Coronary Artery Bypass Graft Patency And Clinical Studies Of Pulmonary Embolism Without Cardiopulmonary Bypass

Objective To evaluate the effect of preoperative continuation of aspirin therapy on the early saphenous venous graft patency after off-pump coronary artery bypass (OPCAB).Methods Using prospectively collected data from582consecutive patients undergoing isolated OPCAB from October2009through September2012, we evaluated the association between aspirin (100mg daily) usage preceding OPCAB and risk of adverse in-hospital postoperative events. All patients had undergone coronary CT angiography (CCTA) by a64-sliceMDCT scanner to assess the graft patency after OPCAB on mean postoperative day5(range,4-7days after operation). The primary outcomes were in-hospital mortality and the occlusion of grafts. Secondary outcomes were stroke, myocardial infarction, pulmonary embolisim and hemorrhage-related outcomes (reexploration rate, blood transfusions and perioperative drainage loss).Results There was no death. Patients receiving preoperative continuation of aspirin therapy (n=400) had significantly higher postoperative total graft patency and saphenous venous graft patency (%) compared with those (n=182) not receiving preoperative aspirin (98.8versus97.3, P=0.02;98.2versus96.1, P=0.02,respectively). No significant differences between the two groups were observed in stroke, myocardial infarction, pulmonary embolisim, hemorrhage-related outcomes. Multivariate analysis indicated that preoperative discontinuation of aspirin therapy significantly increased the risk of occlusion of saphenous venous graft (OR=2.193,95%CI:1.023-4.701, P=0.043). With the increase of mean flow of the grafts, the risk of occlusion decreasd dramatically (OR=0.969,95%CI:0.946-0.993, P=0.012). Conclusions This study indicated that preoperative continuation of aspirin therapy may improve the early saphenous vein graft patency after OPCAB without increasing in-hospital mortality and the occlusion of grafts. Secondary outcomes were stroke, myocardial infarction, pulmonary embolisim, hemorrhage-related outcomes. Object To explore the diagnosis, therapy and risk factors of acute pulmonary embolism (PE) in the early period after off-pump coronary artery bypass graft (OPCAB).Methods A prospective analysis was conducted of582consecutive patients receiving isolated OPCAB during October,2009to September,2012. Their age ranged from16to86years with a mean age of61.4±9.3years.457patients were males with the proportion of79%. All patients had undergone coronary CT angiography (CCTA) by a64-slice MDCT scanner to assess both the graft patency and the existence of PE after OPCAB on mean postoperative day5(range,4-7days after operation) and were followed up until August31,2013.Results CCTA detected clinically silent PE in11patients giving an overall1.9%incidence. It was present in7(1.5%) of the457men and in4(3.2%) of the125women. The age of the patients with PE ranged from56to71years with a mean age of64.6±4.7years.(1)Univariate analysis:the proportion of preoperative left ventricular segmental wall motion abnormalities (LVSWMA) on echocardiogram in patients with PE was higher than in cases without PE (72.7%versus38.7%, P=0.02), and preoperative left ventricular ejection fraction(LVEF,%)was lower in patients with PE (54.9±8.6versus60.2±9.4,P=0.04). Preoperative length of hospital stay(day)and postoperative ICU stay(hour) were longer in PE patients (9(7,16) versus5(3,7), P=0.031;65.0(22.5,115.8) versus41.9(22.0,70.0), P=0.036, respectively).(2)1:5paired logistic regression analysis showed that preoperative LVSWMA was an independent predictor for PE(OR=6.011,95%CI:1.146-31.526, P=0.034).9patients received treatment with low molecular weight heparin plus warfarin. When INR reached2.0-3.0, warfarin alone had been used for3months. Other2cases did not accept anticoagulant therapy because of sensitiveness for anticoagulant. MDCT performed on the former nine cases6-8months after operation showed the pulmonary emboli disappeared. All11patients survived without symptoms in the fellow-up.Conclusion This study showed a1.9%incidence of asymptomatic PE after OPCAB during the first1week of the postoperative period. Postoperative CCTA should be advocated as a conventional protocol to screen the presence of silent PE in OPCAB patients, especially in patients who shows LVSWMA on preoperative echocardiogram. Warfarin is effective in the treatment of PE; additionally, anticoagulant therapy besides aspirin may be taken into account for the prophylaxis of PE in the early postoperative period.