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Background: Often, only saphenous vein grafts (SVGs) are used in emergent coronary artery bypass graft (CABG) procedures to provide quicker myocardial revascularization despite its lower long-term patency relative to the internal mammary artery (IMA) grafts. We examined differences between IMA and non-IMA graft recipients in emergent CABGs and its impact on in-hospital outcomes., Methods: Retrospective review of Society of Thoracic Surgeon National Database was done to identify patients age ≥18 years undergoing primary emergent isolated CABG between 2013 and 2016. Emergent salvage, non-LAD disease, subclavian stenosis and revascularization with other arterial grafts were excluded. The study population was divided in two groups: IMA and non-IMA groups. Demographics, preoperative, intraoperative factors and postoperative outcomes were analyzed between the groups., Results: Of 18,280 emergent CABGs during the study period, 16281 had IMA used and 1999 had only vein grafts. The IMA group was younger, more likely to be male, had lower creatinine and higher ejection fraction. The non-IMA and IMA groups were then propensity risk matched with ratio of 1:2 which showed significantly higher in-hospital mortality in the non-IMA group (15% vs. 7%, P<0.0001). The non-IMA groups also had higher rates bleeding (5% vs. 3%, P<0.01), renal failure (10% vs.6%, P<0.0001) and prolonged vent (44% vs. 30%, P<0.0001)., Conclusions: IMA grafts in primary isolated emergent CABGs are associated with significantly lower rates of in-hospital mortality. Even for emergent CABG there may be a clinical benefit in using IMA grafts rather than SVGs only.

Background: Reoperative coronary artery bypass grafting (redo-CABG) has declined during the last decade, while use of percutaneous coronary intervention (PCI) has increased. The aim of this retrospective study was to evaluate risk factors, in-hospital mortality, and long-term survival between first-time CABG and redo-CABG., Methods: From January 2009 to December 2015, 2,581 patients underwent first-time CABG procedures while 132 underwent isolated redo-CABG. Logistic regression was used to identify risk factors predictive of redo-CABG and after propensity matching the in-hospital morbidity and long-term all-cause mortality were compared., Results: Risk factors for redo-CABG were prior PCI, dyslipidaemia, diabetes and hypertension. After propensity matching there were no significant differences between the redo-CABG (n = 126) and first-time CABG groups (n = 232) in baseline characteristics. The adjusted in-hospital mortality was 3.1% for redo-CABG and 2.1% for first-time CABG (p = 0.55). Redo-CABG required significantly more intraoperative red blood cells (p = 0.03), platelets (p < 0.001), cryoprecipitate (p < 0.007) and fresh frozen plasma (p < 0.001) than first-time CABG. There was no significant difference in reoperation for bleeding (p = 0.72), prolonged ventilation (p = 0.98), postoperative stroke (p = 0.92) or dialysis (p = 0.44). The survival at 1, 3 and 5 years for redo-CABG was 93.5%, 90%, and 85% respectively, and 95.5%, 94.5%, 93% for first-time CABG, respectively (p = 0.2)., Conclusions: Prior PCI after first time CABG and the risk factors for atherosclerotic disease are predictive for redo-CABG. An increased use of blood products is required during redo-CABG. After propensity matching, in-hospital mortality and long-term survival for redo-CABG is comparable to first-time operation. Re-sternotomy does not impact the survival in redo-CABG., (Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Emergency coronary artery bypass grafting (CABG) is associated with increased in-hospital mortality rates and adverse events. This study retrospectively evaluated indications and outcomes in patients who underwent emergency CABG. The Society of Thoracic Surgeons database for a single center (Jewish Hospital) was queried to identify patients undergoing isolated CABG. Univariate analysis was performed. From January 2003 through December 2013, 5,940 patients underwent CABG; 212 presented with emergency status. A high proportion of female patients (28.2%) underwent emergency surgery. Emergency CABG patients experienced high rates of intra-aortic balloon pump support, bleeding, dialysis, in-hospital death, and prolonged length of stay. The proportion of emergency coronary artery bypass grafting declined during years 2008-2013 compared with 2003-2007 (2.2% vs. 4.5%, P < 0.001), but the incidence of angiographic accident (5.3% vs. 29.2%) increased as an indication. Ongoing ischemia remains the most frequent indication for emergency CABG, yet the incidence of angiographic accident has greatly increased. In-hospital mortality rates and adverse events remain high. If we look specifically at emergency CABG cases arising from angiographic accident, we find that 14 (15%) of all 93 emergency CABG deaths occurred in that subset of patients. Efforts to improve outcomes should therefore be focused on this high-risk group.

Background: Perioperative red blood cell transfusion is a risk factor for postoperative mortality and morbidity in coronary artery bypass grafting (CABG). Females have a higher risk of red blood cell transfusion, but few previous studies have accounted for preoperative hematocrit and female sex together as risk factors for red blood cell transfusion. We evaluated female sex as an independent risk factor for red blood cell transfusion in CABG, while accounting for hematocrit., Study Design: A cardiac surgery database was reviewed for isolated, primary, first-time CABG operations from a single center from January 2005 to June 2009. Demographic and clinical variables were evaluated as risk factors of red blood cell transfusion using univariate (Student t-test and chi-square test) and multivariate (logistic regression) analyses., Results: Of 2,107 patients (ALL-patients) reviewed, 640 had known hematocrit (KNOWN-Hct). Women had lower hematocrit (35.77% ± 4.07% vs 40.06% ± 4.79% for men). On multivariate analysis of ALL-patients, older age, smaller body surface area, and female sex were risk factors; higher ejection fraction and off-pump surgery were associated with less red blood cell transfusion. On multivariate analysis of KNOWN-Hct, older age, lower hematocrit, smaller body surface area, and lower ejection fraction were risk factors of red blood cell transfusion and sex was not a significant risk factor in this group., Conclusions: Female sex is not an independent risk factor for red blood cell transfusion in CABG when preoperative hematocrit is included as a covariate in a multivariable model. A lower hematocrit could explain some of the sex-specific disparities in outcomes after CABG and should be included in future analyses., (Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Porcine bioprosthesis (bioroots) are an attractive surgical strategy for ascending aorta and arch replacement. This study evaluated the perioperative and late outcomes using this strategy for proximal aortic aneurysmal disease. Methods: Between March 1998 and November 2009, 170 patients (40% women; median age, 70 years) underwent proximal thoracic aortic replacement using the Freestyle (Medtronics Inc, Minneapolis, MN) bioroot, with graft extension in 149 (87.6%). Aneurysmal etiology included degenerative-atherosclerotic (91.2%), acute dissection (5.3%), and chronic dissection (3.5%); 78% had greater than moderate aortic insufficiency. Surgical procedures were bioroot alone or with aortoplasty (12.3%), bioroot with ascending aortic graft (38.2%), bioroot with hemiarch graft (44.1%), and bioroot with total arch (5.3%). Hypothermic circulatory arrest was required in 49%. Results: The 30-day mortality was 4.7% (n = 8). The overall complication rate was 58% (n = 100), including stroke (6.5%), renal failure (9.2%), respiratory failure (25.9%), and postoperative bleeding (7.6%). Mean hospitalization was 10.5 ± 7.3 days; 38 were discharged to a rehabilitation facility (23.5%). Predictors of 30-day/hospital death were coronary artery disease (p = 0.0003), renal insufficiency (p < 0.0001), emergent/urgent procedure (p = 0.02), and hypothermic circulatory arrest (p = 0.002). The 1-year, 5-year, and 10-year survivals were 90%, 80%, and 35% respectively. Freedom from endocarditis and reoperation was 96% at 1 year and 94% and 95% at 5 years, respectively. Conclusions: Proximal thoracic aortic replacement using a porcine bioroot as part of the repair can be achieved with low perioperative mortality and acceptable late survival in a predominantly elderly population. [ABSTRACT FROM AUTHOR]