1
|
Momin A, Ranjan R, Valencia O, Jacques A, Lim P, Fluck D, Chua TP, Chandrasekaran V. Long Term Survival Benefits of Different Conduits Used in Coronary Artery Bypass Graft Surgery- A Single Institutional Practice Over 20 Years. J Multidiscip Healthc 2024; 17:1505-1512. [PMID: 38617079 PMCID: PMC11011645 DOI: 10.2147/jmdh.s461567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
Objective This study determined hazard factors and long-term survival rate of total arterial coronary artery bypass graft surgery over 20 years in an extensively large, population-based cohort. Methods A total of 2979 patients who underwent isolated CABG from April 1999 to March 2020 were studied in 4 groups- Group-A (bilateral internal mammary artery ± radial artery), Group-B (single internal mammary artery + radial artery ± saphenous vein), Group-C (single internal mammary artery ± saphenous vein; no radial artery), and Group-D (radial artery ± saphenous vein; no internal mammary artery). The study endpoints analysed the correlation between the number and types of grafts with the survival time following isolated CABG surgery. Results The total arterial revascularization (Group A) group had an admirable mean long-term survival of ~19 years, compared to 18.6 years (Group B), 15.86 years (Group C), and 10.99 years (Group D). A Kaplan-Meier curve demonstrated confidence interval (CI) for study groups- (95% CI 18.33-19.94), (95% CI 18.14-19.06), (95% CI 15.40-16.32), and (95% CI 9.61-12.38) in Group A, B, C, D respectively. In the Holm-Sidak method analysis, significant associations existed between the number of arterial grafts and the long-term outcome. A statistically significant (P≤0.05) long-term survival advantage for arterial grafting was demonstrated, especially total arterial revascularisation over all other combinations except single internal mammary artery + radial artery grafting. Conclusion In this series, over 20 years, total arterial CABG use has excellent long-term survival, achieving complete myocardial revascularisation. There is no significant difference between the BIMA group and SIMA with radial artery. However, there is a reduced survival with decreased use of arterial conduits.
Collapse
Affiliation(s)
- Aziz Momin
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Redoy Ranjan
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Oswaldo Valencia
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Adam Jacques
- Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, London, UK
| | - Pitt Lim
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, London, UK
| | - Tuan P Chua
- Department of Cardiology, Royal Surrey NHS Foundation Trust, London, UK
| | | |
Collapse
|
2
|
Saha SK, Ranjan R, Adhikary AB. Comparison of traditional and upper thoracic epidural analgesia after off‐pump coronary artery bypass graft surgery: A Quasi‐experimental study. Health Sci Rep 2022; 5:e774. [PMID: 35957975 PMCID: PMC9364326 DOI: 10.1002/hsr2.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Aims Surgical trauma initiates changes in central and peripheral nervous systems that need to be treated therapeutically to facilitate postoperative pain. The quality of postoperative analgesia is expected to affect clinical outcomes positively. Albeit optimal pain relief following cardiac surgery is often complex, researchers have tried to explore several techniques other than conventional ones during the last decade to find a unique analgesic method for postcardiac surgical patients. This study aims to find a unique analgesic approach that maximizes patient satisfaction after off‐pump coronary artery bypass graft (OPCABG) surgery. Methods The current study will compare the analgesic effect of upper thoracic epidural analgesia (TEA) with conventional analgesia after OPCAB graft surgery. For this, we will use a Quasi‐experimental study design. Patients admitted for coronary artery bypass graft (CABG) surgery will be assigned into two groups. The control group (conventional) will receive intravenous opioids and nonsteroidal anti‐inflammatory medications, and the study (case) group (TEA) will receive Inj. Bupivacaine 0.25% as an infusion through the epidural catheter. Physiologic parameters like hemodynamic and respiratory variables and pain scores will be recorded in predesigned format periodically. Results We expect to analyze a total of 130 consecutive off‐pump CABG surgery patients in Group A (Case, 65 patients) and Group B (Control, 65 patients). Study variables will be the visual analog scale score, hemodynamic parameters (heart rate, mean arterial pressure, and respiratory parameters (respiratory rate, PaO2, PaCO2, PEFR, FEV1). After data collection, the result will be analyzed and published in the public domain and in journals. Conclusion We expect thoracic epidural analgesia with local anesthetics will be a reliable postoperative analgesic option.
Collapse
Affiliation(s)
- Sanjoy Kumar Saha
- Bangladesh University of Professionals Dhaka Bangladesh
- Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
| | - Redoy Ranjan
- Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh
- Royal Holloway University of London Egham UK
| | | |
Collapse
|
3
|
Ranjan R, Adhikary D, Das D, Adhikary AB. Prevalence and Risk Factors Analysis of Carotid Stenosis Among Ischaemic Heart Diseases Patient in Bangladesh: A Cross-Sectional Study. Int J Gen Med 2022; 15:3325-3331. [PMID: 35355796 PMCID: PMC8959875 DOI: 10.2147/ijgm.s349846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/18/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose This study aimed to evaluate the prevalence of carotid stenosis among ischaemic heart disease (IHD) patients undergoing coronary artery bypass graft (CABG) surgery and identify risk factors associated with carotid stenosis at a tertiary-level hospital in Bangladesh. Patients and Methods This cross-sectional study examined 200 IHD patients scheduled for isolated and elective CABG surgery, and multivariate regression analysis was used to determine the impact of independent variables on carotid stenosis with coronary artery disease. A vascular surgeon and sonographer assessed carotid stenosis, and the severity of stenosis was classified according to the current Grayscale and Doppler US diagnosis models. Results We observed that the prevalence of carotid artery stenosis was 13.5%, and the male was significantly higher (85.2%) in the carotid stenosis group. A multivariate regression analysis observed that age (OR 1.79), dyslipidaemia (OR 2.19), uncontrolled hypertension (OR 2.38), uncontrolled DM (OR 2.51), multivessel coronary artery disease (OR 3.79), and multiple comorbidities (OR 4.46) are potential predictors of having significant carotid stenosis in a patient undergoing CABG surgery. Conclusion In Bangladesh, multivessel coronary artery disease, especially in elderly patients with multiple comorbidities, are 4 (four) times higher risk to have significant carotid artery stenosis. Preoperative carotid duplex screening should be performed to curtail the risk of postoperative adverse cerebrovascular events, particularly those who have carotid stenosis associated potential risk factors.
Collapse
Affiliation(s)
- Redoy Ranjan
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Department of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
- Correspondence: Redoy Ranjan, Department of cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, 1000, Bangladesh, Tel +8801717556046, Email
| | - Dipannita Adhikary
- Department of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Debasish Das
- Department of Thoracic Surgery, Dhaka Medical College & Hospital, Dhaka, Bangladesh
| | - Asit Baran Adhikary
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| |
Collapse
|
4
|
Sazzad F, Ganesh G, Cheekoty P, Veerappan M, Kofidis T. Impact of avoiding cardioplegic arrest on clinical outcome in patients undergoing CABG in Bangladesh: a systematic review and meta-analysis. Indian J Thorac Cardiovasc Surg 2021; 37:153-163. [PMID: 33642713 DOI: 10.1007/s12055-020-01054-4] [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: 05/13/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives Over the last decade, the practice of surgical revascularization for the coronary artery disease has been popularized in Bangladesh. Our aim was to compare the outcome of non-cardioplegic versus cardioplegic coronary artery bypass surgery in terms of early postoperative outcomes. Methods A literature search was conducted in March 2020 on Medline (via PubMed), Scopus and Bangladesh Journal Online electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All randomized controlled trials and observational studies reporting findings of coronary revascularization surgery comparing the outcomes were included. Results Fifteen studies were used quantitatively that included a total cohort of 4750 coronary artery bypass graft (CABG) patients in Bangladesh. After the meta-analysis, we observed a longer duration of operating time [mean difference (MD): - 52.30, confidence interval (CI): - 67.73 to - 36.86, I 2 18 = 89%, p < 0.00001] and a higher incidence of postoperative atrial fibrillation [risk ratio (RR): 0.43, CI: 0.14 to 0.80, I 2 = 44%, p = 0.01] in the cardioplegic CABG group as compared with the non-cardioplegic group. Additionally, statistically significant longer duration of ventilation time (MD: - 8.64, CI: - 9.47 to - 7.82, I 2 = 82%, p < 0.00001) and ICU stay (MD: - 17.25, CI: - 33.36 to - 1.14, I 2 = 99%, p = 0.04) was observed in the cardioplegic group. No significant differences in number of grafts and in-hospital mortality were found between the two groups. Conclusion Non-cardioplegic CABG may be a viable alternative to cardioplegic CABG in Bangladeshi population, providing similar postoperative outcomes but offering additional advantage of shorter operation and ventilation times.
Collapse
Affiliation(s)
- Faizus Sazzad
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine National University of Singapore, 14 Medical Drive, MD6 Level-8 (South), Singapore, 117599 Singapore.,Cardiovascular Research Institute, National University of Singapore , Singapore, Singapore
| | - Geetha Ganesh
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.,Indian Institute of Technology Madras, Chennai, India
| | - Prashasth Cheekoty
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.,School of Medical Education, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Muthu Veerappan
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.,School of Medicine, University of Dundee Ninewells Hospital & Medical School, Dundee, DD1 9SY UK
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine National University of Singapore, 14 Medical Drive, MD6 Level-8 (South), Singapore, 117599 Singapore.,Cardiovascular Research Institute, National University of Singapore , Singapore, Singapore
| |
Collapse
|