Preoperative Continuation of Aspirin Therapy May Improve Perioperative Saphenous Venous Graft Patency After Off-Pump Coronary Artery Bypass Grafting

Wu, Hengchao; Wang, Jian; Sun, Hansong; Lv, Bin; Wang, Xinqiang; Hu, Xiaopeng; Ma, Wei-Guo; Zhang, Jing

doi:10.1016/j.athoracsur.2014.07.074

Cited by 20 publications

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References 13 publications

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“…A total of 3922 patients from 12 RCTs and 30 893 patients coming from 28 observational studies met our inclusion criteria and were included in the meta‐analysis. Characteristics of the studies are presented in Tables and .…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen observational studies reported 30‐day mortality with an aggregate of 27 944 patients. Pooling the results of the observational studies, preoperative aspirin showed a significant decrease in postoperative mortality by 32% (OR 0.68; 95%CI 0.55‐0.85; P = 0.0004; I 2 = 23%; P heterogeneity = 0.19) (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…Pooling the results of both RCTs and observational studies, preoperative aspirin showed a significant decrease in postoperative mortality by 29% (OR 0.71; 95%CI 0.6‐0.84; P = 0.0001; I 2 = 7%; P heterogeneity = 0.36). A total of 31 306 patients have been pooled to assess 30‐day mortality of which 93.03% underwent CABG with or without heart valve surgery (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, the Society of Thoracic Surgeons Guidelines on “Use of antiplatelet drugs in patients having cardiac and noncardiac operations” suggest that discontinuation of preoperative aspirin therapy before purely elective operations and in high‐risk patients is reasonable to decrease the risk of bleeding . Several observational studies showed that preoperative aspirin might improve outcomes not only in patients undergoing CABG but also in patients undergoing any other cardiac surgical procedures . Therefore, we performed a systematic review and meta‐analysis to assess the influence of preoperative aspirin administration on patients undergoing all types of cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

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The use of preoperative aspirin in cardiac surgery: A systematic review and meta-analysis

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Preoperative aspirin increases the risk for postoperative bleeding. However, this did not result in an increased need for chest re-exploration and did not increase the rates of PRBC transfusion when preoperative low-dose (≤160 mg/d) aspirin was administered. Aspirin at any dose is associated with decreased mortality and AKI and low-dose aspirin (≤160 mg/d) decreases the incidence of perioperative MI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The use of preoperative aspirin in cardiac surgery: A systematic review and meta-analysis

et al. 2017

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Invited Commentary

Lawrie

2015

The Annals of Thoracic Surgery

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The authors [1] have identified preoperative continuation of aspirin as an important factor affecting perioperative vein graft patency after off-pump coronary bypass surgery. It is timely to recall the many other factors that can also have a significant effect on early or late patency, which have been identified over the last 40 years and which remain important to the present time. Only healthy saphenous veins of good caliber should be harvested. Other important factors include careful physical handling with avoidance of crushing or stretching of the vein during harvest. The adventitia should be preserved and not stripped to "clean" the vein. These goals can be achieved equally well with skilled open or endoscopic vein harvest. After harvest, the vein should be maintained at normothermia and prepared with room temperature balanced salt solution (eg, lactated Ringer solution) under low inflation pressure. Heparinized blood or normal saline should not be used; this has been reconfirmed recently in the publication from the PREVENT IV study regarding preparation solutions [2]. These measures dramatically reduced the early development of obstructive fibromuscular medial lesions; however, early vein graft failures from thrombosis continued to occur, suggesting incomplete endothelial and medial preservation despite these measures. The demonstration by Chesebro and colleagues [3,4] that the addition of perioperative aspirin therapy improved early and late vein graft patency was an early landmark in pharmacologic protection of the vein graft. Interest in the use of statin drugs perioperatively was based initially on the recognition that many late vein graft failures were related to the late development of vein graft atherosclerosis. Although less evidence exists than for aspirin, they continuation of preoperative statin therapy may also have some benefit on early and late vein graft patency. Optimal graft patency requires not only meticulous attention to anastomoses by skilled surgeons, but also careful long-term management of the vein graft itself. References1. Wu H, Wang J, Sun H, et al. Preoperative continuation of aspirin therapy may improve perioperative saphenous venous graft patency after off-pump coronary artery bypass grafting. Ann Thorac Surg 2015;99:576-81. 2. Hasarkamp RE, Alexander JH, Schulte PJ, et al. Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: follow-up from the PREVENT IV randomized clinical trial. JAMA Surg 2014;149:798-805. 3. Chesebro JH, Fuster V, Elveback LR, et al. Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Engl J Med 1984;310:209-14. 4. Chesebro JH, Clements IP, Fuster V, et al. A platelet-inhibitor drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J Med 1982;307:73-8.

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General Preoperative Considerations and Preparation of the Patient for Surgery

2020

Manual of Perioperative Care in Adult Cardiac Surgery

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Preoperative Continuation of Aspirin Therapy May Improve Perioperative Saphenous Venous Graft Patency After Off-Pump Coronary Artery Bypass Grafting

Cited by 20 publications

References 13 publications

The use of preoperative aspirin in cardiac surgery: A systematic review and meta-analysis

The use of preoperative aspirin in cardiac surgery: A systematic review and meta-analysis

Invited Commentary

General Preoperative Considerations and Preparation of the Patient for Surgery

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