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Samanidis G, Kanakis M, Balanika M, Khoury M. Analysis of risk factors for in-hospital mortality in 177 patients who underwent isolated coronary bypass grafting and received intra aortic balloon pump. J Card Surg 2021; 36:1460-1465. [PMID: 33604940 DOI: 10.1111/jocs.15437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/23/2020] [Accepted: 01/16/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Intra-aortic balloon pump (IABP) is the most commonly used device for circulatory support of patients with heart disease. The aim of this study evaluated the risk factors for outcomes of patients who underwent isolated coronary bypass grafting and received IABP. METHODS One hundred-seventy-seven patients underwent isolated coronary bypass grafting and received intraoperative IABP. All perioperative data were recorded. The primary end-point was in-hospital mortality, while the secondary end-points were the length of intensive care unit (ICU) stay and hospital length of stay (LOS). RESULTS In-hospital mortality was 5.6% (10 patients). Multivariable logistic regression analysis showed that the risk factors for in-hospital mortality were preoperative plasma creatinine level and cardiopulmonary bypass (CPB) time (for both p < .05). Multivariable linear regression analysis showed that postoperative acute kidney injury (AKI), immediate plasma troponin after operation, numbers of grafts, and CPB time were predicted the hospital LOS, while postoperative AKI, preoperative left ventricular ejection fraction, and immediate plasma troponin after operation were predicted the lengths of ICU stay. CONCLUSION Our analysis showed that increased preoperative plasma creatinine, postoperative renal dysfunction, and CPB time negatively affected the outcomes of patients who received intraoperative IABP insertion.
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Affiliation(s)
- George Samanidis
- Second Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Marina Balanika
- Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Mazen Khoury
- Second Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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Shah SMA, Awan NI, Jan A, Rehman MU. Characteristics, morbidity and mortality factors associated with Intra-Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery patients. Pak J Med Sci 2020; 36:1318-1324. [PMID: 32968401 PMCID: PMC7500997 DOI: 10.12669/pjms.36.6.2649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The aim of our study is to analyze the characteristics, morbidity and mortality of patients requiring an Intra-Aortic Balloon Pump (IABP) in Coronary Artery Bypass Grafting (CABG). Methods: An analysis was done on the prospectively collected data of 1216 patients who had CABG in our center between July, 2017 and May, 2019 at our hospital. We categorized patients in to an IABP and non-IABP group on the basis of IABP use. We then compared the pre-operative, per-operative and post-operative characteristics of the two groups. We further stratified the patients according to pre-op ejection fraction (EF). Results: Out of 1216 patients, 135(11.10%) patients required an IABP. 70(51.9%) patients of IABP group and 699(64.7%) patients of non-IABP group had hypertension (p-value 0.0036). 23.0% had previous myocardial infarction (MI) in the IABP group and 13.8% had prior myocardial infarction (MI) in non-IABP group (p-value 0.0463). Among the patients requiring an IABP, 21(15.5%) of patients had normal EF (>50%) (P-value<0.0001), 72 (53.3%) had EF 35-50%, and 41(30.3%) patients had EF<35% (p-value <0.0001). Mortality of IABP group (19.3%) was greater than non-IABP group (2.4%) (P-value 0.00001). Conclusions: Use of IABP increased as the EF decreased. Rate of post-operative stroke, prolonged ICU stay, prolonged ventilation, re-opening due to bleeding and mortality was seen to be significantly higher in the IABP group.
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Affiliation(s)
- Sayed Mumtaz Anwar Shah
- Dr. Sayed Mumtaz Anwar Shah, FCPS. Assistant Professor, Department of Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan
| | - Nabil I Awan
- Dr. Nabil I Awan, MBBS. Post-Graduate Resident, Department of Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan
| | - Azam Jan
- Dr. Azam Jan, ABTS Head of Department, Department of Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan
| | - Mujeeb Ur Rehman
- Dr. Mujeeb Ur Rehman, MS. Senior Medical Officer, Department of Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan
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Jannati M, Attar A. Intra-aortic balloon pump postcardiac surgery: A literature review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:6. [PMID: 30815019 PMCID: PMC6383337 DOI: 10.4103/jrms.jrms_199_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/05/2018] [Accepted: 10/24/2018] [Indexed: 12/31/2022]
Abstract
Intra-aortic balloon pump (IABP) has been the most commonly used mechanical assist circulatory device in many postcardiotomy low output disorders for decades. Mechanism of IABP is based on its inflation in time of the diastolic pressure in the aortic root resulting increase in the blood and oxygen amount of the coronary artery and its deflation in left ventricular afterload during the systolic period. Prophylactic and postoperative application of IABP has been suggested by researchers, which has been commonly used in high-risk patients undertaking coronary artery bypass grafting surgery or percutaneous coronary intervention. Other researchers put forward the idea of the percutaneous IABP insertion throughout the left axillary artery as a reliable and relatively well-tolerated approach and also as a recovery tool to bridge patients with end-stage heart failure to heart transplantation. The current review was aimed to give further insight into routine IABP application by presenting the basic principles and trends in the incidence, management, role of IABP recovery, and long-lasting mortality outcomes in patients with cardiovascular disorders and discussing previous and current evidence.
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Affiliation(s)
- Mansour Jannati
- Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Saha KK, Pinto B, Arya M, Saha KK. Total arterial anaortic off-pump coronary artery bypass grafting in a patient with heart failure - Case report. Indian Heart J 2016; 68:700-703. [PMID: 27773410 PMCID: PMC5079124 DOI: 10.1016/j.ihj.2015.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/19/2015] [Accepted: 12/21/2015] [Indexed: 11/11/2022] Open
Abstract
A 69-year-old male diabetic patient of heart failure underwent successful off-pump coronary artery bypass grafting (CABG) using both internal thoracic arteries and left radial artery. There was improvement of left ventricular ejection fraction within 4 days. This is the first ever case report of off-pump CABG in a heart failure patient.
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Affiliation(s)
- Kamales Kumar Saha
- Holy Spirit Hospital, Mahakali Caves Road, Andheri East, Mumbai 400093, Maharashtra, India.
| | - Brian Pinto
- Holy Spirit Hospital, Mahakali Caves Road, Andheri East, Mumbai 400093, Maharashtra, India
| | - Manish Arya
- Holy Spirit Hospital, Mahakali Caves Road, Andheri East, Mumbai 400093, Maharashtra, India
| | - Kakalee K Saha
- Holy Spirit Hospital, Mahakali Caves Road, Andheri East, Mumbai 400093, Maharashtra, India
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Saha KK, Goel S, Kumar A, Saha KK. Anaortic off-pump bilateral internal mammary grafting in severe left ventricular dysfunction - Case report. Indian Heart J 2016; 68 Suppl 2:S54-S56. [PMID: 27751328 PMCID: PMC5067380 DOI: 10.1016/j.ihj.2015.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/11/2015] [Accepted: 03/30/2015] [Indexed: 11/18/2022] Open
Abstract
A 64 years old male diabetic patient with ejection fraction of 16% and renal dysfunction underwent off-pump CABG using both in situ internal mammary artery grafts. Left internal mammary artery was used to bypass left anterior descending artery and right internal mammary artery was used as composite graft. Patient had uneventful recovery and left ventricular ejection fraction improved to 34% within 8 months after surgery. In presence of left ventricular dysfunction, both internal thoracic artery grafting should be preferred for better patency rate and flow reserve. This is the first ever case report of anaortic off-pump bilateral internal thoracic artery grafting in a patient with left ventricular ejection fraction less than 20%.
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Affiliation(s)
- Kamales Kumar Saha
- Cumballa Hill Hospital and Heart Institute, 93/95 August Kranti Marg, Mumbai 400036, Maharastra, India.
| | - Saurab Goel
- Cumballa Hill Hospital and Heart Institute, 93/95 August Kranti Marg, Mumbai 400036, Maharastra, India
| | - Ajay Kumar
- Cumballa Hill Hospital and Heart Institute, 93/95 August Kranti Marg, Mumbai 400036, Maharastra, India
| | - Kakalee K Saha
- Cumballa Hill Hospital and Heart Institute, 93/95 August Kranti Marg, Mumbai 400036, Maharastra, India
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Saha KK, Kumar A, Deval MM, Saha KK, Jacob RV, Jagdale L, Kaul SK. Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kamales Kumar Saha
- Private practice, multiple private hospitals in Mumbai, India
- Fortis S. L. Raheja Hospital, Mumbai, India
- MGM Medical College, Kamothe, Navi Mumbai, India
| | - Ajay Kumar
- Private practice, multiple private hospitals in Mumbai, India
| | | | - Kakalee K. Saha
- Private practice, multiple private hospitals in Mumbai, India
| | - Rinu V. Jacob
- Private practice, multiple private hospitals in Mumbai, India
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Nicorandil Infusion During Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:123-7. [PMID: 26901749 DOI: 10.1097/imi.0000000000000242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion. METHODS Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion). RESULTS A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206). CONCLUSIONS Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.
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Saha KK, Deval MM, Ambardekar S, Kumar A, Saha KK. Total arterial anaortic off-pump coronary artery bypass grafting for diffuse coronary disease - A case report. Indian Heart J 2015; 67:262-5. [PMID: 26138185 DOI: 10.1016/j.ihj.2015.04.005] [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] [Received: 08/06/2014] [Revised: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022] Open
Abstract
Surgical treatment of diffuse coronary artery disease remains challenging. We present here a diabetic patient, with diffuse coronary disease, revascularized using total arterial anaortic off-pump coronary artery bypass grafting. He received total nine distal grafts. He continues to be asymptomatic after more than 2 years. CT angiography follow-up shows eight out of nine grafts are patent. Anaortic off-pump coronary artery bypass grafting has the least incidence of stroke and arterial grafts have the best long-term patency rate. This is the first case report of nine arterial bypass graft performed off-pump using both internal mammary and both radial arteries. Anaortic total arterial off-pump coronary artery bypass grafting has achieved excellent intermediate term result in this patient of diffuse coronary artery disease.
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Affiliation(s)
- Kamales Kumar Saha
- Fortis S L Raheja Hospital, Raheja Rugnalaya Marg, Mahim West Mumbai, Maharashtra, India.
| | - Mandar M Deval
- Fortis S L Raheja Hospital, Raheja Rugnalaya Marg, Mahim West Mumbai, Maharashtra, India
| | - Shekhar Ambardekar
- Fortis S L Raheja Hospital, Raheja Rugnalaya Marg, Mahim West Mumbai, Maharashtra, India
| | - Ajay Kumar
- Fortis S L Raheja Hospital, Raheja Rugnalaya Marg, Mahim West Mumbai, Maharashtra, India
| | - Kakalee K Saha
- Fortis S L Raheja Hospital, Raheja Rugnalaya Marg, Mahim West Mumbai, Maharashtra, India
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