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Keeling WB, Binongo J, Wei J, Leshnower BG, Farrington W, Halkos ME. National trends in emergency coronary artery bypass grafting. Eur J Cardiothorac Surg 2023; 64:ezad352. [PMID: 37878803 DOI: 10.1093/ejcts/ezad352] [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] [Received: 04/11/2023] [Revised: 09/20/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES Emergency coronary artery bypass grafting (CABG) is often omitted from current research, and volumes as well as outcomes are unknown. The purpose of this research is to examine national trends in emergency CABG. METHODS The Society of Thoracic Surgeons national adult cardiac surgical database was queried from 2005 to 2017 for patients who underwent emergency and emergency salvage isolated CABG procedures, and 92 607 patients were included for analysis. Generalized linear mixed models were used to assess time trends, taking into account the clustering effect of region. RESULTS Over the study period, volumes of emergency and emergency salvage CABG declined from 7991 to 6916 cases/year. Emergency and emergency salvage cases accounted for ∼4.9% of all CABG procedures performed nationwide in 2005 and 4.1% in 2017. The predicted risk of mortality (PROM) declined in the entire patient cohort over time from 12% to 8% (P < 0.0001). Rates of important postoperative morbidities also declined including prolonged intubation, re-exploration for haemorrhage and postoperative pneumonia (P < 0.001). Observed-to-expected mortality rates rose over the study period from 0.81 to 1.06 as the overall PROM declined from 9.3% to 7.6%. Emergency salvage CABG rates also declined over the course of the study from 358 to 323 cases/year. The observed-to-expected ratios for mortality increased for emergency salvage CABG during the study from 1.16 to 1.66, and emergency salvage mortality rates averaged 46.5%. CONCLUSIONS The volume of patients undergoing emergency and emergency salvage CABG in the USA has declined. Increases in mortality are largely driven by emergency salvage cases, and the PROM algorithm may not accurately reflect the risk involved for these patients.
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Affiliation(s)
- William B Keeling
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jane Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Woodrow Farrington
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Polo-Gutierrez G, Silva-Tejada HA, Martinez-Ninanqui FW, Robles-Velarde V, Ríos-Ortega J. [Analysis of cardiac surgeries and operative mortality at the National Cardiovascular Institute during 2022]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:55-61. [PMID: 37780951 PMCID: PMC10538925 DOI: 10.47487/apcyccv.v4i2.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/17/2023] [Indexed: 10/03/2023]
Abstract
Objective To describe cardiac surgeries, their approaches, and determine operative mortality according to the type of surgery and the main complications recorded within 30 days postoperatively, performed at the National Cardiovascular Institute of Peru. Materials and methods A descriptive study was conducted on all patients over 18 years of age who underwent cardiovascular surgery at the National Cardiovascular Institute "Carlos Alberto Peschiera Carrillo". Results During the year 2022, a total of 503 cardiac surgeries were performed. Of the patients undergoing surgery, 63.6% (320) were males. Isolated valvular surgery, primarily aortic or mitral valve replacement, was the most frequent surgical procedure, with 136 surgeries (27.0%). This was followed by myocardial revascularization surgery with 110 procedures (21.9%). Throughout the year, there were 23 deaths, resulting in an overall mortality rate of 4.5%. The mortality rate for elective surgeries was 2.8%, while for emergency surgeries, it was 14.3%. The most common complication was paroxysmal atrial fibrillation (14.0%), followed by surgical site infection with 52 cases (10.3%). Conclusions Valvular surgery, whether isolated or combined with other procedures, was the most frequently performed. The obtained mortality rate is considered acceptable for a reference center.
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Affiliation(s)
- Gerber Polo-Gutierrez
- Instituto Nacional Cardiovascular. Lima, Perú Instituto Nacional Cardiovascular Lima Perú
| | | | | | - Victor Robles-Velarde
- Instituto Nacional Cardiovascular. Lima, Perú Instituto Nacional Cardiovascular Lima Perú
| | - Josías Ríos-Ortega
- Instituto Nacional Cardiovascular. Lima, Perú Instituto Nacional Cardiovascular Lima Perú
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Mezzetti E, Maiese A, Spina F, Del Duca F, De Matteis A, Di Paolo M, La Russa R, Turillazzi E, Fineschi V. Early Saphenous Vein Graft Aneurysm Rupture: A Not So-Late Complication. Case Report and Comprehensive Literature Review. Biomedicines 2023; 11:biomedicines11010220. [PMID: 36672728 PMCID: PMC9855650 DOI: 10.3390/biomedicines11010220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Saphenous vein graft (SVG) is a cardiac surgical practice used to create a cardiac bypass in cases of coronary artery obstruction. It consists of a surgical procedure that involves the creation of an aorto-coronary communication by a venous conduit (saphenous vein) to bypass coronary stenosis and allow cardiac revascularization. This practice can be affected by early and late complications. The most feared complication is graft aneurysm or pseudoaneurysm degeneration and rupture which are considered late complications. This paper presents a rare case of SVG aneurysmal rupture that occurred 24 h after surgery and a review of the literature to provide a general look at the state of knowledge. MATERIALS AND METHODS The systematic review was carried out using the guidelines according to the PRISMA method. RESULTS Cases of aneurysmal rupture have never been described prior to one month after surgery. The male sex and subjects under 45 are the most affected by this complication. Death occurs in less than half of the cases, being more frequent in young people. Performing a CT or angio-CT examination led to the diagnosis. CONCLUSIONS It is impossible to estimate the implanted vessel's quality, so postoperative follow-up is fundamental. Transesophageal ultrasound can be useful, and hematochemical tests are valuable early diagnostic tools, whrease CT and angio-CT can be useful even months after surgery. Forensic analysis should always perform an autopsy and graft histological examination.
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Affiliation(s)
- Eleonora Mezzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
- Correspondence:
| | - Federica Spina
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
| | - Marco Di Paolo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Emanuela Turillazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Section of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy
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Takata ET, Eschert J, Mather J, McLaughlin T, Hammond J, Hashim SW, McKay RG, Sutton TS. Enhanced Recovery After Surgery Is Associated With Reduced Hospital Length of Stay after Urgent or Emergency Isolated Coronary Artery Bypass Surgery at an Urban, Tertiary Care Teaching Hospital: An Interrupted Time Series Analysis With Propensity Score Matching. J Cardiothorac Vasc Anesth 2023; 37:31-41. [PMID: 36379833 DOI: 10.1053/j.jvca.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate whether enhanced recovery after surgery (ERAS) was associated with reduced length of stay (LOS) after urgent or emergency coronary artery bypass graft surgery (CABG). DESIGN A retrospective analysis of an institutional database for urgent or emergency isolated CABG before versus after ERAS. Propensity matching identified comparable subpopulations pre- versus post-ERAS. Interrupted time series analysis was used to evaluate LOS. SETTING At a tertiary care teaching hospital. PARTICIPANTS A total of 1,012 patients undergoing urgent or emergent CABG-346 from 2016 to 2017 (pre-ERAS), and 666 from 2018 to 2020 (post-ERAS). Emergent CABG was performed within 24 hours, and urgent CABG was performed during the same hospitalization to reduce clinical risk. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Propensity-matched post-ERAS (n = 565) versus pre-ERAS patients (n = 330) demonstrated reduced LOS (9 [8-13] v (10 [8-14] days p = 0.015), increased likelihood of extubation within 6 hours (46.0% v 35.8%, p = 0.003), shorter ventilation time (6.3 [5.1-10.2] v (7.2 [5.4-12.2] hours, p = 0.003), reduced morphine milligram equivalent use on postoperative days 1 and 2 (69.6 ± 62.2 v 99.0 ± 61.6, p < 0.001), and increased intraoperative ketamine use (58.8% v 35.2%, p < 0.001). There were no differences regarding reintubation, intensive care unit readmission, or 30-day morbidity. Adjusted segmental regression (n = 1,012) for LOS demonstrated reduced mean LOS of approximately 2 days after ERAS (β2 coefficient -1.943 [-3.766 to -0.121], p = 0.037), with stable trends for mean LOS and no change in slope throughout the pre-ERAS and post-ERAS time periods. CONCLUSIONS Enhanced recovery after surgery was associated with reduced LOS after urgent or emergency CABG without adverse effects on prolonged ventilation, reintubation, intensive care unit readmission, or 30-day outcomes.
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Affiliation(s)
- Edmund T Takata
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT
| | - John Eschert
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT
| | - Jeff Mather
- Research Administration, Hartford Hospital, Hartford, CT
| | | | - Jonathan Hammond
- Department of Cardiac Surgery and Heart and Vascular Institute, Hartford Hospital, Hartford, CT
| | - Sabet W Hashim
- Department of Cardiac Surgery and Heart and Vascular Institute, Hartford Hospital, Hartford, CT
| | - Raymond G McKay
- Heart and Vascular Research Institute, Hartford Hospital, Hartford, CT
| | - Trevor S Sutton
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT.
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Bianchi G, Zancanaro E, Margaryan R, Concistré G, Varone E, Simeoni S, Solinas M. Outcomes of Emergent Isolated Coronary Bypass Grafting in Heart Failure Patients. Life (Basel) 2022; 12:life12122124. [PMID: 36556489 PMCID: PMC9783056 DOI: 10.3390/life12122124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Patients with previously diagnosed HF are at greater risk for subsequent morbidity and mortality when hospitalized for an Acute Myocardial Infarction (AMI). The purpose of our study was to describe the time trend of the incidence of emergent CABG in patients with and without HF, the clinical characteristics, outcomes, and the risk factors for mortality of surgical revascularization in the short and medium term. This was a single-center retrospective observational study of patients who underwent isolated emergency CABG from January 2009 to January 2020. A propensity-score matching analysis yielded two comparable groups (n = 430) of patients without (n = 215) and with (n = 215) heart failure. In-hospital mortality did not differ in the two groups (2.8%; p > 0.9); the patients with heart failure presented more frequently with cardiogenic shock, and there was an association with mortality and mechanical circulatory support (OR 16.7−95% CI 3.31−140; p = 0.002) and postoperative acute renal failure (OR 15.9−95% CI 0.66−203; p = 0.036). In the early- and mid-term, heart failure and NSTEMI were associated with mortality (HR 3.47−95% CI 1.15−10.5; p = 0.028), along with age (HR 1.28−95% CI 1.21−1.36; p < 0.001). Surgical revascularization offers an excellent solution for patients with acute coronary syndrome, leading to a good immediate prognosis even in those with chronic heart failure.
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Affiliation(s)
- Giacomo Bianchi
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
- Correspondence: ; Tel.: +39-3404680379
| | - Edoardo Zancanaro
- Department of Cardiac Surgery, Università Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Giovanni Concistré
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Egidio Varone
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Simone Simeoni
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy
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Hecht JP, Huang J, Pruitt A, Gupta A, Clark MJ, He C, Brockhaus K. The Effect of Direct Oral Anticoagulants on Outcomes After Urgent or Emergent Cardiac Surgery. J Cardiothorac Vasc Anesth 2022; 36:4273-4280. [PMID: 36216688 DOI: 10.1053/j.jvca.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the safety of performing urgent or emergent cardiac surgery within 5 days of a patient taking a direct oral anticoagulant (DOAC). DESIGN A multicenter retrospective registry study. SETTING Thirty-three hospitals in a quality collaborative from 2017 to 2019. PARTICIPANTS Patients were included if they underwent urgent or emergent coronary artery bypass grafting (CABG). Patients were excluded if they received any anticoagulant or antiplatelet agent besides DOACs, heparin, or aspirin. INTERVENTIONS Patients were stratified based upon the receipt of a DOAC within 5 days of their surgery. Patient cohorts included DOAC within 2 days, DOAC within 3-to-5 days, and no anticoagulation. Data were unavailable on the specific DOAC agent taken prior to admission. MEASUREMENTS AND MAIN RESULTS There were 7,201 patients included, with 94 on DOACs. Intraoperative blood transfusion was required in 23.9% of patients on no anticoagulant, 26.2% on a DOAC within 3-to-5 days of surgery (odds ratio [OR] 0.98; 95% CI 0.46-2.11), and 30.3% on a DOAC within 2 days (OR 0.99; 95% CI 0.37-2.67). Five or more intraoperative blood products were required in 4.4% on no anticoagulant, 1.7% on DOAC within 3-to-5 days (OR 0.33; 95% CI 0.04-2.71), and 6.1% on DOAC within 2 days (OR 0.47; 95% CI 0.06-4.05). No difference in mortality was observed among the 3 groups (2.9% v 3.3% v 3.0%; p = 0.67). CONCLUSIONS For urgent or emergent CABGs, no significant differences in minor bleeding, major bleeding, or mortality were observed in patients taking a DOAC within 5 days of surgery. This study was hypothesis-generating for performing urgent or emergent surgery sooner than 5 days after holding DOACs.
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Affiliation(s)
- Jason P Hecht
- Department of Pharmacy Services, Saint Joseph Mercy Ann Arbor, Ann Arbor, MI.
| | - Jean Huang
- Department of Pharmacy Services, Saint Joseph Mercy Ann Arbor, Ann Arbor, MI
| | - Andrew Pruitt
- Department of Cardiothoracic Surgery, Saint Joseph Mercy Ann Arbor, Ann Arbor, MI
| | - Ajay Gupta
- Department of Cardiothoracic Surgery, Saint Joseph Mercy Ann Arbor, Ann Arbor, MI
| | - Melissa J Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI
| | - Chang He
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI
| | - Kara Brockhaus
- Department of Pharmacy Services, Saint Joseph Mercy Ann Arbor, Ann Arbor, MI
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Ayati A, Hosseini K, Hadizadeh A, Jalali A, Lotfi‐Tokaldany M, Milan N, Bagheri J, Ahmadi Tafti SH. Surgical coronary revascularization in patients with COVID-19; complications and outcomes: A retrospective cohort study. Health Sci Rep 2022; 5:e751. [PMID: 35957968 PMCID: PMC9364075 DOI: 10.1002/hsr2.751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023] Open
Abstract
Background and Aims Coronary artery disease is high-risk comorbidity of COVID-19 infection. Nonelective coronary artery revascularization in COVID-19 patients carries substantial risk. Therefore, it is essential to understand the risk factors and outcomes fully. This study aims to evaluate the prognosis of coronary artery bypass grafting (CABG) surgery in patients with COVID-19. Methods This retrospective cohort study assesses 171 patients who underwent urgent and emergent CABG in Tehran Heart Center from March 2020 to September 2021. The patients were allocated to cases and controls based on COVID-19 infection status. Demographic and clinical features, alongside the complications and outcomes, were compared between the two groups. Results According to diagnostic criteria, 62 patients were diagnosed with COVID-19 (Case) and 109 patients had no COVID diagnosis (Control). Regarding the demographics and risk factors, hypertension was more prevalent among patients with COVID-19 (64.5% compared to 43.1% p= 0.007). Length of hospital stay, ventilation time, and intensive care unit (ICU) stay time were significantly higher in patients infected with COVID-19. Postoperative complications, including stroke, atrial fibrillation, pleural effusion, blood transfusion, and Inotrope use, were significantly higher in the case group. Mortality rates were also higher in COVID-19 patients with an odds ratio of 1.53; however, this difference is not statistically significant (p: 0.44, 95% CI = 0.50-4.01). Conclusion COVID-19 is associated with a significantly higher hospital stay, ventilation time, and ICU stay. Mortality rates are also higher, albeit insignificantly. Various postoperative complications are also higher with COVID-19.
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Affiliation(s)
- Aryan Ayati
- Tehran Heart Center Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Tehran Heart Center Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Alireza Hadizadeh
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Arash Jalali
- Tehran Heart Center Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Masoumeh Lotfi‐Tokaldany
- Tehran Heart Center Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Nesa Milan
- Tehran Heart Center Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Jamshid Bagheri
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Seyed Hossein Ahmadi Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart CenterTehran University of Medical SciencesTehranIran
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8
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Akhrass R, Gillinov M, Bakaeen F, Akras D, Cameron SJ, Bishop J, Kapadia S, Svensson L. Emergency cardiac surgery in patients on oral anticoagulants and antiplatelet medications. J Card Surg 2021; 37:214-222. [PMID: 34779523 DOI: 10.1111/jocs.16027] [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: 05/11/2021] [Revised: 08/06/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency surgery, blood transfusion, and reoperation for bleeding have been associated with increased operative morbidity and mortality. The recent increased use of direct oral anticoagulants and antiplatelet medications has made the above more challenging. In addition, cardiopulmonary bypass (CPB), with its associated hemodilution, fibrinolysis, and platelet consumption, may exacerbate the pre-existing coagulopathy and increase the risk of bleeding. AIM The aim of this study was to examine available literature with regard to treating patients who are on the above medications and require emergency cardiac surgery. RESULTS Management decisions are typically made on a case-by-case basis. Surgery is delayed when possible, and less invasive percutaneous options should be considered if feasible. Attention is paid to exercising meticulous techniques, avoiding excessive hypothermia, and treating coexisting issues such as sepsis. Ensuring a dry operative field upon entry by correcting the coagulopathy with reversal agents is offset by the concern of potentially hindering efforts to anticoagulate the patient (heparin resistance) in preparation for CPB, in addition to possibly increasing the risk of thromboembolism. CONCLUSION Proper knowledge of anticoagulants, their reversal agents, and the usefulness of laboratory testing are all essential. Platelet transfusion remains the mainstay for antiplatelet medications. Four-factor prothrombin complex concentrate is considered in patients on oral anticoagulants if CPB needs to be instituted quickly. Specific reversal agents such as idarucizumab and andexanet alfa can be considered if significant tissue dissection is anticipated, such as redo sternotomy, but are costly and may lead to heparin resistance and anticoagulant rebound.
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Affiliation(s)
- Rami Akhrass
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deena Akras
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott J Cameron
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jay Bishop
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lars Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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9
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Li Y, Li C, Feng D, Zhang Q, Li K, Liu Y, Yang X, Wang L. Predictive value of ACEF II score in patients with multi-vessel coronary artery disease undergoing one-stop hybrid coronary revascularization. BMC Cardiovasc Disord 2021; 21:489. [PMID: 34629062 PMCID: PMC8504062 DOI: 10.1186/s12872-021-02299-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to investigate the predictive value of recently updated ACEF II score on major adverse cardiac and cerebrovascular events (MACCE) in patients with multi-vessel coronary artery disease (MVCAD) undergoing one-stop hybrid coronary revascularization (HCR). Methods Patients with MVCAD undergoing one-stop HCR were retrospectively recruited from March 2018 to September 2020. Several prediction risk models, including ACEF II score, were calculated for each patient. Kaplan-Meier curve was used to evaluate freedom from cardiac death and MACCE survival rates. Differences of prediction performance among risk scores for predicting MACCE were compared by receiver operating characteristic (ROC) curve. Results According to the ACEF II score, a total of 120 patients undergoing one-stop HCR were assigned to low-score group (80 cases) and high-score group (40 cases). During the median follow-up time of 18 months, the incidence of MACCE in the low-score group and high-score group were 8.8 % and 37.5 %, respectively (p < 0.001); and the cardiac death rate of the two were 2.5% and 12.5%, respectively (p < 0.05). Moreover, the cumulative freedom from cardiac death (97.5% vs. 86.8, p < 0.05) and MACCE (75.2% vs. 52.8%, p < 0.001) survival rates in the high-score group were significantly lower than in the low-score group. According to the Cox proportional hazards regression, the ACEF II score was an independent prognostic indicator for MACCE with hazards ratio (HR) 2.24, p = 0.003. The ROC curve analysis indicated that the areas under the curve (AUC) of MACCE from the ACEF II score was 0.740 (p < 0.001), while the AUC of MACCE from the SYNTAX score II CABG was 0.621 (p = 0.070) and the AUC from the EuroSCORE II was 0.703 (p < 0.001). Thus, the accurate predictive value of ACEF II score was similar to the EuroSCORE II but much higher than the SYNTAX score II CABG. Conclusions The updated ACEF II score is a more convenient and validated prediction tool for MACCE in patients with MVCAD undergoing one-stop HCR comparing to other risk models.
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Affiliation(s)
- Yanyan Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China
| | - Chuang Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China
| | - Dejing Feng
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China
| | - Qian Zhang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China
| | - Kuibao Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China
| | - Yu Liu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China
| | - Xinchun Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China
| | - Lefeng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China.
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10
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Shahinian JH, Gürleyen M, Grodd M, Wolkewitz M, Beyersdorf F, Siepe M, Pingpoh C. Coronary revascularization in acute coronary syndrome: does the choice of the conduit matter? THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:639-645. [PMID: 34520135 DOI: 10.23736/s0021-9509.21.11730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Our retrospective study evaluates the impact on short - and long-term outcome according to the graft selection during emergency coronary revascularization surgery. METHODS 339 Patients with acute coronary syndrome undergoing emergency coronary bypass surgery at our institution from 2008 until 2018 were analyzed using propensity score analysis. The primary endpoint was in-hospital survival. Secondary endpoints were postoperative bleeding, contractile dysfunction, postoperative percutaneous coronary intervention, myocardial infarction and wound infection. Patients were divided in two groups according to the bypass grafts received ((group 0, (n = 222): combined arterial and venous grafts for the and group 1 (n = 117): complete arterial revascularization). RESULTS There is significant improvement of left ventricular function postoperatively in patients undergoing emergency coronary revascularization for acute myocardial infarction where arterial grafts were used. Furthermore, there is significant difference between postoperative cardiac enzymes with lower values in group 1 (creatine kinase myocardial band p=0.0001; Troponin T p= 0,010). There was no significant difference in short and long-term survival between two groups. 5-years survival analysis between both groups did not show significant difference with Log-Rank test adjusted p-value = 0,49 (unadjusted p-value = 0.005). There was no significant difference in perioperative myocardial infarction, postoperative bleeding, and the need for postoperative coronary angiography. CONCLUSIONS Emergency coronary artery bypass grafting with arterial grafts shows significant improvement of left ventricular function postoperatively. However, utilization of bilateral internal mammary artery grafts in emergency coronary revascularization has no significant impact on short term or 5-year survival.
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Affiliation(s)
- Jasmin H Shahinian
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany -
| | - Mertan Gürleyen
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marlon Grodd
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Clarence Pingpoh
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
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Fertouk M, Gordon A, Pevni D, Ziv-Baran T, Sela O, Mohr R, Farkash A, Kramer A, Teich N, Nesher N, Ben-Gal Y. Early and late outcomes of single versus bilateral internal thoracic artery revascularization for patients in critical condition. PLoS One 2021; 16:e0255740. [PMID: 34352035 PMCID: PMC8341519 DOI: 10.1371/journal.pone.0255740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The optimal surgical approach for critically ill patients with complex coronary disease remains uncertain. We compared outcomes of bilateral internal thoracic artery (BITA) versus single ITA (SITA) revascularization in critical patients. METHODS We evaluated 394 consecutive critical patients with multi-vessel disease who underwent CABG during 1996-2001. Outcomes measured were early mortality, strokes, myocardial-infarctions, sternal infections, revisions for bleeding, and late survival. The critical preoperative state was acknowledged concisely by one or more of the following: preoperative ventricular tachycardia/fibrillation, aborted sudden cardiac death, or the need for mechanical ventilation or for preoperative insertion of intra-aortic-balloon counter-pulsation. RESULTS During the study period, 193 of our patients who underwent SITA and 201 who underwent BITA were in critical condition. The SITA group was older (mean 68.0 vs. 63.3 years, p = 0.001) and higher proportions were females (28.5% vs. 18.9% p = 0.025), after recent-MI (69.9% vs. 57.2% p = 0.009) and with left-main disease (38.3% vs. 49.3% p = .029); the median logistic EuroSCORE was higher (0.2898 vs. 0.1597, p<0.001). No statistically significant differences were observed between the SITA and BITA groups in 30-day mortality; and in rates of early CVA, MI and sternal infections (13.0% vs. 8.5%, p = 0.148; 4.1% vs. 6.0%, p = 0.49; 6.7% vs. 4.5%, p = 0.32 and 2.1% vs. 2.5%, p>0.99, respectively). Long-term survival (median follow-up of 15 years, interquartile-range: 13.57-15) was better in the BITA group (median 14.39 vs. 9.31± 0.9 years, p = 0.001). Propensity-score matching (132 matched pairs) also yielded similar early outcomes and improved long-term survival (median follow-up of 15 years, interquartile-range: 13.56-15) for the BITA group (median 12.49±1.71 vs. 7.63±0.99 years, p = 0.002). In multivariable analysis, BITA revascularization was found to be a predictor for improved survival (hazard-ratio of 0.419, 95%CI 0.23-0.76, p = 0.004). CONCLUSIONS This study demonstrated long-term survival benefit for BITA revascularization in patients in a critical pre-operative state who presented for surgical revascularization.
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Affiliation(s)
- Michal Fertouk
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Gordon
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dmitry Pevni
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orr Sela
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rephael Mohr
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Farkash
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Kramer
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadav Teich
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nachum Nesher
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yanai Ben-Gal
- Department of Cardiothoracic Surgery, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- * E-mail: ,
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12
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Hung DQ, Minh NT, Vo HL, Hien NS, Tuan NQ. Impact of Pre-, Intra-and Post-Operative Parameters on In-Hospital Mortality in Patients Undergoing Emergency Coronary Artery Bypass Grafting: A Scarce Single-Center Experience in Resource-Scare Setting. Vasc Health Risk Manag 2021; 17:211-226. [PMID: 34040381 PMCID: PMC8139717 DOI: 10.2147/vhrm.s303726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background In-hospital mortality after emergency coronary artery bypass grafting (CABG) remains an important issue that has needed considerable attention in recent years as the mortality rate is still high and prevention factors are not yet optimal. Our study presents the first largest cohort of emergency CABG from one large institution in Vietnam with the primary aim of comparing a large variety of pre-, intra-and post-operative parameters between in-hospital mortality patients and in-hospital survival patients and investigate risk factors of in-hospital mortality in patients undergoing emergency CABG. Methods We conducted a retrospective evaluation of prospectively collected data in patients undergoing emergency CABG at the Hanoi Heart Hospital (Hanoi, Vietnam) from January 1, 2017, to December 31, 2019. Primary outcome variable was in-hospital mortality. Results A total of 71 patients were included in final analysis. The mean age of the cohort was 68.68 years (± 9.28, range 38-86). The mean weight, height and body mass index were 54.35 kg (± 9.17, range 37-77), 158.96 (±7.64, range 145-179) and 21.48 kg/m2 (±3.08, range 13.59-30.08), respectively. In-hospital mortality rate was 9.86%. Preoperative risk factors for in-hospital mortality included diabetes, decreased ejection fraction (EF), EF below 30%, cardiogenic shock, elevated systolic pulmonary artery pressure (PAP), elevated NT-ProBNP, and Euroscore II. Without grafting with left internal thoracic artery, and prolonged cardiopulmonary bypass (CPB) time were increased intraoperative factors for in-hospital mortality risk. In-hospital mortality's postoperative risk factors were found to be postextubation respiratory failure requiring mechanical ventilation, ventricular fibrillation, dialysis-requiring acute renal failure, pneumonia, bacterial sepsis, gastrointestinal bleeding, and prolonged mechanical ventilation time. Significant predictors determining in-hospital mortality were known as prolonged CPB time in surgery and postoperative ventricular fibrillation. Conclusion Our hospital mortality rate after emergency CABG was relatively high. An optimal preventive strategy in emergency CABG management should target significant factors combined with other previously identified risk factors to reduce in-hospital mortality.
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Affiliation(s)
- Doan Quoc Hung
- Hanoi Medical University, Hanoi, 100000, Vietnam.,Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | | | | | | | - Nguyen Quang Tuan
- Hanoi Medical University, Hanoi, 100000, Vietnam.,Bach Mai Hospital, Hanoi, 100000, Vietnam
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Palaniappan A, Sellke F. An Analysis of Medical Malpractice Litigations in Coronary Artery Bypass Grafting from 1994-2019. Ann Thorac Surg 2021; 113:600-607. [PMID: 33794168 DOI: 10.1016/j.athoracsur.2021.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiothoracic surgery is one of the more highly litigated medical specialties, and coronary artery bypass grafting (CABG) constitutes a substantial portion of cardiothoracic surgery cases. Therefore, understanding litigations relating to CABG would be of benefit to surgeons working to uphold the standards of care that their patients seek and minimize their own legal liability. This study analyzed CABG litigations to identify predictive factors of litigation and verdict type. METHODS This study utilized the Westlaw legal database to compile litigations from 1994-2019 across the United States, and resulted in 307 total litigations. After individual screening, 211 litigations met the criteria for inclusion, and were analyzed for demographic, clinical, chronological, and verdict characteristics. RESULTS Litigations were present in 33 U.S. states, with California, New York, and Florida having the most litigations. Defendant verdicts were reached in 67.78% of litigations, followed by 20.38% of plaintiff verdicts and 11.85% of settlements. Plaintiff verdicts were associated with the incidence of myocardial infarction during hospitalization. The winter season had the most litigations (42.18%), and the most defendant verdicts (37.76%). Patient mortality occurred in 47.39% of litigations. The most common alleged reason for litigation was a procedural error (55.45%). CONCLUSIONS Defendant verdicts were significantly associated with an alleged reason of procedural errors, an alleged reason of a failure to monitor, and congestive heart failure present in patients. The common nature of defendant verdicts, and the significantly greater occurrence of defendant verdicts during the highly-litigated winter season, suggest that surgeons frequently satisfy the legal standard of care.
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Affiliation(s)
- Ashwin Palaniappan
- Alpert Medical School, Brown University, Providence, Rhode Island; Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, Rhode Island.
| | - Frank Sellke
- Alpert Medical School, Brown University, Providence, Rhode Island; Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, Rhode Island
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14
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Hodges K, Weiss AJ, Bakaeen FG, Geube M. Commentary: How Expensive is the Cardiac Surgery Associated Acute Renal Dysfunction? It Comes Down to the Definition. Semin Thorac Cardiovasc Surg 2021; 33:1012-1013. [PMID: 33600993 DOI: 10.1053/j.semtcvs.2021.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aaron J Weiss
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mariya Geube
- Department of Cardiothoracic Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
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15
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Shehata IM, Odell TD, Elhassan A, Spektor M, Urits I, Viswanath O, Jeha GM, Cornett EM, Kaye AD. Preoperative, Multidisciplinary Clinical Optimization of Patients with Severely Depressed Left Ventricular Ejection Fraction Who Are Undergoing Coronary Artery Bypass Grafting. Cardiol Ther 2020; 10:57-66. [PMID: 33367988 PMCID: PMC8126524 DOI: 10.1007/s40119-020-00207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
Coronary artery bypass grafting (CABG) remains a routine operation despite major advancements in angioplastic procedures. Around 200,000 CABG procedures are performed annually in the U.S. Patients who are not candidates for angioplasty intervention often have advanced coronary disease and comorbidities that raise the risk of heart failure with decreased ejection fraction to around 25%. Over the years, significant developments in various preoperative interventions have occurred; in this paper, we suggest a multidisciplinary preoperative algorithm that can be included in a regularly scheduled multidisciplinary care plan.
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Affiliation(s)
| | - Tiffany D Odell
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Amir Elhassan
- Department of Anesthesiology, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Maxim Spektor
- Department of Surgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Ivan Urits
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
- Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, AZ, USA
| | - George M Jeha
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA.
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16
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Nishonov AB, Tarasov RS, Ivanov SV, Barbarash LS. [Coronary artery bypass grafting in myocardial infarction and unstable angina pectoris: analysis of perioperative factors. Part 1]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:132-140. [PMID: 33332315 DOI: 10.33529/angio2020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM The purpose of this study was to assess the perioperative clinical, demographic and anatomo-angiographic factors in patients presenting with non-ST-segment elevation acute coronary syndrome and being candidates for coronary artery bypass grafting, depending on the presence or absence of myocardial infarction. PATIENTS AND METHODS Over the period from 2017 to 2018 within the framework of a single-centre register, the study enrolled a total of 166 consecutive patients admitted with non-ST segment elevation acute coronary syndrome and recommended by the cardiosurgical team to undergo coronary artery bypass grafting. Depending on the outcome of acute coronary syndrome, the patients were divided into 2 groups: Group One included 98 (59%) patients with unstable angina pectoris and Group Two comprised 68 (41%) patients with myocardial infarction. A lethal outcome occurred in 2 (3%) Group Two patients prior to revascularization, hence they were not included into the analysis comparing the results of surgery in both groups, however these data were taken into consideration, being analysed separately. RESULTS The group of patients with myocardial infarction appeared to include significantly more female patients (20 (30.3%) versus 15 (15.3%) in the group of patients with unstable angina pectoris, p=0.02). However, by such parameters as the average age, left ventricular ejection fraction, and the frequency of diabetes mellitus the compared groups did not differ. The group with myocardial infarction was characterised by a severe clinico-angiographic status: more frequently encountered was stage II obesity (3%, n=3 in the first group and 10.6% n=7 in the second group, p=0.04). On the whole, the majority of patients were at intermediate and high risk (44.7% in the group with unstable angina pectoris versus 81.8% in the group of myocardial infarction, p<0.05). Group Two patients significantly more often presented with three-vessel lesions of the coronary bed (40 (40.8%) and 39 (59%), p=0.02). The level of low-density lipoproteins appeared to be significantly higher in patients with myocardial infarction (3.3±1 mmol/l and 2.9±0.9, p=0.04). In the same group more often encountered were peripheral artery lesions (28 (21%) and 12 (11.3%), p=0.04). In its turn, in the group of unstable angina pectoris, there were significantly more patients having received dual antithrombotic therapy prior to surgery (44 (44.9%) and 17 (25%), p=0.01). Approximately half of the patients in the first group (53%, n=52) had a history of myocardial infarction (p=0.001). CONCLUSION The obtained findings suggested that amongst the patients with non-ST-elevation acute coronary syndrome resulting in myocardial infarction prevailing were those of female gender, with obesity, as a consequence, hyperholesterolaemia and triple-vessel disease. At the same time, postinfarction cardiosclerosis, renal dysfunction, and haemodynamically significant lesions of lower-extremity arteries were encountered in the group of unstable angina pectoris.
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Affiliation(s)
- A B Nishonov
- Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - R S Tarasov
- Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - S V Ivanov
- Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
| | - L S Barbarash
- Cardiosurgical Department, Scientific Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
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Elsisy MF, Stulak JM, Alkhouli M. Incidence, Characteristics, and Outcomes of Emergent Isolated Coronary Artery Bypass Grafting. Am J Cardiol 2020; 137:20-24. [PMID: 32998004 DOI: 10.1016/j.amjcard.2020.09.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
Data on emergency coronary artery bypass surgery (CABG) are limited. We studied patients who underwent isolated CABG at Mayo Clinic between 1993 and 2019. Baseline characteristics and in-hospital outcomes of emergent CABG were described in consecutive eras (1993 to 2000, 2001 to 2010, and 2011 to 2019). Cumulative survival was estimated by the Kaplan Meier method for the overall group, and stratified by the indication of surgery. In the 14,455 isolated CABG included, 427 (2.95%) were emergent. The number of emergent CABG decreased from 222 to 150 and 55 in the consecutive study eras. There was a temporal increase in the prevalence of heart failure, but no change in mean age, and prevalence of hypertension, diabetes, renal failure, or atrial fibrillation. The proportion of patients with failed/complicated percutaneous coronary intervention decreased from 38.2% in 1993 to 2000 to 22.7% in 2001 to 2010 and 25.5% in 2011 to 2019 (p = 0.003). In 2011 to 2019, 100% of patient received an internal mammary graft compared with 75.6% in 1993 to 2000 (p < 0.001). Operative mortality was 8.7% overall (8.6% in 1993 to 2000, 10.0% in 2001 to 2010, and 5.5% in 2011 to 2019, p = 0.56). There were no differences in postoperative complications except for the incidence of renal failure and new dialysis which increased over time. Predicted 10-year survival was 57.0% and was not different according to CABG indication (p = 0.12). In conclusion, we documented a temporal decrease in the incidence of emergent CABG between 1993 and 2019, especially those performed due to complications of coronary interventions. Despite the higher prevalence of left ventricular dysfunction and the more complete revascularization in more recent years, in-hospital mortality did not increase.
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Affiliation(s)
- Mohamed Farouk Elsisy
- Department of Cardiovascular Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota.
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Haeder SF, Weimer DL, Mukamel DB. Going the Extra Mile? How Provider Network Design Increases Consumer Travel Distance, Particularly for Rural Consumers. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2020; 45:1107-1136. [PMID: 32464649 DOI: 10.1215/03616878-8641591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
CONTEXT The practical accessibility to medical care facilitated by health insurance plans depends not just on the number of providers within their networks but also on distances consumers must travel to reach the providers. Long travel distances inconvenience almost all consumers and may substantially reduce choice and access to providers for some. METHODS The authors assess mean and median travel distances to cardiac surgeons and pediatricians for participants in (1) plans offered through Covered California, (2) comparable commercial plans, and (3) unrestricted open-network plans. The authors repeat the analysis for higher-quality providers. FINDINGS The authors find that in all areas, but especially in rural areas, Covered California plan subscribers must travel longer than subscribers in the comparable commercial plan; subscribers to either plan must travel substantially longer than consumers in open networks. Analysis of access to higher-quality providers show somewhat larger travel distances. Differences between ACA and commercial plans are generally substantively small. CONCLUSIONS While network design adds travel distance for all consumers, this may be particularly challenging for transportation-disadvantaged populations. As distance is relevant to both health outcomes and the cost of obtaining care, this analysis provides the basis for more appropriate measures of network adequacy than those currently in use.
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19
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Kusu‐Orkar T, Kermali M, Oguamanam N, Bithas C, Harky A. Coronary artery bypass grafting: Factors affecting outcomes. J Card Surg 2020; 35:3503-3511. [DOI: 10.1111/jocs.15013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Nina Oguamanam
- Department of Emergency Medicine East Sussex Healthcare NHS Trust Seaford UK
| | | | - Amer Harky
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Hospital Liverpool UK
- Liverpool Center for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool UK
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20
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Patel K, Adalti S, Runwal S, Singh R, Ananthanarayanan C, Doshi C, Pandya H. Re‐exploration after off‐pump coronary artery bypass grafting: Incidence, risk factors, and impact of timing. J Card Surg 2020; 35:3062-3069. [DOI: 10.1111/jocs.14986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Kartik Patel
- Department of Cardiovascular and Thoracic Surgery U. N. Mehta Institute of Cardiology and Research Center Ahmedabad India
| | - Sudhir Adalti
- Department of Cardiovascular and Thoracic Surgery U. N. Mehta Institute of Cardiology and Research Center Ahmedabad India
| | - Shreyas Runwal
- Department of Cardiovascular and Thoracic Surgery U. N. Mehta Institute of Cardiology and Research Center Ahmedabad India
| | - Rahul Singh
- Department of Cardiovascular and Thoracic Surgery U. N. Mehta Institute of Cardiology and Research Center Ahmedabad India
| | | | - Chirag Doshi
- Department of Cardiovascular and Thoracic Surgery U. N. Mehta Institute of Cardiology and Research Center Ahmedabad India
| | - Himani Pandya
- Department of Research U. N. Mehta Institute of Cardiology and Research Center Ahmedabad India
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Barkhordari K, Khajavi MR, Bagheri J, Nikkhah S, Shirzad M, Barkhordari S, Kharazmian K, Nosrati M. Early respiratory outcomes following cardiac surgery in patients with COVID-19. J Card Surg 2020; 35:2479-2485. [PMID: 32789988 PMCID: PMC7436810 DOI: 10.1111/jocs.14915] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Both coronavirus disease (COVID-19) and cardiac surgery have a negative impact on pulmonary function. This study aimed to determine the postoperative respiratory outcomes of patients with COVID-19 who underwent cardiac surgery. METHODS In this retrospective study, we reviewed and analyzed the patient characteristics and clinical data of 25 asymptomatic patients with COVID-19 who underwent urgent or emergency cardiac surgery at Tehran Heart Center Hospital, Iran, between 29 February and 10 April 2020. RESULTS The mean age, EuroSCORE, and body mass index were 57.3 ± 15.1 years, 6.65 ± 1.29, and 25.7 ± 3.7 kg/m2 , respectively. Four patients underwent off-pump cardiac surgery and 21 underwent on-pump cardiac surgery with a median cardiopulmonary bypass time of 85 minutes (interquartile range (IQR, 50-147). The overall mortality rate and the length of stay in the intensive care unit (ICU) were higher compared to those of a propensity-matched group of patients who underwent cardiac surgery in the pre-COVID era. The median intubation time was 13 hours (IQR, 9.5-18), which was comparable to that of pre-COVID cardiac surgery patients. The readmission rate to the ICU was 16%. In this ICU readmitted group, the mean oxygen index, FiO2 , and mortality rate were higher and the PaO2 /FiO2 ratio was lower than those of the nonreadmitted patients. CONCLUSIONS Although early respiratory outcomes of asymptomatic COVID-19 patients who underwent early cardiac surgery appeared to be satisfactory, compared to the propensity-scored matched non-COVID group, the postoperative outcomes were worse, especially in the ICU readmitted patients. We suggest postponing cardiac operations unless the patient requires emergency surgery.
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Affiliation(s)
- Khosro Barkhordari
- Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad R Khajavi
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Nikkhah
- Food and Drug Bureau, Ministry of Health and Medical Education, Tehran, Iran
| | - Mahmood Shirzad
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Barkhordari
- Department of Neurobiology Physiology and Behavior, College of Biological Sciences, University of California, Davis, California
| | - Katayun Kharazmian
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Nosrati
- Department of Disease Control, Tehran Heart Center, Tehran, Iran
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Trivedi JR, Black MC, Whited WM, Sell-Dottin K, Alwair H, Ganzel BL, Slaughter MS. Is internal mammary artery graft beneficial in emergent coronary artery bypass surgery? A Society of Thoracic Surgeons national database analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:657-661. [PMID: 32352248 DOI: 10.23736/s0021-9509.20.11281-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Often, only saphenous vein grafts (SVGs) are used in emergent coronary artery bypass graft (CABG) procedures to provide quicker myocardial revascularization despite its lower long-term patency relative to the internal mammary artery (IMA) grafts. We examined differences between IMA and non-IMA graft recipients in emergent CABGs and its impact on in-hospital outcomes. METHODS Retrospective review of Society of Thoracic Surgeon National Database was done to identify patients age ≥18 years undergoing primary emergent isolated CABG between 2013 and 2016. Emergent salvage, non-LAD disease, subclavian stenosis and revascularization with other arterial grafts were excluded. The study population was divided in two groups: IMA and non-IMA groups. Demographics, preoperative, intraoperative factors and postoperative outcomes were analyzed between the groups. RESULTS Of 18,280 emergent CABGs during the study period, 16281 had IMA used and 1999 had only vein grafts. The IMA group was younger, more likely to be male, had lower creatinine and higher ejection fraction. The non-IMA and IMA groups were then propensity risk matched with ratio of 1:2 which showed significantly higher in-hospital mortality in the non-IMA group (15% vs. 7%, P<0.0001). The non-IMA groups also had higher rates bleeding (5% vs. 3%, P<0.01), renal failure (10% vs.6%, P<0.0001) and prolonged vent (44% vs. 30%, P<0.0001). CONCLUSIONS IMA grafts in primary isolated emergent CABGs are associated with significantly lower rates of in-hospital mortality. Even for emergent CABG there may be a clinical benefit in using IMA grafts rather than SVGs only.
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Affiliation(s)
- Jaimin R Trivedi
- University of Louisville School of Medicine, Louisevuille, KY, USA -
| | - Matthew C Black
- University of Louisville School of Medicine, Louisevuille, KY, USA
| | - William M Whited
- University of Louisville School of Medicine, Louisevuille, KY, USA
| | | | - Hazaim Alwair
- University of Louisville School of Medicine, Louisevuille, KY, USA
| | - Brian L Ganzel
- University of Louisville School of Medicine, Louisevuille, KY, USA
| | - Mark S Slaughter
- University of Louisville School of Medicine, Louisevuille, KY, USA
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Kwok CS, Amin AP, Shah B, Kinnaird T, Alkutshan R, Balghith M, Ratib K, Nolan J, Bagur R, Mamas MA. Cost of coronary syndrome treated with percutaneous coronary intervention and 30‐day unplanned readmission in the United States. Catheter Cardiovasc Interv 2019; 97:80-93. [DOI: 10.1002/ccd.28660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/07/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group Keele University Stoke‐on‐Trent UK
- Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - Amit P. Amin
- Washington School of Medicine St. Louis Missouri
| | - Binita Shah
- VA New York Harbor Healthcare System (Manhattan Campus) and New York University School of Medicine New York New York
| | | | - Raed Alkutshan
- Royal Commission Health Services Program Jubail Saudi Arabia
| | - Muhammad Balghith
- King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia
| | - Karim Ratib
- Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - James Nolan
- Keele Cardiovascular Research Group Keele University Stoke‐on‐Trent UK
- Royal Stoke University Hospital Stoke‐on‐Trent UK
| | - Rodrigo Bagur
- Keele Cardiovascular Research Group Keele University Stoke‐on‐Trent UK
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group Keele University Stoke‐on‐Trent UK
- Royal Stoke University Hospital Stoke‐on‐Trent UK
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Is there really a benefit of using minimized cardiopulmonary bypass in CABG? A retrospective propensity score-matched study with 5000 cases. Heart Vessels 2019; 35:14-21. [PMID: 31236675 DOI: 10.1007/s00380-019-01458-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
The concept of minimized cardiopulmonary bypass targets at reduction of adverse effects triggered by extracorporeal circulation. In this study, benefits of minimized bypass in CABG were evaluated under particular consideration of patient body mass index and surgeon impact. From 2004 to 2014, 5164 patients underwent coronary bypass surgery (CABG). Conventional cardiopulmonary bypass (CCPB) was used in 2376 patients, minimized cardiopulmonary bypass (MCPB) in 2788 cases. Multivariate regression models were used in the entire cohort and in a propensity score-matched subgroup after expert CABG to figure out clinical differences such as mortality, postoperative renal function, and thromboembolic events. Overall mortality was 1.5% (n = 41) in the MCPB group and 3.5% (n = 82) in CCPB patients (p < 0.001). Postoperative renal failure and hemodialysis occurred in 2.6% (n = 72/MCPB) vs. 5.3% (n = 122/CCPB (p < 0.001). Multivariable regression revealed use of CCPB as risk factor for increased mortality (OR 2.01, p = 0.001), renal failure (OR 1.79, p < 0.001), and myocardial infarction (OR 1.98, p < 0.001) comparable to risk factors such as preoperative ventilation (OR 2.26, p = 0.048), diabetes mellitus (OR 1.68, p = 0.001), and cardiogenic shock (OR 3.81, p = 0.002). Body mass index had no effect on the analyzed outcome parameters (OR 0.92, p = 0.002). Propensity score-matching analysis of an expert CABG subgroup revealed CCPB as risk factor for mortality (OR 2.26, p = 0.004) and postoperative hemodialysis (OR 1.74, p = 0.017). Compared to conventional circuits, minimized bypass use in CABG is associated with lower mortality and less postoperative renal failure. A high body mass index is feasible and not a risk factor for MCPB surgery.
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Coronary artery bypass graft surgery complications: A review for emergency clinicians. Am J Emerg Med 2018; 36:2289-2297. [PMID: 30217621 DOI: 10.1016/j.ajem.2018.09.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications. Risk factors for perioperative mortality and morbidity after CABG surgery can be divided into three categories: patient characteristics, clinician characteristics, and postoperative factors. Emergency physicians will be faced with several postoperative complications, including sternal wound infections, pneumonia, thromboembolic phenomena, graft failure, atrial fibrillation, pulmonary hypertension, pericardial effusion, strokes, renal injury, gastrointestinal insults, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary surgical team is needed, which improves patient outcomes. This review provides several guiding principles for management of acute complications. Understanding these complications and an approach to the management of hemodynamic instability is essential to optimizing patient care. CONCLUSIONS Postoperative complications of CABG surgery can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Early surgical consultation is imperative, as is optimizing the patient's hemodynamics, including preload, heart rate, cardiac rhythm, contractility, and afterload.
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La A, Tranquillo RT. Shear Conditioning of Adipose Stem Cells for Reduced Platelet Binding to Engineered Vascular Grafts. Tissue Eng Part A 2018; 24:1242-1250. [PMID: 29448915 DOI: 10.1089/ten.tea.2017.0475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Conferring antithrombogenicity to tissue-engineered vascular grafts remains a major challenge, especially for urgent bypass grafting that excludes approaches based on expanding autologous endothelial cells (ECs) that requires weeks of cell culture. Adipose-derived stem cells (ASCs) are available from most patients in sufficient number for coronary bypass graft seeding and may be effective as allogeneic cells. We thus compared the adhesion and platelet binding of human ASCs that were shear conditioned with constant and pulsatile shear stress (SS) after seeding the cells on a biologically engineered matrix suitable for arterial grafts. A monolayer of cells was maintained up to 15 dyn/cm2 constant SS and up to 15 dyn/cm2 mean pulsatile SS for 6 days of shear flow. Platelet binding was reduced from 83% to 6% of surface area and nitric oxide production was increased 23-fold with 7.5-15 dyn/cm2 constant SS, but not pulsatile SS, relative to cells cultured statically on the matrix for 6 days. The reduction in platelet binding varied from no reduction to maximum reduction over a constant shear range of ∼2 to 4 dyn/cm2, respectively. Collectively, the study supports the potential use of ASCs to seed the luminal surface of a vascular graft made from this biologically engineered matrix to confer an antithrombogenic surface during the development of an endothelium from the seeded cells or the surrounding blood and tissue.
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Affiliation(s)
- Anh La
- 1 Department of Biomedical Engineering, University of Minnesota , Minneapolis, Minnesota
| | - Robert T Tranquillo
- 1 Department of Biomedical Engineering, University of Minnesota , Minneapolis, Minnesota.,2 Department of Chemical Engineering and Materials Science, University of Minnesota , Minneapolis, Minnesota
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Schumer EM, Chaney JH, Trivedi JR, Linsky PL, Williams ML, Slaughter MS. Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013. Tex Heart Inst J 2016; 43:214-9. [PMID: 27303236 DOI: 10.14503/thij-14-4978] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Emergency coronary artery bypass grafting (CABG) is associated with increased in-hospital mortality rates and adverse events. This study retrospectively evaluated indications and outcomes in patients who underwent emergency CABG. The Society of Thoracic Surgeons database for a single center (Jewish Hospital) was queried to identify patients undergoing isolated CABG. Univariate analysis was performed. From January 2003 through December 2013, 5,940 patients underwent CABG; 212 presented with emergency status. A high proportion of female patients (28.2%) underwent emergency surgery. Emergency CABG patients experienced high rates of intra-aortic balloon pump support, bleeding, dialysis, in-hospital death, and prolonged length of stay. The proportion of emergency coronary artery bypass grafting declined during years 2008-2013 compared with 2003-2007 (2.2% vs. 4.5%, P < 0.001), but the incidence of angiographic accident (5.3% vs. 29.2%) increased as an indication. Ongoing ischemia remains the most frequent indication for emergency CABG, yet the incidence of angiographic accident has greatly increased. In-hospital mortality rates and adverse events remain high. If we look specifically at emergency CABG cases arising from angiographic accident, we find that 14 (15%) of all 93 emergency CABG deaths occurred in that subset of patients. Efforts to improve outcomes should therefore be focused on this high-risk group.
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