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Sef, Davorin, Janko Szavits-Nossan, Mladen Predrijevac, Rajna Golubic, Tomislav Sipic, Kresimir Stambuk, zvonimir korda, Pascal Meier, and Marko Ivan turina. "Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery." Open Heart 6, no. 1 (May 2019): e001027. http://dx.doi.org/10.1136/openhrt-2019-001027.
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ObjectivesUpdated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome.MethodsAmong 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints.ResultsOverall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op).ConclusionsUrgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.
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Kanchi, Muralidhar, Priya Nair, Rudresh Manjunath, and Kumar Belani. "Influence of Body Temperature on Bispectral Index-Guided Anesthetic Management in Off-Pump Coronary Artery Bypass Grafting." Journal of Cardiac Critical Care TSS 4, no. 02 (October 18, 2020): 079–85. http://dx.doi.org/10.1055/s-0040-1718975.
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Abstract Background Perioperative hypothermia is not uncommon in surgical patients due to anesthetic-induced inhibition of thermoregulatory mechanisms and exposure of patients to cold environment in the operating rooms. Core temperature reduction up to 35°C is often seen in off-pump coronary artery bypass graft (OP-CABG) surgery. Anesthetic depth can be monitored by using bispectral (BIS) index. The present study was performed to evaluate the influence of mild hypothermia on the anesthetic depth using BIS monitoring and correlation of BIS with end-tidal anesthetic concentration at varying temperatures during OP-CABG. Materials and Methods In a prospective observational study design in a tertiary care teaching hospital, patients who underwent elective OP-CABG under endotracheal general anesthesia, were included in the study. Standard technique of anesthesia was followed. BIS, nasopharyngeal temperature, and end-tidal anesthetic concentration of inhaled isoflurane was recorded every 10 minutes. The BIS was adjusted to between 45 and 50 during surgery. Results There were 40 patients who underwent OP-CABG during the study period. The mean age was 51.2 ± 8.7 years, mean body mass index 29.8 ± 2.2, and mean left ventricular ejection fraction was 55.4 ± 4.2%. Anesthetic requirement as guided by BIS between 45 and 50 correlated linearly with core body temperature (r = 0.999; p < 0.001). The mean decrease in the body temperature at the end of 300 minutes was 2.2°C with a mean decrease in end-tidal anesthetic concentration of 0.29%. The reduction in end-tidal anesthetic concentration per degree decrease in temperature was 0.13%. None of the patients reported intraoperative recall. Conclusion In this study, BIS monitoring was used to guide the delivery concentration of inhaled anesthetic using a targeted range of 45 to 50. BIS monitoring allowed the appropriate reduction of anesthetic dosing requirements in patients undergoing OP-CABG without risk of awareness. There was a significant reduction in anesthetic requirements associated with reduction of core temperature. The routine use of BIS is recommended in OP-CABG to titrate anesthetic requirement during occurrence of hypothermia and facilitate fast-track anesthesia in this patient population.
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Kanchi, Muralidhar, Manjunath Rudresh, and Sucharita Das. "Continuous Cardiac Output Measurement during Off-Pump Coronary Artery Bypass Grafting: Radial Arterial Pulse Wave versus Femoral Arterial Pulse Wave." Journal of Cardiac Critical Care TSS 01, no. 02 (December 2017): 95–100. http://dx.doi.org/10.1055/s-0038-1624062.
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Abstract Background and Objectives Measurement of cardiac output (CO) during off-pump coronary artery bypass grafting (OP-CABG) is useful to assess the impact of displacement of heart during surgery. FloTrac uses the pulse-contour analysis algorithm to derive stroke volume (SV) and CO. This study was aimed to determine whether the site of monitoring of arterial pressure influences the CO measurement using Flotrac/Vigileo. Methods The authors recorded 75 sets of observations in 15 patients who underwent elective OP-CABG. Each patient had the radial and femoral artery cannulated and connected to FloTrac/Vigileo. The hemodynamic parameters were monitored at specified points of time intraoperatively. Results The CO, cardiac index, SV, stroke volume index, and stroke volume variation measured from radial artery did not differ from those of femoral artery at all points of measurement. Conclusion Either of the sites of monitoring of arterial pressure (namely radial and femoral artery) is acceptable for monitoring CO during OP-CABG.
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Selçuk, Emre, Deniz Günay, Mehmet Aksüt, Tolga Baş, Hasan Erdem, and Mehmet Kaan Kırali. "Clinical Effects of Pleurotomy on Postoperative Outcomes of Patients Undergoing On-Pump Coronary Artery Bypass Grafting with Skeletonized Left Internal Thoracic Artery." Heart Surgery Forum 23, no. 6 (November 24, 2020): E883—E887. http://dx.doi.org/10.1532/hsf.3303.
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Purpose: To evaluate the clinical impact of pleurotomy during skeletonized internal thoracic artery (ITA) harvesting in patients undergoing on-pump coronary artery bypass grafting (CABG). Methods: Consecutive patients (n = 758) who underwent CABG with skeletonized ITA were divided into 2 groups according to pleural integrity: open pleura (OP) and closed pleura (CP). Propensity score matching was performed after retrospective data extraction. The measured outcomes were postoperative pulmonary and hemorrhagic complications, 30-day mortality, and duration of hospital stay. Results: Among 236 propensity score–matched pairs, there was no statistically significant difference between the 2 groups in terms of first 30-day mortality (OP, n = 7 [3%]; CP, n = 5 [2.5%]), blood product use (OP, 0.90 ± 0.71; CP, 0.74 ± 0.7), or median duration of hospital stay. The incidence of postoperative pleural effusion, thoracentesis, prolonged mechanical ventilation, respiratory failure, excessive drainage, cardiac tamponade, and reexploration and the number of patients requiring transfusion were similar in both groups. Conclusion: The clinical effect of pleural protection or pleurotomy on postoperative outcomes is limited in patients undergoing on-pump CABG with skeletonized ITA.
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Rao, Parachuri V., Praveen K. Hosabettu, Sanjay Dhaded, Avery Mathew, Julius Punnen, and Muralidhar Kanchi. "Distal Carotid Perfusion in Combined Carotid Endarterectomy and OP-CABG." Asian Cardiovascular and Thoracic Annals 15, no. 2 (April 2007): 164–66. http://dx.doi.org/10.1177/021849230701500219.
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Atluri, Prashanti, Jennifer Kujawa, and Alexander Hindenburg. "Leukoreduced Packed Red Cells: Do They Have a Role in Decreasing the Incidence of Heparin Induced Thrombocytopenia?." Blood 108, no. 11 (November 16, 2006): 4148. http://dx.doi.org/10.1182/blood.v108.11.4148.4148.
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Abstract It has been demonstrated that neutrophils activate macrophages via the heparin binding protein, thus possibly contributing to the incidence of heparin induced thrombocytopenia (HIT). It would follow that the incidence of thrombocytopenia and its sequelae may be reduced by using leukoreduced blood in patients undergoing cardiac bypass surgery. We had a unique opportunity to study this hypothesis at our institution. Due to a policy change all patients undergoing cardiac bypass surgery received LR blood intra-operatively prior to April 2005. Subsequent to this period non-LR blood was utilized in all patients. A retrospective chart review of 197 non-LR and 316 LR patients was done. The platelet count on admission, the first five days post- op, the day of discharge, the percent drop in platelet count post-op and heparin antibody (HA) test were obtained. Thrombocytopenia was defined as an overall drop in platelet count by > 50%. The CABG and the non-CABG patients were looked at separately. The results are as follows: Percent of patients with > 50% drop in platelet count: all patients CABG patients non-CABG patients leukoreduced arm 64% 62.4% 73.3% non-leukoreduced arm 64.6% 61.7% 82.1% Fisher’s exact test p = 0.92 p = 0.92 p = 0.57 Percent of patients with heparin antibody positivity: all patients CABG patients non-CABG patients leukoreduced arm (n=81) 24.7% 23.3% 28.6% non-leukoreduced arm (n=39) 30.8% 35.5% 12.5% Fisher’s exact test p = 0.51 p = 0.23 p = 0.63 In both the LR and non-LR populations there is only a 0.6% difference in the number of patients with a > 50% platelet drop. The relative risk is 1.01 with the 95% confidence interval of (0.88, 1.15). This is a relatively narrow confidence interval reflective of the relatively large sample size. Heparin antibody testing was not done on all the patients. Only those with persistent or profound thrombocytopenia had the test ordered. Overall heparin antibody positivity in both cohorts was not statistically different. The LR arm had a slightly higher positivity rate overall. The risk ratio is 1.25 indicating that the non-LR arm is 25% more likely to have a positive antibody test compared to the LR arm. The higher positivity rate in non-CABG patients may be due to the more complex nature of the surgery relative to CABG surgery. The non-CABG group has a higher percent of heparin antibody positivity in the LR arm. This inconsistency may be secondary to the smaller sample size of this group. In both the CABG or non-CABG groups, there was no statistically significant difference in the percent platelet drop or heparin antibody positivity. One can conclude that leukoreduction of red blood cell products during cardiac surgery does not significantly impact on thrombocytopenia or the development of HIT.
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Sanz, Rafael Martinez, Pilar Garrido, Ramiro De La Llana, Ibrahim Nassar, Jose Luis Iribarren, Juan Jose Jimenez, Maria Jose Mataro, and Carlos Vaquero. "OP-061 RISK FACTORS PROFILES IN CABG PATIENTS OLDER THAN 70 YEARS." International Journal of Cardiology 140 (April 2010): S18. http://dx.doi.org/10.1016/s0167-5273(10)70063-2.
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Ding, L., J. Shin, and D. Wong. "PRE-OP, INTRA-OP, AND POST-OP RBC TRANSFUSION IN ISOLATED CABG SURGERY IN THE REAL WORLD PRACTICE: EXPERIENCE FROM PROVINCIAL CARDIAC REGISTRY BC." Canadian Journal of Cardiology 30, no. 10 (October 2014): S135—S136. http://dx.doi.org/10.1016/j.cjca.2014.07.191.
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Zander, Sabine, and Eric Opitz. "Koronararterien-Bypass." Im OP 10, no. 05 (August 2020): 188–93. http://dx.doi.org/10.1055/a-1182-9017.
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Fortgeschrittene koronare Herzerkrankungen können sowohl kardiologisch-interventionell als auch chirurgisch-invasiv behandelt werden. Unsere Autorin beschreibt eine chirurgisch relevante Therapieoption, die Koronararterien-Bypass-OP (englisch: coronary artery bypass grafting, kurz CABG) und gewährt dabei einen Blick hinter die Kulissen des Deutschen Herzzentrums Berlin (DHZB). Anhand des prüfungsrelevanten Erwartungshorizonts der Praxisanleiter des DHZB wird erläutert, wie mit körpereigenen Gefäßen die Engstelle im Herzkranzgefäß überbrückt und somit eine bessere Perfusion (Durchblutung) des Herzens wiederhergestellt wird.
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Pieris, Rajeeva R., and Ravindra Fernando. "Coronary Artery Bypass Grafting in a Patient with Organophosphate Poisoning." Heart Surgery Forum 18, no. 4 (August 30, 2015): 167. http://dx.doi.org/10.1532/hsf.1370.
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A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.
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Sbarouni, Eftihia, Panagiota Georgiadou, Sofia Chatzikyriakou, Antonis Analitis, Antigoni Chaidaroglou, Demitris Degiannis, and Vassilis Voudris. "Osteopontin in relation to Prognosis following Coronary Artery Bypass Graft Surgery." Disease Markers 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/1868739.
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Cardiovascular events may occur even after complete revascularization in patients with coronary artery disease. We measured preoperative osteopontin (OPN) levels in 131 consecutive patients (66.5±10years old, 117 men and 14 women) with left ventricular ejection fraction of50.7±9.2%and low logistic EuroScore (3.5±3.2%) undergoing elective Coronary Artery Bypass Grafting (CABG) surgery. Patients were prospectively followed up for a median of 12 months (range 11–24). The primary study endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, need for repeat revascularization, and hospitalization for cardiovascular events. Pre-op OPN plasma levels were 77.9 (49.5, 150.9). Patients with prior acute myocardial infarction (AMI) had significantly higher OPN levels compared to those without [131.5 (52.2, 219) versus 73.3 (45.1, 125),p=0.007]. OPN levels were positively related to EuroScore (r=0.2,p=0.031). Pre-op OPN levels did not differ between patients who had a major adverse event during follow-up compared to those with no event (p=0.209) and had no effect on the hazard of future adverse cardiac events [HR (95% CI): 1.48 (0.43–4.99),p=0.527]. The history of AMI was associated with increased risk of subsequent cardiovascular events at follow-up (p=0.02). OPN is associated with preoperative risk assessment prior to low-risk CABG but did not independently predict outcome.
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Barutçu, A., E. Tatli, F. U. Aksu, M. Aktoz, and A. Altun. "OP-252 BARE METAL STENTS VERSUS CABG IN ISOLATED OSTIAL LESIONS OF THE LAD." International Journal of Cardiology 155 (March 2012): S66. http://dx.doi.org/10.1016/s0167-5273(12)70167-5.
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Berampu, Sabirin, and Indra Alamsyah. "INCENTIVE SPIROMETRY AND DEEP BREATHING EXERCISE PREFER TO PREVENT DECREASED OF LUNG VITAL CAPASITY AS GOOD AS DEEP BREATHING EXERCISE POST CORONARY ARTERY BYPASS GRAFT PHASE I." JURNAL KEPERAWATAN DAN FISIOTERAPI (JKF) 1, no. 1 (October 15, 2018): 36–46. http://dx.doi.org/10.35451/jkf.v1i1.50.
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Coronary artery bypass graft (CABG) is a procedure to remove the blood vessels from internal mammary artery, radial artery or vein saphenus and to the surface of the heart to create a bypass in coronary artery narrowing. Data taken from the patients with heart disease from medical department of rehabilitation H.Adam Malik Medan who undergoing coronary bypass graft surgery. From 73 patients with post-cardiac surgery who were referred to the Medical Rehabilitation, 49 people were post-CABG (in 2010), and 57 people in 2011. General anesthesia, diaphragmatic dysfunction, abdominal distension, changes in chest wall, surgical wound, pleural effusion, pain and dysfunction of the respiratory muscles, may lead to reduction in lung vital capasity of up to 55% post operative. Intervention were incentive spirometry and breathing exercise. The purposes of this study is knowing whether the intervention incentive spirometry and breathing exercise can more minimize the decline in lung capasity than breathing exercise intervention only on post-CABG in phase I. Experimental research with non-probability sampling two group pre test and post test design . Subjects of group I (n = 9) receive incentive spirometry (IS) and deep breathing exercises (DBE), while group II (n=9) receive only a deep breathing exercise. Data analysis with paired samples t-test suggested the mean value of vital capasity (VC) from group I (IS and DBE) was 73.78% (pre op) after 6 days postoperatively decreased to 59.56, average decline in 14.22, P = 0.002. While the VC on group II (DBE) was 74.11 after 6 days postoperatively decreased to 55.78. Average reduction was 18, 33, p value = 0.0001. There was no significantly differences between group I and group II from statistical analysis Independent t-test, with p-value = 0.512 (p>0.05). Conclusions of this study: There was a significant effect of incentives spirometry and deep breathing exercises in preventing the decrease of lung vital capasity in post-CABG patients, There was a significant influence provision of deep breathing exercises in preventing the decrease of lung vital capasity, There were no significant differences between treatment combinations of incentive spirometry and deep breathing exercises with deep breathing exercises only in preventing the decrease of lung vital capasity in post-CABG, with a p-value = 0.512
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Gainer, Ryan A., Janet Curran, Karen J. Buth, Jennie G. David, Jean-Francois Légaré, and Gregory M. Hirsch. "Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives." Medical Decision Making 37, no. 5 (November 2, 2016): 600–610. http://dx.doi.org/10.1177/0272989x16675338.
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Objectives. Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients’ values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Methods. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. Results. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Conclusions. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.
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Farooqui, Marwah W., Samrin Samad, Brittany Blum, Yatri Desai, Sivangi Patel, Shruti Sharma, Krishnan Srinivasan, and Masood Ghouse. "A Comparison of Scoring Systems for Predicting HIT in CABG Patients." Blood 136, Supplement 1 (November 5, 2020): 12–13. http://dx.doi.org/10.1182/blood-2020-138788.
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Heparin induced thrombocytopenia is seen in patients with exposure to unfractionated heparin or low molecular weight heparin products. Surgical patients are at the highest risk for heparin induced thrombocytopenia (HIT) and patients undergoing coronary artery bypass graft (CABG) surgery have the second highest risk for developing heparin antibodies leading to HIT. Eight percent of heparin treated patients develop antibodies and 1-5% develop HIT; of these, 30-50% develop thrombosis along with the thrombocytopenia with a 20-30% morbidity and mortality rate. There are three different scoring systems typically used to determine the probability of HIT. These include the 4T score (most commonly used), HIT Expert Probability (HEP) score, and the Lillo-Le Louet (LLL) model scoring system (used exclusively for post-CABG patients). To date there have been limited studies done to compare the various scoring systems specifically in post CABG patients. The purpose of this study was to determine which scoring system was best at predicting the probability of HIT in a CABG patient. This is a single institution retrospective chart review of all patients between 2017-2019 who underwent CABG surgery. A total of 165 patients were studied and the patients who had HIT workup done were selected for further evaluation. Patient charts were reviewed to document initial platelet counts and post-CABG surgery platelet counts. Platelet counts were followed and documented for up to post-op day #15, if available. Review also included identification of new cases of arterial or venous thrombosis. For each patient that had HIT work-up, the HIT probability score was calculated by three different methods (4T score, HEP score, and LLL score). Sensitivity and specificity of the scoring systems was calculated. ANOVA test was used to determine if there was a difference between the three scoring systems and paired T-test was used to assess between the scoring systems. A total of 37 patients were studied and paired-T tests were used to compare between the scoring systems. There were a total of 6 patients with confirmed HIT based on a positive serotonin release assay (SRA) and 31 patients who had a negative work-up for HIT. The PPV of 4T, HEP, LLL was 0.545, 0.545, 0.667 respectively. Specificity was highest for LLL model: 0.912 and 0.861 for both HEP and 4T. ANOVA test determined in patients with a definitive HIT diagnosis that there was no difference among the 3 tests (p value=0.47792); however there was a difference between the scoring systems when the patients tested negative for HIT (p value= 0.00001). Furthermore, when individually comparing LLL to either 4T or HEP there was a significant difference in both true HIT and non-HIT patients p-value <0.03. These findings suggest that LLL is a better predictor of HIT in patients with CABG and it is especially superior in ruling out HIT in comparison to 4T and HEP. This further goes to support using LLL over 4T score in patients with CABG to help improve predictability of HIT. LLL is a simple calculation similar to 4T score and hence we should utilize it more often in our CABG patients. Disclosures No relevant conflicts of interest to declare.
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Kazaz, H., and M. B. Erdogan. "OP-042 Is Using Bipolar SIRFA Superior at the Pwave dispertion CABG Patients than the Medical Treatment." American Journal of Cardiology 113, no. 7 (April 2014): S18. http://dx.doi.org/10.1016/j.amjcard.2014.01.050.
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Edmonds, Harvey L., Mary H. Thomas, Samuel B. Pollock, and Paul A. Spence. "Room C, 10/16/2000 9: 00 AM - 11: 00 AM (PS) Conventional Coronary Artery Bypass Graft (CABG) Surgery Vs. Off-Pump CABG (OP-CAB): Impact of Neuromonitoring." Anesthesiology 93, no. 3A (September 1, 2000): A—296. http://dx.doi.org/10.1097/00000542-200009001-00296.
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Daci, Armond, Shaip Krasniqi, Raif Cavolli, Rame Alaj, Shpejtim Shurdhiqi, Burim Neziri, and Giangiacomo Beretta. "OP-188 [AJC » Coronary Artery Disease - CABG Surgery] Modulation of vascular Tone by Arctigenin in Human Saphenous Vein." American Journal of Cardiology 119, no. 8 (April 2017): e31. http://dx.doi.org/10.1016/j.amjcard.2017.03.110.
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Chachques, Juan C., Jorge C. Trainini, Noemi Lago, Osvaldo H. Masoli, Jose L. Barisani, Miguel Cortes-Morichetti, Olivier Schussler, and Alain Carpentier. "Myocardial Assistance by Grafting a New Bioartificial Upgraded Myocardium (MAGNUM Clinical Trial): One Year Follow-Up." Cell Transplantation 16, no. 9 (October 2007): 927–34. http://dx.doi.org/10.3727/096368907783338217.
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Cell transplantation for the regeneration of ischemic myocardium is limited by poor graft viability and low cell retention. In ischemic cardiomyopathy the extracellular matrix is deeply altered; therefore, it could be important to associate a procedure aiming at regenerating myocardial cells and restoring the extracellular matrix function. We evaluated intrainfarct cell therapy associated with a cell-seeded collagen scaffold grafted onto infarcted ventricles. In 15 patients (aged 54.2 ± 3.8 years) presenting LV postischemic myocardial scars and with indication for a single OP-CABG, autologous mononuclear bone marrow cells (BMC) were implanted during surgery in the scar. A 3D collagen type I matrix seeded with the same number of BMC was added on top of the scarred area. There was no mortality and no related adverse events (follow-up 15 ± 4.2 months). NYHA FC improved from 2.3 ± 0.5 to 1.4 ± 0.3 (p = 0.005). LV end-diastolic volume evolved from 142 ± 24 to 117 ± 21 ml (p = 0.03), and LV filling deceleration time improved from 162 ± 7 to 196 ± 8 ms (p = 0.01). Scar area thickness progressed from 6 ± 1.4 to 9 ± 1.5 mm (p = 0.005). EF improved from 25 ± 7% to 33 ± 5% (p = 0.04). Simultaneous intramyocardial injection of mononuclear bone marrow cells and fixation of a BMC-seeded matrix onto the epicardium is feasible and safe. The cell-seeded collagen matrix seems to increase the thickness of the infarct scar with viable tissues and helps to normalize cardiac wall stress in injured regions, thus limiting ventricular remodeling and improving diastolic function. Patients' improvements cannot be conclusively related to the cells and matrix due to the association of CABG. Cardiac tissue engineering seems to extend the indications and benefits of stem cell therapy in cardiology, becoming a promising way for the creation of a “bioartificial myocardium.” Efficacy and safety of this approach should be evaluated in a large randomized controlled trial.
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Mansour, S. A. S. A., M. A. E. F. El Helw, A. A. El Sebaie, H. E. El Okda, and M. M. El Fiky. "OP-144 EFFECTS OF INTRAOPERATIVE AND EARLY POSTOPERATIVE ENOXIMONE ADMINISTRATION ON THE OVERALL OUTCOME OF POOR CARDIAC FUNCTION IHD PATIENTS UNDERGOING CABG SURGERY." International Journal of Cardiology 163, no. 3 (March 2013): S57. http://dx.doi.org/10.1016/s0167-5273(13)70145-1.
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Ekim, Meral, and Hasan Ekim. "OP-083 [AJC » Coronary Artery Disease - CABG Surgery] The Frequencies of MTHFR C677T and MTHFR A1298C Polymorphisms in Patients With Coronary Artery Disease." American Journal of Cardiology 119, no. 8 (April 2017): e48. http://dx.doi.org/10.1016/j.amjcard.2017.03.146.
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Samolyk, Keith A., Scott R. Beckmann, and Randall C. Bissinger. "A new practical technique to reduce allogeneic blood exposure and hospital costs while preserving clotting factors after cardiopulmonary bypass: the Hemobag®." Perfusion 20, no. 6 (December 2005): 343–49. http://dx.doi.org/10.1191/0267659105pf831oa.
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Recent data independently linking allogeneic blood use to increased morbidity and mortality after cardiopulmonary bypass (CPB) warrants the study of new methods to employ unique and familiar technology to reduce allogeneic blood exposure. The Hemobag® allows the open-heart team to concentrate residual CPB circuit contents and return a high volume of autologous clotting factors and blood cells to the patient. Fifty patients from all candidates were arbitrarily selected to receive the Hemobag® (HB) therapy. A retrospective control group of 50 non-Hemobag® (NHB) patients were matched to the HB group patient-by-patient for comparison according to surgeon, type of procedure, age, body surface area (BSA), body weight and CPB time. Many efforts to conserve blood (Cell Saver® and ANH) were employed in both groups. Post-CPB cell washing of circuit contents was additionally employed in the control group. There were no significant differences between the HB and NHB groups in regard to patient morphology, pre-op cell concentrations, distribution of surgeon or procedures (41% valve, 16% valve/coronary artery bypass graft (CABG), balance CABG), pump and ischemic times and Bayes National Risk scores. The average volume returned to the patient from the HB was 8179/198 mL (1 SD). Average processing time was 11 min. The Hemobag®contained an average platelet count of 2309/80 K/mm3, fibrinogen concentration of 4139/171 mg/dl, total protein of 8.09/2.8 gm/dl, albumin of 4.49/1.2 gm/dl and hematocrit of 439/7%. Factor VII, IX and X levels in three HB contents averaged 259% greater than baseline. Substantial reductions were achieved in both allogeneic blood product avoidance and cost to the hospital with use of the HB. Infusion of the Hemobag® concentrate appears to recover safely substantial proteins, clotting factor and cell concentration for all types of cardiac procedures, maintaining the security of a primed circuit.
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Yüksel, Ahmet, İris İrem Kan, Atıf Yolgösteren, Yusuf Velioğlu, Mustafa Çağdaş Çayır, Gencehan Kumtepe, Murat Biçer, Mustafa Tok, and Işık Şenkaya. "OP-018 [AJC » Coronary Artery Disease - CABG Surgery] Are Really the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men?" American Journal of Cardiology 119, no. 8 (April 2017): e7-e8. http://dx.doi.org/10.1016/j.amjcard.2017.03.057.
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Feng, Yan, Desiree Carcioppolo, and Alan E. Lichtin. "Low Incidence of Thrombosis in Hemophilic Patients Undergoing Surgeries or Invasive Procedures,." Blood 118, no. 21 (November 18, 2011): 4221. http://dx.doi.org/10.1182/blood.v118.21.4221.4221.
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Abstract Abstract 4221 BACKGROUND AND OBJECTIVE: The major concern for hemophilic patients who undergo surgery is bleeding, and they usually receive factor replacement. Since surgery is a well known risk factor for venous thrombosis, non-hemophilic patients frequently receive DVT prophylaxis in post-op period. However the risk of venous thrombosis in hemophilic patients who undergo surgery is rarely studied or reported. We observed a patient with severe hemophilia B who developed extensive DVT after open heart surgery when he was receiving factor IX replacement. This prompted a retrospective chart review study to evaluate the risk of DVT in hemophilia patients who undergo surgery or invasive procedure. SUBJECTS AND METHOD: A total of 154 patients who received factor VIII or IX replacement from Feb. 1997 to June 2011 at Cleveland Clinic were identified by searching the pharmacy database. A total of 38 patients who underwent 58 elective surgeries were finally included in the analysis. Patients who had surgery for bleeding were excluded RESULTS: All patients are male, except one female hemophilic carrier. Patients' age at surgery varied from 9 months to 85 years with median age 48 years. Twenty seven patients (71%) had factor VIII deficiency with baseline level 1%-31% (median 5%, 25th to 75th 2%-12%). Eleven patients (29%) had factor IX deficiency with baseline level 2%-36% (median 5%, 25th to 75th 3%-8%). Thirteen patients had more than one surgery at Cleveland Clinic. Out of these 58 surgeries/procedures in these 38 patients, 15 were orthopedic, 10 open heart, 10 abdominal (including liver and kidney transplant), 5 neurosurgery, 2 head and neck and 16 other surgery (including 3 vascular procedures). The factor replacement duration was 1–19 days (median 8 days, 25th to 75th5 to 9 days). The median trough level was 97% (25th to 75th77% to 130%). Eighteen (31%) patients had post-op bleeding defined as requiring surgical intervention or more than 1 unit blood transfusion. One patient received subcutaneous heparin for DVT prophylaxis from day 2 after his head/neck surgery and did not experience any episodes of bleeding or DVT. Six patients (5 with open heart surgery and one with carotid endarterectomy) received aspirin post-operatively (one with clopidogrel and one with warfarin on discharge) and two of them experienced bleeding (both had mild thrombocytopenia and one had trough factor IX level 55%). One patient had one episode of TIA on the next day after total knee replacement (his trough level was 98%). Only one patient had DVT after surgery. He was a 72 year old male with hemophilia B (factor IX baseline level 5%) who underwent an open heart surgery (1 vessel CABG, mitral valve repair and pulmonary vein isolation). He did have history of renal thrombosis when he was on factor IX concentrate replacement twenty years ago. He was started with recombinant factor IX twice daily before his open heart surgery, and dose adjusted based on trough level, which was maintained near 100%. On post-op day 5, he developed an occlusive DVT extending from the right internal jugular vein to median cubital vein, where he had a temporary central line placed post-op. He was ambulatory but not on aspirin or DVT prophylaxis. He was anticoagulated with heparin which was subsequently converted to warfarin, along with factor IX infusion. He did well and was discharged home on post-op day 14. CONCLUSION: We found two thrombotic events (DVT and TIA) in this retrospective study (3.4%). Had routine prophylactic anticoagulation been given to all patients, a higher incidence of bleeding could be anticipated. This study therefore supports the position of not giving routine prophylactic anticoagulation to hemophilic patients undergoing surgery, unless there is previous history of excessive thrombosis with factor replacement. Disclosures: No relevant conflicts of interest to declare.
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Kılıcgedik, Alev, Abdulrahman Naser, Ahmet Seyfeddin Gurbuz, Seyhmus Kulahcioglu, Ruken Bengi Bakal, Tuba Unkun, Fatih Yilmaz, Gokhan Kahveci, and Cevat Kirma. "Red Cell Distribution Width with CHADS2 and CHA2DS2-VASc score is associated with Post-operative Atrial Fibrillation after Coronary Artery Bypass Grafting." Heart Surgery Forum 21, no. 3 (May 16, 2018): 170. http://dx.doi.org/10.1532/hsf.1886.
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Background: The use of the CHA2DS2-VASc scoring system and red cell distribution width (RDW) as post-op Atrial Fibrillation (POAF) predictors may be promising for the identification of patients that are at a higher risk of POAF.Methods: A total of 358 patients (57 patients with POAF, and 301 patients with non-POAF ) with sinus rhythm undergoing a coronary artery bypass graft (CABG) operation were included in the study retrospectively. Preoperative RDW levels and electrocardiograms with sinus rhythm were recorded. Patients with at least one 12-lead electrocardiogram with atrial fibrillation in the postoperative period, with or without medical or electrical cardioversion, were considered to have postoperative atrial fibrillation. A CHADS2 and CHA2DS2-VASc score was calculated for all of the patients.Results: RDW levels were significantly higher in POAF group. RDW levels were significantly correlated with CHADS2 ( r = 0.15, P = .007) and CHA2DS2-VASc (r = 0.19 P = .0001) scores. CHA2DS2-VASc scores were significantly higher in patients with POAF, whereas CHADS2 scores did not differ between groups. In multivariate analysis, left atrial diameter (LAD) (OR:2.44 [95% CI 1.16 – 5.1], P = .018), age (OR:1.04 [95% CI 1.01 – 1.08], P = .01), and RDW (OR:1.16 [95% CI 1.0 – 1.36], P = .05) were found to be predictive for POAF. The area under the receiver-operating characteristic curve of RDW was 0.65 (0.57 – 0.72, P = .0001) with 68.4% sensitivity and 51.2 % specificity to predict POAF.Conclusion: Our study showed that age, LAD, and the reduced probability of RDW are predictors of POAF, and that RDW is strongly associated with the thromboembolic risk as determined by CHADS2 and CHA2DS2-VASc scores.
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Jy, Wenche, Orlando Gomez-Marin, Tomas A. Salerno, Anthony Panos, Donald Williams, Sherry Shariatmadar, Max E. Johansen, Carlos Bidot, Lawrence L. Horstman, and Yeon-Soong Ahn. "Transfusion with Washed vs. Unwashed Packed Red Cells in Coronary Artery Bypass Graft (CABG) Surgery: Major Outcome Differences." Blood 124, no. 21 (December 6, 2014): 2887. http://dx.doi.org/10.1182/blood.v124.21.2887.2887.
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Abstract BACKGROUND: Blood transfusion (Tx) carries greater risks of adverse events (AEs) than previously appreciated. These adverse effects include higher incidence of post-surgical infections, longer hospital stay, higher mortality, more frequent serious adverse events (SAE’s), and generally poorer surgical outcomes. Accordingly, ameliorating these adverse effects constitutes an urgent challenge to medical science. Factors responsible for Tx-related adverse events (AE’s) are not well understood. Many potentially toxic substances are released during blood storage, and many of them have been implicated or postulated as culprits. Washing of packed RBC remove these products and may ameliorate transfusion-related AE’s. Benefits of washed RBC are well established for pediatric surgical patients, chiefly by preventing hyperkalemia, but use of washed RBC in adult surgical patients has not heretofore been systematically investigated. We here report results of a prospective randomized study directly comparing surgical outcomes, in terms of mortality and AE’s, between groups of adult CABG patients transfused with either washed or unwashed (conventional) RBC. METHODS: A prospective randomized study of 148 patients undergoing coronary artery bypass graft (CABG) was conducted. Fifty-eight patients were randomized to receive unwashed (conventional) RBC (UW group) and 41 to washed RBC (W group). The remaining 49 did not require Tx. The main in-hospital outcomes recorded included mortality, serious adverse events (SAE’s), non-serious adverse events (AE’s), and SOFA scores pre- and post-surgery. A telephone interview was conducted at day 30 post-discharge, and mortality at one-year was also assessed. The statistical techniques used for the comparison of the UW and W RBC groups included: independent sample t-tests for variables with normal or approximately normal distribution; Mann-Whitney tests for variables with skewed distributions and for ordinal variables; chi-squared tests or Fisher’s exact tests for discrete variables; and logistic regression model for assessing different factors as predictors of the occurrence of each kind of event. RESULTS: Between the 2 groups, demographic, clinical, and comorbidity data were similar and there was no statistically significant difference in number of serious AE’s (SAE’s). However, 4 of 6 patients died from SAE’s in the UW group but all 7of 7 with SAE in the W group survived. The in-hospital mortality was greater in the UW group (4 vs. 0, p = 0.149) but 1-year post-op mortality was significantly higher in UW group (7 vs. 0, p=0.036). Frequency of less serious AE’s was higher in UW group in every category. Negative binomial regression analyses showed that, after adjusting for comorbidities, UW-group are likely to experience 64% more AEs (p= 0.027). The 30-day follow-up showed similar trends of higher AE’s in UW-group, but only CNS-related AE’s were significant (30 vs. 5, p<0.01). CONCLUSIONS / DISCUSSION: These data suggest major benefits to patient outcomes by use of washed RBC in CABG. Most important is significant reduction of mortality. Less serious AE’s were also lower in the W group in nearly every category, but only CNS-related AE’s were statistically significant in this comparatively small patient population. To our knowledge, this is the first prospective randomized study in adults to assess possible benefits of washing RBC prior to cardiac surgery. At present, washed RBCs are seldom used in adults but the present study clearly demonstrates major advantages. It may be possible to reduce costs of washing by using on-site cell call-salvage equipment but this needs to be evaluated. This study was undertaken with the hypothesis that cell-derived microparticles (MP) are major culprits in Tx-associated AE’s. Further study is needed to determine if that hypothesis is correct. Other evidence has led us to conjecture that MP are largely responsible for post-surgical adverse outcomes; the present study is consistent with that conjecture but does not prove it. A major shortcoming of this study is the comparatively small patient population. A much larger study, including other types of surgery, is certainly warranted by these findings, and should be designed to include more quantitative evaluation of post-surgical cognitive impairment. Disclosures No relevant conflicts of interest to declare.
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Greenberg, Charles S., Caroline Dupre Vaughn, Alice Boylan, Jerry E. Squires, Sharon DeGrace, John Lazarchick, Adrian Reuben, Alan C. Finley, and Joseph Mazur. "Analyzing the Impact of Implementing a Systems-Based Hematologist into the Healthcare Delivery System at an Academic Medical Center." Blood 126, no. 23 (December 3, 2015): 4467. http://dx.doi.org/10.1182/blood.v126.23.4467.4467.
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Abstract There remains a clinical shortage of benign hematologists to manage the growing number of patients with non-malignant yet life-threatening and chronic blood diseases. The American Society of Hematology proposed creating System-Based Hematologist (SBH) positions to meet this need. The purpose of this study was to provide quantitative data regarding the impact that a SBH has on health care delivery in both the inpatient and outpatient settings. In 2011, the Department of Medicine successfully negotiated a Medical Directorship position for a SBH for the MUSC Health System. The position functions within the hospital as a part of the Medical Acute Critical Care Service Line, and the clinical service run by the SBH conducts inpatient consults daily. A benign hematology outpatient clinic was also established and is located on the hospital campus. In the years 2013-2014, clinic referrals of new patients grew 20% and the inpatient consult service grew by 38%. The SBH managed all hemophilia admissions from the emergency room and the use of recombinant blood products was reduced by an average of 35% per patient. The SBH evaluated the performance characteristics of the ROTEM instrument, recommended the instrument be purchased by the hospital for clinical use and collaborated to establish algorithms to guide replacement therapy. In CT Surgery, an anesthesiologist was trained in ROTEM and blood management who then served as the champion that implemented the ROTEM-based system for intra- and post- operative CABG care. From 2013 to 2014, we found that the use of FFP in CABG patients decreased from 25.8% to 12.7%. Platelet usage per patient dropped from 0.72 to 0.43. Cryoprecipitate decreased from 0.37 to 0.2 per patient. A ROTEM -based algorithm was also implemented to manage pre-procedure replacement therapy in patients with a coagulopathy from chronic liver disease. This protocol has led to reduction in fresh frozen plasma use from 3 units per patient to 0.4 units per patient, and has eliminated the use of pre-procedure INR correction as a target for promoting hemostasis. The ROTEM-guided algorithm resulted in safe and satisfactory outcomes for all liver disease patients requiring interventional procedures, as well as substantial cost savings. In addition, the SBH established a heparin-induced thrombocytopenia monitoring program. The EMR was specifically modified to provide guidance regarding calculating the 4T score and decision support for heparin-platelet factor 4 antibody testing and use of heparin alternatives. The SBH consults on patients that have positive heparin-platelet factor 4 assays and helps guide safe anticoagulation therapies in those patients that require treatment. Following the implementation of this program, serotonin release assays were reduced by 70% and there was also a substantial reduction in the use of direct thrombin inhibitors of 78%. Clinical outcomes in all patients today have been satisfactory with no major thrombotic complications apart from one patient that could not receive anticoagulation due to recent surgery, who fully recovered despite having DVT/PE. One patient that had a negative heparin platelet factor 4 assay became positive upon repeat testing and suffered arterial thrombosis that has resolved without any residual deficit. The SBH also educates medical students, interns, residents and fellows in the inpatient and outpatient settings. The addition of a nurse practitioner was necessary as the program has developed a rapid access anemia clinic to diagnose and treat pre-and post-op anemia. The MUSC SBH position is transitioning to play a role in a patient blood management program that will serve the entire healthcare network. In conclusion, this study documents a SBH can reduce cost of HITT management, blood product utilization in CABG and pre-procedure management of the coagulopathy in chronic liver disease as well as hemophilia management. The clinical services provided by the SBH in the clinics and outpatient setting can further enhance the education of students, residents and fellows in academic medical centers. The SBH must have the administrative support to initiate and implement programs through productive collaboration with colleagues within the health care system.The ASH program to encourage implementation of SBH positions and training should provide rewarding career opportunities for hematologists interested in non-malignant hematologic disorders. Disclosures No relevant conflicts of interest to declare.
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Keshava-Prasad, Holavanahalli, Krishna Oza, Girindra Raval, and Tamim Antakli. "Management of Intractable Bleeding after Cardiac Surgery with Recombinant Activated Factor VII." Blood 112, no. 11 (November 16, 2008): 4526. http://dx.doi.org/10.1182/blood.v112.11.4526.4526.
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Abstract Background Intractable hemorrhage is a dreaded complication after cardiovascular surgery often requiring re-exploration and the administration of large quantities of blood products. In view of problems with aprotinin, a new safer effective agent is needed. Recombinant activated FVII is approved for use in patients with hemophilia A and B who have inhibitors to factors VIII and IX, and has shown promise in off-label use for the management of life-threatening hemorrhage in several clinical scenarios including cardiac surgery. It may help control bleeding, reduce blood product usage, and avoid potential morbidity. Its exact place in the management of bleeding during and after cardiac surgery is not yet fully known. Methods. We performed a retrospective review of patients who were given recombinant factor VIIa (rFVIIa; Novoseven, NovoNordisk, Copenhagen, Denmark) to control bleeding after major cardiovascular surgery requiring cardiopulmonary bypass (CPB) at our institution. The decision to administer rFVIIa was made empirically based on the observation by the surgeons of refractory bleeding that appeared unresponsive to conventional hemostasis agents including the requirement of large volumes of blood components, and was at least severe enough to prevent chest closure. We compared blood loss and blood component usage in patients before and after rFVIIa. We also performed a detailed review of the English literature to determine the role of rFVIIa in the treatment of bleeding after cardiac surgery. Results. Between August 2002 to February 2006, 1295 patients underwent open heart surgery at our institution; of these, 28 were given Novoseven either to control intractable bleeding, or to prevent major bleeding. Table 1 shows the patient characteristics. Satisfactory hemostasis was achieved in all but 3 patients after a single 90 μg/kg intravenous dose of rFVIIa. In all patients, there was a dramatic reduction in the amount of blood components (PRBCs, Platelets and FFP) used after rFVIIa infusion (Table 2). Cryoprecipitate was administered routinely with rFVIIa and its usage did not change significantly (Table 2). No thromboembolic or other complications directly related to rVIIa occurred. Conclusions. We have demonstrated that intravenous rFVIIa is effective, safe, and valuable in the management of intractable bleeding after complicated cardiac surgeries. There are several reports and reviews in the literature which corroborate our experience and indicate that recombinant factor VIIa is a potent pro-hemostatic agent which has a role in the treatment of life-threatening refractory hemorrhage associated with cardiac surgery. Earlier preemptive administration of rFVIIa during or before surgery may be of value in patients at high risk of intractable bleeding in order to limit blood loss, and to avoid potential morbidity from large volume blood component transfusions. Randomized, controlled trials are warranted to assess the efficacy, safety, and cost-benefit of this intervention in cardiac surgical patients. TABLE 1. Characteristics and operative course of the 28 patients Mean age 60 yrs (range 22–85) Male, M 24(85%); F 4(15%) Total number of surgical procedures performed: 34 Aortic valve: 7; Bentall or modified Bentall: 9 (3 emergent) Mitral Valve Replacement: 4; CABG: 10; Redo 2 Left pneumonectomy/resection of L Atrial cuff & pericardium: 1 Removal of Inferior vena cava tumor (Renal cell ca): Re-exploration: 6; Delayed closure: 5; Both re-exploration and delayed closure: Median bypass time: 214 min (65–358) Timing of Novoseven: intra op: 21 including elective use in 2 pts; post op: 7 Dose of Novoseven: 90mcg/kg in 22; 45 mcg/kg 2 patients Responders 25(89%) Outcome: Deaths 11(38%) Autopsies: 2; no evidence of systemic thrombosis Table 2. Details of the blood products administered both before and after rFVIIa infusion. Componen Mean units Before rVIIa Mean units After rVIIa Difference; p value PRBC usage 15.9 5.033333 0.045 Platelet usage 4.448276 1.37931 0.005 FFP Usage 9.931034 5.793103 0.042 Cryoppt 21.71429 12.54167 0.091
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Walenga, Jeanine M., Takefumi Matsuo, Keiko Wanaka, Josephine Cunanan, Debra Hoppensteadt, and Jawed Fareed. "Thrombotic Biomarker Profiling Of Plasma Samples From Patients Undergoing Bypass Surgery Using Protein Chip Array." Blood 122, no. 21 (November 15, 2013): 3579. http://dx.doi.org/10.1182/blood.v122.21.3579.3579.
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Abstract Introduction Cardiovascular bypass surgical procedures, such as the coronary bypass procedure (CAP), patients are exposed to large doses of heparin and protamine sulfate. There is a high prevalence of anti-heparin platelet factor-4 antibodies in these patients. Although a fraction of these patients develop HIT syndrome, the role of circulating anti-heparin platelet factor-4 antibodies is not clear. Some of these patients may be at a high risk for post-surgical thrombotic complications. Such thrombogenic mediators as the microparticle and tissue factor, may also be up regulated in these patients. Inflammatory processes may also contribute to the overall post-thrombotic complications. The relevance of thrombotic mediators and inflammatory processes remains to be further explored in these patients. Recently protein chip array approach using SELDI/TOF mass spectrometry methods have been employed to identify the unique biomarker in various diseases. The purpose of this study was to determine the protein chip array profile and quantification of various mediators of thrombotic activation in patients who have undergone bypass surgery. Materials & Methods Plasma samples from 79 patients were collected immediately prior to and two weeks after the CAP. Protein chip array profiling was carried out on a SELDI/TOF mass spectrometric method (PCS4000, BioRad, Richmond, CA) employing a gold chip array in the molecular weight range of 3000-150,000. The intensity of unique peaks was also calculated in terms of relative intensities. Microparticles were measured using a functional method (Hyphen Biomedical, France) and tissue factor antigen levels were measured using an ELISA method. The anti-heparin platelet factor-4 antibodies were also measured using a commercially available ELISA method (Genprobe, Wisconsin). Results Of the 79 patients, 20 showed a unique biomarker peak around 11-12kDa in the pre-op samples, which was absent from normal controls. 77 of the patients showed this unique biomarker peak at one week, whereas only 48 patients exhibited at two weeks after surgery. The relative intensity of the 11.6kDa biomarker was much higher at one week (6-fold) and was decreased at two weeks (3-fold). In addition to this unique peak, other biomarker peaks were noted at 15.1 and 15.8kDa. However, these peaks were not changed at different time points. In comparison to the normal, the microparticle levels were higher at the baseline sample (10.1±3.2nM) and increased to 19.3±6.1 and 24.5±8.1nM. Similarly, the tissue factor levels were increased at three weeks’ time period. The anti-heparin platelet factor-4 titer rose 28% from the baseline at week one and 33% at week two. Conclusions The results on the biomarker profile are consistent to the earlier finding, where the presence of a unique biomarker in the range of 11-12kDa have been reported in patients with high prevalence of anti-heparin platelet factor-4 antibody. The increased level of microparticles and tissue factor at post-surgical periods of one week and two weeks suggest endogenous activation of thrombogenic mechanisms, which appears proportional to the up regulation of the anti-heparin platelet factor-4 antibodies. Thus, this data indicates that the non-functional anti-heparin platelet factor-4 antibodies may result in the activation of cellular processes leading to thrombogenesis. Further characterization of the unique biomarkers identified in these patients may be useful in understanding of the pathogenesis of inflammatory processes and their relevance to thrombogenesis in CABG patients. Clinical Implications These results indicate that the nonfunctional anti-heparin platelet factor 4 antibodies are capable of mediating inflammatory and thrombotic responses without symptomatic thrombocytopenia. Therefore, the measurement of these antibodies along with inflammatory and thrombogenic mediators may be helpful in the diagnostic and prognostic management of these patients. Disclosures: No relevant conflicts of interest to declare.
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Singh, Steve K., Nachum Nesher, Nimesh D. Desai, Elsyed Elmistekawy, Fuad Moussa, George T. Christakis, Bernard S. Goldman, et al. "Abstract 3049: Clinical Outcomes after Urgent Coronary Artery Bypass Surgery in Patients on Clopidogrel: Are the Risks Tangible or Anecdotal?" Circulation 116, suppl_16 (October 16, 2007). http://dx.doi.org/10.1161/circ.116.suppl_16.ii_683-a.
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PURPOSE : Clopidogrel is indicated in acute and chronic coronary syndromes and often administered prior to angiography. These patients are often sent subsequently for coronary artery bypass grafting (CABG) surgery, where potential increase in bleeding risk must be balanced with risk of ongoing ischemia if CABG delayed. This study aimed to test the hypothesis that patients undergoing urgent CABG who received clopidogrel, versus those who did not, have worse bleeding outcomes and early mortality. METHODS : We reviewed 451 consecutive patients (04/2005–12/2006) who underwent urgent CABG at our institution: 262 never received clopidogrel pre-CABG, 189 received clopidogrel <5 days prior. The latter all received intraoperative antifibrinolytics. The primary endpoint was in-hospital death, massive transfusion (>10U PRBC) or massive blood loss (>2L chest-tube loss/24 hrs). RESULTS : Patient characteristics were comparable between groups. Prior MI (71% vs 46%), NYHA class 3– 4 (94% vs 81%) and prior PCI (22% vs 13%) were higher in the clopidogrel group (p<0.05). Cross-clamp time was statistically higher in the clopidogrel group (97±30 vs 90±28 min, p=0.02); cardiopulmonary bypass and total operative times were similar. There was no difference in the primary endpoint of in-hospital death or massive bleeding indices (clopidogrel: 7% vs no clopidogrel: 6%, p=0.9). Death, bleeding indices, renal failure, post-op MI and stroke, were no different even after adjusting for the date of stopping clopidogrel pre-CABG. Chart audit showed bleeding as a significant contributor to cause of deaths, was no different in either cohort. After multivariable regression analysis, clopidogrel or the duration it was stopped pre-CABG, were not predictors of outcomes (death, MI, stroke or chest reopening for bleeding). Significant independent predictors of the primary endpoint included pre-op renal dysfunction, peripheral vascular disease and pre-op hemoglobin. CONCLUSION : Clopidogrel, or the time it was stopped prior to CABG, was not a risk factor for in-hospital death, massive bleeding, or other poor early outcomes in patients undergoing urgent CABG. Practice measures such as the use of antifibrinolytic agents may ameliorate the adverse effects of clopidogrel.
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"OP CABG surgery: good short-term outcomes, increased risk for subsequent revascularization." Nature Clinical Practice Cardiovascular Medicine 4, no. 12 (December 2007): 642. http://dx.doi.org/10.1038/ncpcardio1025.
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Omran, H., M. A. Deutsch, E. Groezinger, A. Renner, J. Neumann, D. Westermann, W. Scholtz, et al. "Usefulness of troponin in selecting patients for invasive coronary angiography after cardiac surgery." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.1667.
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Abstract Background Great uncertainty exists about the indication for invasive coronary angiography (ICA) in patients with suspected acute coronary syndrome following cardiac surgery. Aim The aim of this study was to define clinical criteria that best identify patients who benefit from ICA after cardiac surgery. Methods We performed a retrospective analysis of all patients who underwent cardiac surgery between January 2009 and May 2019 at our center. Exclusion criteria included pediatric patients as well as pacemaker, TAVR and LVAD implantation and heart transplantation procedures. The primary outcome was usefulness of ICA as defined by consequent PCI or re-operation due to ICA findings. ECG changes (ST-elevations) and high-sensitivity Troponin I (hsTrop I) were analyzed. Results 48,136 patients were screened and after applying exclusion criteria 29,359 patients were finally included in the analysis (mean age 67.8±11.0 years, 31.1% females, Euroscore II 5.14±8.9%). A total of 1,171 patients (4%) underwent post-op ICA. The primary outcome occurred in 440 patients (1.5%) of which 290 underwent consequent PCI and 214 underwent consequent re-operation. Baseline characteristics are shown in table 1. Unadjusted analyses did not identify significant differences in the level of cardiac biomarkers between useful-ICA and unuseful-ICA groups. In multivariate regression analysis, only ST-elevation on ECG predicted the primary outcome (OR 1.33, 95% CI 1.003–1.76). Dichotomizing hsTrop I concentrations by applying the guideline-specified cut-off (>70x URL) resulted in correct classification of useful-ICA patients in 95.7%. However, the false-positive rate was also extremely high (83.6%) with a positive predictive value (PPV) of 1.6% and a negative predictive value (NPV) of 99.6% (accuracy 17.5%). Using area under the curve (ROC) analysis following optimal cut-off values for hsTrop I were identified: in CABG patients a cut-off value of >650x URL (corresponding absolute value 17000 ng/L) was defined with a corresponding sensitivity of 83.3%, specificity of 83.6%, PPV of 8.9% and NPV of 99.6% (accuracy 83.6%). In non-CABG patients (i.e. valve or aortic procedures), the cut-off was about twice as high as that for CABG patients (1,350x URL or 35,000 ng/L) with a corresponding sensitivity of 84.1%, specificity of 89.2%, PPV of 5.9% and NPV of 99.9% (accuracy 89.1%). Conclusion Our study demonstrates that currently recommended cut-off concentrations of high-sensitivity troponin are not useful for guiding clinical decision-making in patients with suspected acute coronary syndrome following cardiac surgery, while substantially higher cut-off values might be useful. Those cut-off values critically depend on the type of cardiac surgery performed (CABG vs. non-CABG). Troponin_Curves post-op Funding Acknowledgement Type of funding source: None
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Awan, Nabil Iftikhar, Azam Jan, Mujeeb Ur Rehman, and Narmeen Ayaz. "The effect of ejection fraction on mortality in Coronary Artery Bypass Grafting (CABG) patients." Pakistan Journal of Medical Sciences 36, no. 7 (October 14, 2020). http://dx.doi.org/10.12669/pjms.36.7.3266.
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Background and Objectives: Patients with low ejection fraction undergoing isolated CABG surgery are at a higher risk for postoperative complications and mortality. This study was conducted to evaluate the impact of ejection fraction on the outcome of isolated Coronary Artery Bypass Grafting (CABG).
Methods: Between July, 2017 to May, 2019 total 1214 patients underwent isolated CABG. Patients were divided into three groups based on their pre-operative Ejection Fraction (EF). Group-I included 625 patients with EF >50% [Normal EF], Group-II included 484 patients with EF 35-50% [Mild to Moderately Reduced EF], and Group 3 included 105 patients with EF <35% [Severely Reduced EF].
Results: The mean age of Group-I was 57.58 ± 9.206, Group-II was 58.38±9.124 and Group-III was 58.81± 8.663.The male gender was the predominant gender in all three groups: 194(41.1%) in Group-I, 201(52.6%) in Gp2, 52 (61.9%) in Group-III. 231(36.9) patients in Group-I, 234(48.3)in Group-II and 59(56.2) in Group-III had raised creatinine pre operatively. 5(0.8%) patients in Group-I, 2(0.4%) in Group-II and 3(2.9%) in Group-III had history of CVA. Hypertension was present in approximately 60% of all our patients. In the per-operative period 20(3.2%) patients in Group-I required an IABP as compared to 73(15.1%) in Group-II and 41(39.0%) in Group-III. The mean post-operative mortality in Group-I was 19 (3%), Group-II was 24(5.0%) and low EF group was 9(8.6%).
Conclusions: The results clearly indicate that worsening pre-operative ejection fraction is associated with a higher mortality post-operatively in patients undergoing isolated CABG. In addition, use of IABP increases as pre-operative LVEF decreases.
Definitions: *PERFUSION TIME: total time on CPB machine. *CROSS CLAMP TIME: Total time that ascending aorta was CROSS clamped. *STROKE: Defined as presence of neurological deficit, findings on CT scan and confirmed by a Neurology consultant. *RE-OP: Re-operation during index admission.
doi: https://doi.org/10.12669/pjms.36.7.3266
How to cite this:Awan NI, Jan A, Mujeeb-Ur-Rehman, Ayaz N. The effect of ejection fraction on mortality in Coronary Artery Bypass Grafting (CABG) patients. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.3266
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hoegh, Holly, Robert Springborn, Limin Wang, and Christopher Krawczyk. "Abstract 133: Using Administrative Data Registries and Clinical Data Registries to Identify Discrepancies and Improve Data Quality." Circulation: Cardiovascular Quality and Outcomes 11, suppl_1 (April 2018). http://dx.doi.org/10.1161/circoutcomes.11.suppl_1.133.
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Background: The California (CA) Office of Statewide Health Planning and Development (OSHPD) collects three types of patient-level administrative data: patient discharge (PDD), ambulatory surgery (AS), and emergency room (ER). CA hospitals are mandated to submit clinical data to OSHPD for all adult coronary artery bypass graft (CABG) surgeries. This submission is usually a subset of hospital’s Society of Thoracic Surgeons Adult Cardiac Surgery Database submissions. In addition, OSHPD receives clinical data from the National Cardiac Data Registry CathPCI for CA hospitals certified to perform elective PCIs without onsite surgery available. OSHPD implements various data quality efforts to ensure accuracy in each data source, including using data from administrative registries to confirm clinical data and using data from clinical registries to confirm administrative data. Methods: The clinical CABG data submitted to OSHPD is linked to the PDD. The resulting discrepancy reports are shared with hospitals to assist them when revising their data. The reports show discrepancies in over- and under-reporting of CABG cases, isolated and non-isolated CABGs, and post-op complications. For PCI reporting, clinical data from the CathPCI registry is compared to the PDD, AS, and ER to look for discrepancies. Results: For the 2016 CABG data, discrepancy reports issued to 126 hospitals submitting clinical CABG data to OSHPD showed potential under-reporting of 417 CABGs that appeared in the PDD but were not submitted in the clinical data. The report showed an additional 437 CABGs that were submitted in the clinical data, but did not appear in the PDD. Hospital review and response to these reports resulted in an overall increase of 296 CABGs to the clinical database. Discrepancy reports also alerted hospitals to 66 cases where a post-operative stroke occurred but was not reported in the clinical database. Hospital review resulted in 22 post-operative strokes added to the clinical registry. The 2016 CathPCI data for CA certified elective PCI hospitals showed potential under reporting of PCIs in PDD, AS, and ER. Possible missing PCIs ranged from 0.4% to 21.6% per hospital. OSHPD worked with staff at the clinical data and administrative data units at these hospitals to understand the discrepancies. The main issue identified was that AS data submitted by some hospitals used alternate coding (Healthcare Common Procedure Coding System) and failed to convert these codes to Current Procedural Terminology codes as required. The findings plan to be used in an outreach effort to all CA hospital submitting administrative PCI data to OSHPD to ensure accurate reporting. Conclusion: Comparing administrative and clinical data registries data is an effective quality tool to identify discrepancies in each source of data. Sharing discrepancies with hospitals results in improved understanding of data standards and data quality.
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Gainer, Ryan, Karen Buth, Jennie David, Rose Garson, Hani Mufti, and Greg Hirsch. "Abstract 276: A Qualitative Analysis of Shared Decision Making in Cardiac Surgery." Circulation: Cardiovascular Quality and Outcomes 6, suppl_1 (May 2013). http://dx.doi.org/10.1161/circoutcomes.6.suppl_1.a276.
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OBJECTIVES Comprehension of risks, benefits, and alternative treatment options is poor among patients referred for cardiac interventions. We have previously demonstrated that frail, elderly patients undergoing cardiac surgery require complex procedures and are at markedly increased risk of postoperative death and prolonged institutional care. An effective informed consent process is critical in this population. We suggest this vulnerable patient population may benefit from the institution of a formalized shared decision making (SDM) process. METHODS Three focus groups were convened for CABG, Valve, or CABG +Valve patients over 70 who were either within two years post-op, within 4-8 weeks post-op or had had a complicated post-operative course. Two focus groups were convened for the caretaker group: IMCU nurses & ICU nurses and surgeons, anesthesiologists & cardiac intensivists. In a semi-structured interview format, groups were asked questions regarding personal experience with informed consent, comprehension of discussions prior to surgery, potential improvements to the consent process, and SDM in cardiac surgery. Transcribed audio data was analyzed to develop consistent and comprehensive themes. RESULTS Patient groups were supportive of changing standard consent by including patient-specific risk factors through graphics, reduced language complexity and increased font size as means to improve comprehension and discussion. Patient groups felt access to this information earlier on in their care would allow time to identify personal values and desires for treatment. Both care provider groups supported a consent process that would provide patients with information earlier through decisional aids presented in a structured SDM process. All groups were supportive of a dedicated RN employed as a decisional coach to meet with patients and families prior to surgery to discuss their values, concerns, and questions to facilitate SDM with the care team. CONCLUSIONS Data from these groups will aid in the development of decision aids that serve to educate patients about their disease, the procedure proposed, and its risks and alternatives. Utilizing validated risk prediction models from our own experience allows us to provide patient specific risks for in-hospital mortality, major morbidity, and prolonged institutional care as well as long term outcomes freedom from mortality and re-hospitalization for cardiac cause.
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SHAH, Sayed Mumtaz Anwar, AZAM JAN, Nabil I. Awan, and Mujeeb Ur Rehman. "The Characteristics, morbidity and mortality factors associated with Intra-Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery patients." Pakistan Journal of Medical Sciences 36, no. 6 (July 23, 2020). http://dx.doi.org/10.12669/pjms.36.6.2649.
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Objective: The aim of our study is to analyze the characteristics, morbidity and mortality of patients requiring an Intra-Aortic Balloon Pump (IABP) in Coronary Artery Bypass Grafting (CABG).
Methods: An analysis was done on the prospectively collected data of 1216 patients who had CABG in our center between July, 2017 and May, 2019 at our hospital. We categorized patients in to an IABP and non-IABP group on the basis of IABP use. We then compared the pre-operative, per-operative and post-operative characteristics of the two groups. We further stratified the patients according to pre-op ejection fraction (EF).
Results: Out of 1216 patients, 135(11.10%) patients required an IABP. 70(51.9%) patients of IABP group and 699(64.7%) patients of non-IABP group had hypertension (p-value 0.0036). 23.0% had previous myocardial infarction (MI) in the IABP group and 13.8% had prior myocardial infarction (MI) in non-IABP group (p-value 0.0463). Among the patients requiring an IABP, 21(15.5%) of patients had normal EF (>50%) (P-value<0.0001), 72 (53.3%) had EF 35-50%, and 41(30.3%) patients had EF<35% (p-value <0.0001). Mortality of IABP group (19.3%) was greater than non-IABP group (2.4%) (P-value 0.00001).
Conclusions: Use of IABP increased as the EF decreased. Rate of post-operative stroke, prolonged ICU stay, prolonged ventilation, re-opening due to bleeding and mortality was seen to be significantly higher in the IABP group.
doi: https://doi.org/10.12669/pjms.36.6.2649
How to cite this:Shah SMA, Awan NI, Jan A, Rehman MU. Characteristics, morbidity and mortality factors associated with Intra-Aortic Balloon Pump in Coronary Artery Bypass Graft Surgery patients. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2649
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Chachques, Juan, Jorge Trainini, Miguel Cortes-Morichetti, Olivier Schussler, and Alain Carpentier. "Abstract 1861: Myocardial Assistance by Grafting a New Bioartificial Upgraded Myocardium (MAGNUM Clinical Trial): One Year Outcome." Circulation 116, suppl_16 (October 16, 2007). http://dx.doi.org/10.1161/circ.116.suppl_16.ii_398-a.
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Objectives Cell transplantation for myocardial regeneration is limited by poor graft viability and low cell retention. In addition, in ischemic cardiomyopathy the extracellular matrix is deeply altered. Therefore it could be important to associate a procedure aiming at regenerating myocardial cells and restoring the extracellular matrix function. We evaluated intrainfarct stem cell therapy associated with a cell-seeded collagen scaffold grafted onto infarcted ventricles. Methods In 15 patients (aged 54.2±3.8 years) presenting LV postischemic myocardial scars (age of the infarcts 8.2±3.5 months) and with indication for a single OP-CABG, bone marrow was collected by aspiration from the iliac crest. The cell suspension was loaded on Ficoll-Paque density gradient and 300 ± 28 million mononuclear bone marrow cells (BMC) were implanted during surgery in the scar. A type I collagen matrix seeded with the same number of BMC (300 ± 28 million cells) was added on top of the scarred area and fixed onto the epicardium by 6 single PDS sutures and covered by a second non-cellularized matrix. Results There was no mortality and any related adverse events (follow-up 15±4.2 months), no malignant cardiac arrhythmias were reported, no patient was lost to follow-up. NYHA FC improved from 2.3±0.5 to 1.4±0.3 (p=0.005). LV end-diastolic volume evolved from 142±24 to 117±21mL (p=0.03), LV filling deceleration time improved from 162±7ms to 196±8ms (p=0.01). Scar area thickness progress from 6±1.4 to 9±1.5mm (p=0.005). EF improved from 25±7 to 33±5% (p=0.04). Conclusions Simultaneous intramyocardial injection of BMC and fixation of a cell seeded matrix onto the epicardium is feasible and safe. The cell seeded collagen matrix seems to increase the thickness of the infarct scar with viable tissues and help to normalize cardiac wall stress in injured regions, thus limiting ventricular remodelling and improving diastolic function. Functional improvements can not be conclusively related to the cells and matrix due to the association of CABG. Cardiac tissue engineering seems to be a promising way for the creation of “bioartificial myocardium”. Efficacy and safety of this approach should be evaluated in a large randomized controlled trial.
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Erglis, A., G. Latkovskis, D. Krievins, S. Jegere, I. Kumsars, E. Zellans, M. Gedins, et al. "P6172Management of silent myocardial ischemia in patients with peripheral arterial disease needing surgery." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz746.0778.
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Abstract Background Patients with peripheral arterial disease (PAD) needing surgery have increased risk for post-operative myocardial infarction (MI)/death due to coexisting coronary artery disease (CAD). Coronary CT angiography (CTA)-derived fractional flow reserve (FFRCT) can reliably identify ischemia-producing coronary stenosis in patients with suspected CAD but its value in PAD patients is unknown. Purpose To determine the prevalence of silent coronary ischemia in PAD patients undergoing surgery and to assess the value of FFRCT in guiding management of patients with multisite arterial ischemia. Methods Patients admitted for elective carotid, aortic or peripheral vascular surgery with no cardiac history or CAD symptoms were enrolled in a prospective, open-label, ethics committee-approved study and underwent pre-op CTA and FFRCT evaluation with results available to treating physicians. Ischemia-producing coronary stenosis was defined as FFRCT≤0.80 distal to stenosis in >2mm diameter vessels. Patient management was guided by a multidisciplinary team of cardiologists, cardiovascular surgeons and anaesthesiologists. Primary endpoint was major adverse cardiac events (MACE= cardiac death, MI, urgent revasc) at 30 days with follow up at 3,6,12 months. Results Coronary CTA and FFRCT analysis was performed in 179 consecutive patients (age 66±8 years, male 78%, hypertension 79%, diabetes 10%, dyslipidemia 31%, smoking 37%). CTA revealed extensive coronary calcification (Agatston score 995±1004, range 0–4810) and ≥50% stenosis in 64% of patients. Ischemic coronary stenosis (FFRCT≤0.80) was present in 114 patients (64%) with FFRCT ≤0.75 in 97 (54%) and multivessel ischemia in 63 (35%). Clinically indicated vascular surgery was performed as planned in 170/179 patients (95%) with cardiac anaesthesia and close monitoring and postponed in 9 patients for coronary revascularization (3) or medical/other therapy (6). There were no post-op cardiac complications. Elective coronary angiography, performed 1–3 months post surgery in 86 patients with left main, severe or multivessel ischemia, confirmed significant stenosis in each patient with revascularization in 58 patients (53 PCI and 5 CABG) including 8 for LM disease. There have been no cardiovascular deaths; 3 patients have died of lung cancer which was first discovered on CTA. One patient had peri-procedural MI at time of PCI and one had MI and urgent PCI at 6 months. MACE at 30 days=0/179, 3 months = 1/154, 6 months=2/123, 12 months=0/65. Conclusions Patients undergoing elective PAD surgery have a high prevalence (64%) of unsuspected ischemia-producing coronary stenosis. Pre-op diagnosis with CTA- FFRCT can help guide a multidisciplinary team approach with optimum medical management and staged peripheral and coronary revascularization. Favourable early results are promising and suggest the need for prospective controlled studies to define the role of coronary revascularization in PAD patients. Acknowledgement/Funding Heartflow, Inc.; Mikrotikls Ltd
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Carvalho Mendonca, T. J., C. Strong, D. Roque, L. Morais, J. P. Reis, P. M. Daniel, P. Abreu, et al. "P3628Contemporary coronary artery disease prevalence in a valvular heart disease population undergoing surgery." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz745.0486.
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Abstract Background Patients undergoing heart valve surgery are routinely evaluated for the presence of Coronary Artery Disease (CAD), with the standard practice of combining valve intervention with a revascularization procedure, notably Coronary Artery Bypass Graft (CABG). Older studies suggest rates as high as 50% prevalence of CAD in this population. However, CAD prevalence, its treatment and prognostic implication has been questioned recently. Objectives The goal of this study is to evaluate the baseline characteristics, prevalence of CAD and treatment strategies in a contemporary population with valvular heart disease (VHD) referred for valve surgery. Methods In a national multicentre registry, consecutive patients, from Jan 2015 to Dec 2016, with a formal indication for heart valve surgery referred for a pre-op routine coronary angiogram were systematically analysed. Baseline characteristics, valve pathology and CAD prevalence and patterns were determined. Obstructive CAD was defined as luminal angiographic stenosis ≥70% (≥50% for left main artery). The prognostic impact of the different valve disease and CAD treatment strategies were assessed. Results 1175 patients (mean age 72.5±10.1; male 49.2%) fulfilled the clinical or echocardiographic indication for valve surgery by European guidelines. Valvular disease prevalence was: aortic stenosis (66.7%), aortic regurgitation (6.6%), mitral stenosis (6%), mitral regurgitation (19.2%), tricuspid regurgitation (7.5%). Mean follow-up time was 29.06±18.46 months. Prevalence of comorbidities was: Diabetes Mellitus (DM) 26%, chronic obstructive pulmonary disease (COPD) 5.7% and chronic kidney disease (CKD) 23.4%. Mean Euroscore II was 2.6%. Obstructive CAD was present in 27.3% patients. Mean Syntax score was 10.2 (<22 in 88%, 23–32 in 10.2% and >33 in 1.8%). Left main artery and 3-vessel disease were found in 13.1% and 11.8% of patients with CAD, respectively. Valvular surgery was ultimately performed in 80.3%. In patients with CAD, 57.3% were revascularized. All-cause mortality rate during follow-up was 12.9%, with 7.8% from cardiovascular causes. In univariate analysis DM, COPD, CKD, NYHA class, obstructive CAD and no surgery (p<0.05) were associate with mortality on follow up. In multivariate analysis obstructive CAD (OR 2.36, 95% CI 1.53–3.65, p<0.01) and no surgery (OR 6.05, 95% CI 3.95–9.30, p<0.01) persisted as independent all-cause mortality predictors. Conclusion In a contemporary cohort of patients with VHD and surgical indication, CAD prevalence is lower (27.3%) than described in literature. Mortality rates were higher in patients with obstructive CAD, worse NYHA functional class and in those who never underwent surgery.