Coronary artery bypass grafting: Factors affecting outcomes

Kusu-Orkar, Ter-Er; Kermali, Muhammed; Oguamanam, Nina; Bithas, Christiana; Harky, Amer

doi:10.1111/jocs.15013

Cited by 21 publications

(12 citation statements)

References 70 publications

(164 reference statements)

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“…Of primary concern within this group is the necessity for long-term graft patency given the greater average postsurgical life expectancy in this group compared with propensity-matched individuals of more advanced age. 9 Patients requiring RR are subject to higher operative risks and the higher expected postsurgical life expectancy of individuals in this age group increases the chance RR would eventually be warranted. 10 Since the long-term patency of arterial grafts is superior to that of saphenous vein (SV) grafts, arterial grafting may be preferred in younger patients given the need for graft longevity.…”

Section: Cad In Patients Below 40 Yearsmentioning

confidence: 99%

Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting?

et al. 2021

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The etiology of coronary artery disease (CAD) is multifactorial, stemming from both modifiable and nonmodifiable risk factors such as age. Several studies have reported the effects of age on various outcomes of coronary artery bypass grafting (CABG). This article reviews age-related outcomes of CABG and offers direction for further studies in the field to create comprehensive, evidence-based guidelines for the treatment of CAD. Ninety-two primary sources were analyzed for relevance to the subject matter, of which 17 were selected for further analysis: 14 retrospective cohort studies, 2 randomized clinical trials, and 1 meta-analysis. Our review revealed four broad age ranges into which patients can be grouped: those with CAD (1) below the age of 40 years, (2) between the ages of 40 and 60 years, (3) between the ages of 60 and 80 years, and (4) at or above 80 years. Patients below the age of 40 years fare best overall with total arterial revascularization (TAR). Patients between the ages of 40 and 60 years also fare well with the use of multiarterial grafts (MAGs) whereas either MAGs or single-arterial grafts may be of significant benefit to patients at or above the age of 60 years, with younger and diabetic patients benefitting the most. Arterial grafting is superior to vein grafting until the age of 80 years, at which point there is promising evidence supporting the continued use of the saphenous vein as the favored graft substrate. Age is a factor affecting the outcomes of CABG but should not serve as a barrier to offering patients CABG at any age from either a cost or a health perspective. Operative intervention starts to show significant mortality consequences at the age of 80 years, but the increased risk is countered by maintenance or improvement to patients' quality of life.

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Section: Cad In Patients Below 40 Yearsmentioning

confidence: 99%

Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting?

et al. 2021

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“…Blood lactate concentrations have been widely used as markers of altered tissue perfusion, and high blood lactate is associated with major complications after cardiac surgery 6 , 7 . To date, various independent factors have been proposed, such as VIS and lactate, to predict unfavourable outcomes in coronary artery bypass grafting (CABG), but the causal relationship of variables has not yet been evaluated 8 , 9 .…”

Section: Introductionmentioning

confidence: 99%

Vasoactive inotropic score as a predictor of long-term mortality in patients after off-pump coronary artery bypass grafting

Kwon

Yoo

Kim

et al. 2022

Sci Rep

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Increased vasoactive-inotropic score (VIS) is a reliable predictor of mortality and morbidity after cardiac surgery. Here, we retrospectively evaluated the association between VIS and adverse outcomes in adult patients after off-pump coronary artery bypass grafting (OPCAB). We included 2149 patients who underwent OPCAB. The maximal VIS was calculated for the initial 48 postoperative hours using standard formulae. The primary outcome was 1-year death. The composite adverse outcome was death, resuscitation or mechanical support, myocardial infarction, revascularization, new-onset atrial fibrillation, infection requiring antibacterial therapy, acute kidney injury, and stroke. Path-analysis was conducted using lactate and prognostic nutritional index (PNI). VIS was associated with 1-year death (odds ratio [OR] 1.07 [1.04–1.10], p < 0.001) and 1-year composite outcome (OR 1.02 [1.0–1.03], p = 0.008). In path-analysis, high VIS showed a direct effect on the increased risk of 1-year death and composite outcome. In the pathway using lactate as a mediating variable, VIS showed an indirect effect on the composite outcome but no significant effect on death. Low PNI directly affected the increased risk of 1-year death and composite outcome, and had an indirect effect on both outcomes, even when VIS was used as a mediating variable. In patients undergoing OPCAB, high VIS independently predicted morbidity and 1-year death. Patients with increased lactate levels following high VIS had an increased risk of postoperative complications, although not necessarily resulting in death. However, patients with poor preoperative nutritional status had an increased risk of unfavourable outcomes, including death, implying the importance of preoperative nutritional support.

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“…The use of the internal mammary artery (IMA) as a graft insures an improved long-term survival. 12 Nevertheless, the combination of median sternotomy with the harvest of the sternal blood supply, the internal mammary arteries, leads to a decrease in the regional blood perfusion, which predisposes to postoperative wound healing disorders and deep sternal wound infections (DSWI). 1 To minimize the occurence of these complications, the harvest of only the left internal mammary artery (LIMA) is currently favored in most heart surgery centers, 15 while harvesting both internal mammary arteries (BIMA) is used only in chosen cases.…”

Section: Introductionmentioning

confidence: 99%

Infrared Thermographic Imaging of Chest Wall Perfusion in Patients Undergoing Coronary Artery Bypass Grafting

et al. 2022

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Coronary artery disease represents a leading cause of death worldwide, to which the coronary artery bypass graft (CABG) is the main method of treatment in advanced multiple vessel disease. The use of the internal mammary artery (IMA) as a graft insures an improved long-term survival, but impairment of chest wall perfusion often leads to surgical site infection and increased morbidity and mortality. Infrared thermography (IRT) has established itself in the past decades as a non-invasive diagnostic technique. The applications vary from veterinary to human medicine and from head to toe. In this study we used IRT in 42 patients receiving CABG to determine the changes in skin surface temperature preoperatively, two hours, 24 h and 6 days after surgery. The results showed a significant and independent drop of surface temperature 2 h after surgery on the whole surface of the chest wall, as well as a further reduction on the left side after harvesting the IMA. The temperature returned to normal after 24 h and remained so after 6 days. The study has shown that IRT is sufficiently sensitive to demonstrate the known, subtle reduction in chest wall perfusion associated with IMA harvesting.

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Coronary artery bypass grafting: Factors affecting outcomes

Cited by 21 publications

References 70 publications

Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting?

Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting?

Vasoactive inotropic score as a predictor of long-term mortality in patients after off-pump coronary artery bypass grafting

Infrared Thermographic Imaging of Chest Wall Perfusion in Patients Undergoing Coronary Artery Bypass Grafting

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