Background: Intracranial arterial steno-occlusive lesion (IAS) is the most common cause of stroke. We hypothesized that adequate perioperative management for IAS is useful to prevent stroke in coronary artery bypass g...Background: Intracranial arterial steno-occlusive lesion (IAS) is the most common cause of stroke. We hypothesized that adequate perioperative management for IAS is useful to prevent stroke in coronary artery bypass grafting (CABG). Methods: IAS was evaluated using magnetic resonance imaging/angiography (MRI/A, n = 216) in patients without a history of stroke or carotid stenosis (≥50%) in CABG between May 2005 and June 2018 (n = 424). Off-pump CABG was performed in most patients. Different perioperative managements of systolic arterial pressure (SAP) were applied for patients with and without MRI/A. SAP was strictly maintained at ≥80 mmHg in patients with significant IAS (≥50%, n = 28) and ≥90 mmHg for severe IAS (≥70%, n = 44) while SAP less than 80 mmHg (usually ≥70 mmHg) was allowed for patients without MRI/A. Intra-aortic balloon pumping was used for patients with multiple severe IAS and/or occlusion. Clinical outcomes were compared between patients with and without MRI/A. Propensity matching was performed (n = 181 each). Results: Complete revascularization was achieved in all patients. Nine patients (2.12%) had postoperative strokes;the incidence of stroke was signifi-cantly less in patients with preoperative MRI/A (n = 1, p = 0.016). There was no significant difference in the incidence of in-hospital mortality between patients with and without preoperative MRI/A (0.5% and 1.0%, respectively;p = 0.529). Multivariate analysis revealed that no preoperative MRI/A was the only significant predictors of postoperative stroke (p = 0.045). The incidence of stroke was not higher in patients with IAS who underwent MRI/A (p = 0.332). Conclusions: Preoperative evaluation of IAS using MRI/A and following our perioperative management significantly reduced perioperative stroke in patients undergoing CABG.展开更多
Background: Patients on hemodialysis are at high risk of adverse cardiac events after coronary artery bypass grafting (CABG). The aim of this study is to know whether CABG with complete revascularization and similar g...Background: Patients on hemodialysis are at high risk of adverse cardiac events after coronary artery bypass grafting (CABG). The aim of this study is to know whether CABG with complete revascularization and similar graft selection can provide equivalent long-term benefits for patients on and not on hemodialysis. Methods: Between 2004 and 2018, 746 patients underwent isolated CABG, of which 106 were on hemodialysis. Propensity matching on baseline characteristics, graft types and on/off-pump CABG was performed to compare clinical outcomes between patients on (n = 102) and not on (n = 102) hemodialysis. Results: Complete revascularization was achieved in all patients. The mean follow-up was 112.5 ± 46.6 months. Off-pump rates (hemodialysis vs non-hemodialysis, 93/102 vs 94/102, p > 0.999) and graft selections (distal anastomoses: 3.7 ± 1.4 vs 3.8 ± 1.5, p = 0.377, ITA grafts: 1.4 ± 0.6 vs 1.5 ± 0.6, p = 0.560, arterial grafts: 1.9 ± 0.9 vs 2.0 ± 0.8, p = 0.658, vein grafts: 0.69 ± 0.63 vs 0.65 ± 0.70, p = 0.513) were well balanced between the groups. Hospital mortality was higher in patients on hemodialysis than in those not on hemodialysis (5/102 vs 1/102, p = 0.212). The Kaplan-Meier analysis revealed that cardiac death (without non-cardiac causes) was significantly more common in patients on hemodialysis than in those not on hemodialysis (p = 0.018). However, there were no significant differences in deaths due to ischemic heart disease (p = 0.327), repeated revascularization (p = 0.542), myocardial infarction (p = 0.783), and heart failure requiring admission (p = 0.371). Conclusion: CABG with complete revascularization and similar graft selection provides equivalent long-term benefits with regard to the prevention of adverse cardiac events due to ischemic heart disease in patients on and not on hemodialysis.展开更多
文摘Background: Intracranial arterial steno-occlusive lesion (IAS) is the most common cause of stroke. We hypothesized that adequate perioperative management for IAS is useful to prevent stroke in coronary artery bypass grafting (CABG). Methods: IAS was evaluated using magnetic resonance imaging/angiography (MRI/A, n = 216) in patients without a history of stroke or carotid stenosis (≥50%) in CABG between May 2005 and June 2018 (n = 424). Off-pump CABG was performed in most patients. Different perioperative managements of systolic arterial pressure (SAP) were applied for patients with and without MRI/A. SAP was strictly maintained at ≥80 mmHg in patients with significant IAS (≥50%, n = 28) and ≥90 mmHg for severe IAS (≥70%, n = 44) while SAP less than 80 mmHg (usually ≥70 mmHg) was allowed for patients without MRI/A. Intra-aortic balloon pumping was used for patients with multiple severe IAS and/or occlusion. Clinical outcomes were compared between patients with and without MRI/A. Propensity matching was performed (n = 181 each). Results: Complete revascularization was achieved in all patients. Nine patients (2.12%) had postoperative strokes;the incidence of stroke was signifi-cantly less in patients with preoperative MRI/A (n = 1, p = 0.016). There was no significant difference in the incidence of in-hospital mortality between patients with and without preoperative MRI/A (0.5% and 1.0%, respectively;p = 0.529). Multivariate analysis revealed that no preoperative MRI/A was the only significant predictors of postoperative stroke (p = 0.045). The incidence of stroke was not higher in patients with IAS who underwent MRI/A (p = 0.332). Conclusions: Preoperative evaluation of IAS using MRI/A and following our perioperative management significantly reduced perioperative stroke in patients undergoing CABG.
文摘Background: Patients on hemodialysis are at high risk of adverse cardiac events after coronary artery bypass grafting (CABG). The aim of this study is to know whether CABG with complete revascularization and similar graft selection can provide equivalent long-term benefits for patients on and not on hemodialysis. Methods: Between 2004 and 2018, 746 patients underwent isolated CABG, of which 106 were on hemodialysis. Propensity matching on baseline characteristics, graft types and on/off-pump CABG was performed to compare clinical outcomes between patients on (n = 102) and not on (n = 102) hemodialysis. Results: Complete revascularization was achieved in all patients. The mean follow-up was 112.5 ± 46.6 months. Off-pump rates (hemodialysis vs non-hemodialysis, 93/102 vs 94/102, p > 0.999) and graft selections (distal anastomoses: 3.7 ± 1.4 vs 3.8 ± 1.5, p = 0.377, ITA grafts: 1.4 ± 0.6 vs 1.5 ± 0.6, p = 0.560, arterial grafts: 1.9 ± 0.9 vs 2.0 ± 0.8, p = 0.658, vein grafts: 0.69 ± 0.63 vs 0.65 ± 0.70, p = 0.513) were well balanced between the groups. Hospital mortality was higher in patients on hemodialysis than in those not on hemodialysis (5/102 vs 1/102, p = 0.212). The Kaplan-Meier analysis revealed that cardiac death (without non-cardiac causes) was significantly more common in patients on hemodialysis than in those not on hemodialysis (p = 0.018). However, there were no significant differences in deaths due to ischemic heart disease (p = 0.327), repeated revascularization (p = 0.542), myocardial infarction (p = 0.783), and heart failure requiring admission (p = 0.371). Conclusion: CABG with complete revascularization and similar graft selection provides equivalent long-term benefits with regard to the prevention of adverse cardiac events due to ischemic heart disease in patients on and not on hemodialysis.
