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Background: Non-ST elevation myocardial infarction (NSTEMI) significantly reduces patient survival, a condition that is essential for the optimization of results and the restoration of effective vascular flow multivessel coronary artery disease, Emergency coronary artery bypass grafting (CABG) is frequently contemplated. In the aftermath of NSTEMI, the objective of this investigation is to assess the results of urgent CABG, to prioritize risk stratification through the use of the Global Registry of Acute Coronary Events (GRACE) score Methods: An analysis of 60 consecutive patients who underwent emergent CABG following NSTEMI was conducted retrospectively. Data on patients were obtained from a prospectively compiled database, and the GRACE score was implemented to evaluate the probability of mortality. Patients were divided into three risk categories: low (<10%), intermediate (10-19%), and high (?20%), based on their predicted mortality percentages. Results: Patients in the high-risk group (Group 3) exhibited significantly lower Euro Scores and ejection fractions (EF) than those in the low and intermediate groups, as demonstrated by the study. Additionally, the cross-clamp time was notably longer in Group 3, highlighting the urgency of intervention in this population The postoperative complications' overall incidence did not differ significantly between the groups. Even though Group 3 exhibited an increased in-hospital mortality rate. Conclusions: The findings underscore the importance of timely intervention and tailored management strategies for NSTEMI patients, more specifically, the individuals who have been classified as high-risk by the GRACE score. This study contributes to the growing body of literature supporting urgent CABG as a lifesaving procedure and emphasizes the need for further research to optimize outcomes in this vulnerable patient population. The results advocate for a multidisciplinary approach to enhance perioperative care and improve survival rates among NSTEMI patients undergoing CABG.
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Background: Elevated pre-operative uric acid levels significantly impact post-operative renal outcomes in off-pump CABG patients, increasing the risk of acute kidney injury, as evidenced by higher serum creatinine and reduced urine output. Methods: This cross-sectional study was conducted in Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh from January 2021 to December 2022. Total 160 patients undergoing off pump CABG were divided into two groups, group A and group B, each containing 80 patients. In group A, uric acid level was <7 mg/dl for male and <6 mg/dl for female and in group B, it was >7 mg/dl and >6 mg/dL for female. Results: The demographic characteristics, pre-operative serum UA levels and serum creatinine levels between the two groups was not statistically significant. Group A had shorter operative times (mean 265.21�.33 minutes) compared to Group B (mean 327.04�.32 minutes), with more patients in Group-B undergoing longer surgeries (>360 minutes). Group-B also had more grafts (mean 4.4 vs 3.6), higher serum creatinine (1.91 vs 1.17 mg/dl), bilirubin (0.8 vs 0.7 mg/dl), and lower urine output (mean 47.52 vs 95.37 ml/hour), all statistically significant (p<0.001). Conclusions: This study concludes that there is significant impact of pre-operative uric acid levels on post-operative renal outcomes in off-pump CABG patients.
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Background: Off-pump coronary artery bypass grafting抯 most difficult complication is sternal wound. Left internal mammary artery harvesting affects sternal wound complications. It is unclear which left internal mammary artery harvesting method prevents sternal wound complications. Skeletonized and pedicled left internal mammary artery harvesting were compared for sternal wound complications during off-pump coronary artery bypass grafting. As a result, proper methodology might be supported as an attractive method to decrease the incidence of sternal wound complication. Material & Methods: This comparative cross-sectional study was conducted at the department of cardiac surgery, Bangabandhu Sheikh Mujib Medical University. Total 120 patients were enrolled after fulfilling the selection criteria and divided into two groups. Among them,60 patients of group A received skeletonized left internal mammary artery whereas 60 patients of group B received pedicled left internal mammary artery. After performing off-pump coronary artery bypass grafting postoperative ICU care was given to each patient as per ICU protocol. Statistical analysis was conducted using Statistical Package for Social Science (SPSS) version 26.0 for windows software. Comparisons between groups were made with Student抯 t-test, Chi-Square test and Fisher抯 exact test. Observations were recorded as statistically significant if ap-value ?0.05. Results: In this study 10 (8.33%) patients developed sternal wound complication. Among them2 (1.67%) patients in group A and 8 (6.66%) patients in group B developed sternal wound complication. Occurrence of sternal wound complication was more in group B than group A which was not statistically significant(p=0.35). The mean age of patients in Group A and Group B were 54.34�.55 years and 53.50�.70 years respectively. Age was not statistically significant between two groups (p=0.89). The gender difference among two groups were not also statistically significant(p=0.69). Mean BMI was 24.33�65 in group A and 24.55�45 in group B and findings were not statistically significant between groups (p=0.76). The differences between comorbidities (HTN, DM, dyslipidaemia, anaemia) of both groups were statistically insignificant (p>0.05). However, number of smokers was statistically significant between groups (p=0.03). Sternal wound complication was more in smoker patients in group B and this finding was statistically significant(p=0.04). Mean � SD number of bypass grafts used by group A was 2.76�79 and group B was 2.83 �65(P=0.69). Pre-operative parameters such as duration of operation and post-operative parameter like duration of mechanical ventilation, duration of chest drains, duration of central venous line and amount of postoperative mediastinal bleeding were found statistically not significant between groups (p>0.05). Comparison of postoperative laboratory parameters was statistically not significant between groups. Distribution of wound complications, duration of ICU and hospital stay between two groups were also not statistically significant (p>0.05). Conclusions: Occurrence of sternal wound complication was found less in skeletonized left internal mammary artery harvesting than pedicled left internal mammary artery harvesting after off-pump coronary bypass grafting in this study. But this finding was not statistically significant.
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Purpose: Coronary artery bypass grafting surgery (CABG) is a common surgical procedure used to treat coronary artery disease (CAD). Despite advancements in the surgical techniques and perioperative care, cardiac surgery patients remain at risk of developing complications, especially atrial fibrillation (AF), The present study aimed to investigate the impact of posterior pericardiotomy on the incidence of postoperative AF and other relevant complications following CABG. Methods: This study is a randomized controlled trial conducted at a single center. A total of 204 patients were randomly assigned to two groups: the pericardiotomy group and the non-pericardiotomy group (control group). The study assessed the incidence of postoperative atrial fibrillation within the first 7 days following CABG surgery. Results: Our findings revealed no statistically significant difference in the incidence of pericardial effusion and AF between the pericardiotomy and non-pericardiotomy groups. The lack of cardiopulmonary bypass (CPB) in the on-pump CABG method may have contributed to the absence of significant differences in pericardial effusion rates between the groups. Moreover, we found that posterior pericardiotomy did not significantly affect the intubation time, length of stay in the intensive care unit (ICU), and total hospital stay in either group. Our study differs from previous research that focused on off-pump CABG patients. Studies that utilized CPB reported a significant reduction in pericardial effusion and arrhythmias with posterior pericardiotomy. This discrepancy suggests that the use of CPB may play a crucial role in the occurrence of arrhythmias and subsequent complications. Conclusions: our study indicates that posterior pericardiotomy did not significantly influence the incidence of pericardial effusion and AF in on-pump CABG patients. Considering the differences in surgical techniques and patient populations, further research with larger sample sizes is warranted to provide more definitive insights into the role of posterior pericardiotomy in this specific setting. Comprehensive studies will be instrumental in guiding clinical decisions and establishing best practices for the prevention of postoperative pericardial effusion and arrhythmias in on-pump CABG patients.
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Background: The great saphenous vein (GSV) remains the most commonly used conduit worldwide for the majority of coronary artery bypass surgery (CABG) procedures, despite concerns regarding the long-term patency of arterial revascularization. Therefore, our aim is to assess and demonstrate the impact of harvesting techniques on patient quality of life and early post-operative outcomes. Methods: This prospective, single-blinded randomized controlled study enrolled patients with ischemic heart disease indicated for CABG. The study was conducted at the Cardiothoracic and Vascular Surgery Center (CVSC) at Mansoura University, Mansoura, and El-Galaa Military Hospital, Cairo, involving 32 patients. Patients were categorized into two groups: Group I comprised sixteen patients where the GSV was harvested using the open vein harvesting technique (OVH), and Group II included sixteen patients where the GSV was harvested using the endoscopic vein harvesting technique (EVH). Results: Multivariate regression analysis evaluating the effect of the endoscopic technique revealed a significant correlation with postoperative outcomes, particularly in terms of leg wound complications assessed by the ASEPSIS score (p?<?0.001) and the prediction of postoperative NRS values for leg pain (p?0.001). Additionally, the impact on patients' quality of life across all subclinical categories was assessed using the Euro-Qol 5D (p?<?0.001). Conclusion: EVH presents itself as a viable minimally invasive alternative to traditional OVH techniques. It offers greater patient comfort, improved cosmetic satisfaction, a reduced incidence of postoperative leg wound complications, and lower levels of pain. Moreover, there is a statistically significant association between performing EVH techniques and enhanced quality of life, as well as a decrease in total ASEPSIS scores.
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Introduction: The aim of this study was to evaluate the prediction of vasoactive inotropic score (VIS) on early mortality and morbidity after coronary artery bypass grafting (CABG) and to determine the ideal time for score calculation. Materials and Methods: The study included patients who underwent isolated on?pump CABG surgery between November 2021 and November 2022. Pre, intra, and postoperative data were obtained by retrospective chart review. The final VIS value in the operating room (VISintra) and the highest VIS value in the first 24 hours in the intensive care unit (VISmax) were calculated. The patients were divided into two groups; Group 1 who developed early postoperative morbidity and mortality and Group 2 who did not. And the data were analyzed by groups. Results: A total of 221 patients with a mean age of 63.49 ± 9.96 years were evaluated and 73 (33%) were in Group 1. The cut?off value for VISintra was determined to be 6.20, VISmax was 6,05. VISintra and VISmax values were significantly higher in the poor outcome group. Multivariate analysis showed that only VISmax value was an independent variable on mortality?morbidity. Conclusions: Our results imply that the vasoactive inotropic score is an easy and inexpensive score to calculate and can be used as a specific scoring system to predict poor early outcomes in CABG patients. According to statistical analyses, the most predictive time among VIS measurements was VISmax, the highest value calculated in the ICU in the first 24 hours postoperatively.
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Background: The risk assessment for outcomes of older people undergoing cardiac surgery employ scales such as the Euro?Score II, and STS (Society for Thoracic Surgeons), which use clinical and laboratory data. Some studies have suggested a lower accuracy in older patients. Frailty assessment, using functional parameters, has shown promise in this age group. The aim of this study is to compare the validity of risk prediction of Euro?score II, with the Edmonton Frail Scale (EFS), in older patients undergoing elective coronary artery bypass grafting (CABG). Methods: This was a prospective, observational study of a cohort of patients above 60 years scheduled for elective CABG in a single centre. The patients were graded on the Euro?Score II scale and the EFS scales. The primary outcome of 30th day mortality, and the secondary outcome of immediate post?operative complications during hospitalization were recorded. Results: A total of 487 patients were recruited. The mean age was 68 years. Male subjects comprised 81.1% of the study group. Classification of risk as per the EFS placed 76.3 % as low risk, 23.4% as intermediate, and none were considered to be high risk. The EuroScore II classification placed 86% in the intermediate and high risk groups. The AUC in the ROC (receiver operator curve) for the EFS was 0.793 and for the and EuroScoreII it was 0.752. The 30th day mortality threshold fit occurred at 5/6 score for both EuroScore II and EFS. Euroscore? II sensitivity/specificity was 66.7%/75.1% respectively. The EFS had a sensitivity of 66.7% and a specificity of 77.1%. The ROC curves for the secondary outcomes were not significant. Conclusion: Both scales are of modest value in predicting short?term mortality in older patients, and require further refinements for improving clinical decision?making in the individual patient.
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@#Since the advent of coronary artery bypass grafting (CABG), the selection of bypass conduits has always been one of the most controversial topics in this field. Arterial conduits have received extensive attention due to their excellent biological features and high patency. In recent years, the application of arterial grafting and total arterial grafting in China keeps increasing in recent years, but there is still a gap compared to the Europe and America. Previous clinical studies have indicated the benefits of the total arterial grafting in terms of patency and long-term outcomes, but the advantage of multiple arterial grafting over other procedures is still in need to be confirmed with high-quality randomized controlled trials. This article reviews the clinical application and strategy of total-arterial CABG, aiming to provide objective reference for future clinical research and application.
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ObjectiveTo investigate the application of endoscopy in obtaining the great saphenous vein （GSV） during coronary artery bypass grafting （CABG） and explore the learning curve， with a particular focus on common challenges encountered during the learning process and their impact on early clinical outcomes. MethodsA retrospective analysis was conducted on clinical data from 83 patients who underwent off-pump CABG with endoscopic GSV harvesting at the First Affiliated Hospital of Zhengzhou University from July 2013 to April 2014. Patients were categorized into four groups based on the chronological order of their hospitalization： Group A （novice group， n=20）， Group B （proficient group， n=20）， Group C （progressive group， n=20）， and Group D （mature group， n=23）. Differences in perioperative and midterm follow-up outcomes among the groups were analyzed to determine the learning curve period. ResultsThe study population had a mean age of （60.22±8.06） years and a mean body weight of （69.77±11.66） kg. Comorbidities included hypertension （24 cases）， diabetes （26 cases）， and subacute cerebral infarction （14 cases）. The novice group exhibited significantly shorter GSV length-to-harvest time ratio relative to the other three groups （P<0.001） and a significantly higher incidence of main vein damage （P=0.006）. However， there was no statistically significant difference in graft patency at the 1-year follow-up. ConclusionThorough and reliable technical training in endoscopic GSV harvesting is essential to minimize vascular injury caused by novice operators. Approximately 20 cases of hands-on experience and a careful self-analysis of procedural challenges are likely required to achieve proficiency in GSV harvesting.
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Objectives:The aim of this study was to assess the influence of graft anastomosis strategies of radial artery on the flow characteristics and early patency in coronary artery bypass grafting(CABG). Methods:Present study enrolled 99 patients(92 males,7 females,aged[57.2±8.7]years),who underwent isolated CABG using a radial artery(RA)graft from January 2019 to December 2021 in our department.The RA was proximally anastomosed to the aorta in 79 patients(group 1)and to another graft as a composite graft in 20 patients(group 2).The intraoperative flow characteristics were evaluated with the transit time flow measurement(TTFM),and the graft patency was assessed by computed tomography coronary angiograms perioperatively and at 1year after operation respectively. Results:Baseline characteristics were similar between the two groups(all P＞0.05).There was no perioperative death.Incidence of minimally invasive cardiac surgery for CABG(MICS CABG)and mean flow(MF)of RA grafts were both higher in group 2 than in group 1(all P＜0.05).Perioperative RA graft failure rate was 24.2%(n=24),which tended to be lower in group 2 than in group 1(10.0%vs.27.8%,P=0.096).CT angiography showed that RA graft failure reduced to 16.1%at one year after operation.Compared to patency group,patients with failure RA grafts perioperatively had higher pulse index(PI)and lower intraoperative MF(all P＜0.05).Patients with failure RA grafts at one year after operation had higher PI and more bypassed to the right coronary artery(RCA)target territories of RA grafts(all P＜0.05). Conclusions:RA proximal anastomosis to the aorta or to another graft dose not affect the perioperative patency in CABG.Some RA graft that failed perioperatively might recanalize at one year after operation.High intraoperative PI and bypassed to RCA of RA grafts may be predictors of graft failure at one year after operation.
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@#Objective To investigate the role of cardiac rehabilitation program in the early recovery after minimally invasive incision coronary artery bypass grafting with general anesthesia. Methods A retrospective study was performed on the patients who underwent minimally invasive incision coronary artery bypass grafting from January 2015 to January 2020 with general anesthesia in our hospital. The patients were divided into a cardiac rehabilitation group and a control group. The clinical data of the patients were collected in 6 months and 12 months after the beginning of cardiac rehabilitation program and were analyzed by propensity score-matching analysis with a ratio of 1∶1. The main outcomes were the peak oxygen uptake (VO2 peak) of cardiopulmonary function test and the number of patients attending cardiovascular specialties in tertiary hospitals during the follow-up period (20 months). Results A total of 600 patients were enrolled, including 200 patients in the cardiac rehabilitation group [137 males and 63 females, aged 61.00 (56.00, 65.00) years] and 400 patients in the control group [285 males and 115 females, aged 60.00 (56.00, 65.00) years]. After matching, 176 patients were included in each group, and the basical clinical data of the pateints were comparable (P>0.05). The VO2 peak of the cardiac rehabilitation group after 6 months and 12 months of cardiac rehabilitation was significantly different from that of the control group [6 months: 1.96 (1.59, 2.38) L/min vs. 1.72 (1.38, 2.12) L/min, P<0.001; 12 months: 2.40 (2.21, 2.63) L/min vs. 2.12 (1.83, 2.45) L/min, P<0.001]. During the follow-up period, there was a statistical difference in the cardiovascular specialist visits in tertiary hospitals (P=0.004). Conclusion Cardiac rehabilitation program has a positive effect on the recovery of minimally invasive incision coronary artery bypass grafting with general anesthesia, and can improve the exercise ability of patients.
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@#Objective To evaluate the incidence of postoperative atrial fibrillation (POAF) after dexmedetomidine and diazepam in patients undergoing coronary artery bypass grafting (CABG). Methods A retrospective cohort study was conducted in the patients who underwent CABG in the General Hospital of Northern Theater Command from October 2020 to June 2021. By propensity score-matching method, the incidence of POAF after dexmedetomidine and diazepam application in patients undergoing CABG was evaluated. Results Finally 207 patients were collected, including 150 males and 57 females, with an average age of 62.02±8.38 years. Among the 207 patients, 53 were treated with dexmedetomidine and 154 with diazepam before operation. There was a statistical difference in the proportion of hypertension patients and smoking patients between the two groups before matching (P<0.05). According to the 1∶1 propensity score-matching method, there were 53 patients in each of the two groups, with no statistical difference between the two groups after matching. After matching, the incidence of POAF in the dexmedetomidine group was lower than that in the diazepam group [9.43% (5/53) vs. 30.19% (16/53), P=0.007]. There was no death in the two groups during hospitalization, and there was no statistical difference in the main adverse events after operation. The ICU stay (21.28±2.69 h vs. 22.80±2.56 h, P=0.004) and mechanical ventilation time (18.53±2.25 h vs. 19.85±2.01 h, P=0.002) in the dexmedetomidine group were shorter. Regression analysis showed that age, smoking and diabetes were related to the increased incidence of POAF (P<0.05), and preoperative use of dexmedetomidine was associated with a reduced incidence of POAF (P=0.002). Conclusion For patients undergoing CABG, the incidence of POAF with dexmedetomidine before operation is lower than that with diazepam. Preoperative application of dexmedetomidine is the protective factor for POAF, and old age, smoking and diabetes are the risk factors for POAF.
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@#We reported a 59-year-old male with exertional angina pectoris, and the coronary angiography showed multiple vessel lesions. The initial strategy was coronary artery bypass grafting (CABG). The measurement of quantitative flow ration (QFR) before operation indicated that the posterior descending branch (PD) did not need to be treated. The left circumflex branch (LCX) was small, and the QFR of the left anterior descending branch (LAD) and the first diagonal branch (D1) was<0.8. Therefore, the LAD and D1 were re-vascularized. The operation strategy was changed to on-pump CABG through a small incision, and the final strategy was LIMA-D1-LAD (sequential), fractional flow reserve (FFR) of distal LAD and D1 after CABG were>0.8 by computed tomography FFR. SYNTAX scores after CABG were 20 and the functional SYNTAX scores after CABG were 3, indicating a good prognosis.
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A 73-year-old woman presented at our hospital with dyspnea. Echocardiography showed severe aortic stenosis and a coronary angiography revealed right coronary artery disease. Therefore, we performed aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. Proximal anastomosis was initially attempted to the ascending aorta. However, the ascending aorta was thin and weak, we decided to anastomose to the side of the aortic arch. Proximal anastomosis was performed with an anastomotic device. Postoperative coronary computed tomography (CT) showed that the graft was patent.
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ABSTRACT Introduction: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease. Methods: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint. Results: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found. Conclusion: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.
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SUMMARY OBJECTIVE: The aim of this study was to examine the relationship between caregiver burden, family adaptation, partnership, growth, affection, and resolve score, anxiety levels, and the perceived social support of the relatives of patients who had open heart surgery. METHODS: Volunteers among the relatives of patients who had open heart surgery in our cardiovascular surgery clinic and were followed up in the first 3 months were included in the study. The cardiovascular surgeons recorded the sociodemographic data of the relatives of the patients and directed them to a psychiatry clinic for further evaluation. The caregiver burden scale, family adaptation, partnership, growth, affection, and resolve scale, anxiety level scale, and perceived social support scale were applied to the relatives of the patients who participated in the study. RESULTS: Within the scope of the study, a total of 51 individuals, 29.4% (n=15) men and 70.6% (n=36) women, were included in the evaluation. The participants' ages ranged from 32 to 68 years, with an average age of 48 years. There was a statistically significant relationship between the caregiving burden scale score and the scale scores other than age (p<0.05). There was a statistically significant difference in terms of caregiving burden scale score, working status, physical and psychological problems, changes in home life, and changes in family relationships (p<0.05). CONCLUSION: The fact that the need for security and intimacy is related to anxiety and depression can be interpreted as the caregiving problems of the relatives of the patients who think that their patients are safe and feel closer to the intensive care personnel will decrease. Their depression and anxiety levels will also decrease.
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SUMMARY OBJECTIVE: The objective of this study was to reveal whether there was a possible relationship between the blood group and postoperative atrial fibrillation after off-pump coronary artery bypass grafting. METHODS: Between January 2020 and January 2022, 452 patients undergoing off-pump coronary artery bypass grafting surgery consisted of the research population. Patients were divided into two groups based on the occurrence of new-onset atrial fibrillation from the time of operation until discharge. Group 1 (atrial fibrillation group) had 122 patients, whereas group 2 (non-atrial fibrillation group) contained 350 patients. Patients' baseline clinical characteristics and operative and postoperative data were recorded and then compared between the groups. Moreover, a multivariate logistic regression analysis was also conducted to identify the predictors of postoperative atrial fibrillation. RESULTS: Non-O blood groups were substantially more common in the atrial fibrillation group than in the non-atrial fibrillation group. Patient age differences between the atrial fibrillation and non-atrial fibrillation groups were statistically significant, and patients in the atrial fibrillation group were detected to be older. Mean left atrial diameter, rates of obesity and prior percutaneous coronary intervention history, and perioperative intraaortic balloon pump requirement were significantly greater in the atrial fibrillation group than in the non-atrial fibrillation group. According to logistic regression analysis, blood group, age, left atrial diameter, obesity, and prior percutaneous coronary intervention were identified as predictors of postoperative atrial fibrillation. CONCLUSION: We demonstrated for the first time in the literature that ABO blood type was a novel and significant predictor of new-onset atrial fibrillation after off-pump coronary artery bypass grafting.
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Background: Revascularization of the coronary arteries is associated with better short term and long term prognosis in patients having multivessel coronary artery disease (MV-CAD) and chronic kidney disease (CKD). However, whether revascularization using coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) using drug eluting stents (DES) is better remains unknown. Objectives: To compare the outcomes of revascularization by multi-vessel PCI using DES versus revascularization by CABG in patients with CKD having multivessel CAD, regarding in-hospital and one-year major adverse cardiovascular and cerebrovascular events (MACCE). Methods: This was a retrospective analysis of the data of a group of patients having CKD with eGFR less than 60 ml/min with multivessel CAD who underwent revascularization by PCI or revascularization by CABG and were compared as regards in-hospital and one-year MAACE. Results: A total of 565 patients were reviewed in this study, 230 patients had multivessel PCI using DES while 335 patients had CABG. Comparing both revascularization groups regarding in-hospital MACCE, patients who had mutli-vessel PCI had significantly lower in-hospital mortality, cerebrovascular events (stroke/TIA) and lower total MACCE than patients who had CABG (P-value = 0.03 & 0.01 & 0.04 respectively). When comparing both revascularization groups regarding one-year MACCE, patients who had mutli-vessel PCI had significantly lower cerebrovascular events and total MACCE than those patients who had CABG (P-value = 0.02 & 0.03 respectively). Conclusion: This is a retrospective study to determine which strategy is better for revascularization of CKD patients having multivessel CAD; we can conclude that multi-vessel PCI using DES for CKD patients and multivessel CAD had advantages over CABG regarding in-hospital and one-year cerebrovascular accidents (TIA/stroke) and regarding total MACCE. Larger randomized controlled trials are required to confirm our findings.
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Coronary Artery Bypass Grafting (CABG) Surgery is considered the standard treatment for revascularization in Coronary Artery Disease. The Off-Pump Coronary Artery Bypass Graft (OPCAB) which evades the use of Cardiopulmonary Bypass (CPB) became a popular CABG procedure, due to the adverse effect of CPB. Hypothetically, OPCAB may improve the rates of perioperative Myocardial Injury, Neurocognitive Impairment, Stroke and Mortality. However, some studies showed no superior outcomes for OPCAB compared to on-pump CABG. This study aims to evaluate the short-term and long-term outcomes of OPCAB versus On-Pump CABG. The results showed that OPCAB is probably a safe procedure for patients, especially for those with high-risk conditions. OPCAB procedure showed superior short-term outcomes in terms of Myocardial Infarction, Systemic Inflammatory Response, Postoperative Cognitive Dysfunction, Renal Failure, Stroke, Pulmonary Complication, Postoperative Transfusion, Hospital stay length and infection than On-pump CABG. However, regarding long-term outcomes, Off-Pump CABG had a higher rate of incomplete revascularization and repeat revascularization and a higher risk of long-term mortality as well as lower graft patency. Furthermore, the result showed that the higher experience of the surgeons in OPCAB improves the outcome of the Surgery.