INTRODUCTIONThe applicability of off-pump coronary-artery bypass (OPCAB) in patients who present as emergency remains controversial. Herein, we explore the efficacy and safety of OPCAB in patients who were indicated for emergency surgery.

MATERIALS AND METHODSBetween 2002 and 2007, a total of 282 patients underwent OPCAB, of which 68 were presented as emergency. This cohort (group A) was compared to 68 patients who had traditional on-pump coronary artery bypass grafting (CABG, group B) under emergency indications during the same period of time. Baseline demographics, intraoperative data and postoperative outcomes were analysed.

RESULTSPreoperative demographics were comparable in both groups. Mortality during the first 30 days was comparable in both groups and no stroke occurred in the whole series. Patients in group A had significantly less pulmonary complications (4.4% vs 14.7%, P = 0.04), less ventilation time (30.3 ± 33.6 hours vs 41.5 ± 55.4 hours, P = 0.18) and were less likely to have prolonged ventilation, (19.1% vs 35.3%, P = 0.03). Similarly, OPCAB patients had less postoperative renal-failure/dysfunction (5.9% vs 8.8%, P = 0.51) and required less inotropic support (66.2% vs 88.2%, P = 0.002), bloodtransfusions (23% vs 86.8%, P <0.0001), and atrial- (17.6% vs 35.3%, P = 0.02) or ventricular-pacing (17.6% vs 41.2%, P = 0.002). Although the number of diseased vessels was comparable in both groups, patients in group A received less distal anastomoses. (2.78 ± 1.19 vs 3.41 ± 0.89, P = 0.002). Similarly, complete revascularisation was achieved less frequently in group A (76.5% vs 94.1%, P = 0.004).

CONCLUSIONOPCAB strategy is a safe and efficient in emergency patients with reasonable good short-term postoperative outcomes.

Cohort Studies ; Coronary Artery Bypass ; instrumentation ; methods ; Coronary Artery Bypass, Off-Pump ; instrumentation ; methods ; Coronary Artery Disease ; mortality ; surgery ; Emergency Treatment ; Female ; Health Status Indicators ; Humans ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Safety ; Singapore ; Statistics as Topic ; Time Factors

BACKGROUND: The purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery. METHODS: Data analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013. RESULTS: There is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high. CONCLUSION: Policies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.
Busan ; Coronary Artery Bypass ; Daegu ; Health Facilities ; Hospitals, University ; Humans ; Korea* ; National Health Programs ; Seoul ; Statistics as Topic ; Thoracic Surgery*

OBJECTIVETo assess the prognostic accuracy for operative mortality of 4 different risk stratification models in Chinese patients underwent (coronary artery bypass graft) CABG.

METHODSBetween 2002 and 2003, all patients undergoing CABG in our institution were prospectively scored for operative mortality using Parsonnet, EuroSCORE, Cleveland and OPR scoring systems and operative mortality was registered. Operative mortality is defined as postoperative death of any cause during hospitalization. Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).

RESULTSFollow-up was able to be completed in 2251 prospectively scored patients. Registered operative mortality was 1.87% (42/2251). The overall expected mortality calculated by Parsonnet, EuroSCORE, Cleveland and OPR scoring systems were 5.78%, 2.82%, 3.30% and 1.65%, respectively. The actual operative mortality was within the range of 95% confidence interval of OPR model and the other 3 predicted significantly higher operative mortality. Among the four risk scores, Calibration was good in OPR model (chi(2) = 4.842, P = 20.182) and poor in other 3 models (P < 0.001) while discrimination was acceptable in Parsonnet, Cleveland and OPR scoring systems (AUC: 0.711, 0.754, 0.757, respectively) and excellent in EuroSCORE scoring system (0.813).

CONCLUSIONFor Chinese patients undergoing CABG, OPR scoring system best predicted the operative mortality. All systems could be used to discriminate operative mortality for individual patient.

China ; Coronary Artery Bypass ; mortality ; statistics & numerical data ; Humans ; Proportional Hazards Models ; ROC Curve ; Risk Factors ; Survival Rate

PURPOSE: Evidence suggests that technological innovations and reimbursement schemes of the National Health Insurance Service may have impacted the management of coronary artery disease. Thus, we investigated changes in the practice patterns of coronary revascularization. MATERIALS AND METHODS: Revascularization and in-hospital mortality among Koreans > or =20 years old were identified from medical claims filed between 2006 and 2010. The age- and sex-standardized procedure rate per 100000 person-years was calculated directly from the distribution of the 2008 Korean population. RESULTS: The coronary revascularization rate increased from 116.1 (95% confidence interval, 114.9-117.2) in 2006 to 131.0 (129.9-132.1) in 2010. Compared to the rate ratios in 2006, the rate ratios for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in 2010 were 1.16 (1.15-1.17) and 0.80 (0.76-0.84), respectively. Among patients who received PCI, the percentage with drug-eluting stents increased from 89.1% in 2006 to 93.0% in 2010. In-hospital mortality rates from PCI significantly increased during the study period (p=0.03), whereas those from CABG significantly decreased (p=0.01). The in-hospital mortality rates for PCI and CABG were higher in elderly and female patients and at the lowest-volume hospitals. CONCLUSION: The annual volume of coronary revascularization continuously increased between 2006 and 2010 in Korea, although this trend differed according to procedure type. A high percentage of drug-eluting stent procedures and a high rate of in-hospital mortality at low-volume hospitals were noted.
Adult ; Aged ; Aged, 80 and over ; Coronary Artery Bypass/*statistics & numerical data/trends ; Coronary Artery Disease/*surgery ; Drug-Eluting Stents ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Revascularization/*methods/*trends ; Percutaneous Coronary Intervention/*statistics & numerical data/trends ; Republic of Korea/epidemiology

BACKGROUNDLeft main coronary artery (LMCA) stenosis has been recognized as a risk factor for early death among patients undergoing coronary artery bypass grafting (CABG). This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event (MACCE) after off-pump coronary artery bypass grafting (OPCABG), compared with non-left main coronary artery stenosis (non-mainstem disease).

METHODSFrom January 1, 2009 to December 31, 2010, 4869 patients had a primary isolated OPCABG procedure at Beijing Anzhen Hospital. According to the pathology of LMCA lesions, they were retrospectively classified as a non-mainstem disease group (n = 3933) or a LMCA group (n = 936). Propensity scores were used to match the two groups, patients from the non-mainstem disease group (n = 831) were also randomly selected to match patients from the LMCA group (n = 831). Freedom from MACCE in the two groups was calculated using the Kaplan-Meier method.

RESULTSThe difference in the mortality and the rate of MACCE during the first 30 days between the non-mainstem disease group and the LMCA group did not reach statistical significance (P = 0.429, P = 0.127 respectively). With a mean follow-up of (12.8 ± 7.5) months and a cumulative follow-up of 1769.6 patient-years, the difference in the freedom from MACCEs between the two groups, calculated through Kaplan-Meier method, did not reach statistical significance (P = 0.831).

CONCLUSIONAnalysis of a high volume of OPCABG procedures proved that LMCA lesions do not pose additional early and mid-term risk to OPCABG. Therefore, a LMCA lesion is as safe as non-mainstem disease lesion during the OPCABG procedure.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; adverse effects ; mortality ; statistics & numerical data ; Coronary Artery Disease ; surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVE: To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques. MATERIALS AND METHODS: Eighteen patients (mean age, 58 +/- 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group. RESULTS: All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1+/-5.3 mm vs. 14.9+/-4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8+/-4.5 mm vs. 2.1+/-5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89+/-5.41 vs. -15.41+/-3.7, p < 0.05) CONCLUSION: Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium.
Contrast Media/diagnostic use ; *Coronary Artery Bypass ; Coronary Disease/*surgery ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Image Interpretation, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Pericardium/surgery ; Retrospective Studies ; Statistics, Nonparametric ; Ventricular Septum/*physiopathology

BACKGROUNDAtrial fibrillation (AF) occurs commonly in patients with acute myocardial infarction (MI) and is associated with an increased long-term mortality. This study aimed to investigate the clinical characteristics and outcomes of AF in in-hospital elderly Chinese patients with acute MI.

METHODSA total of 967 patients with acute MI, aged >/= 65 years, were categorized on the basis of the absence or presence of AF. Patients with documented AF were classified into two subgroups: the ongoing AF group and the new-onset AF group. We retrospectively evaluated the clinical profile, in-hospital outcomes, and effects of revascularization on the incidence of AF in elderly patients with acute MI.

RESULTSAF was documented in 100 (11.53%) patients and the incidence of new-onset AF was 6.51% during hospitalization. History of old MI and cerebrovascular events were more common in patients with AF than in those without AF (P < 0.001, P < 0.01, respectively). The incidence of AF was higher in patients with non-ST elevated MI (P = 0.014), inferior wall MI (P = 0.004) and cardiac function of Killip class III or IV (P = 0.008). Patients with AF had more complication of pneumonia (P = 0.003) and longer hospital stay. Left circumflex coronary artery involvement was more common in patients with AF (compared with patients without AF, P < 0.001). Percutaneous coronary intervention or coronary artery bypass grafting significantly decreased the incidence of new-onset AF from 7.97% to 3.82% (P = 0.017). AF depended to heart failure, increased the in-hospital mortality.

CONCLUSIONSAF is common in elderly patients with acute MI and is associated with poorer clinical outcomes. Revascularization reduces the incidence of AF and thus improves the clinical outcomes in these patients.

Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Atrial Fibrillation ; complications ; pathology ; therapy ; Coronary Artery Bypass ; Female ; Humans ; Inpatients ; statistics & numerical data ; Male ; Myocardial Infarction ; complications ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo discuss the choice of surgical methods and the safety and efficacy of off-pump coronary artery bypass grafting (OPCAB) in elderly patients.

METHODSFrom Sept. 1997 to Feb. 2003, 63 cases over the age of seventy (including seventy) undertook OPCAB in our department. We compared the clinical data of those patients with that of 94 cases undertook conventional coronary artery bypass grafting (CABG) at the same age group and that of 58 cases younger than seventy received OPCAB.

RESULTSThe clinical outcomes of OPCAB is better than that of CABG in elderly patients concerning inotropic drug, postoperative transfusion, re-operation, intubation time, complications incidence and in-hospital mortality. Furthermore, there is no significant difference of complication incidence and in-hospital mortality between the elderly OPCAB group and the younger OPCAB group.

CONCLUSIONSOPCAB is a safe and efficacious method of myocardial revascularization in the elderly.

Aged ; Aged, 80 and over ; Blood Transfusion ; statistics & numerical data ; Cardiotonic Agents ; administration & dosage ; Coronary Artery Bypass, Off-Pump ; mortality ; standards ; Hospital Mortality ; Humans ; Myocardial Revascularization ; Postoperative Complications ; epidemiology ; Retrospective Studies

To analyze two common factors for perioperative ischemic stroke in patients with concomitant carotid and coronary artery severe stenosis and to improve the therapeutic effect.
 Methods: A total of 44 patients with multi-vessel coronary artery disease combined with carotid stenosis, who admitted to the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University from 2008 to 2014, were enrolled in this study. Among them, 32 cases were male, 12 cases was female. All patients received coronary artery bypass grafting after treatment of neck diseases. The surgical outcomes and follow-up results were analyzed retrospectively.
 Results: One patient received carotid endarterectomy suffered hemiplegia, whose symptoms were improved after positive clinical treatment. One patient suffered transient ischemic attack, and 5 patients displayed the cerebrovascular syndromes a week later after surgery. Twelve patients suffered nerve function damage 48 hours later after surgery. Nine patients received intra-aortic ballon pump, 1 patient received thoracotomy hemostasis, 3 patients suffered sternal dehiscence; 27 patients showed atrial fibrillation. Two patients died after surgery. The follow-up duration ranged from 1-7 years and the follow-up rate was 90%. The ischemic symptoms were improved in 44 patients. Six patients complained the recurrence of angina, but no abnormalities were found in coronary angiography or computed tomography angiography. One patient died of malignant tumor during the follow-up duration.
 Conclusion: For patients with concomitant carotid and coronary artery severe stenosis, it is more likely to suffer ischemic cerebral stroke. However, carotid stenosis is not the only factor, other key factors relevant to ischemic cerebral stroke shouldn't be ignored either.
Atrial Fibrillation ; epidemiology ; Blood Loss, Surgical ; statistics & numerical data ; Carotid Stenosis ; complications ; surgery ; Cerebrovascular Disorders ; epidemiology ; Comorbidity ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; adverse effects ; mortality ; Coronary Artery Disease ; complications ; surgery ; Coronary Stenosis ; complications ; surgery ; Endarterectomy, Carotid ; adverse effects ; Female ; Hemiplegia ; epidemiology ; Humans ; Intra-Aortic Balloon Pumping ; adverse effects ; Intraoperative Complications ; epidemiology ; Ischemic Attack, Transient ; epidemiology ; Male ; Nervous System Diseases ; Peripheral Nerve Injuries ; epidemiology ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke ; epidemiology ; Surgical Wound Dehiscence ; epidemiology ; Thoracotomy ; adverse effects

Urgent coronary artery bypass grafting (CABG) has a higher mortality rate than elective CABG. The purpose of this study was to evaluate the clinical outcome of urgent CABG. From July 1992 to May 2005, 104 patients underwent urgent CABG. All patients required an urgent surgical revascularization within 24 hr of diagnostic coronary angiography. In-hospital mortality after urgent CABG was 17.3% (18/104). We compared preoperative characteristics and postoperative clinical outcomes between the survival group (n=86) and the mortality group (n=18). The mean age was 61.7 yr (range, 35-83). The most common cause of mortality was low cardiac output. The independent preoperative risk factors of mortality included advanced age (>70 yr) (OR=3.998, p=0.046), preoperative shock status (OR=6.542, p=0.011), and low ejection fraction (<40%) (OR=4.492, p=0.034). Other risk factors of mortality included prolonged cardiopulmonary bypass time, prolonged ventilator use, and extended intensive care unit stay. The 10-yr actuarial survival rate was 61%. Although the operative mortality rate was high after urgent CABG, a favorable long-term clinical outcome can be expected if the patients survive.
Treatment Outcome ; Survival Rate ; Survival Analysis ; Risk Factors ; Risk Assessment/*methods ; Outcome Assessment (Health Care) ; Middle Aged ; Male ; Korea/epidemiology ; Incidence ; Humans ; Female ; Critical Care/*statistics & numerical data ; Coronary Artery Bypass/*mortality ; Coronary Arteriosclerosis/*mortality/*surgery ; Aged, 80 and over ; Aged ; Adult