Post-Coronary Artery Bypass Graft Complications; Potential Causes and Risk Factors
Authors: Marzoog Basheer Abdullah , Alexandrovich Karpunkin Oleg , Nikolaevich Tremasov Maxim , Vladimirovich Kostin Sergey 
Published: January 2023

Background

Cardiovascular disease (CVD) remains the leading cause of death worldwide despite the coexistence of the current COVID-19 pandemic. Current emergency management involves revascularization of the coronary arteries.

Aims

Retrospectively evaluating the association between the used number of shunts and postoperative complications. And to evaluate the potential pre/postoperative risk factors for complications development.

Objectives

Several complications are reported after coronary artery bypass graft (CABG) surgery, such as postoperative arrythmia and postoperative stroke. However, the risk factors for the development remain not elaborated.

Material and methods

A retrospective cohort study involved 290 patients for the period 2017-2021 treated surgically for ischemic heart disease. The surgery includes shunts of the internal thoracic arteries with the post-occlusion coronary arteries. The number of shunts is varied depending on the size and number of occluded arteries. According to the number of shunts, the patient may be operated with artificial circulation (CPB; cardiopulmonary bypass), or without working heart (OFF pump; without artificial circulation. For statistical analysis, used T test, one way ANOVA test, and Pearson correlation test by using Statistica program.

Results

The most frequently reported complication is postoperative hydrothorax, 28 (11.20%) patients. Patients with CABG and left ventricle aneurysm plastic surgery repair had a longer aortic cross-clamp time, t-value -2.20413, p <0.028306. Furthermore, patients with CABG have less ejection fraction, t-value 5.10667, p < 0.000001. Patients with post-CABG left ventricle (LV) aneurysm had less ejection fraction, t-value -2.01070, p <0.045292. Furthermore, patients with post-CABG LV aneurysm had a longer CPB time, t value -5.58113, p < 0.000000. Patients with post-CABG LV aneurysm had a longer aortic cross-clamp time, t-value -4.72802, p < 0.000004. Patients with postoperative hydrothorax are with low BMI and longer CPB and Aortic cross-clamp time, t-value -2.33929, p <0.020021; t-value 3.83233, P < 0.000157; t-value 2.71109, p < 0.007119, respectively. Subsequently, post-operative hydrothorax increases the intensive care unit (ICU) and total hospitalization days, t-value 5.80811, p < 0.000000; t-value 7.37431, p < 0.000000, respectively. Patients who have preoperative progressive angina have higher number of complications, t-value 2.108504, p < 0.035866. Post myocardial infarction myocardial sclerosis patients (PMIMS) have a higher number of complications, t-value 2.516784, p < 0.012396. No statistical correlation between number of the complications and the number of the shunts. Furthermore, there was no statistical association between the used number of internal thoracic arteries and the number of complications. A direct correlation between number of complications and age/CPB time/ aortic cross-clamp time/ICU hospitalization days/total hospitalization days, r= 0.138565, 0.204061, 0.162078, 0.487048, 0.408381; respectively.

Conclusions

Postoperative complication rate associated with the pre-existence of progressive angina and PMIMS. Elderly people undergoing CABG are at higher risk of psychosis, arrythmia, longer total and ICU hospitalization days, and stroke. Advanced age, longed CPB time, prolonged Aortic cross-clamp time, long ICU hospitalization days, and long total hospitalization days are risks for more frequent post CABG complications.

Others

The number of complications is not associated with the death and alive status of the patients or with the number of shunts.