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16. Early outcome of bilateral versus single internal mammary artery grafting in the elderly

Author

Rubino, A. S. (Antonino S.), Gatti, G. (Giuseppe), Reichart, D. (Daniel), Tauriainen, T. (Tuomas), De Feo, M. (Marisa), Onorati, F. (Francesco), Pappalardo, A. (Aniello), Chocron, S. (Sidney), Gulbins, H. (Helmut), Dalén, M. (Magnus), Svenarud, P. (Peter), Faggian, G. (Giuseppe), Franzese, I. (Ilaria), Santarpino, G. (Giuseppe), Fischlein, T. (Theodor), Maselli, D. (Daniele), Nardella, S. (Saverio), Gherli, R. (Riccardo), Ahmed, A. (Aamer), Santini, F. (Francesco), Salsano, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Ruggieri, V. G. (Vito G.), Bounader, K. (Karl), Mignosa, C. (Carmelo), D’Errigo, P. (Paola), Rosato, S. (Stefano), Airaksinen, J. (Juhani), Perrotti, A. (Andrea), Biancari, F. (Fausto), Rubino, A. S. (Antonino S.), Gatti, G. (Giuseppe), Reichart, D. (Daniel), Tauriainen, T. (Tuomas), De Feo, M. (Marisa), Onorati, F. (Francesco), Pappalardo, A. (Aniello), Chocron, S. (Sidney), Gulbins, H. (Helmut), Dalén, M. (Magnus), Svenarud, P. (Peter), Faggian, G. (Giuseppe), Franzese, I. (Ilaria), Santarpino, G. (Giuseppe), Fischlein, T. (Theodor), Maselli, D. (Daniele), Nardella, S. (Saverio), Gherli, R. (Riccardo), Ahmed, A. (Aamer), Santini, F. (Francesco), Salsano, A. (Antonio), Nicolini, F. (Francesco), Zanobini, M. (Marco), Saccocci, M. (Matteo), Ruggieri, V. G. (Vito G.), Bounader, K. (Karl), Mignosa, C. (Carmelo), D’Errigo, P. (Paola), Rosato, S. (Stefano), Airaksinen, J. (Juhani), Perrotti, A. (Andrea), and Biancari, F. (Fausto)

Abstract

Background: Bilateral internal mammary artery (BIMA) grafting is increasingly used in elderly patients without evidence of its risks or benefits compared with single internal mammary artery (SIMA) grafting. Methods: In all, 2,899 patients aged 70 years or older (855 [29.5%] underwent BIMA grafting) operated on from January 2015 to December 2016 and included in the prospective multicenter Outcome After Coronary Artery Bypass Grafting (E-CABG) study were considered in this analysis. Results: One-to-one propensity matching resulted in 804 pairs with similar preoperative risk profile. Propensity score matched analysis showed that BIMA grafting was associated with a nonstatistically significant increased risk of inhospital death (2.7% versus 1.6%, p = 0.117). The BIMA grafting cohort had a significantly increased risk of any sternal wound infection (7.7% versus 5.1%, p = 0.031) as well as higher risk of deep sternal wound infection/mediastinitis (4.0% versus 2.2%, p = 0.048). The BIMA grafting cohort required more frequently extracorporeal membrane oxygenation (1.0% versus 0.1%, p = 0.02), and the intensive care unit stay (mean 3.6 versus 2.6 days, p < 0.001) and inhospital stay (mean 11.3 versus 10.0 days, p < 0.001) were significantly longer compared with the SIMA grafting cohort. Test for interaction showed that urgent operation in patients undergoing BIMA grafting was associated with higher risk of inhospital death (5.6% versus 1.3%, p = 0.009). Conclusions: Bilateral internal mammary artery grafting in elderly patients seems to be associated with a worse early outcome compared with SIMA grafting, particularly in patients undergoing urgent operation. Until more conclusive results are gathered, BIMA grafting should be reserved only for elderly patients with stable coronary artery disease, without significant baseline comorbidities and with long life expectancy.

Published
2018

17. Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting:results of a multicenter study

Author

Biancari, F. (Fausto), Dalén, M. (Magnus), Perrotti, A. (Andrea), Fiore, A. (Antonio), Reichart, D. (Daniel), Khodabandeh, S. (Sorosh), Gulbins, H. (Helmut), Zipfel, S. (Svante), Al Shakaki, M. (Mosab), Welp, H. (Henryk), Vezzani, A. (Antonella), Gherli, T. (Tiziano), Lommi, J. (Jaakko), Juvonen, T. (Tatu), Svenarud, P. (Peter), Chocron, S. (Sidney), Verhoye, J. P. (Jean Philippe), Bounader, K. (Karl), Gatti, G. (Giuseppe), Gabrielli, M. (Marco), Saccocci, M. (Matteo), Kinnunen, E.-M. (Eeva-Maija), Onorati, F. (Francesco), Santarpino, G. (Giuseppe), Alkhamees, K. (Khalid), Ruggieri, V. G. (Vito G.), and Dell'Aquila, A. M. (Angelo M.)

Subjects
surgical procedures, operative, Post-cardiotomy, Extracorporeal membrane oxygenation, Coronary artery bypass, Heart failure, ECMO, ECLS, CABG, Extracorporeal life support
Abstract

Background: The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce. Methods: We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study. Results: VA-ECMO was employed in 148 patients after CABG for median of 5.0 days (mean, 6.4, SD 5.6 days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p = 0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p = 0.004, OR 0.98, 95% CI 0.97–0.99), pulmonary disease (p = 0.018, OR 4.42, 95% CI 1.29–15.15) and pre-VA-ECMO blood lactate (p = 0.015, OR 1.10, 95% CI 1.02–1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively. Conclusions: One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.

Published
2017

33. Cerebrovascular Events After Stentless Aortic Valve Replacement During a 9-Year Follow-Up Period

Author

Gulbins, H., Florath, Ines, Ennker, J., Gulbins, H., Florath, Ines, and Ennker, J.

Abstract

Background: One major advantage of biologic aortic valve prostheses is their low thrombogenicity compared with mechanical prostheses. The purpose of this study was to evaluate the incidence of cerebrovascular events during long-term follow-up after stentless aortic valve replacement. Methods: Between 1996 and 2005, 1,014 patients (mean age, 73 years; range, 20 to 90 years) received stentless aortic valve replacement (Freestyle; Medtronic, Minneapolis, MN) and were included into the systematic follow-up that was closed in 2006 with a completeness of 94.7% and a mean follow-up interval of 3 years (range, 0.5 to 9.8 years). Predictors for freedom from cerebrovascular events were identified by Cox regression. Results: Overall survival was 53% ± 5% after 8 years (mean, 6.8 ± 0.2 years). Permanent atrial fibrillation at time of surgery was a strong predictor of impaired survival during follow-up. Freedom from cerebrovascular events during follow-up was 68% ± 5% at 9 years of follow-up. Multivariate regression analysis revealed previous stroke, age at implant, diabetes mellitus, and carotid lesions as significant risk factors. Especially age older than 75 years was a strong risk factor for cerebrovascular events during follow-up (p = 0.004). Atrial fibrillation was not an independent risk factor for cerebrovascular events (p = 0.26) but was a strong predictor of poor survival (p < 0.001) during follow-up. There was no influence of technique of implantation (subcoronary versus full root; p = 0.41), sex (p = 0.35), additional bypass grafting (p = 0.65), and the size of the implanted prosthesis (p = 0.47). Conclusions: The risk of cerebrovascular events during follow-up after stentless aortic valve replacement is related to the individual risk factors of the patients rather than to the valve prosthesis itself. Without additional risk factors, patients with these aortic valve prostheses showed an incidence of cerebrovascular events similar to those reported for a healthy po

Published
2008

34. Contrast-enhanced magnetic resonance angiography for control of minimally invasive coronary artery bypass conduits (MIDCAB/OPCAB)

Author

Dh, Boehm, Bernd Wintersperger, Reichenspurner H, Gulbins H, Detter C, Kur F, Meiser B, and Reichart B

Subjects
Gadolinium DTPA, Male, Treatment Outcome, Contrast Media, Humans, Minimally Invasive Surgical Procedures, Female, Coronary Artery Bypass, Coronary Angiography, Magnetic Resonance Angiography, Vascular Patency, Aged
Abstract

The purpose of this study was to delineate the course and determine the patency of venous and arterial conduits in the early postoperative period following minimally invasive bypass grafting. A less invasive magnetic resonance angiogram was evaluated as alternative to standard contrast angiography and cardiac catheterization.Twelve patients (8 males and 4 females) with a mean age of 65.3 (+/- 7.4 ) years were evaluated four to seven days following minimally invasive direct coronary artery bypass surgery (MIDCAB) or off-pump multivessel revascularization with the Octopus stabilizer on the beating heart. Altogether 17 coronary bypass grafts were investigated: 12 left-sided mammary artery grafts to the LAD and five aortocoronary venous bypass grafts. The examination was performed with a 1.5 Tesla Magnetom Vision (Siemens AG, Erlangen) with phased array coil technology. Data acquisition was done with an ultrafast 3D gradient-echosequence in single breathhold and sagittal and coronal views. Contrast enhancement of the vessels was performed with automatic intravenous bolus injection of Gadolinium-DTPA after determination of the individual contrast transit time. Traditional contrast angiography was obtained in all patients during the same time period as a comparison to assess the sensitivity and specificity of the magnetic resonance imaging.All five venous grafts and 11 of the 12 IMA grafts were detected and shown to be patent with the MRA technique. Contrast angiography demonstrated complete patency for all 17 bypass grafts with adequate anastomoses and no evidence of stenosis. The calculated sensitivity for the visualization with MRA was therefore 92% for IMA grafts and 100% for venous grafts.The contrast-enhanced ultrafast MRA in single breathhold technique is a reliable, noninvasive method for visualization and determination of the patency of arterial and venous coronary grafts.

Published
1998

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