1.Sequential vein bypass grafting is not associated with an increase of either in-hospital or mid-term adverse events in off-pump coronary artery bypass grafting.
Fucheng XIAO ; Jian WANG ; Hengchao WU ; Hansong SUN
Chinese Medical Journal 2015;128(1):63-68
BACKGROUNDThe impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG). We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG.
METHODSFrom October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI), stroke, requirement for intra-aortic ballon pump (IABP) assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization) and angina recurrence were considered as mid-term endpoints.
RESULTSNo significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001). There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45). Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36) and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48) were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence.
CONCLUSIONSCompared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in-hospital or mid-term adverse events in patients undergoing off-pump CABG.
Aged ; Coronary Artery Bypass ; adverse effects ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Female ; Humans ; Male ; Middle Aged
2.Stenting versus Bypass Surgery for the Treatment of Left Main Coronary Artery Disease.
Yonsei Medical Journal 2009;50(6):739-743
Based on data comparing coronary-artery bypass grafting (CABG) with medical therapy, the current guidelines recommend CABG as the treatment of choice for patients with left main coronary artery (LMCA) disease. Percutaneous coronary intervention (PCI) can be selectively performed in patients who are candidates for revascularization but who are ineligible for CABG. Current evidence indicates that stenting results in mortality and morbidity rates compared favorably with those seen after CABG. Data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to choose PCI with stenting as an alternative treatment option for such patients. In addition, these data may inform future guidelines and support the need for well-designed, adequately powered, prospective, randomized trials comparing the two revascularization strategies.
Angioplasty, Transluminal, Percutaneous Coronary/adverse effects/*methods
;
Coronary Artery Bypass/*methods
;
Coronary Artery Disease/*surgery/*therapy
;
Humans
;
Stents/adverse effects
4.Comparison of perioperative myocardial injury between off-pump coronary artery bypass grafting and conventional coronary artery bypass grafting.
Changqing GAO ; Feng ZHOU ; Bojun LI ; Cangsong XIAO ; Xiaohui MA
Chinese Journal of Surgery 2002;40(12):930-931
OBJECTIVETo compare the perioperative release levels of cardiac troponin I (cTnI) between off-pump coronary artery bypass grafting (OPCAB) or conventional coronary artery bypass grafting (CCABG) in an attempt to detect myocardial injury.
METHODSFifty-nine patients with instable angina underwent coronary artery bypass grafting by OPCAB in 34 patients aged (59.15 +/- 1.71) years or CCABG in 25 patients, aged (54.46 +/- 1.81) years.
RESULTSBaseline characteristics were similar. The number of grafts was similar (OPCAB, mean 2.90; CCABG, mean 3.2), and no patient died. Postoperative myocardial serum enzyme measures were significantly lower in OPCAB, suggesting less myocardial injury. OPCAB patients did not receive blood transfusion, and had higher hematocrit at discharge. Most of OPCAB patients were extubated in 4 hours.
CONCLUSIONSCompared with CCABG, OPCAB may achieve similar outcomes; it reduces transfusion volume and creates less myocardial injury.
Cardiomyopathies ; blood ; etiology ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; adverse effects ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Troponin T ; blood
6.Comparison of transient changes in renal function between off-pump and on-pump coronary artery bypass grafting.
Wen-feng ZHANG ; Tian-xiang GU ; Cheng DIAO ; Yu-hai ZHANG ; Chun WANG ; Qin FANG ; Hai-long WANG
Chinese Medical Journal 2008;121(16):1537-1542
BACKGROUNDAcute renal failure following coronary artery bypass grafting (CABG) surgery is associated with high morbidity and mortality. Approximately half of all patients who develop acute kidney injury (AKI) subsequently develop acute renal failure (ARF). The purpose of the study was to compare early transient changes in renal function within the first post-operative week following CABG in patients that were either off-pump or on-pump.
METHODSEight hundred and forty-nine consecutive patients with isolated CABG in a single institution between January 1990 and August 2006 were retrospectively analyzed, including 518 off-pump and 331 on-pump patients. A multivariate Logistic regression model was constructed to identify risk factors for the development of AKI.
RESULTSSixty-one off-pump patients and 63 on-pump patients developed AKI. Risk factors for the development of post-operative AKI included an ejection fraction > or =50% or < or =30%, a pulse pressure > or =60 mmHg, peripheral vascular disease, diabetes, emergent procedure, triple-vessel disease, body mass index, peri-operative and post-operative. intra-aortic balloon pumping, NYHA class III and IV, and cardiopulmonary bypass. An ejection fraction > or =50% and peri-operative and post-operative intra-aortic balloon pumping were protective (OR <1). Peak serum creatinine for post-operative AKI was noted 12 hours and 24 hours in the off-pump and on-pump patients, respectively. Serum creatinine kinetics revealed rapid recovery in the 24th to 48th hour (off-pump) and the 48th to 72nd hour (on-pump).
CONCLUSIONRenal protection strategies are indicated from general anesthesia induction until 48 and 72 hours post-operatively in off-pump and on-pump patients, respectively.
Acute Kidney Injury ; etiology ; Aged ; Coronary Artery Bypass ; adverse effects ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Creatinine ; blood ; Female ; Humans ; Kidney ; physiopathology ; Male ; Middle Aged ; Retrospective Studies
8.Major risk-stratification models fail to predict outcomes in patients with multivessel coronary artery disease undergoing simultaneous hybrid procedure.
Hao-ran WANG ; Zhe ZHENG ; Hui XIONG ; Bo XU ; Li-huan LI ; Run-lin GAO ; Sheng-shou HU
Chinese Medical Journal 2013;126(3):450-456
BACKGROUNDThe hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events (MACCE) in patients with multivessel disease undergoing hybrid coronary revascularization.
METHODSThe data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification (GRC) calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization.
RESULTSDuring a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power (area under curve (AUC)) of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 (95% confidence interval 0.42 - 0.77), 0.65 (0.47 - 0.82), 0.57 (0.39 - 0.75) and 0.65 (0.46 - 0.83), respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 (P = 0.86), 5.39 (P = 0.37), 13.81 (P = 0.32) and 0.02 (P = 0.89), respectively.
CONCLUSIONSIn patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.
Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; methods ; Coronary Artery Bypass ; adverse effects ; methods ; Coronary Artery Disease ; mortality ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged
9.Application of virtual histological intravascular ultrasound in plaque composition assessment of saphenous vein graft diseases.
Jing GAO ; Yue-Ying WANG ; Yin LIU
Chinese Medical Journal 2019;132(8):957-962
OBJECTIVE:
Saphenous vein grafts disease (SVGD) is a common complication after coronary artery bypass graft (CABG) and normally treated by percutaneous coronary intervention (PCI). The most common complication after SVG-PCI is slow or no-reflow. It is known that the no-reflow phenomenon occurs in up to 15% of the SVG-PCI and is associated with high risk of major adverse cardiac events (MACEs) and mortality, therefore, it is important to investigate the factors that could predict the clinical outcome of PCI for risk stratification and guiding interventions. In recent years, the spectral analysis of intravascular ultrasound (IVUS) radiofrequency data (virtual histology-IVUS [VH-IVUS]) has been used to provide quantitative assessment on both plaque compositions and morphologic characteristics.
DATA SOURCES:
The PubMed, Embase, and Central databases were searched for possible relevant studies published from 1997 to 2018 using the following index keywords: "Coronary artery bypass grafting," "Saphenous venous graft disease," "Virtual histology-intravascular ultrasound," "Virtual histology-intravascular ultrasound," and "Percutaneous coronary intervention."
STUDY SELECTION:
The primary references were Chinese and English articles including original studies and literature reviews, were identified and reviewed to summarize the advances in the application of VH-IVUS techniques in situ vascular and venous graft vascular lesions.
RESULTS:
With different plaque components exhibiting a defined spectrum, VH-IVUS can classify atherosclerotic plaque into four types: fibrous tissue (FT), fibro fatty (FF), necrotic core (NC), and dense calcium (DC). The radiofrequency signal is mathematically transformed into a color-coded representation, including lipid, fibrous tissue, calcification, and necrotic core. Several studies have demonstrated the independent relationship between VH-IVUS-defined plaque classification or plaque composition and MACEs, but a significant association between plaque components and no-reflow after PCI in acute coronary syndrome. In recent years, VH-IVUS are applied to assess the plaque composition of SVGD, based on the similarity of pathophysiological mechanisms between coronary artery disease (CAD) and SVGD, further studies with the larger sample size, the long-term follow-up, multicenter clinical trials may be warranted to investigate the relationship between plaque composition of saphenous vein graft (SVG) by VH-IVUS and clinical outcomes in patients with SVGD undergoing PCI.
CONCLUSIONS
In degenerative SVG lesions, VH-IVUS found that plaque composition was associated with clinical features, future studies need to explore the relationship between VH-IVUS defined atherosclerotic plaque components and clinical outcomes in SVGD patients undergoing PCI, an innovative prediction tool of clinical outcomes can be created.
Coronary Artery Bypass
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adverse effects
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Coronary Artery Disease
;
pathology
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Female
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Humans
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Male
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Percutaneous Coronary Intervention
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adverse effects
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Plaque, Atherosclerotic
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pathology
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Saphenous Vein
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pathology
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Ultrasonography, Interventional
10.Circulating endothelial cell injury in on-pump and off-pump coronary-artery bypass grafting.
Tie-niu SONG ; Bing-ren GAO ; Qi-ming ZHAO
Journal of Southern Medical University 2011;31(3):535-538
OBJECTIVETo investigate the difference in circulating endothelial cell (CECs) injuries following on-pump and off-pump coronary-artery bypass surgery.
METHODSWe randomly assigned 48 patients scheduled for urgent or elective coronary artery bypass grafting into two groups to receive on-pump and off-pump procedures. Blood samples were obtained before anesthesia, at the end of operation, and on days 1 and 3 after the operation, and CECs were isolated and counted using dynabeads coated with the specific antibody of CD146. Single cell gel electrophoresis was used to observe the morphological changes of the CECs.
RESULTSIn the cardiopulmonary bypass (CPB) group, the number of CECs was significantly greater than that in non-CPB group (P<0.05) at the end of surgery and 1 day after the operation. On postoperative day 3, the number CECs was similar between the two groups (P>0.05). The length of the comet tail was longer in CPB group with stronger fluorescence intensity than in the non-CPB group.
CONCLUSIONCompared with of-pump coronary artery bypass grafting, on-pump coronary artery bypass grafting results in more serious CEC injury, which is closely related to the prognosis.
Aged ; Cardiopulmonary Bypass ; adverse effects ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Coronary Disease ; surgery ; Endothelial Cells ; pathology ; Endothelium, Vascular ; cytology ; Female ; Humans ; Male ; Middle Aged