Abstract 17465: Analysis of Intra-Operative Heart Rates Reveals a Novel Sub-Phenotype in Coronary Artery Bypass Grafting Patients
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Background: We aim to investigate the use of intra-operative heart rate (HR) trajectories to develop and characterize sub-phenotypes of coronary artery bypass grafting (CABG) patients with distinct risk and outcome profiles. Methods: We used a retrospective cohort including 4194 CABG patients admitted to a large rural healthcare system between 2012 and 2021. Functional data analysis (FDA) was applied to patients’ intra-operative HR trajectories to identify distinct sub-phenotypes. Results: The elbow method suggested that the optimal number of clusters is four. Fig. 1 shows the mean HR trajectory curve (top) and Kaplan-Meier survival curve (bottom) for each of the four identified groups. G1 (Low HR) includes 35.2% of the patients with median age 68 years. Patients in G1 had the lowest ICU after CABG length of stay (LoS) of 76.1 hours and the longest CABG median procedure duration of 4.6 hours. Assignment to G1 was significantly associated with shorter ICU LoS (p= 2.2E-6). G2 (Intermediate HR) includes 35.4% of the patients with median age of 67 years. Patients in G2 had the highest prevalence of urgent admissions, 25.5%. Assignment to G2 was significantly associated with shorter ICU LoS (p=0.016). G3 (Increasing HR) includes 15.6% of the patients with median age 67. Patients in G3 had the shortest median procedure duration of 3.68 hours. Those patients were found to be significantly at risk of prolonged ICU stays (p=0.0002). Finally, G4 (High HR) includes 16.2% with the lowest observed median age of 65 years. Patients in G4 have the highest prevalence of in-hospital mortality (5.2%), 30-day readmission (4.3%), and 1-year mortality (4.8%). Assignment to G4 was significantly associated with the following outcomes: prolonged ICU stays (p=2.62e-9); in-hospital mortality (p=8.03e-5); 30-day readmission (p=0.017); and 1-year mortality (p=0.02). Conclusions: CABG sub-phenotypes based on intra-operative HR trajectories had distinct clinical characteristics and outcomes.National database
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Read the full review for this Faculty Opinions recommended article: Operative mortality in women and men undergoing coronary artery bypass grafting (from the California Coronary Artery Bypass Grafting Outcomes Reporting Program).
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【目 的】 当院の心臓手術ではここ数年は19FR (6.3mm) シリコンドレーン1本で術後管理を行っている. このシリコンドレーンの妥当性について, 内胸動脈グラフト採取を要する冠動脈バイパス術 (CABG) で検討した. 【対 象】 2004年11月から2006年12月までに施行されたCABGで心嚢内に19FR (6.3mm) シリコンドレーンを1本のみ留置して15cm H2Oで持続吸引した139例 (男性102例, 女性37例), 年齢66±10歳. 【結 果】 ドレーン排液総量はon pump CABGでは331±162ml, OPCABでは319±114ml排液され, 両群に有意差を認めなかった. また, 片側内胸動脈採取例は331±162ml, 両側内胸動脈採取例は344±155mlで両群に有意差を認めなかった. ドレーンが閉塞した症例, 再開胸症例, 周術期の心タンポナーデ症例はいずれも認めなかった. 【結 論】 内胸動脈を採取する冠動脈バイパス術でも胸骨下にドレーンを留置しなくても充分管理可能であった.
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Objective:To study the technique ad va nces in coronary artery bypass grafting.Methods:Analyzing the info rmations.Results:The coronary artery bypass grafting technique dev eloped rapidly,with mini trauma.There were some gene therapy applying clinically .Conclusion:The coronary artery bypass grafting is an important t echnique in treating coronary heart disease.
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Nowadays, clinicians generally use the internal mammary artery, radial artery and the great saphenous vein for coronary artery bypass grafting. Different vascular construction, different reaction to vascular reactivities and different distribution of vascular smooth muscle receptors are all factors influencing spasms and early and late patency rate of bypass grafting. A clear understanding of the construction and function of bypass grafting contributes to the selection of a suitable bypass grafting method, and to improving its early and late patency rate.
Mammary artery
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Read the full review for this Faculty Opinions recommended article: Effect of adenosine-regulating agent acadesine on morbidity and mortality associated with coronary artery bypass grafting: the RED-CABG randomized controlled trial.
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Aims: The effect of body mass index (BMI) on outcome after coronary artery bypass grafting (CABG) remains controversial.
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The applicability of the Short Form (SF36) questionnaire to disparate populations led us to use this tool to investigate how health-related quality-of-life (HRQoL) for patients who underwent coronary artery bypass grafting (CABG) is related to gender, age and survival
Cardiovascular Health
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