Aortocoronary Bypass Graft Surgery Research Articles

Update ESC-Leitlinie 2017: Duale Antiplättchentherapie

The updated ESC guidelines on dual antiplatelet therapy (DAPT) focus on individualization of therapy. It is recommended to plan DAPT duration depending on the individual ischemic- vs. bleeding risk of the patient. Evaluation of ischemic- and bleeding risk may be done using heart teams and risk scores respectively. It is underlined that the decision regarding DAPT duration is dynamic and should be re-assessed on a regular basis. For the first time, it is recommended to choose duration of DAPT irrespectively of stent type (bare metal- vs. drug eluting stent). DAPT duration form one- up to 36 months may be considered depending on the individual risk of the patient. Therefore the sight on DAPT has changed from a device dependent therapy to a systemic therapy in patients with coronary artery disease. In this context, recommendations regarding patients with acute coronary syndrome with medical treatment alone (including patients with myocardial infarction with non-obstructive coronary arteries) and undergoing aorto-coronary bypass graft surgery were amended. DAPT is recommended in both groups. Duration of DAPT depends on the individual risk as outlined above. In patients with non-ST elevation myocardial infarction, the initiation of P2Y12 inhibition may already be considered at time of diagnosis if an invasive approach is planned. Additionally, new recommendations regarding patients with coronary interventions and indication for permanent oral anticoagulation due to atrial fibrillation were established. In these patients non vitamin K oral anticoagulants (NOAC) may be considered instead of vitamin K antagonists. Again, duration of DAPT plus oral anticoagulation (triple therapy) should be recommended according to the individual ischemic- and bleeding risk of the patient. Triple therapy only during hospital course and single antiplatelet medication plus oral anticoagulation already at hospital discharge may even be considered in patients with high bleeding risk.

Chondrosarcoma of the sternum. Sternum resection and the plasty of the defect with the titanium mesh. The case report

Chondrosarcoma of the sternum is a rare tumor. Chemotherapy and radiation are not effective in the treatment of these tumors. The only effective treatment is the surgical resection with the wide clear margin. The surgical excision of the sternal tumor results in a large defect of tissue and can lead to instability of the chest wall. This defect must be reconstructed to prevent the violation of the lung function. The skeletal defects with a diameter less than 5 cm can be not reconstructed. The bigger defects must be reconstructed immediately. There are many methods of the reconstruction of the sternum defect. The musculocutaneous flaps, autologous bone transplants, or the alloplastic materials, can be used. There is no ideal prosthetic material. Whereas titanium mash alone or in combination with other materials is the most used. One of the proposed material to restore the defect is the cryopreserved sternum, but the authors prove that this method needs validation. 74-year-old patient diagnosed with the chondrosarcoma of the sternum was admitted to the department of the thoracic surgery of the Lviv regional oncological center. The diagnosis was established by chest computed tomography and the biopsy. Two and half years ago patient underwent the sternotomy during the aortocoronary bypass graft surgery. The tumor in the sternum was detected a half of the year ago, but it was considered as the local osteomyelitis. The treatment was ineffective. After biopsy, the diagnosis of chondrosarcoma was established. After the certain therapy the patient was operated. The wide resection of the body of the sternum was performed. During the procedure, the right pleural cavity was opened. The skeleton defect was repaired using two prosthetic materials. The polypropylene mesh was used as the first layer to protect the heart. It was fixed by the non-absorbable sutures to the wound margin. Upper the polypropylene, the titanium mesh was placed and fixed by the steel sutures to the ribs and the rest of the sternum. The right pleural cavity and the retrosternal space were drained. The pleural drainage tube was eliminated on day 4 after the chest radiology examination. The mediastinal drainage tube was settled on active aspiration and was left until the fluid stopped flowing. It was eliminated on day 16 after surgery. The pain was treated by the non-steroidal analgesics. The patient was discarded one month after the surgery. The control 2 months after surgery showed no pathological signs. The pain disappeared, the physical activity was restored. The surgical treatment of the sternal chondrosarcoma has dual aim. The first one is the adequate resection of the tumor to achieve the clear margin, and the second is the plasty of the tissue defect. To reconstruct a large defect, various surgical techniques and materials can be used. The surgeon must plan the intervention and foresee the difficulties. The type of plastic material can depend of the size of the defect. The surgeon must pay a lot of attention to prevent the infection, which can lead to the rejection of the prosthesis. This can be achieved by the firm fixation of the prosthesis, adequate drainage of the operation field and the antibiotic prophylaxis. Proper analgesic administration, physical exercises, as soon as possible, can accelerate the patient’s recovery.

Takayasu\u2019s arteritis: a case with relapse after urgent coronary revascularization

BackgroundVasculitides are commonly unrecognized causes of coronary stenosis and myocardial ischemia. We report on a 24-year old patient with Takayasu’s arteritis who underwent urgent percutaneous coronary intervention, suffered from symptomatic restenosis of the left main coronary artery during standard immunosuppressive therapy.Case presentationA 24-year old woman was referred for coronary angiography because of typical progressive angina pectoris. On bicycle ergometry, there were both reproducible symptoms and deep ST segment depressions on precordial leads. Semi-selective angiography of the left coronary artery revealed high-grade ostial stenosis. Because of persistent angina pectoris and electrocardiographic signs of acute myocardial ischemia, immediate percutaneous coronary angioplasty with subsequent implantation of an everolimus-eluting stent was performed. This intervention was performed with excellent angiographic results. Because of several concomitant criteria including hypoechogenicity on postprocedural intravascular ultrasonography, the diagnosis of Takayasu’s disease was made. The patient was treated with prednisolone and cyclophosphamide for 5 months. Because of recurrent angina pectoris, another coronary angiography was performed, which revealed high-grade in-stent-restenosis. Immunomodulatory therapy was switched to high-dose prednisolone and the anti-IL-6 receptor antagonist tocilizumab. The high-grade in-stent-restenosis persisted, and aortocoronary bypass graft surgery was performed with two saphenous vein grafts to the left anterior descending and circumflex artery. Since then, the patient has been doing well for 2 years.ConclusionIn cases of treatment refractoriness during standard immunosuppressive therapy, more recently developed biological compounds may offer an alternative strategy.

The use of monocyte to HDL ratio to predict postoperative atrial fibrillation after aortocoronary bypass graft surgery.

OBJECTIVE:Postoperative atrial fibrillation (POAF) is a frequent and serious complication after aortocoronary bypass graft (ACBG) surgery and one that, unfortunately, increases morbidity and mortality. Postoperative stroke, hemodynamic instability, renal failure, infection, need for inotropic agent and coronary unit are complications caused by POAF. Inflammation and oxidative stress are among several mechanisms that contribute to pathogenesis of POAF. Monocyte to HDL (M/H) ratio is a newly defined parameter of both inflammation and oxidative stress. In this study, M/H ratio was investigated as predictor of POAF after ACBG surgery.METHODS:Total of 311 patients who underwent ACBG surgery were included in the study. Blood samples for analysis of routine biochemistry and lipid panel were obtained from the patients on the morning of ACBG surgery after 12 hours of fasting. Patients were continuously monitored for occurrence of POAF throughout hospitalization.RESULTS:POAF was observed in 71 patients following ACBG operation. M/H ratio was significantly higher in POAF(+) group compared with POAF(-) group (p<0.001). Median age of POAF(+) patients was 62.0±10.1 years, which was significantly higher than mean age of POAF(-) patients. Other atrial fibrillation (AF) risk factors, such as hypertension, diabetes mellitus, smoking, and alcohol consumption, were similar between groups. Potassium level was statistically lower in POAF(+) group compared with POAF(-) group (p=0.01).CONCLUSION:M/H ratio is an indicator of inflammation and oxidative stress, both of which play important role in pathogenesis of AF. M/H ratio was found be statistically significantly higher in POAF(+) patients than in POAF(-) patients.

Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact

Objectives. To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients. Design. Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999–2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained. Results. Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = .038), as were death due to heart failure (18% and 14%, v. 7%, p = .007) and sudden death (9% and 5%, v. 2%, p = .029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02–2.12) and 1.28 (1.01–1.63), respectively). Conclusions. Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.

GIANT SAPHENOUS VENOUS GRAFT ANEURYSM COMPRESSING THE PULMONARY ARTERY: RARE CAUSE OF HEART FAILURE

Saphenous venous graft aneurysm (SVGA) is a unique complication after aorto-coronary bypass graft surgery (CABG). Atherosclerotic degeneration is the main cause of SVGA formation. Complications of SVGA include fistula formation with other cardiac cambers, various cardiac chambers and great vessels

A saphenous vein graft aneurysm nineteen years after aortocoronary bypass graft surgery: from diagnosis to reoperation.

2016;11(3-4):114. VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloskih medicinskih sestara i tehnicara Introduction: Giant aneurysm of the saphenous vein grafts (SVG) is a rare complication of coronary artery bypass surgery, with an overall incidence of <1%1. SVG aneurysms are often asymptomatic, incidentally identified by imaging modality; there are reports of aneurysm rupture, fistula formation and hemodynamic compromise resulting from compression of adjacent cardiac and vascular structures.

Perioperacinių veiksnių įtaka sekrecijai per drenus po aortovainikinio nuosrūvio suformavimo operacijų

Bleeding remains a global problem in cardiac surgery. Patients have significant risk of bleeding after cardiac surgery with cardiopulmonary bypass. The amount of blood loss after such operations is directly related to the increased need of blood transfusion, prolonged hospital stay, worse outcome. The aim: to identify factors which lead to the increased chest tube drainage during the first postoperative day after aortocoronary bypass grafting; the volume of blood component transfusion, complications and outcomes; evaluate characteristics of postoperative course in patients over 65 years old. Methodology: a prospective randomized study included 51 patients undergoing isolated aortocoronary bypass grafting surgery in our hospital. Results. During the postoperative period two patients died (3.9%). Complicated course was identified in 16 patients (31.3%). Pneumonia (10 cases, 9.8%), sternal wound infection (5 cases, 4.9%), mediastinitis (2 cases, 3.9%) were the most common complications. One patient was re-explored because of bleeding. Blood component transfusion was performed in three patients at the intensive care unit (5.9%) and in eight patients after the discharge from the intensive care unit. Mechanical ventilation time, intensive care unit stay and hospitalization time was significantly higher in older patients group, however there was no increased requirement for transfusions of blood components. Patients, who preoperatively received clopidogrel (n=21), had higher risk of significant blood loss during the first postoperative day (>500ml) (odds ratio 3.692 [1059-12874], p = 0.036) than the patients without clopidogrel preoperatively (n = 28) (odds ratio, OR 0.271 [0078-0944]). Chest tube drainage did not exceed 500 ml per 16 hours, if clopidogrel was stopped for 6 days or more, but it was 500 ml and higher if clopidogrel was stopped 1 to 5 days preoperatively. Aspirin had no statistically significant influence on chest tube drainage as well as to blood transfusion. Conclusions. Patients who were treated with clopidogrel before the surgery, had a higher risk of bleeding more than 500 ml first postoperative day, than clopidogrel untreated patients. Chest tube drainage was inversely proportional to the stop time of clopidogrel. Aspirin did not affect the volume, excreted through the drains and the rate of blood components transfusion. The study did not show us, that preoperative fibrinogen level is independent factor to assess bleeding. Patients over 65 years had increased risk for a longer mechanical ventilation, longer intensive care unit stay, hospitalization and higher frequency of complications during postoperative period, but this was not related to increased chest tube drainage or blood components transfusion. doi:10.5200/sm-hs.2013.093

The response of the pumping function of the heart to the orthostatic test and monoamines plasma level may serve as markers of early-stage Parkinson's disease

arrhythmia with the help of mobile telemonitoring, which is an uncomplicated technology that facilitates the continuous monitoring and recording of arrhythmias. Methods: We investigated 54 outpatients in the Republic of Georgia with different types of arrhythmia (32 male, 22 female, age range – 12– 80 years). Among them were patients with unexplained syncope, epilepsy, and asymptomatic patients who underwent radiofrequency catheter ablation. In addition, there were asymptomatic patients after aorto-coronary bypass graft surgery and 10 healthy sportsmen. Investigations were made by 3-lead electrocardiograph-ECG loop recorder in automatic recording/transmitting mode. Results: Arrhythmias were registered during 7–68 hours of observation. 52% of arrhythmia episodes were asymptomatic. Arrhythmia relapse was detected in 3/6 patients who underwent radiofrequency catheter ablation for SVT or SVPCs, but mostly they were asymptomatic. Asymptomatic episodes of ventricular premature complexes were detected in patients who underwent aorto-coronary bypass graft surgery. In 10 patients with epilepsy, there were 3 patients with supraventricular tachycardia (SVT) and 2 patients with sinus tachycardia. Among 10 patients with unexplained syncope, there were 2 patients with sinus tachycardia, 2 patients with SVT and 1 patient with sick-sinus syndrome. Asymptomatic episodes of supraventricular tachycardia were detected in 1 sportsman. Asymptomatic episodes were detected in the majority of cases (p = 0.001). No difference between genders in the frequency of arrhythmias was found (p = 0.05). Conclusions: Mobile telecardiology offers a feasible methodology for monitoring arrhythmia outpatients in Georgia. It is also a useful tool for detecting a relapse, or symptomatic and asymptomatic episodes of life-threatening arrhythmia.

The Association of Postcardiac Surgery Acute Kidney Injury with Intraoperative Systolic Blood Pressure Hypotension

Background. Postoperative acute kidney injury (AKI) is associated with high mortality and substantial cost after aortocoronary bypass graft (CABG) surgery. We tested the hypothesis that intraoperative systolic blood pressure variation is associated with postoperative AKI. Methods. We gathered demographic, procedural, blood pressure, and renal outcome data for 7,247 CABG surgeries at a single institution between 1996 and 2005. A development/validation cohort methodology was randomly divided (66% and 33%, resp.). Peak postoperative serum creatinine rise relative to baseline (%ΔCr) was the primary AKI outcome variable. Markers reflective of intraoperative systolic blood pressure variation were derived for each patient including (1) peak and nadir values (absolute and relative to baseline) and (2) excursion episodes beyond selected thresholds (by duration, frequency, and duration × degree). Each marker of systolic blood pressure variation was then separately evaluated for association with AKI using linear regression models with adjustment for several known risk factors (age, aprotinin use, congestive heart failure, previous myocardial infarction, baseline creatinine, bypass time, diabetes, weight, concomitant valve surgery, gender, and preoperative pulse pressure). Results. An association was identified between systolic blood pressure relative to baseline and postoperative AKI (P < 0.006). Conclusions. In CABG surgery patients, intraoperative systolic blood pressure decrease relative to baseline systolic blood pressure is independently associated with postoperative AKI.

Association between depression, anxiety and inflammation process in postoperative periods of coronary angioplasty and aorto-coronary bypass graft surgery

Association between depression, anxiety and inflammation process in postoperative periods of coronary angioplasty and aorto-coronary bypass graft surgery

Response to Letters Regarding Article, “Vascular Reactivity and Flow Characteristics of Radial Artery and Long Saphenous Vein Coronary Bypass Grafts: A 5-Year Follow-Up”

Our study showed that 5 years after aortocoronary bypass graft surgery, radial artery grafts had preserved flow-mediated dilatation, whereas saphenous vein (SV) grafts had not.1 In agreement with Brugaletta et al, we feel it would be ideal to know the preexisting vasomotor response of the study grafts in all patients. Unfortunately, not all the patients who were studied at 3 months agreed to participate at 5 years.1,2 Four patients participated in Doppler studies at both follow-ups (radial artery=2 and SV=2), and we believe that the numbers are …

Endotoxemia related to cardiopulmonary bypass is associated with increased risk of infection after cardiac surgery

The purpose of this study was to examine the prevalence of endotoxemia-supported aortocoronary bypass grafting surgery (ACB), using the endotoxin activity assay (EAA), and to explore the association between endotoxemia and postoperative infection.

Endotoxemia related to cardiopulmonary bypass is associated with increased risk of infection after cardiac surgery: a prospective observational study

IntroductionPrevious studies have documented a high frequency of endotoxemia associated with cardiopulmonary bypass (CPB). Endotoxemia may be responsible for some of the complications associated with cardiac surgery. The purpose of the study was to examine the prevalence of endotoxemia during cardiopulmonary bypass supported aortocoronary bypass grafting surgery (ACB) using a new assay, the Endotoxin Activity Assay (EAA), and explore the association between endotoxemia and post-operative infection.MethodsThe study was a single center prospective observational study measuring EAA during the perioperative period for elective ACB. Blood samples were drawn at induction of anesthesia (T1), immediately prior to release of the aortic cross-clamp (T2), and on the first post-operative morning (T3). The primary outcome was the prevalence of endotoxemia. Secondary outcomes assessed included infection rates, intensive care unit (ICU) and hospital length of stay. An EAA of < 0.40 units was interpreted as "low", 0.41 to 0.59 units as "intermediate", and ≥0.60 units as "high".ResultsA total of 57 patients were enrolled and 54 patients were analyzable. The mean EAA at T1 was 0.38 +/- 0.14, at T2 0.39 +/- 0.18, and at T3 0.33 +/- 0.18. At T2 only 13.5% (7/52) of patients had an EAA in the high range. There was a positive correlation between EAA and duration of surgery (P = 0.02). In patients with EAA ≥0.40 at T2, 26.1% (6/23) of patients developed post-operative infections compared to 3.5% (1/29) of those that had a normal EAA (P = 0.0354). Maximum EAA over the first 24 hours was also strongly correlated with risk of post-operative infection (P = 0.0276).ConclusionsHigh levels of endotoxin occur less frequently during ACB than previously documented. However, endotoxemia is associated with a significantly increased risk of the development of post-operative infection. Measuring endotoxin levels during ACB may provide a mechanism to identify and target a high risk patient population.

Application of prophylactic gel-pads for transcutaneous pacing in patients with complete right bundle-branch block with axis deviation when surgical procedures are performed: 10-year experience from a single Japanese university hospital

This retrospective study aimed to determine whether prophylactic transcutaneous pacing is required for patients with complete right bundle-branch block (CRBBB) and axis deviation (AD), so-called bifascicular block, when surgical procedures are performed under general or local anesthesia. The authors reviewed 34 063 anesthesia cases that took place at Nara Medical University Hospital during a 10-year period (1996-2005). The anesthesia records of all identified patients having CRBBB or bifascicular block were retrospectively reviewed and the incidence of block progression to complete heart block or bradycardia requiring temporary transcutaneous pacing served as the primary endpoint. As a secondary endpoint, the incidence of block progression to complete heart block or bradycardia requiring only medical treatment was checked. Seventy of the 34 063 patients (0.2%) had CRBBB with AD. Only 1 patient with CRBBB with left AD, who underwent on-pump aorto-coronary bypass grafting surgery, developed complete heart block at the resumption of heartbeat. None of the other 69 patients, except for this cardiac case, developed complete heart block during surgery. Based on this analysis of 70 cases, prophylactic gel-pad electrode application in patients with CRBBB and AD does not appear to be necessary during surgical procedures.

Detection of Protamine and Heparin After Termination of Cardiopulmonary Bypass by Thrombelastometry (ROTEM®): Results of a Pilot Study

Our goal of this study was to determine whether protamine's effects on coagulation can be detected and differentiated from those of heparin when using thrombelastometry (ROTEM). To reverse the effects of heparin after cardiopulmonary bypass (CPB), 22 consecutive patients undergoing aortocoronary bypass graft surgery were included. According to clinical routine, all patients received a first dose of protamine calculated from the total amount of heparin given; additional protamine (70 U/kg) was administered to patients with activated clotting time (ACT) above baseline and clinical signs of diffuse bleeding. Simultaneously, routine ACT measurements, ROTEM assays (heparin-sensitive INTEM, and heparinase-containing HEPTEM test) and standard coagulation tests were performed, and the activity of coagulation factors as well as antifactor Xa activity measured. Administration of additional protamine (n = 16) resulted in a statistically significant increase in coagulation times on the intrinsically activated test (INTEM-CT), namely from (mean [+/-SD]) 219.8 (+/-19.1) s to 241.1 (+/-21.7) s (P < 0.001), and on the heparinase-containing test (HEPTEM-CT), namely from 210.2 (+/-19.9) s to 226.8 (+/-21.8) s (P < 0.001). These changes were not observed in patients receiving a single protamine dose (n = 6). The INTEM-CT:HEPTEM-CT ratio correctly identified 56 of the 58 samples as not containing residual heparin and correctly detected residual heparin in 3 of the only 6 samples showing elevated antifactor Xa values after CPB. Our preliminary data show that at termination of CPB administration of additional protamine results in a brief prolongation of coagulation times on the INTEM and HEPTEM test and that ROTEM might be useful in excluding residual heparin in cases showing prolonged ACT.

The effectiveness of a motivation programme for lifestyle change in the course of aortocoronary bypass graft surgery

Objective: To evaluate the effectiveness of a motivation programme the motivation for lifestyle change in patients was measured before and after coronary artery bypass graft (CABG) surgery by comparing a usual care group with a group attending a motivation programme. Design: Prospective controlled study. Setting: University hospital cardiothoracic surgery department. Subjects: One hundred and forty patients (mean age 64.9; SD 8.5 years) who had an elective CABG surgery. Interventions: Each patient was evaluated regarding his or her motivation for lifestyle change two days before and 10 days after CABG surgery. Between January and May 2002 patients in usual care were investigated as a control group (n=70). From January to May 2003 patients had the opportunity to take part in a motivation programme that was provided by a trained clinical psychologist (n = 70). The programme consists of both personalized single sessions and group lectures. Measures: A 30-item questionnaire measuring the six factors Vulnerability, Intention, Social expectation, Outcome expectation, Self-efficacy expectation, and Perceived severity was developed. Results: ANOVA procedures with repeated measurements indicate significant effects in terms of higher motivation for lifestyle change in the treatment group in Vulnerability (F(1, 138) = 4.04; P=0.04), Intention (F(1, 138) = 19.81; P<0.001), Social expectation (F(1, 138)=21.97; P<0.001), Outcome expectation (F(1, 138) =17.95; P<0.001), and Self-efficacy expectation (F(1, 138) =14.31; P<0.001). Conclusions: This motivation programme performed in a cardiac surgery hospital after CABG may increase the motivation for a positive lifestyle change.

Efficacy and Safety of Heparinase I versus Protamine in Patients Undergoing Coronary Artery Bypass Grafting with and without Cardiopulmonary Bypass

Hemodynamic protamine reactions with heparin reversal during cardiac surgery are common and associated with adverse outcomes. As an alternative to protamine, the authors examined heparinase I reversal of heparin after aortocoronary bypass graft surgery. In a randomized, double-blind, double-dummy trial, 167 on- and off-pump aortocoronary bypass graft surgery patients received either heparinase I (maximum 35 microg/kg) or protamine (maximum 650 mg) for heparin reversal, monitored by activated clotting time values and clinical assessment. Hemodynamic parameters were recorded electronically; safety evaluation was to 30 days postoperatively. Noninferiority was predefined as 400 ml or less median 12-h chest tube drainage from intensive care unit arrival for heparinase I patients, after risk adjustment. Hemodynamic instability was defined as systemic hypotension (> or = 30 mmHg decrease) and/or pulmonary hypertension (> or = 40 mmHg with an increase > or = 10 mmHg) within 30 min of heparin reversal initiation. Patient enrollment was terminated on advisement of the Data Safety Monitoring Board. Although heparinase I was noninferior for 12-h chest tube drainage, protamine had a superior safety profile. Overall, heparinase I subjects had longer hospital stays (P = 0.04), were more likely to experience a serious adverse event (P = 0.01), and were less likely to avoid transfusion (P = 0.006). A composite morbidity score was not different (P = 0.24), and similar rates of hemodynamic instability were observed between groups. Findings were consistent in analyses stratified by on- and off-pump surgery. Heparinase I reverses heparin anticoagulation after aortocoronary bypass graft surgery but is not equivalent to protamine because of its inferior safety profile.

Gender-Specific Practice Guidelines for Coronary Artery Bypass Surgery: Perioperative Management*

Gender differences in coronary bypass surgery have been the focus of numerous publications in recent years. Unfortunately these publications have contradictions that leave surgeons with conflicting recommendations for care. To help resolve these inconsistencies, The Society of Thoracic Surgeons (STS) Workforce on Evidence-Based Surgery has carried out an objective review of published information in this field. The STS Workforce recognizes that there are important gender issues associated with referral bias, the impact of body size, psychosocial factors, and postoperative support, but the intent of this guideline is to focus specifically on perioperative management. As with all practice guidelines, our goal is to gather the most important information, analyze the information in a logical and unbiased fashion, and make recommendations based solely on the available evidence.

Association of high serum concentration of the third component of complement (C3) with pre-existing severe coronary artery disease and new vascular events in women

Atherosclerosis is an inflammatory disease. The complement system plays an important role in the atherosclerotic process. However, lesser data is available on the possible role of C3 as a risk factor for atherosclerosis. Therefore, in a follow up study we determined C3 levels in 266 patients with pre-existing severe coronary artery disease (CAD) and compared their serum C3 concentrations with the cause of the disease. We investigated whether C3 levels predict the major complications of severe CAD during a 5-year long follow up period in patients, who have received an aorto-coronary bypass graft surgery. C3 concentrations were elevated in the patients with severe CAD compared to 182 healthy controls, and women had higher C3 concentrations than men. Pathological C3 levels (C3≥1.8 g/L) were able to predict major complications of atherosclerosis (death by cardiac events, new acute myocardial infarction, stroke, carotid surgery and peripheral arterial disease) that developed during the follow up period only in women (OR: 4.1, 95% C.I. 1.23–13.61, p = 0.0249) independent of other risk factors for atherosclerosis. Our data supports the assumption that high C3 indicates the progression of atherosclerosis as a special marker of chronic inflammation.