Comparison of pre- and post-surgery cardiac depression and perceived stress levels in heart patients undergoing different types of surgery.

Review of Case-Mix Corrected Survival Curves

Literature Review

Low-volume coronary artery bypass surgery: Measuring and optimizing performance

Effect of Dietary Fish Oil on Atrial Fibrillation After Cardiac Surgery

ObjectiveDepression and anxiety are associated with poor recovery in coronary artery bypass graft (CABG) patients, but little is known about predictors of depression and anxiety symptoms.DesignWe tested the prospective association between attachment orientation, and symptoms of depression and anxiety in CABG patients, 6–8 weeks, and 12 months following surgery.MethodOne hundred and fifty‐five patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring attachment, depression, and anxiety prior to surgery, then 6–8 weeks, and 12 months after surgery.ResultsAttachment anxiety predicted symptoms of depression and anxiety at both follow‐up time points, whereas attachment avoidance was not associated with depression or anxiety symptoms. The findings remained significant when controlling for baseline mood scores, social support, demographic, and clinical risk factors.ConclusionThese results suggest that attachment anxiety is associated with short‐term and long‐term depression and anxiety symptoms following CABG surgery. These results may offer important insight into understanding the recovery process in CABG surgery. Statement of contribution What is already known on this subject? Depression and anxiety symptoms are twice more likely to occur in coronary artery bypass graft (CABG) populations than in any other medical group.Depression and anxiety are associated with poor recovery following cardiac surgery.Predictors of depression and anxiety in CABG patients have been underexplored. What does this study add? This study highlights the importance of close interpersonal relationships on health.Attachment anxiety was prospectively associated with higher levels of depression and anxiety.These results add to understanding mechanisms linked to recovery following CABG.

BackgroundTo date, the relationship between the Transesophageal Echocardiography (TEE) monitoring indicator tricuspid annular plane systolic excursion (TAPSE) and the incidence of postoperative acute kidney injury (AKI) in Coronary Artery Bypass Grafting(CABG) patients remains unknown. The main objective of this study was to explore the relationship between the TAPSE and the incidence of AKI in CABG patients.MethodsThis was a multicenter prospective cohort study was conducted between September 2021 and July 2022. Among 266 patients aged at least 18 years who underwent elective CABG, 140 were included.ResultsWe measured TAPSE via M-mode TEE via the mid-esophageal (ME) right ventricle(RV) inflow-outflow view (60°). All echocardiographic measurements were performed three separate times at each time point: T0 (before the start of CABG), T2 (approximately 5 ∼ 10 min after neutralization of protamine) and T3 (before leaving the operating room), and then averaged. Serum creatinine was measured 1 day before and within 7 days after CABG. There was no statistically significant association between the TEE-monitoring indicator TAPSE and the incidence of postoperative AKI in patients who underwent CABG.ConclusionsThe TAPSE was not significantly correlated with postoperative AKI incidence and could not predict the early occurrence of postoperative AKI in CABG patients. TEE needs more evaluation for clinical efficacy of predicting the early occurrence of postoperative AKI in isolated CABG.

To investigate whether the diagnosis of acute coronary syndrome (ACS) in coronary artery bypass grafting (CABG) patients with chest pain (CP) is more difficult based on the initial clinical and electrocardiogram (ECG) findings. We included consecutive CP patients attended at a single emergency department (ED) during a 10-year period. CABG status and the final diagnosis of ACS were considered as stated in the ED discharge report. We evaluated the frequency of 21 CP characteristics (CPC) and four ECG signatures, their individual and collective association with ACS, and ED length of stay (LOS) in CABG and non-CABG patients. We included 34 429 patients [median age: 61 years; female: 41.8%; CABG: 2204 patients (6.4%)], and ACS was diagnosed in 6727 (19.5%; CABG/non-CABG 37.2%/18.3%; P < 0.001). CABG patients more frequently had CPC and ECG findings typically associated with ACS, but their final association with ACS was weaker than in non-CABG patients (only significant after adjustment for attendant diaphoresis, throat irradiation, ST-segment elevation and T-wave inversion). The collective discriminative capacity was significantly lower in CABG patients (area under the curve 0.710 vs. 0.793; P < 0.001), even after adjustment (0.708 vs. 0.790; P < 0.001). ED LOS was longer for CABG patients, overall (P < 0.001) and for patients diagnosed with ACS (P = 0.008) and non-ACS (P < 0.001), but these differences disappeared after adjustment. CABG substantially reduces the diagnostic performance of CPC and ECG findings to suggest ACS. A longer LOS in the ED in CABG patients is more related to their baseline characteristics than to CABG itself.

Perioperative B-type Natriuretic Peptide/N-terminal pro-B-type Natriuretic Peptide: Next Steps to Clinical Practice.

Intraoperative graft patency validation: Friend or foe?

Case Presentation : A 76-year-old man developed increased fatigue during his daily 40-lap swim and daily 3-mile walk. His past medical history included use of hydrochlorothiazide for hypertension. His physical examination and baseline ECG were normal. An exercise treadmill test demonstrated ischemia, and cardiac catheterization showed left main and 3-vessel obstructive coronary artery disease. Echocardiography revealed normal left ventricular function. He underwent a 3-vessel coronary artery bypass grafting (CABG) with the left internal mammary artery grafted to the left anterior descending, and separate saphenous vein grafts, harvested endoscopically from the left leg, to the obtuse marginal branch and posterior descending coronary artery. The surgery was uncomplicated, with an aortic cross clamp time of 73 minutes and cardiopulmonary bypass time of 89 minutes. On the first postoperative day, he was transferred out of the intensive care unit. By the fifth postoperative day, he was walking 100 feet steadily without use of any assist device. He was discharged home on the sixth postoperative day on enteric-coated aspirin, hydrochlorothiazide, metoprolol, and atorvastatin. He presented to his community hospital on the 30th postoperative day, complaining of 5 days of increasing fatigue and 1 day of markedly increased shortness of breath. The ECG showed a heart rate of 79 beats per minute and nonspecific ST and T wave abnormalities. The D-dimer level was elevated (>8000 ng/mL). Contrast-enhanced spiral computed tomography (CT) of the pulmonary arteries, including additional sections of the lower extremities, acquired during venous phase of contrast enhancement (“indirect CT venography”) showed a large bilateral central pulmonary embolism (PE) and a right leg deep vein thrombosis (DVT), without DVT in the leg from which the saphenous vein had been harvested (Figure 1). He was transferred to Brigham and Women’s Hospital for further management, where he was hospitalized for 6 days, received enoxaparin as a …

Objective: The purpose of this study was to measure the level of stress perceived by postoperative coronary artery bypass graft (CABG) patients. Coronary artery bypass graft is the most used surgical intervention to treat patients with coronary artery disease (CAD). Many patients consider CABG surgery as life threatening and stressful. There is a need for nurses to be aware of the patient’s perception of stress to create a more therapeutic environment within the intensive care unit (ICU).Methods: The research method was a quantitative descriptive survey design and descriptive statistics were used for data analysis. A convenience sampling method was used resulting in a sample size of 60 participants who had recently undergone a CABG surgical procedure. The participants completed the Intensive Care Unit Environmental Stressor Scale (ICUESS) survey.Results: The results of the ICUESS survey were analyzed according to rank order and mean with standard deviation scores for each of the 40 items. Findings showed the following stressors were ranked as the highest level of stress: “Being in pain”, “missing your husband or wife”, “having tubes in your nose or mouth”, and “only seeing family and friends for a few minutes each day”.Conclusions: The participants in this study were not highly stressed. Pain was the highest ranked stressor. Nurses need to be aware of the perceived level of stress by the postoperative CABG patients to reduce stressors and enhance recovery. The Neuman Systems Model was appropriate for this study.

Benefit to quality of life after Off-Pump versus On-Pump coronary bypass surgery

Background: The American Heart Association’s (AHA) Life’s Essential 8 (LE8) concept serves as a quantitative framework for assessing cardiovascular health (CVH). Post-operative coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) patients are at high-risk for subsequent cardiovascular events (CVE). However, LE8 scores for post-procedural CABG or PCI patients remain unknown. Methods: Isolated post-operative CABG (n=208) or PCI (n=739) non-institutionalized patients from the National Institutes of Health’s (NIH) All of Us (AoU) Research Program (2017-2022) were included. LE8 scores (range 0-100, higher = better CVH; excluding diet metric) were calculated using methods recommended by the AHA. Physical activity and sleep metrics were derived from patients' Fitbit data, while all other metrics were sourced from electronic health records (EHR). Results: Overall LE8 scores for post-operative CABG (57.9 [95% CI: 56.6-59.2]) and PCI patients (55.3 [54.4-56.1]) were significantly lower than that of the general population (65.9 [65.1-66.7] (p&lt;0.001). Significantly lower LE8 metrics were observed in post-op CABG and PCI patients compared to the general population for the following factors: nicotine exposure (-4.1 vs. -8.3, respectively), sleep health (-19.5 vs. -23.6), body mass index (-9.4 vs. -10.8), blood glucose (-36.5 vs. -35.0), and blood pressure (-13.5 vs. -16.5). Physical activity scores were low for post-op CABG patients (56.6 [52.3-60.8]), PCI patients (54.7 [52.3-57.1]), and the general population (51.6 [53.5-59.7]) (Figure 1A, 1B). Conclusion: Our study indicates that post-op CABG and PCI patients, who are at significantly increased risk for subsequent CVE, exhibit critically low overall CVH as measured by AHA’s LE8 metrics. These findings highlight the urgent need for targeted interventions, with nicotine exposure, physical activity, BMI, blood glucose, and blood pressure identified as key areas for improvement. Since LE8 metrics include behavioral and physiologic metrics associated with CVD risk, further research should focus on effective strategies to address these deficits in post-operative PCI and CABG patients.

The effects of a PRECEDE-based educational program on depression, general health, and quality of life of coronary artery bypass grafting patients

Patients with coronary heart disease (CHD) who require coronary artery bypass graft (CABG) surgery are usually older and are more likely to have multiple comorbidities compared with those undergoing percutaneous coronary interventions (Niles et al. 2001). In addition to this increase in disease burden, the prevalence of depressive symptomatology among patients after CABG surgery has also been shown to be as high as 23% (Pirraglia et al. 1999). Depression and depressive symptoms are prevalent in people with CHD and are associated with adverse cardiovascular outcomes (Whooley et al. 2008). There is strong evidence that the detection and treatment of depression improves health outcomes (Somberg & Arora 2008), thus underscoring the importance of screening for depression in the cardiac care setting. As King et al. (2009) correctly highlight, the detection of even mild depression in patients following CABG surgery is important, and the cardiac depression scale (CDS), designed specifically to identify depression in patients with cardiac disease, has been shown to be sensitive in detecting a broad spectrum of depressive symptoms in patients with cardiac disease (Hare & Davis 1996). Although disease-specific health-related quality of life measures is expected to be more responsive to changes in clinical status (Sullivan et al. 2004), whether this is the case for the CDS in assessing depression in patients following CABG surgery is still to be determined. Most patients surveyed in this study by King et al. (2009) reported low scores on the Beck depression inventory (BDI) at all four points in time (mean : 4AE31–8AE08 from a possible range of 0–63), reducing the possibility of capturing any change in depression scores using the BDI is reduced. Despite the low BDI scores, it is surprising that both the BDI and the CDS had similar power in detecting change in depression scores over time. Although the focus of this article by King et al. was an examination of the utility and a validity of the CDS in patients following their first CABG surgery, further clarification about the study context and method was warranted. First, the study sample only included men. Although the authors explained that this was a sub-study of a clinical trial, no explanation was given as to why no women were included. Second, it would be useful for the readers to know why the authors selected a standardised health record audit as well as telephone contact as their method of data collection. One wonders why a self-administered questionnaire was not used, perhaps because of the written English language literacy of the study sample? Third, the authors made a perfunctory mention of the measurement of interrater reliability scores over the course of the study. The specifics of measurement were not stated. Was it only the standardised depression measures used in this study, or was it all data collected via telephone contact, and did they include data collected via the standardised health record audit? Further clarification of these interrater reliability measurements would have been worthwhile for the reader. Nevertheless, King et al. should be commended for assessing depression in their study sample using both the BDI and the CDS at four points in time over the 36-week study period;