Objective To investigate the 30-day mortality risk factors in elderly patients (≥70 years) with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024. Simple random sampling in R was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic stepwise regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. ResultsA total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training cohort, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression with stepwise selection, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065–11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269–67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057–46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997–6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000–2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: training set AUC was 0.898 (95%CI 0.831–0.966); validation set AUC 0.912 (95%CI 0.805–1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.
Objective To review the clinical experience of coronary artery bypass grafting without the assistance of extracorporeal circulation (Off pump CABG, OPCAB). Methods\ Between August 1999 and June 2000, 73 consecutive OPCAB were performed at our institution. The exposure and immobilization of the coronary artery target site during anastomosis were achieved with the help of Octopus mechanical stabilization and intraluminal shunt devices. Results\ There was no mortality, no perioperative myocardial infarct...
Objective To systematically evaluate risk prediction models for 30-day unplanned readmission in patients undergoing coronary artery bypass grafting (CABG). Methods We searched PubMed, EMbase, Cochrane Library, Web of Science, CINAHL, CNKI, CBM, WanFang, and VIP databases from inception to June 25, 2025. Two investigators independently screened literature, extracted data, and assessed bias risk/applicability using PROBAST criteria. Results Thirteen studies comprising 17 prediction models were included. Ten models reported the area under the receiver operating characteristic curve (AUC) for modeling (0.597-0.906), ten models reported the AUC for internal validation (0.57-0.92), and twelve models reported the AUC for external validation (0.537-0.865). Core predictors included age, female sex, diabetes, and heart failure. All studies had a high risk of bias. Conclusion The research on risk prediction models for 30-day unplanned readmission in patients undergoing CABG is still in its exploratory stages. Some models exhibit insufficient performance, and there is a need to enhance the processes of model validation and performance evaluation. It is expected that future efforts will focus on developing prediction models with excellent performance and high applicability, to assist healthcare providers in the early identification of high-risk patients for readmission.
Composite grafting techniques is a commonly used strategy in coronary artery bypass grafting,especially suits elderly patients.It is an attractive myocardial revascularization strategy when the grafts are not sufficient to achieve complete myocardial revascularization.Furthermore,composite grafting in the presence of a diseased aortic wall seems a rational approach to reduce the incidene of postoperative neurological deficit or stroke by avoiding the manipulation of atherosclerotic aorta.Also,it gained excellent short and midterm results.This review provides an overview of the various surgical techniques,outcomes,concerns and controversies associated with composite grafting.
Objective\ To test whether off pump coronary artery bypass grafting(OPCAB) has advantages over conventional coronary artery bypass grafting(CCABG).\ Methods\ Between January 1999 and February 2000, 170 patients with multivessel coronary disease underwent only coronary artery bypass grafting by one surgeon. They were divided into two groups, OPCAB group:88 cases underwent CABG with off pump and beating heart via sternotomy; CCABG group: 82 cases underwent conventional CABG with extracorporeal circulation....
Objective To analyze the results of intra-aortic balloon pump (IABP) support in patients receiving coronary artery bypass graft (CABG) and the risk factors of postoperative death. Methods The clinical data of 334 patients undergoing CABG procedure and receiving IABP support in Fuwai Hospital from January 1999 to April 2012 were retrospectively analyzed. According to the IABP insertion timing, the patients were divided into three groups: pre-, intra- and postoperative IABP groups. There were 45 males and 11 females aged 60.5±10.7 years in the preoperative IABP group, 84 males and 23 females aged 61.1±8.4 years in the intraoperative IABP group and 119 males and 52 females aged 61.4±8.5 years in the postoperative IABP group.Outcomes of the three groups were compared, including mortality, major complications, ICU stay, hospital stay and total costs. Multivariable logistic regression analysis was used to predict independent risk factors for postoperative in-hospital death. Results The total in-hospital mortality was 16.8% (56/334). Mortality was significantly different among the pre-, intra- and postoperative IABP groups (3.6% vs.23.4%vs. 17.0%, P=0.006). There was no significant difference in complications among the three groups (P=0.960). Multivariable logistic regression analysis indicated that independent risk factors for postoperative mortality included old age (OR=1.05, P=0.040), female (OR=3.34, P<0.001) and increasing left ventricular end-diastolic diameter (LVEDD,OR=1.06, P=0.040). Preoperative IABP support was protective factor (OR=0.10, P=0.050). Conclusion The results of IABP support in CABG patients are satisfactory, and patients with preoperative IABP have a lower mortality. Risk factors for postoperative death include old age, female and increasing LVEDD. Preoperative IABP support is a protective factor.
Objective\ To analyze the experiences of emergent or urgent coronary artery bypass grafting(CABG) for patients with acute myocardial infarction(AMI). Methods\ From May, 1996 through December, 1999, 9 patients with AMI underwent emergent CABG including eight males and one female, with mean age 61 years, and year range 44 70. The localization of the AMI was anterior in 4 and inferior in 5. The interval between the onset of AMI and CABG was within 24 hours in 7 cases, 10 days in 1 case and 14 days in 1 case....
ObjectiveTo systematically evaluate the risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting (CABG).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang and VIP Database were electronically searched to collect case-control and cohort studies about the risk factors for perioperative blood transfusion in patients undergoing CABG from inception to February 2020. Two reviewers screened and evaluated the literatures according to the inclusion and exclusion criteria, and meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 26 articles were collected, involving 84 661 patients. The results of meta-analysis showed that age (OR=1.06, 95%CI 1.03 to 1.08, P<0.001), age≥70 years (OR=2.14, 95%CI 1.77 to 2.59, P<0.001), female (OR=1.85, 95%CI 1.55 to 2.22, P<0.001), body mass index (OR=0.94, 95%CI 0.90 to 0.98, P=0.003), weight (OR=0.95, 95%CI 0.93 to 0.96, P<0.001), body surface area (OR=0.19, 95%CI 0.10 to 0.39, P<0.001), smoking (OR=0.80, 95%CI 0.69 to 0.93, P=0.003), diabetes (OR=1.15, 95%CI 1.09 to 1.20, P<0.000 01), chronic heart failure (OR=1.59, 95%CI 1.26 to 1.99, P<0.001), number of diseased coronary arteries (OR=1.17, 95%CI 1.01 to 1.35, P=0.030), reoperation (OR=2.12, 95%CI 1.79 to 2.51, P<0.001), preoperative hemoglobin level (OR=0.60, 95%CI 0.43 to 0.84, P=0.003), preoperative ejection fraction <35% (OR=2.57, 95%CI 1.24 to 5.34, P=0.010), emergency surgery (OR=4.09, 95%CI 2.52 to 6.63, P<0.001), urgent operation (OR=2.28, 95%CI 1.25 to 4.17, P=0.007), intra-aortic balloon pump (OR=3.86, 95%CI 3.35 to 4.44, P<0.001), cardiopulmonary bypass (OR=4.24, 95%CI 2.95 to 6.10, P<0.001), cardiopulmonary bypass time (OR=1.01, 95%CI 1.01 to 1.01, P<0.000 01) and minimum hemoglobin during cardiopulmonary bypass (OR=0.42, 95%CI 0.23 to 0.77, P=0.005) were the risk factors for perioperative blood transfusion in patients undergoing CABG.ConclusionCurrent evidence shows that age, age≥70 years, female, body mass index, weight, body surface area, smoking, diabetes, chronic heart failure, number of diseased coronary arteries, reoperation, preoperative hemoglobin level, preoperative ejection fraction<35%, emergency surgery, urgent operation, intra-aortic balloon pump, cardiopulmonary bypass, cardiopulmonary bypass time and minimum hemoglobin during cardiopulmonary bypass are risk factors for perioperative blood transfusion in patients who undergo CABG. Medical staff should formulate and improve the relevant perioperative blood management measures according to the above risk factors, in order to reduce the perioperative blood utilization rate and improve the clinical prognosis of patients.
Objective To investigate whether the respiratory support weaning based on adaptive support ventilation ( ASV) could reduce the duration of mechanical ventilation in patients after fast-track coronary artery bypass grafting ( CABG) . Methods After CABG during the same fast-track general anesthesia, 46 patients were randomly assigned to an ASV group or a synchronized intermittent mandatory ventilation ( SIMV) group as control. The duration of mechanical ventilation, hemodynamic parameters, and airway pressures were recorded. Meanwhile, the variables and the number of the arterial blood gas were recorded. Results The duration of mechanical ventilation was shorter in the ASV group than that in the control group [ 196( 152-286) ] min vs. 253( 196-498) min, P lt;0. 05] . The duration of ICUstay was shorterin the ASV group than that in the control group [ ( 14. 5 ±0. 7) h vs. ( 16. 8 ±0. 4 ) h, P lt;0. 01] . Fewer arterial blood analyses were performed in the ASV group than those in the control group [ 5 ( 4-7) vs.7( 6-9) , P lt; 0. 05] . Conclusions A ventilation weaning protocol based on ASV is practicable. It may accelerate tracheal extubation, shorten the length of ICU stay, and simplify ventilation management in patients after fast-track CABG.
Abstract: Objective To investigate the relationship between graft flow and incidence of perioperative myocardial infarction (MI) in coronary artery bypass grafting (CABG). Methods Between January 2010 and June 2010, 58 consecutive patients with coronary artery disease who underwent offpump CABG in the First Hospital of Peking University were enrolled in this study. An anastomosis between left internal mammary arteries (LIMA) and left ant erior descending coronary artery (LAD) were performed. And saphenous vein (SV) graft s were used as bypass grafts. Graft flow was measured intraoperatively using a transi t time flowmeter, and the total graft flow of each patient was calculated as a parameter of myocardial revascularization. The 58 patients were divided into a MI group and a nonMI group retrospectively. There were 11 patients in the MI group, including 7 males and 4 females, with an average age of 67.4±10.3 years.There were 47 patients in the nonMI group, 38 males and 9 females, with a mean age of 633±99 years. The graft flow of the two groups was tested and compared, and the preoperative variables were compared. Results There was no statistically significant difference in operation time (205.4±59.6min versus 1834±32.4 min, t=1.691, P=0.096) between the two groups. Therewere also no statistical differences in the average number of grafts (3.00±1.00 branches versus 2.96±0.78 branches, t=0.154, P=0878) or LIMALAD flow (1540±11.37 ml/min versus 16.50±10.83 ml/min, t=0.301, P=0.764) between the two groups. However, a significant difference was found in the total graft flow between the two groups (41.03±19.50 ml/min versus 64.09±32.44 ml/min, t=2.254, P=0.028), with lower total graft flow in the MI group. Further analysis showed [CM(159mm]that a total graft flow lt;48.5ml/min was a risk factor for MI (odds ratio 4.706, 95% confidence interval 1.099 to 20.147). Conclusion Total graft flow could be used to predict the occurrence of perioperative myocardial ischemia, as there is a high probability of MI for patients with a total graft flow of less than 48.5 ml/min.