DOI: https://doi.org/10.22141/2224-0586.7.94.2018.150815

Predictors of intraoperative complications and on-pump conversions of isolated coronary artery bypass grafting in patients with coronary artery disease

O.O. Zhurba, A.V. Rudenko

Abstract


Background. Direct myocardial revascularization is the most effective, and sometimes the only method of treating patients with coronary artery disease. At present, there are basic technologies of coronary artery bypass grafting (CABG) — with artificial circulation, on-pump, and beating heart operations — off-pump. Off-pump CABG has certain advantages, but there are often situations requiring an urgent conversion to artificial circulation. An emergency conversion to artificial circulation affects the immediate results of surgical treatment, so it is optimal preoperative identification of patients at high risk of conversion. The purpose of the study was the optimization of indications for artificial circulation by determining the predictors of intraoperative complications and the conversion of off-pump CABG to cardiopulmonary bypass. Materials and methods. The retrospective analysis of the disease history was performed in 4068 patients who were operated in the department of surgical treatment of coronary artery disease in Amosov National Institute of Cardiovascular Surgery. All patients had isolated CABG, including 82 (2.0 %) patients with emergency conversion to cardiopulmonary bypass and 110 (2.7 %) patients with planned artificial circulation. Results. It was found that in patients with emergent conversion to cardiopulmonary bypass during CABG, levels of 30-day mortality rate and postoperative complications were significantly higher (heart failure, lung failure, renal dysfunction, infections). According to the results of the initial clinical and anamnestic data (concomitant pathology, features of the main and concomitant cardiac pathology, emergency of the operation and features of coronary artery defeat), predictors of intraoperative complications were identified, including those requiring emergent conversion to the artificial circulation, and a comprehensive system was proposed for evaluating the risk of intraoperative complications. Conclusions. The proposed prognostic method allows us to identify patients requiring CABG with planed artificial circulation.


Keywords


coronary artery bypass grafting; artificial circulation; emergency conversion; relative risk; prediction

References


Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459-544. doi: https://doi.org/10.1016/S0140-6736(16)31012-1.

Dudnik S. Cardiovascular diseases in Ukraine: forecasts are disappointing. Vashe zdorov’ja [Internet]. 2015. Available from: http://www.vz.kiev.ua/sercevo-sudinni-zaxvoryuvannya-v-ukrayini-prognozi-nevtishni/. Accessed: January 09, 2015. (In Ukrainian).

Terenda N.O. Trends and forecast estimations general and primary morbidity ischemic heart disease Ukraine Bulletin of social hygiene and health protection organization of Ukraine. Scientific and practical Journal. 2016;3(69):31-5. (In Ukrainian).

Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541-619. doi:10.1093/eurheartj/ehu278.

Rudenko AV, Ursulenko VI, Kupchinskij AV. Myocardial revascularization . Circulation Pathology and Cardiac Surgery. 2006;1:21-5. (In Russian).

Kim JB, Yun SC, Lim JW, Hwang SK, Jung S-Ho, Song H, et al. Long-term survival following coronary artery bypass grafting off-pump versus on-pump strategies. J Am Coll Cardiol. 2014;63(21):2280-8. doi: 10.1016/j.jacc.2014.02.584. Epub 2014 Apr 2.

Lamy A, Devereaux PJ, Prabhakaran D, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med. 2016;375:2359-68.

Aydin A, Erkut B. On-pump beating heart coronary revascularization: Is it valid for emergency revascularization? Ann Saudi Med. 2015;35(2):133-7. doi: 10.5144/0256-4947.2015.133. PMID: 26336019.

Ueki C, Sakaguchi G, Akimoto T, Ohashi Y, Sato H. On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis. Eur J Cardiothorac Surg. 2016;50:813-21. doi:10.1093/ejcts/ezw129-.

Tsai YT, Lin FY, Lai CH, Lin YC, Lin CY, Tsai CS. On-pump beating-heart coronary artery bypass provides efficacious short- and long-term outcomes in hemodialysis patients. Nephrol Dial Transplant. 2012;27(5):2059-65. doi: 10.1093/ndt/gfr536. Epub 2011 Sep 27.

Sepehripour AH, Chaudhry UA, Harling L, Athanasiou T. Off-pump or on-pump beating heart: which technique offers better outcomes following coronary revascularization? Interact Cardiovasc Thorac Surg. 2015;20(4):546-9. doi: 10.1093/icvts/ivu451.

Gurbuz O, Kumtepe G, Yolgosteren A, Ozkan H, Karal IH, Ercan A, et al. A comparison of off- and on-pump beating-heart coronary artery bypass surgery on long-term cardiovascular events. Cardiovasc J Afr. 2017;28:30-5. doi: 10.5830/CVJA-2016-049.

Li Z, Amsterdam EA, Danielsen B, Hoegh H, Young JN, Armstrong EJ. Intraoperative conversion from off-pump to on-pump coronary artery bypass is associated with increased 30-day hospital readmission. Ann Thorac Surg. 2014;98:16-22. doi: 10.1016/j.athoracsur.2014.03.040.

Tabata M, Takanashi S, Horai T, Fukui T, Hosoda Y. Emergency conversion in off-pump coronary artery bypass grafting. Interact CardioVasc Thoracic Surg. 2006;5:555-9. doi: 10.1510/icvts.2006.128884.

Mukherjee D, Ahmed K, Baig K, Patel VM, Darzi A, Athanasiou T. Conversion and safety in off-pump coronary artery bypass: a system failure that needs re-emphasis. Ann Thorac Surg. 2011;91:630-9. doi: 10.1016/j.athoracsur.2010.10.031.

Lim J, Lee W.Y, Ra YJ, Jeong JH, Ko Ho H. Analysis of Risk Factors for Conversion from Off-Pump to On-Pump Coronary Artery Bypass Graft. Korean J Thorac Cardiovasc Surg. 2017;50:14-21. doi 10.5090/kjtcs.2017.50.1.14.

Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734-45. doi: 10.1093/ejcts/ezs043.

Online STS Adult Cardiac Surgery Risk Calculator. Available from: http://riskcalc.sts.org/stswebriskcalc/#/

Abzalova GF, Mayanskaya SD, Teregulov UE, Abashin IO, Khayrullin RN. Changes in cardiac hemodynamics depending on method of surgical myocardial revascularization. The Bulletin of Contemporary Clinical Medicine. 2015;8(4):7-12. (In Russian).

Akchurin RS, Shiryaev AA, Vasiliev VP, Vlasova EE. Modern trends in coronary surgery. Circulation Pathology and Cardiac Surgery. 2017;21(3S):34-44. doi: 10.21688/1681-3472-2017-3S-34-44/ (In Russian).

LiMin Xia, Qiang Ji, Kai Song, JinQiang Shen, YunQing Shi, RunHua Ma, WenJun Ding, et al. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. J Cardiothorac Surg. 2017;12:11. doi: 10.1186/s13019-017-0572-x.

Nicolini FMolardi AVerdichizzo DGallazzi MCSpaggiari ICocconcelli FBudillon AMBorrello BRivara DBeghi CGherli T. Coronary artery surgery in octogenarians: evolving strategies for the improvement in early and late results. Heart Vessels. 2012 Nov;27(6):559-67. doi: 10.1007/s00380-011-0198-1. Epub 2011 Nov 2.

Shen JQJi QDing WJXia LMSong KWei LSun YXWang CS. Myocardial revascularization among patients with severe left ventricular dysfunction: a comparison between on-pump beating-heart and off-pump coronary artery bypass grafting. Zhonghua Wai Ke Za Zhi. 2018 Apr 1;56(4):294-298. doi: 10.3760/cma.j.issn.0529-5815.2018.E010.




Copyright (c) 2019 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта