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Background: According to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians., Objectives: The aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data., Methods: All octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery., Results: Octogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013)., Conclusion: On the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To assess the reliability of EuroSCORE II in an entire population after isolated coronary artery surgery and separately among patients who underwent redo surgery due to bleeding, and to create a model predicting hospital death among patients who underwent redo surgery owing to bleeding., Design: Retrospective study based on data from the Polish National Registry of Cardiac Surgical Procedures., Setting: Multi-institutional study., Participants: The study comprised 41,353 patients who underwent isolated coronary artery surgery in Poland between January 2012 and December 2014., Interventions: None., Measurements and Main Results: EuroSCORE II reliability was estimated using the area under the receiver operating characteristics curve (AUC), the observed-to-expected surgical mortality ratio (O/E), and the Hosmer-Lemeshow test. Parameters of the function correcting the original EuroSCORE II were determined using the least squares method. The original score was adjusted using a created formula. Among the 41,353 patients, 1,406 (3.4%) underwent reexploration. Even though EuroSCORE II was reliable in predicting hospital mortality in the entire population (AUC 0.76, O/E ratio 1.08), it greatly underestimated mortality for patients who required reexploration (AUC 0.74, O/E ratio 4.33). In this subpopulation, the worst performance of the EuroSCORE II was noted among patients with the lowest predicted mortality (0.50%-0.82%) Accurate calibration was obtained by adding a coefficient and creating a nomogram., Conclusions: EuroSCORE II was reliable in a Polish population undergoing isolated coronary surgery. After redo surgery for bleeding, the observed mortality was much higher than in the overall coronary population, but the rate was made more accurate by adding a coefficient to the initially calculated EuroSCORE II., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To assess the suitability of nanocrystalline-coated silver dressings versus standard wound dressings in patients with type 2 diabetes after coronary revascularization., Methods: The study involved 194 patients who were divided into two homogeneous groups. The control group (n = 97) received a standard sterile dressing. The intervention group (n = 97) received silver dressings. Glycosylated hemoglobin, fructosamine, and creatinine were assessed in all patients. The emergence of superficial wound infection within 30 days was the primary endpoint of the study, and deep wound infections were a secondary endpoint., Main Results: Superficial wound infections were documented in 26 patients: 11 patients in the study group and 15 in the control group. There were no statistically significant differences between the analyzed groups regarding the occurrence of the primary endpoint. No deep wound infections were found in either the study or control group., Conclusions: The frequency of sternotomy wound infection in patients with type 2 diabetes is comparable between patients treated with traditional dressings and those receiving silver dressings; therefore, to maximize cost savings, providers should consider using standard wound dressings in this patient population.

Less-invasive left ventricular assist device implantation is becoming the technique of choice for implementation of new-generation heart pumps. The less-invasive technique is particularly useful for patients with a history of cardiac surgical procedures, such as coronary artery bypass grafting. Yet, in redo cases, severe pericardial adhesions may force experienced operators to opt for alternative outflow graft placement, such as in the descending aorta. We propose a surgical technique in which the left ventricular device is implanted through a limited thoracic incision, with the outflow graft anastomosed to the ascending aorta, avoiding collision with coronary bypass grafts. The key element of the proposed technique is a tunnel connecting 2 pleural cavities, in which the outflow graft is placed, entirely bypassing the pericardium., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

INTRODUCTION During the last decade, aortic stenosis (AS) has emerged as one of the most significant concerns in cardiovascular diseases. OBJECTIVES We aimed to characterize AS patients on the basis of data derived from a local registry. PATIENTS AND METHODS We used data from the SILesian CARDiovascular (SILCARD) registry, which was developed under the agreement between the Silesian Centre for Heart Diseases in Zabrze and the Silesian branch of the Polish National Health Fund in Katowice to conduct a comprehensive analysis of patients with cardiovascular diseases in Silesian Voivodeship. RESULTS A total of 15 158 patients hospitalized with a diagnosis of AS between 2006 and 2016 were included (mean [SD] age, 69.87 [11.97] years; male patients, 7644 [50.43%]). Heart failure was reported in 4187 patients (27.62%), and coronary artery disease, in 6217 (41.01%). During the first hospitalization, aortic valve intervention was performed in 2137 patients (14.10%), and during a 12‑‑ month follow‑‑ up, in 3416 (25.32%). During the first hospitalization, percutaneous coronary intervention (PCI) was performed in 666 patients (4.39%), and coronary artery bypass grafting (CABG), in 1071 (6.71%). At 12‑‑ month follow‑‑ up, PCI was reported in 560 patients (4.15%), and CABG, in 560 (4.15%). Between 2006 and 2016, 30‑‑ day mortality was 4.35% (659 patients) and remained stable throughout the study (5.4% in 2005 vs 4.0% in 2016, P = 0.28). The 1‑‑ year mortality was 15.88% (2142 patients) and increased from 14.3% in 2006 to 16% in 2015 (P = 0.07). CONCLUSIONS The SILCARD registry has revealed an increase in the number of AS diagnoses. AS has become one of the most critical issues among cardiovascular diseases in Silesian Voivodeship.

Objectives: This study aimed to investigate the 5-year clinical follow-up of the HYBRID (Hybrid Revascularization for Multivessel Coronary Artery Disease) trial., Background: The HYBRID trial, the only randomized study involving thorough analysis of outcome after the 2 procedures, suggested that hybrid coronary revascularization (HCR) is feasible in selected patients with multivessel coronary disease referred for conventional coronary artery bypass grafting (CABG). There are currently no long-term outcome data from randomized trials in this setting., Methods: A total of 200 patients with multivessel coronary disease referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG. The primary endpoint was the occurrence of all-cause mortality at 5 years., Results: Nine patients (4 in HCR and 5 in CABG group) were lost to the 5-year follow-up. Finally, 191 patients (94 in HCR and 97 in CABG group) formed the basis of this study. The groups were well balanced in terms of pre-procedural characteristics. All-cause mortality at 5-year follow-up was similar in the 2 groups (6.4% for HCR vs. 9.2% for CABG; p = 0.69). The rates of myocardial infarction (4.3% vs. 7.2%; p = 0.30), repeat revascularization (37.2% vs. 45.4%; p = 0.38), stroke (2.1% vs. 4.1%; p = 0.35), and major adverse cardiac and cerebrovascular events (45.2% vs. 53.4%; p = 0.39) were also similar in the 2 groups., Conclusions: HCR has similar 5-year all-cause mortality when compared with conventional coronary bypass grafting (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease; NCT01035567)., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

INTRODUCTION    Rehabilitation after coronary revascularization procedures is an intrinsic part of treatment during the in‑hospital period. OBJECTIVES    We aimed to compare the course and effects of rehabilitation in patients receiving hybrid treatment (minimally invasive direct coronary artery bypass / percutaneous coronary intervention) or classic treatment (coronary artery bypass grafting / off‑pump coronary artery bypass) during hospitalization. PATIENTS AND METHODS    The study included 200 patients participating in a prospective randomized clinical trial (POLMIDES) that assessed the effect of hybrid treatment on in‑hospital outcomes and long‑term results in patients with multivessel coronary artery disease. Patients were divided into the classic and hybrid groups. RESULTS    The classic group showed a higher perioperative risk than the hybrid group (mean [SD] EuroSCORE, 3.54 [2.12] and 2.89 [1.97], respectively). During all the rehabilitation cycles, lower arterial oxygen saturation (SaO2) was reported in the hybrid group (P = 0.002). The classic group showed lower systolic blood pressure (P <0.001), lower diastolic blood pressure (P = 0.029), and a higher rate of blood pressure drops during rehabilitation (P = 0.02). Patients from the classic group were able to sit (P <0.001), assume a vertical position (P <0.001), and walk (P = 0.01) earlier than those from the hybrid group. In the hybrid group, earlier completion of rehabilitation and discharge from the hospital were noted (P = 0.001). CONCLUSIONS    Patients receiving hybrid coronary revascularization less often suffer from hypotonia events but show lower SaO2 values than patients receiving classic treatment. Mobilization of patients receiving the hybrid treatment is slower during the initial days and cycles of rehabilitation, but they achieve full self‑reliance earlier, which enables a shorter hospitalization period.

Background: There is a paucity of data concerning the clinical characteristics, management, and outcomes of coronary artery bypass graft surgery (CABG) in patients ≤ 45 years old., Aim: We aimed to compare the clinical characteristics, and in-hospital and long-term outcomes of patients ≤ 45 years and > 45 years old, who underwent isolated CABG., Methods: We identified consecutive patients who had isolated CABG in the Department of Cardiac Surgery and Transplantology in the Silesian Centre for Heart Diseases in Zabrze between January 2006 and December 2011 and were enrolled in the Polish National Registry of Cardiac Surgery Procedures (KROK registry). A total of 8196 patients were identified and split into two groups, age ≤ 45 years old (young group; n = 130) and > 45 years old (old group; n = 8066)., Results: Patients ≤ 45 years old were less often females (18.5% vs. 27.6%, p < 0.027), more often smokers (84.6% vs. 66.9%, p < 0.0001), and had a higher incidence of previous myocardial infarction (MI) (40.8% vs. 29.6%, p = 0.008). Patients ≤ 45 years old more often received only one graft (27.7% vs. 15.0%, p < 0.0001), were operated on with minimally invasive direct coronary artery bypass (MIDCAB) technique (12.3% vs. 3.9%, p < 0.0001), and had complete arterial revascularisation (55.4% vs. 18.1%, p < 0.0001). There were no significant differences between the groups regarding in-hospital mortality (0.8% vs. 1.4%, p = 0.808). Long-term outcomes revealed that young patients, compared with the older patients, showed no significant differences in the number of MI (4.6% vs. 5.6%), unstable angina (8.5% vs. 9.9%), coronary angioplasty (12.3% vs. 15.1%), reCABG (0.8% vs. 0.1%), and strokes (2.3% vs. 4.3%) during the follow-up period; long-term mortality occurred less often in the young patients (4.6% vs. 15.0%, p = 0.002)., Conclusions: We conclude that patients ≤ 45 years old requiring CABG differ from their older counterparts in clinical and surgical characteristics. We noted no significant differences in the in-hospital mortality; however, patients ≤ 45 years old had a lower mortality rate in the long-term follow-up.

Background: Despite the popularity of less invasive approaches for conduits procurement in coronary artery bypass graft surgery, concerns have been raised about the potential detrimental effects of the endoscopic technique when compared with the conventional "open" technique., Methods: Among 470 patients undergoing coronary surgery with the use of a radial artery conduit, a propensity score analysis was performed among those patients assigned either to an open technique (n = 82) or to an endoscopic approach (n = 82). Endoscopic harvesting was performed with a nonsealed system. The primary endpoint was cardiac-related mortality, and secondary endpoint was survival free from major cardiac and cerebrovascular adverse events. Moreover, hand and forearm sensory discomfort and forearm wound healing were also assessed., Results: No conversion to the open technique occurred in patients undergoing endoscopic harvesting. No patients in either group showed hand ischemia; wound infection occurred only in the open group (open 7.3% versus endoscopic 0%, p = 0.007). Wound healing (Hollander scale) was considerably better in the endoscopic group (open 3.3, endoscopic 4.7; p < 0.001) as well as paresthesia at the latest follow-up (open 19.5% versus endoscopic 3.6%, p < 0.001). Pain (visual analog scale score) was significantly reduced with the endoscopic technique (open 3.2, endoscopic 1.2; p = 0.003). At 5 years of follow-up, freedom from cardiac-related mortality (open 96.3% ± 2.1% versus endoscopic 98.1% ± 1.8%; p = 0.448) as well as survival free from major cardiac and cerebrovascular adverse events (open 93.9% ± 2.6% versus endoscopic 93% ± 3.4%; p = 0.996) were similar among the groups., Conclusions: Endoscopic radial artery harvesting allows for incremental benefits in the short term in terms of improved cosmesis and reduced wound and neurologic complications, without yielding detrimental effects in terms of graft-related events at 5 years of follow-up., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Coronary artery bypass graft (CABG) surgery is rarely performed in very young patients. The purpose of our study is to compare the characteristics, treatments, in-hospital, and long-term outcomes of two groups of patients less than 40 years of age who had CABG in two successive decades: 1990-2000 and 2001-2011., Methods: We identified 145 consecutive patients who underwent primary isolated CABG. Group 1 consisted of 78 patients operated between 1990-2000 and group 2 consisted of 67 patients operated between 2001-2011. Composite end point assessed at follow-up period involved death or recurrence of symptoms, which we defined as myocardial infarction, a need for percutaneous coronary intervention (PCI), reoperation, or congestive heart failure (CHF).  , Results: Smoking and hypercholesterolemia before CABG were noted as more frequent in group 1 than in group 2: 96.1% versus 83.6%, P = .011; 88.5% versus 61.2%, P = .0001, respectively. Patients from group 2 more frequently received one graft (29.8% versus 11.5%, P = .0059), were operated with off-pump (41.8% versus 0%, P &lt; .0001) or MIDCAB (28.4% versus 0%, P = .0008) techniques, and had complete arterial revascularization (58.2% versus 23.1%, P &lt; .0001). Group 1 patients had a higher prevalence of composite end point (33.9% versus 17.9%, P = .035), with no significant difference in mortality (11.5% versus 10.4%, P = .83)., Conclusion: Patients operated between 1990-2000 had a higher prevalence of smoking and hypercholesterolemia and higher frequency of composite-end point during folow-up period without significant difference in mortality.

Despite advanced techniques and improved clinical outcomes, patient survival following coronary artery bypass grafting (CABG) is still a major concern. Therefore, predicting future CABG mortality represents an unmet medical need and should be carefully explored. The objective of this study is to assess whether pre-CABG platelet activity corresponds with 30 days mortality post-CABG. Retrospective analyses of platelet biomarkers and death at 30 days in 478 heart surgery patients withdrawn from aspirin or/and clopidogrel. Platelet activity was assessed prior to CABG for aspirin (ASPI-test) with arachidonic acid and clopidogrel (ADP-test) utilizing Multiplate impedance aggregometer. Most patients (n = 198) underwent conventional CABG, off-pump (n = 162), minimally invasive (n = 30), artificial valve implantation (n = 48) or valves in combination with CABG (n = 40). There were 22 deaths at 30 days, including 10 in-hospital fatalities. With the cut-off value set below 407 area under curve (AUC) for the ASPI-test, the 30-day mortality was 5.90% for the lower cohort and 2.66% for patients with significantly higher platelet reactivity (P = 0.038). For the ADP-test with a cut-off at 400AUC, the 30-day mortality was 9.68% for the lower cohort and 3.66% for patients with higher platelet reactivity, representing a borderline significant difference (P = 0.046). Aside from the platelet indices, patients who received red blood cell (RBC) concentrate had a highly significant (P < 0.0001) risk of death at 30 days. Both aspirin and clopidogrel tests were useful in predicting 30 days mortality following heart surgery, suggesting the danger of diminished platelet activity prior to CABG in such high-risk patients. These preliminary evidence supports early discontinuation of antiplatelet therapy for elective CABG and requires adequately powered randomized trials to test the hypothesis and potentially improve survival.

Background: Predicting bleeding events in patients with coronary artery bypass grafting (CABG) represents an unmet medical need that may improve CABG outcomes., Hypotesis: To assess the potential link between platelet function testing and bleeding risk in patients undergoing CABG., Methods: Platelet aggregation and clinical outcomes in 478 patients treated with aspirin and/or clopidogrel were retrospectively analyzed. Platelet activity was assessed prior to CABG with arachidonic acid (ASPI Test), and adenosine diphosphate(ADP Test) utilizing multiple-electrode aggregometry., Results: In the study group of 478 patients, mean age was 65.2±15.2 years; 138 were women. The majority of patients (n = 198) underwent on-pump surgery, with 162 undergoing off-pump and 30 undergoing minimally invasive surgery. Forty-eight patients received artificial valve implantation alone, and 40 received valve implantation in combination with CABG. The analysis of the entire pool revealed that an ASPI test value <407 area under curve per minute (AUC*min) may be useful in predicting postoperative drainage. In CABG patients only, an ASPI test value <271 AUC*min predicted the need for red blood cell concentrate transfusion following surgery. In patients who stopped clopidogrel for up to 5 days before surgery, the ADP test failed to exhibit prognostic utility for predicting bleeding risk., Conclusions: In patients undergoing heart surgery, an ASPI test value <407 AUC*min may predict higher postoperative drainage, whereas <271 AUC*min may be linked to postoperative use of red blood cell concentrate., (© 2015 Wiley Periodicals, Inc.)

Background: Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes., Methods and Results: In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of ≤35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (≈25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality., Conclusions: CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595., (© 2015 American Heart Association, Inc.)

Objective: Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction., Methods: Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point., Results: Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P < .0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022)., Conclusions: Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling., (Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to assess the feasibility of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD) referred for standard coronary artery bypass grafting (CABG)., Background: Conventional CABG is still the treatment of choice in patients with MVCAD. However, the limitations of standard CABG and the unsatisfactory long-term patency of saphenous grafts are commonly known., Methods: A total of 200 patients with MVCAD involving the left anterior descending artery (LAD) and a critical (>70%) lesion in at least 1 major epicardial vessel (except the LAD) amenable to both PCI and CABG and referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG (in a 1:1 ratio). The primary endpoint was the evaluation of the safety of HCR. The feasibility was defined by the percent of patients with a complete HCR procedure and the percent of patients with conversions to standard CABG. The occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeated revascularization, and major bleeding within the 12-month period after randomization was also assessed., Results: Most of the pre-procedural characteristics were similar in the 2 groups. Of the patients in the hybrid group, 93.9% had complete HCR and 6.1% patients were converted to standard CABG. At 12 months, the rates of death (2.0% vs. 2.9 %, p = NS), myocardial infarction (6.1% vs. 3.9%, p = NS), major bleeding (2% vs. 2%, p = NS), and repeat revascularization (2% vs. 0%, p = NS) were similar in the 2 groups. In both groups, no cerebrovascular incidents were observed., Conclusions: HCR is feasible in select patients with MVCAD referred for conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease [POL-MIDES]; NCT01035567)., (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Left main disease (LMD), combined with carotid artery stenosis (CAS), constitutes a high-risk patient population. Priority is often given to coronary revascularization, due to the severity of the angina. However, the choice of revascularization strategy [off-pump coronary artery bypass (OPCAB) vs coronary artery bypass grafting (CABG)] remains elusive., Methods: A total of 1340 patients with LMD were non-randomly assigned to either on-pump (CABG group, n = 680) or off-pump (OPCAB group, n = 634) revascularization between 1 January 2006 and 21 September 2010. Multivariable regression was used to determine the risk-adjusted impact of a revascularization strategy on a composite in-hospital outcome (MACCE), and proportional hazards regression was used to define the variables affecting long-term survival., Results: Significant CAS was found in 130 patients: 84 (13.1%) patients underwent OPCAB, while 46 patients (6.8%) underwent CABG (P < 0.05). Patients with a history of stroke/transient ischaemic attack were also more likely to receive OPCAB (7.1 vs 4.7%; P = 0.08). OPCAB patients were older, in a higher New York Heart Association (NYHA) class, with a lower LVEF and higher EuroSCORE. A calcified aorta was found in 79 patients [OPCAB-CABG: 49 (7.73%) vs 30 (4.41%); P = 0.016] and resulted in a less complex revascularization (OPCAB-CABG: 2.3 ± 0.71 vs 3.19 ± 0.82; P < 0.05), and 30-day mortality was insignificantly higher in the CABG (2.7 vs 2.8%) as well as MACCE (11.2 vs 12.2%; P = NS). This trend reversed when late mortality was evaluated; however, it did not reach significance at 60 months. Preoperative renal impairment requiring dialysis was found to be a technique-independent predictor of MACCE. The number of arterial conduits also influenced MACCE., Conclusions: Off-pump coronary revascularization may offer risk reduction of neurological complications in patients with a significant carotid artery disease and a history of previous stroke, but a larger study population is needed to support this thesis. The growing discrepancy in long-term survival should draw attention to a more complete revascularization in OPCAB patients.

Background: Several patients with acute coronary syndrome (ACS) are discharged home after the acute phase of ACS and are suitable for elective coronary artery bypass graft (CABG) surgery. The aim of the study was to assess the optimal timing for surgical revascularization and its effect on 12-month outcome in patients discharged from hospital after ACS and referred for elective CABG surgery., Methods: The analysis involved 2028 patients enrolled into the ongoing Polish Registry of Acute Coronary Syndromes (PL-ACS) who were discharged from hospital with the intention to undergo elective CABG surgery., Conclusions: Among 2028 patients 1216 (60.0%) underwent surgery during 12months of follow-up. Patients who underwent surgical revascularization had a lower prevalence of mortality (5.7% vs 11.5%, p<0.0001). Patients who underwent surgery within the first month had a significantly higher prevalence of mortality than those who did not undergo surgery (5.7% vs 1.6%, p<0.0001). By the third month, the two cumulative mortalities were similar (4.2% vs 4.6%, p=0.65). From the beginning of the fourth month, the cumulative mortality was significantly higher among patients who did not undergo surgery., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: To establish what is the prevalence of elevated HbA1c among diabetic patients scheduled for coronary surgery and whether this may influence their postoperative outcome., Methods: We performed a retrospective review of our departmental cardiac surgical database over a 3-year period (2006-2008). Among the 2665 patients, who underwent coronary revascularization, 782 (29.3%) patients had diabetes mellitus, with 735 (94.0%) patients having their HbA1c assessed preoperatively up to 3 days before the start of the procedure. Patients with preoperative normal or elevated HbA1c (>7%) were compared regarding their hospital mortality, morbidity (defined as any postoperative complication such as stroke, renal failure, wound infection, perioperative myocardial infarction (MI), and others) as well as mean intensive care unit (ICU) and hospital stay. Patients for comparisons were matched to achieve similar preoperative status with a use of a Greedy matching procedure. Chi-square test was performed to compare variables of interest; p<0.05 was considered significant., Results: Elevated HbA1c levels were present in 38.4% of diabetic patients - 57.1% of patients among insulin-dependent diabetics, 27.3% of patients on oral medication, and in 7.7% of patients whose diabetes was treated with diet only. In a direct comparison and after matching for preoperative variables, elevated HbA1c levels increased only the frequency of perioperative MI (p=0.01). Other complications, length of ICU and hospital stay as well as early mortality were similar in both the groups., Conclusions: Elevated HbA1c levels are common among diabetic patients scheduled for coronary surgery, particularly in patients receiving insulin, and are associated with more frequent occurrence of perioperative MI., (Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

We present new-onset sustained monomorphic ventricular tachycardia with relatively narrow QRS (width of QRS feminine 120 ms) in the recovery period after aortic valve replacement and surgical revascularisation in a patient with a prior inferior wall myocardial infarction. Ventricular tachycardia probably originating from the left-side His-Purkinje system and mimicking idiopathic posterior fascicular tachycardia was diagnosed. Placement of a bypass graft across occluded artery supplying an infarct zone was a potential trigger of this arrhythmia.

Introduction: Concomitant chronic obstructive pulmonary disease (COPD) is associated with an increased rate of post-coronary artery bypass grafting (CABG) complications. The ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) <70%, proposed by the Global Initiative for Chronic Obstructive Lung Disease as a criterion for the diagnosis of COPD, is criticized for not considering physiological, age-related changes in lung function., Objectives: The aim of the study was to evaluate which of the additional spirometric parameters, adjusted for age and the distribution of values in the population, represent the best predictors of post-CABG complications and to identify patients who are more likely to benefit from off-pump cardiac bypass (OPCAB) than from CABG., Patients and Methods: In the retrospective cohort study, data from a total of 3617 CABG or OPCAB patients were recorded. Patients with COPD, diagnosed prior to admission, were classified according to the spirometry results: group 1 with FEV1/FVC <70%, group 2 with FEV1/FVC below the mean normal value adjusted to age, group 3 with FEV1/FVC below the lower limit of normal (LLN), group 4 with FEV1

Objectives: Extracorporeal circulation is associated with the systemic inflammatory response syndrome. The objective of this study was to measure plasma and myocardial matrix metalloproteinase 2 and 9 levels in patients undergoing off-pump coronary artery bypass and coronary artery bypass grafting., Methods: Twenty patients subjected to coronary artery bypass grafting and 20 subjected to off-pump coronary artery bypass surgery were included in this study. In both procedures blood was collected in 7 equivalent time points up to 12 hours after grafting. The myocardial biopsy specimens were collected before and after extracorporeal circulation in the coronary artery bypass grafting group and after harvesting and completion of proximal anastomoses in the off-pump coronary artery bypass group. Matrix metalloproteinase levels were measured by means of zymography. Myeloperoxidase and tissue inhibitor of metalloproteinase 1 and 2 levels were measured with an enzyme-linked immunosorbent assay., Results: Coronary artery bypass grafting but not off-pump coronary artery bypass led to a 700- to 900-fold increase of plasma matrix metalloproteinase 9 levels. A small but significant increase in matrix metalloproteinase 2 levels was detected in both procedures. Myocardial matrix metalloproteinase 9 levels significantly increased at the end of coronary artery bypass grafting and off-pump coronary artery bypass. Increased matrix metalloproteinase 9 activity at the end of extracorporeal circulation was accompanied by augmentation of the endogenous matrix metalloproteinase inhibitors tissue inhibitor of metalloproteinase 1 and 2 in plasma, but its magnitude was unable to balance the plasma matrix metalloproteinase 9 increase. The matrix metalloproteinase 9 content in plasma at the end of extracorporeal circulation correlated with the myeloperoxidase plasma concentration (r(2) = 0.8212, P < 0.05)., Conclusion: We propose that release of matrix metalloproteinase 9 might contribute to the extracorporeal circulation-induced inflammatory reactions.

Background: Cardiac surgery is supposed to be a risk factor of PRA formation, however the role of PRA presence in non-transplant subjects is not known. Aim of the study was to assess PRA occurrence in patients undergoing elective cardiosurgery procedures and to evaluate its influence on the perioperative course., Material and Methods: Blood samples were obtained before operation in 44 subjects (36M/8F; 55.9 +/- 8.1 y/o) undergoing primary elective cardiosurgery procedures--CABG (n = 30), CABG + valve (n = 2) or valve procedure (n = 12). PRA results were obtained after the discharge, and patients were retrospectively divided into: Group A (n = 18) with PRA > 1%, and Group B (n = 26) with PRA. < or = 1%. PRA screening was repeated 3 months after the procedure in 41 subjects. They were divided into Group I (n = 13) with PRA > 1%, and Group II (n = 28) with PRA < or = 1%. Comparison was performed of Groups A vs. B, and I vs. II., Results: Differences in pre-operative characteristics and procedure type distribution were insignificant. Post-operative complications were more frequent in Groups A and I (pulmonary hypertension in Group I vs. II: 38 vs. 4%; p = 0.01). Duration of post-operative ICU stay was longer in Group I vs. 11 (2.9 vs. 1.9d.; p = 0.01). Overall hospital stay was longer in Group A vs. B (10.1 vs. 7.8d.; p = 0.054). Increase of PRA titers was observed in 10 subjects (3 pts. /17% from Group A, and 7 pts. /27% from Group B), exceeding 10% in 2 females after valve replacement. 6 months after procedure, detectable PRA was still observed in 7 patients., Conclusions: Cardiac surgery is not a strong causative factor of PRA formation. The presence of perceptible PRA level may be associated with increased incidence of complications and consequently prolonged in-hospital stay. Influence of PRA on peri-operative course is not dependent on the source of its increased level.

Objective: The efficacy of percutaneous and surgical revascularization in acute coronary syndromes without ST-segment elevation is similar. Therefore, other factors, like health-related quality of life, should play an important role in choosing the revascularization method., Methods: We compared 12-month health-related quality of life for high-risk patients with acute coronary syndromes without ST-segment elevation assigned to percutaneous coronary intervention (group A) versus coronary artery bypass graft surgery (group B). Patients had an episode of rest angina within 24h prior to admission and had to fulfil at least one of the criteria: (1) ST-segment depression (>or=0.05mV), (2) transient (<20min) ST-segment elevation or T-wave inversion (>or=0.1mV), (3) positive serum cardiac markers. Four hundred and ninety-six (91.34%) of 543 patients alive 12-months after index hospitalization completed a Short Form-36 (SF-36) health status survey. Group A comprised 392 patients and group B comprised 104 patients. We compared mental component summary (MCS) and physical component summary (PCS) scores from the SF-36 survey between analyzed groups., Results: There were no significant differences in MCS scores (47.21+/-12.30 vs. 46.60+/-11.3 in group A and group B, respectively, NS). PCS scores were lower in group A (38.30+/-11.10 vs. 42.64+/-9.76; p=0.003). Patients of group A had a higher rate of unstable angina (22.45 vs. 5.77%, p=0.0002) and repeated revascularization (12.76 vs. 1.92%, p=0.001) at 1 year. Patients of group A also had higher systolic and diastolic blood pressure during follow-up (138.17+/-20.41 vs. 133.47+/-19.21, p=0.04 and 82.48+/-11.32 vs. 77.25+/-16.17, p=0.0003, respectively). Systolic blood pressure was inversely associated with PCS scores in group A (Spearman's R= -0.18 p=0.0007)., Conclusions: This study has shown that there is a significant difference in health-related quality of life 12-months after percutaneous coronary intervention and coronary artery bypass graft surgery. This difference arises from better physical function (physical component summary) for coronary artery bypass graft surgery patients compared with percutaneous coronary intervention patients. Despite impairment of the physical health status (physical component summary), the mental health status (mental component summary) remained similar in both groups.

Background: Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation., Hypothesis: The aim of the study was analysis of clinical characteristics, in-hospital outcome and factors of in-hospital mortality., Methods: The study group comprised 853 patients who were defined as high-risk, based on resting pain episodes within previous 24 hours, changes of ST-T segment in ECG, and elevated serum cardiac markers. All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 73.1% of patients. 16.7% were assigned to CABG (coronary artery bypass graft), 1.6% of patients underwent PCI and CABG and 8.6% of patients were treated conservatively., Results: Overall in-hospital mortality was 3%; 1.4% in the PCI group, 8.4% in the CABG group and 6.8% in conservatively treated patients. The independent risk factors of in-hospital deaths were: Braunwald's IIIC class angina (OR 7.8; 95%CI 3.6-12.37 p=0.004), recurrent angina after revascularization (OR 13.04; 95%CI 7.62-29.23 p=0.002), congestive heart failure (OR 11.45; 95%CI 8.01-18,38 p=0.00001) and evolving myocardial infarction with ST-segment elevation (OR 12.77; 95%CI 8.35-27.35 p=0.0001). Stent implantation was associated with decreased risk of in-hospital death (OR 0.12; 95%CI 0.07-0.41; p=0.003)., Conclusions: Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.

Unlabelled: Early invasive strategy is one of two methods of treatment of acute coronary syndromes without ST-segment elevation (NSTEACS). We aimed at assessing 12-month outcomes and quality of life in patients with NSTEACS and multivessel coronary artery disease (CAD) who underwent percutaneous or surgical revascularization. Analyzed group comprised 412 patients (92%) who were qualified for invasive treatment based on coronary angiography performed 24 hours after admission and in whom long-term follow up data was available. The inclusion criteria were: rest angina within 24 hours prior to admission and at least one of the following: ST segment depression (> or = 0.5 mm), transient (< 20 min) ST-segment elevation, negative T-waves (> or = 1 mm)in at least 2 contiguous leads, positive serum cardiac markers. Patients with single-vessel CAD or qualified for conservative treatment were excluded from the study. We analysed the rate of adverse cardiac events (death, non-fatal myocardial infarction, unstable angina, repeated revascularization, cardiovascular hospitalization) at one year. The quality of life was assessed using Short-Form-36 (SF-36) questionnaire. The rate of death was 5.3% vs 9.3% (NS), myocardial infarction 3.4% vs 0% (p = 0.054), unstable angina 20.9% vs 2.8% (p = 0.0000), repeated revascularization 12.6% vs 0% (p = 0.0001) and cardiovascular hospitalization 36% vs 22.7% (p = 0.001) in the PCI and CABG group respectively. Physical Component Summary scores were 38.7 +/- 11.6 vs 43.08 +/- 9.5, p = 0.001 in the PCI and CABG group respectively. Mental Component Summary Scores were similar in both groups (46.34 +/- 13.05 vs 45.97 +/- 11.9, NS)., Conclusions: Overall mortality rate was similar in both groups. PCI patients had more frequent rate of unstable angina, rate of hospitalization and repeat revascularization. This study has shown that there is a significant difference in health-related quality of life 12 months after PCI and CABG. This difference arises from better physical function (Physical Component) for CABG surgery patients compared with PCI patients. Despite impairment of the physical health status, the mental health status (Mental Component) remained similar in both groups.

Background: Utilization of early invasive strategy for patients with acute coronary syndromes (ACS) without persistent ST-segment elevation remains controversial. In this study we characterized a group of high-risk patients who underwent early invasive assessment and treatment., Methods: We analysed 458 consecutive pts who fulfilled following criteria: (1) rest angina within 24 hours prior to admission, (2) at least one of the following: ST-segment depression (> or = 0.05 mV), transient (> or =20 min) ST-segment elevation (> or = 0.05 mV), T-wave inversion (> or =1 mV) in at least 2 contiguous leads, positive serum cardiac markers. All patients were diagnosed invasively with subsequent revascularization if appropriate. Analysis of long-term survival and occurrence of major adverse cardiovascular events requiring hospitalization (MACE) was performed., Results: Baseline characteristics of the pts: Age: 61.5 +/- 10 years, males: 67.3%, diabetes: 19.6%, hypertension: 72.9%, smokers: 39.5%, hyperlipidemia: 78.6%, previous myocardial infarction: 50.4%, previous CABG 6.5%, previous PCI 14.4%. PCI was performed in 71.8% of pts, 18.2% underwent CABG, 1.3% had combined PCI and elective CABG and 8.7% of pts were treated conservatively. In-hospital and overall mortality was 3.3% and 4.8% respectively. MACE were observed in 20.3% of pts. Multivariate analysis identified two independent predictors of death: diabetes mellitus (OR: 6.01, 95% CI: 1.1-13.2, p = 0.04) and heart failure (OR: 11.6, 95% CI: 2.56-15.6, p = 0.005) and three predictors of combined endpoint (death, non-fatal myocardial infarction, repeat revascularization): male sex (OR: 3.33, 95% CI: 1.30-8.55, p = 0.01), previous MI (OR: 2.32, 95% CI: 1.07-5.03, p = 0.03) and PCI treatment of acute coronary syndrome (OR: 3.11, 95% CI: 1.39-6.98, p = 0.006)., Conclusions: Early invasive strategy in high-risk ACS patients yields good long-term results with low mortality rate, especially during in-hospital observation. Diabetes mellitus and heart failure were independently associated with increased mortality rate, whereas male sex, previous MI and PCI during index hospitalization predicted major adverse cardiovascular events in 6-month follow-up.

Background: Restenosis following percutaneous coronary interventions (PCI) increases re-hospitalisation rate and may lead to new myocardial infarction (MI) or death. Besides medical aspects, it may also reduce cost-effectiveness of the procedure., Aim: To analyse the medical and economical outcome of patients treated with PCI during a one year period., Methods: Medical outcome, cost of PCI and total cost of treatment during one year after PCI were assessed in 188 consecutive patients who underwent PCI during the first three months of 2002. Patients with acute MI treated with PCI were not included in the analysis., Results: The rate of major adverse cardiac events (MACE) which included death, new MI or repeated revascularisation, was 1.6% during hospital stay and 14.4% during one-year follow-up. Re-hospitalisation rate was 28.2%. The mean number of outpatient visits during one year was 9.8. The costs of initial hospitalisation and procedures performed during this hospital stay were 7,839 Polish zlotys (PLN) per patient whereas the costs during one-year follow-up were 3,490 PLN (re-hospitalisations and repeated procedures 3,091 PLN, outpatient visits 238 PLN, and pharmacotherapy costs 161 PLN). In the group of patients with MACE, the costs of treatment during one-year follow-up were 13,398 PLN whereas in patients without complications 1,349 PLN per patient., Conclusions: Patients who develop complications after PCI generate costs exceeding ten times that of patients with a favourable outcome. Thus, from the economical and medical point of view, there is a need to identify high-risk patients before the decision is made as to which type of treatment is used. Because the health service in Poland is under-funded, patients at risk should be treated with the most effective methods (antiproliferative stents or surgical revascularisation) as an initial treatment, which may decrease total costs during a long-term period.

Background: Percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) are well established revascularization methods in stable coronary artery disease and in acute coronary syndromes (ACS) as well., Methods: We analyzed 361 patients hospitalized with clinical diagnosis of ACS without persistent ST segment elevation. Patients had an episode of rest angina in the previous 24 hours and had to fulfil at least one of the criteria: 1. ST segment depression (>0.5 mm), 2. transient ST segment elevation or T-wave inversion (> 1 mm), 3. positive serum cardiac markers. We aimed at assessing the frequency of adverse events (death, myocardial infarction, repeat revascularization unstable angina, cardiovascular hospitalization) during follow-up and determining the predictors of 12-month mortality., Results: In the analyzed group 284 patients (78.7%) underwent PCI and 77 patients (21.3%) were assigned to CABG. Overall mortality in the PCI group and in the CABG group was 3.5% and 9.1% respectively (p=0.04). In-hospital mortality rate was higher in the CABG group (7.8% vs. 1.8% p<0.02). After discharge mortality rate was 1.8% in the PCI and 1.4% in the CABG group (NS). The rate of MI during follow-up was similar in both groups. Fewer CABG patients had episodes of unstable angina, MI, repeat revascularization and cardiovascular hospitalisation. Independent predictors of death in the PCI group were: post-procedure recurrent angina (OR 2.40; 95%CI 1.20-4.19; p=0.03) and heart failure (OR 4.75; 95%CI 1.80-12.70; p=0.01), while in the CABG group these predictors were: inability to determine culprit vessel (OR 4,29; 95%CI 2.20-15.6; p=0.02) and heart failure (OR 7.70; 95%CI 3.74-21.49; p=0.05)., Conclusions: We observed a higher overall mortality rate at one year in CABG patients, whereas PCI patients had a higher rate of unstable angina, repeat revascularization and cardiovascular hospitalization during 12-month follow-up.

Background: No single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive. Methods and findings: Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006–2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7–7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (P<0.001). In an unadjusted comparison, On-Pump surgery was associated with significantly worse survival at 30 days: HR: 1.28; 95%CIs: (1.07–1.53); P = 0.007. Along the 13-year study period, the trend shifted in favor of On-Pump CABG: HR: 0.92; 95%CIs: (0.83–0.99); P = 0.005. After rigorous propensity matching, 636 pairs were identified. The direction and magnitude of treatment effects was sustained with HRs of 3.58; (95%CIs: 1.34–9.61); p = 0.001 and 0.74; [95%CIs: 0.56–0.98]; p = 0.036) for 30-day and late mortality respectively. Conclusions: Off-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Our goal was to evaluate early sequelae and long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). METHODS Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were collected. A total of 7879 patients with underlying AF underwent isolated CABG between 2006 and 2018 in 37 reference centres across Poland. The mean follow-up was 4.7 ± 3.5 years [median (interquartile range) 4.3 (1.7–7.4)]. Propensity score matching and Cox proportional hazards models were used to compare isolated CABG + ablation with isolated CABG. RESULTS Of the included patients, 346 (4.39%) underwent surgical ablation. Patients in this group were significantly younger (66.4 ± 7.5 vs 69.2 ± 8.2; P  < 0.001) but had a non-significant, different baseline surgical risk (EuroSCORE: 2.11 vs 2.50; P  = 0.088). After a rigorous 1:3 propensity matching (LOGIT model: 306 cases of isolated CABG + ablation vs 918 of isolated CABG alone), surgical ablation was associated with a lower 30-day risk of death [risk ratio 0.37, 95% confidence interval (CI) 0.15–0.91; P  = 0.032] and multiorgan failure (risk ratio 0.29, 95% CI 0.10–0.94; P  = 0.029). In the long term, surgical ablation was associated with a significant 33% improved overall survival rate: hazard ratio 0.67, 95% CI 0.49–0.90; P  = 0.008. The benefit of ablation was sustained in the subgroups but was most pronounced in lower risk older patients (age >70 years, P  = 0.020; elective status, P  = 0.011) with 3-vessel disease (P  = 0.036), history of a cerebrovascular accident (P  = 0.018) and preserved left ventricular function [left ventricular ejection fraction >50%; P  = 0.017; no signs of heart failure (per New York Heart Association functional class); P  = 0.001] and those undergoing on-pump CABG (P  < 0.001). CONCLUSION Surgical ablation for AF in patients undergoing isolated CABG is safe and associated with significantly improved long-term survival. [ABSTRACT FROM AUTHOR]

Introduction: Before the operation each cardiosurgery geriatric patient is assessed by the Vulnerable Elders-13 Survey (VES-13) and European System for Cardiac Operative Risk Evaluation (EuroSCORE) scales. Aim: To compare the applicability of the VES-13 and EuroSCORE scale in the assessment of postoperative risk among operated patients > 60 years old qualified most often for coronary artery bypass grafting. Material and methods: VES-13 is a questionnaire containing 13 questions, including patient's age and a health self-assessment. The EuroSCORE includes age, sex and cardiological assessment and vascular changes, respiratory diseases, neurological and nephrological disorders. In both scales the risk of death is high when the patient has > 6 points. The study included 100 patients = 60 (60.83 ±6.18) years old who were divided into subgroups with < 6 points and = 6 points. Results: The number of VES-13 points = 3.06 ±2.25, EuroSCORE = 5.50 ±3.19. In patients > 75 years old VES score was 4.32 ±2.6 vs. 2.707 ±2.02 and EuroSCORE 8.09 ±3.02 vs. 4.77 ±2.83. The most frequent postoperative complication was atrial fibrillation. The most frequent complications were the following: death (5%), delirium (3.64%), bleeding (3.54%), stroke (3.54%), renal failure (3.32%), pacemaker implantation (3.28%), difficult healing of the wound (2.64%), intestinal ischemia (2.56%). The correlation between the VES-13 and EuroSCORE was moderate. Conclusions: In cardiosurgery patients who obtained before the operation = 6 points on the VES-13 or EuroSCORE the risk of postoperative complications is high. VES-13 and EuroSCORE cannot be used interchangeably because the correlation is at a medium level. [ABSTRACT FROM AUTHOR]

Introduction: Off-pump coronary artery bypass grafting is considered potentially more effective than on-pump surgery in elderly patients. Aim: To compare the early and long-term results of these techniques in patients = 80 years of age with left main coronary artery disease. Material and methods: All patients = 80 years of age (N = 3648) who were reported to the Polish National Registry of Cardiac Surgery Procedures between 2006 and 2016 and underwent primary, isolated coronary artery bypass surgery were included in the study. The patients were divided into 2 groups: group A - without significant left main stenosis (LMS) (n = 2094) and B group - with LMS = 50% (n = 1524). The groups were compared according to the type of surgery: on-pump (A = 1107 vs. B = 891), off-pump (A = 908 vs. B = 616) and MIDCAB (A = 79 vs. B = 17). Results: There were significant differences in preoperative status between the groups in the whole cohort, which were not observable after propensity score matching. The in-hospital mortality was significantly higher in the LMS group operated on-pump (10.5% vs. 7.0%; p = 0.01) and non-significant in the off-pump group (5.1% vs. 5.7%; p = 0.78), as well as in the MIDCAB subgroup (5.9% vs. 5.1%; p = 0.64). 10-year survival in all subgroups was comparable and remained at a level of 50-60%. The mean entire cohort follow-up was 3.4 ±2.7 vs. 3.7 ±2.8 years (p = 0.2). Conclusions: Off-pump coronary bypass grafting may optimize the outcomes in elderly patients with significant left main stenosis. Octogenarians surgically treated for coronary artery disease, despite increased post-operative risks, present encouraging long-term survival. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to confirm the generalizability of the conclusions of the STICH (Surgical Treatment for Ischemic Heart Failure) trial. Background: Surgical ventricular reconstruction (SVR) added to coronary artery bypass grafting (CABG) did not decrease death or cardiac hospitalization in STICH patients randomized to CABG with (n = 501) or without (n = 499) SVR. Methods: Baseline clinical characteristics of 1,000 STICH SVR hypothesis patients and 1,036 STICH-eligible Society of Thoracic Surgeons (STS) National Cardiac Database patients undergoing CABG plus SVR were entered into a multivariate model equation to predict a mortality that placed these 2,036 patients in 1 of 32 risk at randomization (RAR) groups. The number of patients in each RAR group profiled the risk of STICH treatment arms and of STICH and STS STICH-eligible patients. Results: That 85% of the 1,000 STICH patients known to have no significant differences in baseline characteristics between the 2 treatment arms shared the same RAR group suggests that the RAR methodology has sufficient accuracy to compare RAR profiles of STICH and STS patients. RAR group was shared by 1,522 of 2,036 STICH and STS STICH-eligible patients (75%) who underwent CABG plus SVR. Differences in baseline characteristics responsible for more low-risk STICH patients and more high-risk STS patients were modest. Cox proportional hazard ratios of 1,000 STICH patients in 3 RAR groups suggested by STICH and STS RAR differences showed no differential treatment effect on survival across the low-, intermediate-, and high-risk groups. Conclusions: The STICH conclusion of no benefit from adding SVR to CABG applies to a broad spectrum of CABG-eligible patients with ischemic cardiomyopathy. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease; NCT00023595) [ABSTRACT FROM AUTHOR]

Background: Perioperative hyperglycemia should be avoided in patients undergoing coronary surgery. The aim of our study was to find out what the influence of cardiopulmonary bypass is on postoperative glycemia and insulin consumption in patients with and without diabetes mellitus undergoing coronary artery surgery and whether a marked hyperglycemia in the early postoperative period is among the factors associated with early mortality and morbidity. Methods: We retrospectively reviewed all patients who underwent first-time coronary artery surgery in our institution during the 11-month period. Among 814 patients, 239 patients (29.4%) had diabetes and 575 patients (70.6%) were nondiabetic. Blood glucose levels were registered every 2 hours in all patients during the first 24 postoperative hours. Outcomes were difficult glycemic control (postoperative blood glucose levels >11.0 mmol/L despite aggressive insulin treatment), hospital mortality, and morbidity (defined as any postoperative complication such as stroke, renal failure, wound infection, perioperative myocardial infarction, ventilation > 24 hours, sepsis, and multiorgan failure). Results: Glycemic control was significantly worse in patients who underwent coronary artery bypass grafting, in comparison with off-pump coronary artery bypass grafting surgery, particularly in nondiabetic patients. Patients with difficult glycemic control had more serious postoperative complications resulting in higher mortality (2.5% versus 0.4%; p = 0.02). In the multivariate analysis, difficult glycemic control was significantly associated with a female sex (odds ratio [OR], 2.36), presence of diabetes (OR, 2.22), and the usage of cardiopulmonary bypass (OR, 1.81). Mortality was significantly associated with the left ventricular ejection fraction less than 0.35 (OR, 7.38), difficult glycemic control (OR, 7.06), and previous stroke (OR, 5.66). Difficult glycemic control was also significantly associated with postoperative morbidity (OR, 1.87). Conclusions: Cardiopulmonary bypass increases postoperative glycemia and insulin consumption in both diabetic and nondiabetic patients. The use of cardiopulmonary bypass during coronary artery surgery in diabetic women is associated with a more difficult glycemic control in the early postoperative period. Difficult glycemic control is significantly associated with early mortality and morbidity in patients undergoing coronary artery surgery. [Copyright &y& Elsevier]

The current investigation aimed to evaluate long-term survival in patients undergoing isolated and combined coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Eleven thousand three hundred sixteen patients with baseline AF (72.4% men, mean age 69.6 ± 7.9) undergoing isolated and combined CABG surgery between 2006–2019 in 37 reference centers across Poland and included in the registry were analyzed. The median follow-up was four years (3.7 IQR 1.3–6.8). Over a 12-year study period, there was a significant survival benefit (Hazard Ratio (HR) 0.83; (95% Confidence Interval (CI): 0.73–0.95); p = 0.005) with concomitant ablation as compared to no concomitant ablation. After rigorous propensity matching (LOGIT model, 432 pairs), concomitant surgical ablation was associated with over 25% improved survival in the overall analysis: HR 0.74; (95% CIs: 0.56–0.98); p = 0.036. The benefit of concomitant ablation was maintained in the subgroups, yet the most benefit was appraised in low-risk patients (EuroSCORE < 2, p = 0.003) with the three-vessel disease (p < 0.001) and without other comorbidities. Ablation was further associated with significantly improved survival in patients undergoing CABG with mitral valve surgery (HR 0.62; (95% CIs: 0.52–0.74); p < 0.001) and in patients in whom complete revascularization was not achieved: HR 0.43; (95% CIs: 0.24–0.79); p = 0.006. [ABSTRACT FROM AUTHOR]

The optimal revascularization strategy in patients with complex coronary artery disease and noneST-segment elevation acute coronary syndromes is undetermined. In this multicenter, prospective registry, 4,566 patients with noneST-segment elevation myocardial infarctions, unstable angina, and multivessel coronary disease, including left main disease, were enrolled. After angiography, 3,033 patients were selected for stenting (10.3% received drug-eluting stents) and 1,533 for coronary artery bypass grafting. Propensity scores were used for baseline characteristic matching and result adjustment. Patients selected for percutaneous coronary intervention (PCI) were younger (mean age 64.4 ± 10 vs 65.2 ± 9 years, p = 0.03) and more frequently presented with noneST-segment elevation myocardial infarctions (32.0% vs 14.5%, p = 0.01), cardiogenic shock (1.5% vs 0.7%, p <0.01), and history of PCI (13.1% vs 5.5%, p <0.01) or coronary artery bypass grafting (10.6% vs 4.6%, p <0.01). European System for Cardiac Operative Risk Evaluation scores were higher in PCI patients (5.4 ± 2 vs 5.2 ± 2, p <0.01). Patients referred for coronary artery bypass grafting more often presented with triplevessel disease and left main disease (82.2% vs 33.8%and 13.7% vs 2.4%, respectively, p <0.01). After adjustment, 929 well-matched pairs were chosen. Early mortality was lower after PCI before matching (2.1% vs 3.1%, p <0.01), whereas after balancing, there was no difference (2.5% vs 2.8%, p = 0.62). Three-year survival was in favor of PCI compared with surgery before (87.5% vs 82.8%, hazard ratio 1.44, 95% confidence interval 1.2 to 1.7, p <0.01) and after (86.4% vs 82.3%, hazard ratio 1.33, 95% confidence interval 1.05 to 1.7, p = 0.01). Stenting was associated with improved outcomes in the following subgroups: patients aged >65 years, women, patients with unstable angina, those with European System for Cardiac Operative Risk Evaluation scores >5, those with Thrombolysis In Myocardial Infarction (TIMI) risk scores >4, those receiving drug-eluting stents, and those with 2-vessel disease. In conclusion, in patients presenting with noneST-segment elevation acute coronary syndromes and complex coronary artery disease, immediate stenting was associated with lower mortality risk in the long termcompared with surgical revascularization, especially in subgroups at high clinical risk. [ABSTRACT FROM AUTHOR]