Impact of Second Arterial Conduit on Outcomes Following Coronary Bypass Grafting.

BACKGROUND: The aim of this study was to compare short-term outcomes and long-term survival in patients following coronary artery bypass grafting in whom second arterial conduit or saphenous vein was used as well as to find out the most optimal second arterial graft. METHODS: Between January 2006 and June 2018, 7,857 patients met the inclusion criteria and were divided into two groups: single internal thoracic artery (SITA) + Vein group (n = 7,140) and second arterial conduit group (n = 717), of these 537 patients received right internal thoracic artery (RITA) and 180 patients received radial artery (RA). We obtained 701 propensity-matched pairs for final comparison. Short-term outcomes included: 30-day mortality and major adverse cardiac and cerebral events (MACCE), reoperation for bleeding, and deep sternal wound infection (DSWI). The long-term outcome was all-cause mortality. RESULTS: No significant differences were observed between second arterial conduit versus SITA + Vein groups and between RITA versus RA groups in terms of 30-day mortality, 30-day MACCE, reoperation for bleeding, and incidence of DSWI in the matched cohort. The use of second arterial conduit was associated with a significant reduction in long-term mortality by 24% in the matched cohort (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.60-0.96; p = 0.02). RA and RITA as second arterial conduit had comparable long-term mortality (HR: 1.12; 95% CI: 0.69-1.82; p = 0.62). CONCLUSION: The use of second arterial conduit, irrespective of type, is safe and associated with improved long-term survival compared with the second venous aortocoronary graft.

Impact of Preoperative Aspirin on Long-Term Outcomes in Diabetic Patients Following Coronary Artery Bypass Grafting: a Propensity Score Matched Study.

INTRODUCTION: This study aimed to determine the effect of preoperative aspirin administration on early and long-term clinical outcomes in patients suffering from diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG). METHODS: In this observational study, a total of 315 patients were included and grouped according to the time interval between their last aspirin dose and the time of surgery; patients who had been continued aspirin intake with last administered dose ≤ 24-hours before CABG (n=144) and those who had been given the last dose of aspirin between 24 to 48 hours before CABG (n=171). RESULTS: Multivariable analysis showed that the continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of 30-day major adverse cardiac and cerebral events (MACCE) (P=0.004) as well as reduced incidence of composite 30-day mortality/MACCE (P=0.012). During mean follow-up of 37±17.5 months, the unadjusted hazard ratio (HR) showed that aspirin ≤ 24 hours prior CABG in patients with DM significantly reduced the incidence of MACCE and composite of mortality/MACCE during follow-up (HR: 0.50; 95% confidence interval [CI]: 0.29-0.87; P=0.014 and HR: 0.61; 95% CI: 0.38-0.97; P=0.039, respectively). However, after propensity score (PS) matching, the PS-adjusted HR showed a non-significant trend towards the reduction of MACCE during follow-up (HR: 0.58; 95% CI: 0.31-1.06; P=0.081). CONCLUSION: Continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of early MACCE, but without significant influence on long-term outcomes.

Impact of preoperative aspirin on long-term outcomes in diabetic patients following coronary artery bypass grafting: a propensity score matched study

Abstract Introduction: This study aimed to determine the effect of preoperative aspirin administration on early and long-term clinical outcomes in patients suffering from diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG). Methods: In this observational study, a total of 315 patients were included and grouped according to the time interval between their last aspirin dose and the time of surgery; patients who had been continued aspirin intake with last administered dose ≤ 24-hours before CABG (n=144) and those who had been given the last dose of aspirin between 24 to 48 hours before CABG (n=171). Results: Multivariable analysis showed that the continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of 30-day major adverse cardiac and cerebral events (MACCE) (P=0.004) as well as reduced incidence of composite 30-day mortality/MACCE (P=0.012). During mean follow-up of 37±17.5 months, the unadjusted hazard ratio (HR) showed that aspirin ≤ 24 hours prior CABG in patients with DM significantly reduced the incidence of MACCE and composite of mortality/MACCE during follow-up (HR: 0.50; 95% confidence interval [CI]: 0.29-0.87; P=0.014 and HR: 0.61; 95% CI: 0.38-0.97; P=0.039, respectively). However, after propensity score (PS) matching, the PS-adjusted HR showed a non-significant trend towards the reduction of MACCE during follow-up (HR: 0.58; 95% CI: 0.31-1.06; P=0.081). Conclusion: Continuation of preoperative aspirin intake ≤ 24 hours before CABG in patients with DM is associated with reduced incidence of early MACCE, but without significant influence on long-term outcomes.

Early and long-term clinical outcomes after minimally invasive direct coronary artery bypass grafting versus off-pump coronary surgery via sternotomy in isolated proximal left anterior descending artery disease: A propensity score matching analysis.

BACKGROUND: This study was designed to compare short-term and long-term clinical outcomes of minimally invasive direct coronary artery bypass (MIDCAB) and off-pump coronary artery bypass grafting (OPCAB) via median sternotomy in patients with single-vessel left anterior descending (LAD) artery disease. METHODS: In this retrospective study, 194-patients met the inclusion criteria and were divided into the MIDCAB group (n = 111) and OPCAB via median sternotomy group (n = 83). Short-term outcomes included: in-hospital mortality, perioperative myocardial infarction (MI), perioperative cerebrovascular adverse events (CAEs), chest drainage, reoperation for bleeding, duration of surgery, ventilation time, deep wound infection, packed red blood cell (pRBC) transfusion and duration of hospital stay. The long-term outcomes included: all-cause mortality, the incidence of MI and stroke, target vessel revascularization (TVR) and composite of mortality/MI/stroke. Propensity score matching (PSM) was used to match patients between the groups. RESULTS: Before as well as after the PSM, no significant differences were observed between both groups in terms of in-hospital mortality, incidence of perioperative MI, incidence of CAEs, reoperation for bleeding, pRBC transfusions, deep wound infection and ventilation time. However, MIDCAB group had lower chest tube drainage and shorter hospital stay. On the other hand, OPCAB group had shorter time of surgery before as well as after PS matching. At 7-years, before and after PSM, freedom from all-cause mortality, MI, stroke, TVR as well as composite of mortality/MI/stroke were comparable between both groups. CONCLUSIONS: Short-term as well as long-term outcomes of MIDCAB in terms of mortality, MI, stroke, and target vessel revascularization are satisfactory and as safe and effective as OPCAB via sternotomy.

Timing Strategy of Preoperative Aspirin and Its Impact on Early Outcomes in Patients Undergoing Coronary Artery Bypass Grafting: A Propensity Score Matching Analysis.

BACKGROUND: Data are lacking regarding optimal discontinuation time of preoperative aspirin before coronary artery bypass grafting (CABG). We aimed at assessing the impact of aspirin discontinuation according to time intervals before CABG and its influence on early postoperative outcomes. METHODS: In this retrospective study, we enrolled 652 patients who underwent primary isolated nonemergent CABG between October 2014 and December 2017. Patients were assigned into groups according to the time interval between the last aspirin dose administration and the time of surgery. The first group comprised patients who were given aspirin ≤24-h before CABG (n = 304), whereas the second group consisted of patients who took aspirin between 24 and 48 h before CABG (n = 348). Efficacy endpoints included 30-d mortality rate, incidence of major adverse cardiac and cerebral events (MACCE) and composite rates of 30-d mortality/MACCE. Propensity score matching was used for final comparison. RESULTS: Overall, multivariate analysis showed that aspirin administration ≤24 h before CABG was associated with reduced 30-d mortality rate and MACCE by 75% and 57%, respectively. Before as well as after propensity score matching, multivariate analysis showed that aspirin administration ≤24-h before CABG was associated with reduced composite rates of 30-d mortality rate and MACCE by 55% and 59%, respectively. Subgroup analysis stratified by the type of surgery showed that aspirin administration ≤24-h significantly reduced composite rates of 30-d mortality/MACCE in patients after off-pump CABG. CONCLUSIONS: Preoperative administration of aspirin ≤24-h before CABG is associated with the reduction of postoperative mortality as well as MACCE. The evidence also suggests that aspirin administration ≤24-h is strongly associated with reduced composite rates of 30-d mortality/MACCE in patients submitted to off-pump CABG.

Association between preoperative aspirin and acute kidney injury following coronary artery bypass grafting.

OBJECTIVE: To test the hypothesis that preoperative aspirin administered within 24 hours before coronary artery bypass grafting (CABG) could reduce the incidence of postoperative acute kidney injury (AKI) following CABG. METHODS: In this retrospective study, 696 patients were assigned to groups according to the time interval between their last aspirin dose administration and the time of surgery. A total of 322 patients received aspirin ≤24 hours before CABG, and 374 patients received aspirin between 24 and 48 hours before CABG. The primary outcome was postoperative AKI of any stage as defined by the Kidney Disease Improving Global Outcomes criteria. Propensity score matching selected 274 pairs for the final comparison. RESULTS: Multivariable analysis showed that administration of aspirin within 24 hours of CABG was independently associated with reduction of AKI incidence by 36% (odds ratio, 0.64; 95% confidence interval, 0.45-0.91; P = .014). It was also noted that patients receiving their last aspirin dose ≤24 hours before CABG had a significantly higher glomerular filtration rate at discharge compared with patients who received aspirin between 24 and 48 hours before CABG. Propensity score matching analysis showed that patients receiving aspirin within 24 hours before CABG had a lower incidence of AKI compared with patients who discontinued aspirin between 24 and 48 hours before CABG (25.1% vs 36.8%; P = .004). CONCLUSIONS: Continuation of aspirin until the day of surgery, with the last aspirin dose administered ≤24 hours before CABG, is associated with a significant reduction of postoperative AKI.

The use of preoperative aspirin in cardiac surgery: A systematic review and meta-analysis.

BACKGROUND: Despite the fact that aspirin is of benefit to patients following coronary artery bypass grafting (CABG), continuation or administration of preoperative aspirin before CABG or any cardiac surgical procedure remains controversial. Therefore, we performed a systematic review and meta-analysis to assess the influence of preoperative aspirin administration on patients undergoing cardiac surgery. MATERIALS AND METHODS: Medline database was searched using OVID SP interface. Similar searches were performed separately in EMBASE, PubMed, and Cochrane Central Registry of Controlled Trials. RESULTS: Twelve randomized controlled trials and 28 observational studies met our inclusion criteria and were included in the meta-analysis. The use of preoperative aspirin in patients undergoing CABG at any dose is associated with reduced early mortality as well as a reduced incidence of postoperative acute kidney injury (AKI). Low-dose aspirin (≤160 mg/d) is associated with a decreased incidence of perioperative myocardial infarction (MI). Administration of preoperative aspirin at any dose in patients undergoing cardiac surgery increases postoperative bleeding. Despite this effect of preoperative aspirin, it did not increase the rates of surgical re-exploration due to excessive postoperative bleeding nor did it increase the rates of packed red blood cell transfusions (PRBC) when preoperative low-dose aspirin (≤160 mg/d) was administered. CONCLUSIONS: Preoperative aspirin increases the risk for postoperative bleeding. However, this did not result in an increased need for chest re-exploration and did not increase the rates of PRBC transfusion when preoperative low-dose (≤160 mg/d) aspirin was administered. Aspirin at any dose is associated with decreased mortality and AKI and low-dose aspirin (≤160 mg/d) decreases the incidence of perioperative MI.

[Vascular anomaly - left anterior descending artery originating from right coronary sinus]. / Anomalia naczyniowa - odejscie przedniej tetnicy zstepujacej od prawej zatoki wiencowej.

A case of a patient with congenital anomaly of coronary blood vessels with left anterior descending artery starting from right coronary sinus is presented. The patient was operated on due to symptoms of myocardial ischaemia by carrying out an off-pump coronary artery bypass graft to left anterior descending artery and obtuse marginal artery, with a very good outcome.