Search Results (733)

Background/Objectives: The comparative efficacy of off-pump and on-pump coronary bypass grafting (CABG) for patients with acute and subacute myocardial infarction (AMI) remains controversial. We compared the outcomes of on-pump versus off-pump coronary artery bypass grafting in Korean patients with acute and subacute myocardial infarction. Methods: This nationwide retrospective cohort study included 14,578 propensity score-matched patients undergoing on-pump or off-pump CABG between 2007 and 2022 using the Korean National Health Insurance Service database. The primary outcomes were recurrent myocardial infarction, repeat revascularization, stroke, all-cause mortality, and major adverse cardiovascular and cerebrovascular events. Chi-square, Kaplan–Meier, and log-rank tests and Cox regression analysis were used. Results: Compared with on-pump CABG, off-pump CABG was associated with significantly lower risks of major adverse cardiovascular and cerebrovascular events (MACCEs), all-cause mortality, and recurrent myocardial infarction in the cause-specific Cox analysis, whereas repeat revascularization and stroke rates were comparable between groups. However, the association with recurrent myocardial infarction was not statistically significant in the Fine–Gray competing-risk analysis. Conclusions: Off-pump CABG was associated with lower risks of all-cause mortality and MACCEs in patients with acute and subacute myocardial infarction. The association with recurrent myocardial infarction was less consistent across analytical approaches and should be interpreted cautiously. Full article

This narrative review summarizes the published literature on robotic coronary revascularization, encompassing robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB), totally endoscopic coronary artery bypass (TECAB), and hybrid coronary revascularization (HCR). These are distinct procedures that differ in operative access, conduit harvesting, use of cardiopulmonary bypass (CPB), and typical patient selection, and are treated as such throughout this review rather than as interchangeable techniques. A structured, non-systematic literature search of PubMed/MEDLINE and major cardiothoracic surgical journals was performed. Articles were selected by the authors based on relevance, methodological quality, and recency. This is explicitly a narrative rather than a systematic review, and no PRISMA methodology was applied. In observational series from experienced centers, RA-MIDCAB and TECAB are associated with low perioperative mortality (0–2.8%), high early left internal thoracic artery (LITA)-to-left anterior descending (LAD) graft patency (>95%), and shorter hospital stay than conventional sternotomy coronary artery bypass grafting (CABG) in selected patients. HCR extends robotic revascularization to selected patients with multivessel and left main disease. However, nearly all of this evidence derives from retrospective, single-center, or registry-based observational studies performed at high-volume expert centers in selected patient populations, and comparative claims against conventional CABG are vulnerable to selection bias and residual confounding. Robotic coronary revascularization is a feasible option that has been reproduced across a growing number of high-volume centers for carefully selected patients, but current evidence does not support broad claims of superiority over conventional CABG, and outcome data remain concentrated among a limited number of expert programs. Prospective multicenter and randomized data, standardized outcome definitions, and structured training pathways are needed to define its long-term role in coronary revascularization. Full article

Background/Objectives: Direct comparative evidence regarding aortic root and pulmonary artery venting during on-pump coronary artery bypass grafting (CABG) remains limited. We evaluated whether pulmonary artery venting was associated with improved early postoperative respiratory recovery compared with aortic root venting. Methods: This single-center retrospective cohort included 488 adults undergoing on-pump CABG between January 2020 and January 2025 (aortic root vent, n = 316; pulmonary artery vent, n = 172). The primary outcome was delayed extubation beyond 8 h. Propensity-score overlap weighting based on 22 covariates addressed baseline confounding. Confidence intervals and p values were obtained from 5000 stratified nonparametric bootstrap samples with refitting of the propensity-score model and recalculation of overlap weights in each sample. Results: Extubation-time data were available for 486 patients. As expected with overlap weighting based on a logistic propensity-score model, exact mean balance was achieved for the covariates included in the model (absolute standardized mean differences < 0.001). The overlap-weighted risk of delayed extubation was 51.4% in the aortic root vent group and 41.1% in the pulmonary artery vent group; the adjusted association was not statistically significant (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.37–1.10; p = 0.110). Pulmonary artery venting was associated with lower odds of fast-track failure (OR 0.53, 95% CI 0.30–0.89), the respiratory composite outcome (OR 0.35, 95% CI 0.17–0.64), and postoperative inotrope requirement (OR 0.39, 95% CI 0.14–0.87), together with a higher arterial oxygen partial pressure (PaO2) at extubation (mean difference 7.08 mmHg, 95% CI 0.72–12.89). Conclusions: The primary outcome of delayed extubation did not differ significantly between venting strategies after overlap weighting. Favorable associations across several secondary outcomes suggest a possible improvement in broader early postoperative recovery with pulmonary artery venting; these exploratory findings require prospective confirmation. Full article

Background/Objectives: Iatrogenic brachial plexus injuries (BPI) are known to occur following a host of surgeries, most often during procedures at the shoulder and cardiac procedures with a median sternotomy. The primary mechanisms include overstretching of the brachial plexus, direct trauma, or compression by hematoma or seroma. Our objective was to determine the pattern of iatrogenic BPI in patients referred to us for electrodiagnostic (EDX) evaluation. Methods: This is a review of 52 patients who were referred to our Neurodiagnostic Center for an iatrogenic BPI over a 16-year (9 July 2010–17 June 2026) period. All patients underwent a clinical examination and EDX studies. Results: The most frequent etiologies of the iatrogenic BPI were shoulder surgery in 28 [53.8%] patients and coronary artery bypass graft procedures with a median sternotomy in 13 [25.0%] patients. The topography of brachial plexus involvement was trunks in 22 (42.3%) and cords in 12 (23.1%). Ten (19.2%) patients had a pan-plexopathy, and the remaining eight (15.4%) patients had multiple sites involving the trunks, cords, and branches. The majority (48 [92.3%]) of patients sustained a stretch injury of the brachial plexus, and four (7.7%) sustained a direct injury. A total of 48 (92.3%) patients had reduced motor unit potential recruitment and/or increased polyphasic motor units on needle EMG, and a similar number had an absence of or low amplitude sensory nerve action potentials. Conclusions: Surgeons should take appropriate precautions to avoid BPI during many surgical procedures especially those of the shoulder and cardiac procedures with a median sternotomy. EDX studies are valuable in detecting and localizing an iatrogenic BPI as well as assessing reinnervation. Preoperative positioning limiting excessive shoulder abduction as well as intraoperative neuromonitoring are measures that may reduce the likelihood of an iatrogenic BPI. Full article

Background/Objectives: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery with cardiopulmonary bypass (CPB), increasing morbidity and prolonging hospitalization. This study aimed to develop and validate an exploratory prediction model that integrates perioperative inflammatory biomarkers with clinical and surgical variables to identify patients at risk of early POAF. Methods: A prospective exploratory cohort of 89 patients undergoing coronary artery bypass grafting (CABG; n = 36), valve surgery (n = 40), or CABG–valve surgery (n = 13) was evaluated. Clinical, surgical, and proinflammatory serum biomarkers (IL-6, IL-8, IL-10, and CRP) were recorded preoperatively (T1) and at 24 h (T2) and 48 h (T3) postoperatively. Multiple-comparison adjustments were made using the Benjamini–Hochberg false discovery rate. Predictor selection was based on bootstrap-derived stability using LASSO-penalized logistic regression, and the final model was estimated using Firth’s bias-reduced logistic regression. Results: POAF incidence was 8.3% in CABG, in contrast to 22.5% and 30.8% in valve and CABG-valve surgeries, respectively. After multiple-comparison corrections, only IL-6 at T2 postoperatively was significantly higher in patients who subsequently developed POAF. Bootstrap-based stability selection retained T2 postoperative IL-10 and magnesium concentrations in the final model, which achieved an apparent AUC of 0.776 and a bootstrap optimism-corrected AUC of 0.728, with acceptable calibration (Brier score = 0.103), negligible multicollinearity (VIF = 1.04), and a negative predictive value of 95.5% at the optimal Youden threshold. Conclusions: Our findings support an exploratory prediction model with moderate discrimination for POAF after cardiac surgery with CPB, providing a methodological foundation for future multicenter validation studies. Full article

Coronary artery bypass grafting via median sternotomy carries considerable morbidity, and minimally invasive robotic approaches have been increasingly performed for surgical revascularization of coronary arteries. We report our institutional experience in robotic-assisted minimally invasive coronary revascularization in a broad patient population with complex multivessel disease. We retrospectively reviewed robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) procedures performed at our center between January 2022 and June 2026. Patient demographics, additional procedures and in-hospital outcomes were recorded. A total of 242 patients were included (mean age 63.4 ± 9.7 years; 31 (12.8%) female). Single-vessel bypass was performed in 25 (10.3%) patients; 212 (87.6%) patients underwent an operation on the arrested heart (mean cross-clamp time 66.9 ± 21.7 min) and 15 (6.2%) received an off-pump operation (mean CPB time in on-pump patients 155.7 ± 46.0 min). Full arterial revascularization was achieved in 42 (17.4%) patients; a bilateral internal mammary artery configuration was used in 9 (3.7%) patients. Coronary endarterectomy was performed in 16 (6.6%) patients and concomitant left atrial appendage (LAA) occlusion was performed in three (1.2%) patients. Epiaortic ultrasonography-guided clamp placement was performed in 27 (11.2%) patients with ascending-aortic plaque. In-hospital mortality occurred in two (0.8%) patients; no patient sustained a major neurological deficit, and the transfusion rate was 9.9%. Mean ventilation time was 4.0 (3.0–6.0) hours and mean intensive care unit stay was 22.6 ± 11.2 h. With careful planning and accumulated experience, the indications for robotic-assisted minimally invasive revascularization can be extended to include patients who require full-arterial revascularization, have ascending aortic plaques, complex coronary disease requiring endarterectomy, or atrial fibrillation where concomitant left atrial appendage occlusion is indicated. Full article

Background: Effective opioid-sparing analgesia after median sternotomy remains an unmet need in cardiac surgery. We evaluated whether bilateral intercostal cryoanalgesia, added to standard multimodal analgesia, was associated with postoperative pain, opioid consumption, recovery and early hospital-resource use after isolated coronary artery bypass grafting (CABG). Methods: This single-centre, non-randomised comparative service evaluation included 60 patients undergoing isolated CABG through median sternotomy between 1 November 2025 and 30 May 2026 (30 cryoanalgesia; 30 standard care). The prespecified primary endpoint was cumulative movement-evoked pain burden, quantified as the area under the curve (AUC) for scores recorded on postoperative days 1–3. Secondary endpoints included rest-pain AUC, opioid consumption expressed as oral morphine equivalents (OME), time to first bowel opening, postoperative length of stay and an exploratory break-even calculation. Results: Cryoanalgesia was associated with lower movement-pain AUC (adjusted mean difference −3.56 score-days, 95% confidence interval [CI] −4.62 to −2.50; p < 0.001) and rest-pain AUC (−3.16 score-days, 95% CI −4.19 to −2.14; p < 0.001). Total observed opioid consumption was lower by 112.9 mg OME (95% CI −192.8 to −33.1; p = 0.006), length of stay by 1.32 days (95% CI −1.93 to −0.71; p < 0.001), and time to first bowel opening by 0.49 days (95% CI −0.92 to −0.06; p = 0.027). Conclusions: In this small non-randomised evaluation, bilateral intercostal cryoanalgesia was associated with lower early pain and opioid exposure and faster recovery. Selection, temporal and residual confounding preclude causal or cost-effectiveness conclusions. Prospective randomised evaluation with fixed observation periods and longer-term safety follow-up is required. Full article

Patients with chronic liver disease are systematically excluded from acute myocardial infarction (AMI) trials, and prior real-world data rely on administrative coding alone. Whether ICD-coded liver disease and laboratory-defined liver fibrosis identify the same patients, and whether they predict the same outcomes, is unknown. We conducted a single-center retrospective cohort study of 1037 consecutive adults admitted with AMI (ICD-10 I21.x) to a tertiary New York center between November 2022 and December 2024. The primary exposure was ICD-defined advanced liver disease (cirrhosis, hepatic failure, or portal hypertension/decompensation; n = 102). The secondary, lab-based exposure was the Fibrosis-4 (FIB-4) index calculated from earliest admission AST, ALT, and platelet count (computable in 1031 patients, 99.4%), stratified as low (<1.45), indeterminate (1.45–3.25), or advanced (>3.25). Co-primary outcomes were invasive management (diagnostic angiography, percutaneous coronary intervention, or coronary artery bypass grafting) and in-hospital mortality. Multivariable logistic regression adjusted for age, sex, diabetes, chronic kidney disease, heart failure, and ST-elevation; the trend across FIB-4 tiers was assessed with the Cochran–Armitage test. Denominators throughout (including the 168/909 occult-fibrosis estimate) use the full exposure group as denominator under a missing-as-not-exposed convention; the four no-LD and two advanced-LD patients with missing FIB-4 are counted as non-advanced fibrosis for this calculation. Patients with ICD-defined advanced liver disease received invasive management less often (12.7% vs. 50.4%; adjusted odds ratio [aOR] 0.17, 95% CI 0.09–0.32) and died in hospital more often (43.1% vs. 7.9%; aOR 8.22, 95% CI 5.02–13.46) than patients without coded liver disease. Outcomes worsened monotonically across FIB-4 tiers (mortality 4.4% → 9.2% → 27.5%; invasive management 55.2% → 45.6% → 33.5%; both p < 0.001 by Cochran–Armitage trend test). Critically, 168 of 909 patients with no coded liver disease (18.5%) had FIB-4 > 3.25, representing a substantial population of unrecognized advanced fibrosis missed by clinical coding. Coded liver disease identifies a small, severely affected subgroup with markedly lower rates of invasive management and 6- to 8-fold higher mortality after AMI. Routine FIB-4 calculation, a free, three-variable lab score, identifies a much larger population with occult advanced fibrosis and graded excess risk that ICD codes miss entirely. Pending prospective validation, FIB-4 may serve as a low-cost adjunct to bedside risk stratification in AMI care. Full article

Coronary artery disease is a leading cause of morbidity and mortality in modern medicine. In contrast, surgical myocardial revascularization via coronary artery bypass grafting (CABG) remains the gold standard of treatment for complex multivessel disease. The great saphenous vein remains the most frequently used conduit due to its availability and technical simplicity, but its long-term patency is significantly inferior to that of arterial grafts. The primary pathological process responsible for vein graft failure is intimal hyperplasia, which represents a complex response of the vascular wall to surgical trauma, vein arterialization, inflammation, and hemodynamic stress. This process is characterized by endothelial dysfunction, inflammatory cell activation, proliferation and migration of vascular smooth muscle cells, and extracellular matrix remodeling. Underpinning these alterations are numerous molecular pathways, including NF-κB, MAPK, PI3K/Akt, TGF-β, and mTOR signaling, as well as substantial contributions from oxidative stress, cytokines, growth factors, and microRNAs. Contemporary research indicates that the phenotypic transformation of vascular smooth muscle cells constitutes the central event in the development of intimal hyperplasia. Understanding the cellular and molecular mechanisms underlying this disease’s onset enables the development of novel therapeutic strategies to preserve long-term graft patency. This review paper aims to provide a systematic overview of current knowledge regarding the molecular and cellular mechanisms of intimal hyperplasia development in vein grafts following CABG. Full article

Background: This study aims to assess the effectiveness and safety of modified parasternal nerve block (MPSB) in providing perioperative analgesia and improving postoperative recovery in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Sixty-five patients scheduled for OPCABG were randomly assigned to either the intervention group (MPSB group), which received a preoperative modified parasternal block, or the control group. The primary outcome measured was intraoperative opioid consumption. Secondary outcomes included levels of inflammatory markers, postoperative pain scores (assessed using the Visual Analog Scale, VAS), incidence of postoperative nausea and vomiting (PONV), total plasma ropivacaine concentration, gastrointestinal recovery parameters, mobilization metrics, intensive care unit (ICU) parameters (mechanical ventilation duration, ICU length of stay, requirement for rescue analgesics), length of hospital stay, incidence of postoperative pulmonary complications (PPCs), and chronic pain. Results: Intraoperative sufentanil consumption was significantly reduced in the MPSB group (130.0 [IQR, 110.0–167.5] μg vs. 280.0 [IQR, 192.5–327.5] μg; p < 0.01). Inflammatory markers were consistently lower in the MPSB group. Pharmacokinetic analysis revealed a mean peak plasma ropivacaine concentration of 0.88 μg/mL, with the maximum individual concentration reaching 1.76 μg/mL at 5 min post-administration. The MPSB group demonstrated superior postoperative outcomes, including lower VAS pain scores, earlier return of gastrointestinal function, reduced duration of mechanical ventilation, decreased rescue analgesic requirements in the ICU, shorter hospital stays, and lower incidence of PPCs. Conclusions: Preoperative modified parasternal block significantly reduced perioperative opioid consumption in cardiac surgery patients. This intervention demonstrated benefits in facilitating rapid postoperative recovery. The conventional ropivacaine dosing regimen was a safe and effective analgesic approach, associated with a low risk of local anesthetic systemic toxicity. Full article

Background/Objectives: Postoperative bleeding remains a major complication following coronary artery bypass grafting (CABG), contributing to transfusion requirements, reintervention, and morbidity. The objective of this study was to assess the clinical significance of preoperative platelet function testing and postoperative viscoelastic testing in patients undergoing elective isolated on-pump CABG. Methods: This prospective observational study included 708 patients undergoing surgery between January 2023 and January 2025. Preoperative platelet function was assessed with Multiplate^® impedance aggregometry (ADPHS and ASPI), and postoperative coagulation was assessed with ClotPro^® after cardiopulmonary bypass. The prespecified Multiplate thresholds were population- and assay-specific and were not intended as universal cutoffs. Postoperative bleeding was defined by cumulative chest-tube drainage during the first 24 h. Results: In unadjusted analyses, low ADPHS values (≤602.5 AU·min) were associated with higher platelet transfusion, cryoprecipitate use, and overall transfusion, and ADPHS showed modest discrimination for blood loss > 500 mL/24 h (AUC = 0.61, p = 0.041). Low ASPI values (≤453 AU·min) were associated with increased cryoprecipitate use and showed modest discrimination for blood loss > 1000 mL/24 h (AUC = 0.62, p = 0.005). After multivariable adjustment for baseline differences, neither ADPHS ≤ 602.5 (adjusted OR 1.01, 95% CI 0.74–1.39, p = 0.936) nor ASPI ≤ 453 (adjusted OR 0.89, 95% CI 0.64–1.23, p = 0.475) was independently associated with postoperative bleeding > 500 mL/24 h. Postoperative ClotPro^® parameters showed statistically significant associations with transfusion and bleeding, but their discriminatory performance was limited. Conclusions: Perioperative platelet function and viscoelastic test results were associated with bleeding and transfusion outcomes in unadjusted analyses, but discrimination was modest, and the platelet function cutoffs were not independently associated with bleeding > 500 mL after adjustment. These findings support a complementary hemostatic assessment role for combined POC testing but do not establish a standalone predictive model or an implementable transfusion algorithm. Full article

Background and Objectives: The internal thoracic artery (ITA) is widely used in coronary artery bypass grafting and reconstructive procedures due to its favorable anatomical characteristics. This study aimed to comprehensively evaluate the morphometric features of the ITA using computed tomography angiography and to investigate variations according to sex and anatomical side. Materials and Methods: In this retrospective cross-sectional study, thoracic computed tomography angiography images of 72 individuals were analyzed. Bilateral measurements of ITA length, diameter at different intercostal levels, anatomical relationships, and perforating branches were recorded. Results: The mean ITA length was slightly greater on the left side (18.6 ± 2.7 cm) compared to the right (18.3 ± 2.3 cm), without significant sex differences. A progressive decrease in arterial diameter from proximal to distal segments was observed. Statistically significant sex-related differences in diameter were identified, particularly at the 3rd and 4th intercostal spaces (p < 0.05). Distances to adjacent anatomical structures also varied significantly between sexes. Perforating branches were most frequently detected at the 4th intercostal space. Conclusions: The ITA demonstrates notable morphometric variability depending on sex and anatomical side. These findings provide anatomical reference data that may contribute to individualized evaluation of the ITA. Full article

Kounis syndrome (KS) is a largely underdiagnosed cause of acute coronary syndromes triggered by allergic or hypersensitivity reactions. The syndrome results from complex immune cell activation with the release of vasoactive and prothrombotic mediators leading to coronary vasospasm (type I KS) or thrombosis of plaque (type II KS), stent (type III KS) or coronary artery bypass graft (type IV KS). Despite increasing recognition over the past few decades, its pathophysiological mechanisms, diagnostic boundaries, and therapeutic implications remain incompletely understood. A comprehensive diagnostic approach, including signs, symptoms, biochemical findings, electrocardiography, echocardiography, coronary angiography, and multimodality imaging, as well as invasive assessment in selected cases, can be recommended, although its implementation in routine practice remains limited. Available data indicate that angiographically documented epicardial coronary spasm is observed in only a minority of patients, while normal or non-obstructive coronary arteries are frequently encountered. Emerging data from provocative testing, invasive coronary functional assessment, cardiac magnetic resonance and nuclear imaging suggests that coronary microvascular dysfunction may contribute substantially to the clinical phenotype, expanding the traditional concept of allergic epicardial vasospasm. Current evidence supports the recognition of type I KS as a distinct allergic vasomotor acute coronary syndrome within the myocardial infarction non-obstructive coronary artery (MINOCA) spectrum, deserving greater recognition in future diagnostic classifications and clinical practice guidelines. This narrative review critically appraises current evidence, integrating historical perspectives with contemporary insights into classification, pathophysiology, triggers, diagnostic strategies and therapeutic approaches, focusing on the most frequent manifestation represented by the vasospastic variant. Full article

Background: Acute kidney injury (AKI) is a common complication following cardiac surgery and is associated with increased morbidity and mortality. Contemporary national estimates of its clinical and economic burden in the United States remain limited. Methods: We conducted a retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS) for 2022–2023. Adult hospitalizations undergoing coronary artery bypass grafting (CABG), valve surgery, or combined CABG and valve surgery were identified using ICD-10-PCS codes. Hospitalizations with end-stage kidney disease were excluded. The primary exposure was AKI. Outcomes included in-hospital mortality, length of stay (LOS), non-home discharge, and hospitalization cost. Survey-weighted multivariable regression models were used to evaluate the independent association between AKI and study outcomes. Results: The final cohort included 133,801 hospitalizations, representing an estimated 669,005 cardiac surgery hospitalizations nationally. AKI occurred in 123,240 weighted hospitalizations (18.4%). Compared with hospitalizations without AKI, those with AKI had higher unadjusted mortality (7.21% vs. 0.71%), longer LOS (14.4 vs. 6.3 days), greater rates of non-home discharge (68.1% vs. 41.2%), and higher hospitalization costs ($97,452 vs. $56,253). After adjustment for demographic, socioeconomic, clinical, and procedural characteristics, AKI remained independently associated with in-hospital mortality (adjusted odds ratio [aOR] 9.91, 95% confidence interval [CI] 8.95–11.00), non-home discharge (aOR 2.52, 95% CI 2.42–2.63), prolonged LOS (adjusted rate ratio [aRR] 1.88, 95% CI 1.85–1.91), and increased hospitalization costs (cost ratio 1.59, 95% CI 1.56–1.61). AKI was associated with an adjusted incremental cost of $33,497 per hospitalization, corresponding to an estimated national attributable cost burden of $4.13 billion during the study period. Conclusions: AKI complicates nearly one in five cardiac surgery hospitalizations in the United States and is associated with substantially increased mortality, healthcare utilization, and hospitalization costs. These findings highlight the significant clinical and economic burden of cardiac surgery–associated AKI and support continued efforts to improve prevention, risk stratification, and perioperative management. Full article

Background and Objective: Prolonged mechanical ventilation (PMV) after cardiac surgery is a common complication associated with increased morbidity, mortality and intensive care resource utilization. Our aim was to determine predictors of PMV > 48 h in patients undergoing coronary artery bypass grafting (CABG). Methods: This was a single-center retrospective observational study including adult patients who underwent CABG between January 2011 and December 2024. The primary outcome was PMV. Results: From 2083 patients, 241 had PMV (11.6%). Compared with patients without PMV, those with PMV had lower hemoglobin levels (12.6 ± 2.1 vs. 13.4 ± 1.9 g/dL, p < 0.001) and worse estimated Glomerular Filtration Rate (67.1 ± 26.9 vs. 78.1 ± 22.6 mL/min, p < 0.001). The model with preoperative variables predicted the risk of PMV (with an area under the receiver operating characteristic curve [AUROC] of 0.789). The prediction improved with the addition of intraoperative variables (AUROC 0.832) and with the further addition of early postoperative re-exploration for bleeding (AUROC 0.847). A simplified preoperative score showed good discrimination (AUROC 0.78; 95% CI 0.749–0.81) and stratified patients into clinically meaningful risk categories. Restricted cubic spline analysis showed a non-linear association between cardiopulmonary bypass duration and PMV, with risk increasing progressively after 120 min. Conclusions: PMV after CABG can be predicted using simple preoperative variables. This prediction has relevant implications for clinical management, intensive care resource allocation, and surgical scheduling. Preoperative anemia. Preoperative anemia was independently associated with PMV and represents a potentially modifiable perioperative risk factor. Full article