Early and late outcomes after minimally invasive direct coronary artery bypass vs. full sternotomy off-pump coronary artery bypass grafting
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PROVIDER: S-EPMC10914960 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Objective: Renal dysfunction and acute renal failure after coronary artery bypass grafting (CABG) are among the main causes of increased mortality and morbidity. A sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced with promising early and midterm outcomes in multivessel coronary artery disease. There are limited data regarding renal complications in patients undergoing the TCRAT technique. The present study analyzed renal outcomes in TCRAT compared to CABG via full median sternotomy (FS). Methods: We analyzed the records of 227 consecutive TCRAT patients (from September 2021 to June 2023) and 228 consecutive FS patients (from January 2017 to December 2018) who underwent nonemergent CABG. Following propensity score matching, preoperative baseline characteristics-including age, sex, diabetes mellitus, arterial hypertension, left ventricular ejection fraction, EuroSCORE II, preoperative serum creatinine, estimated glomerular filtration rate (eGFR), serum urea, and pre-existing chronic renal insufficiency-were comparable between the TCRAT (n = 170) and the FS group (n = 170). The examined postoperative renal parameters and complications were serum creatinine, eGFR, and serum urea on the first postoperative day. Moreover, serum creatinine, eGFR and serum urea at the time of discharge, postoperative ARF, and hemodialysis were investigated. Additionally, the duration of operation, CPB time, aortic cross-clamp time, ICU and hospital stay, ECMO support, rethoracotomy and in-hospital mortality were analyzed. The parameters were compared between groups using a Student's t-test or Mann-Whitney U test. Results: The duration of operation (332 ± 66 vs. 257 ± 61 min; p < 0.05), CPB time (161 ± 40 vs. 116 ± 38 min; p < 0.05), and aortic cross-clamp time (100 ± 31 vs. 76 ± 26; p < 0.05) were longer in the TCRAT group. ICU (1.8 ± 2.2 vs. 2.9 ± 3.6 days; p < 0.05) and hospital (10.4 ± 7.6 vs. 12.4 ± 7.5 days; p < 0.05) stays were shorter in the TCRAT group. There were no differences between groups with regard to the renal parameters examined. Conclusions: Despite a prolonged duration of operation, CPB time, and aortic cross-clamp time when using the TCRAT technique, no increase in renal complications were found. In addition, ICU and hospital stays in the TCRAT group were shorter compared to CABG via full median sternotomy.
| S-EPMC11432697 | biostudies-literature
Project description:BackgroundBeating-heart on-pump coronary artery bypass grafting (CABG), otherwise known as BH-ONCAB, can reduce myocardial injury by preserving native coronary blood flow while maintaining hemodynamic stability by the effective support of cardiopulmonary bypass (CPB). This study aimed to identify whether BH-ONCAB confers a survival, mortality, or morbidity benefit over off-pump CABG (OPCAB).MethodsA systematic literature review identified 18 studies incorporating 5,615 patients (1,548 BH-ONCAB and 4,067 OPCAB cases) who satisfied the inclusion criteria. Outcome measures were meta-analyzed using random-effects modeling. Between-study heterogeneity was investigated through quality assessment and risk of bias analysis.ResultsThe results demonstrated comparable early mortality and long-term survival between BH-ONCAB and OPCAB coronary revascularization with no significant statistical differences. The incidences of stroke, renal failure, blood loss, and arrhythmias were significantly higher in patients who underwent BH-ONCAB than patients who underwent OPCAB. However, BH-ONCAB conferred lower rates of incomplete revascularization and greater numbers of distal anastomoses.ConclusionsBH-ONCAB is a safe and comparable alternative to OPCAB in terms of early mortality and late survival. BH-ONCAB may confer particular advantages in preventing incomplete revascularization and allowing more distal anastomoses compared to OPCAB. However, BH-ONCAB was associated with more postoperative complications due to the use of CPB. Future work should focus on larger matched studies and multicenter randomized controlled trials to optimize our surgical revascularization strategies.
| S-EPMC8339796 | biostudies-literature
Project description:This SuperSeries is composed of the SubSeries listed below.
2010-06-22 | GSE12504 | GEO
Project description:This SuperSeries is composed of the following subset Series: GSE12485: Changes in cardiac transcription profiles following off-pump coronary revascularization surgery GSE12486: Changes in cardiac transcription profiles following on-pump coronary artery bypass grafting Refer to individual Series
2010-07-07 | E-GEOD-12504 | biostudies-arrayexpress
Project description:BackgroundHybrid coronary revascularization (HCR) has been demonstrated as a safe and effective revascularization strategy in selected patients with multivessel coronary artery disease; however, the inclusion criteria are too strict.ObjectivesThis study was conducted to compare in-hospital and midterm outcomes after generalized HCR and off-pump coronary artery bypass (OPCABG) in patients with multivessel coronary artery disease.MethodsWe proposed a generalized idea of HCR. First, the PCI for non-LAD vessels suitable for coronary stents was performed. Then, MICS-CABG for LIMA to the LAD and saphenous to other non-LAD vessels that were not suitable for stents or stenting failed. Propensity score matching was used, and 222 patients (n = 111 in both the generalized HCR and OPCABG groups) were enrolled in the study. The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE) over midterm follow-up, and the secondary endpoints were in-hospital outcomes.ResultsNo significant difference was observed in the cumulative rate of MACCE (9.9% vs. 16.2%; HR, 0.567; 95% CL, 0.268-1.201; P = 0.138) between the generalized HCR and OPCABG groups. The residual SYNTAX score was similar between two groups (6.3 ± 5.5 for generalized HCR vs. 6.8 ± 5.3 for OPCABG; P = 0.486). Compared with OPCABG, generalized HCR was associated with a significantly lower intra-aortic balloon pump (IABP) implantation rate (2.7% vs. 9.9%; P = 0.027) and shorter postoperative length of stay (6.3 ± 3.2 vs. 7.7 ± 3.0; P = 0.001).ConclusionsThe generalized HCR procedure appears to be safe and efficacious, with outcomes similar to those of standard off-pump CABG and satisfactory completeness of revascularization.
| S-EPMC11885308 | biostudies-literature
Project description:To investigate changes in cardiac transcription profiles caused by on-pump cardiac surgery, we collected myocardial samples, prior and after grafting, from patients undergoing on-pump coronary artery bypass grafting with cardiopulmonary bypass and cardiac arrest. The transcriptional profile of the mRNA in these samples was measured with gene array technology. Changes in transcriptional profiles can be correlated with the stress response of heart to surgery, cardiopulmonary bypass and cardiac arrest. Keywords: human, cardiac, CABG coronary surgery, gene expression, cardiopulmonary bypass. Myocardial samples were collected, prior and after grafting, from patients undergoing on-pump coronary artery bypass grafting with cardiopulmonary bypass and cardiac arrest.
2010-07-07 | E-GEOD-12486 | biostudies-arrayexpress
Project description:To investigate changes in cardiac transcription profiles caused by on-pump cardiac surgery, we collected myocardial samples, prior and after grafting, from patients undergoing on-pump coronary artery bypass grafting with cardiopulmonary bypass and cardiac arrest. The transcriptional profile of the mRNA in these samples was measured with gene array technology. Changes in transcriptional profiles can be correlated with the stress response of heart to surgery, cardiopulmonary bypass and cardiac arrest. Keywords: human, cardiac, CABG coronary surgery, gene expression, cardiopulmonary bypass.
2010-06-22 | GSE12486 | GEO
Project description:BackgroundThe safety of minimally invasive direct coronary artery bypass (MIDCAB) has been proven. Nevertheless, reports on clinical outcomes in MIDCAB and the learning curve of this challenging technique in a non-routine off-pump coronary artery bypass (OPCAB) center are still limited. Here, we introduce our clinical outcomes of non-robotic MIDCAB.MethodsBetween August 2022 and March 2024, 72 consecutive patients with a mean age of 67.4 ± 9.5 years underwent non-robotic MIDCAB (defined as off-pump bypass grafting of the left internal mammary artery to the left anterior descending artery through left-sided mini-thoracotomy). We analyzed operation time and incidence of major adverse cardiac and cerebrovascular events (MACCE). Further, subgroup analyses included body mass index (BMI) with a cut-off of 30 kg/m2 [BMI ≧ 30: n = 18 (25.0%)] and body surface area (BSA) with a cut-off of 2.0 m2 [BSA ≧ 2.0: n = 34 (47.2%)].ResultsAll patients survived, whereas MACCE occurred in 4 patients (5.6%). By correlation analyses, no learning curve for operation time was observed in all cases analysis (p = 0.79), but MACCE (n = 4, 5.6%) exclusively observed in the first 34 patients. Furthermore, BMI ≧ 30 or BSA ≧ 2.0 was not significantly related to longer operation time (p = 0.42 and p = 0.52, respectively) and MACCE (p = 0.26 and p = 0.35, respectively). In addition, body size had no effect on operation time according to multiple regression analysis (p = 0.36).ConclusionsOur study suggested that implementing non-robotic MIDCAB can be safely accomplished at a center with no previous routine in OPCAB surgery, even for patients with bigger body sizes. MACCE occurs more frequently in the early stages when adopting this surgical technique.
| S-EPMC11783730 | biostudies-literature
Project description:Epicardial left atrial appendage occlusion using AtriClip during off pump coronary artery bypass grafting is a quick, reliable and reproducible technique which is shown in this video.Supplementary informationThe online version contains supplementary material available at 10.1007/s12055-020-01086-w.
| S-EPMC7876184 | biostudies-literature
Project description:BackgroundInterpretation of recent alterations to the guideline priority of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multivessel disease contests historical data and practice. To reevaluate contemporary outcomes, a large contemporary analysis was conducted comparing CABG with multivessel PCI among Medicare beneficiaries.MethodsThe United States Centers for Medicare and Medicaid Services database was evaluated all beneficiaries with acute coronary syndrome undergoing isolated CABG or multivessel PCI (2018-2020). Risk adjustment was performed using multilevel regression analysis, Cox proportional hazards time to event models, and inverse probability of treatment weighting propensity scores.ResultsA total of 104,127 beneficiaries were identified undergoing CABG (n = 51,389) or multivessel PCI (n = 52,738). Before risk adjustment, compared with PCI, CABG patients were associated with younger age (72.9 vs 75.2 years, P < .001), higher Elixhauser Comorbidity Index (5.0 vs 4.2, P < .001), more diabetes (48.5% vs 42.2%, P < .001), higher cost ($54,154 vs $33,484, P < .001), and longer length of stay (11.9 vs 5.8 days, P < .001). After inverse probability of treatment weighting propensity score adjustment, compared with PCI, CABG was associated with lower hospital mortality (odds ratio, 0.74; P < .001), fewer hospital readmissions at 3 years (odds ratio, 0.85; P < .001), fewer coronary reinterventions (hazard ratio, 0.37; P < .001), and improved 3-year survival (hazard ratio, 0.51; P < .001).ConclusionsContemporary real-world data from Medicare patients with multivessel disease reveal that CABG outcomes were superior to PCI, providing important longitudinal data to guide patient care and policy development.
| S-EPMC10739562 | biostudies-literature