CABG Surgery Research Articles

COMPARISON OF THE EFFECT OF ANTEGRADE AND ANTEGRADE/RETROGRADE CARDIOPLEGIA ON THE OUTCOME OF CORONARY ARTERY BYPASS GRAFT SURGERY FOR SEVERE CORONARY ARTERY DISEASE

Objective: To compare the early outcome of Coronary Artery Bypass Graft surgery using a combination of antegrade and retrograde cardipoplegia with that utilizing antegrade cardioplegia alone in triple vessel coronary artery disease.
 Study Design: Comparative cross-sectional study.
 Place and Duration of Study: Department of Adult Cardiac Surgery of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from Sep 2013 to Apr 2019.
 Methodology: A total of 160 patients with triple vessel coronary artery disease who underwent CABG surgery for 90% or greater stenos is in at least one major vessel in each of the three territories, namely the left anterior descending, the circumflex and the right coronary artery were investigated retrospectively. These were divided into 2 equal groups on the basis of the technique of administration of cardioplegia: in group-1 only ante grade blood cardioplegia was administered for myocardial protection and group-2 was given ante grade and retrograde cardiolplegia. Clinical outcomes like peri-operative mortality and morbidity were recorded, and serum creatine kinase MB, lactate, and mixed venous oxygen saturation levels were monitored. Two dimensional echocardiogram was performed on the 6th post-operative day and follow-up visits were planned 1 week and 4 weeksafter discharge from hospital.
 Results: There were 2 (2.5%) early deaths in group-1 and no peri-operative mortality in group-2. Five patients in group-1 (6.25%) and 2 (2.5%) in group-2 had non-fatal peri-operative myocardial infarction. However, significant differences included increased incidence of intra-operative ventricular dysrythmias, higher CK-MB levels at 24 hours after surgery, and increased requirement of intra-aortic balloon pump and inotropic support in Group-1.
 Conclusion: We conclude from this study that the combined delivery of ante grade and retrograde cardioplegia during CABG surgery for triple vessel coronary artery disease provides better myocardial protection and hence better outcome than antegrade cardioplegia alone.Keywords: , , ,

The effectiveness of olmesartan on inflammation at cardiopulmonary bypass

Aim: Systemic inflammatory response syndrome may develop after coronary artery bypass graft surgery that performed by cardiopulmonary bypass technique. It is known that olmesartan, an angiotensin II receptor blocker, has anti-inflammatory effects. The antiinflammatory efficacy of olmesartan treatment was investigated in patients undergoing cardiopulmonary bypass.Materials and Methods: The study included 50 patients (14 female, 36 male) between 30-80 years of age were underwent CABG surgery. Patients were randomly assigned to control (Group C) and olmesartan (Group O) gruoups. Group O were treated with a single dose of 10 mg per day; 5 days preoperatively and 35 days postoperatively, 30 mg at the operation day. Samples were taken before the induction of anesthesia (T1), 5 minutes before cross clamping (T2), 5 minutes after cross clamping (T3), after protamine infusion (T4), postoperative day 3 (T5) and postoperative day 35 (T6) for total serum levels of IL-6, IL-10 and IL-18; for h-CRP levels preoperative (T1) and postoperative day 35 (T2).Results: Statistically significant decrease of CRP levels were observed on the postoperative 35th day in Group O (p0.05). Statistically significant decrease of IL-6 levels were observed in the Group O after protamine infusion (T4) and postoperative 3rd day (T5) (p 0.05).There was a statistically significant increase at 5 min. after the cross declamping time (T3) for IL-10 levels (p0.05).Conclusion: Although the anti-inflammatory efficacy of olmesartan has been proven, it can be accomplished by combining it with drugs that have anti-inflammatory effects like statins or dose increasing.

Postoperative delirium after coronary artery bypass graft surgery: Dexmedetomidine infusion alone or with the addition of oral melatonin

ABSTRACT Introduction: Postoperative delirium is a common complication of cardiac surgery. This study aimed to assess the effect of supplementing dexmedetomidine infusion with oral melatonin in prevention of postoperative delirium after coronary artery bypass graft surgery. Methods: 110 patients of both sexes above 60 years of age were included. Anesthetic management was standardized. Patients were randomly allocated into one of the two study groups, dexmedetomidine/melatonin (DM) group or dexmedetomidine (D) group. Patients in the DM group received oral Melatonin tablet 5 mg the night before surgery and same dose was repeated every 24 hours for 3 postoperative days. After completion of surgery and upon ICU arrival, patients in both groups received a bolus of 0.4 µg/kg dexmedetomidine followed by 0.2–0.7 µg/kg/h infusion, for 24 maximum hours. Delirium was assessed for 5 days postoperatively at 12 hr intervals using confusion assessment method (CAM) for ICU and after discharge from ICU to surgical ward using CAM. Delirious patients were treated with IV haloperidol. Results: No significant differences between studied groups regarding baseline, preoperative, intraoperative and postoperative characteristics. Incidence of delirium was significantly lower, onset significantly more delayed, and duration was significantly shorter in group-DM as compared to group-D. No significant differences between all cases, cases who had delirium, and cases who did not have delirium in the two groups as regards extubation time, ICU stay, and hospital stay. Conclusion: supplementing dexmedetomidine with melatonin decreases incidence, delays onset, and shortens duration of postoperative delirium in patients above 60 years of age undergoing CABG surgery.

To determine the frequency of stroke and common factors leading to it after coronary artery bypass grafting.

Objective:To determine the frequency of stroke and common factors leading to it after coronary artery bypass grafting.Methods:This study was conducted at Cardiothoracic Surgery Department, Rehman Medical Institute, Peshawar. Study design was descriptive cross sectional study and the duration of the study was six months. The total sample size was 183 cases using 8.3% frequency of stroke after coronary artery bypass grafting, 95% confidence interval, 4% margin of error, using WHO sample size calculator.Results:In this study mean age was 45 years with SD ± 1.26. Seventy five percent patients were male while 46(25%) females. Six patients (3%) patients had stroke while 177(97%) patients did not have any stroke. Among the six patients who were analyzed, all of them had Diabetes Mellitus and 50% patients had recent AMI, while only one patient had prior history of Atrial Fibrillation.Conclusions:Diabetes Mellitus is an independent risk factor for stroke after CABG surgery. whereas, recent MI is also associated with increased incidence of stroke in post CABG patients.

Effect of family presence on stress response after bypass surgery

BackgroundCoronary artery bypass grafting (CABG) is a major surgery that may cause severe surgical stress response (SR). Although the presence of family members in intensive care unit (ICU) is known to benefit intensive care patients socially and emotionally, its effects on surgical SR are unknown. ObjectivesTo investigate the effect of an informed family member (IFM)’s presence in the awakening process in ICU on patients’ SR after CABG. MethodsA nonrandomized controlled clinical study was completed with a total of 73 patients: 37 patients in the control (CG) and 36 in the intervention group (IG) underwent CABG surgery. In the CG patients, no family members were taken into the ICU during the awakening process and routine care and treatment practices were continued. In the IG patients, besides routine care and treatment practices, an IFM was taken into the ICU during the awakening process in accordance with the research method. Groups were statistically compared in terms of serum cortisol level which is the one of the main indicators of surgical SR, state anxiety, sedative drug requirements, and duration of intubation, sedation, and ICU stay. A p value <0.05 was accepted as statistically significant. ResultsPresence of an IFM in the ICU was found to be effective in decreasing serum cortisol level, state anxiety, sedative drug requirements, and the duration of intubation, sedation, and ICU stay (p<0.05). ConclusionsIn CABG, the presence of IFM in ICU is effective in reducing SR.

Low molecular apolipoprotein(a) phenotype and hyperlipoproteinemia(a) associated with age of patients with CABG surgery

Low molecular apolipoprotein(a) phenotype and hyperlipoproteinemia(a) associated with age of patients with CABG surgery

Utility of nuclear stress imaging in predicting long-term outcomes one-year post CABG Surgery

BackgroundEarly MPI after CABG is currently considered rarely appropriate in asymptomatic patients. This study aimed to identify prognostic value of nuclear stress-imaging post-CABG. MethodsThis was a single center prospective study looking at long-term outcomes post-CABG. Per protocol participants underwent SPECT-MPI stress testing and coronary angiogram on the same day, 1-year following CABG. Defect size was semi-quantified. The primary outcomes were the composite of death and congestive heart failure. ResultsEighty-four participants underwent nuclear stress-imaging and angiography, with a median follow-up of 11.1 years. Three separate stress findings predicted the primary outcome: inability to reach stage 3 of a Bruce protocol (OR 7.3, CI 2.4-22.1, P < 0.001), LVEF < 45% (OR 4.0, CI 1.1-15.3, P = 0.041) and a moderate-large stress defect size (HR 2.31, CI 1.1-1.5, P = 0.04). These findings appear to be additive and strongest among patients who underwent exercise stress testing (HR 10.6, CI 3.6-30.6, P < 0.001). Graft disease was identified in 39 (46%) patients and compared to those individuals with no graft disease, did not predict long-term adverse outcomes (P = 0.29). ConclusionIn clinically stable patients early after revascularization with CABG, SPECT-MPI can identify patients at higher risk of heart failure and death.

The current LDL-C target &amp;lt;1.4mmol/l of the ESC is achieved in less than 16% of patients with Coronary Heart Disease despite effective lipid-lowering therapy: data from the LLT-R registry

Abstract Background In the current guideline of the ESC, in patients with very high cardiovascular risk such as coronary heart disease (CHD) a treatment target for LDL-C &amp;lt;1.4mmol/l and/or a halving of the initial value are defined. It is unclear whether these treatment targets are achievable with standard therapy including statins and/or ezetemibe. Methods The primary objective of this prospective, multi-centre register study was the question of the guidance-based adaptation and adherence to lipid-lowering therapy during and after a cardiac rehabilitation in 1,100 patients with CHD up to 12 months after discharge from the six rehabilitation clinics involved. Patients were included from 2016 to 2018. Results The median age of the 1,100 patients was 63.4±10.4 years, the mean BMI was 28.5±4.7kg/m2, and 24.1% of patients were female. 12.2% were active smokers, 91.6% reported dyslipoproteinemia, 33.9% suffered from diabetes mellitus and 86.5% from hypertension. The majority of patients were included with the main indications NSTEMI (31.6%), STEMI (29.6%) and after CABG surgery (26.4%). The proportion of patients treated with statins was more than 94% when admitted and discharged from the rehabilitation clinic, as well as in 3- and 12-months follow-ups. Approximately 9% of patients were treated with ezetemibe at baseline. On discharge from the rehabilitation clinic 23% of patients were treated with ezetemibe, which remains stable at 3 and 12 months. PCSK9 inhibitors were used in 0.1–0.3% of patients at all times. The adjustment of LLT during three week cardiac rehabilitation resulted in median LDL-C values of 2.27mmol/l (1.80/2.84) at baseline, 1.97mmol/l (1.57/2.47) on discharge (p&amp;lt;0.001 compared to baseline), 1.94mmol/l (1.57/2.49) after three months and 1.94mmol/l (1.53/2.40) after 12 months. The proportion of patients with LDL-C &amp;lt;1.4mmol/l was 9% at baseline, 15.7% on discharge (p&amp;lt;0.001 compared to baseline), 15.6% at three-month follow-up and 15.1% at 12-month follow-up (Figure 1). Discussion In the context of cardiac rehabilitation, an effective adjustment of LLT is carried out, which resulted in a significant reduction of LDL-C. However, despite a high percentage of patients on statins and ezetemibe, the proportion of patients in the new target range &amp;lt;1.4mmol/l was only achievable in a small percentage and the question arises whether these treatment targets can be achieved without additional administration of PCSK9 inhibitors in majority of patients with CHD. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This study was supported by an unrestricted grant from Sanofi-Aventis Germany.

Atrial fibrillation up to 50 days after cardiac surgery should be considered postoperative atrial fibrillation

Abstract Introduction Postoperative atrial fibrillation (POAF) occurs in up to 45% of patients following cardiothoracic surgery and is defined as any atrial tachyarrhythmia occurring ≤30 days after surgery. Consequently, atrial arrhythmias after 30 days are regarded as new-onset AF. However, biological and clinical data on the association between POAF and new-onset AF, or empirical data supporting the cut-off of 30 days, are lacking. Purpose We hypothesize that patients with POAF are biologically different with respect to atrial fibrosis compared to patients who develop new-onset AF. Methods PREDICT AF is a prospective, multicenter, observational trial that included patients with a CHA2DS2VAsc score≥2 without a history of AF. Patients underwent CABG or valve surgery and the left atrial appendage (LAA) was removed during surgery. The LAA was obtained for expression analysis of extracellular matrix (ECM) genes such as collagen 1 (COL1A1), collagen 3 (COL3A1) and fibronectin (FN1) by qPCR. Patients were monitored during hospitalisation and followed-up at 1, 6, 12 and 24 months with 24-h Holters and ECGs. The primary endpoint was any recorded atrial tachyarrhythmia lasting &amp;gt;30 seconds. We documented all new-onset arrhythmias over time in order to determine potential cut-offs for POAF (Figure A). We then compared the effects of using a 30-, 50- or 70-day cut-off on the rate of new-onset AF and the differences in expression of fibrosis related genes. Results PREDICT AF included 150 cardiac surgery patients: 115 CABG, 11 valve surgeries and 24 combined surgeries. Participants had a median follow-up of 1.9 years [1.0–2.0], were 68±7 years old and 19 (13%) were female. POAF &amp;lt;30 days occurred in 63 (42%) patients. New-onset AF &amp;gt;30 days developed in 21 (14%) patients. Of the 21 patients with new-onset AF, 20 (95%) also had had POAF. New-onset AF defined by a cut-off of 50 days, developed in 15 (10%) patients. In total, 9 patients had an episode of AF between 30 and 50 days, of whom 6 (66.6%) had no AF episodes thereafter. Most of these patients under–went (concomitant) aortic valve surgery. The gene expression of ECM components was significantly more predictive of new-onset AF when using a cut-off of 50 days or even 70 days than when using a cut-off of 30 days (Figure B). Conclusion With stringent monitoring we detected 42% POAF &amp;lt;30 days. One in three POAF patients developed new-onset AF within two years after surgery. However, the majority of the patients who developed new-onset AF between 30 and 50 days postoperatively had no later episodes of AF. Moreover, applying a 50-day cut-off to discriminate POAF from new-onset AF enhanced the prediction of new-onset AF based on the ECM gene expression levels. Our data suggest that both from a biological and a clinical perspective, the cut-off for POAF should be stretched to 50 days postoperatively. New-onset AF prediction with ECM genes Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): NWO VIDI

Feasibility and safety of minimally invasive cardiac coronary artery bypass grafting surgery for patients with multivessel coronary artery disease: Early outcome and short-mid-term follow up results

To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery. Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD). There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P < 0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up. The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.

Frailty Among Non-Elderly Patients Undergoing Cardiac Surgery.

ResumoFundamento:Geralmente vista como uma característica da velhice, a fragilidade também pode ocorrer em pessoas não idosas, principalmente naquelas que sofrem de doenças crônicas. A fragilidade pode aumentar o risco operatório.Objetivos:Determinar a prevalência de fragilidade em pacientes submetidos à cirurgia de revascularização do miocárdio (CRM) e/ou troca ou reconstrução valvar e/ou cirurgia valvar, bem como a influência da fragilidade nos desfechos pós-operatórios.Métodos:Nosso estudo incluiu 100 adultos que foram submetidos a operações cardíacas eletivas consecutivas. A fragilidade foi avaliada por meio da escala de Fried. Os pacientes também realizaram um teste de caminhada de 6 minutos, e medimos as pressões inspiratória e expiratória máximas. Um valor de p < 0,05 foi considerado significativo.Resultados:De uma coorte de 100 pacientes, com base nos critérios de fragilidade de Fried, 17 pacientes (17%) foram considerados frágeis, 70 (70%) pré-frágeis e apenas 13 (13%) não frágeis. Entre os portadores de valvopatia, 11 (18,6%) foram considerados frágeis e 43 (73%) pré-frágeis. Cinquenta e três por cento dos pacientes considerados frágeis tinham menos de 60 anos (mediana=48 anos). As diferenças no fenótipo de fragilidade entre os pacientes com valvopatia e doença arterial coronariana não foram estatisticamente significativas (p=0,305). A comparação entre pacientes não frágeis, pré-frágeis e frágeis não mostrou diferença significativa na distribuição das comorbidades e do estado funcional cardíaco, independentemente da doença cardíaca. No entanto, a mortalidade hospitalar mostrou-se significativamente maior em pacientes frágeis (29,4%, p=0,026) que em pacientes pré-frágeis (8,6%) e não frágeis (0%).Conclusões:A fragilidade é prevalente mesmo entre pacientes não idosos submetidos a CRM ou cirurgia cardíaca valvar e está associada a maior mortalidade hospitalar pós-operatória.

Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis.

Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG. Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays. The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = -8.21 h, 95% CI = -11.74 to -4.68, p < 0.00001; MD = -0.77 d, 95% CI = -0.81 to -0.73, p < 0.00001; MD = -2.24 d, 95% CI = -3.17 to -1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization. In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.

Novel use of new parameters in nirs cerebral oximetry in cabg surgery to display changes in brain perfusion

Introduction The use of near-infrared spectroscopy (NIRS) to monitor continuous rSO2 values for the brain is well established (1,2). However the separation of oxygenated & deoxygenated components of NIRS is novel. We report a case of these parameters in CABG surgery. Methods A 68 year old diabetic male underwent CABG. Anaesthesia was induced with etomidate, fentanyl and rocuronium and maintained with air oxygen and isoflurane to a sedation index of 30. The surgery proceeded uneventfully. Some new observations were noted: The effect of increased CMRO2 and rising PSI: At 1042 the effect of increased EEG activity and MAP (85mmHg) leads to a rise in the Sedline PSI which increases delta O2HBi as the oxygen requirements of cerebral activity increase. Autoregulation in vivo. Venous (IVC) and aortic cannulation take place uneventfully cardiopulmonary bypass is commenced at 1052. Effect of CPB, hemodilution and non pulsatile flow: As flow switches from pulsatile to non pulsatile flow and CPB starts, there is an immediate reaction in the delta cHbi values. Haemodilution takes place as pump prime enters the circulation, so the haematocrit falls. O3 values fall but we see a large decrease in delta cHbi because of a reduction in delta O2Hbi as clear pump prime is being administered. Then as oxygenated blood from the CPB pump enters the circulation the delta cHbi recovers as oxygenated blood returns to the head. Note the marked reduction in cHbi and delta O2Hbi values that remains throughout subsequently, and which never recovers. This is the effect of non pulsatile blood flow and the effect it has on cerebral autoregulatory capacity. At this point the MAP is 78. Results: Discussion Principles of NIRS: As oxygenation in cerebral tissue changes, the wavelengths of light absorbed by tissue also change, forming the basis for measurement of regional cerebral oxygen saturation, rSO2. With these indices, we can display information about the changes in the underlying components calculating rSO2 values. δO2Hb is an index representing changes in the oxyhemoglobin component of rSO2. δHHb is an index representing changes in the deoxyhemoglobin component of rSO2. These indices provide visibility into changes in underlying oxyhemoglobin and deoxyhemoglobin components of rSO2. The relative contribution of each component to a patient's overall rSO2 was observed and the use of these additional monitoring indices may allow earlier detection of changes in the blood supply to the brain such as during commencement of cardiopulmonary bypass and the effects of raised CMRO2 and its effects on flow, and hence allow earlier corrective intervention. This may be of value in preventing impending cerebral injury in those patients who may be susceptible.

Reducing Sternal Site Surgical Site Infections by Postdischarge Follow-Up Using WhatsApp

Background: We conduct ∼180–200 CABG surgeries a year, and &gt;70% of these patients are diabetic. Our SSI rate for sternal site was 4.4%, above the global benchmarks, and on review of the risk factors, poor glycemic control was identified as a major risk factor. Despite focusing on and achieving excellent glycemic control in the perioperative period, the SSI rates did not decrease significantly. We identified that the predischarge insulin regimens were inadequate for the patient once they returned to meals at home. Hence, we extended the interventions to the postdischarge phase and observed the impact of this change on SSIs. Methods: We developed a multidisciplinary and cross-functional team of cardiac surgeons, endocrinologists, physician assistants, infection control nurses and quality professionals. The CABG admissions information was obtained when financial clearance was sought for the procedure; the quality improvement professionals tracked these patients to ensure involvement of the endocrinology team. The physician assistant conducted the education to the patient and family regarding sugar management and use of a glucometer at home. The quality improvement team took a weekly report from the physician assistant and from the patient regarding the frequency of interactions and achievement of glycemic control. At the time of discharge, each of the diabetic patients who underwent CABG were educated by the physician assistant in the use of a glucometer, were provided with a sugar monitoring and insulin dosing chart as well as a WhatsApp number. The patient’s were instructed to monitor the sugars at specified intervals, to input the data into the personalized chart, and to send it to the PA through WhatsApp. The physician assistant then provided instructions on the insulin dosages using a standing order (dynamic insulin prescription regimen) developed by the endocrinologist. Results: The sternal site infection rate among the CABG patients dropped from 4.44% (4 cases of 90 surgeries) to 1.78% (2 cases of 112 patients), a 60% improvement. Readmissions among the CABG patients dropped from 3 cases in the study period to zero during the project phase. Conclusion: We have achieved significant reduction in sternal site SSI by (1) implementing a novel strategy of focusing on the postdischarge period and home management of blood sugar; (2) using freely available technology, WhatsApp; and (3) effectively using physician assistants by training and developing standing order sets for insulin.Funding: NoneDisclosures: None

TCT CONNECT-156 The Use of CPAP Is Associated With Better Outcomes In Patients With OSA Undergoing CABG Surgery

TCT CONNECT-156 The Use of CPAP Is Associated With Better Outcomes In Patients With OSA Undergoing CABG Surgery

Automated Prediction of Surgical Site Infection Coronary Artery Bypass (CABG) Grafting Surgery

Background: In 5 hospitals located in Belo Horizonte city (&gt;3,000,000 inhabitants) a focused survey on surgical site infection (SSI) was performed in patients undergoing CABG surgery. We statistically evaluated such incidences to enable study of the prediction power of SSI through pattern recognition algorithms, in this case the multilayer perceptron (MLP) artificial neural networks. Methods: Data were collected between July 2016 and June 2018 on SSI by the hospital infection control committees (CCIHs) of the hospitals involved in the research. We collected all data used in the analysis during their routine SSI surveillance procedures. The information was forwarded to the NOIS (Nosocomial Infection Study) Project, which uses the SACIH (Automated Hospital Infection Control System) software to collect data from a sample of hospitals participating voluntarily in the project. After data collection, 3 procedures were performed: (1) a treatment of the collected database for use of intact samples; (2) a statistical analysis on the profile of the hospitals collected; and (3) an assessment of the predictive power of 5 types of MLP (ie, backpropagation standard, momentum, resilient propagation, weight decay, and quick propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% or 75% for testing and 35% or 25% for validation). They were compared by measuring the AUC (area under the curve; range, 0–1) presented for each of the configurations. Results: From 666 initial data, only 278 were able for analysis. We obtained the following statistics: 9.35% manifested SSIs; length of stay varied from 1 to 119 days, with ~40% staying between 10 and 19 days; 15.1% of the patients died. Regarding the prediction power of SSI, the experiments have a maximum value of 0.713. Conclusions: Despite the considerable loss rate of &gt;50% of the database samples due to the presence of noise, it was possible to have a relevant sampling to evaluate the profile of hospitals in Belo Horizonte. In addition, for the predictive process, although some configurations had results equal to 0.5, others reached 0.713, which indicates that the automated SSI monitoring framework for patients undergoing coronary artery bypass grafting surgery is promising. To optimize data collection and to enable other hospitals to use the SSI prediction tool (available at www.sacihweb.com), a mobile application was developed.Funding: NoneDisclosures: None

Prophylaxis postoperative atrial fibrillation (POAF) with exogenous phosphocreatine in cardiac surgery

IntroductionAmong all cardiovascular complications, new onset postoperative atrial fibrillation (POAF) is one of the most common complications, occurring in 30% to 50% of patients after cardiac surgery. (1) One of the possible mechanisms for the development of AF may be myocardial reperfusion after aortic unclamping (reperfusion arrhythmia). In this regard, the use of agents reducing the severity of reperfusion syndrome may reduce the frequency of POAF. One such remedy is exogenous phosphocreatineThe aim of our investigation evaluation efficacy of exogenous phosphocreatine for prevention of new-onset POAF in cardiac patients.MethodsAfter Institutional Ethics Committee approval, 56 patients posted for elective GABG surgery were randomly divided into two groups (n = 28 each). In study group (Pcr) patients received 2 g of exogenous phosphocreatine iv before aortic unclamping followed by continuous infusion at a dose of 1g per hour during 3 hours after aortic unclamping; In control group (C) patients received placebo The baseline and intraoperative characteristics of the patients were similar in both groups. Continuous ECG monitoring for arrhythmias was performed at 48 hours in all patients after CABG. The diagnostic hallmarks of AF on ECG included the loss of P-waves and the presence of irregular ventricular beats. The primary point was to determine the frequency of AF within 48 hours after surgery. Secondary points were frequency of cardioversion use the frequency (paroxysms of AF lasting 5-10 minutes with adverse effects),. Chi-square/Fisher's exact/Mid P exact test and Student's t-tests were applied for categorical and continuous data.ResultsIncidence of postoperative atrial fibrillation (POAF) in group Pcr was 26% vs. 37% in group C;(p = 0.47), a difference that was not signficant. The frequency of episodes of of ventricular tachyarrhythmias requiring cardioversion in group Pcr was significantly lesser than in the control group (n-5/17,8% and n-10/35%, respectively) In the group C 11 (38%) patients developed adverse effects, mostly hypotension, compared with only 4 patient (12,3%) in group Pcr (p = 0.04). The length of ainotropic support in early postoperative period was significantly lower in group Pcr compared with control group (175±37 vs 290±89 minutes).DiscussionProphylactic perioperative infusion exogenous phosphocreatine in patients undergoing CABG surgery reduces the incidence of cardioversion, adverse effects and the length postoperative of inotropic support Among all cardiovascular complications, new onset postoperative atrial fibrillation (POAF) is one of the most common complications, occurring in 30% to 50% of patients after cardiac surgery. (1) One of the possible mechanisms for the development of AF may be myocardial reperfusion after aortic unclamping (reperfusion arrhythmia). In this regard, the use of agents reducing the severity of reperfusion syndrome may reduce the frequency of POAF. One such remedy is exogenous phosphocreatine The aim of our investigation evaluation efficacy of exogenous phosphocreatine for prevention of new-onset POAF in cardiac patients. After Institutional Ethics Committee approval, 56 patients posted for elective GABG surgery were randomly divided into two groups (n = 28 each). In study group (Pcr) patients received 2 g of exogenous phosphocreatine iv before aortic unclamping followed by continuous infusion at a dose of 1g per hour during 3 hours after aortic unclamping; In control group (C) patients received placebo The baseline and intraoperative characteristics of the patients were similar in both groups. Continuous ECG monitoring for arrhythmias was performed at 48 hours in all patients after CABG. The diagnostic hallmarks of AF on ECG included the loss of P-waves and the presence of irregular ventricular beats. The primary point was to determine the frequency of AF within 48 hours after surgery. Secondary points were frequency of cardioversion use the frequency (paroxysms of AF lasting 5-10 minutes with adverse effects),. Chi-square/Fisher's exact/Mid P exact test and Student's t-tests were applied for categorical and continuous data. Incidence of postoperative atrial fibrillation (POAF) in group Pcr was 26% vs. 37% in group C;(p = 0.47), a difference that was not signficant. The frequency of episodes of of ventricular tachyarrhythmias requiring cardioversion in group Pcr was significantly lesser than in the control group (n-5/17,8% and n-10/35%, respectively) In the group C 11 (38%) patients developed adverse effects, mostly hypotension, compared with only 4 patient (12,3%) in group Pcr (p = 0.04). The length of ainotropic support in early postoperative period was significantly lower in group Pcr compared with control group (175±37 vs 290±89 minutes). Prophylactic perioperative infusion exogenous phosphocreatine in patients undergoing CABG surgery reduces the incidence of cardioversion, adverse effects and the length postoperative of inotropic support

TCT CONNECT-430 Transradial Versus Transfemoral Coronary Angiography and PCI in Patients With Previous CABG Surgery: Impact of Access Strategy on Short-Term Safety and Long-Term Efficacy Outcomes

TCT CONNECT-430 Transradial Versus Transfemoral Coronary Angiography and PCI in Patients With Previous CABG Surgery: Impact of Access Strategy on Short-Term Safety and Long-Term Efficacy Outcomes

The Prognosis and Predictors of Recovered Ejection Fraction Heart Failure: A Systematic Review and Meta-analysis

Introduction HFrecEF is a new entity included among the other types of heart failure. It represents the improvement of LVEF above the upper limit of HFrEF which usually ranges from 40 to 55%. Hypothesis We aimed to assess the predictors, measures of mortality and hospitalization of HFrecEF to compare it with HFrEF and HFpEF. Methods We conducted a systematic search in eight databases; PubMed, Scopus, Web of Science, Google Scholar, New York Academy of Medicine (NYAM), System for Information on Grey Literature in Europe (SIGLE), Global Health Library (GHL) and Virtual Health Library (VHL). Our primary endpoint was assessing the prognosis of HFrecEF in comparison with HFrEF and HFpEF. The secondary endpoint was assessing the predictors of LVEF recovery. Results Three-hundred eighty-two records were retrieved from the searched databases. After screening for eligibility criteria, 18 articles were chosen for qualitative synthesis and 15 articles were chosen for quantitative synthesis. All the prognostic measures including all-cause mortality, cardiovascular mortality, all-cause hospitalization, cardiovascular hospitalization and HF hospitalization were significantly lower in HFrecEF than HFrEF (RR= 0.58; 95% CI= 0.45-0.7, RR= 0.41; 95% CI= 0.29-0.58, RR= 0.75; 95% CI= 0.61-0.94, RR= 0.75; 95% CI= 0.73-0.78, RR, 0.56; 95% CI= 0.4-0.78 respectively) (Figures 1, 2, 3). The difference between HFrecEF and HFpEF patients regarding all-cause mortality was insignificant (Figure 1). Female gender, younger age, less severity of HF condition and lower rates of previous indications of CABG surgeries and defibrillator placements were associated with higher rates of LVEF recovery. Conclusion HFrecEF has a significantly different prognosis from HFrEF, which supports the hypothesis considering it a separate entity of heart failure types.

IMPACT OF PRIOR PERCUTANEOUS CORONARY INTERVENTION ON THE SHORT-TERM OUTCOME OF CORONARY ARTERY BYPASS SURGERY

IntroductionThe emergence of drug-eluting stents (DES) has resulted in greater utilization of coronary stents in patients with Class I Indications for Coronary Artery Bypass Surgery. The need for repeat revascularization in patients treated with PCI has led to an increasing percentage of CABG in patients with prior PCI. A study from the Society of Thoracic Surgeons 2018 Adult Cardiac surgery Database revealed that 28.9% of patients referred for CABG had a prior PCI. Several studies have demonstrated worse mid-term and long-term outcomes after CABG in patients with prior PCI. This study aimed to assess the impact of prior successful PCI on the short-term outcome after CABG surgery.Aim of the workThis study aimed to assess the impact of prior successful PCI on the short-term outcome after CABG surgery. Subjects and MethodsThis was a prospective cohort study that included a total of 60 patients admitted at The New Alexandria University Hospital from January 2018 to January 2020. Of these, 30 patients (50%) CABG surgery on native coronary arteries (Group A), and the remaining 30 patients (50%) had prior PCI before CABG (Group B). The primary outcomes of interest were postoperative myocardial infarction, cardiac death, postoperative bleeding, exploration for bleeding. Secondary outcomes included the duration of the ICU stay, the ventilation time, and the inotropic use.