The degree of newly emerging mitral regurgitation during off-pump coronary artery bypass is predicted by preoperative left ventricular function

Akazawa, Toshimasa; Iizuka, Hirotaka; Aizawa, Miyuki; Warabi, Kengo; Ohshima, Masayuki; Amano, Atushi; Inada, Eiichi

doi:10.1007/s00540-007-0585-z

Cited by 8 publications

(6 citation statements)

References 22 publications

(20 reference statements)

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“…In an experimental study, Koga,et al 20) showed that cardiac displacement alone did not cause MR when coronary perfusion was maintained, and occlusion of the LAD rarely caused MR; however, occlusion of the left circumflex artery (LCx) caused MR from the posteromedial site. In a clinical study, Akazawa, et al 21) reported the relationship between left ventricular function and the severity of MR during OPCAB. MR was the most severe during anastomosis of the LCx, and 39% of the patients had moderate to severe MR during anastomosis of the LCx.…”

Section: Intraoperative Managementmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Doi

Okawa

2013

ATCS

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Off-pump coronary artery bypass grafting (OPCAB) is performed in about 65% of patients who require surgical coronary revascularization, and has become the standard procedure in coronary artery bypass grafting (CABG) in Japan. As a background of the high rate of OPCAB, many clinical and experimental studies have been performed and reported in Japan. In this review, several factors associated with OPCAB are discussed based on relevant and important clinical studies published in Japan in the English language.

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Section: Intraoperative Managementmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Doi

Okawa

2013

ATCS

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“…Multivariate logistic analysis of the incidence of MACE with a mean PAP of > 18.8 mmHg, a mean CVP of > 7.5 mmHg, and significant baseline characteristics in Table 2 as explanatory variables showed that PAP (odds ratio [OR], 3.77; 95% CI, 1.52 to 9.35) and an NYHA classification of 3 or 4 (OR, 3.50; 95% CI, 1.32 to 9.26) were significantly associated with the development of MACE (Table 4 ). The presence of mitral regurgitation (MR), anastomoses in the left circumflex artery (LCX), and end-stage renal disease remained potential contributors to pulmonary congestion [ 13 ]. However, these characteristics did not yield a P value of < 0.05 in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Association between intraoperative pulmonary artery pressure and cardiovascular complications after off-pump coronary artery bypass surgery: a single-center observational study

Matsuo

Doi

Katsuki³

et al. 2023

BMC Anesthesiol

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Background The impact of intraoperative pulmonary hemodynamics on prognosis after off-pump coronary artery bypass (OPCAB) surgery remains unknown. In this study, we examined the association between intraoperative vital signs and the development of major adverse cardiovascular events (MACE) during hospitalization or within 30 days postoperatively. Methods This retrospective study analyzed data from a university hospital. The study cohort comprised consecutive patients who underwent isolated OPCAB surgery between November 2013 and July 2021. We calculated the mean and coefficient of variation of vital signs obtained from the intra-arterial catheter, pulmonary artery catheter, and pulse oximeter. The optimal cut-off was defined as the receiver operating characteristic curve (ROC) with the largest Youden index (Youden index = sensitivity + specificity – 1). Multivariate logistic regression analysis ROC curves were used to adjust all baseline characteristics that yielded P values of < 0.05. Results In total, 508 patients who underwent OPCAB surgery were analyzed. The mean patient age was 70.0 ± 9.7 years, and 399 (79%) were male. There were no patients with confirmed or suspected preoperative pulmonary hypertension. Postoperative MACE occurred in 32 patients (heart failure in 16, ischemic stroke in 16). The mean pulmonary artery pressure (PAP) was significantly higher in patients with than without MACE (19.3 ± 3.0 vs. 16.7 ± 3.4 mmHg, respectively; absolute difference, 2.6 mmHg; 95% confidence interval, 1.5 to 3.8). The area under the ROC curve of PAP for the prediction of MACE was 0.726 (95% confidence interval, 0.645 to 0.808). The optimal mean PAP cut-off was 18.8 mmHg, with a specificity of 75.8% and sensitivity of 62.5% for predicting MACE. After multivariate adjustments, high PAP remained an independent risk factor for MACE. Conclusions Our findings provide the first evidence that intraoperative borderline pulmonary hypertension may affect the prognosis of patients undergoing OPCAB surgery. Future large-scale prospective studies are needed to verify the present findings.

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“…2,7 The degree of emerging MR during mechanical heart displacement in OPCAB has been demonstrated to be associated with poor LVEF. 23 Moreover, considering that recent MI and LVEF or the degree of MR is closely associated with each other and that the use of diuretics is usually the first line of treatment in patients with CHF, a more comprehensive selection of variables in the current study may be attributable to the observed discordance in the results. 24 It is interesting to note was that the patients who developed hemodynamic instability during grafting had significantly lower RVEF, CI and SvO 2 even after the completion of grafting despite similar baseline hemodynamic profiles between the groups in the current trial.…”

Section: Discussionmentioning

confidence: 96%

Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors

Oh¹,

Shim

Song³

et al. 2011

Acta Anaesthesiologica Scandinavica

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The degree of newly emerging mitral regurgitation during off-pump coronary artery bypass is predicted by preoperative left ventricular function

Abstract: Preoperative LV dysfunction is a predictor of severe mitral regurgitation during OPCAB. When poor LV function is suggested, it is necessary to be prepared for further hemodynamic deterioration caused by mitral regurgitation.

Cited by 8 publications

References 22 publications

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

Association between intraoperative pulmonary artery pressure and cardiovascular complications after off-pump coronary artery bypass surgery: a single-center observational study

Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors

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