Long-term Outcome of Reexploration for Bleeding After Coronary Artery Bypass Grafting

Stroo, Jasmijn F.; van Steenbergen, Gijs J.; van Straten, Albert HM; Houterman, Saskia; Soliman-Hamad, Mohamed A.

doi:10.1053/j.jvca.2023.06.008

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…We defined the perioperative bleeding events as those that occurred during the perioperative period, that is, the amount of blood loss and blood transfusion, typically occurring within 24 h postsurgery, rather than the bleeding events that were followed up within 1-year postsurgery. The ABCB1 3435 CC genotype was related to these perioperative bleeding events, and the perioperative bleeding complications, including re-exploration due to bleeding, the perioperative use of blood products, and bleeding from vital organs, can increase the risk of poor outcomes and the incidence of MACE in patients undergoing cardiac surgery 54 – 56 . Therefore, ABCB1 3435 CC may exert an indirect role in terms of increasing the incidence of MACE events.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of clopidogrel and ticagrelor in patients undergoing off-pump coronary artery bypass grafting: a retrospective cohort study

Wang,

Ma,

et al. 2024

International Journal of Surgery

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Background: Ticagrelor is reportedly more effective than clopidogrel in preventing atherothrombotic events in patients with percutaneous coronary intervention. However, the optimal antiplatelet therapy strategy after off-pump coronary artery bypass grafting (OPCABG) is yet to be established. Materials and Methods: This study was performed using the prospectively-maintained database at our institution. Patients who underwent OPCABG were divided into the clopidogrel and the ticagrelor groups. Propensity score matching analysis was performed between the two groups. The clinical outcome was the occurrence of major adverse cardiovascular event (MACE), defined as a composite of vascular death, myocardial infarction, or stroke 1 year after surgery. Results: In total, 545 patients completed the entire follow-up assessment. After propensity score matching, 232 patients each were included in the clopidogrel and ticagrelor groups. The primary outcome occurred in 7.8% and 4.3% of patients in the clopidogrel and ticagrelor groups, respectively (P=0.113). CYP2C19 variants (*2, *3, and *17) did not impact the clinical outcomes, regardless of the use of clopidogrel or ticagrelor. The rates of MACE were significantly lower in patients carrying the ABCB1 C3435T CT/TT genotypes in the ticagrelor group than in those carrying the ABCB1 C3435T CC genotype in the clopidogrel group (1.4% vs. 9.1%, adjusted P=0.030), as well as those carrying the ABCB1 C3435T CC genotype in the ticagrelor group (1.4% vs. 8.9%, adjusted P=0.036). The ABCB1 C3435T CC genotype was significantly associated with the incidence of 1-year MACE (HR=1.558, 95% CI 1.109–2.188, P=0.011). Patients who experienced severe perioperative bleeding exhibited a significantly higher incidence of MACE than those who did not experience severe perioperative bleeding (14.0% vs. 4.9%, adjusted P=0.007). Conclusion: There was no significant difference in the 1-year MACE between patients receiving clopidogrel and those receiving ticagrelor after OPCABG. Notably, The ABCB1 C3435T CC genotype was related to a higher risk of MACE.

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Section: Discussionmentioning

confidence: 99%

Clinical efficacy of clopidogrel and ticagrelor in patients undergoing off-pump coronary artery bypass grafting: a retrospective cohort study

Wang,

Ma,

et al. 2024

International Journal of Surgery

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“…Idiopathic ventricular fibrillation is a rare condition characterized by abrupt onset ventricular fibrillation in the absence of known cardiac, respiratory, or metabolic causes. AF after coronary artery bypass grafting is associated with long-term cardiovascular complications, including increased incidence of AF, ischemic stroke, heart failure, and mortality (Stroo et al, 2023).…”

Section: Overview Of Atrial Fibrillation (Af)mentioning

confidence: 99%

The complex interplay between SGLT2 inhibitors and atrial fibrillation: mechanisms and clinical implications

Fahimi,

Beikmohammadi

2024

AFRJMS

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This comprehensive review delves into the intricate relationship between Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors and AF, highlighting the multifaceted actions of these drugs and their significant cardiovascular benefits. Mechanisms: SGLT2 inhibitors induce substantial hemodynamic changes, impacting blood pressure, adipose tissue function, and inflammation. They enhance glycemic control while potentially reducing oxidative stress and inflammation, and they modulate atrial electrophysiology, collectively contributing to the reduction of AF risk. Clinical evidence: This review synthesizes a wealth of clinical evidence, drawing from observational studies and randomized controlled trials, consistently demonstrating a correlation between SGLT2 inhibitors, particularly dapagliflozin and empagliflozin, and a decreased risk of AF. This protective effect is most pronounced in patients with type 2 diabetes and heart failure, underscoring their potential as therapeutic agents for high-risk populations. Potential benefits: SGLT2 inhibitors offer a spectrum of potential benefits, including substantial reductions in AF risk, particularly in patients with type 2 diabetes and heart failure. These drugs have consistently demonstrated benefits in reducing heart failure hospitalizations, cardiovascular mortality, and stroke risk, which indirectly contribute to better AF management. Furthermore, SGLT2 inhibitors exhibit renoprotective properties by slowing the progression of chronic kidney disease and reducing albuminuria, offering substantial benefits for AF patients with comorbid kidney disease. Metabolic improvements involving weight loss, blood pressure reduction, and favorable changes in lipid profiles contribute to enhanced cardiovascular health and reduced AF risk. Originally designed for diabetes management, these medications offer a holistic approach to AF risk reduction, particularly in patients with type 2 diabetes and heart failure.

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“…Coronary artery bypass grafting surgery (CABG) is considered an important approach for treating coronary heart disease. After open heart surgery, patients are at risk of postoperative complications, such as death and wound complications [ 6 - 8 ]. For the past decade, the focus on preventing these complications by improving surgical techniques has remarkably decreased mortality rates [ 9 ], although they remain elevated compared to other types of surgery [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Functional capacity in smoking patients after coronary artery bypass grafting surgery: a quasi-experimental study

Alsubaiei,

Althukair,

Almutairi

2023

JMedLife

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Coronary artery bypass grafting surgery (CABG) is an important approach to treating coronary heart disease. However, patients undergoing open heart surgery are at risk of postoperative complications. Cigarette smoking is one of the preoperative risk factors that may increase postoperative complications. Studies show that early mobilization intervention may reduce these complications and improve functional capacity, but the impact of smoking on early outcomes after CABG has been controversial for the past two decades. This quasi-experimental study explored the effects of early mobilization on functional capacity among patients with different smoking histories undergoing CABG. The study involved 51 participants who underwent CABG surgery, divided into three groups: current smokers, former smokers, and non-smokers (n=17 each). A day before surgery, all groups underwent a six-minute walking test (6MWT). Every participant received the same intervention after surgery, including deep breathing exercises, an upper limb range of motion assessment, an incentive spirometer, and walking with and without assistance. Five days postoperatively, all outcomes - including the 6MWT, length of stay (LOS) in the ICU, and postoperative pulmonary complications - were assessed, and the 6MWT was repeated. There was a reduced functional capacity after CABG in ex-smokers (215.8±102 m) and current smokers (272.7±97m) compared to non-smokers (298.5±97.1m) in terms of 6MWT (p<0.05). Current smokers were more likely to have atelectasis after CABG than ex-smokers (76.5% vs. 52.9%), with non-smokers being the least likely to have atelectasis among the three groups (29.4%, p<0.05). Additionally, current smokers required longer ventilator support post-CABG (11.9±7.3 hours) compared to ex-smokers (8.3±4.3 hours) and non-smokers (7±2.5 hours, p<0.01). Smoking status significantly impacts functional capacity reduction after CABG, with current smokers being more susceptible to prolonged ventilator use and atelectasis.

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Long-term Outcome of Reexploration for Bleeding After Coronary Artery Bypass Grafting

Cited by 4 publications

References 17 publications

Clinical efficacy of clopidogrel and ticagrelor in patients undergoing off-pump coronary artery bypass grafting: a retrospective cohort study

Clinical efficacy of clopidogrel and ticagrelor in patients undergoing off-pump coronary artery bypass grafting: a retrospective cohort study

The complex interplay between SGLT2 inhibitors and atrial fibrillation: mechanisms and clinical implications

Functional capacity in smoking patients after coronary artery bypass grafting surgery: a quasi-experimental study

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