Effects of a Proximal Seal System on Neurologic Outcomes of Off-Pump Coronary Artery Bypass Grafting

Kim, Do Jung; Lee, Seung Hyun; Joo, Hyun‐Chel; Yoo, Kyung-Jong; Youn, Young‐Nam

doi:10.1536/ihj.17-283

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…15 Recently, Kim and colleagues also reported no significant differences in hospital mortality, perioperative stroke, and MACCE, and equivalent 5-year survival rates between the two groups, Heartstring (n ¼ 323) and aortic no-touch (n ¼ 406) undergoing isolated CABG. 21 Although these studies reported acceptable late outcomes with Heartstring, no studies investigated the predictors of late death as our study did.…”

Section: Discussionmentioning

confidence: 62%

Outcomes of 881 Consecutive Coronary Artery Bypass Graft Patients Using Heartstring Device

Amano,

Takami,

Maekawa

et al. 2024

Thorac Cardiovasc Surg

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Backgrounds One of the strategies to prevent stroke after coronary artery bypass grafting (CABG) may be the use of a device for proximal anastomosis without partial clamp of the ascending aorta. Methods We retrospectively investigated early and late outcomes in consecutive 881 patients undergoing isolated CABG using Heartstring for proximal anastomosis from January 2008 to December 2022, to reveal the validity to use it. All patients underwent preoperative imaging workups to evaluate neurovascular atherosclerosis. Results The mean age of the patients was 68.9 years, 20% were female and 13% had previous history of stroke. CABG was on-pump beating heart (52.2%) or off-pump (47.8%) with a mean number of distal anastomoses of 3.38 ± 0.93, using 1.62 ± 0.53 Heartstring devices under different aortic manipulations. In-hospital mortality was 2.0% and perioperative stroke rate was 0.9%, none of them died during hospital stay. During the follow-up period of 70 ± 47 months, the overall actuarial survival rates were 86 and 66%, and major adverse cardiac and cerebrovascular events (MACCEs)-free rates were 86 and 70% at 5 and 10 years, respectively. On multivariable analysis, risk factors for late death included male, previous history of stroke, postoperative sternomediastinitis, late new-onset stroke, and MACCEs, but did not include the perioperative stroke. Conclusion Low stroke rate, as low as 0.9%, after CABG using Heartstring for proximal anastomosis, although under a variety of aortic manipulations, may contribute to the improved long-term prognosis.

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Section: Discussionmentioning

confidence: 62%

Outcomes of 881 Consecutive Coronary Artery Bypass Graft Patients Using Heartstring Device

Amano,

Takami,

Maekawa

et al. 2024

Thorac Cardiovasc Surg

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“…In 3 studies, aortic atherosclerosis was identified as an independent predictor using multivariate regression analyses [ 52–54 ]. This correlation was not observed in 2 studies evaluating the use of a clampless proximal anastomosis facilitating device [ 55 , 56 ]. Apparently the use of these devices helps to prevent the increase in stroke rate associated with increasing aortic atherosclerosis severity.…”

Section: Coronary Artery Bypass Graftingmentioning

confidence: 88%

Intimal aortic atherosclerosis in cardiac surgery: surgical strategies to prevent embolic stroke

Knol

Budde

Mahtab

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Although the incidence of perioperative stroke after cardiac surgery gradually decreased over the last decades, there is much variation between centres. This review aimed to create a concise overview of the evidence on possible surgical strategies to prevent embolic stroke in patients with intimal aortic atherosclerosis. METHODS The PubMed and EMBASE databases were searched for studies on surgical management of aortic atherosclerosis and the association with perioperative stroke in cardiac surgery, including specific searches on the most common types of surgery. Articles were screened with emphasis on studies comparing multiple strategies and studies reporting on the patients’ severity of aortic atherosclerosis. The main findings were summarized in a figure, with a grade of the corresponding level of evidence. RESULTS Regarding embolic stroke risk, aortic atherosclerosis of the tunica intima is most relevant. Although several strategies in general cardiac surgery seem to be beneficial in severe disease, none have conclusively been proven most effective. Off-pump surgery in coronary artery bypass grafting should be preferred with severe atherosclerosis, if the required expertise is present. Although transcatheter aortic valve replacement is used as an alternative to surgery in patients with a porcelain aorta, the risk profile concerning intimal atherosclerosis remains poorly defined. CONCLUSIONS A tailored approach that uses the discussed alternative strategies in carefully selected patients is best suited to reduce the risk of perioperative stroke without compromising other outcomes. More research is needed, especially on the perioperative stroke risk in patients with moderate aortic atherosclerosis.

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“…Delirious patients often remove intubation and infusion tubes from the body, which seriously threatens the safety of patients' lives. For the occurrence of postoperative delirium, current research has confirmed many factors including major bleeding during surgery, hemodynamic instability, and the patient's history of cerebrovascular disease [47][48][49][50][51] . However, there is still a lack of a systematic and effective prediction system, thence it is of great significance to explore and study the prediction scoring system for delirium following OPCABG.…”

Section: Discussionmentioning

confidence: 99%

Lower surgical Apgar score is predictive on delirium in patients following off-pump coronary artery bypass grafting

Liang

Zhu²,

et al. 2021

Preprint

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Objective To determine the predictive value of surgical Apgar score on delirium postoperatively following OPCABG. Method Intraoperative anesthesia data of patients underwent OPCABG during the period of January 2012 and December 2019 were reviewed and SAS score of each patient was calculated. Relationship between SAS score and postoperative occurrence of delirium were analyzed to determine the underlying mechanism. Results There are a total of 436 patients included with a mean age of 62.8±13.8 and 61.2±16.8 in each group. Patients in Delirium group had significantly higher incidence of heart failure (P=0.043) preoperatively in the Delirium group. No significant difference was observed referring to ASA PS III (P=0.102) and no significant difference was observed in duration of the surgery and anesthesia. Also no significant differences was observed as to dexmedetomidine and propofol use (P=0.256, P=0.278). The mean SAS score was in 4.2±0.8, 7.8±1.2 in two groups respectively (P＜0.001) and 96(22.02%) postoperative delirium events were recorded. Patients in Delirium group had much more EBL (P＜0.001) while LHR (P=102) showed no significant statistical difference between two groups. Univariate and multivariate regression analysis showed that the intraoperative SAS score was significant predictors of delirium following OPCABG (P＜0.001; P＜0.001). After adjustment for other clinical predictors, the addition of SAS also improved and the area under the curve to predict delirium was 0.934 (95%CI, 0.907-0.960, P＜0.001). Conclusions Intraoperative SAS score is associated with postoperatively following OPCABG and SAS score may be a valuable component to improve preoperative risk stratification of delirium among patient under OPCABG.

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Effects of a Proximal Seal System on Neurologic Outcomes of Off-Pump Coronary Artery Bypass Grafting

Cited by 6 publications

References 36 publications

Outcomes of 881 Consecutive Coronary Artery Bypass Graft Patients Using Heartstring Device

Outcomes of 881 Consecutive Coronary Artery Bypass Graft Patients Using Heartstring Device

Intimal aortic atherosclerosis in cardiac surgery: surgical strategies to prevent embolic stroke

Lower surgical Apgar score is predictive on delirium in patients following off-pump coronary artery bypass grafting

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