Predictors of contemporary coronary artery bypass grafting outcomes

Abstract

Patients who had heart failure and preserved systolic function had a similar high risk of adverse outcomes as those with low ejection fractions, and new approaches may mitigate this risk. Recognition of patients with excessive atherosclerotic burden may permit perioperative interventions to improve their outcomes. The contemporary risks of coronary artery bypass grafting have changed, and their identification may permit new methods to improve outcomes.

Predictors of immediate and long-term outcomes of coronary bypass surgery in patients with left ventricular dysfunction

“…The preoperative characteristics of the patients of the present study were equivalent to those of studies conducted on populations of patients with advanced ischemic heart disease and LV dysfunction [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The high-risk profile was due mainly to the high rates of heavy comorbidities and risk factors for atherosclerotic disease.…”

“…Although great efforts have been made to establish the best treatment for patients with severe coronary artery disease and LV dysfunction, the management of these patients remains individualized and relies on currently available, and sometimes conflicting, information [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. In the present study, a 15-year period and more of the authors' experience in CABG were reviewed retrospectively to improve knowledge about the causes and mechanisms of immediate and late failure of surgery in the presence of LV dysfunction.…”

“…However, despite the high expected operative risk according to Euro-SCORE II [15], there were a limited number of hospital deaths and the operative mortality was comparable with the Values are number of patients with percentages in brackets AF atrial fibrillation, ECMO extracorporeal membrane oxygenator, IABP intra-aortic balloon pumping, RBCs red blood cells, SVG saphenous vein grafts a Patients in preoperative stable sinus rhythm or paroxysmal AF b Defined as the development of new Q-waves, or significant loss of R-wave forces, in two or more contiguous leads on a 12-lead electrocardiogram together with congruent regional wall motion abnormalities at the echocardiographic assessment, or creatine kinase enzyme peak values >400 IU/l with creatine kinase-MB enzyme peak values >40 IU/l, or cardiac troponin I >12 ng/ml 10 h after release of the aortic clamp c Defined as three consecutive cardiac index measurements <2.0 l/ min/m 2 despite adequate preload, afterload, and inotropic support, or IABP d Defined as postoperative serum creatinine >2.0 mg/l in the patients without preoperative renal impairment, and postoperative increase in serum creatinine of at least 1.0 mg/l above baseline in the patients with preoperative renal impairment e Defined according to The Centers for Disease Control and Prevention classification of surgical site infections (Ref. [ best results of the Literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Glomerular filtration rate <50 ml/min and the preoperative use of IABP identified the patients at risk for hospital death according to the multivariable analysis.…”

“…In this difficult subset of patients, however, outcomes of surgery remain unpredictable and generally poor despite recent encouraging improvements [1][2][3][4][5][6][7]. Along the years, several authors have investigated very thoroughly on this matter.…”

“…Along the years, several authors have investigated very thoroughly on this matter. Selection criteria of the patients, preoperative tests of myocardial viability, the different impact of various cardioplegic solutions on myocardial protection, the value of complete myocardial revascularization with arterial grafts, the role of off-pump or beating heart on-pump techniques and a more extensive perioperative use of intra-aortic balloon pumping (IABP) or non-adrenergic inotropic agents are only part of the issues that have been taken into consideration [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”