Coronary Surgery

Cardiac Magnetic Resonance Imaging Predictors of Short-Term Outcomes after High Risk Coronary Surgery

by

Sheriff MJ, Mouline O, Hsu C, Grieve SM, Wilson MK, Bannon PG, Vallely MP, Puranik R

Heart Lung Circ 2016 Jan;

PMID: 26839164

Abstract

BACKGROUND: The euroSCORE II is a widely used pre-coronary artery bypass graft surgery (CAGS) risk score, but its predictive power lacks the specificity to predict outcomes in high-risk patients (

METHODS: Fifty-two consecutive patients with high euroSCORE II (>16) and left ventricular (LV) dysfunction (<40%) based on 2D-echocardiography who underwent CAGS and in whom CMRI (1.5T) was performed preoperatively were retrospectively studied. Cardiac magnetic resonance imaging parameters were assessed in patients who either had complications immediately post-surgery (n=35), six weeks post-surgery (n=20) or were uncomplicated.

RESULTS: The average age of patients recruited was 69±5 years with high euroSCORE II (22±4) and low 2D-echocardiography LV ejection fraction (38%±2%). Cardiac magnetic resonance imaging results demonstrated that those with immediate complications had higher LV scar/infarct burden as a proportion of LV mass (17±3% vs 10±3%; p=0.04) with lower circumferential relaxation index (2.5±0.46 vs 2.8±0.56; p=0.05) compared to those with no complications. Early mortality from surgery was 17% (n=9) and was associated with lower RV stroke volume (55±12 vs 68±18; p=0.03) and higher LV infarct scar/burden (18±2% vs 10±2%, p=0.04). Cardiac magnetic resonance imaging showed patients with complications at six weeks post-surgery had higher LV scar/infarct burden (14.5±2% vs 6.8±2%, p=0.03) compared to those without complications.

CONCLUSION: Cardiac magnetic resonance imaging preoperative LV and RV parameters are valuable in assessing the likelihood of successful outcomes from CAGS in high-risk patients with LV dysfunction.

Bilateral Internal Thoracic Artery Composite Y Grafts: Analysis of 464 Angiograms in 296 Patients

by

Robinson BM, Paterson HS, Naidoo R, Dhurandhar V, Denniss AR

Ann. Thorac. Surg. 2015 Oct;

PMID: 26507423

Abstract

BACKGROUND: The use of bilateral internal thoracic arteries (BITA) in coronary artery bypass graft surgery improves patient survival. The optimum BITA graft configuration is unknown. This study evaluates outcomes after the use of bilateral internal mammary Y grafting as the primary grafting strategy.

METHODS: Patients who underwent BITA composite Y grafting (n = 1,011) between October 1994 and March 2009 were identified from a cardiac surgical database. Follow-up (mean 12 years) was obtained by cross-reference with the state death registry and local cardiology databases.

RESULTS: Perioperative mortality was 1.6%. Kaplan-Meier 10-year survival was 87.2%. There were 464 episodes of postdischarge angiography in 296 patients, at an average of 5.5 years to first angiography. Graft failure occurred in 151 patients, predominately affecting the right ITA limb (n = 139). Degree of native vessel stenosis (odds ratio [OR] 0.66 per 10% increase), anatomic territory grafted (circumflex OR 2.64, right coronary OR 6.73 versus anterior), and end-to-side free wall anastomoses (OR 1.98) predicted anastomotic occlusion. The left anterior descending artery graft patency was unaffected by sequential grafting. Progression to graft failure after the first angiogram was rarely seen in the 111 patients who had serial angiography.

CONCLUSIONS: Outcomes of BITA Y grafting are similar to those for other BITA configurations. The rate of presentation with arterial graft dysfunction decreases over time. Although competitive flow affects anastomotic patency, there is no threshold at which risk of occlusion substantially increases.

Comparison of the Safety and Efficacy of On-Pump (ONCAB) versus Off-Pump (OPCAB) Coronary Artery Bypass Graft Surgery in the Elderly: A Review of the ANZSCTS database

by

Dhurandhar V, Saxena A, Parikh R, Vallely MP, Wilson MK, Butcher JK, Black DA, Tran L, Reid CM, Bannon PG

Heart Lung Circ 2015 May;

PMID: 26067551

Abstract

BACKGROUND: The elderly population (age >70 years) incurs greater mortality and morbidity following CABG. OPCAB may mitigate these otucomes. A retrospective analysis of the results of OPCAB in this population was performed.

METHODS: We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons’ (ANZSCTS) database for elderly patients (n=12697) undergoing isolated CABG surgery and compared the ONCAB (n=11676) with OPCAB (n=1021) technique. Preoperative and intraoperative risk factors, and postoperative outcomes were analysed. Survival analyses was performed after cross-matching the database with the national death registry to identify long-term mortality.

RESULTS: High-risk patients were more prevalent in the ONCAB group (p<0.05). OPCAB patients received fewer distal anastomoses than ONCAB patients (2.4±1.1 vs 3.3±1.0, p<0.001). Thirty-day mortality and stroke rates between OPCAB and ONCAB were not significantly different (2% vs 2.5% and 1.1% vs 1.8%, respectively). There was a non-significant trend towards improved 10-year survival in OPCAB patients using multivariate analysis (78.8% vs. 73.3%, p=0.076, HR 0.83; 95% CI 0.67-1.02).

CONCLUSIONS: Mortality and stroke rates following CABG surgery are extremely low in the elderly suggesting that surgery is a safe management option for coronary artery disease in this population. OPCAB did not offer a significant advantage over ONCAB with regards to 30-day mortality, stroke and long-term survival. Further prospective randomised trials will be necessary to clarify risks or benefits in the elderly.

Outcomes of On-Pump versus Off-Pump Coronary Artery Bypass Graft Surgery in the High Risk (AusSCORE > 5)

by

Dhurandhar V, Saxena A, Parikh R, Vallely MP, Wilson MK, Butcher JK, Black DA, Tran L, Reid CM, Bannon PG

Heart Lung Circ 2015 Feb;

PMID: 25778621

Abstract

BACKGROUND: Coronary artery bypass graft surgery (CABG) has been established as the preferred intervention for coronary revascularisation in the high-risk population. OPCAB may further reduce mortality and morbidity in this population subgroup. This study presents the largest series of high-risk (AusSCORE > 5) OPCAB patients in Australia and New Zealand.

METHODS: We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons’ (ANZSCTS) database for high-risk patients (n=7822) undergoing isolated CABG surgery and compared the ONCAB (n=7277) with the OPCAB (n=545) technique. Preoperative and intraoperative risk factors, and postoperative outcomes were analysed. Survival analysis was performed after cross-matching the database with the national death registry to identify long-term mortality.

RESULTS: The ONCAB and OPCAB groups had similar risk profiles based on the AusSCORE. Thirty-day mortality (ONCAB vs OPCAB 3.9% vs 2.4%, p=0.067) and stroke (ONCAB vs OPCAB 2.4% vs 1.3%, p=0.104) were similar between the two groups. OPCAB patients received fewer distal anastomoses than ONCAB patients (2.5±1.2 vs 3.3±1.0, p<0.001). The rates of new postoperative atrial arrhythmia (28.3% vs 33.3%, p=0.017) and blood transfusion requirements (52.1% vs 59.5%, p=0.001) were lower in the OPCAB group, while duration of ICU stay in hours (97.4±187.8 vs 70.2±152.8, p<0.001) was longer. There was a non-significant trend towards improved 10-year survival in OPCAB patients (74.7% vs. 71.7%, p=0.133).

CONCLUSIONS: In the high-risk population, CABG surgery has a low rate of mortality and morbidity suggesting that surgery is a safe option for coronary revascularisation. OPCAB reduces postoperative morbidity and is a safe procedure for 30-day mortality, stroke and long-term survival in high-risk patients.

How should I treat a complex critical left main bifurcation lesion in a patient with poor left ventricular function, an occluded dominant right coronary artery and severe peripheral vascular disease?

by

Martínez GJ, Molina J, Byrom M, Puranik R, Ng B, Bailey BP, Patel S, Dworakowski R, MacCarthy P, Ochala A, Smolka G

EuroIntervention 2015 Feb;10(11)

PMID: 25692609

Abstract

Should clopidogrel be discontinued before coronary artery bypass grafting for patients with acute coronary syndrome? A systematic review and meta-analysis

by

Cao C, Indraratna P, Ang SC, Manganas C, Park J, Bannon PG, Yan TD

J. Thorac. Cardiovasc. Surg. 2014 Dec;148(6):3092-8

PMID: 24954178

Abstract

OBJECTIVE: Patients presenting with acute coronary syndrome (ACS) are treated with dual antiplatelet agents, including aspirin and clopidogrel, to prevent mortality and recurrent ischemia. However, those who require coronary artery bypass grafting (CABG) could have increased postoperative bleeding and bleeding-related adverse outcomes. The current guidelines on clinical management differ significantly. The present meta-analysis examined the evidence for clopidogrel in the treatment of patients presenting with ACS requiring CABG, with a focus on the timing of medication cessation before surgery.

METHODS: A systematic review of 9 electronic databases was performed to identify all relevant studies with comparable outcomes for patients with ACS treated with clopidogrel before CABG. The endpoints included reoperation, major bleeding, mortality, and a composite endpoint of mortality and recurrent myocardial infarction.

RESULTS: Five relevant studies were identified according to the predefined selection criteria. Patients who had received clopidogrel had a significantly lower incidence of composite endpoints than those who had not. However, patients who underwent CABG < 5 days after the last dose of clopidogrel had a significantly greater incidence of reoperation, major bleeding, and combined adverse outcomes than those who had had a washout period >5 days.

CONCLUSIONS: The results from the present meta-analysis suggest that patients who present with ACS should be treated with dual antiplatelet therapy, including clopidogrel. However, for patients subsequently referred for CABG, a minimum washout period of 5 days should be observed to minimize perioperative bleeding and bleeding-related complications, unless emergency indications exist. These results differ from those of previous studies and guidelines.

Our Mission

Our mission is to foster research and apply science to improve the outcomes for patients facing heart or lung surgery.

Donate by Phone

+61 2 9550 2350

Donate Now
Subscribe to Our Newsletter

Share with friends

About Us

Resources

You Can Help

The Baird Institute is a Registered Australian Charity

The Baird Institute is registered as a charity with the Australian Charities and Not-for-profits Commission (ACNC).
Eligible tax-deductible donations have Deductible Gift Recipient (DGR) status with the Australian Tax Office.

All content © 2024 The Baird Institute. All rights reserved. ABN 38 096 746 806.

Site by Weber Design Studio

The Baird Institute

Royal Prince Alfred Hospital
Cardiothoracic Department, Level 7,
50 Missenden Road, Camperdown, NSW, 2050

Stay in the loop

Subscribe to our Heart to Heart Newsletter to keep up with the latest developments in heart and lung research from The Baird Institute.

Honour a Loved One

  • Fundraise in memory of someone special to you.

Challenge Yourself

  • Run a marathon
  • Do a long bike ride
  • Walk 10km each day for a month
  • Do 50 sit ups every day for a week
  • Join an organised event such as the City to Surf

Organise a community event

  • Have a backyard sausage sizzle
  • Host a trivia night

Seek sponsorship to help you quit those bad habits

  • Give up smoking
  • Refrain from alcohol for a month or more

Celebrate Through Giving

  • Choose to give on your birthday: Instead of giving you gifts, ask your friends and family to donate to The Baird Institute.
  • Say “I do” to improving the lives of heart and lung patients: Invite guests to donate to The Baird Institute on your wedding day
  • Turn anniversaries or personal milestones into fundraising events.

Create a CrowdRaiser on GiveNow

  1. Go to CrowdRaiser for The Baird Institute.
  2. Click on the button “Fundraise for this cause” – just under the header image.
  3. Create your Crowdraiser. Fill in the requested details.
  4. Customise your campaign. Add images and messages to make your CrowdRaiser unique.
  5. Share the link to your fundraising page via email, social media, or any way you like.
  6. Let us know via [email protected] that you have created a fundraiser so we can say thank you.

Join a community passionate about making a difference. GiveNow provides a dedicated platform for Australian charities, ensuring your efforts directly support our mission.

Start a Facebook Fundraiser

  1. Go to Facebook fundraisers.
  2. Click on the blue button – “Select nonprofit”
  3. Search for and select The Baird Institute
  4. Set your fundraising target
  5. Choose your campaign end date & a title for your Fundraiser
  6. Personalise your fundraiser: Use the existing wording and photos or choose your own.
  7. Click on ‘Create’.
  8. Invite friends and family. Share the link for your fundraiser and encourage others to contribute.
  9. Let us know via [email protected] that you have created a fundraiser so we can say thank you.

Celebrate where your friends and family connect. Leverage your social network to make a real impact.