Predictors of early graft patency following coronary artery bypass surgery

Background: The long-term success of coronary artery bypass graft surgery (CABG) is dependent on graft patency after the operation. Early occlusion (within the first week) affects the long-term results. Therefore, we sought to determine pre-operative, intraoperative, and perioperative factors associated with early coronary graft patency. Methods: Between March 2007 and March 2008, 107 consecutive patients (81 men, 26 women, mean age 60 &#177; 9 years) who underwent CABG were included in this study. The enrolled patients underwent 16-slice computed tomography angiography one week after CABG. Results: Based on the multislice computed tomography, acute graft occlusion was detected in 32 (8.7% of all) grafts, including 26 of 250 (10%) in venous grafts and 6 of 116 (5%) in arterial grafts. In univariate analysis, patients with patent coronary grafts had a lower serum glucose level (119 &#177; 30 vs. 141 &#177; 65 mg/dL, p = 0.02) and longer partial thromboplastin time (34 &#177; 11 vs. 30 &#177; 2 s, p = = 0.04). In addition, pump time was significantly longer in patients with occluded grafts than in those with patent grafts (119 &#177; 43 vs. 102 &#177; 32 min, p = 0.04). Those with longer pump time required more coronary grafts (pump time &#8805; 120 min for 3.5 grafts vs. pump time < 120 min for 2.9 grafts, p = 0.02). Of the multiple pre-operative, intraoperative, and perioperative characteristics of the patients who underwent successful CABG, serum glucose level (OR: 2.014, 95% CI: 1.002-3.026, p = 0.002) and pump time < two hours (OR: 1.502, 95% CI: 1.001-2.030, p = 0.003) were the only predictors of coronary graft patency seven days after surgery in multivariate analysis. Conclusions: Our study demonstrated that the patients with successful CABG and patent coronary grafts within the first week after surgery had optimal blood glucose control and pump time < two hours. (Cardiol J 2010; 17, 4: 344-348

Czynniki wpływające na wczesną drożność pomostów naczyniowych u pacjentów poddawanych pomostowaniu aortalno-wieńcowemu

Wstęp: Sukces terapeutyczny pomostowania aortalno-wieńcowego (CABG) w odległej obserwacji zależy od drożności pomostów naczyniowych po zabiegu. Wczesne zamknięcie pomostu (w ciągu pierwszego tygodnia po CABG) wpływa niekorzystnie na odległe wyniki leczenia. Celem niniejszego badania było określenie czynników przed-, śród- i pooperacyjnych, które mogą się wiązać z drożnością pomostów aortalno-wieńcowych we wczesnym okresie po CABG. Metody: Badanie prowadzono od marca 2007 do marca 2008 roku. Do udziału w nim zakwalifikowano 107 kolejno przyjętych pacjentów (81 mężczyzn, 26 kobiet; średnia wieku: 60 &#177; 9 lat), których poddano CABG. Tydzień po zabiegu u chorych wykonano angiografię tomografii komputerowej (TK) przy użyciu 16-rzędowej TK. Wyniki: Na podstawie obrazowania wielorzędowej TK w 32 pomostach naczyniowych (8,7% wszystkich wszczepionych naczyń) stwierdzono ostrą okluzję, z czego 26 okluzji spośród 250 wykonanych zespoleń (10%) wystąpiło w pomostach żylnych, a 6 z 116 (5%) &#8212; w tętniczych. W wieloczynnikowej analizie u pacjentów z drożnymi pomostami aortalno-wieńcowymi odnotowano niższe stężenie glukozy w osoczu (119 &#177; 30 ml/dl v. 141 &#177; 65 ml/dl; p = 0,02) i dłuższy czas częściowej tromboplastyny po aktywacji (34 &#177; 11 s v. 30 &#177; 2 s; p = 0,04). Ponadto czas wykorzystania krążenia pozaustrojowego był znacznie dłuższy u osób z zamkniętymi pomostami niż u tych z drożnymi wszczepionymi naczyniami (119 &#177; 43 min v. 102 &#177; 32 min; p = 0,04). U chorych z dłuższym czasem krążenia pozaustrojowego konieczne było zastosowanie większej liczby pomostów aortalno-wieńcowych (czas &#8805; 120 min dla 3,5 pomostu v. czas < 120 min dla 2,9 pomostu; p = 0,02). Spośród licznych parametrów przed-, śród- i pooperacyjnych jedynie stężenie glukozy w osoczu [iloraz szans (OR): 2,014; przy 95-procentowym przedziale ufności (95% CI): 1,002&#8211;3,026; p = 0,002] i czas krążenia pozaustrojowego poniżej 2 godzin (OR: 1,502; 95% CI: 1,001&#8211;2,030; p = 0,003) były czynnikami predykcyjnymi drożności pomostów aortalno-wieńcowych po upływie 7 dni od CABG. Wnioski: U pacjentów po operacji CABG zakończonej sukcesem, z drożnymi pomostami naczyniowymi w ciągu pierwszego tygodnia po operacji stężenie glukozy w osoczu było optymalnie kontrolowane, a czas operacji z wykorzystaniem krążenia pozaustrojowego nie przekraczał 2 godzin. (Folia Cardiologica Excerpta 2010; 5, 6: 325&#8211;330

Predictors of early graft patency following coronary artery bypass surgery

Background: The long-term success of coronary artery bypass graft surgery (CABG) is dependent on graft patency after the operation. Early occlusion (within the first week) affects the long-term results. Therefore, we sought to determine pre-operative, intraoperative, and perioperative factors associated with early coronary graft patency. Methods: Between March 2007 and March 2008, 107 consecutive patients (81 men, 26 women, mean age 60 ± 9 years) who underwent CABG were included in this study. The enrolled patients underwent 16-slice computed tomography angiography one week after CABG. Results: Based on the multislice computed tomography, acute graft occlusion was detected in 32 (8.7 of all) grafts, including 26 of 250 (10) in venous grafts and 6 of 116 (5) in arterial grafts. In univariate analysis, patients with patent coronary grafts had a lower serum glucose level (119 ± 30 vs. 141 ± 65 mg/dL, p = 0.02) and longer partial thromboplastin time (34 ± 11 vs. 30 ± 2 s, p = = 0.04). In addition, pump time was significantly longer in patients with occluded grafts than in those with patent grafts (119 ± 43 vs. 102 ± 32 min, p = 0.04). Those with longer pump time required more coronary grafts (pump time � 120 min for 3.5 grafts vs. pump time < 120 min for 2.9 grafts, p = 0.02). Of the multiple pre-operative, intraoperative, and perioperative characteristics of the patients who underwent successful CABG, serum glucose level (OR: 2.014, 95 CI: 1.002-3.026, p = 0.002) and pump time < two hours (OR: 1.502, 95 CI: 1.001-2.030, p = 0.003) were the only predictors of coronary graft patency seven days after surgery in multivariate analysis. Conclusions: Our study demonstrated that the patients with successful CABG and patent coronary grafts within the first week after surgery had optimal blood glucose control and pump time < two hours. © 2010 Via Medica

Primary Endpoint Analysis for a Prospective Multicenter Study Assessing Radiographic Recurrence and Patient Outcomes Following Triplanar Tarsometatarsal Arthrodesis with Early Weightbearing

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The majority of hallux valgus (HV) corrections have been historically performed via a two-dimensional, transverse plane-focused approach, which has demonstrated high long-term recurrence rates. Recent research demonstrates that 87% of HV deformities are three-dimensional with abnormal frontal-plane rotation of the metatarsal, which cannot be completely addressed with a two-dimensional metatarsal osteotomy alone. While correction at the 1st tarsometatarsal (TMT) joint may provide the optimal surgical approach for 3D anatomic restoration at the apex of the deformity, 1st TMT fusion historically entails an extended period of non-weightbearing. This study evaluated the clinical, radiographic, and patient-reported outcomes in patients undergoing instrumented triplanar 1st TMT arthrodesis (TMTA) with a biplanar plating system and protected near- immediate weightbearing. Methods: A prospective multicenter study that will continue for 60 months post-operatively. Patients 14-58 years old with symptomatic HV (intermetatarsal and HV angles between 10-22° and 16-40°, respectively) and no prior HV surgery on the operative foot were eligible for this study. Patients were treated with an instrumented TMTA procedure using a biplanar plating system with protected early weightbearing. The primary endpoint of this study is radiographic recurrence of HV deformity at 24 months for subjects with successful correction (defined as IMA < 9°, HVA < 15° and TSP ≤ 3 at 6 weeks post-procedure). Recurrence is defined by any two of the three conditions: IMA of ≥12°, HVA ≥20° and TSP ≥4. Secondary outcomes (return to weightbearing and activities, pain measured by visual analog scale (VAS), Manchester-Oxford Foot Questionnaire (MOxFQ), and Patient Reported Outcomes Measurement Information System (PROMIS)) were evaluated post-operatively. Two independent fellowship trained musculoskeletal radiologists reviewed all radiographic data. Results: 173 patients underwent TMTA with mean age of 41.0 (range:14-58) years; 92% females. Median (range) time-to-follow-up is 25 (1.5-49.2) months. Eighteen (10.4%) patients have discontinued. Mean (SD) days to protected weightbearing in CAM boot and return to full work were 8.4 (7.4) and 57.9 (46.2), respectively. At 24 months post-procedure, 99.3% (134/135) of patients were recurrence-free. Statistically significant improvements from baseline in HVA, IMA, and TSP (Table 1), VAS score, MOxFQ and PROMIS domains were observed as early as 6 weeks post-operatively and maintained over time. In 143 patients, mean (95% CI) 24-month improvements were VAS: 3.9 (3.5, 4.2); Walking/Standing (MOxFQ): 39.2 (34.9, 43.4); Physical Function (PROMIS): 9.7 (8.3, 11.2). Nineteen (11.0%) patients experienced hardware complications yet maintained radiographic correction. Conclusion: The results of this study’s primary and secondary endpoints provide supporting evidence that TMTA with biplanar plating is successful in correcting the 3D hallux valgus deformity with early return to weightbearing and low recurrence while demonstrating favorable clinical and patient-reported outcomes. Patients exhibited meaningful pain reduction after surgery and were able to return to full, unrestricted work and activities in less than two months, on average. Statistically significant improvements in patients’ health-related quality-of-life were observed through 36 months, post-operatively. Patients will continue to be followed for up to 60 months with additional evaluations for complications, recurrence, and patient satisfaction