Cardiopulmonary Bypass Grafting Research Articles

Effect of different coronary artery revascularization procedures on cognition: A systematic review

Coronary revascularization interventions have been associated with post-intervention cognitive decline. Hence, this systematic review aims to compare the long-term effects of different coronary revascularization interventions on cognition. The Cochrane Library and MEDLINE databases were searched for articles published between January 2009 and January 2023. Articles on clinical trials and cohort studies that compared at least two different interventions with a minimum three months follow up were included to evaluate the consequences of different intervention techniques on cognition. Each selected study was evaluated using a revised tool to assess the risk of bias in randomized trials (RoB 2), and Risk of Bias In Non-Randomized Studies - of Interventions(ROBINS-1) was used for evaluating non-randomized studies. Five eligible studies, with four different comparisons, were included. Out of these studies, three RCTs and two cohort studies were included A participants gone through different procedures; on-pump and off-pump coronary artery bypass grafting (CABG), Percutaneous coronary intervention (PCI conventional cardiopulmonary bypass (CCPB), the miniaturized cardiopulmonary bypass (MCPB) and endoscopic coronary artery bypass grafting (Endo-CABG). These comparisons showed that different interventions have different effects on cognition; however, there is no solid evidence of correlations between them. Thus, the results of this review suggest that there should be greater focus on comparing interventions and that a reasonable follow-up duration should be set to avoid the influence of confounders. There is also a need to determine the effect of long-term cognitive decline while reducing interference by other variables.

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Comparison of the effects of minimally invasive cardiopulmonary bypass and conventional cardiopulmonary bypass on atrial fibrillation after coronary artery bypass grafting and application of magnetic nanoparticles chemiluminescence immunoassay to detect serum indexes

To compare the effects of minimally invasive cardiopulmonary bypass coronary artery bypass grafting (MICB-CABG) and conventional cardiopulmonary bypass (CCPB)-CABG on the occurrence of atrial fibrillation (AF), in this research, totally 86 patients with CABG, admitted in our hospital from March 2020 to October 2021, were selected and divided equally into MICB-CABG and CCPB-CABG groups, according to the random number table method. The incidence of AF and left atrial volume index (LAVI) were compared between the two groups. In total, 104 patients with symptoms such as chest tightness, breathlessness, chest pain, and precordial discomfort were included in the study. All patients were examined by nano-CT and coronary angiography. However, time of ventilator use and time of fever were shorter in the MICB-CABG group. AF is closely related to LAVI, and levels of inflammatory factors, such as high-sensitivity (hs)-CRP, IL-6, and tumor necrosis factor-α (TNF-α), in the CCPB-CABG group were significantly higher than those in the MICB-CABG group. Taking the results of selective coronary angiography as the gold standard, the sensitivity and specificity of nano-CT in detecting coronary artery abnormalities were 99.17% and 97.93%, respectively, suggesting that nano-CT can display coronary artery variations precisely. Compared with the CCPB-CABG group, the incidence of AF after surgery and the risk indicators related to the occurrence of AF were significantly lower in the MICB-CABG group. Compared with traditional CCPB-CABG, MICB-CABG interferes less with the physiological functions of the body, reduces atrium damage, and improves the therapeutic effect. In addition, magnetic nanoparticle CLIA can meet the clinical need for detecting serum indexes and has good potential for clinical use.

Major Interleukins: Role in the Pathogenesis of Atrial Fibrillation

Interleukins (IL) are a group of cytokines with complex immunomodulatory functions, whereas atrial fibrillation (AF) is the most common cardiac arrhythmia. This review article highlights the role of major IL in the pathogenesis of AF. IL-1 had elevated levels in permanent and persistent AF patients as compared to paroxysmal AF. A study had shown a straightforward connection between the development of postoperative atrial fibrillation and IL-2 sera levels shortly after cardiopulmonary bypass graft for the first time. IL-4 has been involved in anti-inflammatory response and played no role in the contribution of AF. The elevated level of IL-6 rapidly induces atrial electrical remodeling by downregulating cardiac connexins. This change could be significantly increased the risk of AF and related complications during active inflammatory processes. Moreover, a study has shown higher IL-8 levels in permanent AF patients as compared with paroxysmal AF patients. An association was found between IL-10 gene -592A/C polymorphism and AF in Han Chinese. Recombinant human IL-11 therapy shortened atrial refractoriness and also created favorable conditions for AF by an indirect mechanism involving volume expression, stretching of atrial myocardial tissue and sodium retention. An elevated IL-12 expression was observed in the left atrial tissues of AF patients. IL-17 signaling pathway has played a significant role, and some genes could be used as potential therapeutic targets for AF. An association between the risk of AF with single nucleotide polymorphism of IL-18 and also resulted in the increased left atrial diameter and decreased left ventricular ejection fraction in AF subjects as compared to control. IL-27 genetic variants had increased the occurrence of AF. AF patients had elevated levels of IL-37 that were closely linked with AF subgroups.

Koroner Arter Bypass hastalarında Kan ve Perikardiyal Signal Peptide-CUB (complement C1r / C1s, Vegf and Bmp 1) -EGF (epidermal growth factor)-like Protein-1 (SCUBE-1) Düzeyleri ve Ventrikül Fonksiyonları Arasındaki İlişki

Background: Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor)- like domain- containing protein 1(SCUBE-1) is a surface cell protein studied as a biomarker in thrombosis and ischemia conditions and secreted at currently studied early embryogenesis. The aim of this study is to investigate the relationship between left ventricular functions and pericardial / serum SCUBE-1 values of patients who underwent coronary artery bypass surgery. Material and Methods: Forty patients who underwent cardiopulmonary bypass graft surgery were included in the study. Detailed echocardiographic findings of the patients were made before the operation. Left ventricular dysfunction markers were determined according to left ventricular fracshortening. SCUBE-1 levels were studied with ELISA kits in blood plasma and pericardial fluid samples. SCUBE-1 levels were statistically compared between the determined groups. Results: Statistical differences were observed in LVDs, IVSd, Neutrophil, RBC, CK-MB, Troponin-I and WBC values in low and high FS groups (p <0.05). SCUBE-1 plasma levels did not differ statistically between the FS groups (p> 0.05). The same situation was similar for pericardial fluid levels (p> 0.05). Correlation was seen between SCUBE-1 plasma levels and SCUBE-1 pericardial levels (p <0.05). There was no significant correlation between echocardiographic findings and SCUBE-1 levels (p> 0.05). Conclusion: These results showed us that SCUBE-1 plasma and the pericardial fluid levels had no effect on the left ventricular dysfunction. SCUBE-1 is not one of the currently identified markers of cardiac dysfunction. Future studies will further increase our knowledge on this subject.

Presurgical use of Melatonin and its significance on enhancing prognosis process in patients undergoing cardiopulmonary bypass graft

One treatment choice for patients with coronary artery disease is coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). After CABG, a series of inflammatory processes occur which affect other organs of the body and even cause severe organ damage and subsequently a worse prognosis. The purpose of this study was to evaluate the effect of pre-surgically administered Melatonin (MTN) on interleukins 22 and 13 in patients undergoing CABG. In this clinical trial study, 22 patients were evaluated, 10 patients (45.5%) in the MTN group, and 12 patients in the placebo group. The MTN group received 10 mg/day of MTN and the placebo group received placebo 2 weeks before surgery. Serum interleukin 13 (IL-13) and interleukin 22 (IL-22) levels were measured two weeks before surgery (T1), on the day of surgery before induction (T2), 6 hours after removal of the pump by the cardiac surgeon (T3), and 2 days after surgery (T4). The mean level of IL-22 at all time points in T2, T3, and T4 was significantly lower in the MTN group (P

Effect of intraoperative dexmedetomidine on renal function in patients undergoing cardiopulmonary bypass graft surgery under cardiopulmonary bypass

IntroductionThis study is aimed to evaluate the effect of intraoperative dexmedetomidine on renal function in patients undergoing cardiopulmonary bypass graft surgery (CABG)by using cardiopulmonary bypass (CBP).MethodsThis randomized clinical trial study was performed on 58 patients who were candidates for CABG. In the dexmedetomidine group, dexmedetomidine infusion at a dose of 0.5 μg / kg / h without a loading dose and in the control group placebo was initiated. After the end of surgery and ICU admission and on days 2 and 3 postoperatively, serum BUN, Cr, and eGFR levels, also urine output, Inotrope usage, and PRBC consumption were recorded. ResultNo significant differences were observed in any of the steps in serum creatinine levels between the two groups (P>0.05). A significant difference in serum BUN levels was observed between the two groups except for the third day (P0.05). There was a significant difference between the mean urine output in the two groups only on the second day (P=0.04). There was no significant difference in PRBC intake and inotrope usage between the two groups (P>0.05).ConclusionThe findings indicate that dexmedetomidine does not affect the renal function of patients undergoing coronary artery bypass graft surgery. According to the findings, dexmedetomidine can increase the urine output of patients during surgery. However, it has no positive effect on the postoperative period.

Oxidative Stress in Patients before and after On‐Pump and Off‐Pump Coronary Artery Bypass Grafting: Relationship with Syntax Score

Objective Coronary artery bypass grafting (CABG) represents the significant source of increased oxidative stress (OS). We aimed to follow the OS status parameters (i.e., ischemia-modified albumin (IMA), malondialdehyde (MDA), superoxide anion, prooxidant-antioxidant balance (PAB), total oxidant status (TOS), total antioxidant status (TAS), and superoxide-dismutase (SOD)) change through the predefined study times in two different surgical procedures, i.e., cardiopulmonary bypass (CPB) and off-pump coronary artery bypass grafting (OPCAB). Additionally, we aimed to investigate those OS status parameters in specific study times according to SYNTAX score (SS), an established angiographic score for evaluating the extensity and severity of coronary artery disease. Patients and Methods. A total of 107 patients that were planned to undergo CABG were included (i.e., 47 patients in OPCAB and 60 patients in CPB group). Blood samples were taken at 6 time intervals: before surgery (t1), immediately after intervention (t2), 6 h (t3), 24 h (t4), 48 h (t5), and 96 h after termination of the operation (t6). Results IMA levels were higher in CPB than that in OPCAB baseline and rose in CPB group in t2 point. TOS decreased in both study groups, compared to baseline values, but without statistical significance. Superoxide anion and PAB significantly increased in t3-t6 study times, in both groups. MDA significantly increased only in CPB group in t5 and t6 interval. MDA was significantly higher in CPB group compared to OPCAB in t6 study point. CPB patients had significantly lower TAS compared to OPCAB patients at the beginning and in t2 and t3 study points. They also had significantly lower SOD activities compared to OPCAB, baseline, and in several study points. Moreover, TAS, SOD, and TAS/TOS ratio were significantly lower, whereas PAB and TOS/TAS were significantly higher in patients with high SS compared to corresponding groups. SOD activity, IMA, and TAS level were the best predictors of high SS. Conclusion CPB patients were in more severe ischemia baseline than OPCAB group and IMA rose in CPB patients immediately after the surgery end, but not later. Also, the antioxidant status was significantly lower, whereas the prooxidant status was significantly higher in patients with high SS compared to corresponding groups. SOD activity, IMA, and TAS level were the best predictors of CAD (as determined with SS), showing that SOD and IMA had very good discriminatory capability towards higher SS status.

Percutaneous Coronary Intervention for Left Main Coronary Artery Bifurcation Lesions: Two-stent versus one-stent Strategy for Comparison of 6-month MACE.

To assess the short term clinical outcomes for a single-stent (SS) strategy versus a double-stent (DS) strategy in percutaneous coronary intervention (PCI) of distal unprotected left main coronary artery (ULMCA) lesions. Descriptive comparative study. Armed Forces Institute of Cardiology, Rawalpindi, Pakistan from January 2017 to April 2018. SS treatment was defined as stenting of the main branch alone and DS treatment as stenting of both the main and side branches. Patients who underwent LMCA PCI were recruited in the study using consecutive sampling. Crossover technique, with or without kissing balloon (KB) dilatation, was employed in those getting PCI with a SS strategy; whereas, DK crush, mini-crush , culotte and T-stenting techniques were used in patients undergoing PCI with a DS strategy. The primary endpoints were a composite of major adverse cardiovascular event (MACE) i.e. myocardial infarction, stroke or death and target lesion revascularisation (TLR). A total of 103 patients were recruited in the study; out of which, 73 underwent LMCA PCI employing a SS technique; whereas, 30 of them were treated with a DS strategy. Mean age of the study participants was 63.2 ±10.6 years. The procedural success rate was 100% in both groups. There was a lower frequency of MACE with single-stent strategy (4.1%) versus the double-stent strategy (16.7%, p=0.031) during the 6-month follow-up period. In comparison to the two-stent strategy of ULMCA bifurcation intervention, a single-stent approach seems to show favourable clinical outcomes and 6-month MACE-free survival. The choice of optimal revascularisation technique proves to be important for the prognosis; therefore, it requires pragmatic decision-making. Key Words: PCI (percutaneous coronary intervention), ULMCA (unprotected left main coronary artery), SS (single-stent), DS (double-stent), MACE (major adverse cardiovascular events), CABG (cardiopulmonary bypass grafting), TLR (target lesion revascularisation).

‘Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?’

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?’ Altogether more than 118 papers were found using the reported search, of which 4 represented the best evidence to answer the clinical question, which included 2 prospective cohort studies and 2 retrospective observational studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. There is a significant variation within the MIDCAB and TECAB techniques amongst the studies-including the experience of the surgeon, use of cardiopulmonary bypass, patient selection, and target vessel grafting strategies-highlighting the complexity of comparing these two minimally invasive procedures. Operative times were comparable across all studies, with TECAB patients having higher transfusions rates and conversion rates to either a median sternotomy or MIDCAB procedure. Overall safety was comparable between the two cohort groups, with similar length of stay and 30-day mortality. However, the TECAB group were more likely to require re-operation for bleeding and reintervention for early revascularisation with greater total hospital costs than the MIDCAB patients. Based on the available evidence, we conclude that TECAB is associated with a higher rate of transfusions, conversion to median sternotomy or MIDCAB, early graft failure and reintervention compared to the MIDCAB approach. We advise caution in adopting a TECAB approach.

The Role of an Ultrasound-Guided Block of the Deep Plane of the Serratus Muscle in a Modified ERAS Protocol for Cardiac Surgery

To date, the use of multimodal techniques can allow substantial opioid-sparing and can reduce pain by using the local and systemic effects of different types of analgesics. Aims: This case report describes a modified ERAS protocol specific for cardiac surgery with the ultrasound-guided block of the deep plane of the serratus muscle (SAP deep block) in a multimodal opioid-sparing approach. \ Two male patients, aged 62 and 67, undergoing elective mini-invasive off-pump Cardiopulmonary Bypass Grafting (CPB), were treated with an opioid-sparing multimodal anesthesiological approach based on the continuous ultrasound-guided SAP deep block. The continuous ultrasound-guided SAP deep block alone can be used in the case of mini-left thoracotomy off-pump cardiopulmonary bypass grafting implementing a multi-modal opioid-sparing strategy. It seems effective in obtaining good (2 hours) weaning from mechanical ventilation, quick (36 hours) discharge from post-operative intensive care, and good post-operative pain control (NRS < 5) even in elderly and frail patients.

Renal Outcome in Patients Undergoing Cardiac Surgery Using Cardiopulmonary Bypass.

IntroductionRenal dysfunction is a significant variable in determining the outcome of surgery, such as cardiopulmonary bypass graft and valvular replacement, used to treat cardiovascular diseases. In Saudi Arabia, the incidence of renal failure and diabetes is higher than in most western populations. Our aim is to determine the renal outcome of patients who underwent cardiac surgery at King Faisal Cardiac Center from 2014 to 2017.MethodsThis a retrospective cohort study using a non-probability consecutive sampling technique for selection of the study population to assess the renal outcome in cardiac surgery patients using cardiopulmonary bypass from May 2014 to June 2017 in King Faisal Cardiac Center, Jeddah. Patients older than 18 years of age undergoing cardiac surgery, with available data, were included. Categorical variables were summarized by percentages and frequencies, and continuous variables by means and standard deviations, or medians and interquartile ranges if their distributions were skewed. Logistic regression was done with post-op renal impairment as the dependent variable and pre-op renal dysfunction, age, gender, smoking status, diabetes, hypertension, dyslipidemia, and cardiopulmonary bypass time as independent variables.ResultsOur sample size included 244 patients who underwent cardiac surgery in this study period; their mean age was 60.5 (SD =7.5) with a mean body mass index (BMI) of 28.62 (SD=5.19). Among our population, 73% (n = 179) were males and 27% (n =66) were females. Two percent (2%) of patients (n = 5) died within 30 days, 4% of patients (n = 10) with temporary dialysis, 8% of patients (n = 19) with postoperative renal dysfunction, and no patients with permanent dialysis. The data showed a significant relationship between levels of creatinine preoperatively and postoperative renal dysfunction (p-value = 0.0001, OR=1.05, 95% CI of 1.031 to 1.064).ConclusionThe main predictor of poor renal outcomes for cardiac surgery is preoperative creatinine. While other factors, such as age, gender, body mass index, cardiopulmonary bypass time, diabetes, hypertension, and dyslipidemia, did not show any risk to the postoperative renal outcome.

Does lobar or size-reduced lung transplantation offer satisfactory early and late outcomes?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether size-reduced or lobar lung transplantation (LLTx) offers the same benefit as classic lung transplantation (LTx). Of the 147 papers found using the reported search, 9 were selected to provide the best evidence. Details of the studies regarding authors, date, journal, country of publication, study type, group studied, relevant outcomes and results are given. All studies reported survival rates of LLTx and most compared it with classical LTx. No statistical differences were reported in medium term and long term. Two of the studies reported a higher incidence of postoperative complications, such as the need for cardiopulmonary bypass, reperfusion oedema or primary graft dysfunction, and longer intubation or intensive care unit stay times. Although the largest study showed a significantly worse 1-year survival in LLTx, a sub-analysis considering patients successfully discharged showed similar outcomes at 1, 3 and 5 years when compared with classic LTx patients. We conclude that LLTx is a valid therapeutic option for recipients with significant donor size mismatch, offering similar outcomes as classical LTx in the medium term and long term.

Platelet reactivity expressed as a novel platelet reactivity score is associated with higher inflammatory state after coronary artery bypass grafting.

Despite therapy, patients operated using a cardiopulmonary bypass demonstrate increased platelet aggregation, which rebounds to above preoperative levels. The aim of the study was to test the interaction between platelet reactivity/activation and selected inflammatory markers in the post-operative period. In total, 103 patients with non-ST elevation acute coronary syndrome (NSTE-ACS) who were not eligible for percutaneous coronary interventions (PCI), and required urgent revascularization, were included. Platelet reactivity was measured using the PFA-100 platelet analyser, multiple electrode aggregometry, and was expressed as a novel platelet reactivity score (PRS). Patients were divided using their PRS scores into high platelet relativity or low platelet reactivity subgroups (HPR or LPR). Platelet basal activation was measured using immunoassays for soluble P-selectin and soluble CD40L. We measured high-sensitivity C-reactive protein (CRP), and used immunoassays for tumour necrosis factor α (TNF-α) and interleukin 6 (IL-6) as inflammation markers. Significant differences between HPR and LPR groups were found for CRP (mg/l): 81.5 vs. 44.6, p < 0.02; and TNF-α (pg/l): 3.51 vs. 2.37, p < 0.02. A significant association was found between CRP, TNF-α, IL-6 and platelet reactivity (platelet reactivity score). Cohen's k showed: CRP = 0.49, p < 0.0001, TNF-α = 0.37, p < 0.002. Perioperative myocardial infarction and rhythm disturbances occurred more frequently in the high platelet reactivity group: 7 (16.3%) vs. 2 (3.3%), p < 0.04, and 9 (20.9%) vs. 4 (6.7%), p < 0.04, respectively. Inflammatory parameters CRP and TNF-α are strongly associated with platelet reactivity (expressed as PRS) in cardiopulmonary bypass graft patients. Platelet hyperreactivity in the early post-operative period combined with a systemic inflammatory state correlates with a higher risk of post-operative rhythm disturbances and myocardial infarction.

The impact of mild renal dysfunction on isolated cardiopulmonary coronary artery bypass grafting: a retrospective propensity score matching analysis

BackgroundMild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG.MethodsAfter propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60–89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria.ResultsThe 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09–2.90, p = 0.035; 95%CI 1.14–2.49, p = 0.027).ConclusionsComparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.

Low hematocrit levels: a risk factor for long-term outcomes in patients requiring prolonged mechanical ventilation after cardiovascular surgery. A retrospective study

While low-risk patients who undergo elective surgery can tolerate low hematocrit levels, the benefits of higher hematocrit levels might outweigh the risk of transfusion in high-risk patients. Therefore, this study...

Intraoperative reduction of vasopressors using processed electroencephalographic monitoring in patients undergoing elective cardiac surgery: a randomized clinical trial.

Intraoperative vasopressor and fluid application are common strategies against hypotension. Use of processed electroencephalographic monitoring (pEEG) may reduce vasopressor application, a known risk factor for organ dysfunction, in elective cardiac surgery patients. Randomized single-centre clinical trial at Jena University Hospital. Adult patients operated on cardiopulmonary bypass or off-pump coronary artery bypass grafting were randomised to receive anesthesia with visible or blinded pEEG using Narcotrend™. In blinded-Narcotrend (NT) depth of anesthesia was extrapolated from clinical signs, hemodynamic response and anesthetic concentration, supplemented by target indices between 37 and 64 in the visible-NT group. Intraoperative norepinephrine requirement (primary endpoint), fluid balance, extubation time, delirium occurrence and adverse events were evaluated. Patients of the intent-to-treat population (visible-NT: n = 123, blinded-NT: n = 122) had similar patient and procedural characteristics. Adjusted for type of surgery intraoperative Norepinephrine application was significantly reduced in visible-NT (n = 120, robust mean of cumulative dose 4.71µg/kg bodyweight) compared to blinded-NT patients (n = 119, 6.14µg/kg bodyweight) (adjusted robust mean difference 1.71 (95% CI 0.33-3.10) µg/kg bodyweight). Although reduction in patients operated on cardiopulmonary bypass was higher the interaction was not significant in post-hoc subgroup analysis. Intraoperative fluid balance was similar among both groups and strata. Extubation time was non-significantly lower in visible than in blinded-NT group. Overall postoperative delirium risk was 16.4% without differences among the groups. Adverse events-sudden movement/coughing, perspiration or hypertension-occurred more often with visible-NT, while one blinded-NT patient experienced intraoperative awareness. Titration of depth of anesthesia in elective cardiac surgery patients using pEEG allows to reduce application of norepinephrine.

Effect of cardiopulmonary bypass versus off-pump coronary artery bupass grafting on platelet inhibition rate and Aspirin resistance after coronary artery bypass grafting surgery

Objective To investigate the effect of cardiopulmonary bypass(CPB)on platelet inhibition rate(INHAA)and Aspirin resistance(AR)after coronary artery bypass grafting(CABG)surgery. Methods A total of 114 patients undergoing CABG surgery were divided into two groups: on-pump group(n=54)and off-pump group(n=60). Aspirin treatment(100 mg/d)was paused 7 days before surgery and continued 6 hours after surgery.INHAA was detected and calculated by using thrombelastography(TEG)at 6 hours after taking the last dose of aspirin before surgery(T0), 12 hours(T1), 5 days(T2), 10 days(T3)and 15 days(T4)after surgery respectively.The incidence of AR was calculated. Results There was no significant difference in the overall INHAA between the two groups of on vs.off-pump(F=0.336, P=0.563), while the differences of INHAA index at each time point was statistically significant between two groups of on vs.off-pump(F=95.519, P=0.000). There was an interaction effect of timing and grouping(F=15.500, P=0.000). In comparison of INHAA between the two groups of on vs.off-pump at each time point, INHAA was higher in on-pump group than in off-pump group at T1(P 0.05). In the on-pump group, the total difference of INHAA at different time points was significant(P 0.05). In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point, the incidence of AR was lower in on-pump group than in off-pump group at T1(P 0.05). Conclusions The increase of platelet inhibition rate and aspirin resistance occurs in early period after CABG surgery.The platelet inhibition rate is higher and aspirin resistance rate is lower in on-pump group than in off-pump group at 12 h after surgery, and the platelet inhibition rate is lower at 5 days after CABG surgery in on-pump group than in off-pump group.CPB has little effect on the platelet inhibition rate and on the incidence of AR after 5 days of CABG surgery. Key words: Coronary artery disease; Extracorporeal circulation; Platelet aggregation inhibitors

Circulating and Urinary miR-210 and miR-16 Increase during Cardiac Surgery Using Cardiopulmonary Bypass – A Pilot Study

A pilot study to measure and compare blood and urine microRNAs miR-210 and miR-16 in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and off-pump coronary artery bypass grafting surgery. Frequent serial blood and urine samples were taken from patients undergoing cardiac surgery with CPB (n = 10) and undergoing off-pump cardiac surgery (n = 5) before, during, and after surgery. Circulating miR-210 and miR-16 levels were determined by relative quantification real-time polymerase chain reaction. Levels of plasma-free haemoglobin (fHb), troponin-T, creatine kinase, and creatinine were measured. Perioperative serum miR-210 and miR-16 were elevated significantly compared to preoperative levels in patients undergoing cardiac surgery with CPB (CPB vs. Pre Op and Rewarm vs. Pre Op; p &lt; .05 for both). There were increases of greater than 200% in miR-210 levels during rewarming and immediately postoperatively and a 3,000% increase in miR-16 levels immediately postoperatively in urine normalized to urinary creatinine concentration. Serum levels of miR-16 were relatively constant during off-pump surgery. miR-210 levels increased significantly in off-pump patients perioperatively (p &lt; .05 Octopus on vs. Pre Op); however, the release was less marked when compared to cardiac surgery with CPB. A significant association was observed between both miR-16 and miR-210 and plasma fHb when CPB was used (r = −.549, p &lt; .0001 and r = −.463, p &lt; .0001 respectively). Serum and urine concentrations of hypoxically regulated miR-210 and hemolysis-associated miR-16 increased in cardiac surgery using CPB compared to off-pump surgery. These molecules may have utility in indicating severity of cardiac, red cell, and renal injury during cardiac surgery.

Comparing the Effectiveness of Patient Control Analgesia Pump and Bolus Morphine in Controlling Pain After Cardiopulmonary Bypass Graft Surgery.

BackgroundPostoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues.Methods68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg, lockout time of 15 minutes, and a maximum of 4 bolus of 0.02 mg/kg for one hour and the other group received morphine bolus (group B). Three patients were excluded from the study, and 33 and 32 patients participated in the groups P and B, respectively. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (nausea and vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid consumption, hemodynamic, and sedation status were measured in both groups.ResultsThere was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complication, sedation score, and hemodynamic status in most of the assessment periods. By assessing the pain severity in the groups at different periods, results showed a significant difference between the groups except at enrollment, and a lower severity of pain was noted in the group P compared to the group B. The consumed opioid was significantly higher in the group P than in the group B. However, higher doses of diclofenac and paracetamol were administered in the group B compared to the group P.ConclusionsResults showed that higher morphine would be used in patients with PCA pump after extubation following heart surgery, and this increased dose of opioid was associated with better pain control and lack of complication. Therefore, PCA pump with underlying infusion could be effectively used in patients undergoing CABG that are directly assessed in intensive care unite.