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Purpose: To compare the effects of myotomy and bypass surgery for treating myocardial bridges (MBs) over the left anterior descending artery (LAD) in a single-center observation study., Methods: Fifty-four eligible patients (34 males, median age of 60 years old) with symptomatic LAD-MBs who underwent myotomy (31 patients) or bypass surgery (23 patients) were included in this study. The primary endpoints were the occurrence of major adverse cardiac events (MACEs) and angiographic demonstration of adverse angiographic results., Results: No surgical death was observed. During a median follow-up of 26 months, 11 patients developed MACEs (7.4% for myotomy vs. 40.9% for bypass surgery, p = 0.007). Surgical strategy (bypass surgery vs. myotomy) was an independent risk factor for MACEs (odds ratio = 3.681, 95% confidence interval 1.814-8.685, p = 0.011). Myotomy compared with bypass surgery had a significantly lower incidence of adverse angiographic results (3.7% of residual compression vs. 40.9% of LIMA graft failure, p = 0.003). Among ten patients suffering from LAD-MBs with concomitant proximal coronary stenosis who underwent bypass surgery, only one reported transient recurrent exertional chest pain, and all LIMA grafts were patent., Conclusions: Myotomy of symptomatic LAD-MBs may be associated with encouraging midterm results. Bypass surgery may be recommended for treating symptomatic LAD-MBs with concomitant proximal coronary stenosis.

This single-center study aimed to evaluate the incidence of deep sternal wound infection (DSWI) following skeletonized bilateral internal mammary artery (BIMA) harvest in a Chinese cohort. Using propensity score matching, this study also provided a present-day assessment of the impacts of skeletonized BIMA grafting versus skeletonized single internal mammary artery (SIMA) grafting on early outcomes.From January 2014 to December 2017, 2403 eligible patients were entered into either a BIMA group (n = 368) or a SIMA group (n = 2035). The incidence of DSWI was recorded. Analysis of early outcomes was further performed for propensity score-matched (1:1) cohorts.The BIMA group received a similar incidence of DSWI as did the SIMA group (1.6% versus 0.9%, P = 0.247). No significant differences between subgroup diabetic-BIMA, subgroup nondiabetic-BIMA, subgroup diabetic-SIMA, and subgroup nondiabetic-SIMA were found regarding the incidence of DSWI (2.0%, 1.4%, 1.0%, and 0.7%, respectively; P > 0.05 between groups). After matching, treatment type (skeletonized BIMA grafting versus skeletonized SIMA grafting) was not an independent risk factor for postoperative DSWI (OR = 1.309, 95% CI 0.897-2.714, P = 0.704) or predictors of other early outcomes. Additionally, the two matched groups shared similar early outcomes (including postoperative DSWI), regardless of whether or not the merger with diabetes (all P > 0.05).Skeletonized BIMA harvest as compared with skeletonized SIMA harvest was not associated with an increased risk of DSWI, regardless of whether or not the merger with diabetes. Patients with skeletonized BIMA grafting received similar surgical mortality and major postoperative morbidity as did matched patients with skeletonized SIMA grafting.

Few reports have focused on which patients with moderate ischemic mitral regurgitation (IMR) were not good candidates for coronary artery bypass grafting (CABG) alone. This single-center study aimed to assess risk factors for moderate or more residual regurgitation within two years after CABG alone for the treatment of moderate chronic IMR to optimize the operation strategy and prognosis.A total of 189 eligible patients were entered into a failure group (n = 108) or an improved group (n = 81) according to whether moderate or more residual regurgitation occurred within two years after surgery. Baseline and surgical characteristics were analyzed, and clinical outcomes were compared between groups.Prior myocardial infarction (MI)/chronic myocardial ischemia and region wall motion abnormality (anterior/inferior-posterior wall) were two independent risk factors for moderate or more residual regurgitation, following CABG alone, for the treatment of moderate chronic IMR (OR = 3.15, 95% CI 1.66-5.75, and OR = 2.45, 95% CI 1.36-4.84, respectively). During a median follow-up of 40 months, compared with the improved group, the failure group was more likely to present with New York Heart Association (NYHA) class III-IV and cardiac re-hospitalization (57.4% versus 11.1%, P < 0.001, and 13.9% versus 4.9%, P = 0.043, respectively) and had worse cumulative survival (χ 2 = 4.259, log-rank P = 0.039).Patients suffering from moderate chronic IMR secondary to prior MI (rather than chronic ischemia) with anterior wall motion abnormalities (rather than inferior-posterior wall motion abnormalities) may not be good candidates for CABG alone, and may have a poor prognosis after CABG alone.

The benefits of concomitant mitral valve procedure (MVP) for treating moderate chronic ischemic mitral regurgitation (IMR) during coronary artery bypass grafting (CABG) have not been clearly established. This study aimed to determine the incidence of moderate or more residual mitral regurgitation (MR) following CABG plus MVP for moderate chronic IMR, and to evaluate the impacts of concomitant MVP vs. CABG alone on clinical outcomes based on propensity-matched data.All eligible patients were entered into either the MVP group (CABG plus MVP, n = 184) or CABG group (CABG alone, n = 162). Moderate or more residual MR rate was investigated, and in-hospital and follow-up outcomes between the groups were compared after matching.Moderate or more residual MR rate was 11.4% at 1 year and 22.9% at 2 years after CABG plus MVP, respectively. Patients in the MVP group as compared with the CABG group had significantly lower moderate or more residual MR rates at various postoperative time points (all P < 0.001). Grouping was not an independent risk factor for in-hospital adverse events in multivariate logistic regression analysis. Also, grouping was a significant variable related to moderate or more residual MR rate and NYHA class III-IV at the latest follow-up in Cox regression analysis (HR = 0.391, 95% CI 0.114-0.628; HR = 0.419, 95% CI 0.233-0.819, respectively).Concomitant MVP as compared with CABG alone for treating moderate chronic IMR was associated with a reduction in moderate or more residual MR rate and an improvement in NYHA functional status, with no increase in in-hospital adverse events or follow-up death.

Background: Circulating microRNAs (miRs) may act as diagnostic and prognostic biomarkers for cardiovascular events in coronary artery bypass graft (CABG) surgery patients. This study measured changes in cardiac- and muscle-related miRs and cardiac and inflammatory biomarkers in acute coronary syndrome patients undergoing CABG surgery as well as investigated the correlations between these indicators., Methods: Creatine kinase-MB (CK-MB), brain natriuretic peptide (BNP), cardiac troponin T (cTnT), interleukin-6 (IL-6), IL-8, IL-10, high-sensitivity C-reactive protein, and tumor necrosis factor-α were measured, and real-time quantitative polymerase chain reaction was performed to determine the plasma levels of miR-1, miR-133a, miR-208a, and miR-499 before and after surgery in 27 acute coronary syndrome patients. Left ventricular ejection fraction was also analyzed in a 3-month follow-up., Results: miR-1, miR-133a, and miR-208a increased significantly (P = 0.0011; P = 0.0057; P = 0.0197, respectively) and the CK-MB, cTnT, BNP, and IL-6 levels were augmented after surgery. miR-133a, miR-208a, and miR-499 positively correlated with cTnT (r = 0.302, P = 0.027; r = 0.326, P = 0.016; r = 0.298, P = 0.029, respectively), but only miR-208a significantly correlated with CK-MB (r = 0.278, P = 0.041). miR-133a and miR-208a were significantly related to IL-6 (r = 0.287, P = 0.036; r = 0.292, P = 0.032, respectively). However, there were no significant associations between miRs and BNP or 3-month left ventricular ejection fraction., Conclusions: CABG surgery-induced myocardial reperfusion damage and subsequent inflammation were related to changes in miR-1, miR-133a, and miR-208a. Notably, miR-208a was the only indicator associated with CK-MB, cTnT, and IL-6, which may reflect heart injury and inflammation in these patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This study aimed to evaluate the feasibility and the mid-term efficacy of an in situ skeletonized right internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD), and to determine risk factors for IMA graft failure in a single-center study.From January 2012 to December 2015, 189 patients (173 males, 50.6 ± 6.0 years old) undergoing first isolated coronary artery bypass grafting surgery with the in situ skeletonized right IMA grafting to the LAD were included in this study. Baseline characteristics, peroperative data, and follow-up outcomes were investigated and analyzed.The length of the in situ skeletonized right IMA grafts was 18.6 ± 1.2 cm (17.0-22.0 cm). Intraoperative graft flow of the in situ skeletonized right IMA grafting to LAD was 42 ± 9 mL/minute (18-72 mL/minute) associated with measured pulsatility index of 0.8-4.3. In-hospital mortality was 0.5%. Postoperative morbidity included acute myocardial infarction (0.5%), stroke (0.5%), and deep sternal wound infections (1.1%). The mid-term survival was 97.2% and the incidence of repeat revascularization was 0.6%. The patency rate of the in situ skeletonized right IMA grafting to the LAD was 97.1% by computed tomography angiography examination during the follow-up period of 23.2 ± 9.7 months. Additionally, logistic regression analysis showed that intraoperative graft flow had an independent influence on the risk of the mid-term right IMA graft failure.The strategy of the in situ skeletonized right IMA grafting to the LAD is feasible and effective. Intraoperative graft flow was an independent risk factor for the mid-term right IMA graft failure.

Background: To evaluate in-hospital and mid-term outcomes of sequential vs. separate grafting of in situ skeletonized left internal mammary artery (LIMA) to the left coronary system in a single-center, propensity-matched study.Methods and Results:After propensity score-matching, 120 pairs of patients undergoing first scheduled isolated coronary artery bypass grafting (CABG) with in situ skeletonized LIMA grafting to the left anterior descending artery (LAD) territory were entered into a sequential group (sequential grafting of LIMA to the diagonal artery and then to the LAD) or a control group (separate grafting of LIMA to the LAD). The in-hospital and follow-up clinical outcomes and follow-up LIMA graft patency were compared. Both propensity score-matched groups had similar in-hospital and follow-up clinical outcomes. Sequential LIMA grafting was not found to be an independent predictor of adverse events. During a follow-up period of 27.0±7.3 months, 99.1% patency for the diagonal site and 98.3% for the LAD site were determined by coronary computed tomographic angiography after sequential LIMA grafting, both of which were similar with graft patency of separate grafting of in situ skeletonized LIMA to the LAD., Conclusions: Revascularization of the left coronary system using a skeletonized LIMA resulted in excellent in-hospital and mid-term clinical outcomes and graft patency using sequential grafting.

Background: Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction., Methods: A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared., Results: Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less., Conclusions: The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.

Background: Mononuclear bone marrow cell (MN-BMC) transplantation has great clinical potential to promote myocardiogenesis and angiogenesis. This randomized study was designed to assess the feasibility and safety of MN-BMC transplantation during coronary artery bypass grafting (CABG) in patients with ischemic heart failure., Methods: Thirty-six patients were prospectively enrolled and randomized to a MN-BMC group (n = 18) and a control group (n = 18). A mean number of 6.59 x 10(8) +/- 5.12 x 10(8) MN-BMC were injected into the infarcted and marginal areas during CABG in the MN-BMC group. The patients in the control group underwent CABG alone. All patients were followed up to 6 months., Results: There was one death in the MN-BMC group and no death in the control group. Two patients developed ventricular arrhythmia in the MN-BMC group. Compared with baseline and the control group, therapeutic effects of MN-BMC transplantation were observed over time. Heart function (New York Heart Association) was significantly improved and angina pectoris was alleviated in the MN-BMC group. Left ventricular ejection fraction in the MN-BMC group was greater than the control group. The thickness and motion velocity of the infarcted wall were significantly increased in the MN-BMC group. More pronounced perfusion improvements of ischemic regions and LV were observed in the MN-BMC group. There was one late death in the MN-BMC group. No procedure-related complications occurred., Conclusions: MN-BMC transplantation improves cardiac function and regional perfusion in ischemic heart failure patients during CABG. A large cohort with long-term follow-up is needed to further evaluate the safety of MN-BMC transplantation.

Background and Aim: Ischemic mitral regurgitation (IMR) recurrence after combined coronary artery bypass grafting (CABG) and mitral valve repair does occur, with a prevalence of 20% to 30% at the 2- to 4-year follow-up. This single-center study aims to identify the predictors of IMR improvement after surgical revascularization plus mitral valve repair for moderate IMR.Methods: A total of 201 eligible patients were entered into an improved group (n = 141) or a control group (n = 60) according to whether moderate or more mitral regurgitation occurred at the 2-year postoperative time point. Clinical outcomes between groups were compared.Results: The left ventricular endo-diastolic diameter (LVEDD), type of ring (rigid complete ring), and the use of repair techniques (restrictive annuloplasty associated with subvalvular and/or leaflet repair) were three predictors of IMR improvement after surgery (odds ratio [OR] = 0.921, 95% confidence interval [CI], 0.865-0.976, P = .025; OR = 7.753, 95% CI, 3.168-17.742, P < .001; and OR = 0.168, 95% CI, 0.076-0.423, P = .004, respectively). The cutoff value of the LVEDD was 65 mm with a sensitivity of 80.0% and a specificity of 65.2%. Patients in the improved group compared with those in the control group demonstrated better cumulative survival during a median follow-up of 41.0 months (χ2  = 4.559, logrank P = .033) and a reduced ratio of the New York Heart Association class III-IV at the latest follow-up (5.7% vs 38.4%, P < .001).Conclusions: An LVEDD of less than 65 mm, the use of a rigid complete ring, and combined restrictive annuloplasty and subvalvular and/or leaflet repair are associated with IMR improvement after CABG plus mitral valve repair for the treatment of moderate IMR; IMR improvement 2 years after surgery is associated with improved midterm outcomes. [ABSTRACT FROM AUTHOR]

Background. An increasing number of elderly patients with ischemic mitral regurgitation (IMR) are referred for coronary artery bypass grafting (CABG). However, data about the management of elderly patients with moderate IMR are scanty. This study evaluates the impacts of two surgical approaches (CABG alone or concomitant mitral annuloplasty (MAP)) on in-hospital and midterm outcomes, to attempt to determine an appropriate treatment option for elderly patients with moderate chronic IMR. Methods. All eligible patients over 65 years of age were included and were entered into either a MAP group (patients undergoing CABG plus MAP, n = 96) or a CABG group (patients receiving CABG alone, n = 104). Baseline and surgical characteristics were analyzed, and in-hospital and midterm outcomes between groups were compared after propensity score-matching (1 : 1). Results. Using propensity score-matching, 82 pairs of patients were successfully established in a 1 : 1 ratio. No significant differences between the two matched groups were found regarding surgical mortality (4.9% vs. 1.2%, p = 0.173) and major postoperative morbidity. 150 patients (76 in the MAP group and 74 in the CABG group) received regular follow-up visit with the median duration of 37 months. Compared with the CABG group, the MAP group received a similar overall survival but a better recurrent MR-free survival (stratified log-rank p , 0.492 and < 0.001, respectively). Using Cox regression, the MAP group as compared with the CABG group did not affect midterm survival probability (propensity score-adjusted hazard ratio, 0.854; 95% confidence interval, 0.571–2.729, p = 0.630). Additionally, patients in the MAP group had a significantly lower ratio of NYHA class III-IV at the latest follow-up by comparison with patients in the CABG group (19.7% vs. 35.5%, p = 0.033). Conclusion. Compared with CABG alone, concomitant mitral annuloplasty is associated with improved midterm outcomes (including reduced IMR recurrence and improved cardiac functional class) but shares similar surgical mortality and major postoperative morbidity and may be a promising treatment option for elderly patients with moderate chronic IMR. [ABSTRACT FROM AUTHOR]

Background: Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction.Methods: A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared.Results: Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less.Conclusions: The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less. [ABSTRACT FROM AUTHOR]

Background: Mild preoperative renal insufficiency is not rare in patients receiving isolated off-pump coronary artery bypass grafting surgery (OPCAB) surgery. However, there is less study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and follow-up outcomes after isolated OPCAB surgery. This single-centre, retrospective propensity score matching study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and long-term outcomes after first isolated OPCAB surgery.Methods: After propensity score matching, 1236 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m(2) undergoing first isolated OPCAB surgery from January 2007 to December 2011 were entered into this study and were divided to normal group (eGFR ≥ 90 ml/min/1.73 m(2), n = 618) and mild group (eGFR of 60-89 ml/min/1.73 m(2), n = 618). The in-hospital and long-term outcomes were investigated and retrospectively analyzed.Results: The 2 propensity score-matched groups had similar baseline and procedural characteristics except the baseline eGFR. Thirty-five patients died during the same hospitalization or within 30 days of operation, with a surgical mortality of 2.8 %. Sixty-seven patients died during follow-up, with a long-term survival of 94.1 %. Univariate factor analysis showed that the 2 propensity score-matched groups have similar rates among in-hospital outcomes. Kaplan-Meier curves displayed a similar in-hospital survival between the 2 groups (χ(2) = 0.728, p = 0.393), while a better long-term survival in patients with normal preoperative renal function compared with mild preoperative renal insufficiency (χ(2) = 4.722, p = 0.030). After Cox proportional model was used, the hazard ratio for long-term mortality in patients with mild preoperative renal insufficiency compared with normal preoperative renal function was 1.72 (95 % CI 1.06-2.83, p = 0.032).Conclusions: Mild preoperative renal insufficiency compared with normal preoperative renal function reduced long-term survival, without evidence of worse in-hospital outcomes. [ABSTRACT FROM AUTHOR]

Background and aim of the study : There is still controversy with regard to adequate therapy for symptomatic patients who are refractory to medical management with myocardial bridges of the left anterior descending artery. This study sought to evaluate the treatment of symptomatic coronary myocardial bridges with coronary artery bypass graft surgery. Methods: Thirteen patients who underwent surgery between October 2005 and May 2008 were included in this study. The mean patient age was 51.3 ± 10.2 years (range, 39-75 years). There were ten men and three women. All 13 patients had angina pectoris preoperatively, and they had myocardial bridges only. Coronary angiography prior to surgery demonstrated myocardial bridging of the left anterior descending artery with systolic compression ≥75% in all patients. They underwent off-pump coronary artery bypass grafting using the internal mammary artery. Results: The acute clinical success rate was 100% with respect to the absence of myocardial infarction, death, or other major in-hospital complications. Postoperative coronary CT angiography studies in seven patients after one year demonstrated no graft stenosis. During follow-up, no patient had symptoms of angina. Conclusions: Coronary artery bypass graft surgery using a LIMA graft is a safe and effective treatment for symptomatic coronary myocardial bridges. (J Card Surg 2012;27:405-407) [ABSTRACT FROM AUTHOR]

We sought to investigate the predictive value of platelet function assessment for bleeding in clopidogrel- or ticagrelor-treated patients undergoing off-pump coronary artery bypass grafting (OPCABG). This prospective study included patients treated with acetylsalicylic acid and clopidogrel or acetylsalicylic acid and ticagrelor and scheduled for OPCABG. The percentage of platelet aggregation was evaluated by thromboelastography. Postoperative blood loss was measured as the chest tube drainage (CTD) and excessive blood loss was settled as CTD with more than 600 mL at first postoperative 12 h. Major bleeding complications were defined by Bleeding Academic Research Consortium (BARC) type 4-CABG related bleeding or class 3 or class 4 bleeding in universal definition of perioperative bleeding (UDPB) in adult cardiac surgery. A total of 434 consecutive patients were included. There was a negative correlation (r = −0.133, P = 0.0056) between ADP-induced platelet aggregation and CTD at 12 h. The platelet aggregation exhibited a moderate performance (AUC = 0.616) for predicting excessive postoperative blood loss. Multivariable analysis showed that ADP-induced platelet aggregation <33.45% (OR = 2.976, 95% CI: 1.325–6.711, P = 0.008) was independently associated with excessive postoperative blood loss. However, the percentage of ADP-induced platelet aggregation predicted neither UDPB-defined nor BARC-defined major bleeding. Instead, P2Y 12 receptor antagonist discontinuation time was independently related to the risk of major bleeding complication. ADP-induced platelet aggregation detected by thromboelastography was negatively related to postoperative blood loss and platelet aggregation <33.45% was associated with excessive postoperative blood loss. However, platelet function assessment by thromboelastography failed to predict major bleeding complications. [ABSTRACT FROM AUTHOR]

Dual antiplatelet therapy (DAPT) consisting of acetylsalicylic acid and clopidogrel or ticagrelor increased bleeding complications in patients undergoing coronary artery bypass grafting (CABG). We aimed to compare the bleeding risks between patients treated with clopidogrel and ticagrelor preoperatively and investigate the influence of discontinuation of clopidogrel and ticagrelor on bleeding risk in off-pump CABG (OPCABG). We conducted a retrospective analysis of patients with DAPT who underwent OPCABG. The propensity score matching was performed given the baseline differences between clopidogrel- and ticagrelor-treated patients. Bleeding was assessed by chest tube drainage volume and universal definition of perioperative bleeding. This study included 836 patients. Five hundred and fifty patients were treated with clopidogrel and 286 patients treated with ticagrelor before surgery. After matching, 275 patients treated with clopidogrel and 275 patients with ticagrelor were included. There were no significant differences in bleeding between clopidogrel and ticagrelor group. Patients who discontinued clopidogrel before surgery <3 d had a higher risk of severe perioperative bleeding compared with those who discontinued ≥5 d (16.4 % vs. 5.0 %, P = 0.045). By contrast, the risk of severe perioperative bleeding was comparable among patients who discontinued ticagrelor for <3 d, ≥3–5 d and ≥5 d preoperatively (16.2 % vs. 9.1 % vs. 10.1 %, P = 0.317). The multivariable analysis confirmed that time since discontinuation (<3 d vs. ≥5 d: OR = 2.732, 95 % CI: 1.332–5.605, P = 0.006) but not the types of P2Y 12 receptor antagonist was an independent predictor for severe perioperative bleeding. There were no significant differences in severe perioperative bleeding between clopidogrel and ticagrelor groups. Discontinuation of clopidogrel <3 d before OPCABG increased the risk of severe perioperative bleeding. • Severe perioperative bleeding was similar between clopidogrel and ticagrelor groups. • Discontinuation of clopidogrel ≤3 d before OPCABG increased severe bleeding. • Severe bleeding was comparable when ticagrelor discontinued ≤3 d, 3–5 d and >5 d. • Severe perioperative bleeding was associated with other poor perioperative outcomes. [ABSTRACT FROM AUTHOR]