameed I, Rodgers ML, Sandner S, Sun LY, Yong CM. Considerations on the Management of Acute Postoperative Ischemia After Cardiac Surgery: A Scientific Statement From the American Heart Association. Circulation 2023; 148:442-454. [PMID: 37345559 DOI: 10.1161/cir.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Acute postoperative myocardial ischemia (PMI) after cardiac surgery is an infrequent event that can evolve rapidly and become a potentially life-threatening complication. Multiple factors are associated with acute PMI after cardiac surgery and may vary by the type of surgical procedure performed. Although the criteria defining nonprocedural myocardial ischemia are well established, there are no universally accepted criteria for the diagnosis of acute PMI. In addition, current evidence on the management of acute PMI after cardiac surgery is sparse and generally of low methodological quality. Once acute PMI is suspected, prompt diagnosis and treatment are imperative, and options range from conservative strategies to percutaneous coronary intervention and redo coronary artery bypass grafting. In this document, a multidisciplinary group including experts in cardiac surgery, cardiology, anesthesiology, and postoperative care summarizes the existing evidence on diagnosis and treatment of acute PMI and provides clinical guidance.
Collapse
|
4
|
Robinson NB, Sef D, Gaudino M, Taggart DP. Postcardiac surgery myocardial ischemia: Why, when, and how to intervene. J Thorac Cardiovasc Surg 2023; 165:687-695. [PMID: 34556355 DOI: 10.1016/j.jtcvs.2021.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/21/2021] [Accepted: 05/30/2021] [Indexed: 01/18/2023]
Affiliation(s)
- N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Davorin Sef
- Department of Cardiac Surgery, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - David P Taggart
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
| |
Collapse
|
5
|
Commentary: Postcardiac surgery myocardial ischemia: Be on the lookout and sort it out! J Thorac Cardiovasc Surg 2023; 165:696-697. [PMID: 34247866 DOI: 10.1016/j.jtcvs.2021.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 01/18/2023]
|
6
|
Acute kidney injury following coronary artery bypass grafting and control angiography: a comprehensive analysis of 221 patients. Heart Vessels 2020; 36:1-6. [PMID: 32653953 DOI: 10.1007/s00380-020-01655-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
Postoperative coronary angiography offers the basis for prompt management of ischemic complications after coronary artery bypass grafting (CABG). Little is known about the effects of postoperative angiography on renal function. The current study aims to assess the incidence and risk factors for acute kidney injury (AKI) following postoperative coronary angiography. A total of 221 CABG patients (mean age, 67 ± 8 years) underwent postoperative coronary angiography due to perioperative myocardial infarction (PMI). AKI was defined according to the KDIGO criteria. Logistic regression analyses were performed to find out risk factors responsible for AKI and to ascertain significant associations between AKI and in-hospital death. Mean delay from CABG operation to postoperative angiography was 1.4 ± 1.0 days. AKI occurred in 79/221 (36%) patients. Mean serum-creatinine (sCr) values peaked on the first day after the angiography and reached the lowest level at the fourth day. In the multivariable analysis, the following variables were independent predictors for AKI: postoperative peak values of CK-MB (p = 0.049, OR 1.03, 95% CI 1.00-1.06 per 10 U/l), EuroSCORE I (p = 0.011, OR 1.18, 95% CI 1.04-1.35), and AKI before re-angiography (p = 0.004, OR 3.50, 95% CI 1.51-8.16), whereas a delayed angiography (p = 0.031, OR 0.69, 95% CI 0.49-0.97) was protective against AKI. Patients with post-angiography AKI had a significantly higher mortality after multivariable adjustment than patients without AKI (15.5% vs. 2.11%, p = 0.001, OR 5.42, 95% CI 1.35-21.75). Over one-third of patients who undergo postoperatively angiography develop AKI. The occurrence of AKI must be considered during the decision-making prior to coronary angiography, especially in patients presenting the identified risk factors for AKI.
Collapse
|
7
|
Sef D, Szavits-Nossan J, Predrijevac M, Golubic R, Sipic T, Stambuk K, Korda Z, Meier P, Turina MI. Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery. Open Heart 2019; 6:e001027. [PMID: 31168389 PMCID: PMC6519404 DOI: 10.1136/openhrt-2019-001027] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022] Open
Abstract
Objectives Updated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome. Methods Among 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints. Results Overall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op). Conclusions Urgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.
Collapse
Affiliation(s)
| | - Janko Szavits-Nossan
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Mladen Predrijevac
- J.J. Strossmayer University, Osijek, Croatia.,Department of Cardiovascular Surgery, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | - Rajna Golubic
- Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Tomislav Sipic
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Kresimir Stambuk
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Zvonimir Korda
- Department of Cardiovascular Surgery, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | - Pascal Meier
- Royal Brompton and Harefield NHS Foundation Trust, London, London, UK.,Kantonsspital Graubunden, Chur, GR, Switzerland
| | | |
Collapse
|
8
|
Biancari F, Anttila V, Dell'Aquila AM, Airaksinen JKE, Brascia D. Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis. J Cardiothorac Surg 2018; 13:24. [PMID: 29482583 PMCID: PMC5828145 DOI: 10.1186/s13019-018-0710-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perioperative myocardial ischemia (PMI) in patients undergoing coronary artery bypass grafting (CABG) is associated with poor outcome. The aim of this study was to pool the available data on the outcome after control angiography and repeat revascularization in patients with perioperative myocardial ischemia (PMI) after coronary artery bypass grafting (CABG). METHODS A literature review was performed through PubMed, Scopus, ScienceDirect and Google Scholar to identify studies published since 1990 evaluating the outcome of PMI after CABG. RESULTS Nine studies included 1104 patients with PMI after CABG and 1056 of them underwent control angiography early after CABG. Pooled early mortality after reoperation for PMI without control angiography was 43.6% (95%CI 29.7-57.6%) and 79.8% of them (95%CI 64.4-95.2%) had an acute graft failure detected at reoperation. Among patients who underwent control angiography for PMI, 31.7% had a negative finding at angiography (95%CI 25.6-37.8%) and 62.1% had an acute graft failure (95%CI 56.6-67.6%). Repeat revascularization was performed after early control angiography in 46.3% of patients (95%CI 39.9-52.6%; 54.2% underwent repeat surgical revascularization; 45.8% underwent percutaneous coronary intervention). Pooled early mortality after control angiography with or without repeat revascularization was 8.9% (95%CI 6.7-11.1%). Three studies reported on early mortality rates which did not differ between repeat surgical revascularization and PCI (11.7% vs. 9.2%, respectively; risk ratio 1.45, 95%CI 0.67-3.11). In these three series, early mortality after conservative treatment was 5.9% (95%CI 3.6-8.2%). CONCLUSIONS Control angiography seems to be a valid life-saving strategy to guide repeat revascularization in hemodynamically stable patients suffering PMI after CABG.
Collapse
Affiliation(s)
- Fausto Biancari
- Department of Surgery, University of Turku, Turku, Finland. .,Department of Surgery, University of Oulu, Oulu, Finland. .,Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, 20521, Turku, PL 52, Finland.
| | - Vesa Anttila
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, 20521, Turku, PL 52, Finland
| | | | - Juhani K E Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, 20521, Turku, PL 52, Finland
| | - Debora Brascia
- Department of Surgery, University of Turku, Turku, Finland
| |
Collapse
|