Coronary Artery Bypass Surgery Surgery Research Articles

Blood group AB is associated with reduced blood loss but also elevated cardiovascular mortality in aortocoronary bypass surgery.

Patient blood group (BG) is predictive for von-Willebrand-factor (VWF) and Factor VIII variation. The clinical impact of this ABO-effect on blood loss, cardiovascular complications and outcome has been described for several patient cohorts. The aim of this study was to investigate the impact of patient BG on blood loss and outcome after coronary artery bypass surgery (CABG). Patient records, intraoperative data and perioperative transfusion records of 5713 patients receiving an on-pump CABG procedure between 05/2004 and 12/2018 were analyzed. A logistic regression model for death due to perioperative myocardial ischaemia (PMI) was developed from initially 24 variables by using an univariate and multivariate selection process. BG AB patients required less blood transfusions as compared to the other blood groups, especially in case of emergency operations. However, BG AB patients also had a higher mortality which was due to secondary cardiovascular complications. The impact of blood type on the rate of cardiovascular mortality was confirmed in the logistic regression model. BG AB patients have a worse outcome after CABG surgery due to an increased incidence of fatal cardiovascular complications. As perioperative myocardial ischemia due to graft occlusion appears to be the most likely explanation, stricter anticoagulation for BG AB patients should be discussed.

Outcomes and Direct Cost of Isolated Nonemergent CABG in Patients With Low Ejection Fraction.

Preoperative left ventricular ejection fraction (LVEF) is one of the main predictors of outcomes in cardiac surgery. We present current era outcomes and associated direct cost in nonemergent isolated coronary artery bypass surgery (CABG) patients with LVEF <20% over the past 6 years and compare it with higher EF subgroups. Six-year data from 2016 to 2022 at hospitals sharing Society of Thoracic Surgeons and financial data with Biome Analytics were analyzed based on 3 EF subgroups (EF ≤20%, EF 21% to 35%, and EF >35%). Outcomes and costs were assessed. Overall 30-day mortality of 12,649 patients was 1.9%. The EF ≤20% (n = 248), EF 21% to 35% (n = 1,408), and EF >35 (n = 10,993) cohorts had mortality of 6.9%, 3.7%, and 1.6%, respectively. The EF ≤20% subgroup had higher use of cardiopulmonary bypass, blood products, and mechanical support. In addition, the EF ≤20% subgroup had higher complication rates in almost all measured categories. Also, the EF ≤20% cohort had significantly higher length of stay, intensive care unit (ICU) hours, ICU and hospital readmissions, and lowest discharge to home rate. The strongest factors associated with mortality were postoperative cardiac arrest, renal failure requiring dialysis, extracorporeal membrane oxygenation, sepsis, prolonged ventilation, and gastrointestinal event. The overall median direct cost of care was $37,387.79 ($27,605.18, $51,720.96), with a median direct cost of care in the EF ≤20%, EF 21% to 35%, and EF >35% subgroups of $52,500.17 ($34,103.52, $80,806.79), $44,108.32 ($31,597.58, $63,788.03), and $36,521.80 ($27,168.91, $50,019.31), respectively. In nonemergent isolated CABG surgery, low EF continues to have higher surgical risks and higher direct cost of care despite advances in cardiovascular care.

Number of blood neutrophil granulocytes is associated with diffuse coronary involvement in patients with increased lipoprotein (a)

Aim. To assess the level of lipoprotein (a) (Lp(a)) and other lipid profile parameters, the composition of blood leukocytes in patients with focal and diffuse coronary atherosclerosis who underwent coronary artery bypass surgery (CABG), as well as to study the effect of Lp(a) on the activation of leukocytes in vitro.Material and methods. The study included 120 male patients (mean age, 67±5 years) with multivessel coronary artery disease after elective CABG surgery. According to the type of coronary artery involvement, patients were divided into groups of diffuse (n=77) and focal (n=43) atherosclerosis. In peripheral blood samples, the content of the main fractions of lipoproteins, including Lp(a), was determined. Activation of neutrophil granulocytes upon addition of Lp(a) was assessed in whole blood and in primary cell culture.Results. In patients with diffuse coronary stenosis, there was a tendency to higher Lp(a) levels; no changes in other lipid profile parameters were detected. In this group of patients, an increase in the absolute leukocyte count was noted due to neutrophilic granulocytes. An absolute neutrophil count &gt;2,9 million/mL was associated with diffuse disease (AUC, 0,69 (95% confidence interval (CI) 0,600,77), p=0,0002, sensitivity 85%, specificity 42%). In patients with Lp(a) ³30 mg/dL, the diagnostic value of a neutrophil count &gt;2,9 million/mL for diffuse stenosis was higher (AUC, 0,74 (95% CI 0,60-0,86), p= 0,005, sensitivity 90%, specificity 48%). According to logistic regression analysis with the introduction of neutrophils and conventional risk factors (age, body mass index, hypertension and smoking) into the model, only the number of neutrophils above the threshold level remained an independent factor in diffuse coronary stenosis. Lp(a) can induce neutrophil activation, detected by increased CD66b overexpression in whole blood, as well as the formation of neutrophil extracellular traps in primary cell culture.Conclusion. Neutrophil granulocytes can participate in the formation of diffuse atherosclerotic coronary lesions. One of the neutrophil activators may be Lp(a). The combination of high neutrophil count and Lp(a) level in the blood increases the risk of diffuse coronary atherosclerosis.

Ethnic Disparities in Major Adverse Cardiac and Cerebrovascular Events (MACCEs) and Postoperative Outcomes Following Coronary Artery Bypass in Northeastern Iran (2007-2016).

Turkmens are an ethnic group mainly living in northeastern Iran. Despite previous studies on coronary artery bypass surgery (CABG) outcomes among different ethnicities, the effect of Turkmen ethnicity on outcomes of CABG surgery is still unknown. We aimed to assess the association between Turkmen ethnicity and postoperative outcomes following CABG. We used the CABG data from two heart centers in northeastern Iran between 2007 and 2016. We included adult patients undergoing CABG surgery. The study outcomes were in-hospital major adverse cardiac and cerebrovascular events (MACCEs), consisting of myocardial infarction (MI), stroke, and cardiovascular death, and postoperative outcomes, including postoperative arrhythmia, acute atrial fibrillation (AF), major bleeding, and acute renal failure (ARF). Over the course of one decade, 3632 patients, with an average age (standard deviation) of 59.0 (9.8) years, were studied. Of these, 3,331 patients were of non-Turkmen ethnicity, and 301 patients were Turkmens. According to adjusted analysis, ethnicity was not associated with MACCEs (OR: 1.15, 95 % CI: 0.61, 2.16; P=0.663), postoperative arrhythmia (OR: 1.10, 95% CI: 0.78, 1.54; P=0.588), acute AF (OR: 1.17, 95 % CI: 0.83, 1.66; P=0.359), major bleeding (OR: 1.21, 95 % CI: 0.55, 2.67; P=0.636), or ARF (OR: 2.60, 95 % CI: 0.60, 11.75, P=0.224). This study found that despite ethnic disparity and preoperative differences, Turkmen ethnicity was not associated with in-hospital MACCEs, AF, major bleeding, or ARF after coronary artery bypass.

The Impact of Complete Revascularization in Symptomatic Severe Left Ventricular Dysfunction between Coronary Artery Bypass Graft and Percutaneous Coronary Intervention.

The study aimed to compare the clinical outcomes between the patients receiving coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the patients with symptomatic severe left ventricular (LV) dysfunction and coronary artery disease (CAD). Between February 2007 and February 2020, a total of 745 patients who received coronary artery angiography for reduced LV ejection fraction (LVEF) < 40% and symptomatic New York Heart Association (NYHA) functional class ≥ 3 were recruited. The patients (N = 236) who were diagnosed with dilated cardiomyopathy or valvular heart disease without coronary artery stenosis, those with prior history of CABG or valvular surgery (N = 59), those who presented ST-segment elevated myocardial infarction (STEMI), those with a CAD and SYNTAX score of ≦ 22 (N = 175), those who received emergent CABG for coronary perforation (N = 3), and those who had NYHA class ≦ 2 (N = 65) were excluded. Finally, 116 patients with reduced LVEF and those who had a SYNTAX score >22, who received CABG (N = 47) and PCI (N = 69), were recruited for this study. There was no significant difference in the incidence values of in-hospital course and those of in-hospital mortality, acute kidney injury, and postprocedural hemodialysis. There was no significant difference in the 1-yearfollow-up of recurrent MI, revascularization, or stroke between the groups. The 1-year heart failure (HF) hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (13.2% vs. 33.3%; p = 0.035); however, there was no significant difference in the same variable between the CABG group and the complete revascularization subgroup (13.2% vs. 28.2%; p = 0.160). The revascularization index (RI) was significantly higher in the CABG group than in all patients of the PCI group or complete revascularization subgroup (0.93 ± 0.12 vs. 0.71 ± 0.25; p < 0.001) and (0.93 ± 0.12 vs. 0.86 ± 0.13; p = 0.019). The 3-year HF hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (16.2% vs. 42.2%; p = 0.008); however, there was no difference in the same variable between the CABG group and the complete revascularization subgroup (16.2% vs. 35.1%; p = 0.109). In patients with symptomatic (NYHA class ≥ 3) severe LV dysfunction and CAD, CABG brought less HF admission when compared to patients in the PCI group, but this did not differ when compared to the complete revascularization subgroup. Therefore, an extensive revascularization, achieved by CABG or PCI, is associated with a lower HF hospitalization rate during the 3-yearfollow-up period in such populations.

Tranexamic acid is associated with improved hemostasis in elderly patients undergoing coronary-artery surgeries in a retrospective cohort study.

More elderly patients undergo coronary artery bypass surgery (CABG) than younger patients. Whether tranexamic acid (TA) is still effective and safe in elderly patients undergoing CABG surgeries is still unclear. In this study, a cohort of 7,224 patients ≥70 years undergoing CABG surgery were included. Patients were categorized into the no TA group, TA group, high-dose group, and low-dose group according whether TA was administered and the dose administered. The primary endpoint was blood loss and blood transfusion after CABG. The secondary endpoints were thromboembolic events and in-hospital death. The blood loss at 24 and 48 h and the total blood loss after surgery in patients in the TA group were 90, 90, and 190 ml less than those in the no-TA group, respectively (p < 0.0001). The total blood transfusion was reduced 0.38-fold with TA administration compared to that without TA (OR = 0.62, 95% CI 0.56-0.68, p < 0.0001). Blood component transfusion was also reduced. High-dose TA administration reduced the blood loss by 20 ml 24 h after surgery (p = 0.032) but had no relationship with the blood transfusion. TA increased the risk of perioperative myocardial infarction (PMI) by 1.62-fold [p = 0.003, OR = 1.62, 95% CI (1.18-2.22)] but reduced the hospital stay time in patients who were administered TA compared to that of patients who did not receive TA (p = 0.026). We revealed that elderly patients undergoing CABG surgeries had better hemostasis after TA administration but increased the risk of PMI. High-dose TA was effective and safe compared with low-dose TA administration in elderly patients undergoing CABG surgery.

Abstract 13536: Cardiac Rehabilitation Enrollment Among Medicare Beneficiaries: Surgical Hospitals Play a Critical Role!

Introduction: Hospitalization for myocardial infarction (MI), percutaneous coronary intervention (PCI), or cardiac surgery [coronary artery bypass surgery (CABG) or valve surgery] represents a key opportunity to refer and recruit eligible patients to cardiac rehabilitation (CR.) However, little is known about how hospitals influence CR enrollment at the national level. Methods: Using Medicare fee-for-service claims from 2017, we identified all patients with a principal discharge diagnosis of MI, PCI, CABG, or valve surgery. We defined CR enrollment as attending ≥ 1 session within 90 days and calculated hospital-specific CR enrollment rates. To assure stability of our statistical results, we limited our sample to hospitals where cardiac surgery was performed, and then examined the association between patient demographics, procedures, comorbidities, and hospital characteristics on CR enrollment using mixed effects hierarchical logistic regression. We calculated the median odds ratio (MOR) to estimate the extent to which the hospital where a patient was cared for influenced their chance of enrolling in CR. Results: At 3,420 hospitals, we identified a total of 264,970 eligible patients (age 77 ± 8 yrs., 58% male, 85% white, 39% surgical), of which 25% attended CR. While a minority (38%) of hospitals performed cardiac surgery - these hospitals cared for the vast majority (92%) of all eligible patients. At these hospitals, the median CR enrollment rate was low (22%) and varied 10-fold across hospitals at the 10 th and 90 th percentiles (3%, 42%). After multivariable adjustment, the factors most associated with CR enrollment were having cardiac surgery or undergoing PCI (OR 5.8, 2.6 vs. MI respectively), advancing age (OR 0.77 per 5-year increase), low socioeconomic status (OR 0.33), smoking (OR 0.59), or living in the Midwest (OR 2.3 vs. South), p &lt;0.001 for all. The hospital MOR was 2.1, similar in effect size to PCI or Midwest location. Conclusions: In this large national study of older adults, participation rates in CR were low, and the hospital where patients receive their care was strongly associated with CR enrollment. As surgical hospitals care for the majority of all eligible patients, they appear to be the most logical place to focus improvement efforts.

Influence of cardioplegic solution on incidence of delirium after CABG surgery: Use of Calafiore blood cardioplegia versusHTK-Bretschneider-solution in a single-center retrospective analysis from 2017 to 2021.

Purpose of the present study is an evaluation of postoperative incidence for delirium after coronary artery bypass surgery (CABG). Study addressed whether application of Histidine-Tryptophan-Ketoglutarate (HTK) solution (Bretschneider) or blood cardioplegia (Calafiore) is associated with increased of postoperative delirium cases. In a retrospective, single center evaluation a total number of 273 patients were enrolled in the study from January 2017 to October 2021. There were 124 patients assigned to the Calafiore groupblood cardioplegic solution (BCC) and 149 patients were included in the Bretschneider group (HTK). The primary endpoint was the postoperative delirium rate in its frequency of occurrence. Definition of the dilirium status was performed using the Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) score during the first three postoperative days. Secondary endpoints were the time intervals of intensive care duration of stay, mechanical ventilation, total extracorporeal circulation, ischemia and reperfusion. Serum levels of the electrolytes Sodium, Potassium, ionized Calcium, and Chloride were monitored. Although no significant difference in delirium status between the groups were noticed, on third postoperative day, delirium rate dependent on cardioplegia solution used (HTK 12.0%; BCC 3.0%; p = .024) and duration of intensive care stay differed (HTK 4.5 vs. BCC 3.0 days; p = .001). Although Ischemic time (HTK 73.0 vs. BCC 83.0 min; p < .001) and reperfusion time (HTK 35.0 vs. Calafiore 24.0 min; p < .001) were extended in the BCC group less cases of delirium were diagnosed. Serum sodium levels after HTK cardioplegic infusion were decreased (HTK 129.68 vs. BCC 138.96 mmol/l; p < .001). The significant difference persists up to the hundredth extracorporeal circulation circuit min(p = .005). The present data suggest an impact of the cardioplegic solution used upon postoperative delirium rates. Optimization of cardiac arrest protocols is needed. Present data encourage further prospective studies regarding the impact of cardioplegic solutions on electrolyte imbalance for postoperative delirium rates in CABG surgery.

Endoscopic Saphenous Vein Harvesting and Surgical Site Infections after Coronary Artery Bypass Surgery (CABG)

Introduction: Coronary artery bypass grafting (CABG) surgery remains the most common procedure in adult cardiac surgery for coronary artery disease. Objectives: The main objective of the study is to find the infection in open vs endoscopic saphenous vein harvest for patients undergoing CABG surgery. Material and method: This comparative analysis was conducted at Rawalpindi Institute of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi and Shifa International Hospital, Islamabad from October 2019 to 2021. The data was collected with the permission of the ethical committee of hospital. The data was collected with the permission of the ethical committee of the hospital. Patients undergoing CABG or combined valve/CABG with EVH and OVH were differentiated from each other in the MHCCSR as of the start of the study period. The OVH was performed by either a continuous, longitudinal incision or through multiple smaller incisions. Results: The data were collected from 122 patients, from these 22 patients were not extubated and none of them survived. The most common indication for surgery was myocardial revascularization (30.6%), followed by valve replacement (22.7%) and thoracic aortic aneurysm repair. Practical implication: EVH is now considered not to be the best method in CABG surgery. Conclusion: It is concluded that, patients undergoing CABG surgery with EVH presented with worse systolic function and more recent myocardial infarction. Keywords: CABG, Procedure, EVH, Systolic, Myocardial infarction, Endoscopic

Evolocumab administration prior to Coronary Artery Bypass Grafting in patients with multivessel coronary artery disease (EVOCABG): study protocol for a randomized controlled clinical trial

BackgroundDespite advances in surgical and postoperative care, myocardial injury or infarction (MI) is still a common complication in patients undergoing coronary artery bypass surgery (CABG). Several studies that aimed to reduce postoperative myocardial injury, including those investigating statin loading, have been conducted but did not indicate any clear benefits. Evolocumab, a PCSK9 inhibitor, has been reported to lower lipids and prevent ischemic events in various medical conditions. However, the effect of evolocumab in cardiovascular surgery has not been evaluated. The objective of this trial is to evaluate the cardioprotective effects of evolocumab in elective CABG patients with multivessel coronary artery disease.MethodsEVOCABG is a prospective, randomized, open, controlled, multicenter, superiority, phase III clinical trial. Patients with multivessel coronary artery disease without initial cardiac enzyme elevation will be recruited (n=100). Participants will be randomly allocated into two groups: a test group (evolocumab (140mg) administration once within 72 h before CABG) and a control group (no administration). The primary outcome is the change in peak levels of serum cardiac marker (troponin-I) within 3 days of CABG surgery compared to the baseline. Secondary outcomes include post-operative clinical events including death, myocardial infarction, heart failure, stroke, and atrial fibrillation.DiscussionThis trial is the first prospective randomized controlled trial to demonstrate the efficacy of evolocumab in reducing ischemic-reperfusion injury in patients undergoing CABG. This trial will provide the first high-quality evidence for preoperative use of evolocumab in mitigating or preventing ischemic-reperfusion-related myocardial injury during the surgery.Trial registrationClinical Research Information Service (CRIS) of the Republic of Korea KCT0005577. Registered on 4 November 2020.

A Comparison of AKIN, KDIGO, and RIFLE Definitions to Diagnose Acute Kidney Injury and Predict the Outcomes after Cardiac Surgery in a South Asian Cohort

Background: Acute kidney injury (AKI) after cardiac surgery is associated with an increased mortality and morbidity. Different definitions for AKI have been used such as Acute Kidney Injury Network (AKIN), Kidney Disease: Improving Global Outcomes (KDIGO), or risk, injury, failure, loss, end-stage kidney disease (RIFLE). Each of these definitions has their own benefits and limitations for predicting the degree of AKI and adverse outcomes following cardiac surgery. This study was aimed to compare the three AKI definitions to diagnose AKI and their predictive ability for mortality and morbidity after isolated coronary artery bypass surgery (CABG) in a South Asian cohort. Material and Methods: A single-center retrospective review was conducted on 1,508 patients having undergone isolated CABG surgery from January 2015 to January 2019. AKI was assessed on three definitions, and comparative receiver operating characteristics curves were built against the outcomes to assess discriminative power of each. Results: Mean age of participants was 59.43 (±1.12) years, predominantly males (82.6%). Patients with AKI were elder, more likely to be diabetic and hypertensive. AKI by any definition occurred in 58.7% (885/1,508) patients. Frequency of AKI was 508 (33.7%), 517 (34.4%), and 871 (57.8%) on AKIN, KDIGO, and RIFLE criteria, respectively. The proportion of patients with RIFLE-risk 619 (41%) was greater compared with AKIN stage 1 (342 [22.7%]) and KDIGO stage 1 (330 [21.9%]), while for stages 2 and 3 the proportions were comparable across the three systems. Area under the curve (AUC) for 30-day mortality for AKIN was (0.786, [95% CI: 0.764–0.806]), KDIGO: (0.796, [95% CI: 0.775–0.816]) and for RIFLE (0.844, [95% CI: 0.825–0.862]). AUC for overall morbidity was in undesirable ranges (i.e., >0.5–≤0.7) for all three definitions. Conclusion: In a South Asian cohort, performance of AKIN and KDIGO criteria was comparable to diagnose AKI, while RIFLE definition, though overestimated the incidence of AKI particularly stage 1, and had an excellent discriminatory power to predict mortality compared to other two definitions.

The Effect of Acute Kidney Injury on TGF-β1 and Smad3 in Patients with Coronary Heart Disease after Off-Pump Coronary Artery Bypass Grafting.

Background Acute kidney injury (AKI) is one of the most common and serious complications for coronary disease (CAD) patients, suffering from coronary artery bypass surgery (CABG). AKI occurs in nearly 30% of cardiac surgery patients, including CABG patients, affecting renal function, prolonging hospitalization time, and increasing all-cause mortality. TGF-β1 and Smad3 are sensitive biomarkers in evaluating kidney function. Therefore, comparing the TGF-β1 and Smad3 levels between the AKI patients and non-AKI patients after CABG surgery might have an important significance for identifying the risk degree of AKI and applying effective preventive measures after CABG surgery. Objective This study aims at comparing the TGF-β1 and Smad3 levels between the AKI patients and non-AKI patients after CABG surgery to identify the risk degree of AKI and apply effective preventive measures after CABG surgery in clinics. Materials and Methods A total of 25 proper patients, diagnosed as coronary disease (CAD) and undergoing AKI after CABG, were selected as the AKI group. The 25 participants, who did not suffer from AKI after CABG, were recruited using the case-control matching method in SPSS 25.0 software as the non-AKI group. Also, corresponding surgical specimens (tissues) and samples of blood were collected from them. Histopathological analysis and immunofluorescent microscopy of lesion artery and kidney of patients, who have been treated with kidney transplants, were performed on surgical specimens to find the pathological and histological change difference between the two groups. RT-PCR and Western blot were conducted to quantify the levels of TGF-β1 and Smad3 expression in serum for the patients of AKI and non-AKI groups, respectively. Results Serious renal fibrosis was noted in patients of the AKI group. In addition, by H&E staining of the lesion artery, severe histopathological changes including smooth muscles proliferation with endothelial cell infiltration, focal degeneration and disruptions, and less collagen accumulation were found in the lesion artery of patients from the AKI group. Higher levels of TGF-β1 and Smad3 were observed in serum of patients of the AKI group. Conclusion: The increased levels of TGF-β1 and Smad3 in serum might be risk factors for triggering AKI for CAD patients undergoing CABG.

Epicardial Transplantation of Autologous Cardiac Micrografts During Coronary Artery Bypass Surgery.

Background: Cardio-regenerative cell therapies offer additional biologic support to coronary artery bypass surgery (CABG) and are aimed at functionally repairing the myocardium that suffers from or is damaged by ischemia. This non-randomized open-label study assessed the safety and feasibility of epicardial transplantation of atrial appendage micrografts (AAMs) in patients undergoing CABG surgery.Methods: Twelve consecutive patients destined for CABG surgery were included in the study. Six patients received AAMs during their operation and six patients were CABG-operated without AAMs transplantation. Data from 30 elective CABG patients was collected for a center- and time-matched control group. The AAMs were processed during the operation from a biopsy collected from the right atrial appendage. They were delivered epicardially onto the infarct scar site identified in preoperative late gadolinium enhancement cardiac magnetic resonance imaging (CMRI). The primary outcome measures at the 6-month follow-up were (i) patient safety in terms of hemodynamic and cardiac function over time and (ii) feasibility of therapy administration in a clinical setting. Secondary outcome measures were left ventricular wall thickness, change in myocardial scar tissue volume, changes in left ventricular ejection fraction, plasma concentrations of N-terminal pro-B-type natriuretic peptide levels, NYHA class, number of days in hospital and changes in the quality of life.Results: Epicardial transplantation of AAMs was safe and feasible to be performed during CABG surgery. CMRI demonstrated an increase in viable cardiac tissue at the infarct site in patients receiving AAMs treatment.Conclusions and Relevance: Transplantation of AAMs shows good clinical applicability as performed during cardiac surgery, shows initial therapeutic effect on the myocardium and has the potential to serve as a delivery platform for cardiac gene therapies.Trial Registration:ClinicalTrials.gov, identifier: NCT02672163.

Determinants and Prediction Equations of Six-Minute Walk Test Distance Immediately After Cardiac Surgery.

Background: To date, there is no reference for a 6-min walk test distance (6-MWD) immediately after cardiac surgery. Therefore, this study aimed to identify the determinants and to generate equations for prediction reference for 6-MWD in patients immediately after cardiac surgery.Methods: This is a cross-sectional study of the 6-min walk test (6-MWT) prior to participation in the cardiac rehabilitation (CR) program of patients after coronary artery bypass surgery (CABG) or valve surgery. The 6-MWT were carried out in a gymnasium prior to the CR program immediately after the cardiac surgery. Available demographic and clinical data of patients were analyzed to identify the clinical determinants of 6-MWD.Results: This study obtained and analyzed the data of 1,509 patients after CABG and 632 patients after valve surgery. The 6-MWD of all patients was 321.5 ± 73.2 m (60–577). The distance was longer in the valve surgery group than that of patients in the CABG group (327.75 ± 70.5 vs. 313.59 ± 75.8 m, p < 0.001). The determinants which significantly influence the 6-MWD in the CABG group were age, gender, diabetes, atrial fibrillation, and body height, whereas in the valve surgery group these were age, gender, and atrial fibrillation. The multivariable regression models generated two formulas using the identified clinical determinants for patients after CABG: 6-MWD (meter) = 212.57 + 30.47 (if male gender) − 1.62 (age in year) + 1.09 (body height in cm) − 12.68 (if with diabetes) − 28.36 (if with atrial fibrillation), and for patients after valve surgery with the formula: 6-MWD (meter) = 371.05 + 37.98 (if male gender) − 1.36 (age in years) − 10.61 (if atrial with fibrillation).Conclusion: This study identified several determinants for the 6-MWD and successively generated two reference equations for predicting 6-MWD in patients after CABG and valve surgery.

Early Outcome of Minimally Invasive Direct Coronary Artery Bypass Surgery- A hospital based study

Background: coronary artery bypass surgery (CABG) is expensive, uses disposable appliances and patients require more perioperative intensive care, long stay in hospital and often have a lengthy recovery time. These complications, together with the growing trend towards less invasive techniques in other areas of surgery, have encouraged cardiac surgeons to see if minimally invasive cardiac surgery can become a reality with improved outcomes and costs.&#x0D; Methods: This is a prospective nonrandomized comparative clinical study done at the Department of Cardiac Surgery in National Institute of Cardiovascular Diseases (NICVD) Sher-E- Bangla Nagar, Dhaka from July 2006 to June 2008 among routine CABG patients. Purposive sampling was done with 26 patients in group A selected for MIDCAB and 24 patients in Group B selected for conventional CABG surgery. Patients were followed up for three months. Postoperative outcomes were assessed to evaluate the safety and efficacy of MIDCAB in relation to conventional CABG.&#x0D; Results: Mean age were 54.19 vs 53.87 in group A and Group B. 92.3% vs 87.5% were male respectively. Mean duration of operation, per operative blood loss transfusion and arrythmia were lower in MIDCAB group (p&lt;0.05) number of grafts were also statistically significant (p&lt; 0.001). Regarding post-operative outcome ventilation time in hours ICU stay post-operative hospital stay in days, postoperative MI and stroke rate were lower in favor of group A MIDCAB patients (p&lt;0.001). Three months postoperatively six-meter walking distance is also statistically significant in favor of Group A MIDCAB (p&lt;0.01) patients. However, pain score in early post-operative period was higher in group A significantly but it decreased significantly in late post-operative period which is also highly statistically different (p&lt;0.001). However, mortality and quality of life at three months were similar in both groups.&#x0D; Conclusion: No difference in mortality rates detected between MIDCAB and CCABG group. But there was evidence that MIDCAB is associated with less perioperative and early postoperative morbidity and improved quality of life. The MIDCAB surgery is an effective procedure of complete revascularization in ischemic heart diseases like CCABG. The procedure is associated with shorter operating time, shorter ICU stay time, shorter hospital stays and better quality of life than for CCABG.&#x0D; Cardiovasc. j. 2021; 13(2): 135-143

Decreased brain-derived neurotrophic factor levels may predict early perioperative neurocognitive disorder in patients undergoing coronary artery bypass surgery: A prospective observational pilot study

Study objectiveTo determine the prognostic value of the change in intraoperative BDNF (Brain-derived neurotrophic factor) levels during cardiac surgery with cardiopulmonary bypass (CPB) on early perioperative neurocognitive disorder (PND). DesignProspective observational pilot study. SettingThe study was performed in the Medical Faculty Hospital, from January 2020 to August 2020. Patients45 adult patients undergoing elective coronary artery bypass surgery (CABG) with CPB. InterventionsNone. MeasurementsCognitive function was evaluated 1 day before and 4 days after the surgery. Serum BDNF levels were measured at four time points (T1: after induction; T2: with aortic cross-clamp; T3: without aortic cross-clamp; T4: 4 days after surgery) by enzyme-linked immunosorbent assay. Main resultsThe incidence of PND was 37.8% four days after surgery. Serum BDNF (T2 and T4) levels were significantly lower in PND group compared to non- PND group (p = 0.003 and p = 0.016, respectively). Moreover, lactate, rSO2 (regional cerebral oxygen saturation), aortic cross-clamp time, CPB duration, and the amount of blood transfusion differed between the groups. Logistic regression analysis identified serum BDNF-T2, age, cross-clamp time, and rSO2-T2 as independent risk factors for PND. Based on the ROC analysis, the area under curve (AUC) of BDNF-T2 concentration for prediction of PND was 0.759 with sensitivity of 71.4% and specificity of 64.7% (p < 0.01). ConclusionIntraoperative BDNF serum levels may be a useful biomarker in predicting PND in patients undergoing CABG surgery. More comprehensive studies is needed in order to confirm the effect of decreasing intraoperative BDNF serum levels on the development of PND. Trial registration numberNCT04250935 www.clinicaltrials.gov.

Effect of Low Triiodothyronine (T3) Hormone Levels on Atrial Fibrillation Development After Coronary Artery Bypass Surgery

Aim: Atrial fibrillation (AF) after coronary artery bypass surgery (CABG) is the most common type of arrhythmia and it causes serious morbidity. Low levels of triiodothyronine (T3) hormone are thought to be a strong determinative factor on poor prognosis of cardiac patients. This study was planned to investigate the effect of low levels of T3 on the development of AF after off-pump coronary artery bypass surgery (OPCAB) and conventional CABG surgery. Methods: The study was prospectively planned on 60 patients undergoing CABG surgery. Thirty of them were randomly selected among the patients undergoing OPCAB, and the other 30 were randomly selected among the patients undergoing conventional CABG surgery. Thyroid function profiles of all patients were evaluated before the operation and on the first day of postoperative period. Results: The average age of the patients was 58.7± 8. After the operation, 3 patients from each group, 6 patients in total, developed AF. Postoperatively measured TT3 levels of the patients who developed AF after the operation (0.39±0.09) were found to be significantly lower than the preoperatively measured TT3 levels (0.97± 0.06) (p=0.042). Moreover, postoperatively measured fT3 levels of the patients who developed AF after operation (1.58± 0.30) were found to be significantly lower than the preoperatively measured fT3 levels (2.95±0.37) ( p=0.001). However, by univariate logistic regression analysis, it was seen that the variables that were thought to be risk factors for AF were not significantly effective. Also, when the effects of the variables were examined together by multivariate regression analysis, no significant result was found.Conclusion: In our study, it was seen that low levels of thyroid hormone in patients undergoing OPCAB and conventional CABG surgery had no effect on AF development.

Evaluation of liver function tests after coronary artery bypass surgery (CABG).

Background:Coronary artery bypass graft surgery (CABG) may have systemic effects on the body organs as liver. The purpose of present study was to evaluate changes in liver function tests(LFT) after on-pump CABG surgery and risk factors associated with LFT changes.Also, the incidence of acute liver injury after on-pump CABG is determined.Methods:385 patients who underwent on-pump CABG surgery were randomly selected.Preoperative and intraoperative risk factors were obtained from their medical records .Postoperative liver function tests at 24, 48 and 72 hours following surgery and discharge time were compared with the preoperative ones. A univariate linear regression analysis was used to assess the possible relationships between these changes and the preoperative and intraoperative risk factors.Results:Statisitcal analysis revealed direct and significant relationship between LFT changes and pump time, aortic cross-clamp clamp time and use of intra-aortic balloon pump(IABP). Also a medical history of previous myocardia infarction was significantly related to the changes in direct bilirubin in the first 48 hours following surgery.level of preoperative left ventricle ejection fraction,smoking and using opium had significant correlation with postoperative AST changes in different days.In 12.9% of patients, the aminotransferases levels increased to more than three folds over normal upper limit but the probability for incidence of acute ischemic liver injury (transient increase in aminotransferases to over 500IU/L) was 0.77%.Conclusion: Using techniques to reduce clamp and pump time when possible is important during CABG. Probable liver injuries post inserting IABP should be expected for appropriate monitoring and treatment.

Usage and Results of Levosimendan in Ischemic Mitral Valve Surgery

Objective: Large number of comprehensive studies has been carried out on levosimendan. There are many studies on its use, especially in cardiac dysfunction, ischemic cardiac surgery, and heart transplantation surgery. But, there are limited number of studies regarding its use in mitral valve interventions and ischemic mitral dysfunction combined with coronary artery by-pass surgery (CABG). We aimed to investigate the efficacy of levosimendan usage on patients undergone combined coronary artery by-pass grafting and mitral valve surgery because of ischemic mitral dysfunction.Methods: Subsequent patients, who have undergone concurrent CABG and mitral valve repair surgery by a single surgery team, were retrospectively examined. 36 patients were divided into 2 groups; Group 1 (levosimendan therapy group, n=15) and Group 2 (n=21).Results: There was no statistically significant difference between the groups in terms of preoperative characteristics, echocardiographic data of the patients and preoperative medication. Inotrope therapy was required for 12 patients in Group 1, which was statistically higher than Group 2 (n=5, p=0.001). Moreover, IABP following LCOS utilized six and two patients in group 1 and 2 with a statistically significant difference (p=0.03), espectively.Conclusion: We recommend using levosimendan on selected patients for its several beneficial effects. However, we do not satisfied with the treatment because the pathology of all patients was not related to ischemia, more to the alteration of ventricle anatomy with deterioration of diameters.

Spontaneous closure of grade IV coronary perforation.

Previous coronary artery bypass surgery (CABG) is an independent risk factor for coronary perforation (CP) during percutaneous coronary intervention (PCI) because of complexity of the cases. However in patients with prior CABG surgery, cardiac tamponade is rare because of local or regional pericardial adhesions.