Cardio-Protective Effects of Multiport Antegrade Cold Blood Cardioplegia Versus Antegrade Cold Blood Cardioplegia in Patients With Left Ventricular Systolic Dysfunction Undergoing Conventional Coronary Artery Bypass Grafting

Abstract OBJECTIVES Left ventricular systolic dysfunction (LVSD) is common and associated with adverse events in patients receiving coronary artery bypass grafting (CABG). However, the prognosis of mild LVSD has not been clearly described. We aimed to evaluate the mid-term outcomes of patients with mild LVSD following CABG. METHODS This multicentre cohort study using propensity score matching took place from December 2012 to October 2019 in Jiangsu Province, China, with a mean and maximum follow-up of 3.2 and 7.2 years, respectively. Patients were classified to normal left ventricular systolic function (left ventricular ejection fraction ≥53%) and mild LVSD (left ventricular ejection fraction >40%/<53%). The primary outcomes were death from all causes and death from cardiovascular causes. The secondary outcomes were heart failure, myocardial infarction, repeat revascularization and a composite of all mentioned outcomes, including death from all causes (major adverse events). RESULTS A total of 581 pairs were formed after matching. In-hospital death (1.5% vs 2.1%, P = 0.51) did not differ between 2 cohorts. Throughout 7 years, mild LVSD was associated with higher rates of death from all causes [hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.39–0.89; P = 0.012], death from cardiovascular causes (HR 0.55, 95% CI 0.36–0.90; P = 0.017), heart failure (HR 0.60, 95% CI 0.37–0.93; P = 0.023) and major adverse events (HR 0.66, 95% CI 0.49–0.91; P = 0.009). There was no difference in the rates of myocardial infarction and repeat revascularization. CONCLUSIONS Mild LVSD was associated with a worse mid-term prognosis in patients following CABG.

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Multiple arterial conduits for multi-vessel coronary artery bypass grafting in patients with mild to moderate left ventricular systolic dysfunction: a multicenter retrospective study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01463-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hang Zhang ◽

Wen Chen ◽

Yang Zhao ◽

Lichun Guan ◽

Min Yu ◽

...

Keyword(s):

Adverse Events ◽

Internal Thoracic Artery ◽

Left Ventricular Systolic Dysfunction ◽

Artery Bypass ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Repeat Revascularization ◽

Major Adverse Events

Abstract Background Advantages of multiple arterial conduits for coronary artery bypass grafting (CABG) have been reported previously. We aimed to evaluate the mid-term outcomes of multiple arterial CABG (MABG) among patients with mild to moderate left ventricular systolic dysfunction (LVSD). Methods This multicenter study using propensity score matching took place from January 2013 to June 2019 in Jiangsu Province and Shanghai, China, with a mean and maximum follow-up of 3.3 and 6.8 years, respectively. We included patients with mild to moderate LVSD, undergoing primary, isolated multi-vessel CABG with left internal thoracic artery. The in-hospital and mid-term outcomes of MABG versus conventional left internal thoracic artery supplemented by saphenous vein grafts (single arterial CABG) were compared. The primary end points were death from all causes and death from cardiovascular causes. The secondary end points were stroke, myocardial infarction, repeat revascularization, and a composite of all mentioned outcomes, including death from all causes (major adverse events). Sternal wound infection was included with 6 months of follow-up after surgery. Results 243 and 676 patients were formed in MABG and single arterial CABG cohorts after matching in a 1:3 ratio. In-hospital death was not significantly different (MABG 1.6% versus single arterial CABG 2.2%, p = 0.78). After a mean (±SD) follow-up time of 3.3 ± 1.8 years, MABG was associated with lower rates of major adverse events (HR, 0.64; 95% CI, 0.44–0.94; p = 0.019), myocardial infarction (HR, 0.39; 95% CI, 0.16–0.99; p = 0.045) and repeat revascularization (HR, 0.42; 95% CI, 0.18–0.97; p = 0.034). There was no difference in the rates of death, stroke, and sternal wound infection. Conclusions MABG was associated with reduced mid-term rates of major adverse events and cardiovascular events and may be the procedure of choice for patients with mild to moderate LVSD requiring CABG.

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Functional Capacity Change after Phase II Cardiac Rehabilitation as a Predictor of Major Adverse Cardiac Event in Left Ventricular Dysfunction Patients Underwent Coronary Artery Bypass Grafting

International Journal of Research and Review ◽

10.52403/ijrr.20211044 ◽

2021 ◽

Vol 8 (10) ◽

pp. 326-332

Author(s):

Hery D. Putra ◽

Cut Aryfa Andra ◽

Zainal Safri

Keyword(s):

Coronary Artery ◽

Cardiac Rehabilitation ◽

Phase Ii ◽

Functional Capacity ◽

Cardiac Event ◽

Left Ventricular Systolic Dysfunction ◽

Artery Bypass ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction

Background: Phase II cardiac rehabilitation is essential for management post coronary artery bypass graft (CABG), especially in patients with left ventricular systolic dysfunction. Change in functional capacity after phase II cardiac rehabilitation (∆METs) is an indicator of cardiopulmonary and hemodynamic improvement after CABG. This study assessed the correlation of ∆METs as a predictor of major adverse cardiac event (MACE) 3 months after CABG in patients with left ventricular systolic dysfunction. Methods: A cohort study was conducted on patients with left ventricular systolic dysfunction who underwent CABG between January 2019 to January 2021. Then patients were recruited to phase II cardiac rehabilitation, ∆METs was measured and tabulated by differences of functional capacity before and after the program. The abnormalities of ∆METs were discovered as a predictor of MACE determined by cut-off point, which is combination of death and rehospitalization. Patients were monitored for 3 months after CABG. Result: Among 91 patients, 24.2% had MACE (6.6% death and 17.6% rehospitalization). We found significant correlation between ∆METs and MACE with cut-off point 3.25 METs (p <0.001). Multivariate analysis using logistic regression showed lower ∆METs group had significant correlation with MACE (OR 0.135; p 0.03). Kaplan Meier survival analysis showed lower ∆METs group was predictor of MACE on 3 months after CABG, risk of MACE occurrence 3.9 times than higher ∆METs group (p <0.001). Conclusion: Change in functional capacity could predict MACE on 3 months follow-up of left ventricular systolic dysfunction patients who underwent CABG. Keywords: Change in functional capacity; left ventricular systolic dysfunction; MACE; CABG.

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Multiple Arterial Conduits for Multi-Vessel Coronary Artery Bypass Graft in Patients with Mild to Moderate Left Ventricular Systolic Dysfunction: A Multicenter Retrospective Study

10.21203/rs.3.rs-49935/v1 ◽

2020 ◽

Author(s):

Hang Zhang ◽

Wen Chen ◽

Yang Zhao ◽

Lichun Guan ◽

Min Yu ◽

...

Keyword(s):

Wound Infection ◽

Left Ventricular Systolic Dysfunction ◽

Artery Bypass ◽

Systolic Dysfunction ◽

Bypass Graft ◽

Left Ventricular ◽

Sternal Wound Infection ◽

Ventricular Systolic Dysfunction ◽

Repeat Revascularization

Abstract Background: Advantages of multiple arterial conduits for coronary artery bypass graft (CABG) have been reported previously. We aimed to evaluate the mid-term outcomes of multiple arterial CABG (MABG) among patients with mild to moderate left ventricular systolic dysfunction (LVSD).Methods: This multicenter study using propensity score matching (PSM) took place from January 2013 to June 2019 in Jiangsu Province and Shanghai, China, with a mean and maximum follow-up of 3.3 and 6.8 years, respectively. We included patients with LVSD, underwent primary, isolated multi-vessel CABG with left internal thoracic artery (LITA). The in-hospital and mid-term outcomes of MABG versus traditional LITA supplemented by saphenous vein grafts [single arterial CABG (SABG)] were compared. The primary endpoints were death from all causes and death from cardiovascular causes. The secondary endpoints were stroke, myocardial infarction (MI) and repeat revascularization, and a composite of all mentioned outcomes, including death from all causes [major adverse events (MAEs)]. Sternal wound infection was included with 6 months of follow-up after surgery.Results: 243 and 676 patients were formed in the MABG and SABG after PSM in a 1:3 ratio. Compared with SABG, MABG was associated with lower rate of MAEs (HR, 0.64; 95% CI, 0.44-0.94; P=0.02), MI (HR, 0.39; 95% CI, 0.16-0.99; P=0.05) and repeat revascularization (HR, 0.42; 95% CI, 0.18-0.97; P=0.03). There was no difference in the rate of death, stroke, and sternal wound infection.Conclusions: In patients with mild to moderate LVSD, MABG was associated with reduced mid-term rate of MAEs and cardiovascular events, but without reduced rate of death and stroke. MABG did not increase sternal wound infection rate.

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