Coronary Artery Graft Surgery Research Articles

Anaesthesia for Minimally Invasive Cardiac Surgery.

Minimally invasive cardiac surgery (MICS) has been used since the 1990s and encompasses a wide range of techniques that lack full sternotomy, including valve and coronary artery graft surgery as well as transcatheter procedures. Due to the potential benefits offered to patients by MICS, these procedures are becoming more common. Unique anaesthetic knowledge and skills are required to overcome the specific challenges presented by MICS, including mastery of transoesophageal echocardiography (TOE) and the provision of thoracic regional analgesia. This review evaluates the relevance of MICS to the anaesthetist and discusses pre-operative assessment, the relevant adjustments to intra-operative conduct that are necessary for these techniques, as well as post-operative care and what is known about outcomes.

Determining the life status of obese patients after coronary artery graft surgery

Determining the life status of obese patients after coronary artery graft surgery

Investigation of medication compliance after surgery and the possibility of readmission in patients after coronary artery graft surgery

Investigation of medication compliance after surgery and the possibility of readmission in patients after coronary artery graft surgery

Relationship between Cardiac Rehabilitation before Coronary artery Graft Surgery on Parameters of Surgical Satisfaction

Relationship between Cardiac Rehabilitation before Coronary artery Graft Surgery on Parameters of Surgical Satisfaction

Determining the Contribution of Hyperlipidemia to Mortality Post anesthesia in Patients who are Candidates for Coronary Artery Graft Surgery

Determining the Contribution of Hyperlipidemia to Mortality Post anesthesia in Patients who are Candidates for Coronary Artery Graft Surgery

A Cross-Sectional Study: Progression into Renal Replacement Therapy in Post Coronary Bypass Artery Graft Surgery Patients with Varying Pre-Operative Serum Creatinine Levels

A Cross-Sectional Study: Progression into Renal Replacement Therapy in Post Coronary Bypass Artery Graft Surgery Patients with Varying Pre-Operative Serum Creatinine Levels

Mechanism of IL-6-related spontaneous atrial fibrillation after coronary artery grafting surgery: IL-6 knockout mouse study and human observation

We established a mouse model of cardiac surgery with nonpaced sPOAF. IL-6 knockout mice were protected from sPOAF compared with wild-type mice. At 48 hours after surgery, the heart was separated into 6 regions and cultured. IL-6 was expressed in all regions, with highest abundance in the left atrium (LA). In PHASE III, we demonstrated that IL-6 in the LA elicited early profibrotic properties in atria via the pSTAT3/STAT3 signaling pathway and contributed to sPOAF. In a translational prospective clinical study, we demonstrated that humans with POAF had a higher IL-6 concentration in pericardial drainage (PD). This study provides preliminary evidence of a causal relationship between IL-6 and POAF in a novel nonpaced sPOAF mouse model. IL-6 is a crucial prerequisite for eliciting profibrotic properties in cardiac myocytes via the pSTAT3 pathway during the early postoperative period, leading to an increased susceptibility to POAF. Measuring IL-6 in PD could be a new noninvasive biomarker for the clinical prediction of POAF.

Bilateral internal thoracic artery grafting in coronary surgery: 10-year outcomes

Abstract Background The advantages to use the bilateral internal thoracic artery grafting (BITA) technique for coronary artery bypass grafting (CABG) have been recently questioned, but data on long-term follow-up is limited. Using data from the PRIORITY project, this study aims to assess the outcome with the use of BITA grafting and its implications for public health. Methods The PRIORITY project was planned to evaluate the long-term outcomes of two prospective multicenter studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG were linked to administrative data in order to retrieve patients' late outcome. Time-to-event distributions were analyzed accordingly to primary event-type (death, major adverse cardiac events (MACEs)) using the Kaplan-Meier and the Cox proportional hazards methods. Results The study population consisted of 11021 patients who underwent isolated CABG. BITA grafting was employed in 24.6% of patients. The median follow-up time was 8.0 years (interquartile range 7.6-10.0 years). After adjustment for potential confounding factors, BITA grafting was significantly associated with better survival (HR 0.85, 95%CI 0.76-0.95, p = 0.003). Moreover, using BITA grafting reduced the incidence of MACE (HR 0.87, 95%CI 0.80-0.94, p = 0.001), showing to be a protective factor for recurrent acute myocardial infarction (HR 0.84, 95%CI 0.71-0.99, p = 0.05) and for rehospitalization for percutaneous cardiac intervention (HR 0.82, 95%CI 0.70-0.96, p = 0.013). Conclusions BITA grafting during isolated CABG is associated with survival advantage at 10-year with a significantly reduced incidence of MACE. Being the choice to perform isolated CABG with or without BITA based mainly on operator personal preferences, these findings may have important implications from a public health perspective. Key messages The choice to perform CABG with or without BITA grafting is associated to different outcomes. The choice to perform CABG with or without BITA grafting is mainly based on operator preferences and may have important implications in terms of healthcare expenditures.

Effect of Home-based-Nursing Intervention on Knowledge, Daily Living Activities and pain for Patients after Coronary Artery Bypass Graft

The advantages of nursing support for cardiac rehabilitation patients can improve the health outcomes and reduce the risk of a new cardiac event through education, support, supervision, and reinforcement .The aim of this study was to assess the effectiveness of home-based-nursing intervention on knowledge, daily living activities and pain for patients after coronary artery bypass graft. Study Design: A quasi experimental research design was utilized. Study Setting: The study was conducted in the out- patient clinics of Mahalla Cardiac Center, Mahalla city, Al-Gharbia Governorate, Egypt. Study Sample: A purposive sample of 140 post- coronary artery graft surgery patients was included. The total sample was divided randomly into two groups study group (70 patients) and control group (70 patients). Study Tools: 1) A structured interviewing questionnaire including; 1) the socio- demographic data of studied patients. 2) Medical data including patient information about present and past history .3) Knowledge assessment data. 4) Barthel Index Scale of measuring activities of daily living (BIS). Study Results: After implementing the Home Based Nursing Intervention, there was high statistical significance improvement in study groups’ total knowledge compared to controls. Pain level had significantly improved, as well as daily living activities among study group than control group. Conclusion: Home based nursing intervention was effective in improving patient’s knowledge, level of pain and daily living activities after coronary artery bypass graft. Also, it played an important role in improving those patients through tailoring health education about healthy life styles for complete recovery and preventing complications. Recommendations: Nurses have to povide awareness program for educating patients about Home based nursing intervention to prevent complication and attaining complete recovery after coronary artery bypass graft (CABG) surgery

Atrial Fibrillation Post Coronary Artery Graft Surgery: A Review Of Literature.

Atrial fibrillation (AF) is a failure that is observed in heart disease and is also known to be the most common heart rhythm disturbance post coronary artery bypass surgery. Although AF is considered a transient problem, it is usually accompanied with a variety of complications and morbidity for patients and may result in death. In the present study, pre- and post-operative considerable factors which may increase the risk and mortality of AF, and possible treatments have been concisely reviewed.

Comparison the Effect of Active Cyclic Breathing Technique and Routine Chest Physiotherapy on Pain and Respiratory Parameters After Coronary Artery Graft Surgery: A Randomized Clinical Trial.

BackgroundThere are limited reports available on preferred chest physiotherapy methods in patients with coronary artery graft (CABG) surgery.ObjectivesThe aim of this study was to compare the effect of active cyclic breathing technique (ACBT) and routine chest physiotherapy on pain and respiratory parameters in patients undergoing CABG surgery.MethodsThis randomized clinical trial was carried out from July to November 2018. Seventy patients were selected randomly after CABG according to inclusion criteria and then assigned in two groups (35 in ACBT and 35 in routine physiotherapy) by random minimization method. The arterial blood gas levels, pain, heart rate, and respiratory rate were measured for both groups before and after the intervention on two consecutive days after surgery. Data were analyzed by SPSS software V.22, at a significance level of 0.05.ResultsThe two groups were similar in terms of demographic variables. In within group comparison in the physiotherapy group, the level of PaO2, HR, RR, and pain increased significantly on both days (P = 0.001), SaO2 on the first day (P = 0.005) and second day (P = 0.001), and PaCO2 on the first day (P = 0.02). In ACBT group, the level of SaO2, HR, RR, and pain increased significantly on both days (P = 0.001), HCO3 on the first day (P = 0.021), and PaO2 on the second day (P = 0.001) post intervention. In between group comparison, on the first day, the level of PH (P = 0.034), and on the second day HCO3 (P = 0.032) decreased, while RR (P = 0.011) increased significantly in the physiotherapy group, at post-intervention phase.ConclusionsACBT and routine physiotherapy had similar effects on arterial oxygenation, HR, and pain perception following CABG surgery. The physiotherapy on the second day increased the RR to an abnormal range.

On the truncation of time frequency distributions to improve the computational performance in the estimation of fundamental parameters of a Doppler ultrasound blood flow signal

Accurate estimation of mean velocity and bandwidth of a Doppler Ultrasound blood flow signal, is essential to evaluate the success of a coronary artery graft surgery. The estimation accuracy and efficiency obtained depends on the spectral method used and some fundamental parameters such as frequency resolution and window length. However, some suitable methods are very complex and as a consequence computationally very intensive which could not be appropriate for real-time applications. This paper presents a series of studies using time frequency distributions to estimate mean frequency and RMS bandwidth, introducing a truncation index in the context of measuring blood flow in arteries. Results show that truncating a number of terms in the generalized auto-correlation function would introduce errors that, if carefully chosen, will not be significant. Furthermore, besides the reduction on calculating an important number of terms, the method offers the alternative of increasing the spectral resolution at no extra computational cost, both important elements to be considered in real-time applications.

Heart catheterization in adults in a sub-Saharan tertiary centre: 8 years' experience.

The goal of the investigation was to analyze the results of heart catheterization in the Cardiac centre Shisong from December 2010 till December 2017. This retrospective study done in the Cardiac centre Shisong in adult patients that underwent a procedure in the catheterization laboratory from December 2010 till December 2017. Three hundred and sixty-five adult underwent a cardiac catheterization procedure during the study period. Among the patients, 126 were female while 239 were male. The mean age at presentation was 52.6±12.9 years old. Patients were coming from neighboring countries: Nigeria n=5 (1.3%), Tchad n=3 (0.8%), Equatorial Guinea n=4 (1%), Democratic republic of Congo n=2 (0.5%). Patients were also coming from all the ten regions of Cameroon: Littoral n=122 (33.2%), Centre n=127 (34.8%), North west n=47 (12.9%), South west n=17 (4.5%), West n=26 (7.1%), North n=7 (1.8%), Adamaoua n=8 (2.1%), Far North n=5 (1.3%), South n=2 (0.5%), East n=4 (1%). Depending on the type of procedures diagnostic coronarography in case with suspicion of coronary artery disease and presurgical coronarography were the main procedures done in 171 patients (46.8%) and in 146 patients (40%) respectively. Diagnostic coronarography was positive in 31 cases (8.4%). In patients with ischemic heart disease (IHD), percutaneous intervention with dilatation of the coronary arteries and implantation of stents was done in 19 cases (5.2%). The remaining 12 cases (3.2%) were having many lesions that could be managed only by coronary artery grafting surgery, done with success in all the cases. In grown up congenital heart disease patients, diagnostic catheterization was done in 48 cases meanwhile interventional catheterization: pulmonary artery valvuloplasty, patent ductus arteriosus (PDA) closure, atrial septal defect closure and decoarctation of the aorta were done in n=11 (3.4%), n=9 (2.4%), n=12 (3.2%), n=6 (1.6%) cases respectively. Coronary heart disease was confirmed by angiography in 8.4% cases, and among grown up congenital heart disease 'patients, atrial septal defect was the pathology the most managed. Heart catheterization is done in the Cardiac centre Shisong with good results.

Clopidogrel in Combination With Aspirin Improves Vein Graft Patency Following CAGS

A best-evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was in patients who have undergone coronary artery graft surgery (CAGs) does aspirin + clopidogrel postoperatively improve vein graft patency when compared with aspirin only? Altogether, 81 papers were found using the reported search, of which four represented the best evidence to answer the clinical question. An additional two papers were included following more extensive analysis of the literature available. The authors, title, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers were tabulated. Of the six papers analysed, three did not demonstrate statistical significance between the two treatment arms and rates of vein graft patency. However, the three remaining papers suggest, with statistical significance, that aspirin + clopidogrel does improve vein graft patency. In total, 219 of 239 (91.6%) versus 198 of 231 (85.7%; p = .043), 238 of 257 (92.6%) versus 232 of 267 (86.9%; p = .04), and 803 of 860 (93.4%) versus 755 of 846 (89.2%; p = .003) of vein grafts were found to be patent when comparing aspirin + clopidogrel with aspirin only. Comparing aspirin + clopidogrel with aspirin only, we conclude that clopidogrel in combination with aspirin improves vein graft patency following CAGS. Given the low incidence of morbidity/mortality associated with the administration of aspirin + clopidogrel post–CAGS, we recommend that aspirin + clopidogrel be administered post–CAGS to improve rates of vein graft patency.

Analysis of Circulating miR-1, miR-23a, and miR-26a in Atrial Fibrillation Patients Undergoing Coronary Bypass Artery Grafting Surgery.

Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. From a pathophysiological point of view, a myriad of factors such as trauma, atrial dilation, ischemia, mechanical myopericarditis, autonomic imbalance, loss of connexins, AF nest remodeling, inflammation, sutures, and dysfunction caused by postextracorporeal circulation can contribute to postoperative atrial fibrillation (POAF) resulting in a longer hospital stay and consequently higher cost. Recent studies showed that short fragments of RNA, called microRNA (miRNA), can contribute to the development of several cardiovascular diseases, including AF. The aim of this study was to evaluate the levels of circulating miRNAs (miR-1, -23a, and -26a) that can be involved in POAF. Patients submitted to coronary artery bypass graft surgery were grouped in POAF (24 patients) and without POAF (24 patients). Results showed older age, longer clamp-time, and more days in the intensive care unit as well as a longer total hospital stay in the POAF group. Preoperative levels of circulating miRNAs were similar. Analysis of miRNAs revealed significantly lower circulating levels of miRNA-23a (P = 0.02) and -26a (P = 0.01) in the POAF group during the postoperative period. Receiver operating characteristic (ROC) analysis showed the area under theROC curveof miR-23a and miR-26a for predicting FA was 0.63 (95% confidence interval [CI]: 0.51-0.74; P = 0.02) and 0.66 (95% CI: 0.55-0.77; P = 0.01), respectively. Our data suggests that circulating miRNA-23a and -26a may be involved in the underlying biology of postoperative AF development.

Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Trial

During cardiac failure, cardiomyocytes have difficulty in using the substrates to produce energy. <smlcap>L</smlcap>-carnitine is a necessary nutrient for the transport of fatty acids that are required for generating energy. Coronary artery graft surgery reduces the plasma levels of <smlcap>L</smlcap>-carnitine and increases the oxidative stress. This study demonstrates the effect of <smlcap>L</smlcap>-carnitine supplementation on the reverse remodeling of patients undergoing coronary artery bypass graft. Patients with ischemic heart failure who underwent coronary graft surgery were randomized to group A - supplemented with <smlcap>L</smlcap>-carnitine or group B controls. Left ventricular ejection fraction, left ventricular systolic and diastolic diameters were assessed preoperatively, 60 and 180 days after surgery. Our study included 28 patients (26 [93.0%] males) with a mean age ± SD of 58.1 ± 10.5 years. The parameters for the evaluation of reverse remodeling did not improve after 60 and 180 days of coronary artery bypass grafting in comparison between groups (p > 0.05). Evaluation within the <smlcap>L</smlcap>-carnitine group showed a 37.1% increase in left ventricle ejection fraction (p = 0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and diastolic diameters, respectively. <smlcap>L</smlcap>-carnitine supplementation at a dose of 50 mg/kg combined with artery bypass surgery did not demonstrate any additional benefit in reverse remodeling. However, evaluation within the <smlcap>L</smlcap>-carnitine group may indicate a clinical benefit of <smlcap>L</smlcap>-carnitine supplementation.

A Small Cohort Omega-3 PUFA Supplement Study: Implications of Stratifying According to Lipid Membrane Incorporation in Cardiac Surgical Patients.

Epidemiological studies and randomised clinical trials (RCTs) report disparate findings in relation to omega-3 polyunsaturated fatty acids (n-3 PUFA) benefit for cardiac patients. With RCTs interpretation is potentially confounded by background n-3 PUFA intake. The goal of this pilot, small cohort, pre-surgical supplementation study was to evaluate postoperative atrial fibrillation (AF) and cardiac molecular expression profiles employing two data analysis approaches - by treatment randomisation and by stratification using measured n-3 PUFA. Patients (n=20) received 3g/day of fish or placebo oil (FO vs PO) in a double blind randomised protocol prior to elective coronary artery graft and valve surgery. Groups were matched for age, gender, and mean treatment duration (∼20 days). Resected atrial myocardium was sampled for assay of viability metabolic markers, and blood obtained for erythrocyte membrane lipid measurement. There was substantial overlap of cell membrane n-3 PUFA content across PO and FO groups, and no group treatment effects on AF incidence or myocardial molecular marker levels were detected. In contrast, data stratification using membrane n-3 PUFA content (at 8% total membrane lipid) achieved significant separation of patients (by n-6:n-3 PUFA ratio), a significant differential cardiac expression of the marker peroxisomal proliferator-activated receptor, but no difference in AF incidence. This small n-3 PUFA case study demonstrates that the same cohort may yield differing findings when evaluated using randomisation or stratification approaches based on direct molecular measures in cell membranes.

Clinical factors associated with postoperative length of time on ventilator among coronary artery graft surgery patients

Background: Very little is known about the optimum required length of time on ventilator after CABG surgery. Further there are inconsistencies in the practice of ventilator weaning criteria after CABG surgery. Identification of factors associated with ventilator weaning recovery may help to promote patient safety and quality care after CABG surgery. Objectives: The purposes of this secondary analysis were to identify the factors associated with the length of time on ventilator and to determine the factors associated with the prolonged mechanical ventilator more than 8 hours. Materials and Methods: Secondary analysis of a case control primary study data Results: The results of this secondary analysis revealed the factors associated with the length of time on the ventilator including Age, Sex, COPD, and CHF. Among patients with a history of COPD, 29.1% remained > 8 hours on the ventilator compared to 67.7% among those without COPD (COPD: p 8 hours compared to 31% among those without CHF ( p = 0.01 and Cramer’s V = 0.21). Conclusion: These associations remained significant after adjusting for age, sex, number of grafts and body surface area. Based on the above findings, this analysis concludes that ventilator weaning outcomes should be closely monitored, while implementing weaning protocols for patients with diagnosis of COPD, and CHF co morbid conditions after CABG surgery. Key Words: Ventilator Weaning, CABG surgery, Postoperative Ventilator Time, Clinical factors

Comparison between the level of interleukin-6 and B-type natriuretic peptide as predictors of the outcome after coronary artery bypass graft surgery

Introduction The B-type natriuretic peptide (BNP) and interleukin-6 (IL-6) are increasingly being used as biomarkers for the diagnosis, management, and prognosis of complications after cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to assess preoperative and postoperative levels of BNP and IL-6 in patients undergoing coronary artery graft surgery (CABG) with CPB and investigate their variation and ability to correlate with immediate postoperative outcome. Patients and Methods Patients scheduled for elective CABG with CPB were enrolled in this study. Plasma levels of BNP and IL-6 were measured preoperatively, 6, 12, and 24 h after CPB. The main endpoints were the correlation between the level of BNP and IL-6 and the requirements for an intra-aortic balloon pump, artificial ventilation for more than 24 h, intensive care unit (ICU) stay longer than 5 days, requirement for inotropic support, hospital stay, and clinical complications (infection, myocardial infarction, ventricular arrhythmias, stroke, or renal failure). Results Sixty-eight patients (eight women and 60 men), median age 63.3 ± 6.9 years, were included in the study. Preoperative BNP levels correlated with longer ICU stay (P = 0.003), longer mechanical ventilation (P = 0.016), and longer epinephrine and milrinone use (P Conclusion BNP correlates with clinical endpoints more than IL-6 and both can be used together as predictors of early outcome after coronary artery bypass grafting surgery.

89 NOVEL VASOPROTECTIVE ACTIONS OF NITROXYL (HNO) IN THE VASCULATURE

Background: Nitric oxide (NO•) plays a fundamental role as a vascular protectant with its well reported ability to induce vasorelaxation in human vessels and reduce leukocyte to endothelium adhesion, an initiating event of vascular inflammation. Nitroxyl (HNO), the one-electron reduced redox sibling of NO•, has distinct pharmacology to NO• and the effects of HNO in this context are not known. Objective: We aimed to determine the vasodilatory and anti-inflammatory actions of HNO using the HNO donor, Angeli's Salt (AS) compared to the NO• donor, GTN. Methods and Results: Cumulative concentration-response curves (CRCs) to AS or GTN were constructed in radial arteries (RA) and saphenous veins (SV) obtained from patients undergoing coronary artery graft surgery mounted in organ baths. AS induced vasorelaxation of RA (EC50 = 6.5 ± 0.1 M; n = 8) and SV (EC50 = 6.6 ± 0.1 M; n = 9) with similar potency to GTN, and AS-induced vasorelaxation was inhibited by the HNO scavenger L-cysteine (3 mM) but not the NO• scavenger hydroxocobalamin (100 μM). Adhesion of monocytic THP-1 cells to activated HUVECs (with tumour necrosis factor α (TNFα)) was decreased in a concentration-dependent manner by AS and GTN (P<0.05). Furthermore, experiments which allow the visualization of leukocyte-endothelium adhesion in isolated mouse (C57BL/6) aorta, using whole blood, showed that AS (10 μM) and GTN (10 μM) significantly attenuated (5 ± 2 and 3 ± 1 cells/field, respectively, n = 4-5;P<0.05) the TNFα-stimulated increase (16 ± 3 cells/field, n = 5-11) in leukocyte adhesion. Conclusions: This study shows for the first time that HNO can relax human blood vessels and reduce leukocyte-endothelium adhesion which will aid in determining the therapeutic potential of HNO donors.