Bypass Graft Surgery Research Articles

Assessing risk factors of bypass graft surgery through the implementation of Bayesian and non-Bayesian methodologies

The aim of this research is to determine the key risk factors that influence the need for Bypass Graft surgery (BGS). A cohort of one hundred adult patients underwent coronary angiography operations at the Erbil Cardiac Center from January 2016 to December 2020. Multiple logistic regression (MLR) analysis was used to identify the determinants of BGS. Upon detailed statistical analysis, a significant association with BGS was found for several variables, including Age, BMI, Eosinophil, WBC, DBP, HbA1c, MCH, Blood Sugar, PLT, and T3. It was found that the significant variables contributing the most to predicting the likelihood of Bypass Graft surgery through Bayesian logistic regression analysis were Age, WBC, and MCH. These variables were identified as the pivotal risk factors associated with the probability of undergoing BGS. Age, DBP, and Blood Sugar had minimal influence on the likelihood of Bypass surgery. However, for each unit increase in WBC, the odds of surgery reduced by 38 %, and for MCH, the odds reduced by 19 %. DBP and Blood Sugar had little effect on Bypass surgery (Bayesian odds ratio close to 1). This study revealed that Bayesian logistic models offer superiority over classical logistic models. The Bayesian-based models provide more accurate predictions by incorporating informative prior distributions. To improve the accuracy and generalizability of the findings, future research should consider a larger sample size and incorporate informative prior distributions within the Bayesian framework. Also, machine learning algorithms can offer new insights into BGS outcomes by considering various variables and assessing model sensitivity.

Can Triglycerides-HDL-C Ratio, HOMA-IR, ApoB, Non-HDL Cholesterol, and Free Cholesterol be Laboratory-Associated Flags of Female Coronary Atherosclerosis Regardless of Being Diabetic?

Aim The study aimed to evaluate biomarkers, ratios, and indexes as flags of coronary obstructions in women with established coronary atherosclerotic disease regardless of diabetes. Methods A cross-sectional study was conducted on 42 confirmed atherosclerotic coronary female patients, stratified into diabetic or not and scheduled for angioplasty or coronary graft bypass surgery. Blood samples were collected immediately before coronary intervention for laboratory determinations, such as glycemia, HbA1c, insulin, HDL-C, PON-1, free cholesterol, LDL-C, Apo A-1, Apo B, and TG. Results In diabetic patients, insulin was positively correlated with triglycerides (p < 0.0108; r = 0.2009), apo B (p < 0.0006; r = 0.3737), non-HDL cholesterol (p < 0.0084; r = 0.2156), and free cholesterol (p < 0.0084; r = 0.3251). Applying a linear regression model, insulin from diabetic patients showed an association with glycemia, triglycerides, and HOMA-IR (p < 0.001, R2 = 0.9868), but in non-diabetics, the association was only found between insulin and HOMA-IR (p = 0.002, R2 = 0.9031). On the other hand, using triglycerides as a dependent variable, its association has been found in both groups, but only with HOMA-IR (diabetics: p = 0.006, R2 = 0.2504; non-diabetics: p = 0.014, R2 = 0.4697). Also, the TG/HDL-C ratio was higher than 2.5 in 90% of diabetics and 83.33% of non-diabetic patients. Conclusion The high prevalence of females with a TG/HDL-C ratio above 2.5, the association among insulin, HOMA-IR, and TG/HDL-C, and correlations with apoB, non-HDL-C, and free cholesterol, should be evaluated as flags of female precocious coronary atherosclerosis.

Off-pump vs. on-pump bypass surgery grafting in diabetic patients with three-vessel disease: a propensity score matching study

BackgroundControversy exists regarding the advantages and risks of off-pump vs. on-pump coronary artery bypass grafting (CABG) for patients with diabetes. We therefore compare the early clinical outcomes of off-pump vs. on-pump procedures for diabetic patients with three-vessel disease.Materials and methodsWe conducted a retrospective analysis of clinical data obtained from 548 diabetic patients with three-vessel coronary artery disease who underwent isolated CABG between January 2016 and June 2020. To adjust the differences of baseline characteristics between the off-pump CABG (OPCAB) and on-pump CABG (ONCAB) groups, propensity score matching (PSM) was used. Following 1:1 matching, we selected 187 pairs of patients for further comparison of outcomes within the first 30 days after surgery.ResultsThe preoperative characteristics of the patients between the two groups were clinically comparable after PSM. The OPCAB group exhibited a significantly higher incidence of incomplete revascularization (27.3% vs. 14.4%; P = 0.002) compared with the ONCAB group. No differences were seen in mortality within 30 days between the matched groups (1.1% vs. 3.7%; P = 0.174). Notably, the OPCAB group had a lower risk of respiratory failure or infection (2.1% vs. 7.0%; P = 0.025), less postoperative stroke (1.1% vs. 4.8%; P = 0.032), and reduced postoperative ventilator assistance time (35.8 ± 33.7 vs. 50.9 ± 64.8; P = 0.005).ConclusionOPCAB in diabetic patients with three-vessel disease is a safe procedure with reduced early stroke and respiratory complications and similar mortality rate, myocardial infarction, and renal failure requiring dialysis to conventional on-pump revascularization.

The Prevalence of Coronary Artery Disease in Amyloidosis Is 23%

Purpose: This observational cross-sectional analysis evaluates the prevalence of coronary artery disease in TTR and non-TTR amyloidosis. Methods: Amyloidosis cases were identified in a large multi-center medical database using defined criteria. The presentation of CAD was determined through ICD codes for cardiac catheterization records and other precisely identifiable data, such as the history of stenting or bypass graft operations. TTR and non-TTR amyloidosis groups were compared regarding their baseline demographics, clinical, laboratory, and imaging presentations. Results: Out of 5273 subjects in the study, 79 had TTR, and 5194 had non-TTR amyloidosis. On average, non-TTR patients are significantly older than TTR patients (70.39±13.26 vs. 63.09±19.40, p=.0013). Overall, CAD was present in 1221 (23.16%) subjects. The prevalence of CAD was comparable between the non-TTR and TTR amyloid groups (23.2% vs. 22.8%, p>0.05). However, hypertension was more present in the non-TTR group than in TTR (32% vs. 12%, p=.0001). Race, gender, diabetes, and hyperlipidemia did not differ between the two groups (p>0.05). Conclusion: CAD prevalence in TTR and non-TTR is around 23%. The type of amyloidosis does not impact the prevalence of CAD.

The comparison of the short and mid-term results of endovascular interventions and bypass graft surgery in the treatment of patients with intermittent claudication complaints because of isolated femoropopliteal artery disease.

Intermittent Claudication (IC) is exercise pain seen in lower extremity arterial diseases. If it is left untreated, it may be the initial sign of a process leading to amputation. In the present study, the purpose was to compare the postoperative early and mid-term results of the patients who were treated with endovascular methods and those who underwent bypass graft surgery in the treatment due to IC complaints because of isolated Femoropopliteal Arterial Disease. Postoperative first-month, sixth-month, and 12th-month follow-up results, procedure requirements, and demographic characteristics of the 153 patients who underwent femoropopliteal bypass because of isolated Femoropopliteal Arterial Disease and 294 patients who underwent endovascular intervention in our hospital between January 2015 and May 2020 were compared in the study. It was found in demographic characteristics that endovascular intervention was performed more frequently in smokers and graft bypass surgery was performed more frequently in hyperlipidemic patients, and the results were found to be statistically significant. High amputation rates were detected at statistically significant levels in diabetic and hypertriglycemic patients and 1-year primary patency rates were found to be higher in patients who underwent graft bypass surgery. No differences were detected between the two methods in terms of mortality. Interventional treatment modalities must be considered for patients with isolated Femoropopliteal Arterial Disease whose symptoms persist despite exercise and the best medical treatment. We think that Bypass Graft Surgery has more positive results than endovascular interventions when short and medium-term amputation, repetitive intervention needs, and changes in quality of life are compared in patients who receive the same medical treatment.

Comparison of graft bypass surgery and endovascular ınterventional techniques ın ıliofemoral and above knee femoropopliteal arterial occlusion

ÖZ
 Amaç: Periferik damar hastalığı önemli morbidite ve mortalite ile ilişkilidir. Bu çalışmada iliofemoral ve diz üstü femoropopliteal arter tıkanıklığında cerrahi baypas greftleme ile endovasküler stentleme arasında bir karşılaştırma yaparak her bir tedavi yönteminin avantaj ve dezavantajlarını ortaya çıkarmaya çalıştık.
 Yöntemler: Ocak 2015 ile Aralık 2020 arasında 60 hasta bu çalışmaya dahil edildi. Hastalar tedavi yöntemlerine göre iki gruba ayrıldı. Grup I 33 hastadan oluşuyordu ve cerrahi baypas greftleme ile ameliyat edildi, grup II ise endovasküler girişim ile 27 hastadan oluşuyordu. Hastaların morbiditeleri, görüntüleme yöntemleri, tıkanıklığın lokalizasyonu, greft tipi ve endovasküler işlem, damar açıklığı, hastanede kalış süresi, kan transfüzyonu, revizyon ve komplikasyonlar değerlendirildi ve analiz edildi.
 Bulgular: Grup I'de femoral arter tıkanıklığı (%72.7) çoğunluktayken, Grup II'de iliak arter (%66.7) idi. Grup I'de 3, Grup II'de balon uygulanan 14 hasta vardı. Vasküler açıklık açısından Grup I'de 10 (%45,5) hastada greftler, Grup II'de ise 12 (%54,5) hastada stent tıkandı. Grup I'de on beş hastaya, Grup II'de altı hastaya kan transfüzyonu yapıldı.
 Sonuç Grup I'de greft açıklık oranı daha yüksek, cerrahi tedavinin yeniden revaskülarizasyon oranı endovasküler tedaviye göre daha düşüktü. En yüksek greft açıklık oranı, safen venlerden sonra Dakron greftlerde görüldü. Grup I hastalara Grup II hastalarından daha fazla kan transfüzyonu yapıldı ve hastanede kalış süreleri uzatıldı.

The association of hyperhomocysteinemia with acute post-operative complications following coronary artery bypass grafting.

Hyperhomocysteinemia is associated with an increased risk for cardiovascular diseases. The influence of hyperhomocysteinemia on post-operative events, after coronary artery bypass surgery graft, is less studied. This cross-sectional study aimed to determine if hyperhomocysteinemia was associated with post-operative complications in patients < 50 years who underwent off-pump coronary artery bypass graft for coronary artery disease. A set of major post-operative complications were considered as primary outcome measures. The independent effect of hyperhomocysteinemia and other risk factors in the incidence of post-operative complications was determined by multivariate analysis. The mean homocysteine levels among the study participants who had post-operative complications were significantly higher than those without post-operative complications (17.37 mmol/L vs. 12.84 mmol/L). On multivariate analysis, hyperhomocysteinemia, diabetes mellitus, and higher body mass index (> 25) were significant predictors of adverse events during the post-operative period. Hyperhomocysteinemia was a significant predictor of immediate post-operative adverse events after coronary artery bypass surgery graft. Necessary precautions and management strategies have to be evolved for these high-risk subsets.

Effect of molar mass and alkyl chain length on the surface properties and biocompatibility of poly(alkylene terephthalate)s for potential cardiovascular applications.

Cardiovascular diseases are the leading cause of death worldwide. Treatments for occluded arteries include balloon angioplasty with or without stenting and bypass grafting surgery. Poly(ethylene terephthalate) is frequently used as a vascular graft material, but its high stiffness leads to compliance mismatch with the human blood vessels, resulting in altered hemodynamics, thrombus formation and graft failure. Poly(alkylene terephthalate)s (PATs) with longer alkyl chain lengths hold great potential for improving the compliance. In this work, the effect of the polymer molar mass and the alkyl chain length on the surface roughness and wettability of spin-coated PAT films was investigated, as well as the endothelial cell adhesion and proliferation on these samples. We found that surface roughness generally increases with increasing molar mass and alkyl chain length, while no trend for the wettability could be observed. All investigated PATs are non-cytotoxic and support endothelial cell adhesion and growth. For some PATs, the endothelial cells even reorganized into a tubular-like structure, suggesting angiogenic maturation. In conclusion, this research demonstrates the biocompatibility of PATs and their potential to be applied as materials serving cardiovascular applications.

Fractional Flow Reserve versus Angiography-Guided Management of Coronary Artery Disease: A Meta-Analysis of Contemporary Randomised Controlled Trials.

Background and Aims: Randomised controlled trials (RCTs) comparing outcomes after fractional flow reserve (FFR)-guided versus angiography-guided management for obstructive coronary artery disease (CAD) have produced conflicting results. We investigated the efficacy and safety of an FFR-guided versus angiography-guided management strategy among patients with obstructive CAD. Methods: A systematic electronic search of the major databases was performed from inception to September 2022. We included studies of patients presenting with angina or myocardial infarction (MI), managed with medications, percutaneous coronary intervention, or bypass graft surgery. A meta-analysis was performed by pooling the risk ratio (RR) using a random-effects model. The endpoints of interest were all-cause mortality, MI and unplanned revascularisation. Results: Eight RCTs, with outcome data from 5077 patients, were included. The weighted mean follow up was 22 months. When FFR-guided management was compared to angiography-guided management, there was no difference in all-cause mortality [3.5% vs. 3.7%, RR: 0.99 (95% confidence interval (CI) 0.62−1.60), p = 0.98, heterogeneity (I2) 43%], MI [5.3% vs. 5.9%, RR: 0.93 (95%CI 0.66−1.32), p = 0.69, I2 42%], or unplanned revascularisation [7.4% vs. 7.9%, RR: 0.92 (95%CI 0.76−1.11), p = 0.37, I2 0%]. However, the number patients undergoing planned revascularisation by either stent or surgery was significantly lower with an FFR-guided strategy [weighted mean difference: 14 (95% CI 3 to 25)%, p =< 0.001]. Conclusion: In patients with obstructive CAD, an FFR-guided management strategy did not impact on all-cause mortality, MI and unplanned revascularisation, when compared to an angiography-guided management strategy, but led to up to a quarter less patients needing revascularisation.

Therapeutic Efficacy of a Staged Hybrid Technique vs. Coronary Artery Bypass Surgery Grafting in The Treatment of Multi-Vessel Coronary Artery Disease.

Hybrid coronary revascularization (HCR) integrates the advantages of coronary artery bypass surgery grafting (CABG) and percutaneous coronary intervention (PCI) and provides another effective treatment for multi-vessel coronary artery disease (CAD). This study aimed to investigate the short- and intermediate-term efficacies of a staged hybrid technique vs. CABG in treating older patients with multi-vessel CAD. Patients, who received elective revascularization for multi-vessel CAD between May 2016 and May 2018, were recruited. They were divided into the CABG group (N = 38) and HCR group (N = 38). The major adverse cardiovascular and cerebrovascular events (MACCE), including myocardial infarction and stroke, were recorded. The results of death and second revascularization also were recorded. In this study, 90.1% of patients received follow up for a median time of 24 months. At 60 days after surgery, the cumulative mortality in the CABG group was significantly higher than in the HCR group, but the incidence of second revascularization in the CABG group was markedly lower than in the HCR group. The incidence of MACCE was comparable between the two groups. In older patients with multi-vessel CAD, the mortality after CABG is higher than after HCR, but the incidence of second revascularization after CABG is lower than after HCR.

Fibrinolytic Enzyme - An Overview.

Cardiovascular diseases, like coronary heart disease or artery disorders (arteriosclerosis, including artery solidification), heart failure (myocardial infarction), arrhythmias, congestive heart condition, stroke, elevated vital signs (hypertension), rheumatic heart disorder, and other circulatory system dysfunctions are the most common causes of death worldwide. Cardiovascular disorders are treated with stenting, coronary bypass surgery grafting, anticoagulants, antiplatelet agents, and other pharmacological and surgical procedures; however, these have limitations due to their adverse effects. Fibrinolytic agents degrade fibrin through enzymatic and biochemical processes. There are various enzymes that are currently used as a treatment for CVDs, like streptokinase, nattokinase, staphylokinase, urokinase, etc. These enzymes are derived from various sources, like bacteria, fungi, algae, marine organisms, plants, snakes, and other organisms. This review deals with the fibrinolytic enzymes, their mechanisms, sources, and their therapeutic potential.

Physiotherapy Management in Cardiac Rehabilitation Phase-I

Cardiac diseases are the considered one of the prevalent disease in community nowadays. It involves myocardial infarction, coronary artery disease, valvular disease. Patients suffering from these conditions have taken the surgical treatment. Surgical procedures are common among all the patients and coronary graft bypass surgery to reduce the complications and symptoms such as dyspnea, chest pain, and fatigue is frequently used procedure. These procedures leads towards the post-operative complications and recovery depends upon the early ambulation and physical activity. Physiotherapy is need of the time to improve the symptoms and quality if life of these patients. Multiple techniques of physiotherapy are beneficial and necessary in cardiac rehabilitation phase-I. Keywords: Aerobic training, Chest Physiotherapy, Coughing, Cardiac rehabilitation, Phase-I, Mobility, Post Surgical.

Spontaneous left main coronary artery dissection occurred in a young male: a case report and review of literature

BackgroundSpontaneous coronary artery dissection (SCAD) is now recognized as an important cause of acute coronary syndrome (ACS), which is thought to be more prevalent in women. However, the male patients, on the other hand, cannot be easily ignored.Case presentationA 26-year-old male suffered from SCAD that occurred in the left main coronary artery (LMCA) and a secondary acute myocardial infraction (AMI). Coronary CT angiography and coronary angiography (CAG) revealed aneurysms in the LMCA and right coronary artery (RCA), as well as a total occlusion in the proximal branch of the left anterior descending artery (LAD). Along with drug therapy, coronary artery bypass graft (CABG) surgery was recommended, and the patient has been symptom-free for one year.ConclusionWe report a case of spontaneous left main coronary artery dissection that occurred in a young male. The necessity of identifying typical imaging features and following up patients with SCAD for life to reduce the risk of fatal cardiac complications cannot be overstated.

Real Life Outcomes of Infrapopliteal Endovascular and Surgical Bypass Intervention for Chronic Limb Threatening Ischaemia in GLASS Stages II and III

Great efforts have been made to choose between bypass surgery and angioplasty as the first choice for revascularisation in chronic limb threatening ischaemia (CLTI). Endovascular therapy predominates despite limited evidence for its advantages. The purpose of this observational cohort study was to investigate outcomes after open and endovascular infrapopliteal revascularisation in extensive infrainguinal arterial disease. The medical records of 1 427 patients who underwent infrainguinal revascularisation exclusively for CLTI in the period January 2014 to February 2019 were reviewed. After detailed analysis, only infrapopliteal revascularisations classified as GLASS stage II or III were considered, resulting in 326 procedures. In total, 127 patients underwent endovascular therapy and 199 patients underwent bypass graft surgery (BGS). The primary endpoints included amputation free survival (AFS) and overall survival (OS). Secondary endpoints included the analyses of multiple factors related to long term AFS. Regarding the primary endpoint, AFS was 75.2% and 65.2% at one and three years, respectively. OS at one and three years was 91.2% and 83.1%, respectively. In the univariable analysis, the hazard of the combined endpoint of major amputation or death was higher after bypass surgery than after endovascular therapy (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.13 - 2.89; p= .013). After either revascularisation method, TASC II femoropopliteal D was associated with a higher risk of amputation or death (HR 1.69, 95% CI 1.10 - 2.58; p= .015). Multivariable Cox regression analysis revealed no association between the variables analysed for AFS. Patients with CLTI submitted to infrapopliteal revascularisation and classified as GLASS II and III had satisfactory AFS and OS rates after an individualised team conference decision. Furthermore, the revascularisation modality (endovascular or open) did not influence the AFS results.

Signature transcriptome analysis of stage specific atherosclerotic plaques of patients

BackgroundInflammation plays an important role in all the stages of atherosclerotic plaque development. The current study aimed at assessing the altered expression of genes functioning in inflammation within the early stage (ES) and advanced stage (AS) atherosclerotic plaques obtained from patients undergoing coronary artery bypass grafting (CABG) surgery and identifying biomarker panel/s that may detect the status of plaque stages using peripheral blood samples.MethodsA section of ES and AS plaques and normal left internal mammary arteries (LIMA) were obtained from 8 patients undergoing the CABG surgery. Total RNA isolated was analyzed for mRNA and miRNA expression profile by Affymetrix arrays. A significant number of mRNAs was found to be differentially expressed in ES and AS plaque tissues relative to LIMA. The pathway analysis of differentially expressed mRNAs in the two plaque stages was also performed using DAVID Bioinformatics Database.ResultsThe mRNAs were found to be involved in critical inflammatory processes such as the toll-like receptor signaling pathway and cytokine-cytokine receptor interaction. Few miRNAs targeting these mRNAs were also altered in the two plaque conditions. QRT-PCR results showed a similar expression pattern of a few of the mRNAs and miRNAs in peripheral blood of the same patients relative to healthy controls.ConclusionChanges in mRNA and miRNA expression associated with various inflammatory processes occur in different atherosclerotic stage plaques as well as peripheral blood. Detection of such variations in patients’ blood can be used as a possible prognostic tool to detect and/or predict the risk and stage of atherosclerosis.

Clinical characteristics, outcomes and regional variations of acquired valvular heart disease patients undergoing cardiac surgery in China

AimsTo characterize surgical valvular heart diseases (VHDs) in China and disclose regional variations in VHD surgeries by analyzing the data derived from the Chinese Cardiac Surgery Registry (CCSR).Methods and resultsFrom January 2016 to December 2018, we consecutively collected the demographic information, clinical characteristics and outcomes of 38,131 adult patients undergoing valvular surgery in China. We sought to assess the quality of VHD surgery by examining in-hospital deaths of all patients from 7 geographic regions. Using a hierarchical generalized linear model, we calculated the risk-standardized mortality rate (RSMR) of each region. By comparing VHD characteristics and RSMRs, we pursued an investigation into regional variations. The mean age was 54.4 ± 12.4 years, and 47.2% of the patients were females. Among cases, the number of aortic valve surgeries was 9361 (24.5%), which was less than that of mitral valve surgeries (n = 14,506, 38.0%). The number of concurrent aortic and mitral valve surgeries was 6984 (18.3%). A total of 4529 surgical VHD patients (11.9%) also underwent coronary artery bypass grafting (CABG) surgery. The overall in-hospital mortality rate was 2.17%. The lowest RSMR, 0.91%, was found in the southwest region, and the highest RSMR, 3.99%, was found in the northeast.ConclusionAlthough the overall valvular surgical mortality rate in large Chinese cardiac centers was in line with high-income countries, there were marked regional variations in the characteristics and outcomes of surgical VHD patients across China.

Prevalence and correlated factors for chronic total occlusion in patients with coronary artery disease in Iraqi Kurdistan

Patients with significant coronary artery disease often have at least one vessel with Chronic Total Occlusion (CTO) as demonstrated by coronary angiography. However, the prevalence and determinants of CTO differ according to ethnicity. We aimed to investigate the prevalence and determinants of CTO in the Iraqi Kurdistan population in 2015. Clinical and angiographic data were collected in consecutive patients that underwent coronary angiography at our institution between January and December 2015. Coronary artery disease (CAD) was determined as 50% diameter stenosis in one coronary artery and CTO as total coronary artery occlusion of 3-month duration. Among 260 patients diagnosed with ischemic coronary artery disease and undergone coronary angiography, 28.5% (n=74) were diagnosed to have at least one CTO vessel and 69 (26.5%) patients had a previous history of myocardial infarction. CTOs were located in the left anterior descending coronary artery in 45% of patients while in the right coronary artery in 32%. CTO patients were substantially older (61 vs 56 years; p &lt;0.0001) and more likely to live in non-urban areas. They frequently had more hypertension, dyslipidemia, diabetes mellitus, previous myocardial revascularization, being an exsmoker, and renal dysfunction as compared to patients without CTOs. At univariate analysis, a previous history of coronary artery bypass graft (CABG) surgery was the only predictor of having a diagnosis of CTO. Patients diagnosed with CTO in Iraqi Kurdistan had several comorbidities including cardiovascular risk factors and renal dysfunction. Previous CABG was the only predictor of CTO diagnosis.

The effect of continuous intercostal nerve block vs. single shot on analgesic outcomes and hospital stays in minimally invasive direct coronary artery bypass surgery: a retrospective cohort study

BackgroundMinimally invasive direct coronary artery bypass (MIDCAB) grafting surgery is accompanied by severe pain. Although continuous intercostal nerve block (CINB) has become one of the multimodal analgesic techniques in single port thoracoscopic surgery, its effects on MIDCAB are unclear. The purpose of this study was to compare the effects of CINB and single shot on analgesic outcomes and hospital stays in patients undergoing MIDCAB in a real-world setting.MethodsA retrospective cohort study was carried out at Peking University Third Hospital, China. Two hundred and sixteen patients undergoing MIDCAB were divided into two groups: a CINB group and a single block (SI) group. The primary outcome was postoperative maximal visual analog scale (VAS); secondary outcomes included the number of patients with maximal VAS ≤ 3, the demand for and consumed doses of pethidine and tramadol, and the length of intensive care unit (ICU) and hospital stays. The above data and the area under the VAS curve in the 70 h after extubation for the two subgroups (No. of grafts = 1) were also compared.ResultsThe maximum VAS was lower in the CINB group, and there were more cases with maximum VAS ≤ 3 in the CINB group: CINB 52 (40%) vs. SI 17 (20%), P = 0.002. The percentage of cases requiring tramadol and pethidine was less in CINB, P = 0.001. Among all patients, drug doses were significantly lower in the CINB group [tramadol: CINB 0 (0–100) mg vs. SI 100 (0–225) mg, P = 0.0001; pethidine: CINB 0 (0–25) mg vs. SI 25 (0–50) mg, P = 0.0004]. Further subgroup analysis showed that the area under the VAS curve in CINB was smaller: 28.05 in CINB vs. 30.41 in SI, P = 0.002. Finally, the length of ICU stay was shorter in CINB than in SI: 20.5 (11.3–26.0) h vs. 22.0 (19.0–45.0) h, P = 0.011.ConclusionsCINB is associated with decreased demand for rescue analgesics and shorter length of ICU stay when compared to single shot intercostal nerve block. Additional randomized controlled trial (RCT) is needed to support these findings.

Postoperative Thromboembolism According to the Type of Surgery: A Nationwide Study in the Republic of Korea.

Postoperative thromboembolism (TE) is a serious, but preventable, complication in surgical patients. Orthopedic surgery, neurosurgery, and vascular surgery are considered high risk for TE, and current guidelines recommend TE prophylaxis. However, insufficient data exist regarding TE risk in other general surgeries. This study identified the actual incidence and relative risk of postoperative TE in the real world, according to surgery type. Twenty-six surgeries between 1 December 2017 and 31 August 2019 were selected from the Health Insurance Review and Assessment Service database and analyzed for postoperative TE events. Among all patients, 2.17% had a TE event within 6 months of surgery and 0.75% had a TE event owing to anticoagulant treatment. The incidence of total TE events was the highest in total knee replacement (12.77%), hip replacement (11.46%), and spine surgery (5.98%). The incidence of TE with anticoagulant treatment was the highest in total knee replacement (7.40%), hip replacement (7.20%), and coronary artery bypass graft (CABG) surgery (3.81%). Hip replacement, total knee replacement, CABG surgery, spine surgery, and cardiac surgery except CABG surgery, showed relatively higher risks for total claimed venous TE. The relative risk of venous TE with anticoagulant treatment was the highest for hysterectomy, partial hepatectomy, hip replacement, cardiac surgery except CABG surgery, and total knee replacement. The relative risk of arterial TE was the highest for cardiac surgery, total knee replacement, and hip replacement. In the real world, the incidence of postoperative TE events from total knee replacement and those from hip replacement remain high, and some surgeries could have a relatively higher risk of TE than other surgeries. For patients undergoing these surgeries, studies to reduce the incidence of postoperative TE in clinical practice should be conducted.

Prediction of clinical course in patients with diffuse coronary artery disease after coronary bypass surgery

Aim. To determine the incidence, predictors and develop a model for long-term risk stratification of ischemic events in patients with coronary artery disease after coronary bypass surgery.Material and methods. This retrospective study of the clinical course in patients with diffuse coronary artery disease (CAD) after coronary endarterectomy and bypass grafting surgery. A total of 232 patients were included, while long-term outcomes were assessed in 202 patients. Among them, complete data on clinical status were obtained from survivors (n=191). The median follow-up was 60 (interquartile range, 42; 74) months, while the minimum follow-up — 12 months, the maximum was 96 months. The primary composite endpoint reflecting the unfavorable course of CAD included coronary ischemic events (recurrent angina, myocardial infarction, repeat revascularization), while secondary endpoint — allcause mortality. The factors influencing the development of primary and secondary endpoints were studied.Results. An unfavorable CAD course was diagnosed in 39 patients (20,4%), while 11 deaths were recorded (5,4%). Univariate analysis demonstrated a significant role of prior myocardial infarction in the increase in mortality rate (p=0,029). Among the factors influencing the CAD course, no significant differences were obtained for any of them. A multivariate analysis was performed to identify a high-risk group for an unfavorable course of diffuse CAD. Independent predictors were identified, the most significant contribution of which was made by multifocal atherosclerosis (odds ratio (OR)=1,99, 95% confidence interval (CI), 0,93-4,21, p=0,072), low adherence to secondary prevention measures (OR=2,21, 95% CI, 0,86-6,89, p=0,128) and diabetes (OR=1,73, 95% CI, 0,79-3,72, p=0,162). Using the results obtained, a prognostic model with high specificity (64%) and moderate sensitivity (53%) was created.Conclusion. The highest probability of an unfavorable long-term course of diffuse CAD was noted in patients with diabetes, multifocal atherosclerosis, and low adherence to secondary prevention measures. The obtained results make it possible to identify a high-risk group in this cohort of patients, determine the reserve of secondary prevention measures and a direction of actions to improve outcomes.