CABG Surgery Research Articles

P3661Effect of severe mental disease on distribution of CAG, PCI, CABG and valve surgery following MI, a nationwide register based study

P3661Effect of severe mental disease on distribution of CAG, PCI, CABG and valve surgery following MI, a nationwide register based study

P5243Echocardiographic pre-operative early mitral inflow velocity-to-early diastolic strain rate ratio predicts post-operative paroxysmal atrial fibrillation in patients undergoing CABG surgery

P5243Echocardiographic pre-operative early mitral inflow velocity-to-early diastolic strain rate ratio predicts post-operative paroxysmal atrial fibrillation in patients undergoing CABG surgery

Effect of Remote Ischemic Preconditioning on Intestinal Ischemia-Reperfusion Injury in Adults Undergoing On-Pump CABG Surgery: A Randomized Controlled Pilot Trial

Cardiopulmonary bypass (CPB) surgery commonly threatens the heart and remote organs with ischemia-reperfusion injury. Transient episodes of ischemia to nonvital tissue, known as remote ischemic preconditioning (RIPC), is thought to help local and remote vital organs to withstand subsequent ischemic insults. Prospective, randomized, double-blinded control trial. Tertiary referral academic teaching hospital. Thirty patients undergoing elective CPB surgery INTERVENTION: RIPC was achieved via three 5-minute cycles of upper limb ischemia using a blood pressure cuff or control (sham cuff). Primary outcome was the occurrence of intestinal injury, as measured by an increase in intestinal fatty acid binding protein (I-FABP). Secondary outcomes included incidence of gastrointestinal complications and duration of intensive care unit (ICU) stay. RIPC did not affect serum IFABP levels at the end of surgery and on the first postoperative day (p = 0.697 and p = 0.461, respectively). For all patients, mean I-FABP levels significantly increased at the end of surgery and decreased to under baseline levels on the first postoperative day (from a mean [± standard deviation] baseline value of 764 ± 492 pg/mL to 2,002 ± 974 pg/mL and decreased to 568 ± 319 pg/mL, p < 0.001). All patients remained clinically absent of gastrointestinal complications until hospital discharge. Duration of ICU stay was not correlated with I-FABP levels at the end of surgery. Neither duration of CPB nor duration of aortic clamping significantly correlated with postoperative I-FABP levels. These findings suggest that RIPC does not affect intestinal injury in patients undergoing CPB surgery. In patients undergoing cardiac surgery, intestinal injury appears to be moderate and transient without any clinical relevant complication.

Relationship between toll-like receptor 2 R753Q and T16934A polymorphisms and Staphylococcus aureus nasal carriage.

The association among specific single-nucleotide polymorphisms (SNPs) in TLR2 R753Q (rs5743708) and T16934A (rs4696480) and the nasal carriage of Staphylococcus aureus was studied in adults before CABG. The TLR2 polymorphisms were genotyped in 299 consecutive patients prepared for a CABG operation. Genotyping was performed using restriction fragment length polymorphism (RFLP) analysis of PCR-amplified fragments. Two nasal swab cultures were taken within 2 weeks before the operation. Subjects were classified as Staphylococcus aureus carriers if at least one culture was positive while those patients with both cultures found to be negative were classified as non-carriers. The prevalence of nasal S. aureus carriage in the final cohort was 22.1% (66/299), while no MRSA was detected in our study group. No significant differences in the TLR2 polymorphisms were observed between the study and the control groups. No associations were found between TLR2 haplotypes and the covariates of age, sex, NYHA, weight, height, BMI, CAD, smoking status and ESlog score. No differences were found between carriers and noncarriers regarding the allelic distribution of the TLR2 T-16934A SNP. Almost 93% of the patients who were screened for the presence of the TLR2 Arg753Gln (rs5743708) were GG wild type homozygous. Twenty one subjects from the study group (7.1%) were GA heterozygous, while no patient in either group was homozygous for the TLR2 Arg753Gln (rs5743708) mutation. TLR2 Arg753Gln genotyping showed that GA heterozygous patients were detected more frequently in the group of Staphylococcus aureus nasal carriers than in non-carrier adults. Our results suggest that the carrier status for the GA variant of the TLR2 Arg753Gln (rs5743708) polymorphism may be a risk factor for Staphylococcus aureus carriage.

72 Offset of ticagrelor prior to coronary artery bypass graft surgery (cabg) surgery

IntroductionTicagrelor is a more potent platelet inhibitor than clopidogrel but also has a more rapid offset of inhibitory effect. The optimal timing of discontinuation of ticagrelor prior to coronary artery...

62 Angiography after cabg surgery; solving the problem of missing surgical records with a sternal wire code

Background The recommendation that surgical records (graft notes) are obtained before coronary angiography in patients with previous coronary artery bypass graft (CABG) surgery is not always followed. Lack of prior information on the number and origin of grafts increases procedure time, complexity and risk to patients. Here, we determine the proportion of angiograms undertaken without graft notes, and propose a code to permanently provide this information. Methods For patients undergoing angiography at the Barts Heart Centre, London (September 2015-September 2016), records of patients with previous CABG were retrieved. From the procedure reports, we identified patients without graft notes and the indication for the angiogram. Results Of 6483 patients undergoing angiography, 559 had undergone previous CABG surgery; graft notes were unavailable in 91/559 patients (16%). In 88/91 patients (97%), angiography was an unplanned emergency procedure; 84 acute coronary syndromes and 4 out-of-hospital arrests. Three patients had planned angiograms for stable angina. In 20/91 patients additional imaging investigations were required because of uncertainty over whether all grafts had been identified and one patient consequently developed pulmonary oedema due to a large contrast load. Conclusion About 1 in 6 patients with previous CABG surgery, who require coronary angiography, undergo this procedure without graft notes, almost all in the emergency setting. A clinical code, based on the orientation of the wires used to close the sternum after CABG, could provide a permanent record of the number and origin of the surgical grafts (see Table). We propose that this code, which requires no new technology or technique, be adopted routinely in CABG surgery.

Intraoperative tranexamic acid is associated with postoperative stroke in patients undergoing cardiac surgery.

BackgroundStroke is a devastating and potentially preventable complication of cardiac surgery. Tranexamic acid (TXA) is a commonly antifibrinolytic agent in cardiac surgeries with cardiopulmonary bypass (CPB), however, there is concern that it might increase incidence of stroke after cardiac surgery. In this retrospective study, we investigated whether TXA usage could increase postoperative stroke in cardiac surgery.MethodsA retrospective study was conducted from January 1, 2010, to December 31, 2015, in 2,016 patients undergoing cardiac surgery, 664 patients received intravenous TXA infusion and 1,352 patients did not receive any antifibrinolytic agent. Univariate and propensity-weighted multivariate regression analysis were applied for data analysis.ResultsIntraoperative TXA administration was associated with postoperative stroke (1.7% vs. 0.5%; adjusted OR, 4.11; 95% CI, 1.33 to 12.71; p = 0.014) and coma (adjusted OR, 2.77; 95% CI, 1.06 to 7.26; p = 0.038) in cardiac surgery. As subtype analysis was performed, TXA administration was still associated with postoperative stroke (1.7% vs. 0.3%; adjusted OR, 5.78; 95% CI, 1.34 to 27.89; p = 0.018) in patients undergoing valve surgery or multi-valve surgery only, but was not associated with postoperative stroke (1.7% vs. 1.3%; adjusted OR, 5.21; 95% CI, 0.27 to 101.17; p = 0.276) in patients undergoing CABG surgery only. However, TXA administration was not associated with postoperative mortality (adjusted OR, 1.31; 95% CI, 0.56 to 3.71; p = 0.451), seizure (adjusted OR, 1.13; 95% CI, 0.42 to 3.04; p = 0.816), continuous renal replacement therapy (adjusted OR, 1.36; 95% CI, 0.56 to 3.28; p = 0.495) and resternotomy for postoperative bleeding (adjusted OR, 1.55; 95% CI, 0.55 to 4.30; p = 0.405). No difference was found in postoperative ventilation time (adjusted B, -1.45; SE, 2.33; p = 0.535), length of intensive care unit stay (adjusted B, -0.12; SE, 0.25; p = 0.633) and length of hospital stay (adjusted B, 0.48; SE, 0.58; p = 0.408).ConclusionsBased on the 5-year experience of TXA administration in cardiac surgery with CPB, we found that postoperative stroke was associated with intraoperative TXA administration in patients undergoing cardiac surgery, especially in those undergoing valve surgeries only. This study may suggest that TXA should be administrated according to clear indications after evaluating the bleeding risk in patients undergoing cardiac surgery, especially in those with high stroke risk.

Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience

BackgroundThe reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhythmia usually occurring between second and fourth postoperative days. Postoperative AF after CABG was associated with greater in-hospital mortality and worse survival at long-term follow-up. Therefore, intensive attention has focused on the prevention of AF in high-risk patients. Many perioperative factors have been suggested to increase the incidence of postoperative AF after conventional CABG. In this study we are trying to examine some of these risk factors as predictors for Post-operative AF in our patients. In this study, our aim was to identify the perioperative predictors of AF in our patients who underwent Coronary Artery Bypass Grafting.MethodsOur Patients were divided into two groups; Group A included patients who did not develop PO AF (168 patients) and Group B patients who developed PO AF (84 patients). Perioperative Data, including gender, age, demographic variables and postoperative morbidity and mortality were extracted from the medical records.ResultsThis retrospective cohort study was conducted on 252 consecutive adult patients underwent CABG, in King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia. The mean age for patients with PO AF was 65 years (P = .0001). Eight-three patients (49.4%) were diabetics in group A and 56 patients (66.7%) in group B (P = .0001). Patients who developed POAF had a lower ejection fraction (44.8 ± 5.7%) (P = .0001), diastolic dysfunction (P = .0001), Larger Left atrial volume (P = .0001). Bleeding requiring re-opening for exploration and Postoperative shock were identified as significant predictors for POAF. Multivariate logistic regression (odds ratio, ±95% CI, P value) was performed to identify the effect of age, preoperative heart rate, ejection fraction, postoperative bleeding, Shock, ventilator time, Sensitivity was 89.5%, specificity was 94.6%, positive predictive value was 89.5%, and negative predictive value was 94.6%.ConclusionIn our study, advanced age, enlarged LA volume, low ejection fraction, combined surgeries and prolonged ventilation time were found to be predictors of atrial fibrillations after coronary artery bypass grafting.

The Effect of Various Cardiac Rehabilitation Programs on Cardiac Dimensions of Post-CABG Patients

Background: In the majority of cardiovascular diseases, cardiovascular structure changes in line with the type of disease. One of the goals of cardiac rehabilitation is the improvement of cardiac performance and reversibility of hypertrophied cardiac dimensions. The present research aimed to compare the effectiveness of various cardiac rehabilitation programs on cardiac dimensions of patients with post-coronary artery bypass grafting (CABG). Methods: In this semi-experimental research, among CABG patients, 40 males with cardiovascular disease after CABG operation were selected using purposeful sampling method and divided into 4 groups of 10 persons: 1) aerobic continuous training group; 2) aerobic interval + resistance training group; 3) aerobic continuous + resistance training group; and 4) control group. Trainings were held for eight weeks, three training sessions a week, and every session included aerobic trainings with intensity of 50% - 85% of reserved heart rate and resistance trainings with 40% - 60% of maximum repetition. One day before and one day after the training intervention, the investigated variables were measured using two-dimensional echocardiography. For statistical analysis, the multivariate variance analysis was used (P ≥ 0.05). Results: No significant reduction was observed in cardiac dimensions in any of the research groups (P ≤ 0.05). However, the results of the inter-group comparisons showed that there was a significant difference in ejection fraction between the various groups (P ≤ 0.05). Further investigation showed that the aerobic interval - resistance trainings would further increase the ejection fraction than the aerobic continuous trainings (P ≤ 0.05). Conclusions: Although adding a resistance part to the routine cardiac rehabilitation exercises does not have a significant effect on the cardiac structure of patients with diastolic functional disorder, it can be more effective in the heart performance.

One-year costs of bilateral or single internal mammary grafts in the Arterial Revascularisation Trial

ObjectiveCoronary artery bypass grafting (CABG) using bilateral internal mammary arteries (BIMA) may improve survival over CABG using single internal mammary arteries (SIMA), but may be surgically more complex (and therefore...

Blood transfusions may impair endothelium-dependent vasodilatation during coronary artery bypass surgery

ObjectiveThe hemolytic product free-hemoglobin (fHb) reduces nitric oxide (NO) bioavailability. The present study aims to establish whether administration of different blood transfusions result in increased circulating fHb levels and NO consumption with effects on arterial NO-dependent blood flow in patients undergoing CABG surgery. MethodsNinety-five consecutive patients undergoing elective CABG surgery were prospectively divided in four groups based on blood transfusion requirements during surgery: stored blood cells (SBC, n. 21), intraoperative autologous salvaged blood (ASB, n. 25), SBC and ASB (n.22), no transfusion (control, n. 27).Blood samples were collected before and after intervention to analyse plasma levels of fHb and NO consumption. Endothelium-dependent relaxation was assessed in left internal mammary artery (LIMA) rings harvested before chest closure. Peripheral artery tonometry was assessed after intervention. ResultsTransfusions with SBC increased plasma fHb (p<0.05). Transfusions of ASB resulted in higher plasma fHb compared to SBC (p<0.01). fHb concentrations directly correlated with NO consumption (r=0.65, p<0.001). Maximal endothelium-dependent relaxation in LIMA was significantly attenuated in SBC and ASB patients compared to control (15.2±3.1% vs 21.1±2.5% vs 43±5.0% respectively; p<0.01). Significant correlations were identified between the aortic pressure wave velocity, plasma fHb concentration and NO consumption (p<0.01). ConclusionsIntraoperative blood transfusions and particularly autologous salvaged blood impair endothelium-dependent relaxation through NO scavenging by fHb. These findings obtained in vitro and in vivo provide new insights into the adverse relation between blood transfusions and patient outcome.

OP-018 [AJC » Coronary Artery Disease - CABG Surgery] Are Really the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men?

OP-018 [AJC » Coronary Artery Disease - CABG Surgery] Are Really the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men?

OP-188 [AJC » Coronary Artery Disease - CABG Surgery] Modulation of vascular Tone by Arctigenin in Human Saphenous Vein

OP-188 [AJC » Coronary Artery Disease - CABG Surgery] Modulation of vascular Tone by Arctigenin in Human Saphenous Vein

PP-029 [AJC » Coronary Artery Disease - CABG Surgery] Computerized Assessment of Autonomic Nervous System Via Dynamic Pupillometry in Patients With Myocardial Bridging

PP-029 [AJC » Coronary Artery Disease - CABG Surgery] Computerized Assessment of Autonomic Nervous System Via Dynamic Pupillometry in Patients With Myocardial Bridging

OP-083 [AJC » Coronary Artery Disease - CABG Surgery] The Frequencies of MTHFR C677T and MTHFR A1298C Polymorphisms in Patients With Coronary Artery Disease

OP-083 [AJC » Coronary Artery Disease - CABG Surgery] The Frequencies of MTHFR C677T and MTHFR A1298C Polymorphisms in Patients With Coronary Artery Disease

Sexual dysfunction before and after coronary artery bypass graft surgery in males

BackgroundDecreased sexual activity and function are common in patients with CVD and are often interrelated to anxiety and depression. A vast majority of patients won't be able to resume their normal sexual activity after a cardiac event or procedure. Objective: To evaluate and compare the pattern of sexual dysfunction before and after coronary artery bypass graft surgery in male patients. MethodsThe study included all male patients aged less than 60 years, who were candidate for on-pump CABG at Ain Shams University Hospital. Patients underwent the following tests: Structured Clinical Interview for DSM-IV (SCID-I) to exclude psychiatric morbidity affecting the patients' sexual functions. Arabic male version of Sexual behavioral questionnaire (SBQ) for determination of incidence and type of sexual dysfunctions and the Arabic version of Marital Satisfaction Inventory (MSI) which was applied for the patients' wives. Assessment was performed 2 days pre-operatively and 12 weeks after surgery. ResultsCompared to the preoperative state, there was a significant deterioration of sexual functions in patients after CABG surgery. Impairment was evident in elements of ejaculation, erection, sexual excitement, and enjoyment and satisfaction items of SBQ (P ≤ 0.0001). Logistic regression analysis was performed to evaluate the predictive factors for sexual dysfunction, which revealed that prolonged CPBT was significantly correlated with the incidence of premature ejaculation (P = 0.04) and the need for re-exploration was significantly correlated with reduced patients' sexual excitement post operatively (P = 0.04). ConclusionsSexual dysfunction is not uncommon following CABG surgery however, sexual counseling is still not being addressed adequately. Participation in the rehabilitation program is the responsibility of the cardiac surgeons, rehabilitation nurses and the patient's partner.

CLOPIDOGREL IS NOT COMMONLY USED BUT ASSOCIATED WITH LESS RE-HOSPITALIZATION IN PATIENTS WITH PERIOPERATIVE MYOCARDIAL INFARCTION FOLLOWING CABG SURGERY

Background: Perioperative myocardial infarction (periop MI) after CABG has been associated with worse outcome. We assessed the association between clopidogrel use and short-term outcomes in patients with periop MI following CABG surgery. Methods: We used data from 3 clinical trials: RED-CABG, MEND-

Abstract 141: Increasing Storage Age of Transfused Red Blood Cell Units Is Not Associated with Cardiac Surgical Outcomes

Introduction: First-in, first-out institutional blood management practices are based on evidence associating increased risk of sequelae from exposure to older red blood cell (RBC) transfusions. Nonetheless, research to date within the setting of cardiac surgery has been limited by previously unmeasured confounding (i.e., use of leukoreduction, timing and volume transfused). Hypothesis: After accounting for exposure to leukoreduction and the timing and volume of RBC units, older RBC units will not increase a patient’s odds of developing post-operative sequelae following cardiac surgery. Methods: We reviewed 659 adult patients undergoing CABG and/or valve operations between January 1, 2008-December 31, 2015 at a tertiary center. During this time period, all RBCs given to cardiac surgery patients were leukoreduced. To address confounding by timing and volume of RBCs, we analyzed patients receiving 1 or 2 units of RBCs intraoperatively. Logistic regression was used to model the maximum storage age of RBCs against a composite endpoint (prolonged mechanical ventilation, pneumonia, renal failure, operative mortality). We further explored any differences when modeling age of RBCs as quintiles and dichotomously (≥14 vs. &lt;14 days). We present our results using odds ratios and 95% confidence intervals. Results: The average maximum storage age of RBCs ranged from 5 to 42 days (mean 20.8, sd: 7.0). The primary endpoint occurred among 122 (18.5%) subjects. There was neither a significant association between increasing age of RBCs and our composite endpoint (OR 1.0; 95% CI 0.98, 1.04), nor evidence of confounding in univariate analysis. These findings were qualitatively unchanged when modeling age of RBCs as quintiles (Figure; ptrend =0.50) or dichotomously (OR 1.6; 95% CI 0.88, 2.79). Conclusion: In this single center study, we did not detect a significant adverse effect of increasing age of RBCs contrary to prior conclusions. Our findings suggest that current institutional RBC storage policies that prioritize distribution of older age RBC units may not adversely impact patient outcomes following cardiac surgery.

Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective

In the United States, cardiac surgery-related blood transfusion rates reached new highs in 2010, with 34% of patients receiving blood products. Patients undergoing both complex (coronary artery bypass grafting [CABG] plus valve repair or replacement) and non-complex (isolated CABG) cardiac surgeries are likely to have comorbidities such as anemia. Furthermore, the majority of patients undergoing isolated CABG have a history of myocardial infarction. These characteristics may increase the risk of complications and blood transfusion requirement. It becomes difficult to demonstrate the association between transfusions and mortality because of the fact that most patients undergoing cardiac surgery are also critically ill. Transfusion rates remain high despite the advances in perioperative blood conservation, such as the intraoperative use of cell saver in cardiac surgery. Some recent prospective studies have suggested that the use of blood products, even in low-risk patients, may adversely affect clinical outcomes. In light of this information, we reviewed the literature to assess the clinical outcomes in terms of 30-day and 1-year morbidity and mortality in transfused patients who underwent uncomplicated CABG surgery.

Minimal Invasive Extracorporeal Circulation (MIECC) and the Role of Shed Blood Separation on the Inflammation-Process after CABG Surgery

Minimal Invasive Extracorporeal Circulation (MIECC) and the Role of Shed Blood Separation on the Inflammation-Process after CABG Surgery