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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 3/2023

09-08-2022 | Heart Surgery | Original Article

Symptom progression following on-pump versus off-pump coronary artery bypass graft surgery in patients with peripheral arterial disease

Authors: Utkan Sevuk, Mehmet Veysi Bahadir

Published in: General Thoracic and Cardiovascular Surgery | Issue 3/2023

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Abstract

Objective

This study aims to examine whether cardiac surgery leads to symptom progression in the early postoperative period in patients with the peripheral arterial disease (PAD) and evaluate the difference between on-pump (OPCAB) and off-pump (ONCAB) coronary artery bypass graft surgery with regard to the symptom progression.

Methods

This retrospective study included one hundred consecutive adult patients with PAD at Fontaine stage 2b (pain-free walking distance less than 100 m) undergoing ONCAB and one hundred consecutive adult patients with PAD at Fontaine stage 2b (pain-free walking distance less than 100 m) undergoing OPCAB. Symptom progression was defined as the development of ischemic rest pain (Fontaine stage 3).

Results

In the first week after surgery, 12 patients in the OPCAB group and 53 patients in the ONCAB group had postoperative symptom progression (p < 0.001). Rest pain resolved in most of these patients on the 15th postoperative day. At the end of the second month, rest pain resolved in all patients. Logistic regression analysis revealed that cardiac surgery with CPB, ABI < 0.5, postoperative nadir hct levels ≤ 25%, and intraoperative tissue hypoxia were independently associated with postoperative symptom progression.

Conclusions

In summary, we found that cardiac surgery may lead to symptom progression in patients with severe claudication in the early postoperative period. Our results suggest that OPCAB may lead to lower rates of symptom progression compared to ONCAB.
Literature
1.
De Blasi RA, Tonelli E, Arcioni R, Mercieri M, Cigognetti L, Romano R, et al. In vivo effects on human skeletal muscle oxygen delivery and metabolism of cardiopulmonary bypass and perioperative hemodilution. Intensive Care Med. 2012;38(3):413–21.CrossRefPubMed
2.
Vincent JL, Sakr Y, De Backer D, Van der Linden P. Efficacy of allogeneic red blood cell transfusions. Best Pract Res Clin Anaesthesiol. 2007;21(2):209–19.CrossRefPubMed
3.
den Os MM, van den Brom CE, van Leeuwen ALI, Dekker NAM. Microcirculatory perfusion disturbances following cardiopulmonary bypass: a systematic review. Crit Care. 2020;24(1):218.CrossRef
4.
Shaefi S, Mittel A, Loberman D, Ramakrishna H. Off-pump versus on-pump coronary artery bypass grafting-a systematic review and analysis of clinical outcomes. J Cardiothorac Vasc Anesth. 2019;33(1):232–44.CrossRefPubMed
5.
Grenon SM, Vittinghoff E, Owens CD, Conte MS, Whooley M, Cohen BE. Peripheral artery disease and risk of cardiovascular events in patients with coronary artery disease: insights from the heart and soul study. Vasc Med. 2013;18(4):176–84.CrossRefPubMedPubMedCentral
6.
Nakatsu T, Tamura N, Yanagi S, Kyo S, Koshiji T, Sakata R. Bilateral internal thoracic artery grafting for peripheral arterial disease patients. Gen Thorac Cardiovasc Surg. 2014;62(8):481–7.CrossRefPubMed
7.
Nielsen ND, Martin-Loeches I, Wentowski C. The effects of red blood cell transfusion on tissue oxygenation and the microcirculation in the intensive care unit: a systematic review. Transfus Med Rev. 2017;4:205–22.CrossRef
8.
Mandak J, Pojar M, Cibicek N, Lonsky V, Palicka V, Kakrdova D, et al. Impact of cardiopulmonary bypass on peripheral tissue metabolism and microvascular blood flow. Perfusion. 2008;23(6):339–46.CrossRefPubMed
9.
De Backer D, Creteur J, Dubois MJ, Sakr Y, Vincent JL. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J. 2004;147(1):91–9.CrossRefPubMed
10.
Dekker NAM, Veerhoek D, Koning NJ, van Leeuwen ALI, Elbers PWG, van den Brom CE, et al. Postoperative microcirculatory perfusion and endothelial glycocalyx shedding following cardiac surgery with cardiopulmonary bypass. Anaesthesia. 2019;74(5):609–18.CrossRefPubMedPubMedCentral
11.
Mand’ák J, Zivný P, Lonský V, Palicka V, Kakrdová D, Marsíková M, et al. Changes in metabolism and blood flow in peripheral tissue (skeletal muscle) during cardiac surgery with cardiopulmonary bypass: the biochemical microdialysis study. Perfusion. 2004;19(1):53–63.CrossRefPubMed
12.
Tripodaki ES, Tasoulis A, Koliopoulou A, Vasileiadis I, Vastardis L, Giannis G, et al. Microcirculation and macrocirculation in cardiac surgical patients. Crit Care Res Pract. 2012;2012: 654381.PubMedPubMedCentral
13.
Butler E, Mahendran S, Nguyen J, Aneman A. Microvascular reactivity, assessed by near-infrared spectroscopy and a vascular occlusion test, is associated with patient outcomes following cardiac surgery: a prospective observational study. Eur J Anaesthesiol. 2018;35(5):356–64.CrossRefPubMed
14.
Kim TK, Cho YJ, Min JJ, Murkin JM, Bahk JH, Hong DM, et al. Microvascular reactivity and clinical outcomes in cardiac surgery. Crit Care. 2015;19(1):316.CrossRefPubMedPubMedCentral
15.
Scolletta S, Franchi F, Damiani E, Cennamo A, Domizi R, Meola A, et al. Tissue oxygen saturation changes and postoperative complications in cardiac surgery: a prospective observational study. BMC Anesthesiol. 2019;19(1):229.CrossRefPubMedPubMedCentral
16.
Maier S, Hasibeder WR, Hengl C, Pajk W, Schwarz B, Margreiter J, et al. Effects of phenylephrine on the sublingual microcirculation during cardiopulmonary bypass. Br J Anaesth. 2009;102(4):485–91.CrossRefPubMed
17.
Boerma EC, Kaiferová K, Konijn AJ, De Vries JW, Buter H, Ince C. Rectal microcirculatory alterations after elective on-pump cardiac surgery. Minerva Anestesiol. 2011;77(7):698–703.PubMed
18.
Butler E, Chin M, Aneman A. Peripheral near-infrared spectroscopy: methodologic aspects and a systematic review in post-cardiac surgical patients. J Cardiothorac Vasc Anesth. 2016;S1053–0770(16):30299–303.
19.
Vandenbulcke L, Lapage KG, Vanderstraeten KV, De Somer FM, De Hert SG, Moerman AT. Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anesthesia in cardiac surgery patients: an observational study. Eur J Anaesthesiol. 2017;34(10):688–94.CrossRefPubMed
20.
Atasever B, Boer C, Goedhart P, Biervliet J, Seyffert J, Speekenbrink R, et al. Distinct alterations in sublingual microcirculatory blood flow and hemoglobin oxygenation in on-pump and off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2011;25(5):784–90.CrossRefPubMed
21.
Lanzarone E, Gelmini F, Tessari M, Menon T, Suzuki H, Carini M, et al. Preservation of endothelium nitric oxide release by pulsatile flow cardiopulmonary bypass when compared with continuous flow. Artif Organs. 2009;33(11):926–34.CrossRefPubMed
22.
Dedichen HH, Hisdal J, Aadahl P, Nordhaug D, Olsen PO, Kirkeby-Garstad I. Elevated arterial lactate concentrations early after coronary artery bypass grafting are associated with increased anaerobic metabolism in skeletal muscle. J Cardiothorac Vasc Anesth. 2015;29(2):367–73.CrossRefPubMed
23.
Obi AT, Park YJ, Bove P, Cuff R, Kazmers A, Gurm HS, et al. The association of perioperative transfusion with 30-day morbidity and mortality in patients undergoing major vascular surgery. J Vasc Surg. 2015;61(4):1000-9.e1.CrossRefPubMed
24.
Al-Sarraf N, Al-Shammari F, Vislocky I, Malek L. Lower limb compartment syndrome following coronary artery bypass surgery: a rare entity. Gen Thorac Cardiovasc Surg. 2010;58(3):131–3.CrossRefPubMed
25.
Tsui AK, Dattani ND, Marsden PA, El-Beheiry MH, Grocott HP, Liu E, et al. Reassessing the risk of hemodilutional anemia: some new pieces to an old puzzle. Can J Anaesth. 2010;57(8):779–91.CrossRefPubMed
26.
Szabó Z, Andersson RG, Arnqvist HJ. Intraoperative muscle and fat metabolism in diabetic patients during coronary artery bypass grafting surgery: a parallel microdialysis and organ balance study. Br J Anaesth. 2009;103(2):166–72.CrossRefPubMed
27.
Flick M, Duranteau J, Scheeren TWL, Saugel B. Monitoring of the sublingual microcirculation during cardiac surgery: current knowledge and future directions. J Cardiothorac Vasc Anesth. 2020;34(10):2754–65.CrossRefPubMed
28.
Koning NJ, Vonk AB, Meesters MI, Oomens T, Verkaik M, Jansen EK, et al. Microcirculatory perfusion is preserved during off-pump but not on-pump cardiac surgery. J Cardiothorac Vasc Anesth. 2014;28:336–41.CrossRefPubMed
29.
Koning NJ, Simon LE, Asfar P, Baufreton C, Boer C. Systemic microvascular shunting through hyperdynamic capillaries after acute physiological disturbances following cardiopulmonary bypass. Am J Physiol Heart Circ Physiol. 2014;307(7):H967–75.CrossRefPubMed
30.
Atasever B, Boer C, Speekenbrink R, Seyffert J, Goedhart P, de Mol B, et al. Cardiac displacement during off-pump coronary artery bypass grafting surgery: effect on sublingual microcirculation and cerebral oxygenation. Interact Cardiovasc Thorac Surg. 2011;13(6):573–7.CrossRefPubMed
Metadata
Title
Symptom progression following on-pump versus off-pump coronary artery bypass graft surgery in patients with peripheral arterial disease
Authors
Utkan Sevuk
Mehmet Veysi Bahadir
Publication date
09-08-2022
Publisher
Springer Nature Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 3/2023
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-022-01855-x

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