| The effect of preoperatively continued aspirin use on early and mid-term outcomes in patients receiving off-pump coronary artery bypass graftingObjective:To date, studies regarding the effect of preoperatively continued aspirin administration remain controversial and have been conducted mainly in conventional on-pump coronary artery bypass grafting (CABG). Effect of preoperatively continued aspirin administration in off-pump CABG is less known. We aimed to assess the effect of preoperatively continued aspirin use on early and mid-term outcomes in patients receiving off-pump CABG.Methods:From October 2009 to September 2013,5787 patients with only aspirin use for anti-platelet therapy underwent elective isolated off-pump CABG at the Euwai Hospital. Of those,720 patients continued aspirin use preoperatively. Propensity score constructed from core patient characteristics was used to match preoperative aspirin user with preoperative nonaspirin users in a 1-to-1 fashion to obtain risk-adjusted outcome comparisons between the two groups (709 patients for each group). Cox proportional hazard regression analysis was performed to identify statistical significant factor predicting mid-term outcome. Early outcomes were in-hospital death, stroke, intra- and post-operative blood loss, reoperation for bleeding and blood product transfusion. Major adverse cardiac events (death, myocardial infarction or repeat revascularization), angina recurrence, and readmission for cardiac reasons were considered as mid-term endpoints.Results:There were no significant differences among the groups in baseline characteristics after propensity score matching. The median intraoperative blood loss (600 ml VS 450 ml, P=0.56), median postoperative blood loss (800 ml VS 790 ml, P=0.60), blood transfusion requirements (25.1% VS 24.4%, P=0.76) and composite outcome of in-hospital death, stroke and reoperation for bleeding (2.8% VS 1.6%, P=0.10) were similar in aspirin and nonaspirin use group. At about 4 years follow-up, no significant difference was observed among the aspirin and nonaspirin use group in major adverse cardiac events free survival estimates (95.7% VS 91.5%, P=0.23) and freedom from cardiogenic readmission (88.5% VS 85.3%, P=0.77) whereas the angina recurrence free survival rates was 83.7% and 73.9% in the aspirin and nonaspirin use group respectively (P=0.02), with hazard ratio for preoperative aspirin estimated at 0.71 (95% Confidence Interval, CI:0.49-1.04, P=0.08).Conclusions:Preoperatively continued aspirin use was not associated with increased risk of intra- and post-operative blood loss, blood transfusion requirements and composite outcome of in-hospital death, stroke and reoperation for bleeding in off-pump CABG. Preoperative aspirin use tended to decrease the hazard of mid-term angina recurrence.The impact of sequential vein bypass grafting on early and mid-term outcomes in patients undergoing off-pump coronary artery bypass graftingObjective:The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting. We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump coronary artery bypass grafting.Methods:A cohort of 920 consecutive patients who underwent isolated off-pump CABG from October 2009 to September 2013, operated by one surgical team at the Fuwai Hospital was obtained.Of those patients,127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction, stroke, requirement for intra-aortic ballon pump assistance and prolonged ventilation. Major adverse cardiac events (death, myocardial infarction or repeat revascularization) and angina recurrence were considered as mid-term endpoints.Results:No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups VS 59.5ml in sequential venous grafts groups (P<0.001). There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, myocardial infarction, stroke, intra-aortic ballon pump assistance and prolonged ventilation (11.0% VS 14.2%, P=0.45). Individual in-hospital measurement also did not differ significantly between the two groups. At about 4 years follow-up, the survival estimates free from major adverse cardiac events (92.5% VS 97.3%, P=0.36) and survival rates free of angina recurrence (80.9% VS 85.5%, P=0.48) were similar among individual and sequential venous grafts groups. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both major adverse cardiac events and angina recurrence, with hazard ratio estimated at 0.21 (95% Confidence Interval CI:0.03-1.85, P=0.16) and 0.70 (95% CI:0.27-1.83, P=0.47) respectively.Conclusion:Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in-hospital or mid-term adverse events in patients undergoing off-pump coronary artery bypass grafting.
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