Reoperation for bleeding following coronary artery bypass surgery with special focus on long-term outcomes

Marteinsson, Steinthor A; Heimisdottir, Alexandra Aldis; Axelsson, Tomas; Johannesdottir, Hera; Arnadottir, Linda O; Gardarsdóttir, Helga; Johnsen, Arni; Sigurdsson, Martin I.; Helgadóttir, Sólveig; Guðbjartsson, Tómas

doi:10.1080/14017431.2020.1751265

Cited by 8 publications

(3 citation statements)

References 35 publications

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“…We also observed a lower risk of reintervention for bleeding with robotic off‐pump HCR in comparison with ONCAB but not OPCAB. It is well known that OPCAB is associated with a lower risk of reoperation for bleeding in comparison with ONCAB, 17 however, the robotic off‐pump HCR approach combines this aspect of OPCAB with the sternal‐sparing advantage, bringing about even less bleeding, which would explain the difference in terms of reoperation for bleeding in the ONCAB group but not in the OPCAB group.…”

Section: Discussionmentioning

confidence: 98%

Hybrid robotic off‐pump versus conventional on‐pump and off‐pump coronary artery bypass graft surgery in women

Torregrossa

Sá

Eynde

et al. 2022

Journal of Cardiac Surgery

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Objective To compare outcomes of three methods of coronary artery bypass graft surgery (CABG): robotic off‐pump hybrid coronary revascularization (HCR) versus conventional CABG off‐pump (off‐pump coronary artery bypass [OPCAB]) and on‐pump (on‐pump coronary artery bypass [ONCAB]) in women. Methods Data on women who underwent robotic off‐pump HCR or conventional OPCAB or conventional ONCAB between May 2005 and January 2021 were collected. Inverse probability of treatment weighting (IPTW) with doubly robust method was used to analyze the data. Results A total of 731 women were included (181 robotic off‐pump HCR, 138 conventional ONCAB, and 412 conventional OPCAB cases). IPTW‐adjusted analyses revealed the following: (1) for operative times, robotic off‐pump HCR presented longer times when compared with OPCAB, but shorter times when compared with ONCAB; (2) compared with ONCAB and OPCAB, robotic off‐pump HCR presented lower rates of reintervention for bleeding, intra‐ and postoperative blood transfusions, higher rates of extubation in the OR with less prolonged ventilation, lower rates of postoperative atrial fibrillation, and shorter intensive care unit and hospital length of stay; (3) no statistically significant differences for operative mortality were observed comparing robotic off‐pump HCR with ONCAB (IPTW‐adjusted odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.07–7.85; p = .822) and with OPCAB (IPTW‐adjusted OR: 4.27; 95% CI: 0.27–66.88; p = .301); 4. long‐term survival was similar with HCR compared with ONCAB (hazard ratio [HR]: 0.74, 95% CI: 0.36–1.50, p = .401) and OPCAB (HR: 0.89, 95% CI: 0.50–1.58, p = .683). Conclusions In our local experience, robotic off‐pump HCR in women was as safe as conventional ONCAB and OPCAB and may further improve postoperative outcomes when performed frequently by a dedicated team, producing better perioperative outcomes without compromising survival in the long run.

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Section: Discussionmentioning

confidence: 98%

Hybrid robotic off‐pump versus conventional on‐pump and off‐pump coronary artery bypass graft surgery in women

Torregrossa

Sá

Eynde

et al. 2022

Journal of Cardiac Surgery

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“…Postoperative bleeding following cardiothoracic procedures remains an important concern with multiple avenues of investigation continuing to assess factors predisposing and potentially influencing the severity of this adverse event. Recent areas of interest include: development of new antifibrinolytic agents to reduce bleeding; 31 measurement of platelet function to reduce bleeding and mortality; 32 single or dual agent antiplatelet therapy to maximize bypass graft patency, but increase postoperative bleeding; 33 – 36 direct linkage of postoperative cardiac surgical bleeding with increased cost; 4 , 5 safe and efficacious use of postoperative fibrinogen concentrates; 37 , 38 role of patient blood management in reducing blood product transfusion and improving cardiac surgical outcomes; 39 , 40 transfusion reductions associated with the use of prothrombin complex concentrate; 41 , 42 morbidity associated with reoperation for bleeding following cardiac surgery; 3 , 43 , 44 methods of employing thromboelastometry (ROTEM) during cardiac surgery; 45 , 46 contribution of albumin/gelatin to postoperative bleeding; 47 – 49 advantages of anticoagulation management using thromboelastography (TEG) during cardiopulmonary bypass; 50 – 52 benefit of thrombin inhibitors for pediatric VAD anticoagulation; 53 , 54 reduction of postoperative blood loss using Unilastin as an antifibrinolytic agent; 55 , 56 and blood loss leading to multisystem organ failure and hematologic complications following LVAD insertion. 7 , 57 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Safety and Efficacy of a Novel Thrombin Containing Combination Hemostatic Powder Using a Historical Control

Bruckner

Spotnitz

Suarez

et al. 2021

Clin Appl Thromb Hemost

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This clinical study compares 2 hemostatic agents, a novel combination powder (CP) (HEMOBLAST™ Bellows) and an established polysaccharide starch powder (PP) (Arista™ AH) to assess the usefulness of CP. Retrospective comparative analysis of CP (July 2018 to July 2019, 68 patients) to PP (January 2011 to January 2013, 94 patients) in cardiothoracic patients was performed using linear regression models adjusting for age, sex, and procedure type for the endpoints: blood loss; protamine to skin closure time (hemostasis time); chest tube output and blood products required 48 hours postoperatively; ICU stay; postoperative comorbidities; and 30 day mortality. 162 patients (108 M: 54 F) underwent 162 cardiothoracic surgical procedures including: transplantation (n = 44), placement of ventricular assist device (n = 87), and others (n = 31). Use of CP compared to PP (Estimated Mean Difference [95% CI], P-value) produced significant reductions: blood loss (mL) (−886.51 [−1457.76, −312.26], P = 0.003); protamine to skin closure time (min) (−16.81 [−28.03, −5.59], P = 0.004); chest tube output (48 hrs, mL) (−445.76 [−669.38, −222.14], P < 0.001); packed red blood cell transfusions (units) (−0.98 [−1.56, −0.4], P = 0.001); and postoperative comorbidities (−0.31 [−0.55, −0.07], P = 0.012). There were no differences in the ICU stay (4.07 [−2.01, 10.15], P = 0.188) or 30-day mortality (0.57 [0.20, 1.63], P = 0.291). The use of CP in complex cardiothoracic operations resulted in improved hemostasis and significant clinical benefits in blood loss, transfusion requirements, morbidity, and time in operating room.

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“…early, especially before surgery, has been linked to improved outcomes, such as decreased ICU LOS and lower fatality rates [24] . Several factors can impact the likelihood of undergoing a second surgery following coronary artery bypass grafting (CABG), such as the utilization of an intra-aortic balloon pump, the need for emergency surgery, and the administration of clopidogrel prior to the operation [25] . Prolonged ICU LOS following coronary artery bypass grafting (CABG), can also be caused by the need for additional surgery, which is linked to higher rates of death during the hospital stay and a worse long-term outlook.…”

Section: Cardiopulmonary Bypass Time With Values ≤180 Minutes and >18...mentioning

confidence: 99%

Correlation Between Cardiopulmonary Bypass Time (CPB Time) during Coronary Artery Bypass Graft on ICU Length of Stay

Nugraha,

Limanto,

Setiawan

et al. 2024

CCJ

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Highlight: 1. CHD remains one of the most threatening CVD in Indonesia. Studies discussing CHD will contribute in future studies for cardiologists to assert better options for treatment. - Abstract Background: Coronary heart disease (CHD) is one of the deadliest diseases in Indonesia. Coronary artery bypass graft using cardiopulmonary bypass (CPB) is an integral measure in its treatment. The objective of this study is to identify the correlation of CPB Time and Length of Stay (LOS) in the Intensive Care Unit (ICU) in Dr.Soetomo General Academic Hospital, Surabaya. Material and Methods: This study was conducted using observational and analytic methods. The population are coronary heart disease patients who underwent coronary artery bypass graft. A total sampling method was used from the medical records of Dr. Soetomo General Academic Hospital, Surabaya from October 2021 until September 2022. The research variables are: CPB time and ICU LOS. The relationship between CPB and ICU LOS was analyzed using the Spearman correlation test and logistic regression as well Mann-Whitney test using Microsoft Excel and SPSS version 25. Results: From the results of the correlation test, there is no correlation between CPB Time and ICU LOS with a correlation coefficient of r=0212, there is no significant difference between CPB ≤180 minutes and CPB >180 minutes on ICU LOS p=0.123. From the overall sample, the average age was 62.24+7.765 years, with the majority of the sample were male 87.3%. Conclusion: There is no correlation between the CPB Time and ICU LOS in patients after coronary artery bypass graft at RSUD Dr. Soetomo.

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Reoperation for bleeding following coronary artery bypass surgery with special focus on long-term outcomes

Cited by 8 publications

References 35 publications

Hybrid robotic off‐pump versus conventional on‐pump and off‐pump coronary artery bypass graft surgery in women

Hybrid robotic off‐pump versus conventional on‐pump and off‐pump coronary artery bypass graft surgery in women

Evaluation of the Safety and Efficacy of a Novel Thrombin Containing Combination Hemostatic Powder Using a Historical Control

Correlation Between Cardiopulmonary Bypass Time (CPB Time) during Coronary Artery Bypass Graft on ICU Length of Stay

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