Coronary Artery Bypass Grafting Using the No-Touch Great Saphenous Vein Graft Harvesting Technique: A Retrospective Study

Background We focused on coronary artery bypass grafting using the great saphenous vein and compared the no-touch great saphenous vein and conventional great saphenous vein. Methods Coronary artery bypass grafting using the great saphenous vein was performed at our hospital over a 15-year period from 2007/04 to 2022/08. The primary endpoint was the patency of the great saphenous vein at discharge, and secondary endpoints were delayed healing of the great saphenous vein harvest wound, delayed healing of the mid-thoracic wound, and factors related to coronary artery bypass surgery. Results There were 183 patients who underwent coronary artery bypass surgery using the great saphenous vein during the study period. There were 131 male patients (72%) and 52 female patients (28%) with a mean age of 69 years (38-94 years). The method of harvesting the great saphenous vein was a no-touch great saphenous vein graft (NT-SVG) in 29 cases (16%) and conventional SVG in 154 cases (84%). Patients were divided into two groups: the NT-SVG group and the standard-collection saphenous vein graft (SVG) group. We compared graft patency at discharge, healing failure of the lower leg wound, healing failure of the mid-thoracic wound, and flow by transit-time flow measurement (TTFM). Conclusion There were no significant differences in perioperative outcomes between the NT-SVG and conventional SVG groups in this study.

Giant Right Coronary Artery Aneurysm in a Patient With Multiple Coronary Artery Aneurysmatic Dilatations

One kind of coronary artery disease that is uncommon is coronary artery aneurysm (CAA). According to angiographic reports, the incidence of coronary artery aneurysms ranges from 1.5% to 4.9%, with a higher frequency in men. A patient with both coronary heart disease and an aneurysm in the right coronary artery (RCA) underwent a successful simultaneous coronary bypass together with an aneurysmal reconstruction procedure.

Predicting Determinants for Conversion of Off-Pump Coronary Revascularization to On-Pump Surgery: A Retrospective Analysis

A global consensus has not yet been reached regarding the preference for off-pump versus on-pump coronary revascularization. Although the coronary trial indicates that the secondary endpoint outcomes favor on-pump surgery, the cost-effectiveness and significantly lower immediate and early complications in off-pump surgery make it favorable for the Indian population. To analyze patients who underwent coronary revascularization, specifically coronary artery bypass grafting (CABG), a retrospective five-year study was conducted. During the given duration, a total of 652 patients underwent CABG. The study revealed a positive correlation between diabetes, high body surface area (BSA), and preexisting renal dysfunction as strong predictors for converting off-pump coronary artery bypass surgery (OPCABG) to on-pump surgery coronary artery bypass surgery (ONCABG). Preoperative electrocardiographic (ECG) changes and the use of intra-aortic balloon pulsation (IABP) as a mechanical assist device were strongly associated with the incidence of conversion from OPCABG to ONCABG. Tight left main disease and ostial coronary disease indicate a progressive dysfunction during off-pump surgery, necessitating early conversion to on-pump surgery to avoid complications. The on-pump group had more adverse outcomes in regard to renal and neurological dysfunction, which can be attributed to pump-induced dysfunction. In such scenarios, a surgeon's preparedness to convert an OPCABG to an ONCABG can be swift and efficient. In anticipation of increased pump-related complications in the ONCABG group, a measured approach can be implemented to avoid adverse postoperative outcomes in high-risk patients.

Coronary Artery Bypass Grafting in a Patient With Severe Factor VII Deficiency

Factor VII deficiency is a rare bleeding disorder. Clinical presentation is highly variable and can range from mild symptoms like mucosal bleeding to life-threatening hemorrhages in early infancy. Some people remain asymptomatic and are only diagnosed incidentally on laboratory tests. Given the low incidence in the population and variable phenotypes, there are no official guidelines on the management of such patients perioperatively to minimize bleeding risk. We present a case of a man with inherited severe factor VII deficiency who underwent successful coronary artery bypass grafting.

Frequency of Blood Transfusion in Elective Coronary Artery Bypass Grafting and Its Correlation With Acute Kidney Injury at a Tertiary Care Hospital in a Lower Middle-Income Country

Background

Blood transfusion remains a significant management aspect in various cardiac surgical procedures including coronary artery bypass grafting (CABG). These patients have a reportedly high incidence of transfusion of blood products. It varies considerably amongst different institutions; most variability being seen in the transfusion trigger. This case series enumerate the frequency of administration of blood products in patients during elective CABG and its association with acute kidney injury (AKI) and ascertain whether blood transfusion is justifiable at a tertiary care hospital.

Materials and methods

Using non-probability consecutive sampling, 172 patients were enrolled in the study. Patient’s preoperative hemoglobin and creatinine, intraoperative hemoglobin, transfusion trigger, number of transfusions (whole blood and packed RBCs-PRBCs), postoperative hemoglobin and creatinine in the ICU and number of transfusions in the first 24 hours were recorded.

Results

Out of the 172 patients, 96 (55.81%) patients received blood transfusion and 73 (42.69%) patients suffered from AKI. 45 (61.64%) patients with AKI received transfusion whereas 28 (38.36%) patients had no transfusion. Of these 96 patients, 45 (46.8%) received transfusion intra-operatively, 24 (25%) patients received both intra-operatively and post-operatively while 27 (28.2%) patients were transfused postoperatively. Majority of the patients, 46 (88.3%), received unjustifiable transfusion (Hb >8 g/dl) during the first 24 hours post-operatively.

Conclusion

There is marked divergence in the peri-operative use of blood products that remain on a loco-regional as well as international basis. A standardized and a multidisciplinary strategy as well as robust institutional regulation would significantly reduce inappropriate patient exposure to blood products.

Determinants of the Downward Trend in Coronary Artery Bypass Graft Surgery Among Patients With Multivessel Disease and Class-I Indication for Surgery

Introduction

Coronary artery bypass graft (CABG) is the most effective coronary revascularization procedure, and it has been endorsed by many trials and studies over the years. However, due to CABG's immediate adverse effects, patients tend to prefer percutaneous coronary intervention (PCI) for coronary revascularization over it. This article focuses on the recent downtrend in CABG procedures for revascularization among patients for whom it is indicated. This study’s main objective was to identify the factors responsible for the downtrend in patients undergoing CABG despite a clear indication for it in those with multivessel diseases.

Methods

This study was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from August 1, 2020, to January 1, 2021. A total of 340 patients with a class-I indication (presence of conditions regarding which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective) for CABG were enrolled in the study. Data related to all the variables were collected from patients and hospital records through an adequately designed proforma. For analysis, we applied the chi-square test to elaborate on the data for information and point biserial correlation to rule out the effect of age and weight on CABG’s downward trend.

Results

The mean age of the patients was 58.77 ± 9.54 years; 65.88% were male, and 34.12% were female. Only 17.65% of the patients underwent CABG; 71.47% opted for medical treatment, and 9.41% underwent PCI. Out of the 280 patients who did not undergo CABG, 26.76% had financial issues; 23.82% were high-risk patients and hence refused surgeries by the surgeons; 20.59% of patients were not willing to undergo surgery; 7.94% were on the waiting list, and 3.24% had deranged renal function tests (RFTs).

Conclusions

A limited number of patients underwent revascularization therapy even though they had clear indications for CABG. The high-risk status of patients, patients' unwillingness, and the cost of the procedure were the primary reasons behind the downtrend in CABG procedures among patients with a clear indication for the same.