Cirugía coronario

Card Fail Rev. 2025 Aug 26;11:e23. doi: 10.15420/cfr.2025.18. eCollection 2025.

ABSTRACT

BACKGROUND: Blood troponin I (TnI) concentrations, the reasons for increases in TnI after coronary artery bypass grafting (CABG) and the effects of TnI on short- and long-term outcomes are not well understood.

METHODS: Patients undergoing off-pump CABG at Anzhen Hospital between 2011 and 2022 were reviewed. Data on peak postoperative TnI and high-sensitivity (hs) TnI were collected, and patients were divided into a high TnI group (TnI ≥10 ≥g/l or hsTnI ≥10,000 pg/ml) and low TnI group. Baseline characteristics, graft flow, perioperative outcomes and long-term mortality were compared between the two groups.

RESULTS: In all, 19,196 patients were included in the study (median age 63 years; interquartile range [IQR] 57-68 years; 14,423 (75.1%) male). Compared with the low TnI group, patients in the high TnI group were more likely to have an intra-aortic balloon pump inserted (17.8% vs. 2.9%; p<0.001), receive extracorporeal membrane oxygenation support (3.6% vs. 0.1%; p<0.001), and undergo early revascularisation (2.81% vs. 0.12%; p<0.001); the high TnI group also had more in-hospital deaths (2.7% vs. 0.2%; p<0.001). After propensity score matching, patients in the high TnI group had fewer grafts to the left circumflex artery (LCX; 0.71 ± 0.58 versus 0.81 ± 0.57; p<0.001) and right coronary artery (RCA; 0.89±0.53 versus 0.95±0.53; p=0.011), as well as less graft flow to the LCX (median 33 [IQR 21-55] versus 41 [IQR 25-67] ml/min; p<0.001) and RCA (30 [IQR 18-50] versus 35 [IQR 22-55] ml/min; p<0.001) than patients in the low TnI group. Patients with high postoperative TnI also had reduced long-term survival (HR 2.59; 95% CI [1.76-3.82]; p<0.001).

CONCLUSION: Elevated TnI following off-pump CABG may be associated with incomplete revascularisation in the LCX and RCA. It is also associated with increased early and late mortality.

PMID:40964441 | PMC:PMC12439194 | DOI:10.15420/cfr.2025.18

J Thorac Dis. 2025 Aug 31;17(8):5561-5574. doi: 10.21037/jtd-2025-634. Epub 2025 Aug 22.

ABSTRACT

BACKGROUND: Previous studies comparing off-pump versus on-pump coronary artery bypass grafting (CABG) have shown inconsistent results, especially for left main coronary artery disease (LM CAD), largely due to variations in surgical expertise. This study evaluates outcomes from a high-volume center with considerable experience in both techniques.

METHODS: We retrospectively analyzed 1,410 patients with significant LM CAD (stenosis ≥70% or functionally significant 50-69%) who underwent isolated CABG between 2003 and 2017. The primary endpoint was a composite of death, myocardial infarction (MI), or stroke within 5 years. Analyses included Cox regression, inverse probability of treatment weighting (IPTW), and propensity score (PS) matching with adjustments for surgeon type and temporal trends.

RESULTS: Of 1,410 patients, 824 underwent off-pump and 586 underwent on-pump CABG. The off-pump group demonstrated a low conversion rate (1.0%) and high left internal mammary artery (LIMA) utilization (97.0%). The 5-year composite endpoint (death, MI, or stroke) was similar between groups [14.7% for off-pump vs. 15.0% for on-pump; unadjusted hazard ratio (HR): 0.98, 95% confidence interval (CI): 0.74-1.30], and this finding persisted after adjustments for baseline differences. Individual components showed comparable rates of death and stroke, while in-hospital composite outcomes were lower in the off-pump group (1.3% vs. 3.5%; P=0.01).

CONCLUSIONS: Our findings suggest that in a high-volume center with experienced surgeons, off-pump CABG for LM CAD can achieve long-term outcomes comparable to on-pump CABG. Larger prospective studies are warranted to confirm these findings and establish optimal patient selection criteria.

PMID:40950864 | PMC:PMC12433041 | DOI:10.21037/jtd-2025-634

Am J Transl Res. 2025 Jul 15;17(7):5465-5474. doi: 10.62347/VKEY9889. eCollection 2025.

ABSTRACT

OBJECTIVE: To compare the therapeutic effects of off-pump versus conventional coronary artery bypass grafting (CABG) in elderly coronary heart disease (CHD) patients.

METHODS: This retrospective study analyzed 98 elderly CHD patients (47 conventional CABG, 51 off-pump CABG) treated between April 2019 and March 2021. Outcomes included intraoperative and postoperative indicators (distal anastomoses, mechanical ventilation time, hospital stay), graft patency, left ventricular function (LVEF, LVEDD), cardiac biomarkers (cTnI, CK, CK-MB), complication rates, 3-month quality of life (QoL), and long-term major adverse cardiovascular and cerebrovascular events (MACCE).

RESULTS: The two groups had similar distal anastomoses and graft patency rates (P>0.05). However, the off-pump group had shorter mechanical ventilation time and hospital stay than the conventional group (both P<0.05). LVEF and LVEDD showed no significant differences between the two group pre- and post-surgery. Cardiac biomarkers (cTnI, CK, CK-MB) increased postoperatively in both groups but were significantly lower in the off-pump group (P<0.05). The off-pump group had fewer complications, better QoL scores in social, mental, emotional, and overall health, and lower long-term MACCE incidence than the conventional group (all P<0.05).

CONCLUSION: Off-pump CABG reduces surgical trauma, shortens recovery time, lowers complication rates, and improves QoL compared to conventional CABG, making it a preferable option for elderly CHD patients.

PMID:40821072 | PMC:PMC12351558 | DOI:10.62347/VKEY9889

Perfusion. 2025 Aug 17:2676591251370076. doi: 10.1177/02676591251370076. Online ahead of print.

ABSTRACT

IntroductionPostoperative delirium affects up to 60% of cardiac surgical patients. No reliable gold standard method exists for preventing delirium after cardiac surgery. An example of patient-personal monitoring is cerebral autoregulation (CA). This study aims to highlight the personal monitoring of patients' cerebral autoregulation and to determine its relationship with postoperative delirium. Additionally, it seeks to test the hypothesis that the duration of CA impairment influences the onset of postoperative delirium.MethodsA prospective study was conducted in 2021-2023. After approval of the Ethics Committee and with the patient's written consent, 104 adult patients undergoing elective coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) surgery were enrolled. To diagnose possible delirium, all patients underwent a Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test. CA monitoring using transcranial Doppler was performed. CA status index - Mx was recorded.ResultsOur study found that 12.5% of patients were diagnosed with delirium after on-pump CABG surgery. The total duration of cerebral autoregulation impairment (TCAI) was longer in the delirium group, 4783.0 seconds versus 4204.5 seconds (p = .047), with a cut-off at 4380 s. Longer cardiopulmonary bypass (CPB) leads to prolonged CA impairment (p < .001). The mean arterial pressure (MAP) during CPB was 69.67 mmHg in the non-delirium group and 74.91 mmHg in the delirium group (p = .001), with a cutoff at 73.669 mmHg.ConclusionsCA impairment is crucial for delirium development after cardiac surgery. The duration of the TCAI event increases the risk of delirium.

PMID:40820307 | DOI:10.1177/02676591251370076

Braz J Cardiovasc Surg. 2025 Jul 29;40(5):e20250199. doi: 10.21470/1678-9741-2025-0199.

ABSTRACT

The Off-pump versus On-pump Coronary Artery Bypass Grafting in Frail Patients (FRAGILE Trial) is a multicenter, randomized controlled trial comparing off-pump and on-pump coronary artery bypass grafting in frail or pre-frail patients undergoing coronary artery bypass grafting. This manuscript presents an update to the FRAGILE Trial study design, detailing protocol modifications made in response to the time gap between the study's conception and its actual implementation. These changes were implemented early in the trial and were formally approved by the Ethics Committee, ensuring the scientific and ethical integrity of the study and reinforcing its relevance to address a gap in a vulnerable patient population.

PMID:40728943 | PMC:PMC12306569 | DOI:10.21470/1678-9741-2025-0199

Interdiscip Cardiovasc Thorac Surg. 2025 Jul 3;40(7):ivaf144. doi: 10.1093/icvts/ivaf144.

ABSTRACT

OBJECTIVES: To determine the differential impact of low cardiac function (ejection fraction [EF] ≤ 35%) and diabetes mellitus (DM) on survival and to identify causes of death after coronary artery bypass grafting (CABG).

METHODS: Overall, 1036 patients who underwent isolated CABG between 2009 and 2022 were divided into four groups based on EF and DM. Kaplan-Meier analysis was performed to calculate each group's estimated survival. Inter-group multivariate Cox regression was performed with the reference group showing EF > 35% and DM (-). Additional Cox regressions were performed to investigate the associations of EF ≤ 35% and DM (+) with death from heart failure, myocardial infarction, cancer, pneumonia, cerebrovascular disease and renal failure.

RESULTS: Off-pump techniques were used in 980 patients (95%). Patient population and estimated 10-year postoperative survival were as follows: EF > 35% DM (-), 430, 75.1%; EF > 35% DM (+), 456, 66.3%; EF ≤ 35% DM (-), 73, 62.5%; and EF ≤ 35% DM (+), 77, 53.5%. Hazard ratios (HRs) (P values) for the three groups were as follows: EF > 35% DM (+), 1.53 (0.006); EF ≤ 35% DM (-), 1.84 (0.017); and EF ≤ 35% DM (+), 2.23 (0.001). For death from heart failure, HR (P value) for EF ≤ 35% versus EF > 35% was 3.62 (0.012). For deaths from cancer and pneumonia, HRs (P values) for DM (+) versus DM (-) were 1.73 (0.097), and 2.72 (0.046), respectively.

CONCLUSIONS: EF ≤ 35% and DM (+) are associated with worse post-CABG survival. Each is associated with specific causes of death.

PMID:40577802 | PMC:PMC12231534 | DOI:10.1093/icvts/ivaf144

Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):852-862. doi: 10.1007/s12055-025-01907-w. Epub 2025 Mar 6.

ABSTRACT

BACKGROUND: The efficacy and safety of off-pump relative to on-pump coronary artery bypass grafting (CABG) in patients with left main coronary artery disease (LMCAD) remain unclear.

OBJECTIVES: Conduct a meta-analysis assessing the outcomes following CABG comparing off-pump CABG vs. on-pump CABG.

METHODS: MEDLINE, Cochrane, and Embase were examined for randomized controlled trials (RCTs) and observational studies that communicated outcomes after off-pump vs. on-pump CABG in patients with LMCAD. Odds ratios (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Cochrane recommendations for quality assessment and risk of bias were performed. This study was registered in the PROSPERO platform, ID: CRD42023451467.

RESULTS: One RCT and 17 observational studies with 16,848 patients were included, 6735 (40.0%) of whom underwent off-pump CABG. In patients with LMCAD undergoing CABG, off-pump CABG was associated with a lower incidence of all-cause mortality (OR 0.52, 95% CI 0.38-0.71; p < 0.001), acute renal dysfunction (OR 0.40; 95% CI 0.27-0.59; p < 0.001), postoperative use of intra-aortic balloon pump (IABP) (OR 0.38; 95% CI 0.22-0.64; p < 0.01), and wound infection (OR 0.66; 95% CI 0.48-0.9; p = 0.01). There was no difference between the groups for myocardial infarction (OR 0.81; 95% CI 0.59-1.11; p = 0.193), stroke, or transitional ischemic attack (TIA) (OR 0.64; 95% CI 0.38-1.06; p = 0.085). The number of grafts per patient was also lower in the off-pump CABG group (mean deviation (MD) -0.32; 95% CI -0.50 to -0.14; p < 0.001). After a mean follow-up of 38.1 months, no significant difference in all-cause mortality incidence was observed between the two techniques (OR 0.72; 95% CI 0.30-1.74; p = 0.47). This underscores that the reduction in mortality rates was primarily driven by short-term outcomes.

CONCLUSION: In this meta-analysis with 16,848 patients with LMCAD undergoing CABG, off-pump CABG was associated with lower rates of all-cause mortality, acute renal dysfunction, IABP use, and wound infection compared with on-pump CABG.

GRAPHICAL ABSTRACT: On-pump versus off-pump CABG in patients with LMCAD.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-025-01907-w.

PMID:40535226 | PMC:PMC12170468 | DOI:10.1007/s12055-025-01907-w