Coronary Artery Bypass Grafting Procedures Research Articles

Global variations in coronary revascularisation and acute myocardial infarction mortality between 2006-2020: a longitudinal, population-level analysis of 16 high-income nations from the OECD database

Abstract Background Revascularisation options for ischaemic heart disease (IHD) includes either, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Whilst PCI remains the preferred choice in ST-elevation myocardial infarction (STEMI)(1), several landmark trials have questioned its universal superiority (2,3), thus prompting re-evaluation of guidelines. A wide-scale contemporary overview of revascularisation trends is lacking. Purpose To examine the evolving pattern in PCI and CABG rates, alongside mortality from acute myocardial infarction (AMI) across a group of 16 high-income countries between 2006 and 2020. Methods Standardized PCI and CABG procedure rates alongside AMI age-standardised mortality rate (ASMR) were obtained from the Organisation for Economic Co-operation and Development (OECD) database. Data from 2006-2020 was extracted for; Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, United Kingdom (UK). Together, these countries are commonly known as the European Union (EU) 15+ and represent a cluster of high-income nations with comparable levels of health expenditure. Procedural trends including the estimated annual percentage change (EAPC) were evaluated using Joinpoint analysis whilst Locally Weighted Scatterplot Smoothing (LOESS) models was used to analysis trends in AMI mortality. Results Over 15 years, 14.0 million PCI and 2.8 million CABG procedures were recorded in total. PCI rates varied amongst nations (Figure 1), however showed an overall increase in 11 countries, led by Finland (+36.0%). The steepest increase was observed in France between 2012-2018 (EAPC 5.4, 95% CI: 4.8 – 6.1). The greatest overall decrease in PCI was observed in Luxemburg (-33.5%). The fastest decrease was seen during 2018-2020 in the UK (EAPC -7.2, 95% CI: -9.7 – -4.6). CABG rates declined overall in 15 countries (Figure 1), with Luxembourg (-71.3%), experiencing the largest fall and showing the steepest decline between 2014-2018 (EAPC -20.7, 95% CI: -28.3 – -12.3). Ireland was the only country to show an increase in CABG rate (+16.3%). Throughout the study period, the PCI-to-CABG ratio increased (Figure 2A), whilst AMI mortality decreased consistently across all countries (Figure 2B). Conclusion Despite evidence supporting CABG over PCI in specific scenarios, CABG rates have declined, and PCI rates have increased. This trend may be influenced by several factors including patient preference for less invasive procedures and advancements in interventional techniques. The varied use of PCI among these nations, alongside a sustained decline in AMI mortality rates, may be expected given the importance of optimal medical therapy in the management of IHD. The results further highlight the significance of factors beyond revascularisation in driving improved outcomes.PCI and CABG rates between 2006 and 2020PCI to CABG ratio and AMI mortality rate

Acute Kidney Injury after Isolated Coronary Bypass Surgery

AbstractAcute kidney injury (AKI) is among the most serious of the common postoperative complications of cardiac surgeries, which can increase the short- and long-term morbidity and mortality of patients. This study aimed to examine possible risk factors that lead to AKI. We sought to compare our AKI rates to national averages in coronary artery bypass grafting (CABG) reported by the Society of Thoracic Surgeons (STS). We reviewed our institution's data for renal failure in CABG procedures performed between January 1, 2020, and June 30, 2023. From the database, we identified 1,068 CABG patients and reviewed demographics, nonmodifiable conditions, and modifiable risk factors. The STS database uses the Risk, Injury, Failure, Loss, and End-stage renal disease definition for renal failure. Of our patient sample, 14 (1.3%) experienced renal failure. The national rate for AKI after isolated CABG was 1.9% in 2023. Chronic lung disease was a risk factor for AKI development. The mean perfusion, cross-clamp, ventilator times, and hospital stay increased in AKI patients. All patients who suffered from AKI had undergone perioperative blood transfusion. Our single-center experience with renal failure is slightly better than the national average. In our population, chronic lung disease and lower preoperative ejection fractions were associated with increased rates of AKI. Modifiable risk factors in our population included perioperative blood transfusion and increased perfusion/cross-clamp times. Lastly, AKI patients spent longer time on ventilators, increased lengths of stay, and increased postoperative mortality.

9370 Thinking Outside the Box: A Rare Case of Using Plasmapheresis Treatment of Amiodarone-Induced Thyrotoxicosis in Preparation For CABG

Abstract Disclosure: K. Shaik: None. A. Kartoumah: None. J. Alsheikh: None. A. Nayeem: None. M.H. Horani: None. Introduction: Amiodarone, a standard treatment for arrhythmias, poses a risk of disrupting thyroid function and causing amiodarone-induced thyrotoxicosis (AIT). In critical cases where AIT is refractory to first-line treatment, plasmapheresis can be a vital option to rapidly lower thyroid hormone levels, which is essential for pre-surgical stabilization. This case report describes plasmapheresis in managing AIT in a patient undergoing coronary artery bypass grafting, highlighting its role in preventing potential thyrotoxic crises. Case Presentation: A 75-year-old male with a past medical history of diabetes mellitus, coronary artery disease, arrhythmias treated with amiodarone, and a ninety-pack-year history of tobacco presented to the ED with complaints of chest pressure and dyspnea. Initial troponin levels were normal at 24 ng/mL but trended upward toward 66 ng/mL. In the ED, he was not tachycardic and denied recurrent pain, fever, or chills. A CT angiogram of his chest showed no pulmonary embolus. The patient was found to have low TSH (0.005), and his T3 and T4 were both elevated (3.89/1.96, respectively), confirming thyrotoxicosis; however, he was negative for Graves’ disease. While in the hospital, his amiodarone was discontinued, and he was started on prednisone 10 mg for 14 days and methimazole 5 mg for 14 days. He was ultimately discharged on the same prednisone and methimazole regimen and told to follow up with outpatient endocrinology. However, the patient reappeared a week later with dyspnea on exertion; blood work performed after admission revealed a higher free T4 at 2.87. The patient was admitted, and angiography showed three-vessel disease; however, a coronary artery bypass graft (CABG) procedure was delayed over the concern of a potential thyroid storm. Thus, CABG was planned for when free T4 was less than 2, and the patient underwent two rounds of plasmapheresis, which initially decreased free T4 to 1.7 and finally to 1.4. Ultimately, a CABG was performed and well tolerated. Discussion: Amiodarone-induced thyrotoxicosis (AIT) poses a challenge in patient management, especially in patients requiring urgent surgeries. Plasmapheresis is shown to be a valuable option for rapidly lowering thyroid hormone levels and stabilizing the patient in the pre-operative stages. This case demonstrates the effectiveness of plasmapheresis in reducing free thyroxine levels, facilitating a safe and successful CABG. Due to its ability to quickly remove circulating thyroid hormones, plasmapheresis has excellent potential in managing refractory AIT. It is crucial to carefully time plasmapheresis relative to surgery and monitor for complications throughout. Further research is required to optimize proper plasmapheresis protocols in AIT. Conclusion: This case study highlights plasmapheresis as a promising adjunctive therapy in managing AIT and preventing potential thyrotoxic crises. Presentation: 6/1/2024

Community paramedicine program and outcomes of referred coronary artery bypass grafting patients.

Community paramedicine is a field in its infancy. The use of community paramedics has expanded in recent years as an alternative or adjunct to home health in the continued drive to decrease health disparities and complications. In current practice, they function in a position like a home healthcare nurse with an expanded scope of practice, such as providing specialized follow-up care, for example with postoperative care for patients who have undergone major surgery or recent hospitalization. This study assesses if community paramedics are a valid option in reducing rehospitalization of patients who underwent a coronary artery bypass grafting (CABG) procedure. A retrospective chart review between 2021 and 2022 was performed on all patients who underwent CABG in Bismarck, North Dakota, along with obtaining a referral for the community paramedics spanning urban and rural areas. A comparison was made between individuals who saw the community paramedics in their post-care versus those who continued with the standard of care. There were 80 participants and 38 location-matched controls. All variables were found to be statistically insignificant except for the number of walk-in visits (urgent care), in which 7 out of 38 sought medical attention in the controls and 4 out of 80 sought medical attention in the participants. The proportions of inpatient readmission rates and emergency department (ED) visits were similar. Given that paramedicine is in its infancy, the emergence of other variations of the community paramedic certification has brought a discussion of their scope of practice. While walk-in visits, even with the limitations, showed significant improvement with the addition of community paramedics, more research is still needed to show their effectiveness in reducing readmission to hospital. Additionally, the patients who sought help from community paramedics may be more likely than the controls to seek help from medical professionals. This study provided a novel look into the effect that community paramedics can have on patients in urban and rural areas in regard to reducing postoperative complications and minimizing unnecessary advanced healthcare utilization.

Adults who Smoke Should Have Pulmonary Function Testing Before and After Coronary Artery Bypass Grafting (CABG)

Background: Recent research has shown that coronary artery bypass grafting (CABG) has a mortality rate of 0.6–3.0%, making it a popular and generally safe cardiac operation. The purpose of this study is to examine the relationship between sex, age, and diabetes in the early changes in lung volumes measured by pulmonary function tests before and after coronary artery bypass grafting (CABG) in individuals who smoke. Subjects and procedures: Elective coronary artery bypass surgery was the procedure of choice for 200 consecutive patients in this prospective controlled trial. Participants who were not part of the trial were those who were in an emergency or who had a valve operation done alongside a CABG procedure. Based on the data from the operation, the cardiopulmonary bypass time was 98.89 minutes with a standard deviation of 25.14 minutes. The average time for cardiac ischemia was 67.8 minutes with a standard deviation of 26.6 minutes and a range of 25 to 227 minutes. The total time spent in the intensive care unit was 53.54 hours with a standard deviation of 27.98 hours and a range of 4 to 102 hours. Thirteen patients, or 6.5%, were cold, while the remaining patients were warm. Thirteen patients, or 6.5%, used ice slush as a topical cooling method. The results of the pulmonary function tests taken before and after surgery were significantly different. Conclusion: Postoperative obstructive and restrictive breathing problems are associated with cigarette smoking's detrimental effects on pulmonary functioning. Patients with a smoking history who are scheduled for elective revascularization surgery should have their pulmonary status evaluated before surgery, and they should be strongly encouraged to quit smoking as soon as possible before surgery to minimize the risk of respiratory complications after surgery.

Acetylsalicylic acid alone or in combination with either enoxaparin or unfractionated heparin for postoperative thromboprophylaxis in coronary artery bypass surgery patients. A randomised clinical trial assessing surrogate outcomes

IntroductionCoronary artery bypass graft surgery has considerable effects on patient haemostasis. Heparins as thromboprophylaxis may be beneficial but may also increase the risk of bleeding complications. ObjectivesTo assess the effects of heparins on haemostasis in post-coronary artery bypass graft patients. MethodsAcross one year, we randomised 60 participants scheduled for an elective coronary artery bypass graft-procedure with or without aortic valve replacement. The trial was a prospective, open-label (though blinded for the laboratory), randomised, single-centre trial with three intervention groups (n = 20 in each): group 1 received acetylsalicylic acid, group 2 received subcutaneous low molecular weight heparin and acetylsalicylic acid, and group 3 received intravenous unfractionated heparin and acetylsalicylic acid. Primary outcomes were platelet activation (Multiplate® ASPI-test) and time to clot initiation (TEG® R-time). We secondly assessed several additional Multiplate® and TEG® parameters. ResultsGroup 3 (intravenous unfractionated heparin) compared with group 1 (acetylsalicylic acid alone) showed evidence of 1) increased clot initiation time (R-time + 0.9 min; 95 % CI: +0.4 to +1.4 min; P = 0.009), and 2) decreased 30-min lysis (−1.3 %; 95 % CI: −2.1 to −0.5 %; P = 0.02). The remaining analyses of primary and secondary outcomes showed no evidence of a difference between the three groups. DiscussionIntravenous unfractionated heparins may increase the clot initiation time post-operatively after coronary artery bypass graft surgery and reduce lysis. Otherwise, there seems to be no effect of low molecular weight or unfractionated heparin on haemostatic parameters after coronary artery bypass surgery patients.

A posterior pericardial chest tube is associated with reduced incidence of postoperative atrial fibrillation after cardiac surgery: A propensity score–matched study

ObjectivePostoperative atrial fibrillation (POAF) is a common complication after cardiac surgery that is associated with other adverse outcomes. Recent studies have shown that drainage of pericardial effusion by a posterior pericardial incision reduces the incidence of POAF. An alternative approach is a chest tube placed posteriorly in the pericardium. We evaluated whether the use of a posterior pericardial drain was associated with reduced risk of POAF in patients undergoing coronary artery bypass graft (CABG) and/or aortic valve replacement (AVR). MethodsThis observational study included 2535 patients who underwent CABG (n = 1997), AVR (n = 293), or combined CABG and AVR (n = 245) in Iceland from 2002 to 2020. From our study population, 553 (22%) received a 20-Fr posterior pericardial chest tube in addition to standard mediastinal and left pleural drains. The incidence of POAF in patients with and without a posterior pericardial drain was compared before and after 1:1 propensity score matching. ResultsOf 2535 patients, 1100 were included in the matched cohort. The incidence of POAF was lower in patients receiving posterior pericardial chest tube drainage compared with the control group, both before (34% vs 43%, P < .001) and after (33% vs 43%, P = .002) matching. In a multivariable analysis, posterior pericardial chest tube drainage was independently associated with a reduced risk for POAF (adjusted odds ratio 0.67; 95% confidence interval, 0.52-0.88; P = .003). ConclusionsThis observational study suggested that posterior pericardial chest tube drainage is associated with a significant reduction of POAF after routine CABG and/or AVR procedures. The results are hypothesis-generating and must be confirmed in prospective randomized trials.

Off versus on pump myocardial revascularization in patients with severe asymptomatic carotid stenosis.

Coronary artery disease is a global cause of morbidity and mortality, often managed by coronary artery bypass grafting (CABG). This study addresses a critical decision-making dilemma in CABG procedures for patients with severe asymptomatic carotid stenosis, comparing off-pump and on-pump techniques. We conducted a retrospective single-center analysis, employing propensity scored matched-pair methodology to compare perioperative outcomes in patients with asymptomatic severe carotid stenosis undergoing off-pump or on-pump CABG. The primary endpoint was the occurrence of perioperative stroke. Secondary endpoints included postoperative delirium, intrahospital mortality, intensive care unit stay, length of hospitalization and long-term survival. The study involved 243 patients with asymptomatic severe carotid stenosis operated between July 2009 and October 2018, subsequently propensity score matched into two groups of 78 patients each (off-pump and on-pump). The incidence of perioperative stroke was significantly higher in the On-Pump group compared to the off-pump group (10.3% vs. 1.3%, P=0.03). However, secondary endpoints, such as intrahospital mortality and length of hospitalization, showed no significant differences between the two groups. Long-term survival rates were also comparable. Our findings indicate that off-pump CABG significantly reduces the risk of perioperative stroke in patients with severe asymptomatic carotid stenosis compared to on-pump CABG, without compromising long-term outcomes. These results support the preference for off-pump CABG in this high-risk patient population, highlighting the need for tailored surgical approaches based on individual patient risk profiles.

Unlocking vascular vitality: Exploring the impact of LIMA harvesting technique on endothelial health

BackgroundThis study investigates the impact of different harvesting techniques on the morphology and endothelial function of the left internal mammary artery (LIMA) grafts in coronary artery bypass grafting (CABG). MethodsFifty-three patients undergoing elective CABG were randomly assigned to two groups based on the harvesting technique: traditional clipping and nonclipping. Histological analyses revealed that arteries in the nonclipped group exhibited greater dilation and preserved endothelial integrity compared to the control group. ResultsThe nonclipped group exhibited greater arterial dilation and preserved endothelial integrity compared to the clipped group. Immunostaining for endothelial nitric oxide synthase (eNOS) showed significantly higher expression in the nonclipped group, conversly COX-2 staining showed fewer expression in the nonclipped group indicating better endothelial function preservation. ConclusionThese findings suggest that maintaining perfusion during LIMA harvesting may improve endothelial function and potentially enhance graft patency in the long term. Further research is warranted to validate these results and optimize harvesting techniques for CABG procedures.

To be or not to be on: aspirin and coronary artery bypass graft surgery.

Aspirin's role in secondary prevention for patients with known coronary artery disease (CAD) is well established, validated by numerous landmark trials over the past several decades. However, its perioperative use in coronary artery bypass graft (CABG) surgery remains contentious due to the delicate balance between the risks of thrombosis and bleeding. While continuation of aspirin in patients undergoing CABG following acute coronary syndrome is widely supported due to the high risk of re-infarction, the evidence is less definitive for elective CABG procedures. The literature indicates a significant benefit of aspirin in reducing cardiovascular events in CAD patients, yet its impact on perioperative outcomes in CABG surgery is less clear. Some studies suggest increased bleeding risks without substantial improvement in cardiac outcomes. Specific to elective CABG, evidence is mixed, with some data indicating no significant difference in thrombotic or bleeding complications whether aspirin is continued or withheld preoperatively. Advancements in pharmacological therapies and perioperative care have evolved significantly since the initial aspirin trials, raising questions about the contemporary relevance of earlier findings. Individualized patient assessments and the development of risk stratification tools are needed to optimize perioperative aspirin use in CABG surgery. Further research is essential to establish clearer guidelines and improve patient outcomes. The objective of this review is to critically evaluate the existing evidence into the optimal management of perioperative aspirin in elective CABG patients.

Exploring the Potential of Saphenous Vein Grafts Ex Vivo: A Model for Intimal Hyperplasia and Re-Endothelialization.

Coronary artery bypass grafting (CABG) utilizing saphenous vein grafts (SVGs) stands as a fundamental approach to surgically treating coronary artery disease. However, the long-term success of CABG is often compromised by the development of intimal hyperplasia (IH) and subsequent graft failure. Understanding the mechanisms underlying this pathophysiology is crucial for improving graft patency and patient outcomes. Objectives: This study aims to explore the potential of an ex vivo model utilizing SVG to investigate IH and re-endothelialization. Methods: A thorough histological examination of 15 surplus SVG procured from CABG procedures at Hospital Canselor Tuanku Muhriz, Malaysia, was conducted to establish their baseline characteristics. Results: SVGs exhibited a mean diameter of 2.65 ± 0.93 mm with pre-existing IH averaging 0.42 ± 0.13 mm in thickness, alongside an observable lack of luminal endothelial cell lining. Analysis of extracellular matrix components, including collagen, elastin, and glycosaminoglycans, at baseline and after 7 days of ex vivo culture revealed no significant changes in collagen but demonstrated increased percentages of elastin and glycosaminoglycans. Despite unsuccessful attempts at re-endothelialization with blood outgrowth endothelial cells, the established ex vivo SVG IH model underscores the multifaceted nature of graft functionality and patency, characterized by IH presence, endothelial impairment, and extracellular matrix alterations post-CABG. Conclusions: The optimized ex vivo IH model provides a valuable platform for delving into the underlying mechanisms of IH formation and re-endothelialization of SVG. Further refinements are warranted, yet this model holds promise for future research aimed at enhancing graft durability and outcomes for CAD patients undergoing CABG.

The prognostic impact of unplanned invasive coronary angiography following coronary artery bypass grafting.

Myocardial ischaemia following coronary artery bypass grafting (CABG) is a potentially devastating complication. Nevertheless, the incidence, aetiology and prognostic relevance of unplanned coronary angiography (uCAG) remain understudied. We aimed to investigate the prevalence and outcome of patients undergoing urgent, uCAG in the postoperative period following CABG. We screened all patients undergoing isolated elective CABG in an academic referral centre between 2016 and 2021 and identified patients undergoing uCAG within 30 days of surgery. For uCAG patients, a distinction was made between patients undergoing re-revascularization (REV) and patients receiving conservative management (CON). The primary outcomes were 30-day mortality and unadjusted and adjusted long-term survival. Secondary outcomes were the indication for and prevalence of uCAG and urgent revascularization. Of the 1918 patients undergoing isolated CABG, 78 individuals needed uCAG (4.1%), of whom 45 underwent immediate revascularization (REV group; 2.3% overall, 57% within the uCAG group, median age 69.9 years) and 33 were treated conservatively (CONS group; 1.7% overall, 42% within the uCAG group, median age 69.1 years). Patients undergoing uCAG (n = 78) had a higher 30-day mortality than patients not undergoing uCAG (n = 1840, 30-day mortality: 9.0% vs 0.4%, P < 0.001). Long-term survival was significantly decreased in patients undergoing uCAG in both unadjusted (hazard ratio 2.20, 95% confidence interval 1.30-3.73) and EuroSCORE-, age- and sex-adjusted models (hazard ratio uCAG 2.03, 95% confidence interval 1.16-3.56). Unplanned postoperative coronary angiography is performed in 4.1% of isolated CABG procedures, and patients in need of such urgent invasive evaluation are subjected to decreased short- and long-term survival.

This video shows our setting for minimally invasive off-pump coronary artery bypass grafting procedures, which includes preparing the skeletonized LITA with a heparine-papaverine solution and sewing of the left internal thoracic artery to LAD artery.

This video shows our setting for minimally invasive off-pump coronary artery bypass grafting procedures, which includes preparing the skeletonized LITA with a heparine-papaverine solution and sewing of the left internal thoracic artery to LAD artery.

Deep Learning Analysis of Surgical Video Recordings to Assess Nontechnical Skills

Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging. To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechnical skills during cardiac surgical procedures. This cross-sectional study used video recordings of cardiac surgical procedures at a tertiary academic US hospital collected from January 2021 through May 2022. The OpenPose library was used to analyze videos to extract body pose estimations of team members and compute various team motion features. The Non-Technical Skills for Surgeons (NOTSS) assessment tool was employed for rating the OR team's nontechnical skills by 3 expert raters. NOTSS overall score, with motion features extracted from surgical videos as measures. A total of 30 complete cardiac surgery procedures were included: 26 (86.6%) were on-pump coronary artery bypass graft procedures and 4 (13.4%) were aortic valve replacement or repair procedures. All patients were male, and the mean (SD) age was 72 (6.3) years. All surgical teams were composed of 4 key roles (attending surgeon, attending anesthesiologist, primary perfusionist, and scrub nurse) with additional supporting roles. NOTSS scores correlated significantly with trajectory (r = 0.51, P = .005), acceleration (r = 0.48, P = .008), and entropy (r = -0.52, P = .004) of team displacement. Multiple linear regression, adjusted for patient factors, showed average team trajectory (adjusted R2 = 0.335; coefficient, 10.51 [95% CI, 8.81-12.21]; P = .004) and team displacement entropy (adjusted R2 = 0.304; coefficient, -12.64 [95% CI, -20.54 to -4.74]; P = .003) were associated with NOTSS scores. This study suggests a significant link between OR team movements and nontechnical skills ratings by NOTSS during cardiac surgical procedures, suggesting automated surgical video analysis could enhance nontechnical skills assessment. Further investigation across different hospitals and specialties is necessary to validate these findings.

German Heart Surgery Report 2023: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

Based on a voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 1980, a well-defined but limited dataset of all cardiac and vascular surgery procedures performed in 77 German heart surgery departments is reported annually. For the year 2023, a total of 168,841 procedures were submitted to the registry. Of these operations, 100,606 are defined as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 28,996 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 2.8:1) was 97.6%; 97.7% for the 39,859 isolated heart valve procedures (23,727 transcatheter interventions included); and 99.2% for 19,699 pacemaker/implantable cardioverter defibrillator procedures. Concerning short and long-term mechanical circulatory support, a total of 2,982 extracorporeal life support/extracorporeal membrane oxygenation implantations and 772 ventricular assist device implantations (left/right ventricular assist device, BVAD, total artificial heart) were reported. In 2023, 324 isolated heart transplantations, 248 isolated lung transplantations, and 2 combined heart-lung transplantations were performed. This annually updated registry of the DGTHG represents nonrisk adjusted voluntary public reporting and encompasses acute data for nearly all heart surgical procedures in Germany. It constitutes trends in heart medicine and represents a basis for quality management (e.g., benchmark) for all participating institutions.

Differentiation, Metabolism, and Cardioprotective Secretory Functions of Human Cardiac Stromal Cells from Ischemic and Endocarditis Patients.

This study investigates the characteristics of cardiac mesenchymal stem cell-like cells (CMSCLCs) isolated from the right atrial appendage of human donors with ischemia and a young patient with endocarditis (NE-CMSCLCs). Typical CMSCLCs from ischemic heart patients were derived from coronary artery bypass grafting procedures and compared against bone marrow mesenchymal stromal cells (BM-MSCs). NE-CMSCLCs had a normal immunophenotype, but exhibited enhanced osteogenic differentiation potential, rapid proliferation, reduced senescence, reduced glycolysis, and lower reactive oxygen species generation after oxidative stress compared with typical ischemic CMSCLCs. These differences suggest a unique functional status of NE-CMSCLCs, influenced by the donor health condition. Despite large variances in their paracrine secretome, NE-CMSCLCs retained therapeutic potential, as indicated by their ability to protect hypoxia/reoxygenation-injured human cardiomyocytes, albeit less effectively than typical CMSCLCs. This research describes a unique cell phenotype and underscores the importance of donor health status in the therapeutic efficacy of autologous cardiac cell therapy.

Comparing Fair Control of Hyperglycemia contrary to Intensive Control in Patients after Coronary Artery Bypass Grafting Procedure

Comparing Fair Control of Hyperglycemia contrary to Intensive Control in Patients after Coronary Artery Bypass Grafting Procedure

A meta-analysis supporting the superiority of staged carotid artery stenting and coronary artery bypass grafting in patients with concurrent severe coronary and carotid artery stenosis.

This study sought to ascertain whether a staged approach involving carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) holds superiority over the synchronous (Syn) strategy of CAS or carotid endarterectomy (CEA) and CABG in patients necessitating combined revascularization for concurrent carotid and coronary artery disease. Studies were identified through 3 databases: PubMed, EMBASE, and the Cochrane Library. Statistical significance was defined as a P value of less than .05 for all analyses, conducted using STATA version 12.0. In the comparison between staged versus Syn CAS and CABG for patients with concomitant severe coronary and carotid stenosis, 4 studies were analyzed. The staged procedure was associated with a lower rate of 30-day stroke (OR = 8.329, 95% CI = 1.017-69.229, P = .048) compared to Syn CAS and CABG. In the comparison between staged CAS and CABG versus Syn CEA and CABG for patients with concomitant severe coronary and carotid stenosis, 5 studies were examined. The staged CAS and CABG procedure was associated with a lower rate of mortality (OR = 2.046, 95% CI = 1.304-3.210, P = .002) compared to Syn CEA and CABG. The Syn CAS and CABG was linked to a higher risk of peri-operative stroke compared to staged CAS and CABG. Additionally, patients undergoing staged CAS and CABG exhibited a significantly decreased risk of 30-day mortality compared to Syn CEA and CABG. Future randomized trials or prospective cohorts are essential to confirm and validate these findings.

The use of transcutaneous electrical acupoint stimulation to reduce opioid consumption in patients undergoing off-pump CABG: a randomized controlled trial

BackgroundHigh doses of long-acting opioids were used to facilitate off-pump coronary artery bypass grafting procedure, which may result in opioid-related adverse events after surgery. Transcutaneous electrical acupoint stimulation (TEAS) had been reported to be effective in reducing intraoperative opioids consumption during surgery. The aim of this study is to assess whether TEAS with difference acupoints can reduce the doses of opioid analgesics.MethodsThis was a multicenter, randomized, controlled, double-blind trial. Patients underwent off-pump coronary artery bypass grafting under general anesthesia were enrolled. Eligible patients were randomly and equally grouped into sham acupuncture group (n = 105), regional acupoints combination group (n = 105), or distal–proximal acupoints combination group (n = 105) using a centralized computer-generated randomization system. Transcutaneous electrical acupoint stimulation was applied for 30 min before anesthesia induction. The primary outcome was the doses of sufentanil during anesthesia. Secondary outcomes included the highest postoperative vasoactive-inotropic scores within 24 h, intraoperative propofol consumption, length of mechanical ventilation, duration of cardiac care unit and postoperative hospital stay, incidence of postoperative complications, and mortality within 30 days after surgery.ResultsOf the 315 randomized patients, 313 completed the trial. In the modified intention-to-treat analysis, the doses of sufentanil were 303.9 (10.8) μg in the distal–proximal acupoints group, significantly lower than the sham group, and the mean difference was − 34.9 (− 64.9 to − 4.9) μg, p = 0.023. The consumption of sufentanil was lower in distal–proximal group than regional group (303.9 vs. 339.5), and mean difference was − 35.5 (− 65.6 to − 5.5) μg, p = 0.020. The distal–proximal group showed 10% reduction in opioids consumption comparing to both regional and sham groups. Secondary outcomes were comparable among three groups.ConclusionTranscutaneous electrical acupoint stimulation with distal–proximal acupoints combination, compared to regional acupoints combination and sham acupuncture, significantly reduced sufentanil consumption in patients who underwent off-pump coronary artery bypass grafting surgery.

First initiation of mobilization out of bed after cardiac surgery – an observational cross-sectional study in Sweden

BackgroundCardiac surgery is associated with a period of postoperative bed rest. Although early mobilization is a vital component of postoperative care, for preventing complications and enhancing physical recovery, there is limited data on routine practices and optimal strategies for early mobilization after cardiac surgery. The aim of the study was to define the timing for the first initiation of out of bed mobilization after cardiac surgery and to describe the type of mobilization performed.MethodsIn this observational study, the first mobilization out of bed was studied in a subset of adult cardiac surgery patients (n = 290) from five of the eight university hospitals performing cardiothoracic surgery in Sweden. Over a five-week period, patients were evaluated for mobilization routines within the initial 24 h after cardiac surgery. Data on the timing of the first mobilization after the end of surgery, as well as the duration and type of mobilization, were documented. Additionally, information on patient characteristics, anesthesia, and surgery was collected.ResultsA total of 277 patients (96%) were mobilized out of bed within the first 24 h, and 39% of these patients were mobilized within 6 h after surgery. The time to first mobilization after the end of surgery was 8.7 ± 5.5 h; median of 7.1 [4.5–13.1] hours, with no significant differences between coronary artery bypass grafting, valve surgery, aortic surgery or other procedures (p = 0.156). First mobilization session lasted 20 ± 41 min with median of 10 [1–11]. Various kinds of first-time mobilization, including sitting on the edge of the bed, standing, and sitting in a chair, were revealed. A moderate association was found between longer intubation time and later first mobilization (ρ = 0.487, p < 0.001). Additionally, there was a moderate correlation between the first timing of mobilization duration of the first mobilization session (ρ = 0.315, p < 0.001).ConclusionsThis study demonstrates a median time to first mobilization out of bed of 7 h after cardiac surgery. A moderate correlation was observed between earlier timing of mobilization and shorter duration of the mobilization session. Future research should explore reasons for delayed mobilization and investigate whether earlier mobilization correlates with clinical benefits.Trial registrationFoU in VGR (Id 275,357) and Clinical Trials (NCT04729634).