Graft failure and recurrence of symptoms after coronary artery bypass grafting

Janiec, Mikael; Shafti, Timo Z Nazari; Dimberg, Axel; Lagerqvist, Bo; Lindblom, Rickard P F

doi:10.1080/14017431.2018.1442930

Cited by 23 publications

(17 citation statements)

References 16 publications

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“…In addition, some patients could course asymptomatic, making it difficult to discover the problem 9 . Nonetheless, our patients, usually after an acute presentation, frequently showed cardiac symptoms, something typical in other previously published series 12 …”

Section: Discussionmentioning

confidence: 60%

Internal mammary artery graft failure: Clinical features, management, and long-term outcomes

Núñez‐Gil

Alfonso

Salinas

et al. 2018

Indian Heart Journal

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ObjectiveData on long-term outcomes after internal mammary artery (IMA) coronary graft failure are scarce. Our objective was to describe the clinical characteristics, management, and prognosis after angiographically confirmed IMA graft failure following coronary revascularization.MethodsA three-hospital retrospective registry, observational and descriptive, with prospective follow-up of all consecutive cases of IMA graft failure between 2004 and 2014 was conducted. After treatment, clinical and procedural features were compared between those with and without cardiovascular events.ResultsFifty-seven patients were included (89% male, mean age: 62 years, at surgery) in the registry. Most patients underwent an IMA angioplasty (percutaneous coronary intervention [PCI], 74%). In nine cases, the PCI failed at the graft level, and seven underwent a native vessel revascularization. Native vessel treatment was performed in 20% of the study subjects, all with stents. Finally, medical management was decided in three cases. Events after treatment for IMA graft failure were frequent (50.8%), during a median follow-up of 7.5 years. Acute presentation (hazard ratioMACE = 1.35; 95% confidence interval (CI): 1.12–3.00, p < 0.01), age of the patient (hazard ratioMACE = 1.85, 95% CI: 1.17–2.11, p < 0.01), presence of diabetes mellitus (hazard ratioMACE = 2.75, 95% CI: 1.13–6.69, p = 0.02), and the management modality used (IMA-simple angioplasty VS IMA-stenting: hazard ratioMACE = 5.5, 95% CI: 1.40–21.15, p = 0.01) displayed prognostic relevance on multivariate analysis. All-cause mortality occurred in 21.1% and presentation as infarction (hazard ratioDEATH = 1.05, 95% CI: 1.01–2.17, p = 0.01), age (hazard ratioDEATH = 9.08, 95% CI: 2.52–32.69, p < 0.01), and left ventricular ejection fraction (hazard ratioDEATH = 3.68, 95% CI: 1.65–8.18, p < 0.01) were independent predictors of the same.ConclusionsIn this long-term registry, most patients presented with an acute condition (myocardial infarction, progressive angina) within 12 months after surgery. Acute presentation, age, diabetes mellitus, reduced left ventricular ejection fraction, IMA graft failure segment affected, and the management strategy were related with long-term prognosis.

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Section: Discussionmentioning

confidence: 60%

Internal mammary artery graft failure: Clinical features, management, and long-term outcomes

Núñez‐Gil

Alfonso

Salinas

et al. 2018

Indian Heart Journal

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“…Recombinant factor VII is a novel agent used to treat coagulopathy. In addition, tranexamic acid and aminocaproic acid are also frequently used [ 7 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients who require reoperation are at higher risk of kidney injury, cerebral complications, and sternal wound infections as well as increased mortality [ 1 , 9 ]. Literature shows causes of excessive bleeding were due to technical reasons (74%), coagulopathy (13%), a combination of coagulopathy and technical reasons (10%), and others (3%) [ 6 , 10 ]. Studies also reveal that most of the reoperations for bleeding are due to technical reasons rather than coagulation failures [ 4 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Apart from immediate outcomes, long-term graft patency after coronary artery bypass grafting (CABG) is also reduced in patients who are re-opened for excessive bleeding. Early graft failure seems to be more frequent with the use of great saphenous veins, in poor target vessels and re-explored patients [ 10 ]. Direct trauma to anastomotic site, fresh frozen plasma (FFPs), platelet transfusions, and tranexamic acid are other possible contributors.…”

Section: Introductionmentioning

confidence: 99%

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Early Chest Re-Exploration for Excessive Bleeding in Post Cardiac Surgery Patients: Does It Matter?

Islam¹,

Ahmad²,

Khan³

et al. 2021

Cureus

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IntroductionRe-explorations after open-heart surgery are often required if the patient is bleeding or shows features of cardiovascular instability and does not improve with conservative measures. Our study aims to determine whether timely re-exploration of patients who are bleeding has an impact on the morbidity and mortality of the patients. MethodsA retrospective analysis of 75 patients that underwent open-heart surgery and subsequently underwent chest re-exploration for excessive bleeding between March 2018 and March 2020. Patients who were reopened post-op for indications other than excessive bleeding were excluded. ResultsA total number of cases were 700, out of which 75 (9.3%) patients were reopened, as compared to the literature, which shows worldwide 2-11% being reopened. Post-operative drain output was 1000ml to 1500ml in 47 (62.7%) and more than 1500ml in 28 (37.3%) patients before they were reopened. In 67 (89.3%) patients, three to five units of blood were transfused, and in eight (10.7%) patients, more than five units of blood were transfused. We believe our mortality in the reopened patients was low, because of timely intervention and early re-exploration, and is probably the reason why our figures land in a higher range (2-11%) of reopened cases (9.3%). Reopening time was less than five hours in 49 (65.3%) patients and less than 10 hours in 26 (34.7%) patients in our study. We tried to minimize the loss of blood and re-explored the patients before they lose excessive blood, the average time for reopening in our study was less than 10 hours. The average intensive care unit (ICU) stay was 4.2 days (range three to six days). Wound infections were reported in one of three patients. There was no mortality in these patients. Surgical site of bleeding was identified in 54 (72%) patients and no particular site was found in 21 (28%) patients. Suggesting that it is common to have a surgical bleeder than coagulopathy induced bleeding in post-cardiac surgery patients ConclusionsWe believe our low mortality (0%) is due to early reopening in patients who are bleeding excessively after cardiac surgery.

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“…For over 50 years, CABG has been recognized as an effective and safe procedure for critical CAD [1] and in recent years, surgical techniques have evolve considerably: shorter cardio-pulmonary bypass times, global usage of arterial conduits and optimal medical treatment (OMT) strategies have increased the effectiveness of CABG in clinical practice. O n the other hand, CABG patients carry unique problems in their follow-up, such as graft failure and the need of recurrent coronary angiographies (CAG) for anginal attacks, and a substantial number of them undergo recurrent CAG procedures, whereas the majority of these cases have been recognized with patent surgical grafts [2].…”

Section: Introductionmentioning

confidence: 99%

Koroner Arter Bypass Greft Cerrahisi Hastalarının Nativ Koroner Arterlerinde Yeni Kronik Total Oklüzyon Gelişimi

et al. 2020

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ÖZAmaç: Koroner arter bypas greftleme (KABG) cerrahisi hastalarının postoperatif klinik takibinde preoperatif olarak tam tıkalı olmayan nativ koroner arterlerin kronik total oklüde (KTO) hale gelmesi sık görülse de, seyriyle ilgili veriler kısıtlıdır. Çalışmamızın amacı postoperatif dönemde nativ koroner arterlerde yeni KTO gelişim sıklığını ve bu konuda rol oynayan faktörleri araştırmaktır. Yöntem: Başkent Üniversitesi Hastanesi Alanya Uygulama ve Araştırma Merkezi'nde gerçekleştirilen tüm KABG operasyonları bilgisayar sisteminden tarandı ve postoperatif ilk 6 aylık dönemden sonra rekürren koroner anjiyografi (KAG) prosedürü uygulanan hastalar çalışma grubuna alındı. Rekürren KAG görüntüleri yeni KTO gelişimi açısından değerlendirildi ve nativ koroner arterlerde yeni KTO gelişimine yol açan demografik ve anjiyografik özellikler lojistik regresyon analizi kullanılarak test edildi. Bulgular: Rekürren KAG yapılmış olan 73 KABG hastası istatistiksel analize dahil edildi (Ortalama yaş 65.2 ± 9.8 yıl; erkek cinsiyet %76.7). Preoperatif olarak tam tıkalı olmayan ve greftlenmiş olan 218 nativ koroner arter incelendi ve 119'unda (%54.5) yeni KTO saptandı. Preoperatif proksimal darlığın ≥%90 olması 3 kat daha fazla yeni KTO gelişimi ile ilişkili bulundu (%67.8 vs. %22.2) (p<0.001). İkili antiplatelet tedavisinin nativ koroner arterlerin açıklığını koruyucu rolü olduğu tespit edildi (HR:-0.259; %95 CI:-0.475'den -0.017'ye; p=0.036). Sonuç: Nativ koroner arterlerde postoperatif yeni KTO gelişimi CABG hastalarında sık görülmektedir. Preoperatif darlığın daha ciddi olması ve ikili antiplatelet tedavinin yokluğu yeni KTO gelişimi için temel faktörler olarak bulundu.

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Graft failure and recurrence of symptoms after coronary artery bypass grafting

Abstract: 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.

Cited by 23 publications

References 16 publications

Internal mammary artery graft failure: Clinical features, management, and long-term outcomes

Internal mammary artery graft failure: Clinical features, management, and long-term outcomes

Early Chest Re-Exploration for Excessive Bleeding in Post Cardiac Surgery Patients: Does It Matter?

Koroner Arter Bypass Greft Cerrahisi Hastalarının Nativ Koroner Arterlerinde Yeni Kronik Total Oklüzyon Gelişimi

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