We provide evidence that 5 proteins were altered years before AS surgery and that the associations seem to be driven by concurrent atherosclerotic disease.
A substantial amount of angiographies occur in patients without any graft failure and a large part of postoperative recurrence of CAD symptoms and are likely attributed to IMA failure or progression of atherosclerosis in the native coronary arteries.
In cardiac surgery, perioperative death in low-risk patients is uncommon, but does occur. Reports on the incidence, cause and circumstances of death in this population are rare. We analyzed the early mortality and cause of death in patients with an additive EuroSCORE≤3 who underwent cardiac surgery between 2001 and August 2009 in Stockholm. We also investigated if death could be considered preventable, and in that case, if it was due to a technical or a system error. Among 3924 low-risk patients, 15 died within 30 days of surgery, and early mortality was 0.38%. Cause of death was mostly cardiac related (11 of 15). Death occurred after hospital discharge in three patients, and was classified as non-preventable in 13 patients. In the remaining two patients, the circumstances leading to death were categorized as due to a system error. A systematic and structured analysis of the circumstances resulting in death in low-risk patients, in addition to traditional morbidity and mortality conferences, have the potential to identify problems and offer improvements in the quality of care.
Patients who had arterial grafts as second conduits did not demonstrate a better outcome in any of the studied end-points. Radial artery grafts seem to be preferable to BIMA grafts as an alternative to an SVG.
BackgroundCoronary artery bypass grafting (CABG) using saphenous vein grafts (SVG) is vitiated by poor long-term patency of the vein grafts. Pedicled SVG harvested with the “no-touch” (NT) technique have demonstrated improved patency and could confer better outcomes. We aim to compare long-term results after CABG where NT or conventional technique was used for vein graft harvesting in a hypothesis-generating registry-based study.MethodsTwo propensity score matched cohorts (1349 patients) undergoing CABG with veins harvested with NT (NTT) or conventional (CT) technique in Sweden over the period 2005–2015 were used to compare long-term outcomes. Mortality, postoperative incidence of coronary angiography and need for reintervention was recorded and multivariable hazard ratios adjusted for risk factors were calculated.ResultsThe mean follow-up time (SD) was 6.8 (3.3) years for NTT and 6.6 (3.2) years for CT. The adjusted hazard ratios for death, first angiography and need for reintervention for NTT patients were (95% CI) 0.97 (0.80–1.19), 0.76 (0.63–0.93), 0.91 (0.78–1.05), and 0.91 (0.71–1.17), respectively. Failed grafts were found in 43.2% of NTT patients and 53.6% of CT patients at angiography.ConclusionsIn this study NT grafting was associated with a lower risk for repeat angiography, however no difference could be observed for mortality and need for reintervention. The earlier reported improvements in patency of NT veins could possibly be reflected in an improved clinical outcome during the first 10 years after surgery.Electronic supplementary materialThe online version of this article (10.1186/s13019-018-0800-z) contains supplementary material, which is available to authorized users.
Re-exploration for bleeding is associated with an increased risk for the need of repeat coronary reintervention during the first year after coronary artery bypass surgery.
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