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Schoonen A, van Klei WA, van Wolfswinkel L, van Loon K. Definitions of low cardiac output syndrome after cardiac surgery and their effect on the incidence of intraoperative LCOS: A literature review and cohort study. Front Cardiovasc Med 2022; 9:926957. [PMID: 36247457 PMCID: PMC9558721 DOI: 10.3389/fcvm.2022.926957] [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: 04/23/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesLow cardiac output syndrome (LCOS) is a serious complication after cardiac surgery. Despite scientific interest in LCOS, there is no uniform definition used in current research and clinicians cannot properly compare different study findings. We aimed to collect the LCOS definitions used in literature and subsequently applied the definitions obtained to existing data to estimate their effect on the intraoperative LCOS incidences in adults, children and infants.DesignThis is a literature review, followed by a retrospective cohort study.SettingThis is a single-institutional study from a university hospital in the Netherlands.ParticipantsPatients from all ages undergoing cardiac surgery with cardiopulmonary bypass between June 2011 and August 2018.InterventionsWe obtained different definitions of LCOS used in the literature and applied these to data obtained from an anesthesia information management system to estimate intraoperative incidences of LCOS. We compared intraoperative incidences of LCOS in different populations based on age (infants, children and adults).Measurements and main resultsThe literature search identified 262 LCOS definitions, that were applied to intraoperative data from 7,366 patients. Using the 10 most frequently published LCOS definitions, the obtained incidence estimates ranged from 0.4 to 82% in infants, from 0.6 to 56% in children and from 1.5 to 91% in adults.ConclusionThere is an important variety in definitions used to describe LCOS. When applied to data obtained from clinical care, these different definitions resulted in large distribution of intraoperative LCOS incidence rates. We therefore advocate for standardization of the LCOS definition to improve clinical understanding and enable adequate comparison of outcomes and treatment effects both in daily care and in research.
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Affiliation(s)
- Anna Schoonen
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Anna Schoonen
| | - Wilton A. van Klei
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Anesthesia and Pain Management Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, ON, Canada
| | - Leo van Wolfswinkel
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kim van Loon
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
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2
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On-pump beating heart versus off-pump myocardial revascularization-a propensity-matched comparison. Indian J Thorac Cardiovasc Surg 2021; 37:639-646. [PMID: 34776662 DOI: 10.1007/s12055-021-01209-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 10/20/2022] Open
Abstract
Objective On-pump beating heart (OP-BH) coronary artery bypass grafting (CABG) is often undertaken as an alternative between off-pump coronary artery bypass (OPCAB) and conventional on-pump coronary artery bypass grafting (On-pump CABG), especially in India. However, outcome data following OP-BH surgery is sparse. The aim of this study was to compare the outcomes of OP-BH CABG with OPCAB. Methods From our institutional database, all patients undergoing OP-BH CABG (n = 531) were identified. A propensity-matched cohort undergoing OPCAB (n = 531) was identified from the database. Nearest neighbor matching technique was used and the groups were matched for variables including age, gender, body mass index, EuroSCORE, history of recent myocardial infarction or unstable angina, hypertension, peripheral vascular disease, chronic obstructive airway disease, diabetes, pre-op renal impairment, pre-op neurological events, and left ventricular function. Results The propensity-matched groups were well matched in terms of baseline characteristics. The mean EuroSCORE was 3.17 and 3.20 in the OP-BH and the OPCAB groups. The unadjusted 30-day mortality in the propensity-matched OPCAB group was 2.07% (11/531) while mortality in the on-pump beating heart group was significantly higher at 6.9% (37/531). Multivariate analysis showed that OP-BH CABG was an independent risk factor for 30-day mortality as well as major adverse post-operative outcomes including renal, neurological, and respiratory outcomes and post-operative atrial fibrillation. Conclusions OP-BH CABG is associated with worse clinical outcomes compared to patients undergoing OPCAB.
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Wang C, Jiang Y, Jiang X, Chen S. On-pump beating heart versus conventional on-pump coronary artery bypass grafting on clinical outcomes: a meta-analysis. J Thorac Dis 2021; 13:4169-4184. [PMID: 34422346 PMCID: PMC8339771 DOI: 10.21037/jtd-21-568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023]
Abstract
Background A hybrid surgery method, on-pump beating heart coronary artery bypass graft (ON-BH CABG), is supposed to be a promising technology for coronary artery revascularization. Here, we conducted a comprehensive meta-analysis of the data derived from published studies on ON-BH CABG and conventional on-pump coronary artery bypass graft (C-CABG) to compare their short-term and long-term clinical outcomes. Methods We searched major electronic databases and 24 studies incorporating 6,862 patients (1,847 ON-BH CABG and 5,015 C-CABG) were included eventually, and 9 studies of them were focusing on high-risk patients. Results Compared with ON-BH CABG, C-CABG was associated with a higher risk in early mortality [odds ratio (OR), 1.45; 95% confidence interval (CI), 1.09 to 1.93; P=0.01], myocardial infarction (MI) (OR, 2.60; 95% CI, 1.41 to 4.78; P<0.01), low output syndrome (LOS) (OR, 2.56; 95% CI, 1.55 to 4.23; P<0.01), renal failure (OR, 1.84; 95% CI, 1.38 to 2.44; P<0.01). In contrast, there was no significant difference in long-term survival [hazard ratio (HR), 1.08; 95% CI, 0.81 to 1.43; P=0.60]. In systematic analysis of the studies in high-risk patients, ON-BH CABG showed a lower risk in terms of early mortality, intra-aortic balloon pump (IABP) usage, renal failure, hemodialysis, MI and pulmonary complication. No significant difference was observed in the long-term survival between ON-BH CABG and C-CABG. Conclusions With experienced and adept surgical team and mature ON-BH technology, ON-BH CABG may reduce the risk of postoperative death and complications in some patients. It might be an attractive alternative for high-risk patient populations.
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Affiliation(s)
- Chen Wang
- Department of Cardiovascular Surgery and Heart transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yefan Jiang
- Department of Cardiovascular Surgery and Heart transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xionggang Jiang
- Department of Cardiovascular Surgery and Heart transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si Chen
- Department of Cardiovascular Surgery and Heart transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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4
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Gelsomino S, Tetta C, Matteucci F, Del Pace S, Parise O, Prifti E, Dokollari A, Parise G, Micali LR, La Meir M, Bonacchi M. Surgical Risk Factors for Ischemic Stroke Following Coronary Artery Bypass Grafting. A Multi-Factor Multimodel Analysis. Front Cardiovasc Med 2021; 8:622480. [PMID: 34291093 PMCID: PMC8287035 DOI: 10.3389/fcvm.2021.622480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ischemic stroke after coronary artery bypass (CABG) has been often linked to aortic manipulation during surgery. Objectives: The objective of the study was to estimate the rate of postoperative ischemic stroke within 30 days from CABG by surgical risk factors alone or in combination. Methods: The multinomial propensity score for multiple treatments was used to create six models with a total of 16,255 consecutive patients undergoing isolated CABG. For each model, a different classification variable was used to stratify patients. Results: Balance achieved in all models was substantial, enabling unbiased estimation of the treatment estimand. Both off-pump techniques with (0.009; 95% CI 0.006-0.011) or without proximal anastomoses (0.005; 0.005-0.003), and surgery performed on the beating heart using cardiopulmonary bypass with (0.009; 0.006-0.011) or without proximal anastomoses (0.024; 0.021-0.029) showed a mean stroke estimate significantly lower than the other techniques. Off-pump surgery and on-pump surgery without an aortic cross-clamp yielded nearly equal incidences of stroke (0.012; 0.008-0.015 and 0.018; 0.012-0.023, respectively). Using an aortic cross-clamp significantly increased the stroke estimate (0.075; 0.061-0.088), whereas using a side-biting clamp did not (0.039; 0.033-0.044). The number of aortic touches (0.029; 0.026-0.031) and the number of proximal anastomoses (0.044; 0.035-0.047) did not significantly increase the incidence of stroke. Conclusions: Aortic cross-clamping was found to be the primary cause of post-CABG ischemic stroke. Instead, additional aortic manipulation from a side-biting clamp, on-pump surgery, multiple aortic touches, number of proximal anastomoses, and aortic cannulation were found not to increase the estimate of stroke significantly. Further research on this topic is warranted.
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Affiliation(s)
- Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardiac Surgery Department, Vrije Universiteit Brussels, Brussels, Belgium
| | - Cecilia Tetta
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Francesco Matteucci
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardio-Thoraco-Vascular Department, Careggi Hospital, Florenze, Italy
| | - Stefano Del Pace
- Cardio-Thoraco-Vascular Department, Careggi Hospital, Florenze, Italy
| | - Orlando Parise
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardio-Thoraco-Vascular Department, Careggi Hospital, Florenze, Italy
| | - Edvin Prifti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Aleksander Dokollari
- Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Gianmarco Parise
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Linda Renata Micali
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mark La Meir
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardiac Surgery Department, Vrije Universiteit Brussels, Brussels, Belgium
| | - Massimo Bonacchi
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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5
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Dominici C, Salsano A, Nenna A, Spadaccio C, Mariscalco G, Santini F, Chello M. On-pump beating-heart coronary artery bypass grafting in high-risk patients: A systematic review and meta-analysis. J Card Surg 2020; 35:1958-1978. [PMID: 32643847 DOI: 10.1111/jocs.14780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Operative technique for surgical myocardial revascularization in high-risk patients remains an argument of debate. On-pump coronary artery bypass graft (CABG) with cardioplegic arrest and off-pump CABG have intrinsic limitations. The hybrid approach of on-pump beating-heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta-analysis intends to summarize the contemporary literature. METHODS A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study. RESULTS Compared with on-pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36-0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39-0.91). Also, interesting trends towards reduced postoperative intra-aortic balloon pump use (RR, 0.56, 95% CI, 0.31-1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22-1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off-pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off-pump CABG (RR, 0.53, 95% CI, 0.33-0.87) but higher than conventional on-pump CABG (RR, 1.71, 95% CI, 1.23-2.39). CONCLUSION OPBHC is an effective technique to perform surgical revascularization in high-risk patients as preventing haemodynamic deterioration and guaranteeing adequate end-organ perfusion. OPBHC represents an alternative technique to on-pump and off-pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.
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Affiliation(s)
- Carmelo Dominici
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonio Salsano
- Department of Cardiac Surgery, University of Genoa, Genoa, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | | | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Sirgo J, Gil Ó, Campos E, Taylor J, Dalmau MJ, Juez M, García-Fuster R, Hornero F, Martínez-León J. Cirugía coronaria asistida con circulación extracorpórea sin pinzamiento aórtico en pacientes con disfunción ventricular severa: resultados a corto y medio plazo. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Gordon-Evans WJ, Carney JP, Lahti MT, Bianco RW. Pilot study investigating the feasibility of mitral valve repair without aortic cross-clamping and cardioplegia. CANADIAN JOURNAL OF VETERINARY RESEARCH = REVUE CANADIENNE DE RECHERCHE VETERINAIRE 2020; 84:159-162. [PMID: 32255912 PMCID: PMC7088510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/20/2019] [Indexed: 06/11/2023]
Abstract
There is evidence that perfusing the heart with a heart and lung machine is less injurious than cross-clamping the aorta and administering cardioplegia during cardiac surgery. Although mitral valve replacement has been carried out without aortic cross-clamping and cardioplegia, it has been stated that cross-clamping is necessary in order to maintain visualization and a motionless surgical field for mitral valve repair. The purpose of this study was to determine the surgical feasibility of mitral valve repair without cross-clamping the aorta and using cardioplegia. Our hypothesis was that a completely bloodless and motion-free field would not be necessary to carry out mitral valve repair with annuloplasty and synthetic chordae tendineae sutures. Papillary muscles, chordae tendineae, annulus, and mitral valve leaflets were all readily visualized. Chordae tendineae sutures were used and annuloplasty was conducted without visual obstruction or motion interference. Our results show that mitral valve repair is feasible without cross-clamping the aorta and using cardioplegia.
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Affiliation(s)
- Wanda J Gordon-Evans
- Veterinary Medical Center North, University of Minnesota, 1365 Gortner Avenue, St. Paul, Minnesota 55108, USA (Gordon-Evans); University of Minnesota Medical School, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, Minnesota 55455, USA (Carney, Lahti, Bianco)
| | - John P Carney
- Veterinary Medical Center North, University of Minnesota, 1365 Gortner Avenue, St. Paul, Minnesota 55108, USA (Gordon-Evans); University of Minnesota Medical School, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, Minnesota 55455, USA (Carney, Lahti, Bianco)
| | - Mathew T Lahti
- Veterinary Medical Center North, University of Minnesota, 1365 Gortner Avenue, St. Paul, Minnesota 55108, USA (Gordon-Evans); University of Minnesota Medical School, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, Minnesota 55455, USA (Carney, Lahti, Bianco)
| | - Richard W Bianco
- Veterinary Medical Center North, University of Minnesota, 1365 Gortner Avenue, St. Paul, Minnesota 55108, USA (Gordon-Evans); University of Minnesota Medical School, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, Minnesota 55455, USA (Carney, Lahti, Bianco)
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8
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Nadeem R, Agarwal S, Jawed S, Yasser A, Altahmody K. Impact of Cardiopulmonary Bypass Time on Postoperative Duration of Mechanical Ventilation in Patients Undergoing Cardiovascular Surgeries: A Systemic Review and Regression of Metadata. Cureus 2019; 11:e6088. [PMID: 31857920 PMCID: PMC6897343 DOI: 10.7759/cureus.6088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of this study was to detect if cardiopulmonary bypass time duration has any impact on the duration of postoperative mechanical ventilation (MV). The study design was a systematic review and regression analysis of pooled data from previously published studies. All available data are from prospective, retrospective, cross-sectional, and observational studies. Participants included only patient/human studies. There were no interventions. PubMed and Cochrane libraries were searched by utilizing different combinations of keywords: cardiopulmonary bypass and mechanical ventilation. Inclusion criteria were: (1) English articles, (2) studies with an adult population that underwent cardiac surgeries using cardiopulmonary bypass (CPB), (3) studies where the duration of CPB is provided as well as the duration of mechanical ventilation. A regression analysis was performed on the metadata. For the hours of MV, eight studies with 13 data sets (as some studies provide data in subgroups) were included for a total number of 989 subjects. The duration of CPB ranged from 55 to 173.5 minutes for these operations. Postoperative MV hours ranged from nine to 408 hours. Stepwise multiple regression analysis found that cardiopulmonary bypass time (CPBT), age, diabetes, male gender, and ejection fraction correlated with prolonged mechanical ventilation; CPBT was the most strongly correlated variable. Cardiopulmonary bypass time appears to affect clinical outcomes adversely and is associated with prolonged MV. Avoiding CPB or limiting it to a minimum may decrease the days of MV required.
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Affiliation(s)
| | | | - Shafaq Jawed
- Surgery, Jinnah Sindh Medical University, Karachi, PAK
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Zhu MZ, Huq MM, Billah BM, Tran L, Reid CM, Varatharajah K, Rosenfeldt FL. On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction: A Propensity-Score Matched Analysis From the ANZSCTS Database. Heart Lung Circ 2019; 28:1267-1276. [DOI: 10.1016/j.hlc.2018.06.1051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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10
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Chan MJ, Lee CC, Chen SW, Tsai FC, Lin PJ, Fan PC, Hsu HH, Chang MY, Chen YC, Chang CH. Effect of different surgical type of coronary artery bypass grafting on kidney injury: A propensity score analysis. Medicine (Baltimore) 2017; 96:e8395. [PMID: 29137024 PMCID: PMC5690717 DOI: 10.1097/md.0000000000008395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with a less favorable outcome. Off-pump surgery results in lower kidney dysfunction than conventional on-pump arrest surgery. On-pump arrest surgery results in a lower revascularization rate compared with off-pump surgery. On-pump beating heart (OPBH) CABG combines the advantages of beating heart surgery and cardiopulmonary bypass. This study compared the renal outcomes of 3 cardiac surgical methods. From January 2010 to December 2012, 373 patients who underwent on-pump CABG were enrolled. Propensity analysis was performed to compare the postoperative outcomes of postoperative AKI, renal replacement therapy (RRT), intensive care unit (ICU) stay, mortality, and extubating time. In total, 98 patients received conventional on-pump surgery, 160 received OPBH surgery, and 115 received off-pump surgery. The Society of Thoracic Surgeons scores of these 3 groups were 6.1 ± 13.6, 7.4 ± 13.6, and 5.6 ± 10.9, respectively. Propensity analysis revealed lower AKI incidence in the off-pump group than in the on-pump surgery group. No substantial differences were observed in mortality, RRT, and the ICU stay between the off-pump and OPBH surgery groups. Among the 3 surgical methods, off-pump surgery results in lower AKI incidence. The short-term outcome, including kidney function, of OPBH surgery is similar to that of the off-pump group. Therefore, OPBH surgery is a considerable choice for patients with a high surgical risk.
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Affiliation(s)
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | | | | | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | | | | | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
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11
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Yousif A, Addison D, Lakkis N, Rosengart T, Virani SS, Birnbaum Y, Alam M. Use of cardiopulmonary pump support during coronary artery bypass grafting in the high-risk: a meta-analysis. Ir J Med Sci 2017; 187:369-377. [PMID: 28936580 DOI: 10.1007/s11845-017-1679-8] [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: 05/09/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Data from randomized trials evaluating the efficacy of on- versus off-pump coronary artery bypass grafting remain inconclusive, particularly in high-risk populations. AIMS The aim of this study is to compare the outcomes associated with on- versus off-pump coronary artery bypass grafting among high-risk patients. METHODS We performed a meta-analysis of randomized control trials comparing on- versus off-pump coronary artery bypass grafting, focusing on high-risk populations. Studies focusing on "high-risk" features: European System of Cardiac Operative Risk Evaluation (EuroSCORE) ≥ 5, age > 70 years, preexisting renal insufficiency, history of stroke(s), and the presence of left ventricular dysfunction were included. MEDLINE, Scopus, and Embase were searched for all publications between January 1, 2000 and August 1, 2016, using the following terms: on-pump, off-pump, coronary artery bypass, high-risk, left ventricular dysfunction, elderly, aged, and renal insufficiency. Endpoints included cardiovascular and all-cause mortality, non-fatal myocardial infarction, stroke, need for revascularization, renal failure, and length of hospital stay. RESULTS Nine studies incorporating 11,374 patients with a mean age of 70 years were selected. There was no statistical difference in cardiovascular mortality, all-cause mortality, non-fatal myocardial infarction, and renal failure between the two groups. There was a decrease in further revascularization at 1 year with on-pump (OR 0.67 (0.50-0.89)). However, there was an increase in length of hospital stay by 2.24 days (p = 0.03) among the on-pump group with no difference in stroke (OR 1.34 (1.00-1.80)). CONCLUSIONS On-pump is associated with a decreased risk of additional revascularization by 1 year. However, this appears to be a cost of longer hospitalization.
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Affiliation(s)
- A Yousif
- Department of Medicine, Section of Cardiology, University of Oklahoma School of Medicine, Oklahoma City, OK, USA
| | - D Addison
- Department of Medicine, Section of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Internal Medicine, Division of Cardiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114, USA.
| | - N Lakkis
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - T Rosengart
- Department of Surgery, Section of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - S S Virani
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Center Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Y Birnbaum
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - M Alam
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
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12
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Xia L, Ji Q, Song K, Shen J, Shi Y, Ma R, Ding W, Wang C. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. J Cardiothorac Surg 2017; 12:11. [PMID: 28231841 PMCID: PMC5322671 DOI: 10.1186/s13019-017-0572-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/25/2017] [Indexed: 12/05/2022] Open
Abstract
Background Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction. Methods A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared. Results Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less. Conclusions The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.
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Affiliation(s)
- LiMin Xia
- Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China
| | - Qiang Ji
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - Kai Song
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - JinQiang Shen
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - YunQing Shi
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - RunHua Ma
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - WenJun Ding
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - ChunSheng Wang
- Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China.
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Gologorsky E, Gologorsky A, Salerno TA. Lung-Centered Open Heart Surgery: A Call for a Paradigm Change. Front Cardiovasc Med 2016; 3:12. [PMID: 27243021 PMCID: PMC4863883 DOI: 10.3389/fcvm.2016.00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/28/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Tomas Antonio Salerno
- Cardiovascular Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
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Ueki C, Sakaguchi G, Akimoto T, Ohashi Y, Sato H. On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis. Eur J Cardiothorac Surg 2016; 50:813-821. [DOI: 10.1093/ejcts/ezw129] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/08/2016] [Indexed: 01/30/2023] Open
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15
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Depression and Anxiety following Coronary Artery Bypass Graft: Current Indian Scenario. Cardiol Res Pract 2016; 2016:2345184. [PMID: 27034884 PMCID: PMC4789419 DOI: 10.1155/2016/2345184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/26/2016] [Accepted: 02/03/2016] [Indexed: 01/18/2023] Open
Abstract
Epidemiological studies have shown a high prevalence of coronary artery disease among the Indian Population. Due to increasing availability and affordability of tertiary care in many parts of India, carefully selected patients undergo coronary artery bypass surgery to improve cardiac function. However, the procedure is commonly associated with depression and anxiety which can adversely affect overall prognosis. The objective of this review is to highlight early identifiable symptoms of depression and anxiety following coronary artery bypass graft (CABG) in Indian context so as to facilitate prompt intervention for better outcome. The current review was able to establish firm evidence in support of screening for depression and anxiety following CABG. Management of depression and anxiety following CABG is briefly reviewed.
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Chaudhry UA, Harling L, Sepehripour AH, Stavridis G, Kokotsakis J, Ashrafian H, Athanasiou T. Beating-Heart Versus Conventional On-Pump Coronary Artery Bypass Grafting: A Meta-Analysis of Clinical Outcomes. Ann Thorac Surg 2015; 100:2251-60. [DOI: 10.1016/j.athoracsur.2015.05.057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/03/2015] [Accepted: 05/14/2015] [Indexed: 11/25/2022]
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17
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Gatti G, Maschietto L, Dell'Angela L, Benussi B, Forti G, Dreas L, Soso P, Russo M, Sinagra G, Pappalardo A. Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction. Heart Vessels 2015; 31:1045-55. [PMID: 26174428 DOI: 10.1007/s00380-015-0714-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/03/2015] [Indexed: 01/14/2023]
Abstract
Despite encouraging improvements, outcomes of coronary artery bypass grafting (CABG) in the presence of left ventricular (LV) dysfunction remain poor. In the present study, the authors' experience on this subject was reviewed to establish the predictors of immediate and long-term results of surgery. Out of 4383 consecutive patients with multivessel coronary artery disease who underwent primary isolated CABG at the authors' institution from January 1999 throughout September 2014, 300 patients (mean age 66.1 ± 9.6 years) suffered preoperatively from LV dysfunction (defined as LV ejection fraction ≤35 %). The mean expected operative risk (EuroSCORE II) was 10.3 ± 13 %. Hospital deaths and perioperative complications were analyzed retrospectively. Outcomes were evaluated during a mean follow-up of 6.2 ± 4 years. None, one or both internal thoracic arteries (ITAs) were used in 6.3, 29 and 64.7 % of cases, respectively. There were 16 (5.3 %) hospital deaths. Prolonged invasive ventilation (17.7 %), acute kidney injury (14.7 %) and multiple blood transfusion (21.3 %) were the most frequent major postoperative complications. The 10-year non-parametric estimates of freedom from all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were 47.8 [95 % confidence interval (CI) 44.1-51.5], 65.3 (95 % CI 61.4-69.2), and 42.3 % (95 % CI 38.3-46.3), respectively. Shared predictors of decreased late survival and MACCEs were old age (P < 0.04), chronic lung disease (P < 0.01), chronic dialysis (P < 0.0001) and extracardiac arteriopathy (P < 0.045). After adjustment for corresponding risk factors, freedom from cardiac death was higher when both ITAs were used but only for patients with significant increase of LV ejection fraction early after surgery (P = 0.04). In patients with LV dysfunction, CABG may be performed with acceptable hospital mortality and long-term survival. Late outcomes depend mainly on preoperative characteristics of the patients. The use of both ITAs for myocardial revascularization may give long-term survival benefits but only for patients whose LV function improves significantly early after surgery.
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Affiliation(s)
- Giuseppe Gatti
- Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy.
| | - Luca Maschietto
- Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy
| | - Luca Dell'Angela
- Divisions of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Bernardo Benussi
- Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy
| | - Gabriella Forti
- Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy
| | - Lorella Dreas
- Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy
| | - Petar Soso
- Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy
| | - Marco Russo
- Divisions of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Divisions of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Divisions of Cardiac Surgery, Ospedale di Cattinara, Ospedali Riuniti and University of Trieste, via P. Valdoni, 7, 34148, Trieste, Italy
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Al Jaaly E, Chaudhry UA, Harling L, Athanasiou T. Should we consider beating-heart on-pump coronary artery bypass grafting over conventional cardioplegic arrest to improve postoperative outcomes in selected patients?: Table 1:. Interact Cardiovasc Thorac Surg 2014; 20:538-45. [DOI: 10.1093/icvts/ivu425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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