Reoperative Coronary Artery Bypass Surgery: The Role of On-Pump and Off-Pump Techniques on Factors Affecting Hospital Mortality and Morbidity

Kara, İbrahim; Çakalağaoğlu, Cantürk; Ay, Yasin; Salehi, Saleh Al; Yanartaş, Mehmed; Anasiz, Hüseyin; Köksal, Cengiz

doi:10.5761/atcs.oa.12.02043

Cited by 21 publications

(31 citation statements)

References 13 publications

(22 reference statements)

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“…These findings could explain a tendency for the shorter hospital stay observed with redo-OPCAB in our study, which was 0.6, 0.75 and 1.3 days shorter for the unmatched, Matched B and Matched A analyses, respectively. This is in keeping with the reports by others [ 1 , 18 , 20 , 22 ].…”

Section: Discussionsupporting

confidence: 93%

“…The largest report in 617 patients from Japan focuses on in-hospital outcome only with no late survival and suggests that redo-OPCAB surgery is associated with lower 30 days mortality (3.5 vs 7%) and less complications (11 vs 21.5%) compared to redo-CABG [ 1 ]. Other studies from North America and India have reported on redo-OPCAB, although in small cohorts [ 1 , 7 , 17 , 18 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Early health outcome and 10-year survival in patients undergoing redo coronary surgery with or without cardiopulmonary bypass: a propensity score-matched analysis

Bruno

Zakkar

Rapetto

et al. 2017

European Journal of Cardio-Thoracic Surgery

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OBJECTIVESTo investigate the in-hospital health outcome and 10-year survival in patients undergoing redo coronary surgery with (redo-CABG) or without (redo-OPCAB) cardiopulmonary bypass.METHODSA total of 349 redo coronary surgery patients were identified from our registry. Of these, 143 redo-OPCAB patients (40.97%) were compared with 206 redo-CABG patients. To minimize the bias, we also conducted propensity score matching. In Matched Analysis A, 111 redo-OPCAB patients with any type of primary cardiac operation were compared with 111 redo-CABG cases. In Matched Analysis B, 84 redo-OPCAB patients with isolated coronary surgery as their primary operation were compared with 84 redo-CABG patients. We assessed for all 3 analyses a composite of in-hospital mortality, acute kidney injury, stroke and severe low cardiac output requiring intra-aortic balloon pump. In addition, we assessed 1-, 5-, and 10-year survival.RESULTSIn the unmatched analysis, redo-CABG was associated with higher usage of intra-aortic balloon pump (10 vs 3%, P = 0.01) and composite compared with redo-OPCAB (25 vs 16%, P = 0.06) and similar 10-year survival (67.2 vs 68.5%, log-rank test: P = 0.78). Matched Analysis A showed similar rates of composite (15 vs 21%, P = 0.25) and 10-year survival (65.1 vs 60.8%, log-rank test: P = 0.5). Matched Analysis B showed reduction of the composite (19 vs 8%, P = 0.04), less in-hospital mortality (5 vs 0%, P = 0.13), 4.5 times less need for intra-aortic balloon pump (2 vs 11%, P = 0.02) favouring redo-OPCAB and a similar 10-year survival (71.6 vs 71.7%, log-rank test: P = 0.61).CONCLUSIONSRedo-OPCAB surgery is feasible, safe and effective with improved in-hospital outcome and similar 10-year survival compared to redo-CABG.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Early health outcome and 10-year survival in patients undergoing redo coronary surgery with or without cardiopulmonary bypass: a propensity score-matched analysis

Bruno

Zakkar

Rapetto

et al. 2017

European Journal of Cardio-Thoracic Surgery

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“…(2) Furthermore, the advances in the use of percutaneous catheter interventions have also decreased the need for isolated redo coronary artery bypass grafting. (2) The recent tendency towards total arterial grafts use decreased the need for Redo CABG, however this means that patients who are in need for redo CABG will be at older age with consequent increase in mortality and morbidity (2) The mortality rate of redo CABG is reported to be more than three times higher than that of primary CABG (3,4,5).Redo coronary artery included in this study were above 70 years. Redo CABG with valvular surgery was excluded.…”

Section: Introductionmentioning

confidence: 99%

“…In recent studies mortality in redo CABG is reported to vary between 4.2%and 11.4 %. (3) In this study, we retrospectively analysed our results of redo CABG in patients above 70 years old. The endpoints evaluated for the study were in hospital mortality and morbidity and one year mortality.…”

Section: Introductionmentioning

confidence: 99%

Is Redo Coronary Artery Bypass Graft in Patients over 70 Years Old Safe ?

Abuanzeh¹,

Shawabkeh²,

Al-Edwan³

2016

JRMS

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Objective:The aim of this study is to examine the outcomes post redo CABG in patients above 70 years old.Method: This retrospective study was carried out at Liverpool Heart and Chest Hospital, for 148 patients above the age of 70 (Mean age 74.29±3.4 years) who underwent reoperation for Coronary Artery Bypass Graft (CABG) over 10 years period between 2001-2011. Post operative mortality and morbidity was analyzed. We used Major Adverse Vascular Events (MAVE) as in-hospital safety of treatment assessment tools. Results:The mean EURO score was 7.41± 2.67. Thirty-day mortality was 6% (9 out of 148), and the one-year survival was 84.4% (n=125). MAVE show 4.7% post-operative Q-wave MI and 4% stroke. Renal impairment was noted in 14.2%. Rate of re-exploration was 12.8% mainly for bleeding and tamponade 8.1% and 2.7% respectively. Mean length of stay was 16.3 days. Conclusion:This study shows acceptable survival and post operative mortality and morbidity in this high risk group. Therefore, Redo CABG in patients over 70 alone should not deter a cardiac surgeon from offering such a potentially beneficial intervention.

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“…Kara et al reported that the rate of mortality and morbidity was higher with CPB (on-pump) than without CPB (off-pump), showing more importance of antibiotic prophylaxis for surgery with CPB. 9) In patients undergoing cardiovascular surgery without CPB, we previously reported the pharmacokinetics of ampicillin-sulbactam and optimization of dosing regimens for prophylaxis. 10) However, the pharmacokinetics of ampicillin in patients receiving cardiovascular surgery with CPB as an an-tibiotic prophylaxis regimen for SSIs has not been examined.…”

mentioning

confidence: 99%

Pharmacokinetics of Prophylactic Ampicillin–Sulbactam and Dosing Optimization in Patients Undergoing Cardiovascular Surgery with Cardiopulmonary Bypass

Yokoyama

Matsumoto

Ikawa

et al. 2015

Biological & Pharmaceutical Bulletin

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Antibiotic concentrations must be maintained at an adequate level throughout cardiovascular surgery to prevent surgical site infection. This study aimed to determine the most appropriate timing for intraoperative repeated dosing of ampicillin-sulbactam, a commonly used antibiotic prophylaxis regimen, to maintain adequate concentrations throughout the course of cardiovascular surgery with cardiopulmonary bypass (CPB). The total plasma concentrations of ampicillin were monitored in 8 patients after ampicillin (1 g)-sulbactam (0.5 g) administration via initial intravenous infusion and subsequent CPB priming. Pharmacokinetic parameters were estimated and used to predict the free plasma concentrations of ampicillin. The mean values for the volume of distribution, elimination rate constant, elimination half-life, and total clearance of ampicillin were 15.8 4.1 L, 0.505 0.186 h 1 , 1.52 0.47 h, and 7.72 2.72 L/h, respectively. When ampicillin (1 g)-sulbactam (0.5 g) was intravenously administered every 3, 4, 6, and 12 h after the start of CPB, the predicted free trough plasma concentrations of ampicillin were 15.20, 8.25, 2.74, and 0.13 µg/mL, respectively. Therefore, an every-6-h regimen was needed to maintain the free ampicillin concentration at more than 2 µg/mL during cardiovascular surgery with CPB. We suggest that the dose and dosing interval for ampicillin-sulbactam should be adjusted to optimize the efficacy and safety of treatment, according to the minimum inhibitory concentrations for methicillin-sensitive Staphylococcus aureus isolates at each institution. Registration number: UMIN000007356.Key words ampicillin; sulbactam; cardiovascular surgery; prophylaxis; cardiopulmonary bypass The United States Centers for Disease Control National Nosocomial Infections Surveillance system demonstrated that surgical site infection (SSI) is the most frequently reported nosocomial infection, accounting for 14-16% of such infections among hospitalized patients and 38% in surgical patients.1) According to the Japan Nosocomial Infections Surveillance Open Report 2013, the incidence of SSI in cardiovascular surgery was 1.5-4.8%. 2)Postoperative SSIs are a major cause of postoperative morbidity and mortality in patients undergoing cardiac surgery. SSIs of the sternal wound and underlying mediastinum occur in 0.4-4% of cardiac surgical operations.3) The administration of antibiotic prophylaxis in patients treated with cardiothoracic operations can reduce the rate of SSI, and placebo-controlled trials of cardiothoracic antibiotic prophylaxis have found a benefit in preventing postoperative wound infections. 4)Cardiopulmonary bypass (CPB) is a technique that is nearly exclusively used by cardiac surgeons and has profound effects on the volume of distribution (V d , L) and elimination kinetics for a variety of drugs, including commonly used antibiotic prophylaxis agents.3) Antibiotic prophylaxis should be selected according to the type of surgery, with administration starting within 60 min of the skin incision. When the duration of...

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Reoperative Coronary Artery Bypass Surgery: The Role of On-Pump and Off-Pump Techniques on Factors Affecting Hospital Mortality and Morbidity

Cited by 21 publications

References 13 publications

Early health outcome and 10-year survival in patients undergoing redo coronary surgery with or without cardiopulmonary bypass: a propensity score-matched analysis

Early health outcome and 10-year survival in patients undergoing redo coronary surgery with or without cardiopulmonary bypass: a propensity score-matched analysis

Is Redo Coronary Artery Bypass Graft in Patients over 70 Years Old Safe ?

Pharmacokinetics of Prophylactic Ampicillin–Sulbactam and Dosing Optimization in Patients Undergoing Cardiovascular Surgery with Cardiopulmonary Bypass

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