CABG Patient Research Articles

Statins have profound effects on the epicardial fat transcriptome

Abstract Background Epicardial adipose tissue (EAT) has direct contact with the myocardium, which enables a common microcirculation allowing bidirectional signaling between the tissues. It is possible that a change in the balance of protective and damaging mediators produced by EAT is a major driver for myocardial dysfunction. Notably, EAT volume and thickness associate with increased pro-inflammatory secretome and with coronary artery disease (CAD). Purpose This aim of this study was to analyze the total transcriptome in EAT and relate putative differences between patient groups to metabolic parameters as well as ongoing medications. Methods Between 2011 and 2016, 44 patients (mean age 68.0 years, 18.2% women) had a biopsy taken from the epicardial fat during coronoray by-pass surgery (CABG, n=36), or during elective aortic valvular replacement due to aortic stenosis (AVR, n=8). RNA from epicardial fat biopsis was extracted and sequenced. Differentially expressed genes were obtained by custom scripts that performed a negative binomial distribution test on effective counts. Multivariate regression analysis with orthogonal partial least-squares-discriminant analysis (OPLS-DA) was applied to extract and interpret the systematic variation in the resolved RNA sequencing profiles. To identify enrichment of biologically relevant functional gene sets, our data were entered in evidence-based network enrichment analysis (EviNet). Results The CABG surgery was performed approximately 7 days after an acute coronary event (75% acute MI), and 44% of them had previously known CAD. None of the AVR cases had significant CAD. At surgery, 97% of the CABG cases were prescribed statins, and 36% of them had statins alredy before the actual admission (long-term statin treatment). 63% of the AVR cases were on statins at admission. The OPLS analysis revealed only one medication with significant outcome, i.e., patients with long-term treatment with statins (n=18) versus patients without (n=26). Long-term statin treatment associated with down-regulated gene expression involved in beta-oxidation and triglyceride biosynthesis whereas gene expression involved in extracellular matrix organization were up-regulated. Gene expression involved in MHC class II presentation and interferon signalling were also reduced in patients with long-term treatment with statisn. A downregulation of genes in the interleukin- and complement cascade genes among CABG patient (versus AVR patients) without long-term statin treatment showed normal levels in statin pretreated patients. Conclusion Long-term statin treatment has a major influence on transcriptional regulation of genes involved in beta-oxidation, triglyceride biosynthesis, extracellular matrix composition, MHC class II presentation and interferon signalling in epicardial adipose tissue. These findings support important metabolic and immune effects of statins beyond the lipid-lowering function.

428 Progressive shortness of breath in a post CABG patient: Thinking beyond the obvious

Abstract Background Post-coronary artery bypass graft (CABG) chylothorax is rare accounting for 0.06-0.09% of the cases. Case presentation A 62 year old male patient presented with progressive shortness of breath (mMRC grade 1 to 3) for 6 months. He underwent CABG surgery 7 months prior due to ischemic heart disease. Clinical examination supplemented with radiological imaging revealed evidence of progressive bilateral pleural effusion. Pleural fluid aspiration showed bloody appearance of fluid on right side. Lipid analysis of the aspirate confirmed presence of chylomicrons along with a raised triglyceride level(138mg/dL). Clinical outcome A diagnosis of right-sided post CABG chylothorax with left sided transudative fluid was made. Patient was managed with ICD insertion on the right side and started on total parenteral nutrition (TPN). This was followed by permissible carbohydrate intake and TPN for 11 days. Gradual decrease in collection was noticed in the follow-up x-ray with no recurrence of symptoms. Discussion Most likely that the anterior mediastinal lymphatic chain got injured during the harvesting of internal mammary artery causing leakage of chyle into the thoracic cavity leading to dyspnoea and chest discomfort. Conclusion Lipid measurements may be indicated in all patients with undiagnosed pleural effusion in order to rule out chylothorax. Chylothorax can meet criteria of transudate if associated with congestive cardiac failure, cirrhosis, or nephrotic syndrome. However, the colour of pleural fluid is not always indicative of a chylothorax. While most of the patients can be managed conservatively, surgery is recommended if drainage lasts for more than 1-3 weeks, and daily drainage is 200-500mL.

35 Years Angiographic Follow Up Of Atherosclerotic Cardiovascular Disease Including Redo Cabg, Carotid Artery Stenting & Multiple Interventions To Saphenous Venous Grafts

Percutaneous coronary intervention (PCI) has got more benefit as compared to redo CABG in terms of morbidity & mortality in patients presented with degenerated CABG grafts. We report a case of post CABG patient treated successfully with multiple PCI to SVG grafts- a 35 years follow up.

Abstract 16718: The Impact of Prior Revascularization in Acute Myocardial Infarction Patients With Cardiogenic Shock: Prior Bypass Surgery a Marker of Worse Outcome?

Background: Cardiogenic shock (CS) in patients with acute myocardial infarction (AMI) is a marker of worse prognosis with extremely high mortality rates. We assessed the impact of previous surgical revascularization by CABG or percutaneous coronary intervention (PCI) on in-hospital outcomes of AMI patients with CS undergoing primary PCI. Methods: Between 1/2010 and 5/2019, a total of 1,170 patients were diagnosed with AMI and CS, defined by New York State Percutaneous Coronary Interventions Reporting System (PCIRS) as acute and persistent systolic blood pressure <80 mmHg on mechanical or pharmacological support. Baseline clinical, angiographic and procedural characteristics, as well as in-hospital outcomes were prospectively collected among all patients undergoing primary PCI as part of the New York State PCIRS data collection. Results: There were no significant baseline differences between the two groups. Patients with a prior CABG were older and had a history of congestive heart failure. All other risk factors were similar (Table). There was a trend towards higher mortality rates in post CABG patients but longer length of stay in post PCI patients. The combined endpoint of death, reinfarction, acute kidney failure requiring dialysis or stroke (MARCCE) was numerically higher in post CABG patients but did not reach statistical significance. Conclusions: The results of this study show that in patients with AMI and CS undergoing PCI: 1) Patients with a prior history of CABG are usually older at presentation and had a prior history of heart failure; 2) there was a trend to higher in-hospital mortality rates in post CABG patient but MARCCE rates were similar in both groups.

Perioperative management of liver transplantation in a post CABG patient with very low ejection fraction – A challenging case

Perioperative management of liver transplantation in a post CABG patient with very low ejection fraction – A challenging case - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/j.ijca.2020.133, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Frequency of Shoulder Pain and Disorders among CABG Patients in District Rawalpindi

Objective: To determine the frequency of shoulder pain among patients undergone coronary artery bypass grafting. Methodology: The descriptive cross sectional study was conducted at Rehabilitation department of Armed forces institute of cardiology/national institute of heart disease (AFIC/NIHD) Rawalpindi, Pakistan in 6 months from Mar 2019 to Aug 2019. The total calculated sample size was 378. Data was collected through survey by using self-structured questionnaire on Shoulder Pain and Disability Index and Numeric Pain Rating Scale. Male and female post CABG patients with age of 45 to 75 years and 1st week to 6 months postoperatively were included while shoulder pain due to neurological conditions and valvular surgery were excluded. Results: Out of 378 post CABG patient’s males were 324(85.7%) and females with post CABG were 54 (14.2%). Frequency of pain on SPADI pain subscale was 293(77%), SPADI disability subscale was 245(64%) and mean of SPADI was 63.70+14. Conclusion: It is concluded that there is high frequency of shoulder pain and disability among post-CABG patients. Keywords: Coronary arteries bypass grafting, disorders, Pain, Shoulder

Efficacy of Nadishodhan Pranayama - Alternate Nostril Breathing (ANB) on Functional Improvement in Post CABG Patient

Introduction CAD is a narrowing or blockage of the arteries or vessels that provide oxygen and nutrients to the heart due to atherosclerotic plaque formation on the inner lining of the arteries. 50% 0f patient with CAD present with sudden death (cardiac arrest) as their first symptom.CAD is the c

Extubation time and postoperative blood pressure in CABG patient

Extubation time and postoperative blood pressure in CABG patient

Failure of Stent Delivery in Lima PCI

AbstractBack Ground: The internal mammary artery was the most effective conduit for coronary artery bypass surgery and it was associated with significantly better long term patency, survival, and reintervention rates compared to other bypass conduits. The internal mammary artery (IMA) is not immune to atherosclerosis. IMA interventions constitute low percentage out of all coronary interventions. In addition to the tortuous course, the long length of IMA than native coronaries adds procedural difficulties to IMA PCI.Aim: To analyze the acute outcomes of Percutaneous intervention procedures to the internal mammary artery and to found any association with clinical and demographic parameters to the procedural success at a single tertiary care hospital from IndiaMaterials And Methods: This study was a retrospective analysis of post CABG patient who required and undergone the IMA intervention. We collected the clinical, demographic and procedural details of the IMA intervention. We defined as failure of the procedure when the stent could not be delivered to the lesion site through IMA.Results: Total 21 patients were included in this retrospective analysis. Mean age of the study population was 56.1± 9.98 years and 18 patients were male. Twelve (57.1%) patients presented with chronic stable angina and six (28.6%) had Left ventricular dysfunction (LVD) (mild LVD in 5 and one patient had severe LVD). Mean stent diameter was 2.75±0.442 mm and the mean stent length was 17.71 ±5.63 mm. Transient slow flow occurred in 5 patients, but the end result of PCI procedure was good in them. In 4 (19.1%) patients stent could not be delivered. No LIMA dissections were observed. On binary logistic regression, there was no significant difference between successful PCI to the failed PCI with respect to age (p=0.9, z=0.16, OR=0.99, 95%CI=0.83to1.17), male sex (p=0.7, Z=0.34, OR=1.68), type of presentation (p=0.7, Z=0.38, OR=1.60, 95%CI= 0.14 to 17.7), presence of Left ventricular dysfunction (p=0.7, z=0.38, OR=1.60, 95%CI= 0.14 to 16.97) and with pre-dilatation during PCI (p=0.9, z=-0.16, OR=0.99).Conclusion: PCI to the internal mammary artery was associated with 80.95% of success. Not able to deliver the stent to the target lesion was the major problem with LIMA PCI, in addition, to slow or no flow. The success or failure of PCI were not dependent on the age, sex, type of presentation or LV dysfunction.

Estimating The Value Of Cangrelor From Eliminating Preloading In Coronary Artery Bypass Graft (Cabg) Patients.

2011 AHA and 2012 ESC guidelines recommend antiplatelet therapy at presentation for suspected ACS patients. For CABG patients (approximately 10% of ACS presentations) this strategy creates a dilemma: delay CABG to washout antiplatelet therapy or perform surgery and risk bleeding. Bridging strategies have been proposed using GPIs. Cangrelor, a novel reversible, IV P2Y12 inhibitor with rapid onset/offset, demonstrated in the CHAMPION PHOENIX trial a reduction in ischemic events vs. clopidogrel in patients undergoing PCI. Adoption of cangrelor for angiography in ACS patients eliminates the need to washout an oral P2Y12inhibitor in case of unanticipated CABG. The aim of our analysis was to quantify the annual value of this pathway change to a US hospital. A decision analytic model based on the current CABG patient pathway was developed to quantify the value of a reduction in bridging by adopting cangrelor from a US hospital perspective. Premier hospital database informed the timing of CABG after washout; demographics, drug-mix, LOS, blood product utilization, and hospital ward costs. Ischemic event rates and costs were informed by published sources. Drug costs were 2014 wholesale acquisition costs. Cangrelor cost was set to $0. For a hypothetical US hospital treating 195 CABG patients/year (patient mix: 4% STE-ACS, 26% NSTE-ACS, 70% SA), shifting away from bridging with GPI by adopting cangrelor resulted in a total annual cost reduction of $120,000. Total costs in the base-case are estimated to be $2.95MM vs. the scenario case of $2.83MM. Cost savings were derived from eliminating GPI utilization, lowering washout drug costs and reducing hospitalization days. Removal of the need to washout oral antiplatelet therapy prior to CABG through adoption of cangrelor is estimated to deliver a clinical value of ~$615/CABG patient with fewer total days spent hospitalized.

Leukemoid like reaction in a post CABG patient.

The presentation of leukemoid reaction in patients post-cardiac surgery is rare with limited prior reports in the English language literature. We report a case of raised leukocyte count with no evidence of infection in a patient post coronary artery bypass graft surgery. The exaggerated inflammatory response by the patient to extra-corporeal circulation was drastically elevated, but fell short of the leukaemoid reaction definition – so we have defined it as a leukaemoid like reaction. A clear correlation between the extra-corporeal circulation and inflammatory response is documented.

Outcome of Tight Versus Standard Glycemic Control in Coronary Artery Bypass Patients

Abstract Objectives : To compare the outcome of tight versus standard glycemic control and its impact on post oper-ative morbidity and short term mortality in patients undergoing Coronary Artery Bypass Grafting (CA-BG). Patients and Methods : A prospective surveillance of 124 patients undergoing isolated CABG surgery (on pump) was included in the study, 62 patients in each group were randomly assigned to tight and standard glucose control group. The main exposure was insulin in respect to level of blood glucose and the primary outcome measures were Sternotomy wound infection, Leg wound infection and new Myocardial Infarction. Surgical Site infection was assessed on a daily basis during the patient's stay in the Department of Cardio-thoracic Surgery, Sheikh Zayed Hospital, Lahore or within 30 days of operation prompting the patient to return to the hospital. Chi-square test or test was used to identify the significance of various short term morbidities and mortality. Results: In this study, 12 patients in the standard group and 4 patients in the tightly controlled group developed Sternal wound infection (p value 0.046). Similarly, 9 versus 2 patients in the standard and tight group respectively developed Leg wound infection (p-value 0.035). Test of proportion was applied and it was found that there was significant difference in the pro-portion of infection in the two groups (p value 0.05). However, there were no significant differences in other morbidities and the short term mortality. Conclusion: Study confirmed that tight glucose con-trol post operatively in CABG patient's results in redu-ced sternal and leg wound infection rates; however, there was no effect on other morbidities and short term mortality. Key words: Glycemic control, Coronary artery by-pass grafting, Surgical Site Infections.

Coronary Artery Bypass Graft Surgery Patient Education: A Systematic Review

Patient education post-coronary artery bypass graft (CABG) surgery is an essential component of nursing care aimed at assisting patients in caring for themselves at home, following discharge from hospital. While there has been a recent interest in conducting meta-analysis and systematic reviews on the effectiveness of patient education during the preoperative period, no review was found on the topic of postoperative CABG patient education. This systematic review addressed the clinically-relevant questions: what approach, mode, and dose is most effective in producing changes in CABG patient education? Studies were included in the systematic review if they met the following selection criteria: (1) the sample represented adult (> or =18 years) patients who underwent CABG surgery; (2) the educational intervention involved the provision of self-care information following surgery but before discharge from hospital; (3) the outcome assessed related to self-care behavior; and (4) the study report was published in English between 1986 and 2008. A descriptive synthesis was used to code and extract data on publication information, study design, sample size, and quality of study, as well as postoperative CABG teaching, self-care behavior performance, and demographic characteristics of the patients who participated in the studies. A quantitative synthesis consisted of a statistical approach, which was used to calculate the magnitude of the treatment effects on self-care behavior. Results indicated larger effect sizes for CABG patient education in which the content was individualized, and given in a combination of media on an individual basis, and in more than one session.

Timing for Delivering Individualized Patient Education Intervention to Coronary Artery Bypass Graft Patients: An RCT

The primary focus of this study is on the timing of the delivery of education to patients who had CABG surgery. To determine the efficacy of an individualized telephone patient education intervention, delivered at two different points in time (1-2 days pre-discharge versus 1-2 days post-discharge) in enhancing the CABG patient's knowledge of self-care behaviours, performance of self-care behaviours, and symptom frequency. A randomized clinical trial that included a convenience sample of first time CABG patients. Individuals who received education pre-discharge were compared to individuals who received education post-discharge on the outcomes. Results indicated no statistically significant difference in outcomes between the two time points. As well, anxiety levels were found to be significantly higher in the pre-discharge group than the post-discharge group. The individualized nature of the educational intervention may have accounted for non-significant findings reported in outcomes between the two time points. Nurses may consider assessing anxiety levels prior to delivery of educational interventions, implement interventions aimed at reducing anxiety levels, and provide individualized teaching.

Corrigendum

British Journal of HaematologyVolume 132, Issue 4 p. 533-533 Free Access Corrigendum First published: 10 January 2006 https://doi.org/10.1111/j.1365-2141.2005.05896.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In Orr et al (2005) the Y-axes labels were omitted from Fig. 1. The correct figure is reproduced below. Figure 1Open in figure viewerPowerPoint A CD10−/CD16low neutrophil sub-population emerges in the peripheral blood during neutrophilia induced by CABG. Whole blood flow cytometry was used to determine neutrophil CD10 and CD16 expression on blood from CABG patients. A. Representative dot plot of neutrophils from a CABG patient at baseline (C1). Neutrophils are represented by events in the upper and lower right quadrants; CD10−/CD16− events in the lower left quadrant represent the contaminating eosinophil population. B.Representative dot plot of neutrophils from the same CABG patient early post-operatively (C6) demonstrating appearance of a CD10−/CD16low subpopulation (lower right quadrant events). We apologise for this error. Reference Y. Orr, J. M. Taylor P. G. Bannon, C. Geczy & L. Kritharides (2005) Circulating CD10−/CD16low neutrophils provide a quantitative index of active bone marrow neutrophil release. British Journal of Haematology, 131, 508– 519. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume132, Issue4February 2006Pages 533-533 FiguresReferencesRelatedInformation

Antiphospholipid syndrome in cardiac surgery—an underestimated coagulation disorder?☆

Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with recurrent arterial and venous thrombotic events. We analysed our experience with five APS patients who underwent cardiac surgery. In three of them the diagnosis of APS had been established before surgery, two patients were diagnosed after surgery. From March 1999 to March 2004 five patients with APS underwent cardiac surgery using cardiopulmonary bypass (CPB). We retrospectively reviewed their clinical data, operative and postoperative courses, and the long-term results. Procedures performed were heart and lung transplantation (patient 1), endoventriculoplasty and CABG (patient 2), biventricular resection of endoventricular fibrosis and thrombus (patient 3), mitral valve repair repair and coronary artery bypass grafting (CABG, patient 4), and mitral valve replacement with closure of a patent foramen ovale (patient 5). There were three perioperative deaths (patients 1, 2 and 3), two of three patients in whom the diagnosis was known before surgery, survived (patients 4 and 5). In these patients, only half the dose of protamin (patient 4) and no protamin at all (patient 5) was applied to reduce the probability of postoperative thromboembolic complications. At 1 year follow up, only patient 4 had survived, patient 5 had died of the complications of intestinal thromboembolism. Patients with APS undergoing cardiac surgery belong to a high risk subgroup. Thus, though rare, APS can be a critical issue in cardiac surgery. Some of the cardiac patients with unexplained perioperative thromboembolic complications, such as graft occlusion, may turn out to have an undiagnosed APS.

PCV33: COST-ANALYSIS OF CABG SURGERY IN PATIENTS WITH AND WITHOUT RETHORACOTOMY FROM THE HOSPITAL PERSPECTIVE IN GERMANY

OBJECTIVES: German hospitals receive the same reimbursement by the statutory health insurance for CABG surgery irrespective of whether or not a rethoracotomy, which involves higher in-hospital costs, has to be performed following hemorrhage. In order to evaluate the in-hospital costs for CABG with and without rethoracotomy from the hospital perspective, a cost-analysis of CABG surgery was performed. Furthermore, the cost-effectiveness of prophylactic administration of the antihemorrhagic agent aprotinin was investigated. METHODS: The detailed resource utilization of 138 CABG patients, 68 with rethoracotomy and 70 without, was analysed based on sample of patient medical records from 7 German hospitals. Resource costs were provided by hospital administrations and supplemented by literature. The overall costs for both groups were then combined with rethoracotomy rates in patients with and without prophylactic administration of aprotinin derived from a published meta-analysis of all relevant clinical trials in open heart surgery. RESULTS: The total in-hospital costs per patient with CABG were on average DM 21,241 and increased to DM 31,326 for a CABG patient requiring rethoracotomy. Besides the costs of the rethoracotomy, the costs of intensive care were the main cost driver in patients with rethoracotomy. The meta-analysis showed with statistical significance that aprotinin can reduce the rethoracotomy rate from 5.0% to 1.8% in patients undergoing heart surgery. When combining the cost data with the results of the meta-analysis, the expected average costs per patient treated with aprotinin (including drug costs) were DM 21,432 compared to DM 21,655 per patient without aprotinin treatment. A cost-effectiveness analysis (costs per patient without rethoracotomy) resulted in a difference of DM 970 in favour of the prophylactic antihemorrhagic treatment. CONCLUSION: The analysis showed that CABG patients requiring an additional rethoracotomy generated about 47% higher costs than patients with CABG surgery only. The administration of the antihemorrhagic agent aprotinin can be recommended in the light of the reduced complication rate and improved cost-effectiveness of CABG-surgery.

Comparison of the effects of three bolus infusion regimes with propofol on systemic & coronary haemodynamics & right ventricular function in CABG patient

Comparison of the effects of three bolus infusion regimes with propofol on systemic & coronary haemodynamics & right ventricular function in CABG patient

The gastroepiploic arteries as alternative coronary artery bypass conduits

The indications for GEA grafting may expand due to increased coronary bypass demand and superior patency. The utilization of the right GEA as an alternative conduit may become a future trend for complex CABG patient populations. Nurses must document more cases and conduct more research to guide future nursing actions.