Artery Bypass Graft Surgery Patients Research Articles

Preventive medication efficacy after 1-year follow-up for graft failure in coronary artery bypass surgery patients: Bayesian network meta-analysis.

To compare preventive medications against graft failures in coronary artery bypass graft surgery (CABG) patients after a 1-year follow-up. Systematic review with Bayesian network meta-analysis and meta-regression analysis. We searched PubMed, Scopus, and Web of Science databases in February 2023 for randomized controlled trials, comparing preventive medications against graft failure in CABG patients. We included studies that reported outcomes at 1 year after surgery. Our primary outcome was graft failure After screening 11,898 studies, a total of 18 randomized trials were included. Acetylsalicylic acid (ASA) [odds ratios (OR) 0.51, 95% credibility interval (CrI) 0.28-0.95, meta-regression OR 0.54, 95% CrI 0.26-1.00], Clopidogrel + ASA (OR 0.27, 95% CrI 0.09-0.76, meta-regression OR 0.28, 95% CrI 0.09-0.85), dipyridamole + ASA (OR 0.50, 95% CrI 0.30-0.83, meta-regression OR 0.49, 95% CrI 0.26-0.90), ticagrelor (OR 0.40, 95% CrI 0.16-1.00, meta-regression OR 0.43, 95% CrI 0.15-1.2), and ticagrelor + ASA (OR 0.26, 95% CrI 0.10-0.62, meta-regression OR 0.28, 95% CrI 0.10-0.68) were superior to placebo in preventing graft failure. Rank probabilities suggested the highest likelihood to be the most efficacious for ticagrelor + ASA [surface under the cumulative ranking (SUCRA) 0.859] and clopidogrel + ASA (SUCRA 0.819). The 95% CrIs of ORs for mortality, bleeding, and major adverse cardio- and cerebrovascular events (MACE) were wide. A trend towards increased bleeding risk and decreased MACE risk was observed when any of the medication regimens were used when compared to placebo. Sensitivity analysis excluding studies with a high risk of bias yielded equivalent results. Of the reviewed medication regimens, dual antiplatelet therapy combining ASA with ticagrelor or clopidogrel was found to result in the lowest rate of graft failures.

Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery.

Thirty-day readmission is associated with increased morbidity and mortality among postoperative coronary artery bypass graft (CABG) surgery patients. Interventions such as case management and follow-up care may reduce 30-day readmission. The purpose of this article is to report a study on modifiable factors that may have significant implications for case management in the prevention of readmission after CABG surgery. The study population included all the adult patients who underwent first-time CABG surgery from January 1, 2013, to January 1, 2016, from a Mid-South hospital. A retrospective case-control study was employed to examine 1,712 patients who underwent CABG surgery. The results revealed that patients readmitted within 30 days had a significantly shorter length of stay (LOS) (6 days vs. 10 days; p < .0001), more days in intensive care unit (6 days vs. 4 days; p = .0391), and significantly higher diabetes/renal (4% vs. 1%), infection (17% vs. 2%), and respiratory-related diagnoses (10% vs. 1%; p < .0001). Among these factors, hospital LOS is a major factor that can be addressed through case management in addition to other modifiable risk factors. Understanding modifiable factors associated with higher readmission risk is crucial for effective intervention and case management planning.

Abstract 18472: Plasma Proteome Changes in Heart Failure and Non-Heart Failure Patients Undergoing Cardiac Surgery

Introduction: Patients with and without heart failure display different clinical courses after cardiac surgery. Hypothesis: Unbiased analyses of the plasma proteome from extreme phenotypes in myocardial function may identify differences in candidate proteins differentially modified by cardiac surgery using cardiopulmonary bypass (CPB). Methods: We combined two prospectively-collected datasets: Left ventricular assist device (LVAD) recipients from the INSPIRE-FLO trial (N=94, NCT03081052) and coronary artery bypass graft (CABG) surgery patients with normal biventricular function (N=50). For each population, we obtained EDTA-plasma from arterial blood sampling in the operating room and on postoperative day 1. Including quality control pools, 304 total samples were digested in a 96-well format with trypsin. Peptides were analyzed by microflow liquid chromatography coupled to tandem mass spectrometry using data-independent acquisition. Proteins were identified and quantified at a 1% false discovery rate (FDR) in Spectronaut. Statistical analyses utilized a t-test with FDR correction (significance defined by log2FC&gt;1 and q&lt;0.05). Results: There were 943 protein groups quantified in at least one plasma sample. Patients undergoing LVAD surgery had significantly higher levels of 135 proteins including acute phase reactants (CRP, SAA1, SAA2), putative neutrophil-derived proteins (S100A8/9) and markers of renal insufficiency (B2M and REG3A) (Figure 1). Cardiac surgery using cardiopulmonary bypass increased acute phase and inflammatory markers, and cardiac proteins (ENOB, MYG and KCRM), with NGAL, TIMP1 and PAI1 among proteins with higher absolute increase after LVAD implantation versus CABG surgery ( Fig.1 ). Conclusions: Unbiased analyses of the plasma proteome identifies baseline and postoperative differences associated with extreme phenotypes of myocardial function undergoing cardiac surgery using CPB.

Hesperidin reduces serum levels of triglyceride after coronary artery bypass graft surgery

AbstractHesperidin, as an antioxidant and anti‐inflammatory agent, has beneficial effects on cardiovascular diseases. This study aimed to determine the effects of hesperidin supplementation on inflammation, oxidative stress, and lipid profile in depressed coronary artery bypass graft surgery (CABG) patients. Eighty patients after coronary artery bypass graft surgery participated in this clinical trial and were randomly divided into two groups. The intervention group received 200 mg/d pure hesperidin supplement and the second group received placebo for 12 weeks. Both groups continued their usual diet. Serum concentrations of inflammatory and stress oxidative markers (hs‐CRP, P‐selectin, and ox‐LDL) were measured and compared at baseline and the end of the intervention. The changes in serum levels of triglyceride were significantly different between the two groups (p &lt; .05). HDL‐c significantly increased in groups but the differences between the two groups were not statistically significant (p &gt; .05). Hesperidin did not affect FBS, other lipid parameters, hs‐CRP, P‐selectin, and OX‐LDL (p &gt; .05). SBP and DBP differences were not statistically significant (p &gt; .05). After 12 weeks of intervention, hesperidin reduced serum levels of triglyceride in depressed post‐CABG patients.

Correlation between psychological co-morbidities and functional capacity in hospitalized coronary artery bypass graft surgery (CABG) patients.

Background: Coronary Artery Bypass Graft surgery(CABG) is used to treat blockage or narrowing of one or more coronary arteries, hence it restore blood supply to the heart muscle. It can effectively relieve patient previous symptoms such as discomfort from chest pain (angina), fatigue ,breathlessness and heart attack and increases life expectancy. It is usually a stressful events for patients. After cardiac surgery. If there is alterations in psychological comorbidities are common during recovery. Functional capacity is ability to perform daily tasks or exercise.This well documented value gives information to the doctors, medical staff, physiotherapist and caregivers to give early intervention for emotional disorders after surgery in hospitalized patients Aim: to find the Correlation Between Psychological Co-Morbidities And Functional Capacity. In Hospitalized Coronary Artery Bypass Graft Surgery Patients. Study design: cross-sectional, observational &amp; correlation study. Method: A total of 40 hospitalized CABG patients from tertiary healthcare centre of a metropolitan city. The assessment tool used in this study was Depression, Anxiety and Stress Scale (DASS-21), 6 Minute walk test(6MWT), and Borg scale. The patients taken who fulfilled inclusion criteria and were willing to participate. After obtaining written consent, the DAS Scale was administered to patient and made to performing 6 minute walk test in cardio-vascular &amp; thoracic surgery(CVTS) wards. For each participants required time was 30-40 mins. Results: Pearson correlation was used to find correlation between Psychological Comorbidities and Functional Capacity. r value for Psychological Comorbidities (DASS Scale score) and percent predicted value of 6MWT (Functional Capacity) is -.399 which shows weak negative correlation and is statistically significant with p value of 0.011. This implicates that if slightly high DASS Scale score for measuring psychological comorbidities was slightly reduced functional capacity. Conclusion: The result of this study showed weak negative correlation between Psychological comorbidities and Functional capacity. It may be due to post operative fatigue, incisional pain, unable to fall a sleep, loud noises in wards, coughing etc. So this study gives us an understanding to improve quality of life of patients.

The impact of telenursing on level of depression, stress and anxiety in discharged patients after coronary artery bypass graft surgery: A randomized clinical trial

BackgroundAfter coronary artery bypass graft surgery patients are susceptible to mental disorders such as stress, anxiety, and depression following discharge from the hospital and often require post-discharge support and follow-up. Telenursing is an accessible method that may reduce stress, anxiety, and depression experienced by patients. This study aimed to investigate the impact of telenursing on depression, stress, and anxiety in discharged patients after CABG surgery. Materials and methodsA randomized clinical trial was carried out. Eligible patients were divided randomly into intervention (n=40) and control (n=40) groups. Depression Anxiety Stress Scale-21 (DASS21) questionnaire was filled out by both groups one day before discharge from the hospital. The intervention group received SMS reminders of their treatment plan, referrals to the cardiac rehabilitation clinic, and routine care three times a week for six weeks, while the control group received routine care provided by the hospital only. In the week following the completion of the intervention period, both groups returned to fill out the questionnaire, and the data were analyzed using SPSS version 16.0, descriptive and inferential statistics, and independent and paired T-tests. ResultThe mean scores of depression, stress, and anxiety before intervention in the intervention group were 11.95, 18.75, and 18.17, and in the control group were 11.55, 18.37, and 17.4 respectively. The mean scores of depression, stress, and anxiety after intervention in the intervention group were 7.85, 10.5, and 10.45, and in the control group were 10.56, 17.9, and 16.5 respectively. No significant differences were seen between the two groups before the intervention (P>0.05), but the results showed significant differences between the two groups’ mean scores of depression, stress, and anxiety after intervention (P<0.001). ConclusionTelenursing can reduce stress, anxiety, and depression in discharged patients after coronary artery bypass graft surgery by providing proper and cost-effective follow-up.

Off-Pump Versus On-Pump Coronary Artery Bypass Grafting In Patients With Left Main Coronary Artery Disease: A Randomized Controlled Trial.

To compare the outcome of off-pump and on-pump coronary artery bypass graftsurgery in patients with left main coronary artery disease. The randomised, controlled, prospective, multicentric study was conducted in 2020 during the period from January 2020 to December 2020 at Kafrelsheikh University Hospital, International Cardiac Centre and Alexandria New Medical Centre, Egypt, and comprised patients with left main coronary artery disease who underwent coronary artery bypass graftsurgery. The patients were randomised to on-pump surgery group I (Control Group) and off-pump surgery group II(Interventional Group). All patients were assessed pre-operatively for the presence of comorbid conditions and post-operatively for myocardial infarction, acute kidney injury, pneumonia, sternal dehiscence and 3-month mortality. Data was analysed using SPSS 20. Of the 60 patients, 44(73.3%) were men and 16(26.6%) were women. The overall mean age was 66.4±9.2 years. There were 30(50%) patients in each of the two groups. There were 2(6.7%) cases of myocardial infarction in group I and 1(3.3%) in group II. There was 1(3.3%) case of acute kidney injury in group I and none in group II. There were 3(10%) cases of pneumonia in group 1 compared to 1(3.3%) in group II. There was 1(3.3%) case of sternal dehiscence in group I and none in group II. Mortality at 3 months was 2(6.7%) in group I and 1(3.3%) in group II. There was no significant difference with respect to outcome between the groups (p>0.05). Off-pump coronary artery bypass graft surgery was found to be efficient and non-inferior to on-pump procedure in patients with left main coronary artery disease. The RCT was registered retrospectively at the Pan African Clinical Trials Registry (PACTR) (Trial #: PACTR202301506140749 Date of Approval: 06/01/2023). Link: https://pactr.samrc.ac.za/Search.aspx.

The trajectory of statin compliance after coronary artery bypass grafting surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background The current guidelines about dyslipidemia classify coronary artery bypass grafting surgery (CABG) patients, as a very high-risk population. This is translated to a LDL-target ≤ 55mg/dL, based on observational studies that demonstrate better vein graft patency and deceleration of the native vessels’ atherosclerosis. Despite the well-defined benefit, the compliance of statin therapy at the secondary prevention is ailing. Purpose To capture and evaluate the trajectory of statin compliance during 4 years follow-up in patients after CABG, in a middle-income country. Methods This is a single-center, cohort, observational study, conducted in 365 consecutive post-CABG patients, from 2018-2021. We used data from the electronical files of the patients and the national electronical prescription platform, after consent. The follow-up period was divided: t1 = 6 months, t2 = 1 year, t3= 2 years, t4 = 3 years, and t5= 4 years. We defined as potent statin therapy the administration of ≥ 40mg of atorvastatin, ≥ 20mg of rosuvastatin or the concomitant use of ezetimibe. Results We included 365 patients, 52 females (14.4%). The median age was 69 years (ΙQR: 47-84). The indication for CABG was 65.7% an acute coronary syndrome and 34.3% stable coronary disease. At baseline, the mean LDL value was 108mg/dL, whereas one month post procedure was 71mg/dL, indicating reduction: Δ=34%. Alas, the achieved post-CABG LDL-level still is beyond the target of ≤ 55mg/dL. At t0 (discharge) the percentage of prescribed statins was 81%, but only in 68% of them, the statin was high potent. At t1 the rate of the compliance raised up to 92.5% and the potency rate to 74.6%. At t2 the compliance and the potency remained high, 94.3% and 74.8% respectively. At t3 the compliance is rather stable (92.3%) but the rate of potency declines (64%) and decline further at t4 (89% and 58% respectively). Finally, at t5 both indexes depleted (81% and 57.1%, respectively). The rate of escalation to a potent statin was: t1= 36.3%, t2= 13.9%, t3 = 12.4%, t4 = 3.8%, t5=2.1%. The de-escalation rate was: t1= 13.9%, t2= 2.4%, t3 = 7.3%, t4 = 0.8%, t5=0.1%. The prescribed statin remained the same at t1= 50.8%, t2= 83.6%, t3 = 76.6%, t4 = 79% and t5=75%. The rate of permanent discontinuation was null during the first year, 4.1% at 2 years, 18.2% at 3 years and 19.5% at 4 years. Conclusions The LDL level one-month post-CABG, remains out of target and a further 22% reduction is needed. We highlight the significant rate of prescribed statin at discharge and substantial compliance which is rather sustained during the follow-up period. Nota bene the rate of potency lessens over time, whereas the rate of permanent discontinuation raises, implying that as the patient enters a "stabilized period" at 2 years post-surgery, the eagerness to maintain high-potent statin therapy, declines. This real-world practice subtracts the pleiotropic benefits of potent statins, not only over the ongoing atherosclerosis.

Management of anxiety and depression in post coronary artery bypass graft surgery

Depression and anxiety are common events in 30-40 percent of post coronary artery bypass graft (CABG) surgery patients. Depression symptoms in patients with CAD are expected to be significantly more, comparing the public incidence rate. Impaired remedy after coronary artery events may partly be attributed to depression and anxiety. If anxiety continues, it may lead to elevate metabolism and oxygen consuming. High level of anxiety increases the pain sensation in post CABG patients. This paper aimed to review results and findings of previous studies in the field of anxiety and depression management of post coronary artery bypass graft surgery. Up to 78 credited studies collected and compared in this review. Findings revealed that depression and anxiety could more complicate medical post CABG remedy. In addition, preoperative depression and anxiety symptoms would be persisted in post CABG recovery. Therefore, prior patients training about depression and anxiety symptoms would be wise strategy to help them describe their psychological mood before and after surgery. Findings also suggest that anxiety amplified depression prevalence in post CABG patients. Among the other methods, Benson relaxation is the best complementary medicine to mitigate pre-CABG anxiety. In addition, massage and music therapy could influence on post CABG anxiety and depression. There are also some robust evidences, indicating that perceived social support could influence post CABG anxiety and depression. Furthermore, sedative (such as propofol) and opioid and non-opioid analgesics, which used in post CABG pain management, could directly reduce anxiety level. Antidepressants sertraline and citalopram are the best studied post CABG pharmacological treatments which influence on post CABG remedy and hospitalization. The results suggest that treatment for anxiety is essential for alleviating patient suffering. In addition, anxiety treatment could protect patient against depression before and after CABG surgery.

The effect of training on coronary artery bypass graft surgery patients.

In the pre-operative process, patients who will undergo cardiovascular surgery and their families require planned education and education materials. Education given to patients plays a key role in reducing anxiety, overcoming stress, and accelerating discharge. This study was conducted to determine the effect of an education booklet in addition to training by nurses on efficacy expectation, pain and anxiety levels in coronary artery bypass grafting (CABG) surgery patients. This quasi-experimental study was conducted in the cardiovascular surgery service of a university hospital in Izmir, Turkey, between June and October 2018 and involved 60 patients. The patients were divided into two groups: control (n= 30) and intervention (n= 30). The intervention group was patients educated before surgery by using the booklet, but the control group only received routine care by nurses. The data were collected using the Mini-Mental Test, Patient Information Form, Visual Analogue Pain Scale, Spielberger State-Trait Anxiety Scale, Barnason Efficacy Expectation Scale, and Education Evaluation Form. After the intervention at discharge, there was a significant difference between the mean scores of anxiety, pain, and efficacy expectation among the intervention group which received booklet education with the control group which received routine care (p< .05). The booklet education given to patients before CABG surgery was found to have potential effects on patients' post-operative pain levels, the efficacy expectation, and satisfaction. In the pre-operative process, the use of booklet education in addition to routine care increases the level of efficacy expectation and decreases pain and anxiety in CABG surgery patients. Therefore, nurses can use booklet education to improve self-efficacy and reduce pain and anxiety in patients who have CABG surgery.

Independent predictors and equation of six-minute walk test in post-cardiac surgery

BackgroundThe six-minute walk test (6MWT) has been used to evaluate postsurgical recovery in cardiac patients. No previous study has compared the 6MWT at follow-up with a baseline, or evaluated the long-term effects of cardiac surgery on post-discharge 6MWT ObjectivesTo identify the factors independently associated with 6MWD, and to develop an equation to predict 6MWT at the 4–6-week follow-up after post-cardiac surgery hospital discharge. MethodsPatient data of elective coronary artery bypass graft (CABG) or non-CABG surgery patients were retrospectively collected. The 6MWT was performed at hospital discharge and at the 4–6-week follow-up. Available demographic and clinical data of patients were analyzed to determine the independent factors of 6MWT. An equation to predict 6MWT were generated by forward stepwise multiple linear regression analysis. ResultsThe data of 275 patients (mean age: 62.20±14.57 years, 64.7% male) were analyzed. The mean 6MWT was 179.14±92.18 m at discharge, and increased to 335.20±115.51 m at the 4–6-week follow-up. The 6MWT at the 4–6-week follow-up was independently correlated with 6MWT at discharge, regular exercise, age, gender, and preoperative New York Heart Association (NYHA) classification. ConclusionThe independent predictors: 6MWT at discharge, regular exercise, age, gender, and NYHA classification were used to generate an equation to predict 6MWT at 4–6 weeks after hospital discharge.

Angiotensin‐(1‐7)/Mas receptor agonist: a disease modifying therapeutic for VCID protects cognitive function and inhibits serum neurofilament light protein

AbstractBackgroundVascular contributions to cognitive impairment and dementia (VCID) and Alzheimer’s disease related dementias (ADRD) are associated with increases in systemic and brain inflammatory cytokines, increased reactive oxygen species (ROS) and decreased brain blood flow. We have completed preclinical development of novel synthetic glycopeptide derivatives of Angiotensin‐(1‐7) (Ang‐1‐7) MasR agonists that have outstanding brain penetration, improved half‐life, reverse cognitive impairment and decreases plasma neurofilament light protein (NfL) in our preclinical model of VCID. Ang‐(1‐7)/MasR mechanisms of action include inhibition of 1) microglia activation, 2) brain cytokines activation and, 3) vascular endothelial ROS production. The purpose of this pilot study was to 1) determine if plasma NfL is increased in coronary artery bypass graft (CABG) surgery patients at‐risk for VCID and 2) determine if treatment with an Ang‐(1‐7)/MasR agonist protects cognitive function post‐surgy and modifies NfL.MethodSubjects were randomly assigned to receive either 200 micrograms/kg/day s.c. (n = 3) or saline‐placebo (n = 2). Injections were begun 2 hours prior to surgery and then daily for 21 days. Cognitive function was measured prior to surgery and at 21‐ and 90‐days post‐surgery. Serum NfL was measured via Quanterix Simoa assay. Statistical analysis was performed using GraphPad and significance tested using Welch’s ANOVA, Dunnett’s post. Memory function was measured using a composite score comprised of memory, executive functioning, language, and processing speed.ResultPlasma levels of NfL prior to surgery were significantly increased by 176% in CABG patients (n = 5) as compared to age‐matched healthy controls (n = 8, p = .003). Treatment with Ang‐(1‐7) for 21‐days via subcutaneous injections protected memory function as measured by both the Face‐Name and Cured Name Retrieval associative memory tests at both 21‐ and 90‐days post ‐surgery and significantly attenuated CABG induced increases in NfL as compared to placebo‐saline treatment (p = .004).ConclusionThese preliminary data suggest that NfL may serve as a biomarker of VCID in CABG surgery patients and for MasR target engagement for VCID‐modifying treatments with Ang‐(1‐7) analogs. We have begun studies to develop NfL as a biomarker for Ang‐(1‐7)/MasR target activation and for patient stratification for treatment of VCID (Supported by NIH U01HL131014, U01AG066623).

The Spillover Effects of Quality Improvement Beyond Target Populations in Mechanical Ventilation.

Before-during-and-after implementation interrupted time series analysis to assess the effect of the intervention between coronary artery bypass grafting (CABG) surgery patients (included) and left-sided valve surgery patients (excluded). Academic medical center. Patients undergoing CABG and left-sided valve procedures were analyzed. A postoperative mechanical ventilation quality improvement program was developed for patients undergoing CABG. Patients undergoing CABG had a median mechanical ventilation time of 11 hours during P0 ("before" phase) and 6.22 hours during P2 ("after" phase; p < 0.001). A spillover effect was observed because mechanical ventilation times also decreased from 10 hours during P0 to 6 hours during P2 among valve patients who were excluded from the protocol (p < 0.001). The interrupted time series analysis demonstrated a significant level of change for ventilation time from P0 to P2 for both CABG (p < 0.0001) and valve patients (p < 0.0001). There was no significant difference in the slope of change between the CABG and valve patient populations across time cohorts (P0 vs P1 [p = 0.8809]; P1 vs P2 [p = 0.3834]; P0 vs P2 [p = 0.7672]), which suggests that the rate of change in mechanical ventilation times was similar between included and excluded patients. Decreased mechanical ventilation times for patients who were not included in a protocol suggests a spillover effect of quality improvement and demonstrates that quality improvement can have benefits beyond a target population.

Relationship between Psychological Distress and Demographic Characteristics among Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery.

Coronary artery bypass graft (CABG) surgery patients often present with anxiety and depression. These symptoms coupled with pain are major concerns and are widely reported among CABG patients. The study aimed to evaluate the relationship between psychological distress and patients’ demographic data. This cross-sectional study in which 178 patients from a surgery ward were selected using the census method. Data were collected using the Hospital Anxiety and Depression Scale and the Brief Pain Inventory (Short Form). The participants’ mean age was 57.49 ± 13.78 years. The majority of participants had a moderate level of anxiety (89.3%) and a moderate level of pain interference (74.7%). Significant differences were noted, with a higher proportion of moderate anxiety level participants aged between 60 and 74 years old, married, and with a tertiary level education (p < 0.05) being found. There were also significant differences between gender (p < 0.05) and pain severity (p < 0.01) across the levels of depression. The levels of anxiety, depression, and pain were significant, especially among older patients. These symptoms should be routinely assessed, and further identification of predictors such as socioeconomic status before the procedure is necessary.

ACTIVE CYCLE OF BREATHING TECHNIQUES IMPROVES POST-OPERATIVE PULMONARY COMPLICATIONS IN CORONARY ARTERY BYPASS GRAFT SURGERY PATIENTS

Objectives: To determine effects of active cycle breathing technique (ACBT) on pulmonary function of post coronary artery bypass Graft surgery (CABG) patients. Methodology: A randomized control trial was conducted with a sample size of 40 post CABG patients from September 2018 to January 2020. Vitally stable both male and female post CABG Consecutive patients of age bracket 30-65 years were included in study. Two groups were made by randomization through sealed envelope method. Patients in ACBT group (n=20) did ACBT whereas control group (n=20) performed deep breathing exercises along with conventional treatment. Lung volumes &amp; capacities, vitals (heart rate, respiratory rate, oxygen saturation and blood pressure) and chest expansion were assessed at baseline and on fifth post-operative day. Data was analyzed using SPSS version 21. Results: Out of all the 40 patients 26 (65%) were males and 14 (35%) were females with the mean age of 53±7.9 years in conventional and 56±5.9 years in group performing ACBTs. There was significant improvement in Forced Expiratory Volume (FEV1) and chest expansion (p≤0.05) of ACBT group. However, within group analysis revealed significant improvement in all parameters of both groups (p&lt;0.01). Conclusion: Active cycle breathing technique has beneficial effects in improving FEV1 and chest expansion as compared to traditional physical therapy in post CABG patients during phase I of cardiac rehabilitation.

The effect of acute high-intensity interval exercise on post-exercise blood pressure in post coronary artery bypass graft surgery patients: a pilot study

Coronary artery disease is the main cause of death worldwide. Coronary artery bypass graft (CABG) is a preferred treatment option for multi-vessel disease and left main disease patients. Physical training (recovery) enhances exercise tolerance, an activity of daily living, and quality of life in this patient. For this, the aim of the current study was to investigate the effect of acute high-intensity interval exercise on post-exercise blood pressure in CABG patients. In this study, all patients underwent open-heart surgery at least 1 month before involvement in the study. All Subjects were included after Medical rigorous screening. Participants carried out two experimental sessions of high-intensity interval exercise (HIIE) and mild continuous exercise (MCE) with a minimum of 72 h intervals: This study employed a randomized, cross-over design, Brachial systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were measured Immediately before (pre) and after (post) and approximately15 min(post-15) and 30 min (post-30) after each exercise bout. The Split-Plot Analysis of Variance with repeated measures (group × time) was used to analyze the data. Significant post-exercise increases in SBP, and HR were seen following each protocol (p&amp;lt;0.05). Following two bouts, SBP decreased at 15- and 30-min post-exercise in two groups but this decline was more in the HIIE group than MCE. Based on the findings of this study, both high-intensity intermittent and continuous exercise can improve heart function in CABG patients by diminishing BP.

Effects of Music and Preoperative Education on Coronary Artery Bypass Graft Surgery Patients' Anxiety

The aim of this study was to evaluate the effectiveness of music and preoperative education on anxiety, physiological responses, length of hospital stay, and quality of life in Coronary Artery Bypass Graft Surgery (CABG) patients. This was a non-randomized quasi-experimental study. For this study, 214 patients were separated into an experimental and control group. A dual intervention using preoperative education and a CD with classical Turkish music was applied to the experimental group. The control group was provided with an uninterrupted rest period at the same time. The primary outcome was the difference in anxiety of the patients. Other outcomes included differences in the physiological responses, length of hospital stay, and quality of life. Anxiety decreased in the preoperative and postoperative periods in both groups (P = .000), and patients' anxiety level in the experimental group was lower than the control group (P = .000). The experimental group patients had a decrease in systolic blood pressure, diastolic blood pressure, and heart rate in the preoperative period (P = .000), and all physiological responses in the postoperative period were lower than the control group (P = .000). Furthermore, the experimental group's length of hospital stay was shorter (5.8 ± 1 days), and their quality of life was better (P = .000). The dual integrative nursing intervention (music and preoperative education) was effective in reducing anxiety in CABG patients. The results of the study will contribute to nonpharmacological approaches in the management of anxiety in CABG patients.

Intensivist -Driven Ventilator Management Shortens Duration of Mechanical Ventilation in Coronary Artery Bypass Graft Surgery Patients.

Prolonged mechanical ventilation in post Coronary Artery Bypass Graft Surgery (CABG) is associated with deleterious effects including, increased ICU and hospital length of stay (LOS), infectious complications, and mortality. Standardized ventilator weaning protocols and the utilization of critical care physicians in post CABG patient care vary substantially among institutions. The purpose of this study was to evaluate if intensivist consultation in conjunction with a multidisciplinary, standardized ventilator weaning protocol improves outcomes in CABG patients. We performed a single-center, retrospective, before-after cohort analysis at Miami Valley Hospital in Dayton, OH, a 970-bed community hospital. Patients were divided into two arms: the before cohort or delayed-consult group (critical care consult after six hours on ventilator) and after cohort or immediate-consult group (immediate critical care consult). All patients were weaned from ventilator using a standardized weaning protocol. A total of 764 patients were enrolled, 411 in the delayed-consult group and 353 in the immediate-consult group. The immediate-consult group had less time on initial mechanical ventilation than the delayed-consult group (5.86 ± 4.75 h vs. 6.00 ± 6.64 h, P = 0.038). The small advantages to immediate critical care consultation for higher percent of early extubations, fewer re-intubations, shorter ICU LOS, and lower rate of ICU readmission were not statistically significant. The two groups had similar ventilator free days, prolonged mechanical ventilation, hospital LOS, and in-hospital mortality. Our study suggests that intensivist-driven ventilator management in conjunction with a multidisciplinary standardized weaning protocol shortens duration of mechanical ventilation in coronary artery bypass graft surgery patients.

The role of aromatherapy with lavender in reducing the anxiety of patients with cardiovascular diseases: A systematic review of clinical trials

Most studies have shown the positive effects of lavender inhalation in decreasing anxiety in patients with cardiovascular diseases. We aimed to systematically review the role of aromatherapy with lavender in these patients. By PRISMA standards, we explored the studies on the role of aromatherapy with lavender in reducing the anxiety of patients with cardiovascular diseases in English databases through the words and terms "aromatherapy", "lavender", "lavandula", "anxiety", "cardiovascular diseases". Out of 16 647 papers, 12 papers up to January 2022 encountered the inclusion criteria for involving in this systematic review. The majority of studies (7 studies, 70%) were used Spielberger Standard Questionnaire as a measurement scale for their studies. Lavender aromatherapy was mostly used for myocardial infarction (3 studies, 30%) and coronary artery bypass graft (CABG) surgery (3 studies, 30%) patients. We concluded that aromatherapy with lavender essential oil significantly ameliorated the anxiety signs in some cardiovascular diseases, e.g., CABG surgery, myocardial infarction, and cardiac ischemia; however, more studies are required in this field to obtain more specific evidence.

Relevance of Preoperative Pain Education To The Cardiac Patients on Their Response To Postoperative Pain Therapy

To observe the effects of preoperative pain education on Coronary artery bypass graft surgery (CABG) patients on postoperative pain management. Methods: A randomized control trial was performed from April-December 2019, after seeking ethical approval. Patients of Punjab institute of cardiology, Lahore, scheduled for CABG were selected after informed consent. Those with psychiatric illness, chronic pain/opioid addiction, or allergic to opioids, were excluded. The population was divided into control (received routine preoperative care) and interventional (received additional preoperative education via pain management booklet) groups, data was collected postoperatively via questionnaire and analyzed on SPSS. Chi-square was used as a statistical test and p-value &lt;0.05 was significant. Results: Eighty patients with 47 males and 33 females aged 50-80 years (mean=61.05±8.32) were recruited. The interventional group agreed to the significance of instant in-hospital notifying/managing pain and 38(95%) controls agreed to it, 39(98%) interventional patients were willing for a stronger pain-relief medicine if not cured by the initial dose, while 12(30%) controls were willing for it. 38(95%) interventional patients denied the fear of addiction to painkillers, contrarily 5(12.5%) controls negated this fear. All interventional patients rejected the concern of incurable nausea with pain-relief medicine, while 37(92.5%) controls were threatened with this concern. Constipation associated with pain-relief medicine was refused by all interventional patients, 25(62.5%) controls accepted it. All the differences between both groups were significant (p&lt;0.001). Conclusion: A significantly improved postoperative patient compliance/outcome (pain-related) was observed in the interventional group who preoperative received pain education compared to the control.