Coronary Bypass Surgery Patients Research Articles

Fractional Flow Reserve–Guided Percutaneous Coronary Intervention (PCI) as Compared with Coronary Bypass Surgery in Patients with Three-Vessel Coronary Artery Disease

Fractional Flow Reserve–Guided Percutaneous Coronary Intervention (PCI) as Compared with Coronary Bypass Surgery in Patients with Three-Vessel Coronary Artery Disease

Relationship between vascular calcification, osteoporosis and systemic inflammation

A lot of patients with coronary heart disease often suffer from vascular calcification. In many cases it is accompanied by harmful cardiovascular events. The modern ideas of the relationship between osteoporosis, vascular calcification and inflammation, the general mechanisms of development of vascular calcification and low bone mineral density are discussed. Despite a growing number of studies concerning the combined pathology of the cardiovascular and skeletal systems, a causal relationship between vascular calcification and a decrease in bone mass has not yet been established. Moreover, there is insufficient data on the effect of inflammation on ectopic calcification. Based on the analysis of available clinical and experimental studies, this review describes the main pathogenetic mechanisms of vascular calcification in coronary atherosclerosis. The influence of calcium and vitamin D medicines on the development of vascular calcification is discussed in this article. The author’s attention is focused on early and long-term consequences of percutaneous coronary intervention and coronary bypass surgery in patients with vascular calcification.

Long-term outcomes of complete bilateral internal thoracic artery grafting and traditional coronary bypass surgery in patients with multivessel coronary artery disease

Aim. To evaluate the long-term results of complete bilateral internal thoracic artery (BITA) grafting and traditional coronary bypass grafting (CABG) in patients with multivessel CAD.Material and methods. From June 2018 to December 2021, 646 CABG operations were performed in patients with multivessel CAD at the Federal Center for Cardiovascular Surgery (Krasnoyarsk). There were 178 patients receiving BITA grafting and 468 — traditional revascularization technique. After propensity score matching, 356 patients were selected, of which 99 had on-pump BITA (group 1), 178 — on-pump traditional revascularization (group 2), and 79 — off-pump BITA (group 3). There were more males (p=0,143 and p=0,547). The groups were comparable in age (p=0,343 and p=0,104), body mass index (p=0,532 and p=0,759), diabetes (p= 0,705 and p=0,667), the number of hemodynamically significant coronary stenoses (p=0,370 and p=0,595).Results. The follow-up period lasted 32,8±8,52 months. Long-term patient survival was 83,9% in group 2,93% in group 1 (p=0,041) and 94% in group 3 (p=0,039). Freedom from cardiovascular mortality was 100% in both groups of BITA grafting and 92,5% in group 2 (p=0,001 and p=0,039), freedom from major cardiovascular events was 94,2% in group 1, 85,1% in group 2 and 98,5% in group 3 (p=0,032 and p=0,03).Conclusion. BITA grafting is a modern effective and safe method of surgical myocardial revascularization both on- and off-pump. Up to 33 months. BITA grafting was associated with significantly better patient survival, complete freedom from cardiovascular mortality and a lower incidence of major cardiovascular events.

The Value of Routine Non-Selective Peripheral Vascular Screening and Its Potential Impact on Coronary Bypass Surgery Patients

The Value of Routine Non-Selective Peripheral Vascular Screening and Its Potential Impact on Coronary Bypass Surgery Patients

Left Atrial Appendage Closure During Coronary Bypass Surgery in Patients on Hemodialysis.

Patients with end-stage renal disease on hemodialysis (ESRD-HD) have a lifelong risk of atrial fibrillation-related stroke. We compared clinical outcomes in ESRD-HD patients undergoing coronary artery bypass grafting (CABG) with and without concomitant left atrial appendage (LAA) closure.Methods and Results: Of 2,783 consecutive patients undergoing isolated CABG between 2002 and 2020, 242 patients had ESRD-HD with sinus rhythm. The primary outcome was a composite of death and stroke. An inverse probability (IP)-weighted cohort was created based on the propensity score. The 2 IP-weighted groups had well-balanced baseline and surgical backgrounds, with an equivalent follow-up. Five-year stroke-free survival was significantly higher in patients with LAA closure (log-rank test, P=0.035). The adjusted hazard ratio of LAA closure for death and stroke was 0.43 (95% confidence interval [CI] 0.20-0.92; P=0.023). Competing risk analysis showed that LAA closure was significantly associated with a risk reduction of stroke (subhazard ratio 0.26; 95% CI 0.08-0.96; P=0.028). No significant difference was observed in adjusted risk ratios for reoperation for bleeding, new atrial fibrillation, 30-day mortality, and readmission for heart failure. Concomitant LAA closure during CABG can reduce the risk of death and stroke in ESRD-HD patients with normal sinus rhythm.

Comparison of Cardioplegic Solutions in Coronary Bypass Surgery Over Autophagy and Apoptosis Mechanisms.

Coronary artery disease (CAD) due to myocardial ischemia causes permanent loss of heart tissue. We aimed to demonstrate the possible damage to the myocardium at the molecular level through the mechanisms of autophagy and apoptosis in coronary bypass surgery patients. One group was administered a Custodiol cardioplegia solution, and the other group was administered a Blood cardioplegia solution. Two myocardial samples were collected from each patient during the operation, just before cardiac arrest and after the aortic cross-clamp was released. The expressions of autophagy and apoptosis markers were evaluated. The level of statistical significance adopted was 5%. The expression of the BECLIN gene was significant in the myocardial tissues in the BC group (p=0.0078). CASPASE 3, 8, and 9 gene expression levels were significantly lower in the CC group. Postoperative TnT levels were significantly different between the groups (p=0.0072). CASPASE 8 and CASPASE 9 gene expressions were similar before and after aortic cross-clamping (p=0.8552, p=0.8891). In the CC group, CASPASE 3, CASPASE 8, and CASPASE 9 gene expression levels were not found to be significantly different in tissue samples taken after aortic cross-clamping (p=0.7354, p=0.0758, p=0.4128, respectively). With our findings, we believe that CC and BC solutions do not have a significant difference in terms of myocardial protection during bypass operations.

Overexpression of the PTEN Gene in Myocardial Tissues of Coronary Bypass Surgery Patients.

Coronary artery disease is a complex disorder that causes death worldwide. One of the genes involved in developing this disease may be PTEN. This study aimed to investigate the PTEN gene and protein expression in tissue and blood samples taken from coronary bypass surgery patients. Molecular studies were performed at Erciyes University Genome and Stem Cell Center (GENKOK). Right atrial appendage and blood samples were taken from the central vein of 22 coronary bypass surgery patients before starting and ending cardiopulmonary bypass. PTEN expression was determined using quantitative real-time PCR and western blot analysis. The significance level was accepted as p<0.05. There was no significant difference in the PTEN gene expression in blood samples taken before and after cardiopulmonary bypass. However, a substantial increase in both protein and gene expression levels of P-PTEN and PTEN was observed in the tissue samples. Myocardial expression of the PTEN gene was significantly increased at the end of the cardiopulmonary bypass. PTEN gene expression in the post-cardiopulmonary bypass period was increased when compared to the pre-bypass period, but it was insignificant when compared to healthy controls. This study first revealed the role of the PTEN gene by analyzing both mRNA and protein expression in coronary bypass patients, appearing in both myocardial tissue and blood samples. Increased levels of PTEN may be a marker in myocardial tissue for patients with coronary artery disease.

Disse index and free fatty acids as markers of insulin resistance and their association with hospital outcomes of coronary bypass surgery in patients with different glycemic status

AIM: to analyze various indices of insulin resistance and plasma free fatty acid (FFA) levels, and their association with the preoperative status and in-hospital complications after coronary artery bypass grafting (CABG) in normoglycemic patients and patients with carbohydrate metabolism disorders (CMD).MATERIALS AND METHODS: The study included 708 patients who underwent CABG. The glycemic status, preoperative parameters, the specifics of surgical intervention, in-hospital complications were analyzed. The patients were divided into 2 groups: Group 1 (n=266) — patients with CMD (type 2 diabetes mellitus (T2DM) and prediabetes); Group 2 (n=442) — patients without CMD. Plasma FFA and fasting plasma insulin levels were determined, the Disse index, the quantitative insulin sensitivity check index (QUICKI), revised QUICKI were estimated in 383 patients.RESULTS: Screening prior to CABG increased the number of patients with T2DM from 15.2% to 24.1%, prediabetes – from 3.0% to 13.4%, with any CMD – from 18.2% to 37.5%.Patients with CMD showed a higher percentage of significant hospital complications (25.2% vs 17.0%, p=0.007), progression of renal failure (6.3% vs 2.9%, p=0.021), multiple organ failure (4.5% vs 1.7%, p=0.039), sternal wound complications (6.3% vs 2.9%, p=0.018), renal replacement therapy (3.7% vs 1.1%, p=0.020), surgery on peripheral arteries (1.5% vs 0%, p=0.039).According to the results of multivariate analysis, the Disse index turned out to be a significant predictor of the end point (hospital stay &gt;10 days or any significant complication CABG) in several regression models (OR 1.060 in one of the models; 95% CI 1.016–1.105; p=0.006). Independent predictors of the end point were: female gender, age, body mass index, cardiopulmonary bypass duration, left atrium size, left ventricular end diastolic dimension, T2DM, FFA levels (OR 3.335; 95% CI 1.076–10.327; p=0.036), average postoperative glycemia on the 1st day after CABG, failure to achieve the target range of perioperative glycemia.CONCLUSION: Screening for CMD prior to CABG can significantly increase the number of patients with diagnosed CMD. Significant in-hospital complications after CABG tend to be more prevalent in patients with CMD compared with normoglycemic patients. Insulin resistance index Disse, FFA, postoperative glycemia are independent predictors of prolonged hospital stay or postoperative complications of CABG.

Postoperative Atrial Fibrillation After Coronary Bypass Surgery In Patients Having Pre-Operative Hypoalbuminemia.

Hypoalbuminemia commonly occurs in cardiac patients, especially in elderly patients and those with chronic congestive heart failure, and it has been associated with adverse events such as atrial fibrillation. The study aimed to determine the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary bypass surgery (CABG) with pre-operative hypoalbuminemia in a major cardiac surgery institute in Karachi, Pakistan. This descriptive cross-sectional study included patients of any gender, aged between 30-80 years, who underwent CABG surgery and had hypoalbuminemia at the time of pre-operative assessment. Hypoalbuminemia was defined as a serum albumin level less than 3.8 mg/dL (normal range: 3.8-4.5 mg/dL). We recorded routine daily 12-lead ECGs and monitored the occurrence of POAF within 72 hours of surgery. A total of 144 patients were included in the study, of which 77.8% (112) were male, and the mean age was 58.1±8.4 years. The average serum albumin levels before surgery were 3.5±0.2 mg/dL. The majority of patients, 71.5% (103), had three-vessel disease (3VD), and 20.8% (30) had 3VD with left main (LM) disease. Hypertension was observed in 70.1% (101) of the patients, diabetes in 52.1% (75), and prolonged CBP time in 61.8% (89). The frequency of POAF was 10.4% (15), and it was significantly higher in non-hypertensive and non-diabetic patients, with a crude odds ratio of 4.19 [1.39-12.65] and 8.47 [1.84-39.09], respectively. The study found that approximately one in every ten patients undergoing CABG experienced POAF. Surprisingly, the rate of POAF was higher among non-hypertensive and non-diabetic patients.

Human macrophages are immunoprofiled by pericardial fluid small extracellular vesicles modulating lipid metabolism mechanisms

Abstract Background The incidence and severity of ischemic heart disease (IHD) is exacerbated by coronary artery disease (CAD). Monocytes and macrophages are central to atherosclerosis. Endogenous small extracellular vesicles (sEVs) can shuttle microRNAs and other molecular cargos from cell to cell, mediating expressional and functional response in the recipient cells. Recent evidence supports a role for sEVs in modulating macrophage phenotype. The pericardial fluid (PF) is in direct contact with the epicardium and contain sEVs. We recently showed that human PF-sEVs are capable to modulate cardiovascular cells via microRNA shuttling. Purpose This study sought to investigate whether PF-sEVs regulate macrophages, contributing to a specific immunophenotype in CAD patients. Methods PF was collected from either CAD patients undergoing coronary bypass surgery (CABG) or non-atherosclerotic patients operated for mitral valve repair (non-CAD control group). sEVs were isolated using size exclusion chromatography and characterised for size (Nanosight tracking analysis; NTA), tetrasapanin content (by Nanoview chips), microRNA content by RNA seq and proteomic analysis. Monocytes from healthy donors were isolated from buffy coats and differentiated into macrophages following established protocols. Macrophages were incubated with either CAD-sEVs or non-CAD sEVs for 24h at 37oC. The cells were collected and processed for mRNA analyses (qRT-PCR) and flow cytometry. Human PF-cells were isolated and analysed to be compared with the in vitro setting. Further bioinformatics were employed to understand functional pathways and validated in PF from patients. Results Exposure to CAD-sEVs induces a proinflammatory profile of human macrophages. CAD-sEVs treated macrophages showed a CD36+low, CD206+low CD40+high profile. While non-CAD-sEVs did not statistically differ from PBS nor untouched groups, CAD-sEVs increased the mRNA level of IL1a, IL1b, TNFa and decreased MRC1. Proteomics revealed that PF-sEVs from CAD patients carried higher amounts of pro-inflammatory molecules (ICAM-1 and IL18) compared to NonCAD control. Bioinformatics analysis showed that 861 miRNAs were decreased in the PF-sEVs from CAD patients compared to non-CAD. miRNA targets prediction and pathway analyses reported that clusters of deregulated miRNAs could regulate CD36 and SRB1 which were shown to be decreased in CAD-sEVs treated macrophages. Human PF-cells revealed a reduced expression of CD36 on PF-macrophages. Conclusions We demonstrate, for the first time, that sEVs isolated from the PF of CAD patients induce a proinflammatory profile of human macrophages and that target crucial lipid metabolism pathways. These clinically relevant results could drive to decipher improved therapeutics able modulate the epicardial/myocardial immune response in CAD patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Fundation

Coronary Bypass Surgery in Patients with Previous Pneumonectomy

Introduction: Severe pulmonary dysfunction is a commonly occurring postoperative complication following cardiac surgery. Resection of a lung causes major anatomical and physiological changes. Shift of the mediastinum and reduction in respiratory function following pneumonectomy makes cardiac surgery challenging not only for the surgeon but also for the anaesthetist. The reported experience is sparse for patients with prior pneumonectomy who are undergoing surgery for ischemic or valvular heart disease.&#x0D; We report a case of cardiac surgery following pneumonectomy to highlight certain important features that we think are important while managing these patients.&#x0D; Case Presentation: The patient was a 56-year male who had undergone extra-pericardial pneumonectomy 30 years earlier for tuberculosis of the left lung. Echocardiography showed a left ventricular function of 50%. His coronary angiogram revealed severe triple vessle disease. Preoperative spirometry showed FVC 1.94 L (52% of predicted), FEV1 1.3 L (48% of predicted), FEV1/FVC ratio 70%. The pre-operative workup of this patient included computerised tomography of the chest to assess distortion of intra-thoracic anatomy. In an attempt to improve the pulmonary function this patient was admitted 10 days prior to surgery for intensive chest physiotherapy and incentive spirometry. He underwent coronary artery bypass grafting (CABG) using cardiopulmonary bypass and antegrade cold blood cardioplegia. Internal thoracic artery was used to graft left anterior descending artery (LAD), saphenous vein (SVG) was used to graft posterolateral branch of the right coronary artery, first diagonal and frist obtuse marginal arteries. Access to arteries in the circumflex region was difficult due to shift of heart to the left side. The patient was weaned from the ventilator 14 hours after and CPAP helmet was immediately applied for a period of 48 hours continuosly. After on it was applied at intervals for 5 days. The subsequent recovery was slow but progressive and the patient was discharged on the 11th postoperative day in good conditions.&#x0D; Conclusion: We conclude that with attention to the specific features of the preoperative, intraoperative, and postoperative management, open heart procedures can be performed successfully on patients after pneumonectomy.

Ticagrelor versus aspirin 2 years after coronary bypass: Observational analysis from the TARGET trial

Compared to conventional aspirin therapy, ticagrelor did not improve vein graft patency 1 year after coronary bypass surgery (CABG) in the ticagrelor antiplatelet therapy to reduce graft events and thrombosis (TARGET) trial. However, it is unknown whether ticagrelor may impact graft patency long-term following surgery. In the TARGET multicenter trial, 250 CABG patients were randomized to aspirin 81 mg or ticagrelor 90 mg twice daily. In this observational analysis,2 years after surgery, vein graft occlusion and clinical events were compared among subjects who agreed to a second year of double-blind study drug administration (N = 156). Two-year graft assessment was performed for 142 patients (80 aspirin patients, 62 ticagrelor patients, 425 total grafts), with an overall 2-year graft occlusion rate of 10.6%. Vein graft occlusion at 2 years, the primary outcome of this study, did not significantly differ between the two groups (15.7% vs. 13.2%, aspirin vs. ticagrelor, p = .71). The incidence of vein grafts with any disease (stenosis or occlusion) did not significantly differ between the groups (19.4% vs. 19.8%, aspirin vs. ticagrelor, p = 1.00), and the number of patients with vein graft disease did not significantly differ between the groups (30.0% vs. 29.0%, aspirin vs. ticagrelor, p = 1.00). Vein grafts developing new disease did not significantly differ between the two groups (1.5% vs. 3.8%, aspirin vs. ticagrelor, p = .41). Freedom from major adverse cardiovascular events at 2 years was similar between the groups (p = .75). Compared to conventional aspirin therapy, ticagrelor did not significantly reduce vein graft disease 2 years after CABG.

Human pericardial fluid exosomes regulate macrophage immunophenotype: new prospective for cardiovascular myocardium-epicardium crosstalk in coronary artery disease

Abstract Background The incidence and severity of ischemic heart disease (IHD) is exacerbated by coronary artery disease (CAD). Monocytes and macrophages are central to atherosclerosis. Endogenous small extracellular vesicles (sEVs) can shuttle microRNAs and other molecular cargos from cell to cell, mediating expressional and functional response in the recipient cells. Recent evidence supports a role for sEVs in modulating macrophage phenotype. The pericardial fluid (PF) is in direct contact with the epicardium and contain sEVs of myocardial origin (C. Beltrami et.al 2017). We recently showed that human PF-sEVs are capable to modulate cardiovascular cells via microRNA shuttling (C.Beltrami et.al. 2017). Moreover, epicardial cells reportedly cross-talk with the myocardium to regulate immune response to IHD (V.Ramjee et.al 2017). Purpose This study sought to investigate whether PF-sEVs regulate macrophages, contributing to a specific immunophenotypes in CAD patients. Methods PF was collected from either CAD patients undergoing coronary bypass surgery (CABG) or non-atherosclerotic patients operated for mitral valve repair (non-CAD control group). sEVs were isolated using size exclusion chromatography and characterised for size (Nanosight tracking analysis; NTA) and microRNA content (Exiqon miR-array). Monocytes from healthy donors were isolated from buffy coats and differentiated into macrophages following established protocols. Macrophages were incubated with either CAD-sEVs or non-CAD sEVs for 24h at 37oC. PBS and sEV-free serum were used as negative controls and LPS as a proinflammatory control. The cells were collected and processed for mRNA analyses (qRT-PCR) and Flow cytometry (FACS). Results Twenty-four-hour exposure to CAD-sEVs induces a proinflammatory profile of human macrophages. While non-CAD-sEVs did not statistically differ from PBS nor Exo-free groups, CAD-sEVs increased the mRNA level of IL1a, NOS3, TNFa, CCL2 and IL6 (comparison to both non-CAD and negative controls). These data were not associated with changes in apoptosis. Bioinformatics analysis showed that 11 miRNAs where consistently increased, and 67 miRNAs decreased in the PF-sEVs from all CAD patients compared to non-CAD. miRNA targets prediction and pathway analyses (R-Project) revealed that the deregulated miRNAs could regulate macrophage motility and cytokine signalling. Conclusions We demonstrate, for the first time, that sEVs isolated from the PF of CAD patients induce a proinflammatory profile of human macrophages. These clinically relevant results could drive to decipher improved therapeutics able to modulate the epicardial/myocardial immune response in CAD patients. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Biritish Heart Fundation grant to Prof. Costanza Emanueli

Six Minute Walking Test As Predictor For Mortality and Rehospitalization Within 3 Months In Post Coronary Bypass Surgery Patients

AbstractBackground: Patients underwent Coronary Artery Bypass Surgery are at risk of developing post-operative complications that affect length of stay, re-hospitalization and increase in mortality rate. Impaired functional capacity is associated with poor outcomes in patients after CABG. The Six Minute Walk Test (6MWT) is generally used to evaluate functional capacity before cardiac rehabilitation and to prescribe the intensity of exercise training. The six minute walk test (6MWT) is a simple test and has been used in heart failure patients to assess exercise tolerance, the effects of therapy and prognosis. This study is to investigate the relationship between the distance of 6MWTwith re- hospitalization and mortality rate in post coronary artery bypass surgery patients.Method: This is a retrospective cohort study conducted at Cardiac Centre of Adam Malik Hospital. Subjects of the study consists of 104 patients underwent coronary bypass surgery between January 2019 until February 2020. 6MWT is performed before the patient discharge. Rates of re-hospitalisation and mortality were observed during 3 months of follow-up. The distance walk during 6MWT was compare to rate of rehospitalization and cardiac mortality. Result: Total of 104 patients (91 males, mean age 57,4±5,7 years). Six patients died (5,8%) of cardiovascular cause and 18 (17,3%) were rehospitalized. Significant relationship was found between the distance of 6MWT and incidence of mortality and re-hospitalization (p &lt;0.001). Patients with 6MWT &lt;250 meters had a higher risk of re-hospital compared to those with 6MWT &gt;250 meters with RR 16.74 (95% CI: 2.53-110.78) and p = 0.008. Conclusion: The six minute walk test (6MWT) is a predictor of re-hospitalization in patients post CABG. Patients who walked in shorter distance group &lt;250 meters would increase risk of re-hospitalization rate 16.74 greater than patients with distances &gt;250 meters. Keywords: 6MWT; CABG; rehospitalization; mortality

Levosimendán preoperatorio en cirugía coronaria con disfunción ventricular severa: ¿tiene sentido?

Introduction and objectivesNumerous studies have demonstrated the benefit of levosimendan in patients with chronic and acute heart failure. However, when it comes to its preoperatory use in coronary by-pass surgery in patients with severe ventricular dysfunction, there are some contradictory results. The objective of this study is assessing preconditioning efficiency with levosimendan in surgical myocardial revascularization in patients with severe ventricular dysfunction. MethodsWe design a propensity score-matched cohort study. The study included patients with a LVEF less or equal to 35% who underwent isolated coronary artery by-pass grafting or associated to ischemic/functional mitral surgery from January 2009 to October 2019. They were split into two cohorts whether they received levosimendan preoperatively (Levo) or not (NoLevo); after matching there were 64 patients per cohort. Outcome variables were postoperative morbi-mortality, readmission and follow-up mortality. Statistical analysis: categorical data were compared with a Chi-square or Fisher exact test, and quantitative data with a t-Student or W-Wilcoxon tests. RR/HR were estimated for assessing the association between preoperative use of levosimendan and outcomes. ResultsPreoperative levosimendan use did not decreased in-hospital mortality (RR = 0,86, p = 0.770), and neither do hospital stay, nor postoperative complications. Event-free survival was similar between cohorts in terms of cardiological readmissions, all-cause and cardiological follow-up mortality. ConclusionsOur results do not support the widespread use of levosimendan previously to myocardial revascularization surgery in patients with severe ventricular dysfunction.

Atrial Fibrillation After Coronary Artery Bypass Surgery: Risk Factors, Prevention and Treatment

This review focuses on the issue of atrial fibrillation (AF) following coronary bypass surgery in patients with ischemic heart disease. Risk factors of this complication are discussed in detail. The authors addressed the effect of diabetes mellitus on development of postoperative AF. Data on current methods for prevention and treatment of AF are provided.

Investigation of the Effect of Preoperative Hypoalbuminemia, Blood Urea Nitrogen and Creatinine Levels on Postoperative Atrial Fibrillation on Off-Pump Coronary Bypass Surgery Patients.

Postoperative atrial fibrillation (PoAF) is one of the most common complications to occur after open heart surgery. It has been shown that hypoalbuminemia accompanies some cardiovascular disorders. The present study evaluates the effects of pre-procedural albumin, blood urea nitrogen (BUN), and creatinine levels on PoAF. The data of 81 patients who underwent off-pump coronary artery bypass graft (CABG) surgery was evaluated. Patients who developed atrial fibrillation (AF) in the first 48 hours post surgery constituted the PoAF (+) group, while those without AF constituted the PoAF (-) group. The pre-procedural hematological parameters of patients in both groups were included in the analysis. The PoAF (+) group was comprised of 57 patients (70.3%) with a mean age of 65.5 ± 9.8 years, while the PoAF (-) group was comprised of 24 patients (29.7%) with a mean age of 60.6 ± 9.6 years. A comparison of the demographic characteristics of the two groups showed that age (P = .036), frequency of renal failure (P = .007), and frequency of DM (P = .001) were higher in the PoAF (+) group. An examination of the laboratory data revealed a negative correlation between Hct (P = .001) and albumin (P = .000) levels and presence of PoAF. Also, the MPV (P = .02), BUN (P = .007), and Cr (P = .043) values were higher in the PoAF (+) group. The present study, whose focus was on the effects of albumin levels on the occurrence of PoAF, found that low levels of pre-procedural albumin, as one of the major proteins in the blood, is a risk factor for the development of PoAF.

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

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

Renal function and coronary bypass surgery in patients with ischemic heart failure

ObjectiveChronic kidney disease is a known risk factor in cardiovascular disease, but its influence on treatment effect of bypass surgery remains unclear. We assessed the influence of chronic kidney disease on 10-year mortality and cardiovascular outcomes in patients with ischemic heart failure treated with medical therapy (medical treatment) with or without coronary artery bypass grafting. MethodsWe calculated the baseline estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula, chronic kidney disease stages 1-5) from 1209 patients randomized to medical treatment or coronary artery bypass grafting in the Surgical Treatment for IsChemic Heart failure trial and assessed its effect on outcome. ResultsIn the overall Surgical Treatment for IsChemic Heart failure cohort, patients with chronic kidney disease stages 3 to 5 were older than those with stages 1 and 2 (66-71 years vs 54-59 years) and had more comorbidities. Multivariable modeling revealed an inverse association between estimated glomerular filtration rate and risk of death, cardiovascular death, or cardiovascular rehospitalization (all P < .001, but not for stroke, P = .697). Baseline characteristics of the 2 treatment arms were equal for each chronic kidney disease stage. There were significant improvements in death or cardiovascular rehospitalization with coronary artery bypass grafting (stage 1: hazard ratio, 0.71; confidence interval, 0.53-0.96, P = .02; stage 2: hazard ratio, 0.71; confidence interval, 0.59-0.84, P < .0001; stage 3: hazard ratio, 0.76; confidence interval, 0.53-0.96, P = .03). These data were inconclusive in stages 4 and 5 for insufficient patient numbers (N = 28). There was no significant interaction of estimated glomerular filtration rate with the treatment effect of coronary artery bypass grafting (P = .25 for death and P = .54 for death or cardiovascular rehospitalization). ConclusionsChronic kidney disease is an independent risk factor for mortality in patients with ischemic heart failure with or without coronary artery bypass grafting. However, mild to moderate chronic kidney disease does not appear to influence long-term treatment effects of coronary artery bypass grafting.

2225“New-onset atrial fibrillation efter cardiac surgery is associated with increased long-term morbidity and mortality”: a population-based study from the SWEDEHEART-registry

Abstract Background New-onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, but the prognostic implications are not settled. In contrast to previous reports, a recent Danish study in coronary bypass surgery (CABG) patients (Butt et al. JAMA Cardiol 2018) did not show any increased risk for thromboembolic complications in POAF patients. Purpose To compare long-term outcome in patients with vs. without POAF after CABG. Methods All CABG patients in Sweden 2005–2015 (n=38040) were included in a retrospective population-based cohort study. Data from the SWEDEHEART registry, the National Patient Registry and the National Population Registry were merged. POAF was defined as any new-onset atrial fibrillation (AF) episode up to the 30thpostoperative day. Inverse Probability Treatment Weighting (IPTW) adjusted Cox regression models were used to compare outcome variables after the first 30 postoperative days until the end of follow-up (median 5 years, range 0–10). The models were adjusted for age, gender, CHA2DS2-VASc score, co-morbidity, and medications. Results The mean age of the entire cohort was 68 years, 79% were men and 90% had a CHA2DS2-VASc score ≥2. The incidence of POAF was 28.5% (10845/38040). During follow-up POAF, patients had a significantly higher adjusted risk for all-cause mortality [Hazard Ratio (HR) 1.16 (95% CI 1.09–1.24)], ischemic stroke [HR 1.19 (1.09–1.30)], transient ischemic attack [HR 1.17 (1.03–1.33)], pulmonary embolism [HR 1.24 (1.01–1.54)], myocardial infarction [HR 1.14 (1.04–1.25)], heart failure hospitalizations [HR.1.46 (1.35–1.59)] and recurrent AF [HR 4.33 (4.09–4.65)]. Conclusions POAF was in this comparatively large study associated with increased risk for mortality and morbidity during long-term follow-up after CABG and is hence not a trivial complication.