Coronary artery bypass grafting in patients with low ejection fraction: what are the risk factors?

Vickneson, Keeran; Chan, Siew‐Pang; Li, Yue; Aziz, Muhammad N. Bin Abdul; Luo, Hai; Kang, Giap Swee; Caleb, Michael George; Sorokin, Vitaly

doi:10.23736/s0021-9509.19.10670-2

Cited by 14 publications

(11 citation statements)

References 35 publications

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“…The most frequent postoperative complications were prolonged invasive ventilation (17.7%), acute renal failure (14.7%), and multiple hemotherapy (21.3%). Vickneson et al [7] conducted a retrospective analysis of 346 patients with low EF (≤ 30%) in the period from 2019 to 2015. It was shown that patients with significant LV dysfunction who underwent CABG surgery had a full recovery within a month.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Predictors of the Early Postoperative Period in Patients After Coronary Artery Bypass Graft Surgery

Moldotashev

Osmonov²,

Кудайбергенова

et al. 2021

Wiad Lek

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The aim: The purpose of the present research was to study the results of coronary artery bypass graft (CABG) surgery depending on the degree of left ventricular ejection fraction (LVEF) reduction with the aim to identify additional echocardiographic predictors of the early postoperative period. Materials and methods: Were fixed, the results of CABG in 97 patients operated on in the “Bikard” private clinic from March 2016 to December 2018 were the material of the research. All patients underwent CABG surgery under cardiopulmonary bypass and cardioplegia, and in the preoperative period underwent echocardiographic examination according to the standard technique on the Vivid 7 machine. Patients, in dependent of the LVEF, were divided into 3 groups: group 1 35 people (LVEF < 40%), group 2 32 people ( 40% < LVEF < 50%), group 3 30 people (LVEF > 50%). Results: Our studies showed that the most important echocardiographic predictors of a complicated development of the disease in the early postoperative period, in addition to LVEF of the heart, can be the size of the left ventricle and left atrial, the presence and severity of mitral regurgitation and diastolic dysfunction of the left ventricle of the heart. Conclusions: Comprehensive measurement of these echocardiographic parameters will allow more accurately predict the results of coronary artery bypass grafting in the early postoperative period.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic Predictors of the Early Postoperative Period in Patients After Coronary Artery Bypass Graft Surgery

Moldotashev

Osmonov²,

Кудайбергенова

et al. 2021

Wiad Lek

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“…The risk of mortality in patients subjected to CABG surgery depends on the patients’ age, comorbidities, physiological functional reserve, degree of left ventricular dysfunction, the surgeons’ experience, and the hospital procedure volume [ 8 – 10 ]. The operative all-cause mortality rate in our hospital was 11.2%.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes of coronary artery bypass graft surgery in Johannesburg, South Africa

Reiche

Mpanya

Vanderdonck

et al. 2021

J Cardiothorac Surg

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Background The perioperative complications in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery have been reported predominantly from developed countries, with a paucity of data from sub-Saharan Africa. We aim to report on the clinical characteristics and perioperative complications in patients with obstructive coronary artery disease, managed with CABG surgery at a tertiary academic hospital in Johannesburg, South Africa. Methods We retrospectively reviewed data from adult patients who underwent CABG surgery during a 17-year period (January 2000 – December 2017). Data was collected from the cardiothoracic surgery department’s pre- and postoperative reports, the cardiology department’s medical records, and anaesthesiology’s intra-operative reports. We collected demographic, biochemical, clinical, surgical, echocardiographic, and angiographic data. Outcomes data collected included perioperative complications and mortality. Results We analysed 1218 consecutive patient records. The study cohort consisted of 951 (78.1%) males, and the mean age was 60.1 ± 10.1 years. During the study period, 137 (11.2%) patients demised with cardiac and sepsis-related causes of death accounting for 49.6 and 37.2%, respectively. Other perioperative complications included excessive bleeding in 222 (18.2%), prolonged ventilation (exceeding 48 h) in 139 (11.4%), and sternal sepsis in 125 (10.3%). On univariate logistic regression analysis, advanced age, a lower left ventricular ejection fraction, smoking, increased cardiopulmonary bypass (CPB) time, and a higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) II were all significantly associated with mortality. The EuroSCORE II [OR: 0.15 95%CI: 0.09–0.22; p = 0.000], and prolonged CPB time [OR: 0.01 CI: 0.00–0.02; p = 0.000] were independent predictors of in-hospital all-cause mortality. Conclusions In our study, the crude perioperative mortality rate was 11.2%. Our mortality rate was significantly higher than the mortality rates reported in other developed and developing countries. To better understand the factors driving this high mortality rate, a prospective outcomes registry has been initiated, and this promises to inform on our contemporary mortality and morbidity outcomes.

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“…Both the LVEF and WMSI measured using early postoperative cardiac CT (OR = 0.9625 and OR = 14.3605, respectively) predicted MACE, and also the WMSI measured using cardiac CT predicted all-cause death (OR = 10.6017). Several predictors such as age, female sex, and low ejection fraction are associated with long-term outcomes, including death and the development of cardiac events after CABG [31][32][33][34][35][36] . However, to the best of our knowledge, regional wall motion evaluated with cardiac CT have not been investigated as a means to predict death and MACE in patients who have undergone CABG.…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting

Kang

Lim

Park

et al. 2020

Sci Rep

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We evaluated the clinical utility of early postoperative cardiac computed tomography (ct) for evaluating left ventricular (LV) function and predicting prognosis in patients who had undergone coronary artery bypass grafting (CABG). Of the 205 patients who underwent CABG from March 2011 to December 2014, 136 underwent early postoperative cardiac CT (within 30 days after CABG) and were enrolled as the study population. The baseline and postoperative follow-up echocardiographic findings, major adverse cardiac events (MACE), and death were recorded for a follow-up period (mean, 5.9 ± 1.1 years). functional cardiac ct parameters were compared to echocardiographic measurements. the associations between cardiac CT findings and functional recovery and prognosis were evaluated by logistic regression analyses. The LVEF measured via cardiac CT was significantly higher (56.2 ± 11.5% vs. 61.9 ± 12.9%; p = 0.0002) compared to those via early postoperative echocardiography, but the wall motion score index (WMSI) was not significantly different (1.23 ± 0.33 vs. 1.21 ± 0.28, p = 0.5041) between the two methods. During the follow-up period, 17 patients (12.5%) died and 40 (29.4%) developed MACE. Both the LVEF and WMSI measured with early postoperative echocardiography (p = 0.0202 and odds ratio [OR] = 5.0171, p = 0.0039, respectively), and cardiac CT (OR = 0.9625, p = 0.0091 and OR = 14.3605, p = 0.0001, respectively) predicted MACE OR = 0.9630, but only the WMSI, measured using cardiac CT, predicted all-cause death (OR = 10.6017, p = 0.0035). In CABG patients, LVEF and the WMSI measured with early postoperative cardiac CT were comparable with echocardiography and predicted the development of MACE and all-cause death. Coronary artery bypass grafting (CABG) restores myocardial contractile function in patients with multi-vessel coronary artery disease 1,2 , but this is not always effective 3,4. Global ischemia and superimposed reperfusion injury might have deleterious effects on the heart 5-7. Moreover, the time course of functional recovery after CABG varies from immediately intra-operatively to 1 year postoperatively 7-11. Therefore, monitoring cardiac function in patients who have undergone CABG is important to predict their clinical outcome. Early anatomical recognition of bypass graft failure is important in terms of predicting clinical outcomes after CABG 12-15. Computed tomography (CT) is a powerful noninvasive technique providing anatomical information on graft patency, with simultaneous evaluation of cardiac function without any need for additional examination 16. Several studies have shown that CT is comparable to echocardiography and MRI for assessment of global left ventricular (LV) function and regional wall motion 17,18. Moreover, CT is quicker and easier to perform than MRI, which makes it suitable for the examination of patients who have recently undergone CABG.

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Coronary artery bypass grafting in patients with low ejection fraction: what are the risk factors?

Cited by 14 publications

References 35 publications

Echocardiographic Predictors of the Early Postoperative Period in Patients After Coronary Artery Bypass Graft Surgery

Echocardiographic Predictors of the Early Postoperative Period in Patients After Coronary Artery Bypass Graft Surgery

Perioperative outcomes of coronary artery bypass graft surgery in Johannesburg, South Africa

Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting

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