Coronary Artery Bypass Grafting In Patients With Perioperative Blood Product Use, Postoperative Extension Of Assisted Ventilation, The Long-term Clinical Results

Part one: Effect of perioperative blood transfusion on short-term, long-term outcomes following coronary artery bypass graftingObjective:To analyze the effect of perioperative blood transfusion after isolated coronary atery bypass grafting on short-term, long-term outcomes.Methods:4022consecutive patients undergoing isolated coronary atery bypass grafting from Jan2006to Dec2008were analyzed retrospectively. Multivariate logistic regression analyses were performed to investigate the predictors of perioperative blood transfusion. The patients were divided into three groups by the useage amount of red blood cells and blood plasma respectively. Multivariate logistic regression analyses were performed to investigate the in-hospital morbidity and other events of perioperative blood transfusion. All-cause deaths, cardiac deaths, major adverse cardiac and cerebrovascular events(MACCE), angina, rehospitalization for any cardiovascular diease were defined as long-term endpoint events, and multivariate Cox analysis was uesed to examine the difference in long-term prognosis. Patients were stratified into three groups according to sinoSCORE, and we analyzed the effects of perioperative blood transfusion on short-term, long-term outcomes in those three groups respectively.Results:Blood transfusion was used in2644patients. Gender, age, BMI, cerebrovascular accident medical history, extracorporeal circulation, use of IABP, preoperative Haemoglobin b level, prioperative use of clopidogrel were independent predictors of perioperative blood transfusion. Perioperative use of red blood cells and plasma were significantly related with in-hospital morbidity, major events, secondary events, and the results were consistent after the risk stratification. Perioperative use of red blood cells and plasma were significantly related with lont-term all-cause deaths, cardiac deaths, and after the risk stratification the results showed that there were no siginificant differences between high and low risk polulation in the long-term outcomes with the use of red blood cells, while massive transfusion of red blood cells increased the cardiac deaths (HR=10.05,95%CI,1.32-76.51) of intermediate risk population significantly; there were no siginificant differences between intermediate and low risk polulation in the long-term outcomes with the use of plasma, while transfusion of plasma increased the all-cause deaths of high risk population significantly, and the risk increased with the volume of plasma transfusion, small amount of plasma transfusion (HR=166.96,95%CI,2.91-9581.79),massive plasma transfusion (HR=243.37,95%CI,2.87-20621.69)Conclusions:age, gender, BMI, cerebrovascular accident medical history, extracorporeal circulation, use of IABP, preoperative haemoglobin level, hematocrit, prioperative use of clopidogrel are the risks of blood transfusion in CABG patientr, and it increases in-hospital mobidity and the rates of major events, secondary events, long-term all-cause deaths, cardiac deaths. Part two: Effect of prolonged mechanical ventilation on short-term, long-term outcomes following coronary artery bypass graftingObjective:To analyze the effect of prolonged mechanical ventilation after isolated coronary atery bypass grafting on short-term, long-term outcomes.Methods:4022consecutive patients undergoing isolated coronary atery bypass grafting from Jan2006to Dec2008were analyzed retrospectively. The patients were divided into two groups by the time:conventional mechanical ventilation group≤12hours(n=1783) and prolonged mechanical ventilation group>12hours(n=2239). Univariate and multivariate logistic regression analyses were performed to investigate the predictors, in-hospital morbidity and mortality of PMV. All-cause deaths, cardiac deaths, major adverse cardiac and cerebrovascular events(MACCE), angina, rehospitalization for any cardiovascular diease were defined as long-term endpoint events, and multivariate Cox analysis was uesed to examine the difference in long-term prognosis. Patients were stratified into three groups according to sinoSCORE, and we analyzed the effects of PMV on short-term, long-term outcomes in those three groups respectively.Results:Average mechanical ventilation time was19.12hours. Multivariate logistic regression revealed that age, BMI, hypertension, angina, NYHA classes, lesion coronory number, the use of IABP, blood transfusion, preoperative intravenous nitrates in use were independent predictors of PMV. PMV was significantly related with in-hospital morbidity (OR=2.10,95%CI,1.75-2.51), major events (OR=6.70,95%CI,3.80-11.80), secondary events (OR=1.28,95%CI,1.02-1.61), and the results were consistent after the risk stratification. In the long-term follow-up, the rates of cardiac deaths (HR2.54,95%CI,1.14-5.66) and rehospitalization for any cardiovascular diease (HR1.36,95%CI,1.10-1.69) were significantly higher in the PMV patients, and after the risk stratification the results showed that PMV increased rehospitalization (HR=1.37,95%CI,1.03-1.80) of low risk population significantly,while there were no siginificant differences between high and intermadiate risk polulation in the long-term outcomes of PMV.Conclusions:old age, lower BMI, hypertension, frequent heart attacks, poor cardiac function, more lesion coronory, use of IABP, blood transfusin and preoperative use of intravenous nitrates increase the risk of PMV. PMV increases in-hospital mobidity and the rates of major events, secondary events and long-term rehospitalization, cardiac deaths for any cardiovascular diease.