CABG Patients Research Articles

Outcomes of del Nido cardioplegia after surgical aortic valve replacement and coronary artery bypass grafting.

The use of del Nido cardioplegia (DNC) was initially adopted in the field of pediatric cardiac surgery. Several studies in adult patients suggested there were no differences in early postoperative outcomes as compared to blood-based cardioplegia. We sought to evaluate the impact of DNC as compared to modified Buckberg cardioplegia (BC) on early postoperative outcomes in patients undergoing surgical aortic valve replacement with and without coronary artery bypass grafting (SAVR ± CABG). All SAVR ± CABG procedures were switched from BC to DNC at our institute in 2012. We compared outcomes of BC (November 2007-October 2012; n = 1037) with DNC (November 2012-December 2017; n = 1067). Significant baseline differences were observed between the two groups and such differences were adjusted via inverse propensity treatment weighting. After adjustment, SAVR ± CABG patients who received DNC required longer aortic cross-clamp times, while postoperative peak troponin I and creatinine kinase-MB isotype were significantly lower in the BC group. Length of hospital and intensive care unit stay were significantly shorter in the DNC group. The incidence of postoperative complications was lower in the DNC cohort. Thirty-day mortality rate was significantly lower in the DNC group (3.0% vs 4.9%, p = 0.002). The use of DNC cardioplegia in our cohort of adult patients who underwent SAVR ± CABG was safe and associated with improved postoperative outcomes. However, the use of DNC may be associated with higher degrees of myocardial injury.

The Effect of Coronavirus Outbreak on the Utilization of Coronary Revascularization Procedures: An Interrupted Time Series Analysis

The coronavirus disease 19 (COVID-19) pandemic represented a great challenge for health systems, which had to quickly readapt and dedicate most of their resources to managing this crisis. The postponement of programmed interventions such as coronary revascularization procedures represented a critical issue in the first wave of the COVID-19 pandemic, especially in the hardest-hit countries such as Spain. However, the precise consequences of the delay of coronary revascularizations are not clearly determined. In the present work, interrupted time series (ITS) analysis was used to evaluate the utilization rates and assessment of the risk profiles of patients receiving two main coronary revascularization procedures (percutaneous coronary intervention-PCI and coronary artery bypass graft-CABG) and compared them in the periods before and after March 2020 using the Spanish National Hospital Discharge Database (SNHDD). Our results show that the abrupt reorganization of hospital care that represented the first wave of COVID-19 in March 2020 in Spain led to a reduction in cases, which was accompanied by an increase in the risk profile of CABG patients, but not PCI. On the other hand, the risk profile of both coronary revascularization procedures began before the pandemic, showing a significant temporal trend toward an increase in the risk profile. Future works should be directed to study and validate our results, evaluating other databases, regions, or countries.

Microarray Profiling of Differentially Expressed Genes in Coronary Artery Bypass Grafts of High-Risk Patients with Postoperative Cognitive Dysfunctions.

Postoperative cognitive dysfunction (POCD) is cognitive decline after surgery. The authors hypothesized that gene-level changes could be involved in the pathogenesis of POCD. The present study evaluated the incidence of POCD and its associated differentially expressed genes. This was a prospective cohort study conducted on high-risk coronary artery bypass graft patients aged 40 to 75 years. POCD classification was based on a one standard deviation decline in the postoperative scores compared to the preoperative scores. The differentially expressed genes were identified using microarray analysis and validated using quantitative RT-PCR. Forty-six patients were recruited and completed the study. The incidence of POCD was identified using a set of neurocognitive assessments and found to be at 17% in these high-risk CABG patients. Six samples were selected for the gene expression analyses (3 non-POCD and 3 POCD samples). The findings showed five differentially expressed genes in the POCD group compared to the non-POCD group. The upregulated gene was ERFE, whereas the downregulated genes were KIR2DS2, KIR2DS3, KIR3DL2, and LIM2. According to the results, the gene expression profiles of POCD can be used to find potential proteins for POCD diagnostic and predictive biomarkers. Understanding the molecular mechanism of POCD development will further lead to early detection and intervention to reduce the severity of POCD, and hence, reduce the mortality and morbidity rate due to the condition.

Effect of modified ultrafiltration in patients undergoing coronary surgery using cardiopulmonary bypass. A literature review

Aim: The purpose of this research is to describe the benefits of modified ultrafiltration (MUF) in cardiac surgery patients, especially in coronary revascularization patients. Introduction: The modified ultrafiltration is the new generation of ultrafiltration, which is used to filtrates the excess water and low molecular weight substances like IL-6, IL-8, TNF and endothelin out of the blood. These excess fluid and low molecular weight substances are the main factors of post-operative complications in coronary artery bypass graft patients. There is limited information about the use of MUF in adult surgery, but is mostly used in congenital cardiac surgery patients. It is found to be very beneficial in pediatric cardiac surgery, but we need more data for using it in adult cardiac surgery Material and Methods: This is a review article; in which we used the articles collected from world’s creditable journals and platforms. These articles have published since 2000. Results: From articles which we reviewed, 17 were about the benefits of MUF in congenital cardiac surgery and 8 articles were about the favorable effects of MUF in adult cardiac surgery. The rest of the articles were related indirectly to the MUF. About 5 of these researches proved the beneficial role of MUF on lungs functions after surgery, in 4 researches confirmed the significant decrease in post-operative bleeding and the need for blood transfusion, in 5 researches it has been measured that the level of inflammatory factors like interleukins, TNF and endothelin were decreased. In 6 articles the role of MUF in welfare of kidney functions were emphasized. And 1 article discussed about the benefits of MUF on cerebral metabolism correction. Nearly in all of the articles it was mentioned that MUF decreases the time of ventilation and vigorous urination after surgery. Conclusion: Modified ultrafiltration (MUF) is a technique which decreases the post-operation complications due to cardio-pulmonary bypass, and could be beneficial in CABG patients.

Frequency of the clinical indicators of ‘ineffective airway clearance’ among patients after coronary artery bypass grafting at tertiary care hospitals Karachi, Pakistan.

Objective: To determine the frequency of the clinical indicators of ineffective airway clearance among patients after Coronary Artery Bypass Grafting at tertiary care hospitals in Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Dow University Hospital (DUH), Ojha Campus, and Tabba Heart Institute (THI) Karachi. Period: December 2019 to July 2020. Material & Methods: A total of 113 patients were enrolled after CABG surgery through purposive sampling nine clinical indicators were assessed in post-CABG patients for the presence of Ineffective Airway Clearance (IAC). A data collection tool with demographic variables and nine clinical indicators (defining characteristics) of IAC was used. The association of clinical indicators with IAC was determined through the Fisher Exact Test. Results: The mean age of study patients was 57.50± 9.107 years. IAC was found in 105 (92.9%) patients in post-CABG surgery patients within 24 hours of intubating of the ventilator. The most frequent clinical indicator was adventitious breath sounds (ABS) which has shown up in 90 (79.6%) patients of the study population. The majority of the indicators were found to be statistically significantly associated with IAC. Conclusion: This study concludes high incidence of IAC 92.2% among the study population of post CABG patients. The most frequent clinical indicator were ABS, excessive sputum, and ineffective cough.

Patients’ experiences regarding severe leg wound infection associated with coronary artery bypass grafting: A qualitative study

IntroductionCoronary artery bypass grafting (CABG) is the most common cardiac surgery throughout the world. The most commonly used graft is the saphenous vein. Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2% to 20%. Surgical site infection can be long-lasting, and the wound healing can be difficult and also presumably troublesome for the patient. CABG patients’ experiences of severe infection in the harvesting site have not been studied before. Aim: The aim of this study was to describe patients’ experiences associated with acquiring a severe infection in the harvesting site after CABG. MethodA qualitative study with descriptive design was conducted at the department of vascular and cardiothoracic surgery in a Swedish university hospital from May to December 2018. Patients diagnosed with a severe surgical site infection in the harvesting site following CABG were included. Data from 16 face-to-face interviews were analysed with inductive qualitative content analysis. ResultThe main category, varying impact on body and mind, was the core of the patients’ experiences of severe wound infection in the harvesting site after CABG. Two generic categories were identified: physical impact and thoughts about the complication. The patients described experiencing different degrees of pain, anxiety, and limitation in daily life. ConclusionThese findings indicate that a severe infection in the harvesting site after CABG was experienced as an important issue with varying impact. Overall, the participants experienced pain, anxiety, and limitations in daily life. However, most of them were satisfied with the outcome after the wound had healed. Patients should be advised to seek care at an early stage if symptoms of infection occur. Improved individual pain management is needed for those with severe pain, and varied experiences imply a need for person-centred care.

NUMBERS AND FUNCTION OF PLATELETS ARE NOT REDUCED DURING CARDIOPULMONARY BYPASS, BUT BOTH ARE REDUCED AFTER ADMINISTRATION OF PROTAMINE

<h3>Objective</h3> To assess changes in numbers and function of platelets during cardiopulmonary bypass (CPB) in CABG surgery. <h3>Methods</h3> Platelet concentration and numbers corrected for hemodilution using hemoglobin as a marker were measured before anesthesia induction (Baseline), at the end of CPB (End CPB), after administration of protamine (After protamine), at arrival at the ICU (ICU) and after 3 hours in the ICU (ICU 3h). Platelet function was assessed after activation with thrombin PAR1-receptor activating peptide (TRAP) and adenosine diphosphate (ADP), with both flow cytometry for fibrinogen receptor activation and impedance aggregometry. Flow cytometry data are presented as median fluorescence intensity (MFI), impedance aggregometry data as area under the curve in units (U). Mean ± SD and repeated measures mixed effects model together with Šídák's multiple comparisons test was used. Subsequent time points were compared to baseline. In addition, "After protamine" was compared to "End CPB". <h3>Results</h3> Thirty-nine CABG patients with mean CPB time 85.1 ± 21.3 mins were studied. During CPB platelet concentration decreased from 227 ± 48 *109/L at baseline to 179 ± 38*109/L at end of CPB (p<0.001), remained at 171 ± 41*109/L after protamine, but increased to 204 ± 48*109/L at ICU 3h (p<0.001 vs baseline). Corrected for hemodilution the number of platelets increased during CPB from 1.73 ± 0.41*109/g to 1.91 ± 0.49 *109/g (p<0.001) but decreased to 1.74 ± 0.51*109/g after protamine (p<0.01 vs End CPB), and then increased to 1.82 ± 0.48*109/g at ICU 3h (p<0.01 vs Baseline). Activation of the fibrinogen receptor, after stimulation using TRAP, did not change during CPB, but was reduced after protamine administration and lower than baseline at ICU arrival (see figure). With ADP as agonist the fibrinogen receptor activation increased from baseline 2.15 ± 1.6 to end of CPB 2.55 ± 1.6 (p<0.001) but decreased to 2.01 ± 1.3 after protamine (p<0.001 vs End CPB), returning to baseline levels at ICU 2.17 ± 1.2 and ICU 3h 2.26 ± 1.2. Platelet function measured with impedance aggregometry using TRAP as activator showed a similar pattern from baseline 114 ± 29 U, maintained levels at end of CPB 118 ± 40 U, but decreased after protamine 103 ± 34 U (p<0.05 vs End CPB), and returned to baseline levels at ICU 118 ± 32 U and finally increased at ICU 3h 126 ± 30 (p<0.05 vs Baseline). With ADP as activator the changes were similar; baseline 77.1 ± 26 U, maintained at end of CPB 68.6 ± 28 U, reduced after protamine 58.9 ± 29 U (p<0.001 vs Baseline), with return to baseline levels at ICU 66.5 ± 28 U, and ICU 3h 86.7 ± 26 U. <h3>Conclusions</h3> The number of circulating platelets increased during CPB when corrected for hemodilution. CPB did not impair platelet function. Administration of protamine reduced the function and numbers of platelets with a return to normal values at the arrival or after 3 hours in the ICU.

Frequency of Delirium Associated with Dexmedetomidine and Propofol in Post CABG Patients: A Comparative Study

Objective: To find out the frequency of delirium associated with peri-operative use of dexmetedomidine and propofol in post CABG patients.&#x0D; Study Design: Comparative Cross-sectional study.&#x0D; Place and Duration of Study: Adult Intensive Care unit, Department of Cardiac Anesthesiology and Intensive Care, Armed Force Institute of Cardiology, Rawalpindi Pakistan from Feb to Jun 2022.&#x0D; Methodology: All post CABG patients who have undergone elective surgery were included through non-probability consecutive sampling technique. All the delirious patients amongst them were subjected to a modified version of ICU-CAM to establish post-operative delirium (POD) caused by either dexmedetomidine or propofol. POD in both the category of patients was compared.&#x0D; Results: A total of 179 CABG patients were included in our study. 140(78.2%) of the patients were subjected to the use of dexmedetomidine throughout their surgery while 39(21.8%) of the patients were given propofol. After subjecting the patients to our exclusion criteria which aimed to eliminate the confounding causes of POD in post-CABG patients, only 30(16.8%) had delirium while 149(83.2%) didn’t develop delirium (p-value=0.003). Majority of the delirious patients were given dexmedetomidine (n=29; 20.77%) in the operation theatre while only a fraction (n=1; 2.58%) were given propofol. Average duration of ICU stay in our study population was 5 days. 15(8.4%) cases out of our total study population underwent reintubation and re-ventilation because of low cardiac output or respiratory distress.&#x0D; Conclusion: Dexmedetomidine could possibly be associated with POD in patients undergoing cardiac surgery. Propofol on the other hand is considerably safe in this regard and doesn’t cause POD.

Effects of Melatonin on Cardiac Injury and Inflammatory Biomarkers in Patients Undergoing Coronary Artery Bypass Graft Surgery: a Meta-analysis.

The antiinflammatory and antioxidative effects of melatonin have been established in recent years. Several studies indicate that oxidative stress and inflammation are key drivers of post-coronary artery bypass graft (CABG) surgery complications. In the present study, we aimed to investigate the effects of melatonin on cardiac injury and inflammatory biomarkers in CABG candidates. Embase, Medline/PubMed, Web of Science, Scopus, and the Cochrane library were searched up to 5 June 2022. All randomized controlled trials examining cardiac injury and inflammatory biomarkers of CABG patients who received melatonin were included. The random-effects model was utilized to perform the analysis. A total of 947 citations were retrieved through database searches. Finally, five articles (six trials with 342 patients) were included after the screening. Melatonin supplementation led to a significant reduction in cardiac troponin I (CTnI) [weighted mean difference(WMD): -2.28ng/ml; 95% CI -2.87, -1.69; P < 0.01; I2: 91.25%] and high sensitivity-C reactive protein (hs-CRP) levels (WMD: -0.62mg/L; 95% CI -0.73, -0.5; P < 0.01; I2: 99.98%) in patients undergoing CABG surgery. We found a nonsignificant decrease in creatine kinase isoenzyme muscle/brain (CK-MB) levels (WMD: -2.87ng/ml; 95% CI -5.97, 0.23; P = 0.07; I2: 99.98%) after melatonin supplementation. No publication bias was found according to Egger's test. Melatonin supplementation may be useful in reducing cardiac injury and inflammatory biomarkers in CABG candidates. Future studies should investigate the clinical significance of these findings.

Abstract 13346: Long Term, Synergistic Benefit of Transmyocardial Laser Revascularization and Platelet Rich Plasma - Significant Improvement of Global Longitudinal Strain in Coronary Artery Bypass Graft Patients

Introduction: Transmyocardial revascularization (TMR) is a procedure designed to treat patients with end-stage coronary artery disease (CAD). TMR creates myocardial micropores which undergo endothelialization and redistribute ischemic stress, thereby improving regional wall motion. Autologous platelet rich plasma (PRP) growth factors contribute to endothelialization and neovascularization. In this study, we evaluate the effectiveness of TMR combined with PRP to improve cardiac function in patients undergoing CABG using echocardiograms. Methods: A single-center, single surgeon retrospective analysis of CABG patients was performed (2019-2021). Patients in the TMR group had ten channels (7 Watts/channel) created in the infero-lateral wall of the left ventricle (LV) and those in the PRP group had autologous PRP extract injected(1ml, without calcium) in the same area. In patients treated with both TMR and PRP, ten channels were made in the inferolateral LV with PRP extract injected in the peri-TMR zone, 5mm adjacent to the channels. Post-operative ejection fraction (EF) and global longitudinal strain (GLS) were measured using speckle tracking up to one year. Results: Fifty-two patients (71% men, mean age 66y ±9.04y) were enrolled in the study and randomized to four experimental groups: CABG only (n=16); CABG/TMR (n=17); CABG/PRP (n=10); and CABG/TMR/PRP (n=9). At one-year follow-up, patients treated with both TMR and PRP had a significant improvement in average GLS (-15.96, p= 0.02) compared to TMR alone (-13.78, p= 0.26) and PRP alone (-15.79, p= 0.08). Patients treated with TMR and PRP also had a significant rise in post-operative EF (57.78%, SD +/- 6.18) compared to TMR alone (55.0%, SD +/- 6.85) and PRP alone (49.5%, SD +/- 11.65). Conclusions: TMR with PRP extract treatment at the time of CABG confers a significant one year improvement in cardiac function as measured by LVEF and GLS. These outcome metrics highlight cardiac remodeling and can mitigate the incidence of heart failure readmissions. With further prospective trials and longer follow-up periods, concomitant adjunctive TMR with PRP extract therapy at time of CABG may have durable and significant cardiac scar remodeling benefits leading to heart recovery in CABG patients.

Outcomes of Left Main Coronary Artery Revascularization after Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting Surgery

Background: Our study's major goal is to examine how several existing ULMCAD Currently, percutaneous coronary intervention (PCI) and coronary artery bypass grafting are the most common non-invasive methods of treating (unprotected left predominant) CAD in the United States (CABG). Place of study and duration: Conducted at the department of Cardiology, Hayatabad Medical Complex, Peshawar for the Duration from July 1 -2016 to Jun 30 -2017. Methods and Results: The effects of PCI and CABG have been analyzed in 558 patients with ULMCAD in a row (suggest age 71.9 years, eighty-one percent male). The most important end results were a total prevalence of mortality, nonfatal MI, and stroke. Diabetes prevalence increased to 29 percent, whereas acute coronary syndrome increased to 56 percent and 11 became the standard Euro SCORE. An extremely complicated form of coronary disease affected 50% of the patients (SYNTAX score &gt;32). Up to four years after PCI and CABG, the primary composite outcomes were equivalent (15, 53, 1 percent vs. 17,126.6 percent; p=0.585). Additionally, the impacts on the top findings were equivalent for the 2 cohorts with similar propensity ratings. Revascularization was required in 5.5 percent of PCI patients and 1.5 percent of CABG patients, respectively, due to ischemia (p=0.010). Conclusions: According to our local network of ULMCAD patients, the long-term scientific outcomes of the present PCI or CABG revascularization procedures were equivalent. No matter the intricacy of the coronary artery.

Patients' Views of Needs for Education in Jordan: Implications of Post Coronary Artery Bypass Grafting for a Discharge Education Program

Aims. To investigate, before to hospital discharge, the educational needs of Jordanian patients who have had coronary artery bypass graft surgery. Design: A quantitative, correlational design. Methods: Before leaving the Jordanian Hospital, 120 CABG patients had their data gathered using a modified version of the Cardiac Patients Learning Needs Inventory (CPLNI) instrument. Results: Prior to discharge, CABG patients were found to appreciate information on chest and leg wound care, medication information, other important information, and complications the most. Conclusion. According to this study, CABG patients have significant information needs in the 24-48 hours before being released from the hospital. Additionally, this study's findings revealed that the education needs of patients varied statistically significantly depending on their demographic factors.

Thiamine as an outcome predictor in postoperative CABG patients

Abstract Introduction Coronary artery bypass graft surgery (CABG) is one of the most performed cardiovascular procedures worldwide. Despite good outcomes, CABG induces systemic inflammation, increases oxidative stress and increases catabolism. As thiamine act as a cofactor in glucose metabolism and glutathione synthesis, its deficiency could have a high prevalence in critically ill patients. Purpose To assess the association between plasma thiamine concentrations and clinical outcomes and 30-day mortality in patients undergoing non-emergency CABG. Methods Prospective and observational study that included consecutive patients older than 18 years undergoing CABG that assigned the consent form. Plasma thiamine concentrations were determined before and 24 hours after the procedure by the high-performance liquid chromatography method. The clinical outcomes evaluated were perioperative acute myocardial infarction, heart failure, cardiogenic shock, arrhythmias, stroke and acute kidney injury. Mortality was evaluated on the 30th day after CABG. Results The study included 131 patients submitted to CABG. The mean age was 61±9.1 years, 73.3% were men, and the mean EuroScore II value was 1.78±1.3%. Before CABG, plasmatic thiamine concentration was 33±15ng/ml, and 15% of the patients had thiamine deficiency. After CABG, plasmatic thiamine concentration was 20±8ng/ml. All patients diminished plasmatic thiamine concentration after CABG. Mortality was 16% and 24% of patients presented acute kidney injury. Combined outcomes, which included the presence of acute myocardial infarction, heart failure, cardiogenic shock, arrhythmias, stroke, acute kidney injury or death, was present in 52% of the patients. Percentage of thiamine variation between before and after CABG was not associated with mortality (34±14 vs 41±10%; p=0.063); however, it was associated with acute kidney injury (40±14 vs 34±13%; p=0.027) and combined outcomes (37±13 vs 33±14%; p=0.035). Conclusion Percentage of thiamine variation from before to after CABG was associated with acute kidney injury and combined outcomes in these patients. Funding Acknowledgement Type of funding sources: None.

Costochondritis After Coronary Artery Bypass Grafting

Costochondritis is painful inflammatory condition of costochondral junctions, which can be reproduced by palpating the affected joints. After CABG, musculoskeletal problems are major cause of chest pain due to median sternotomy. Prevalence of costochondritis in emergency department is 14% but its frequency in patients after coronary artery bypass grafting is not well established. Objective: To identify costochondritis as complication of sternotomy in post-operative CABG patients. Methods: This was a descriptive case series study in which 43 patients were included in study according to inclusion and exclusion criteria. 28 males and 15 females were included in the study with same baseline characteristics. Each patient was assessed using diagnostic criteria based on clinical history and physical examination, after 3 weeks of coronary artery bypass grafting, under supervision of cardiologist. Results: Mean age of patients was 51.14, with range minimum 30 years to maximum 70 years. 15 patients (34.9%) had costochondritis after CABG and 28 patients (65.1%) had other musculoskeletal causes of chest pain. Conclusions: Costochondritis after CABG is one major complication of sternotomy which causes severe chest pain, affecting 34.9% patients. It affects females twice as compare to males

Effect of Continuous Positive Airway Pressure in Phase-I Cardiac Rehabilitation after CABG

Background: Coronary artery bypass surgery is associated with sever alteration of Lung parameters after 1st post-operative day. The purpose of this study to determine The effect of CPAP on, arterial blood gasses, walking time and long term effect on Ejection fraction and quality of life. Objective: To determine the effect of continues positive airway pressure on arterial blood gases, walking time, long term effect on ejection fraction and quality of life in post coronary artery bypass grafting patients. Methods: Randomized control study was conducted in North West General Hospital Peshawar, from July 2019 to December 2019. Patients underwent coronary artery bypass grafting were included in cardiac rehabilitation. 60 patients were randomly divided into two groups with equal half’s. Experimental group received exercises with continues positive airway pressure (CPAP) and control group received only exercise. PAP was applied 20 minutes prior to exercise and ABG’s test and Vitals were recorded after 5minutes of exercise. Walking time was observed by 6MWT on last day of hospital discharge. Ejection fraction was observed by Echo and quality of life by SF12 questionnaire after four weeks. Results: mean age in control group was (55.27±8.80) and in experimental group was (4.70±1.535). Mean and standard deviation of post Echo in experimental group was 48.30±1.493 and control group was 46.17±1.191. Both groups showed significant difference P value less than 0.05 in arterial blood gases PH, HCO3, and PCO2. PO2 showed significant difference only in experimental group. Both groups showed statistically significant difference for 6 MWT. Mean of quality of life in experimental group was 37.4±5.062 and in control was 36.54±4.46. Conclusion: it is concluded that the use of CPAP in post CABG patients have effective outcome in arterial blood gases, walking time, ejection fraction and in quality of life. Keywords: Continuous Positive Airway Pressure, Coronary artery bypass graft surgery, Inpatients rehabilitations.

The Impact of Diabetes on Acute Kidney Injury After Off-Pump Coronary Artery Bypass Grafting.

Acute kidney injury (AKI) is one of the most frequent complications after coronary artery bypass grafting. Previous studies have shown that diabetes is a key pathogenic factor. But how diabetes is related to AKI in off-pump CABG patients still is in debate. Here, we aim to study the relationship between diabetes and AKI after off-pump coronary artery bypass grafting (off-pump CABG). Patients who underwent off-pump CABG from April 2017 to December 2020 in The First Affiliated Hospital of USTC were enrolled in this retrospective study. AKI was defined and classified, according to the criteria proposed by the Acute Kidney Injury Network. The incidence risk of acute kidney injury was measured by logistic regression and compared. A total of 395 patients, who underwent off-pump CABG, were included in this study. The postoperative acute kidney injury rate for a patient with diabetes was significantly higher than for patients without diabetes (x2 = 5.09, P = 0.024). Logistic regression analysis showed that patients with diabetes have a much higher risk with acute kidney injury occurring after off-pump coronary artery bypass grafting (OR 1.852, 95% CI 1.161 - 2.954, P = 0.01). Diabetes is an independent risk factor for postoperative AKI for patients undergoing off-pump CABG.

One year follow-up of unprotected left main coronary artery disease, a prospective cohort study of 139 patients

Objectives: Coronary artery revascularization is the standard treatment for patients with severe left main coronary artery disease (LMCAD). In cases where the patient refuses surgical revascularization or PCI, medical treatment will be the only option. The purpose of this study was to compare the one-year outcomes of patients with (LMCAD) in terms of surgical or medical treatment.&#x0D; Methods: This prospective cohort study was conducted on 139 patients (91 men and 48 women) with severe left main coronary artery disease who were diagnosed by coronary angiography from 1st Mar 2014 to 28th Feb 2014. Patients were followed up for one year as to major adverse cardiac and cerebral events (MACCE) including death, non-fatal myocardial infarction, stroke, and hospitalization.&#x0D; Results: From total of 2661 coronary angiographies, 139 patients (5.2%) with a mean age of 63.2±7.2 years had LMCAD. The mortality rate in the medical treatment group and the surgical group appeared to be 16.7% (6 cases) and 8.7% (9 cases) respectively (p =.156). The rate of stroke in the medical group turned out to be 5.6% (n=2) and in the surgery group 2% (n=2) (p =.27). The rehospitalization rate was 19.4% in the medical treatment group but 4.9% in the surgical group (p =.013). During one year, the survival rate was significantly lower in the medical group than the group undergoing coronary artery bypass graft surgery (58.3% vs. 84.5%) (p =.002).&#x0D; Conclusions: In the short term, the optimal medical treatment of patients with LMCAD was not significantly different from that of CABG patients in terms of fatal cardiac and cerebral events. However, rehospitalization was more common due to recurrent angina pectoris.

Differences in Recovery After Coronary Artery Bypass Grafting or Off-pump Coronary Artery Bypass

Background. The main part of the study was to determine the lower frequency of postoperative complications and fewer days spent in hospital and in the intensive care unit postoperatively, among patients operated on using the OPCAB method, as opposed to those operated on using the CABG method.Methods: In a cross-sectional, epidemiological study, data were collected and processed from the medical database. The parameters taken into consideration were: the incidence of postoperative complications, the number of days spent in the intensive care unit postoperatively and the number of days spent in the hospital postoperatively. Main findings: From a total of 60 patients operated on at the Department of Cardiac Surgery, 8.33% of patients had postoperative complications. Half of the patients underwent CABG surgery and 13.3% had postoperative complications. The other half who underwent OPCAB surgery had 3.3% postoperative complications. CABG patients spent an average of 2.57 days in the intensive care unit, whereas OPCAB patients spent 2.17 days there.Principal conclusion: There is no statistically significant difference in the number of days spent in the intensive care unit and the incidence of postoperative complications between patients operated by on using the CABG or the OPCAB method.Key words: CABG method, OPCAB method, postoperativecomplication, intensive care unit

Pathology-related changes in cardiac energy metabolites, inflammatory response and reperfusion injury following cardioplegic arrest in patients undergoing open-heart surgery.

IntroductionChanges in cardiac metabolites in adult patients undergoing open-heart surgery using ischemic cardioplegic arrest have largely been reported for non-ventricular tissue or diseased left ventricular tissue, with few studies attempting to assess such changes in both ventricular chambers. It is also unknown whether such changes are altered in different pathologies or linked to the degree of reperfusion injury and inflammatory response. The aim of the present work was to address these issues by monitoring myocardial metabolites in both ventricles and to establish whether these changes are linked to reperfusion injury and inflammatory/stress response in patients undergoing surgery using cold blood cardioplegia for either coronary artery bypass graft (CABG, n = 25) or aortic valve replacement (AVR, n = 16).MethodsVentricular biopsies from both left (LV) and right (RV) ventricles were collected before ischemic cardioplegic arrest and 20 min after reperfusion. The biopsies were processed for measuring selected metabolites (adenine nucleotides, purines, and amino acids) using HPLC. Blood markers of cardiac injury (Troponin I, cTnI), inflammation (IL- 6, IL-8, Il-10, and TNFα, measured using Multiplex) and oxidative stress (Myeloperoxidase, MPO) were measured pre- and up to 72 hours post-operatively.ResultsThe CABG group had a significantly shorter ischemic cardioplegic arrest time (38.6 ± 2.3 min) compared to AVR group (63.0 ± 4.9 min, p = 2 x 10−6). Cardiac injury (cTnI release) was similar for both CABG and AVR groups. The inflammatory markers IL-6 and Il-8 were significantly higher in CABG patients compared to AVR patients. Metabolic markers of cardiac ischemic stress were relatively and significantly more altered in the LV of CABG patients. Comparing diabetic and non-diabetic CABG patients shows that only the RV of diabetic patients sustained major ischemic stress during reperfusion and that diabetic patients had a significantly higher inflammatory response.DiscussionCABG patients sustain relatively more ischemic stress, systemic inflammatory response and similar injury and oxidative stress compared to AVR patients despite having significantly shorter cross-clamp time. The higher inflammatory response in CABG patients appears to be at least partly driven by a higher incidence of diabetes amongst CABG patients. In addition to pathology, the use of cold blood cardioplegic arrest may underlie these differences.

Short Terms Safety of Chinese Origin Covid-19 Vaccine in Cardiac Patients

Objective: To find out short terms safety of Chinese origin Covid-19 vaccines in cardiac patients. To identify frequency of major and minor cardiovascular events in Covid-19 vaccinated cardiac patients. Methodology: It was a cross sectional study conducted in Qazi Hussain Ahmad Medical Complex Nowshera and Kuwait Teaching Hospital Peshawar, Pakistan from February 2021 to April 2021 on a sample of 325 cardiac patients irrespective of their gender. Cardiac patients who received 2 doses of sinopharm vaccine were included in our study. The clinical characteristics of patients included age, gender, comorbids like diabetes and hypertension and those patient s who have undergone any cardiac procedures i-e post CABG and post PCI. The data was analyzed with SPSS version Results: Total 325 known cardiac patients who received 2 doses of sinopharm vaccine were enrolled in the study, among them 198 were male and 127 were female. Participants age range was 56.48±5.9 years and among them mean age of male was 56.59±6.55 years and of female was 57.64±4.27 years. Among the participants 76(23.3%) were hypertensive out of which 44(22.2%) were male. Total number of diabetics were 98(30.15%) among which 59(29.79%) were male. Post CABG patients were 56(17.23%) in number, and among these 34(17.17%) were male. Among them 176(54.15%) were post PCI and among these 102(51.51%) were male. Out of total 325 participants the frequency of major adverse cardiovascular events was 4(1.2%) which include major cardiovascular events , death of any cause, urgent repeat revascularization, MI (not revascularized) an ischemic stroke were 1.2%, 0.91%, 0.31%, 0.92%, 0% respectively. Frequency of minor adverse cardiovascular events in cardiac patients after sinopharm vaccination was 4(1.2%) out of total 325 participants. which include minor cardiovascular events(9.85%), atrial fibrillations(0.92%), complete heart block(0%), increase in angina functional class(2.46%), increase in NYHA functional class(2.53%), and palpitations(3.69%). Conclusion: Chinese origin covid-19 vaccine (sinophorm) is safe in cardiac patients and has minor side effects and rare major side effects in cardiac patients. Keywords: Sinopharm vaccine, Cardiac patients, Corona virus