Bypass Graft Surgery Research Articles

Prophylactic intra-aortic balloon counterpulsation before surgical myocardial revascularization in patients with acute myocardial infarction.

Prophylactic intra-aortic balloon counterpulsation (pIABC) is recommended for high-risk patients undergoing coronary artery bypass grafting (CABG) surgery. Criteria for high-risk patients benefiting from pIABC are unclear. This study aimed to specifically describe the effect of pIABC on outcomes of patients with acute myocardial infarction (AMI) undergoing CABG. In 178 of 484 AMI patients (non-ST-segment elevation myocardial infarction [NSTEMI] or ST-segment elevation myocardial infarction [STEMI] ≤5 days before surgery) without cardiogenic shock who underwent CABG between 2008 and 2013, pIABC was initiated preoperatively. After propensity score matching, the outcomes of 400 patients were analyzed (pIABC: 150; Control: 250). After propensity score matching, baseline and operative characteristics were balanced between the groups except for a higher rate of patients with a left ventricular ejection fraction (LVEF)≤30% in the pIABC group (26% vs. Control: 13%; p=0.032). Seven point two percent (7.2%) of the control patients received an IABP intraoperatively or postoperatively. Postoperative extracorporeal life support (ECLS) was only needed in the control group (1.2% vs. 0%; p=0.01). Postoperative plasma curves of troponin I, creatine kinase (CK) and creatine kinase isoform MB (CK-MB) levels were reduced in the pIABC group compared with the control group. In-hospital mortality was reduced in the pIABC group (3.3% vs. control: 6.4%; p=0.18). After multivariate adjustment for other preoperative risk factors, pIABC was significantly protective concerning in-hospital mortality (HR 0.56; 95%-CI 0.023-0.74; p=0.021). Mortality (pIABC vs. control) was more affected in patients with preoperative LVEF≤30% (2/36 (5.6%) vs. 6/31 (19%); heart rate (HR) 0.25; 95%-CI 0.046-1.3; p=0.13) compared with LVEF>30% (3/114 (2.6%) vs. 10/219 (4.6%); HR 0.56; 95%-CI 0.15-2.1; p=0.55). Long-term survival did not differ between the groups. pIABC in CABG for AMI is associated with reduced perioperative cardiac injury and in-hospital mortality. Long-term survival is not affected.

In Vivo Evaluation of Cerebral Hemodynamics and Tissue Morphology in Rats during Changing Fraction of Inspired Oxygen Based on Spectrocolorimetric Imaging Technique.

During surgical treatment for cerebrovascular diseases, cortical hemodynamics are often controlled by bypass graft surgery, temporary occlusion of arteries, and surgical removal of veins. Since the brain is vulnerable to hypoxemia and ischemia, interruption of cerebral blood flow reduces the oxygen supply to tissues and induces irreversible damage to cells and tissues. Monitoring of cerebral hemodynamics and alteration of cellular structure during neurosurgery is thus crucial. Sequential recordings of red-green-blue (RGB) images of in vivo exposed rat brains were made during hyperoxia, normoxia, hypoxia, and anoxia. Monte Carlo simulation of light transport in brain tissue was used to specify relationships among RGB-values and oxygenated hemoglobin concentration (CHbO), deoxygenated hemoglobin concentration (CHbR), total hemoglobin concentration (CHbT), hemoglobin oxygen saturation (StO2), and scattering power b. Temporal courses of CHbO, CHbR, CHbT, and StO2 indicated physiological responses to reduced oxygen delivery to cerebral tissue. A rapid decrease in light scattering power b was observed after respiratory arrest, similar to the negative deflection of the extracellular direct current (DC) potential in so-called anoxic depolarization. These results suggest the potential of this method for evaluating pathophysiological conditions and loss of tissue viability.

Promoting effects of dual heart care mode on patients' health behaviors in perioperative period of coronary artery bypass surgery

Objective To evaluate the effects of dual heart care mode in perioperative period of coronary artery bypass grafting (CABG) surgery on improving health behavior in patients with coronary atherosclerotic heart disease. Methods A total of 131 patients with atherosclerotic heart disease who were treated in the Cardiac Surgery Department of Yancheng Third People's Hospital of Jiangsu Province from January 2011 to December 2016 were recruited by convenience sampling method. All the patients were divided into observation group (2014.1-2016.12, n=68) and control group (2011.1-2013.12, n=63) according to the admission date. The observation group was treated with dual heart path nursing mode, while the control group was treated with routine perioperative care. The scores of self-rating anxiety scale (SAS) , health promoting lifestyle profile (HPLP) and the incidence of adverse cardiovascular events were compared between the two groups. Results There was no significant difference in the incidence of anxiety, the scores of SAS and HPLP between the two group on admission (P>0.05) . Before surgery and 7 days after surgery, the incidence of anxiety and the score of SAS of the observation group were all lower than those of the control group, and the difference was statistically significant (P<0.05) . The score of HPLP of the observation group was higher than that of the control group before discharge, and the difference was statistically significant (P<0.05) . After surgery, there were 6 cases of adverse cardiovascular events in the observation group, and 17 cases in the control group. The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group, with statistical significant difference (P<0.05) . Conclusions Dual heart path nursing mode guides nurses to give standardized perioperative holistic nursing and psychological nursing according to predetermined care plan, so that the perioperative nursing work is more standardized, more secure and more humanized. In conclusion, it improves the quality of nursing overall. Key words: Coronary artery bypass, off-pump; Perioperative nursing; Health behavior; Dual heart path care

The association between hope, marital status, depression and persistent pain in men and women following cardiac surgery

BackgroundCardiac surgery is a major life event, and outcomes after surgery are associated with men’s and women’s ability to self-manage and cope with their cardiac condition in everyday life. Hope is suggested to impact cardiac health by having a positive effect on how adults cope with and adapt to illness and recommended lifestyle changes.MethodsWe did a secondary analysis of 416 individuals (23% women) undergoing elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013 enrolled in randomized controlled trial. Hope was assessed using The Herth Hope Index (HHI) at three, six and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations after cardiac surgery between hope, marital status, depression, persistent pain, and surgical procedure.ResultsFor the total sample, no statistically significant difference between global hope scores from 3 to 12 months was observed (ranging from 38.3 ± 5.1 at 3 months to 38.7 ± 5.1 at 12 months), and no differences between men and women were observed at any time points. However, 3 out of 12 individual items on the HHI were associated with significantly lower scores in women: #1) I have a positive outlook toward life, #3) I feel all alone, and #6) I feel scared about my future. Over the study period, diminished hope was associated with older age, lower education, depression prior to surgery, and persistent pain at all measurement points. Isolated valve surgery was positively associated with hope. While neither sex nor marital status, as main effects, demonstrated significant associations with hope, women who were divorced/widowed/single were significantly more likely to have lower hope scores over the study period.ConclusionAddressing pain and depression, and promoting hope, particularly for women living alone may be important targets for interventions to improve outcomes following cardiac surgery.Trial registrationClinical Trials gov Identifier: NCT01976403. Date of registration: November 28, 2011.

Physiotherapy following cardiac surgery: Program comparison

The objective is to examine and compare the usability of two physiotherapy programmes, analyzing respiratory function in patients before and after cardiac surgery in hospital during seven postoperative days (POD). Quantitative randomized prospective study of 157 patients before and after the valve replacement surgery, coronary artery bypass graft and combined surgeries, who moved independently. Participants were randomized into two groups (1 and 2) with different physiotherapy programmes. The routine physiotherapy of breath-enhancing techniques, micro-circulation improvement were used for the first group, for the second group - modified physiotherapy – the improvement of inspiration muscles, mm. quadriceps. gluteus max strength. Anthropometric measurements were defined for both groups on the day before surgery and during spirography - dynamic indicators - forced vital capacity (FVC), forced expiratory volume in the 2nd second (FEV1), Tiffeneau index (FEV1 / VC (%)), peak expiratory flow (PEF), operation parameters. By comparing the postoperative respiratory parameters between the two groups and using independent samples t test, it was found out that the difference in FVC between groups is 1.71 [95% CI: −8.25 to 4.8] and it is not statistically significant (t (155) = −0.52; p = 0.60). Based on the Leuven test results FVC the distribution variance is not statistically notably different for group 1 and group 2 (F = 0.27, p=0.60). Using routine and modified physiotherapy and comparing postoperative dynamic respiratory performance of the two groups, there was no statistically significant difference, proving that the two models are equally effective.

On-Pump Coronary Artery Bypass Grafting in a Patient With Renal Transplant and Familial Hypercholesterolemia

A 19-year-old male patient presented to the cardiology clinic with complaints of chest pain during efforts for a month. He had a renal transplantation when he was 12 years old. He had been diagnosed with familial hypercholesterolemia. On-pump coronary artery bypass grafting (CABG) surgery (LIMA-LAD, DI, Cx (OMI), RCA (PD)) was performed. On-pump CABG can be performed successfully in patient with renal transplant. However, renal recipients have higher risk of infection and renal damage compared with patients without transplants. In addition, as in our case, familial hypercholesterolemia would affect the clinical outcome negatively. I would like to think the sensitivity and close follow-up in standard CABG cases, and it should be applied to the highest level in such patients. J Med Cases. 2018;9(1):8-10 doi: https://doi.org/10.14740/jmc2878w

Sevoflurane-medicated the pathway of chemokine receptors bind chemokines in patients undergoing CABG

AbstractBackgroundWe aim to identify sevoflurane-induced modules and pathways in patients following coronary artery bypass graft (CABG) surgery, and to further elucidate the molecular mechanisms of the cardioprotective effects of sevoflurane.MethodsDifferential co-expression network (DCN) was constructed. Candidate modules were identified via three steps: selection of seed genes, search of modules using snowball sampling, and refinement of modules. Afterwards, the significance of the candidate modules was assessed. Ultimately, pathway analyses for genes in differential modules were implemented to illuminate the biological processes.ResultsOverall, 122 genes were identified to serve as seed genes. From every seed gene, we extracted 122 modules and the mean node size in a module was 3. By setting the classification accuracy cutoff at 0.9 and the number of nodes in a module at 5, 7 candidate modules were identified, including module 80, 82, 82, 84, 85, 86 and 89. Based on the random permutation test, we found that these 7 candidate modules were all differential ones. Moreover, pathway analysis showed that genes in the differential modules 80, 82, and 85 were all enriched in the pathway of chemokine receptors bind chemokines.ConclusionSevoflurane might exert cardioprotective functions in patients following CABG, partially through regulating the pathway of chemokine receptors bind chemokines.

Epicardial delivery of autologous atrial appendage micrografts during coronary artery bypass surgery\u2014safety and feasibility study

BackgroundThe atrial appendages are a tissue reservoir for cardiac stem cells. During on-pump coronary artery bypass graft (CABG) surgery, part of the right atrial appendage can be excised upon insertion of the right atrial cannula of the heart-lung machine. In the operating room, the removed tissue can be easily cut into micrografts for transplantation. This trial aims to assess the safety and feasibility of epicardial transplantation of atrial appendage micrografts in patients undergoing CABG surgery.Methods/designAutologous cardiac micrografts are made from leftover right atrial appendage during CABG of 6 patients. Atrial appendage is mechanically processed to micrografts consisting of atrial appendage-derived cells (AADCs) and their extracellular matrix (ECM). The micrografts are epicardially transplanted in a fibrin gel and covered with a tissue-engineered ECM sheet. Parameters including echocardiography—reflecting cardiac insufficiency—are studied pre- and post-operatively as well as at 3 and 6 months of the follow-up. Cardiac functional magnetic resonance imaging is performed preoperatively and at 6-month follow-up. The primary outcome measures are patient safety in terms of hemodynamic and cardiac function over time and feasibility of therapy administration in a clinical setting. Secondary outcome measures are left ventricular wall thickness, change in the amount of myocardial scar tissue, changes in left ventricular ejection fraction, plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, New York Heart Association class, days in hospital, and changes in the quality of life. Twenty patients undergoing routine CAGB surgery will be recruited to serve as a control group.DiscussionThis study aims to address the surgical feasibility and patient safety of epicardially delivered atrial appendage micrografts during CABG surgery. Delivery of autologous micrografts and AADCs has potential applications for cell and cell-based gene therapies.Trial registrationClinicalTrials.gov Identifier: NCT02672163. Date of registration: 02.02.2016

Abstract 23086: Impact of Rivaroxaban Alone or in Combination With Aspirin versus Aspirin in Preventing Graft Occlusion in Patients With CABG Surgery COMPASS CABG

Background: Coronary artery bypass grafting (CABG) surgery reduces mortality in patients with severe ischemic heart disease. Patients with recent CABG surgery are at risk for early graft failure which is associated with an increased risk of myocardial infarction (MI) and death. Aspirin reduces the risk of graft failure and major adverse cardiovascular events (MACE) in patients with CABG, but is only modestly effective. We hypothesized that in patients with recent CABG surgery, rivaroxaban in combination with aspirin or rivaroxaban alone would be more effective than aspirin alone for the prevention of bypass graft failure. Methods: COMPASS CABG was designed to evaluate whether rivaroxaban 2.5mg twice-daily in combination with aspirin 100mg daily or rivaroxaban 5mg twice-daily is superior to aspirin 100mg daily for prevention of bypass graft failure and vascular events in patients with recent CABG surgery. The primary outcome was graft failure and the secondary outcome was a composite of MI, stroke, or CV death. Graft patency was assessed with a CT angiogram at 1 year after surgery. Results: Between March 2013 and May 2016, the COMPASS trial randomized 27,395 patients from 602 centers in 33 countries. Of these patients, 1,488 were randomized within 4-14 days after CABG surgery. Elective CABG was performed in 78.4% of these patients. Triple vessel disease was present in 77.8% of patients, double vessel disease in 17.1% and 24.1% of patients had a left main disease. The IMA was harvested as a pedicle in 70.9% of patients and with a skeletonized technique in 29.1%. Vein grafts were harvested in an open fashion in 87.8% of patients and with a minimally invasive approach in 12.2% of patients. Conclusion: The results of COMPASS CABG will be presented on the efficacy and safety of rivaroxaban, alone or in combination with aspirin on graft patency and MACE in the long-term management of patients with recent CABG surgery.

Metformin therapy and postoperative atrial fibrillation in diabetic patients after cardiac surgery

BackgroundPostoperative atrial fibrillation (AF) commonly occurs in cardiac surgery patients. Studies suggest inflammation and oxidative stress contribute to postoperative AF development in this patient population. Metformin exerts an anti-inflammatory effect that reduces oxidative stress and thus may play a role in preventing postoperative AF.MethodsWe conducted a matched, retrospective cohort study of diabetic patients’ age ≥18 undergoing a coronary artery bypass graft (CABG) and/or cardiac valve surgery from January 1, 2009, to November 30, 2014. We extracted data from The Society of Thoracic Surgeons National Adult Cardiac Surgery Database. Primary exposure was ongoing metformin use at a dose of ≥ 500 mg in effect before cardiac surgery as captured before admission. Primary study outcome was postoperative AF incidence. Matching was used to reduce selection bias between metformin and non-metformin groups. Comparison between the groups after matching was accomplished using the McNemar test or paired t test.ResultsOut of the 4177 patients with cardiac surgery (CABG and/or valve surgery), 1283 patients met our study criteria. These patients were grouped into metformin [n = 635 (49.5%)] and non-metformin [n = 648 (50.5%)] users. Pre-matching, postoperative AF was found in 149 (23.5%) patients in the metformin group and 172 (26.5%) in the non-metformin group (p = 0.2088). Matching resulted in a total of 114 patients in each group (metformin vs. non-metformin). We found no statistically significant difference for postoperative AF between the two groups after matching (p = 0.8964).ConclusionsPrior use of metformin therapy in diabetic patients undergoing cardiac surgery was not associated with decreased rate of postoperative AF.

The effect of preoperative liver dysfunction on cardiac surgery outcomes

BackgroundTo determine the impact of preoperative Liver Dysfunction (LD) on outcomes after elective Coronary Artery Bypass Grafting (CABG) and Valvular surgery (VS).MethodsThe Nationwide Inpatient Sample (2002–2010) was queried to identify patients with LD who had elective CABG or VS utilizing ICD-9-CM diagnosis and procedure codes. These patients were matched with the similar patients without LD (controls) by propensity score matching. Chi-square and Wilcoxon rank sum tests were used for analysis.ResultsWe identified 1197 patients with LD (CABG = 755; VS = 442) who were matched to 2394 controls. LD significantly increased hospital mortality after both CABG (OR = 5.19; 95%CI = 2.93–9.20) and VS (OR = 7.49; 95%CI = 3.12–17.96). Overall rates of complications after CABG with LD were greater than in non-complicated cases (OR = 1.73; 95%CI = 1.46–2.05). Among them, there was an increase in bleeding (OR = 1.81;95%CI = 1.44–2.28), respiratory (OR = 2.33;95%CI = 1.86–2.93), renal (OR = 2.79;95%CI = 2.04–3.81), and infectious (OR = 2.93;95%CI = 2.14–4.01) complications. In general, the rates of complications after VS with LD were also greater than in non-complicated cases (OR = 2.77;95%CI = 2.13–3.60), specifically for bleeding (OR = 3.07;95%CI = 2.17–4.34), respiratory (OR = 3.57;95%CI = 2.51–5.07), renal (OR = 4.40;95%CI = 2.80–6.92), and infectious (OR = 4.63;95%CI = 2.85–7.51) complications. The development of LD significantly increased mean hospital length of stay (LOS) and total hospital charges after both CABG (from7.0 ± 4.0 to 9.2 ± 9.1 days and from $100,265 ± 87,107 to $117,756 ± 99,320, respectively; P < 0.0001 for both) and VS (from 7.9 ± 5.0 to 11.4 ± 9.9 days and from $134,306 ± 114,216 to $176,620 ± 147,049, respectively; P < 0.0001 for both).ConclusionsLD worsened the outcomes after cardiac surgery. It increased rates of complications, hospital mortality, length of stay and total hospital charges after both procedures.

P649Impact of short-term exercise training and residual ischemia on QT dispersion and double product in patients after bypass graft surgery

P649Impact of short-term exercise training and residual ischemia on QT dispersion and double product in patients after bypass graft surgery

Abstract 035: A Clinician’s Transfusion Trigger Predicts Variation in Red Blood Cell Transfusions During Cardiac Surgery

Introduction: Variation in red blood cell (RBC) transfusions persists across providers, and is thought, in part, to be attributed to a lack of consensus regarding thresholds to support transfusion decision-making. We developed standardized clinical vignettes to assess differences in inclinations to transfuse RBCs among surgeons, anesthesiologists and perfusionists in the setting of coronary artery bypass grafting (CABG) surgery. Methods: We surveyed operating room transfusion decision-makers across all 33 non-federal cardiac surgery programs in the state of Michigan. Respondents were asked for their transfusion threshold (hematocrit “trigger”). Ten clinical vignettes were developed to elicit a provider’s inclination to transfuse (on a 6-point Likert Scale) in situations having moderate (Class IIa) or weak (Class IIb) evidence to support a transfusion. Hierarchical generalized linear models were used to estimate the effect of provider type and hematocrit trigger on the inclination to transfuse across clinical vignettes. Results: There was a 45% (186 of 413) response rate. Of the respondents, 75.3% (140 of 186) reported having a hematocrit trigger, with a mean of 20.4 (SD 2.2). For every 1-unit increase in a hematocrit trigger, the inclination to transfuse increased by 0.19 points on the Likert scale (p&lt;0.001). Inclination to transfuse differed by provider type: anesthesiologists vs. perfusionists (difference: 0.71, p&lt;0.001); surgeons vs. perfusionists (difference: -0.11, p=0.51). After accounting for a provider’s transfusion trigger, the magnitude and significance of the effect diminished for anesthesiologists (difference: 0.30, p=0.06), while strengthening for surgeons (difference: -0.29, p=0.05) ( Figure ). Twenty-seven percent of the variation in a provider’s inclination to transfuse was accounted for by the transfusion trigger, while 15% of the variation was explained by the provider type. Conclusion: In our statewide survey of intra-operative transfusion decision-makers, a provider’s hematocrit trigger was the strongest predictor of variation in blood transfusions. Reducing variation in provider hematocrit triggers may serve as an effective blood management target, especially in clinical situations less well supported by evidence.

HEMODYNAMICS-BASED LONG-TERM PATENCY OF DIFFERENT SEQUENTIAL GRAFTING: A PATIENT-SPECIFIC MULTI-SCALE STUDY

Background and aims: Sequential grafting is one of the common coronary artery bypass grafting (CABG) surgery. But the influence of the sequential grafting position on hemodynamics and the graft patency is still unclear. Materials and methods: The zero-dimensional/three-dimensional (0D/3D) coupling method was used to finalize the multi-scale simulation of two different sequential grafting models. First, a patient-specific 3D model was reconstructed based on coronary computed tomography angiography (CCTA) images. Two different sequential grafts were implemented on this patient-specific 3D model by using virtual surgery. Thus, two different postoperative 3D models were built. Then, a lumped parameter model (LPM; 0D) was built based on the patient physiological data to simulate the cardiovascular system. Finally, the 0D/3D coupling method was used to perform the numerical simulation by coupling a 0D LPM of the cardiovascular system and the patient-specific 3D models. Moreover, the long-term patency of these two different sequential grafts was discussed in this paper. Results: The coronary flow rate and the graft flow were calculated and illustrated. The instantaneous wave-free ratio (iFR) were calculated. Postoperative iFR values increase to over 0.90 for both sequential grafts. Some hemodynamics parameters were also illustrated, such as wall shear stress (WSS), oscillatory shear index (OSI). The area of low WSS in Model 1 was much less than that in Model 2. Two regions of high OSI exist in Model 2, while only one in Model 1. Conclusions: No significant differences exist on the short-term outcomes of two models. But the long-term patency of Model 2 was worse. The Model 1 may enhance long-term patency of grafting and should be priority when the sequential grafting need to be carried out.

Terlipressin infusion versus norepinephrine infusion for management of postcoronary artery bypass grafting refractory hypotension: a comparative study

Objective The aim was to evaluate outcome of diabetic patients who developed refractory hypotension after coronary artery bypass grafting (CABG) surgery on using terlipressin (TP) versus norepinephrine (NE) infusions. Patients and methods A total of 44 patients were divided into two groups: group NE received NE infusion (0.1 µg/kg/min) and group TP received TP infusion (2 µg/kg/h). On cardiopulmonary bypass weaning (0 h), hemodynamic parameters, levels of blood glucose (BG) and blood lactate, serum creatine kinase-MB, and cardiac troponin T were determined. If systolic less than 90 mmHg and/or mean arterial pressure (MAP) less than 60 mmHg persisted after 5 min of adequate volume resuscitation, vasopressor infusions were started and hemodynamic parameters were recorded. If initial doses failed to achieve adequate hemodynamic stability at 10 min, the dose was increased. Postoperative levels of studied parameters were estimated. Results NE significantly whereas TP nonsignificantly increased heart rate. Both infusions induced persistently higher MAP at 10 min, 30 min, and 4 h compared with 0 h, with nonsignificantly higher MAP with TP versus NE. Both infusions increased BG levels compared with 0 h estimates, with significant difference with NE. At 24 h, serum creatine kinase-MB levels were significantly lower with TP than NE, whereas serum cardiac troponin T levels showed nonsignificant difference. Lactate clearance rate was significantly higher with TP. Conclusion Vasopressor infusion improved hemodynamics. TP did well than NE with significant increase of blood pressure measures but minimized cardiac ischemic risk and the increase of BG and blood lactate levels.

Early Mortality after Isolated Coronary Artery Bypass Grafting (CABG) Surgery Among Hospitals in Australia and New Zealand

Early Mortality after Isolated Coronary Artery Bypass Grafting (CABG) Surgery Among Hospitals in Australia and New Zealand

To Study the Effect of Post-Operative Physiotherapy Management in PostCABG Patients

Backround: Coronary Artery Bypass Graft (CABG) surgery is a form of heart surgery that redirects blood around clogged arteries to increase blood flow and oxygen to the heart. During CABG surgery, the surgeon uses a portion of a healthy vessel (either an artery or vein) from the leg, chest, or arm to create a bypass around the clogged artery. Patients typically receive 1 to 5 bypasses per operation depending on how many coronary arteries (and their main branches) are blocked. During CABG surgery with cardiopulmonary bypass a heart-lung machine artificially maintains blood circulation and oxygenation while the surgeon operates on the heart. Aims and Objectives: To increase cardiac efficiency, increase exercise tolerance or endurance and to get the effective and better post-operative results. Further at the end of the study we should be able to plan out an effective treatment plan for post-operative CABG patients and know the effect of Master 2-minute step test and 6- minute walk test in post–operative CABG patients. Methodology: Study was conducted in Hero DMC heart institute in Punjab. Sixty-seven study participants (aged between 40 years to 70 years) were randomly recruited to the study. Recruited study participants received treatment in two sessions that is master 2-minute step test procedure was used in morning and 6-minute walk test procedure was used in evening session. Assessment and reassessment was done before and after completion of treatment procedure on every day and data was collected using assessment format for 3rd and 7th day. Outcome measures: Primary outcome in both master 2- min step test and 6-min walk test showed that there occurs decrease in heart rate, respiratory rate, increase in oxygen saturation and decrease in exertion. Secondary outcomes included more decrease in heart rate, respiratory rate and fatigue and increase in oxygen saturation. Improvement in faster heart function elaborated from the Heart rate (p<0.05) with both procedures that is master 2-minute step test and 6- minute walk test. Conclusion: The result obtained after statistical analysis shows that both master 2-minute step test and 6-minute walk test has the additional advantage of faster recovery as analyzed from mean of the before and after exercise using Tukey’s method on both of 3rd day and 7th day.

Combined Analysis of Endothelial, Hematopoietic, and Mesenchymal Stem Cell Compartments Shows Simultaneous but Independent Effects of Age and Heart Disease.

Clinical trials using stem cell therapy for heart diseases have not reproduced the initial positive results obtained with animal models. This might be explained by a decreased regenerative capacity of stem cells collected from the patients. This work aimed at the simultaneous investigation of endothelial stem/progenitor cells (EPCs), mesenchymal stem/progenitor cells (MSCs), and hematopoietic stem/progenitor cells (HSCs) in sternal bone marrow samples of patients with ischemic or valvular heart disease, using flow cytometry and colony assays. The study included 36 patients referred for coronary artery bypass grafting or valve replacement surgery. A decreased frequency of stem cells was observed in both groups of patients. Left ventricular dysfunction, diabetes, and intermediate risk in EuroSCORE and SYNTAX score were associated with lower EPCs frequency, and the use of aspirin and β-blockers correlated with a higher frequency of HSCs and EPCs, respectively. Most importantly, the distribution of frequencies in the three stem cell compartments showed independent patterns. The combined investigation of the three stem cell compartments in patients with cardiovascular diseases showed that they are independently affected by the disease, suggesting the investigation of prognostic factors that may be used to determine when autologous stem cells may be used in cell therapy.

Acute kidney injury following cardiopulmonary bypass surgery

In spite of recent advances in the techniques of cardiopulmonary bypass (CPB), both incidence and mortality rates associated with acute kidney injury (AKI) post CPB remain high. Perioperative risk factors for the AKI include advanced age, diabetes mellitus, underlying kidney disease, and poor cardiac function. Attempts should be made to avoid or modify risk factors such as anemia, preoperative contrast exposure, and excessive hemodilution. The benefits of off-pump coronary artery bypass graft (CABG) surgery on AKI remain equivocal. Well-controlled randomized studies are needed to further clarify the role of various pharmacologic agents such as atrial natriuretic peptides and fenoldopam on the prevention of AKI post-CABG. Continuous renal replacement therapy is preferable to intermittent hemodialysis in patients needing dialysis.

Predictive value of myocardial viability on the volume change of left ventricle after coronary artery bypass graft

Objective To evaluate the predictive role of myocardial viability assessed by 99Tcm-MIBI GSMPI and 18F-FDG PET on the volume change of the left ventricle(LV) after coronary artery bypass graft (CABG) operation. Methods From December 2013 to December 2014, 39 patients (37 males, 2 females; average age (64±9) years) with ischemic cardiomyopathy planned for surgical revascularization in the Third Affiliated Hospital of Soochow University were prospectively recruited. All patients underwent 99Tcm-MIBI GSMPI and myocardial 18F-FDG PET to assess myocardial viability preoperatively and GSMPI to assess myocardial perfusion 3-6 months after CABG. Reduction of LV volume ≥10% was considered significant. Patients were divided into two groups based on the reduction of LV volume, and the clinical data were compared between the two groups including gender, age, BMI, history of hypertension, diabetes, hyperlipidemia, angina pectoris, CCS classification for angina pectoris, NYHA classification for functional status, EDV, ESV, LVEF, preoperative creatinine, Gensini score, the number of viable myocardium, scar and normal myocardium and follow-up duration, by independent-sample t test, χ2 test and Mann-Whitney test. Multivariate logistic regression analysis was performed to determine the factors to predict reduction of LV volume after revascularization. ROC curve analysis was performed to determine the cut off number of hibernating segments for reduction of LV volume after revascularization. Results The number of viable segments in the reduced group (n=26) was significantly higher than that in the non-reduced group ((n=13; 4.5±2.8 vs 2.4±1.5; t=-3.011, P 0.05). The number of viable segments was directly related to reduction of LV volume after revascularization (odds ratio(OR)=2.462, P<0.05). ROC curve analysis revealed that 3 viable segments yielded the highest sensitivity, specificity and accuracy (all were 76.92%; 10/13, 20/26, 30/39) for predicting reduction of LV volume, and the AUC was 0.743. The rate of LV volume reduction in patients with more than 3 viable segments (86.96%, 20/23) was higher than that of patients with less than 3 viable segments (37.50%, 6/16; χ2=10.39, P<0.01). Conclusions The reduced group has more viable segments and less scarring segments than the non-reduced group. The number of viable segments is directly related to LV volume reduction after revascularization. The presence of more than three mismatched segments on GSMPI and myocardial 18F-FDG PET in patients with ischemic cardiomyopathy before CABG is an independent predictor of LV volume reduction. Key words: Coronary disease; Coronary artery bypass; Myocardium; Ventricular function, left; Tomography, emission-computed; Tomography, emission-computed, single-photon; Deoxyglucose; MIBI