Risk Factors and Outcomes in Redo Coronary Artery Bypass Grafting

Gallo, Michele; Trivedi, Jaimin R.; Monreal, Gretel; Ganzel, Brian L.; Slaughter, Mark S.

doi:10.1016/j.hlc.2019.02.008

Cited by 20 publications

(18 citation statements)

References 24 publications

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“…Redo coronary surgery presents a great challenge with higher post-operative mortality than firsttime coronary surgery. 17,56 Although the recent metaanalysis of off-versus on-pump first-time CABG demonstrated there was no differences in either ⩽30-day mortality or MI, 57 our meta-analysis showed that offpump redo CABG was associated with a significant reduction in 30-day and in-hospital mortality, and could provide better myocardial protection in redo coronary surgery patients. The overall in-hospital mortality of included trials was 5.6%, comparable with the study that evaluated the evolving trends and outcomes of patients undergoing isolated re-operative coronary artery bypass grafting at Society of Thoracic Surgeons Adult Cardiac Surgery Database from 2000 to 2009.…”

Section: Discussionmentioning

confidence: 62%

“…16 Redo CABG is associated with a two to four-fold higher operative mortality than primary CABG and is more difficult and challenging than primary CABG in many aspects. 17,18 Firstly, probably due to more suitable grafts option and the optimal medical therapy after CABG, the duration of the non-eventful period after the first coronary operation has been prolonged. [18][19][20] So, patients who need to undergo redo coronary surgery are usually older and have more diseased coronary arteries, poorer left ventricular function, more comorbidities, and more noncardiac atherosclerosis 20 than the primary coronary surgery patients.…”

Section: Introductionmentioning

confidence: 99%

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Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis

et al. 2020

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Background: Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG. Methods: Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays. Results: The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = −8.21 h, 95% CI = −11.74 to −4.68, p < 0.00001; MD = −0.77 d, 95% CI = −0.81 to −0.73, p < 0.00001; MD = −2.24 d, 95% CI = −3.17 to −1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization. Conclusion: In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis

et al. 2020

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“…Furthermore, the prevalence of repeat surgery in the non-survivor group was six times greater than that in the survivor group. In the previous literatures, repeat cardiac surgery for valvular disease and coronary artery bypass grafting (CABG) could have results comparable to those of first-time surgery performed at experienced centres 21,22 . However, as reported by Rylski and Estrera et al, open surgical repair of ATAAD after previous cardiac surgery was associated with higher in-hospital mortality and brain stroke rates and a more frequent need for postoperative cardiac support compared to first-time surgery 23,24 .…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Lin

See

Tseng

et al. 2020

Sci Rep

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This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). Between January 2007 and June 2019, 603 consecutive patients underwent ATAAD repair at our institution. According to patients’ preoperative presentations and imaging studies, uncomplicated ATAAD was found in 276 (45.8%) patients by excluding preoperative complicated factors. Patients with uncomplicated ATAAD were classified into the survivor (n = 243) and non-survivor (n = 33) groups. Clinical features, surgical information, and postoperative complications were compared. Three-year survival and freedom from reoperation rates for survivors were analyzed using the Kaplan–Meier actuarial method. The in-hospital surgical mortality rate of uncomplicated ATAAD patients was 11.9%. The non-survivor group had a higher rate of postoperative malperfusion-related complications, and a multivariate analysis revealed that repeat surgery, retrograde cerebral perfusion, and intraoperative extracorporeal membrane oxygenation support were predictors of in-hospital mortality. In the survivor group, 3-year cumulative survival and freedom from aortic reoperation rates were 89.6% (95% confidence interval [CI] 84.8–92.9%) and 83.1% (95% CI 76.8–87.7%), respectively. In conclusion, uncomplicated and complicated ATAAD rates were similar; the short-term and mid-term surgical outcomes in patients with uncomplicated ATAAD were generally acceptable.

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“…The need for reoperative CABG procedures has progressively declined over the last 15 years [43] as a consequence of optimised medical care, with adequate antiplatelet therapy after coronary procedures, strict glucose control, and the increasing application of endovascular coronary revascularisation [44][45][46]. Compared to primary CABG, redo CABG is often challenging as a result of patient comorbidities, more complex coronary artery disease, and increased age, placing patients at higher risk of periprocedural AEs [45]. Based on data from randomised trials, an OPCAB approach at the time of primary CABG did not affect periprocedural outcomes and 5-year repeat revascularisation [47,48].…”

Section: Discussionmentioning

confidence: 99%

Repeat Coronary Artery Bypass Grafting: A Meta-Analysis of Off-Pump versus On-Pump Techniques in a Large Cohort of Patients

Tzoumas

Giannopoulos

Kakargias

et al. 2021

Heart, Lung and Circulation

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Risk Factors and Outcomes in Redo Coronary Artery Bypass Grafting

Cited by 20 publications

References 24 publications

Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis

Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Repeat Coronary Artery Bypass Grafting: A Meta-Analysis of Off-Pump versus On-Pump Techniques in a Large Cohort of Patients

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