CABG Surgery Research Articles

Changes of biventricular function after CABG surgery: does cardioplegia type matter?

we choose to evaluate, whether type of cardioplegia is an important predictor to determine biventricular function changes after CABG. 81 patients who underwent CABG surgery and matched inclusion criteria were enrolled in this study. The exclusion criteria were acute MI within 30 days, impaired systolic left ventricle function (LVEF ⩽35%), atrial fibrillation.TTE was performed for all patients and echocardiographic parameters of biventricular geometry and function were assessed before CABG surgery, first postoperative day and 6 months after surgery. Cardioplegia type was randomly chosen. First group consisted of 49 patients (60.5%) when CC was performed and the others 32 patients (39.5%) formed the second - BC group. Patients' demographic characteristics were similar in both groups, except the lower rates of AH and BSA in BC group (p = 0.015, p = 0.001 respectively). Longer duration of XCT and CBP time was observed in BC group (p = 0.019 and p = 0.028). BC group patients showed more efficient right heart chambers size reduction (p = 0.001 for RV diameter; p = 0.015 for RA diameter) and better improvement of longitudinal RV function (p = 0.02 for TAPSE; p = 0.001 for RV S') 6 months after surgery when compared with CC group patients. RV global systolic function diminished in both groups postoperatively, but the reduction was higher in CC group, although the difference was significant in comparing early postoperative measurements with the late after CABG surgery (p = 0.03). Changes of LV systolic function as well as diameter of LA did not differ between groups (p = 0.165 and p = 0.279, respectively), while diastolic function improved significantly in BC group patients at the late follow-up period: E/e' decreased (p < 0.001) and e' velocity of interventricular septum augmented significantly (p < 0.001). BC is associated with better RV reverse remodelling and improvement of longitudinal RV function, as well as LV diastolic function improvement after CABG surgery.

Relationship between interleukin-1β gene expression in epicardial adipose tissue and coronary atherosclerosis based on computed tomographic analysis

BackgroundAnti-inflammatory therapy targeting interleukin (IL)-1β reduced cardiovascular events in a randomized trial. We evaluated the relationship between IL-1β mRNA expression in epicardial adipose tissue (EAT) and clinically-assessed coronary atherosclerosis on computed tomography (CT). MethodsWe studied 45 patients before cardiac surgery (coronary artery bypass grafting [CABG], n ​= ​18; non-CABG, n ​= ​27). EAT volume, the coronary calcium score (CCS), and the presence of non- and/or partially-calcified coronary plaques (NCPs) and high-risk coronary plaques (HRPs; minimum CT density <30 Hounsfield units and vascular remodeling index >1.1) on CT angiography were assessed. EAT samples were obtained during cardiac surgery. IL-1β mRNA expression in EAT was measured using quantitative real-time PCR and normalized to that of β-actin in each patient. ResultsThere was no difference in IL-1β mRNA levels between patients who were scheduled for CABG and non-CABG surgery or among subgroups based on the CCS. However, patients with NCPs (median [interquartile range], 4.1[2.0-11.6]E-4 versus 1.8[0.6-4.5]E-4, p ​= ​0.024) and HRP (7.6[3.0-20.4]E-4 versus 1.9[0.7-4.3]E-4, p ​= ​0.0023) had higher IL-1β mRNA levels than those without these plaques. On multivariate analysis adjusted for age, sex, coronary risk factors, statin therapy, CCS, and EAT volume, the presence of HRPs was significantly correlated with elevated IL-1β mRNA levels in EAT (β ​= ​0.39, p ​= ​0.047). ConclusionOur data suggest a contribution of EAT to coronary atherosclerosis through molecular behavior, such as IL-1β gene expression, which may be a new therapeutic target.

Abstract 344: Circulating MicroRNA Signature as a Predictive Biomarker for Postoperative Heart Failure

Background: Advancements in cardiac surgical techniques have led to decreasing operative risk. However, postoperative heart failure (PoHF) continues to be a major risk factor for adverse cardiac events in 20-35% of patients after cardiac surgery, with a 10-fold increase in 30-day mortality. Prediction of PoHF is challenging, particularly in patients with preserved ventricular function. Circulating microRNAs (miRNAs) recently were identified to predict HF or AF after surgery, but their role in predicting PoHF is not known. This study aimed to find novel noninvasive circulating biomarkers along with clinical factors that can identify patients at risk of developing PoHF immediately after surgery. Methods: Patients undergoing CABG surgery with no previous history of HF, ventricular or supraventricular tachycardia were recruited, and preoperative blood assessed for circulating levels of protein biomarkers using ELISA. Differences in relative plasma levels of 13 miRNAs between the PoHF and no-PoHF groups were assessed by qPCR. Preoperative echocardiography was obtained. SAS was used for statistical analysis and ROC curve. Results: Out of 68 patients, 13 developed PoHF (19.1%, mean age 64.1±11.6y, 53.8% males), whereas 55 (mean age 68.3±12.4y) remained free of HF. Patients who developed PoHF had lower LVEF (51.4±13.7 vs 58.2±9.9, P&lt;0.05) with no differences in prevalence of hypertension, diabetes, hyperlipidemia, obesity, previous myocardial infarction, stroke, COPD, sleep apnea, or use of cardiac medications. The correlation matrix of all 13 miRNAs was transformed in a principal component (PC), resulting in 3 main clusters with eigenvalue &gt;1. PC cluster2 consisted of miR-23a, -23b, -25 and -26a2, principally involved in oxidatives stress, fibrosis and contractility, and had the strongest association (AUC=0.797; P&lt;0.01) with PoHF. A model combining PC cluster2 with age and LVEF improved sensitivity and specificity of the model to identify patients at risk of PoHF (AUC=0.880; 95% CL, 0.761-0.991; P&lt;0.001) Conclusion: Our study demonstrates that miR-23a, -23b, -25 and -26a2 may be useful predictors of PoHF. Circulating miRNA as biomarkers may have diagnostic potential to preoperatively, noninvasively identify patients at risk of developing PoHF.

A comparitive study between tranexamic acid and epsilon-amino-caproic acid in reducing post-operative bleeding in patients undergoing on pump cabg surgeries.

The amount of strain that cardiac surgery exerts on blood bank services is an example that emphasises the need for multimodel blood conservation stratergy. The most common factor which is being attibutable to increased bleeding after cardiac surgery is hyperfibrinolysis. Thererfore the use of antifibrinolytics during high risk cardiac surgery becomes inevitable. Commonly used antifibrinolytic include Tranexamic Acid(TA) and Epsilon-amino-caproic acid (EACA) .The aim of our study was to compare the effectiveness of both TA and EACA in reducing post surgical bleeding in on-pump CABG surgeries and to asses the post operative complications associated with its use.Material and Methods After obtaining informed written consent,approval of ethics and research commitee patients who were scheduled for on-pump CABG were included in the study.Patients were divided into two groups randomly by using a comupter generated randomized block design namely group TA(n=40) and group EACA (n=40). TA group received tranaxamic acid at a dose of 10mg/kg IV over 20 min at the time of induction then 1-2 mg/kg in CPB prime followed by 1 mg /kg/hr infusion during surgery. Group EACA received EACA in a dose of 100mg/kg/IV over 20 min at he time of induction then 5-10mg/kg in CPB prime followed by 10mg/kg/hr infusion during surgery . Pateints were assessed for blood loss and were monitored for fibrinogen level and D- dimer levels, Re-exploration and post operative complications. Result Primary outcomes like bleeding at 4hrs, there was no significant difference between the groups but when total bleeding at 24 hrs was compared there was a significantly lesser bleed in group TA group compared to group EACA (P=0.0022).The requirement of PRBC in group TA was for 3 patients,where as in EACA group 4 patients required PRBC (P&gt;0.05).There was no significant difference in the rate of post operative complications between the groups.(P&gt;0.05) .Conclusion from our study we concluded that both TA &amp; EACA effectively inhibits fibrinolysis during on pump CABG surgery and thus results in decreased post operative bleeding.When compared between the two, TA was slightly better with respect to post operative bleeding at 24hrs.Our study also re emphesized the fact that neither of the drug led to any additional risk of post operative thrombotic complications.

Effect of Intraoperative Loading Dose of Amiodarone for Prophylaxis Against Atrial Fibrillation in Patients with Rheumatic Valvular Heart Disease Undergoing Valve Replacement Surgery

Background: Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery and its peak incidence is between second or third postoperative day. It occurs in 40% to 50% of patients after valve surgery alone or combined valve and CABG surgery respectively. Among all the anti-arrhythmic drugs evaluated for AF, amiodarone has shown the most promising results with successful conversion and maintenance of normal sinus rhythm achieved in 50%–70% of patients.&#x0D; Methods: Sixty diabetic patients purposively selected who underwent isolated off pump coronary artery bypass procedure in NICVD. Group A – 30 patients receiving loading dose of amiodarone intra-operatively before establishment of CPB during valve replacement surgery and Group B- 30 patients without receiving loading dose of amiodarone intra-operatively during valve replacement surgery. Incidence of atrial fibrillation in postoperative period was evaluated.&#x0D; Results: Atrial fibrillation was observed in 8 (26.7%) patients in group A and 18 (60%) patients in group B (p=0.009). Ventricular tachycardia developed in 6.7% patients in group B and none in group A (p=0.47). Mean duration of ICU stay was 2.04±0.30 days in Group A and Group B was 2.98±0.77 days (p=0.03). Mean duration of post-operative stay was 7.20±0.66 days in Group A and Group B was 7.85±0.60 days (p=0.10).&#x0D; Conclusion: A single intra operative dose of intravenous amiodarone increases the incidence of conversion of AF to normal sinus rhythm. When AF persisted, use of amiodarone reduces the frequency of need for cardioversion and the energy required for it.&#x0D; Cardiovasc. j. 2020; 12(2): 102-108

Association of Preoperative HbA1c Level with Incidence of New-onset Atrial Fibrillation during Early Postoperative Period after Off-Pump Coronary Artery Bypass Grafting Surgery in Diabetic Patients

Background: Diabetes mellitus is an independent risk factor for coronary artery disease and it adversely affects the postoperative outcome after CABG surgery. Adequate control of diabetes for a longer period, which can be assessed by HbA1c, before OPCAB may reduce development of postoperative atrial fibrillation and thus improve outcome.&#x0D; Methods: This was an observational study included sixty diabetic patients purposively who underwent isolated off pump coronary artery bypass procedure in NICVD. Total sample contained 60 diabetic patients, which were divided in two equal groups. Grouping was Group I – 30 Diabetic patients with preoperative HbA1c &lt;7% and Group II – 30 Diabetic patients with preoperative HbA1c ≥7% and all of whom underwent isolated OPCAB. Postoperative atrial fibrillation and other complications were recorded and compared in two groups of patients.&#x0D; Results: Most postoperative atrial fibrillation (AF) developed in higher age group 61-70 years (61.5%). Postoperative complications were higher in group II. Postoperative AF was significantly higher in diabetic patients having preoperative HbA1c ≥7% compare to diabetic patients with HbA1c &lt;7% in early postoperative period after OPCAB. Age (61-70 years) (OR=1.872, p=0.018), preoperative HbA1c ≥7% (OR=19.029, p=0.002) and hypertension (OR=1.091, p=0.019) was found significantly associated with increased development of postoperative atrial fibrillation.&#x0D; Conclusion: Our study revealed that higher preoperative HbA1c level was associated with increased incidence of new onset atrial fibrillation after OPCAB. So, it can be used as a reliable indicator for adequate control of diabetes preoperatively among patients selected for isolated elective OPCAB in future.&#x0D; Cardiovasc. j. 2020; 12(2): 113-119

Clinical Value Of Routine Early Postoperative CT Imaging After CABG Surgery

Clinical Value Of Routine Early Postoperative CT Imaging After CABG Surgery

Assessment of preoperative risk scoring systems in geriatric and non-geriatric coronary bypass surgery patients

Aim: The need to predict mortality in patients undergoing cardiac surgery has resulted in the development of numerous preoperative risk scoring systems, which are being successfully implemented in clinical practice. Although the criteria of scoring systems use patient age as a risk factor, their effectiveness should also be evaluated in the subgroups of these systems. Methods: Our retrospective cohort study includes all patients who underwent isolated CABG surgery at Private Akay Hospital Cardiovascular Surgery Clinic between May 2012 and March 2014. Patients were subdivided into two cohorts as geriatric (≥65 years) and non-geriatric (<65 years) patients. In this study, intraoperative deaths and deaths within 30 days postoperatively were considered as mortality. We retrospectively evaluated demographic data, preoperative risk factors, preoperative treatments, postoperative data, postoperative complications, laboratory findings, and mortality and morbidity outcomes from patient files and the hospital database. Results: The coherence between observed and EuroSCORE II-predicted mortality, logistic Euro-SCORE-predicted mortality and Parsonnet-predicted mortality were 93%, 94%, and 89%, respectively for patients aged 65 and older, and 78%, 77%, and 71%, respectively for patients aged below 65 years (P=0.01 for all). Conclusion: In general, we observed that EuroSCORE II, Log EuroSCORE and Log Parsonnet scoring systems are more effective in predicting mortality among elderly coronary bypass surgery patients compared to younger patients.

Timing of Coronary Artery Bypass Grafting Surgery after Acute Myocardial Infarction

Background: Optimal timing for CABG surgery after myocardial infarction remains a matter of debate. The aim of our study was to analyze the effect of timing of CABG after acute myocardial infarction on operative mortality and morbidity.&#x0D; Methods: This prospective study included 60 patients who underwent isolated CABG within 30 days of acute myocardial infarction over 20 months (from the first of November 2014 till the end of June 2016) in Kasr Al-Ainy University Hospitals. Patients were divided into two groups; the early group (0 – 3 days) included 14 patients (23.3%) and the late group (4 – 30 days) included 46 patients (76.7%). The primary outcome was all-cause hospital mortality.&#x0D; Results: Our study included 43 males (71.7%) and 17 females (28.3%). The mean age was 58.4 ± 7.3 years. The total mortality rate was 8.3%. Patients undergoing early CABG experienced a higher mortality rate than those undergoing late CABG (21.4% vs 4.3%, P = 0.043). Also, early CABG was associated with more postoperative complications. Cardiogenic shock and early CABG were independent risk factors of mortality.&#x0D; Conclusion: CABG in the first 3 days after acute myocardial infarction was associated with high mortality and morbidity in comparison with late CABG. This suggests that CABG may best be deferred for more than 3 days after acute MI in non-urgent cases.

P0622FIGHTING AGAINST PROXIMAL AND DISTAL TUBULAR DAMAGE BY REDUCING INFLAMMATORY BURDEN AFTER CARDIAC SURGERY

Abstract Background and Aims Going on cardiopulmonary bypass (CPB) during cardiac surgery causes systemic inflammatory response syndrome. In different studies Pentoxifylline and Calcitriol have shown inhibitory effects on pro-inflammatory cytokines such as tumor necrosis factor (TNF) and interleukin-6 (IL-6) accompanying with production of free oxygen radicals in the ischemic reperfusion injury. On the other hand, they have positive effects on reducing oxidative stress. To investigate the effects of these drugs on reducing tubular injury after CABG surgery, by their anti-inflammatory properties we compared pre- and postoperative levels of urinary NGAL (as a proximal tubular damage marker), KIM-1 level (as a distal tubular damage marker), serum level of Malondialdehyde (MDA) (as an oxidative stress marker) and serum inflammatory markers such as IL-6, IL-8, and TNF levels in two groups of patients undergoing CABG, those who received Pentoxifylline and Calcitriol before surgery and those who didn't Method After signing an informed consent, 150 consecutive adult patients undergoing elective on-pump CABG were enrolled in a randomized control trial. Patients with collagen-vascular disease or having a history of treatment with immunosuppressive agents, corticosteroids (&amp;gt; 3 days), Methylxantines, Diltiazem or sodium Nitroprusside and patients with a history of angiography in the past 7 days or hemorrhagic diathesis and coagulopathy, uncontrolled diabetes mellitus, sepsis, renal failure (sCr &amp;gt; 2 mg/dl), hepatic failure (AST or ALT &amp;gt; 40 U/L) or urinary tract infection were excluded. All patients received the same anesthetic regimen and routine CPB management. The patients were randomly assigned to one of two groups: PTX was administered as an oral 400 mg tab every 12hours plus IV Calcitriol (0.01 mcg/kg) daily starting from 3 days before surgery. In the control group placebo tab and IV injection of normal saline were prescribed in the same direction. Results Results demonstrated that after three days prophylactic use of oral pentoxifylline plus IV Calcitriol there is improvement in selected checked inflammatory markers in the intervention group. Moreover Pentoxifylline+ Calcitriol showed beneficial effects by controlling the oxidative stress burden and reducing the mean serum MDA level in the patients undergoing CABG who are at risk of developing AKI as a post surgery complication. Probably by reducing inflammation and oxidative stress combination of these two drugs before CABG could decrease proximal and distal tubular damage which presented with significantly lower levels of uNGAL and KIM-1, as markers of tubular injury, in the intervention group. Conclusion Combination of Pentoxifylline and Calcitriol showed a promising prophylactic role in patients undergoing CABG with anti-inflammatory, anti-oxidant properties. This study provided scope of add-on drug therapy for better prognosis in post CABG population, involving risk of endothelial dysfunction and renal tubular damage due to inflammatory milieu and renders support to future prospective clinical studies to demonstrate net control of inflammation and oxidative stress after cardiac surgery.

Evaluation of the risk factors for neurological and neurocognitive impairment after selective cerebral perfusion in thoracic aortic surgery.

Neurologic complications are seen often after the surgery of the thoracic aorta that uses selective antegrade cerebral perfusion. The objective of this study was to evaluate the impact of atherosclerotic risk factors on neurologic complications in patients who underwent surgery to the thoracic aorta using SCP. Data were collected retrospectively on 94 patients who underwent elective ascending aorta/aortic arch replacement. Concomitant procedures were performed as needed. All patients had magnetic resonance imaging (MRI), angiography (MRA) and carotid ultrasound before surgery. Individual cognitive status was measured using four neuropsychological tests before surgery and 7days after extubation. We compared perioperative factors for risk factors associated with postoperative stroke and postoperative cognitive decline (POCD). 11 patients had strokes after surgery. Operation and extracorporeal circulation times were significantly longer in patients with stroke than those without stroke. Coronary artery disease and SCP time > 150min were independently associated with postoperative stroke. Of the 83 patients without postoperative stroke, 20 suffered POCD. POCD patients had a significantly higher rate of heterogeneous carotid plaque, and operation time was significant longer in patients with POCD than those without POCD. Independent predictors of POCD were concomitant CABG, heterogeneous carotid plaque, history of cerebrovascular disease and operation time > 450min. We found that prolonged SCP time and coronary artery disease increased the risk of postoperative stroke. Heterogeneous carotid plaque, history of cerebrovascular disease, concomitant CABG and prolonged operation time were further significant predictors of POCD.

Coronary artery bypass grafting surgery differentially modulates the leucocyte gene expression profile

Abstract Coronary artery bypass grafting (CABG) surgery triggers a systemic inflammatory response activating leucocyte subsets and cytokine secretion. Changes to the patient immune profile post-surgery may contribute to adverse outcomes such as infection. Investigating patient immune modulation at the molecular level may improve our understanding of the underlying mechanisms associated with adverse outcomes post-surgery. This study assessed changes to the leucocyte gene expression profile of CABG patients (n=50) at 5 time-points (admission, intra-operative, ICU, day 3, day 5). RNA was isolated from freshly collected whole blood for cDNA synthesis, pre-amplification and RT-PCR of 48 genes using the TaqMan Gene Expression Array Cards (Applied Biosystems). Gene expression at each time-point was compared to admission (repeated-measures one-way ANOVA with Dunnett’s post-test; P&amp;lt;0.05). Antigen presentation capacity was decreased throughout the post-operative period, evidenced by reduced expression of key regulator genes TAP1, TAP2, HLA-DRA and CD40. CABG surgery increased gene expression of cytokines and chemokines including IL-12A, IL-6 and TNF before decreasing throughout the post-operative period. CABG also modulated the expression of signalling molecules including JAK1, RELA and STAT3, however expression returned towards baseline levels post-surgery. This study demonstrated CABG significantly impaired the patient immune response and key immune pathways at the molecular level. Understanding how CABG alters the patient immune profile assists in elucidating underlying mechanisms of adverse outcomes.

Oral vs intravenous acetaminophen as a constituent of multimodal analgesia after coronary artery bypass graft surgery: A randomized, blinded trial

Background &amp; Aim: This trial aimed to compare the pain relief and side effects of Oral Acetaminophen (OA) and Intravenous Acetaminophen (IVA) after CABG surgery. Methods &amp; Materials: This parallel-group, triple-blinded, randomized trial was conducted on 113 CABG patients from September 2017 through February 2018. The samples were selected through blocked randomization and allocated into two groups using computer-generated. The participants administered 1gr oral (OA group, n=57) or intravenous Acetaminophen (IVA group, n=56) every 6h for the first 24h following surgery; also, pain controlled in both group with Morphine multimodal analgesia strategy. Pain intensity measurement by VAS was followed after extubating the endotracheal tube at the 0, 1, 6, 12, 18 and 24 hours during the rest and deep breathing. The Morphine consumption and the incidence of nausea and vomiting in the first 24h were assessed. Data were analyzed using SPSS software and Chi-square, t-test, mixed ANOVA and ANCOVA test. Results: The pain score in the IVA group was found to be statistically significantly lower than the OA group at rest (P&lt;0.001) and during deep breathing (P&lt;0.001) in the first 24h. There was no statistically significant difference between groups regarding the cumulative Morphine consumption (P=0.056). The use of IVA was associated with a reduction in frequencies of nausea and vomiting incidents (P=0.029). Conclusion: Administration of IVA for the management of postoperative pain in CABG patients significantly reduced pain score and incidence of nausea and vomiting compared to OA. Any reduction in cumulative Morphine consumption did not accompany the lower pain.

Effect of Cold Application on Chest Incision Pain Due to Deep Breathing and Cough Exercises

BackgroundWe determined the effect of cold application after coronary artery bypass graft surgery on chest incision pain due to deep breathing and coughing exercises. Thoracotomy performed for coronary artery bypass graft surgery is one of the most painful surgical procedures. This pain prevents deep breathing and effective coughing. These problems increase the risk of morbidity in the postoperative period. AimsThis study aimed to determine the effect of cold application after CABG surgery on chest incision pain due to deep breathing and cough exercises. DesignExperimental study with control group and repeated measurements. SettingsPatients were selected through convenience sampling in the Cardiovascular Surgery Intensive Care Unit at a hospital. ParticipantsThe study was conducted with 57 patients who underwent open heart surgery (29 and 28 in the experimental and control groups, respectively). MethodsRepeated pain assessment was performed before, immediately after, and 5 min after deep breathing and coughing exercises performed in 4 periods at 2-h intervals. The first pain assessment was performed 24 h postoperatively. In the first and third assessments of the experimental group, pain was recorded before the exercise; the exercise was performed 15 min after cold gel pack application to the incision area. Pain was assessed before, immediately after, and 5 min after exercise using the Short- Form McGill Melzack Pain Questionnaire. ResultsReduction in pain severity within and between the groups was statistically significant in the first and third evaluations (p = .001). ConclusionsThe results provide evidence to support the use of cold gel pack.

F18-FDG Cardiac PET/CT: An alternative tool for myocardial viability determination prior to coronary revascularization decision in severe ventricular dysfunction

Purposes: The aim of the present study was to evaluate clinical value and accuracy of Fludeoxyglucose Cardiac Positron Emission Tomography Computerized Tomography (FDG C-PET/CT) as an alternative tool for myocardial viability determination prior to coronary revascularization decision in lower left ventricular ejection fraction (LVEF) patients. We accepted lower LVEF as 35% or less for the study. FDG C-PET/CT is reported to be the gold standart for myocardial viability detection among other techniques such as thallium-201 rest-redistribution scintigraphy myocardial perfusion imaging and dobutamine stress echocardiography.&#x0D; Materials and Methods: Between the dates of 01.01.2010 and 10.07.2019, 191 consecutive patients (mean age 64±9.1 years) underwent CABG operations with severe LVEF dysfunction with 35% or less. These impaired LVEF patients were calculated as the 4.4% total CABG cases. Myocardial viability was also studied and elaborated by F18-FDG C-PET/CT for all cases. Elaboration was detailed as viable myocardial tissue, hibernated myocardial tissue or necrosis areas (scars, nonviable tissue) via segmentally images of the heart. Final surgical decision was primarily depended on F18-FDG C-PET/CT for the majority of cases.&#x0D; Results: 191 CABG operations were performed. Perioperative deaths occured in 18 (9.4%) cases. Mortality reasons were prolonged CPB in 4 (2%) cases, severe and unmanageable ventricular arrhytmias in 5 (2.6%) cases, MOD with prolonged intubation in 6 (3.1%) cases and major neurological complication in 2 (1%) cases. Our mean coronary graft number was 3.5±0.8. LIMA was used in the majority of cases (n=176, 92.1%). LIMA was anastomosed to LAD for each case. IABP insertions were applied in 81(42.4%, 43 cases intraoperatively, 38 cases at ICU) patients. 236 patients with impaired LVEF and severe coronary artery disease were evaluated by F18-FDG C-PET/CT prior to operation. 191 cases (80.9%) were accepted as canditates for revascularization with multiple viable segments.45 cases (19.1%) presented transmural scar tissue (non-viable) images by FDG uptake analysis. This group cases were considered to be with non-beneficial results from revascularization. Thus, these patients were referred to medical treatments. Mean number of viable segments on F18-FDG C-PET/CT were calculated as 5.2±1.4 for each patient.&#x0D; Conclusions: The presence of myocardial viability is crucial to define reasonable canditates for revascularization in cases with lower LVEF. Among other preoperative viability detection techniques such as dobutamin echocardiography and myocardial perfusion scintigraphies, F18 FDG cardiac PET/CT is accepted as the ‘Gold Standart’ for segmental analysis on basis of distinguishing scar tissue from viable components. We strongly advocate F18-FDG cardiac PET/CT to be a suitable and effective tool to evaluate CABG indications in severe ventricular dysfunction.

Assessment of Coronary Artery Bypass Graft by Using Multidetector Computed Tomography Coronary Angiography

Background: CABG surgery is the standard care in the treatment of advanced coronary artery disease. Assessment of the status of the grafts after CABG surgery is an important issue. Recently, MDCT has gained rapid acceptance as a diagnostic cardiac imaging modality, allowing assessment of coronary bypass graft patency with high spatial resolution. Aim: Evaluate the role of (MDCT) in assessment of CABG. Patients and methods: In this prospective study, 30 patients after coronary artery bypass graft surgery are included. The 30 patients were examined by ECG gated MDCT coronary angiography in CT unit in radiology department of national heart institute between (October 2018 to April 2019). Results: The study included 30 patients with prior CABG surgery. Mean age was 61 +/- 6.9 years with male gender predominance represented 86 % (26 patients). The evaluable grafts were 75 grafts. The most common used grafts were the venous grafts represented 59 %( 44 grafts) while arterial grafts represented 41% (31 grafts).The most common landing site of arterial grafts was LAD (with incidence 84%), while the most common landing site of venous grafts was RCA(with incidence 39%). Conclusion: MDCT coronary angiography is a potentially safe, non-invasive modality in assessment of coronary artery bypass grafts in post-CABG patients.

Abstract P348: Long-term Cognitive Decline in Older Adults After Incident Coronary Heart Disease or After First Receipt of Coronary Artery Bypass Grafting Surgery or Percutaneous Coronary Intervention

Objective: We investigated two hypotheses: First, incident CHD, defined as myocardial infarction or definite angina, leads to faster long-term cognitive decline. Second, among those with CHD, treatment with CABG surgery or PCI leads to slower long-term cognitive decline. Methods: The Cardiovascular Health Study is a cohort of US adults aged 65+. Global cognitive ability was assessed annually up to 9 times from 1990 to 1998 with the 100-point Modified Mini-Mental State Examination (3MS). We estimated trajectories of 3MS scores in the absence of stroke, adjusting for demographics, health behaviors, and comorbidities. For hypothesis 1, we compared 3MS trajectory after incident CHD with 3MS trajectory in the absence of CHD, censoring at first receipt of CABG/PCI. For hypothesis 2, among participants with CHD, we compared 3MS trajectory after first receipt of CABG/PCI with 3MS trajectory without CABG/PCI. Results: For hypothesis 1, of 4,122 participants, 398 had incident CHD during a mean of 5.9 years of follow-up. Figure Panel A shows model-predicted mean 3MS trajectories without CHD (blue) and after incident CHD (red) diagnosed at ages 70, 75, 80, or 85. Model-predicted 3MS score declined faster after incident CHD, especially for CHD diagnosed at age 80 or later. For example, after incident CHD at age 85, predicted 5-year decline in mean 3MS score through age 90 was 13.9 points (95% CI: 11.0, 16.7) versus 8.9 points (95% CI: 8.1, 9.7) among those without CHD. For hypothesis 2, of 1,183 participants who had prevalent or incident CHD, 118 had their first CABG/PCI during a mean of 4.1 years of follow-up. Model-predicted 3MS score declined faster after first receipt of CABG/PCI ( Figure Panel B ). Conclusions: Older adults diagnosed with incident CHD had faster average cognitive decline than those without CHD. However, treatment with CABG/PCI did not slow cognitive decline among those with CHD. This finding may be due to adverse effects of CABG/PCI on brain health or CABG/PCI recipients having more severe CHD or more cerebral atherosclerosis.

SAT-115 PROLONGED ICU STAY IN POST CABG CKD PATIENTS AND POST-OPERATIVE QUALITY OF LIFE (QOL) AT 6 MONTHS

Intensive Care Unit(ICU) is associated with costly and limited resources in third world countries. Prolonged ICU stay not only increases hospital cost but it also prevents hospital equipment to be used by other patients who need them. Conflicting results have been found regarding risk factors that prolong ICU stay after cardiac surgery in Chronic Kidney Disease(CKD) patients. The aim of this study was to identify factors that impact the duration of ICU stay in post CABG CKD patients and to assess how CKD and prolonged ICU stay affect their QOL 6 months after Cardiac Surgery. Knowing these factors can help timely management and resource planning. We analysed medical records of 191 post CABG patients at our Cardiac Surgery ICU. CABG patients, above 18 years with and without CKD were included. However, those with redo CABG and valve surgery were excluded. Patients were categorized as normal ICU stay (less than 48 hours) and prolonged ICU stay (more than 48 hours). The effect of different patient variables and peri operative risk factors on prolonged ICU stay were analysed using Pearson Chi square test. QOL was assessed at 6 months follow up using SF36 QOL questionnaire: categorised as poor, good and excellent. Mean age of the patients was 57.83 years (± 9.862 SD). 32(16.8%) were females and 159(83.2%) were males.145 patients (75.9%) were hypertensive and 110(57.6%) were diabetic and all had dyslipidemias(Table 1). 72/191 (37.6%) patients had CKD 3-5 : 66- CKD 3, 4-CKD 4, 2-CKD 5). 56/191 patients (29.3%) had prolonged ICU stay. Patients who had Diabetes Mellitus and Chronic kidney disease(stage 3-5) had prolonged ICU stay(p value of 0.003 and 0.027 respectively). Patients who had a recent Myocardial Infarction (MI) (less than 90 days prior to CABG), diastolic dysfunction, and LV EF (Left Ventricular Ejection Fraction)less than 35% also had prolonged ICU stay (p value of 0.072, 0.06 and 0.003). Within the ICU, patients with post CABG arrhythmias(Atrial fibrillation, Supraventricular tachycardia, Ventricular tachycardia) and Cardiogenic shock had prolonged ICU stay(p value of 0.001 and 0.029). Patients with AKI and those who had dialysis post CABG had prolonged ICU stay (p value 0.02 and 0.02 respectively), as shown in Table 2. Out of 72 CKD patients,24 patients had prolonged ICU stay. Among CKD cohort, prolonged ICU stay was observed in diabetics (p : 0.05), patients who needed dialysis (p:0.04), patients with post op arrhythmias (p :0.001) and in those with LV EF <35% (p:0.002) (Table 3). Further analysis revealed a strong correlation of on pump surgeries with prolonged ICU stay (p value :0.04) and 50% of the CKD patients on pump had prolonged ICU stay. Out of 191 patients, 129 were available for follow up of QOL at 6 months. Only one patient in Stage 3 CKD had poor QOL. 34 patients in CKD 3 and 4 had good QOL. 14 patients with CKD 3 and 4 had excellent QOL (Table 4). There was no mortality at 6 months follow up. Significant correlation of the following risk factors was found with prolonged ICU stay: Diabetes mellitus, CKD, AKI, Dialysis, MI less than 90 days pre CABG, Post op arrhythmias, Shock, Diastolic dysfunction and LV EF<35%. However in CKD cohort, prolonged ICU stay was seen with AKI, dialysis, diabetics, post op arrhythmias and LV EF<35%.

Furoemside versus mannitol as a renal protection after adult cardiac surgery

Abstract Background Occurrence of acute oliguric renal failure in the immediate postoperative period carries important morbidity and mortality after a successful cardiac surgical procedure. Adult cardiac and aortic surgical procedures are especially prone to this complication with the incidence varying between 2% to 15% and the mortality rate as high as 40% to 60%. Aim of the Work to compare between furosemide versus mannitol as a renal protection after adult cardiac surgery. Patients and Methods This prospective comparative trial was conducted at Academy of Cardiothoracic Surgery Ain Shams University on patients undergoing CABG operation consisting of a total of 50 patients with normal renal function, EF of greater than 40%, normal protein and electrolyte levels. Results the study revealed no statistically significant difference between groups according to cystatin-C Conclusion The difference between patients given mannitol and patients given furosemide regarding urinary microalbumin, urinary creatinine and serum cystatin-c was insignificant. Addition of mannitol to the priming solution of the cardiopulmonary bypass acts as a renal protector against AKI postoperative. Finally, giving furosemide infusion to patients undergoing cardiac surgery at the beginning of the CPB improves renal perfusion.

Left main coronary artery disease: when and how to perform PCI?

Left main coronary artery (LMCA) disease has been reported in up to 10% of all patients with coronary artery disease (CAD) and in the majority of cases are associated with severe three-vessel CAD. Among patients with chronic coronary syndrome revascularization of significant LMCA disease improves prognosis, while there is a debate about which revascularization strategy, CABG surgery or percutaneous coronary interventions to use. We do a review of the available evidence about the impact of LMCA lesions on patient prognosis according to CAD extension and clinical presentation, the outcome after percutaneous or surgical revascularization, the procedural challenges of LMCA PCI and the available armamentarium to optimally treat this relevant population.