Neurological injury is a frequent and important complication of coronary artery bypass grafting (CABG). Several risk factors for this type of sequela have been identified, among them aortic arch atherosclerosis. Our previous study indicated that atherosclerotic burden in coronary arteries may likewise predict postoperative neurological complications (Pawliszak et al., 2016b). We assessed the severity of this condition by using the SYNTAX score calculator. However, diagnosing angiographic three-vessel coronary artery disease (3VD) could be an even simpler method of achieving this goal.
Aged ; Coronary Angiography ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Coronary Artery Disease/surgery* ; Female ; Glial Fibrillary Acidic Protein/blood* ; Humans ; Male ; Middle Aged ; Neurofilament Proteins/blood* ; Neuropeptides/blood* ; Phosphorylation ; Prospective Studies ; Serpins/blood* ; Neuroserpin

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

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

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

We performed a prospective cohort trial on 220 patients undergoing elective off-pump coronary artery bypass surgery and taking aspirin to evaluate the effect of aspirin resistance on myocardial injury. The patients were divided into aspirin responders and aspirin non-responders by the value of the aspirin reaction units obtained preoperatively using the VerifyNow(TM) Aspirin Assay. The serum levels of troponin I were measured before surgery and 1, 6, 24, 48 and 72 hr after surgery. In-hospital major adverse cardiac and cerebrovascular events, graft occlusion, the postoperative blood loss and reexploration for bleeding were recorded. Of the 220 patients, 181 aspirin responders (82.3%) and 39 aspirin non-responders (17.7%) were defined. There were no significant differences in troponin I levels (ng/mL) between aspirin responders and aspirin non-responders: preoperative (0.04 +/- 0.08 vs 0.03 +/- 0.06; P = 0.56), postoperative 1 hr (0.72 +/- 0.87 vs 0.86 +/- 1.10; P = 0.54), 6 hr (2.92 +/- 8.76 vs 1.50 +/- 2.40; P = 0.94), 24 hr (4.16 +/- 13.44 vs 1.25 +/- 1.95; P = 0.52), 48 hr (2.15 +/- 7.06 vs 0.65 +/- 0.95; P = 0.64) and 72 hr (1.20 +/- 4.63 vs 0.38 +/- 0.56; P = 0.47). Moreover, no significant differences were observed with regard to in-hospital outcomes. In conclusion, preoperative aspirin resistance does not increase myocardial injury in patients undergoing off-pump coronary artery bypass surgery. Postoperative dual antiplatelet therapy might have protected aspirin resistant patients.
Aged ; Aspirin/*administration & dosage ; Cohort Studies ; Coronary Artery Bypass, Off-Pump/*adverse effects ; Coronary Disease/*surgery ; Drug Resistance ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Reperfusion Injury/*prevention & control ; Platelet Aggregation Inhibitors/*administration & dosage ; Postoperative Hemorrhage/etiology ; Preoperative Care/methods ; Prospective Studies ; Stroke/etiology ; Troponin I/blood

INTRODUCTIONDiabetes and habitual smoking cause advanced coronary artery disease (CAD) in Asian patients at a younger age. No definite data exist as to whether off-pump (OPCAB) is better than conventional on-pump coronary artery bypass grafting (CCAB) in terms of postoperative renal complications. Thus, we aimed to compare the renal outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) on our patients, which constituted a predominantly Asian population.

MATERIALS AND METHODSA cohort of 395 patients following CCAB were compared with 293 patients who underwent OPCAB. Baseline demographics, comorbidities, intraoperative data, intensive care unit stay, number of grafts, New York Heart Association (NYHA) score, American Society of Anesthesiologists (ASA) score, EuroSCORE risk assessment model, and postoperative complications particularly renal, were collected and analysed.

RESULTSThe off-pump group consisted of significantly older patients with higher Canadian Cardiovascular Society (CCS) and ASA scores. Additionally, the off-pump group involved a significantly greater number of smokers and chronic obstructive pulmonary disease (COPD) patients. Other demographic parameters were not different between the groups. Postoperative investigations showed a significantly elevated serum creatinine (100.3 +/- 42.5 vs 127.6 +/- 114.2 micromol/L; off-pump vs on-pump; P = 0.039) and urea levels (5.9 +/- 3.1 vs 10.6 +/- 15.6 mg/dL; off-pump vs on-pump; P = 0.006) in the on-pump group. Moreover, there was a high tendency towards a higher rate of renal dysfunction associated death in this group.

CONCLUSIONSOPCAB is a safe and equally efficient operative method compared to CCAB, and has a significant lower risk for postoperative renal complications as a treatment modality for surgical coronary revascularisation.

Adult ; Aged ; Asia ; ethnology ; Cohort Studies ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Critical Care ; Female ; Humans ; Male ; Medical Audit ; Middle Aged ; Postoperative Complications ; Renal Insufficiency ; etiology ; Singapore

OBJECTIVETo investigate the value of cardiac troponin I (cTnI) levels in assessing myocardial protection by remifentanil precondition against myocardial injury induced by off-pump coronary artery bypass (OPCAB).

METHODSTwenty-four patients undergoing OPCAB were randomized into control and remifentanil preconditioning group (n=12). All the patients received pretreatment with oral diazepam (10 mg), intramuscular morphine (10 mg) and hyosine (0.3 mg). General anesthesia was induced with midazolam (0.08 mg/kg), etomidate (0.1-0.3 mg/kg), fentanyl (5-10 microg/kg), and rocuronium (1 mg/kg), and maintained with isoflurane inhalation and propofol infusion. Intermittent fentanyl and pipecuronium were given intravenously. In remifentanil preconditioning group, remifentanil (5 microg/kg in 50 ml normal saline) was infused in 10 min after anesthesia induction, and only NS was administered in the control group. Blood samples were obtained before and at 0, 2, 6, 24, and 48 h after the operation to determine serum cTnI levels.

RESULTSIn both of the two groups, the cTnI levels increased significantly at the postoperative time points (0, 2, 6, 24, and 48 h) as compared with those before the operation (P<0.05). The cTnI levels of remifentanil preconditioning group were markedly decreased after the operation in comparison with those of the control group (P<0.05).

CONCLUSIONRemifentanil preconditioning decreases the cTnI levels and reduces myocardial injury induced by OPCAB.

Aged ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Female ; Heart ; drug effects ; Humans ; Ischemic Preconditioning, Myocardial ; Male ; Myocardial Reperfusion Injury ; blood ; etiology ; metabolism ; Myocardium ; metabolism ; Piperidines ; pharmacology ; Postoperative Period ; Time Factors ; Troponin I ; blood ; metabolism

BACKGROUNDCoexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) in patients with coexistent carotid and coronary artery diseases.

METHODSBetween January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out.

RESULTSA total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was (25.5 +/- 7.0) minutes. The mean number of distal grafts per patient was 3.30 +/- 0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was (11.3 +/- 5.4) hours, (2.1 +/- 0.9) days, and (12.5 +/- 6.1) days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients (92.16%) with a mean follow-up of (39.5 +/- 12.5) months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred.

CONCLUSIONCombined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.

Aged ; Carotid Artery Diseases ; surgery ; Coronary Artery Bypass, Off-Pump ; adverse effects ; methods ; Coronary Artery Disease ; surgery ; Endarterectomy, Carotid ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

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

Moyamoya disease is an occlusive intracranial arteriopathy owing to intimal hyperplasia with formation of abnormal cerebrovascular collateral networks; however, the etiology remains unclear. Although this disease is known to be associated with renovascular hypertension, it is extremely rare for it to be associated with stenoses of the coronary arteries. We herein described a case of a 56-year-old female with angina and asymptomatic moyamoya disease. We performed off-pump coronary artery bypass grafting (OPCAB) to avoid cardiopulmonary bypass and the risk of intraoperative hypotension. Conventional coronary artery bypass grafting has a potential risk of brain ischemia in moyamoya patients, but OPCAB may avoid this perioperative cerebral ischemic complication.
*Coronary Artery Bypass, Off-Pump/adverse effects ; Coronary Stenosis/complications/surgery ; Female ; Humans ; Intraoperative Complications/prevention & control ; Middle Aged ; Moyamoya Disease/complications/*surgery ; Risk Factors