Heart Coronary Artery Bypass Grafting Research Articles

Comments on 'Comparison between off-pump versus on-pump beating heart CABG'.

On-pump beating heart coronary artery bypass grafting helps the surgeon in his learning curve period on off-pump heart surgery, however, it increases the risk of incomplete revascularization. Off-pump with cannulas in readiness is an alternative option.

Comparison between off-pump versus on-pump beating heart coronary artery bypass grafting.

Although coronary artery bypass grafting (CABG) is performed via three different techniques, conventional, on-pump beating heart CABG (ONBHCAB), or off-pump CABG (OPCAB), data is limited to compare ONBHCAB versus OPCAB. We retrospectively investigated postoperative cardiac biomarkers, creatine kinase-MB (CK-MB) and Troponin I (cTnI), early and late outcomes in 806 patients undergoing isolated ONBHCAB or OPCAB between February 2008 and September 2022. To eliminate the bias between different groups, propensity score matching was conducted to validate the findings. After matching, the number of each study group totaled 270 patients. In both complete and matched cohorts, early outcomes, including morbidities and mortalities, were similar. However, cTnI and CK-MB levels were significantly higher after ONBHCAB than after OPCAB with the median peak cTnI of 9.85 ng/mL versus 4.60 ng/mL and the median peak CK-MB of 48.45 ng/mL versus 17.10 ng/mL in the matched cohort, which were quite low below the threshold for values defining perioperative myocardial infarction. At follow-up of 73 ± 45 months, the overall actuarial survival rates were similar between the ONBHCAB and OPCAB patients (86 % versus 87 % at 5 years and 64 % versus 68 % at 10 years, respectively, in the matched cohort). ONBHCAB may be a comparable alternative to OPCAB with similar early and late outcomes, despite higher elevation of postoperative cardiac biomarkers. ONBHCAB provides more efficient hemodynamic support, providing a better surgical visual field, than OPCAB while reducing the risk of incomplete revascularization.

Patient-Reported Postoperative Neuropsychological Deterioration After Heart Valve Replacement and Coronary Artery Bypass Grafting

BackgroundPostoperative cognitive decline (POCD) after cardiosurgical interventions are well described through objective psychometric tests. However, a patient’s subjective perception is essential to clinical assessment and quality of life. This study systematically evaluated patient-reported POCD between subjects undergoing coronary artery bypass grafting and heart valve replacement. MethodsThis study was a multicentre, prospective questionnaire survey conducted at the cardiac surgery departments at the Kerckhoff Clinic in Bad Nauheim and the University Hospital in Giessen, Germany. We included patients undergoing elective coronary artery bypass grafting (CABG), aortic valve replacement (AVR), mitral valve replacement or reconstruction (MVR), and combined surgery (CABG + valve replacement [VR]) with extracorporeal circulation. The Hospital Anxiety and Depression Scale, the Cognitive Failures Questionnaire (CFQ) for Self-assessment (CFQ-S), and the external assessment (CFQ-foreign [F]) were completed preoperatively, as well as at 3 and 12 months postoperatively. ResultsA total of 491 patients were available for analyses (CABG = 182, AVR = 134, MVR = 93, CABG + VR = 82). POCD and postoperative depression increase (PODI) were observed for each surgical procedure. (At the 3-month follow-up: CFQ-S [CABG = 7.1%, AVR = 3.7%, MVR = 9.7%, CABG + VR = 9.8%]; CFQ-F [CABG = 9.9%, AVR = 9.7%, MVR = 9.7%, CABG + VR = 15.9%]; PODI [CABG = 7.7%, AVR = 9.7%, MVR = 6.5%, CABG + VR = 8.5%]. At the 12-month follow-up: CFQ-S [CABG = 6.6%, AVR = 7.5%, MVR = 15.1%, CABG + VR = 7.3%]; CFQ-F [CABG = 7.1%, AVR = 14.9%, MVR = 10.8%, CABG + VR = 9.8%]; PODI [CABG = 10.4%, AVR = 11.2%, MVR = 6.5%, CABG + VR = 4.9%]). No significant between-group effects were observed for the CFQ-S, CFQ-F, or the Hospital Anxiety and Depression Scale. ConclusionsFor clinicians, paying attention to patients' self-reported experiences of reduced cognitive function and symptoms of depression following cardiac surgery is important. Such reporting is an indication that interventions such as cognitive training or psychotherapy should be considered.

A Case Report on Combination Formulation Glimepiride and Metformin Induced Hypoglycemia

The medications glimepiride and metformin are used to treat type 2 diabetes. The pancreatic cells that create insulin are stimulated by glimepiride, which aids in removing sugar from the circulation. Metformin slows down the creation of sugar by liver cells and delays the absorption of sugar from the intestines. A 56-year-old female patient was known case of Hypertension and IHD. She came to tertiary care hospital with complaint of sudden drowsiness and falling at home. Patient had a history of Ischemic Heart Disease (IHD) and Coronary Artery Bypass Graft Surgery (CABG) done before 2 weeks and newly detected Diabetes Mellitus (DM) for which she was prescribed with T. Glycomet GP (0.5/500) (1-0-1). To manage an Adverse Drug Reaction (ADR), the doctor prescribed the suspected drug on hold until the symptoms improved. Close monitoring during treatment course, creating awareness, recognition of the problem, and careful monitoring of all patients who receive this medication are required to prevent serious adverse drug reactions of this drug.

On‐pump beating‐heart coronary artery bypass grafting: Single Center Experience and Literature Review

Purpose: In this retrospective, observational, non-randomized study, we present the results of our department in on‐pump beating‐heart coronary artery bypass grafting and we review the relevant medical literature. Methods: All data related to patients who underwent on‐pump beating‐heart coronary artery bypass grafting at our center for three consecutive years were collected. These patients were classified into two groups: isolated bypass grafts or combined with aortic valve replacement. All data related to preoperative characteristics, procedural characteristics, and clinical outcomes are presented separately for the two groups. Results: During the study period, 175 patients underwent on‐pump beating‐heart bypass grafting alone and 32 combined with aortic valve replacement. Despite higher than average Euroscore in both groups, mortality, and morbidity were satisfactory while the rate of complete revascularization was higher than previously reported for classic off-pump surgery. Conclusion: On‐pump beating heart coronary artery bypass grafting offers an excellent alternative in the surgical treatment of coronary artery disease. Patient selection is very important, and in the hands of skilled surgeons, it may prevent intraoperative complications and offer the appropriate revascularization, especially for high-risk patients.

Pathophysiology and Management of Heart Failure in the Elderly.

The population of elderly adults is increasing globally. It has been projected that the population of adults aged 65 years will increase by approximately 80% by 2050 in the United States. Similarly, the elderly population is rising in other countries; a notable example being Japan where approximately 30% of the population are aged above 65 years. The pathophysiology and management of heart failure (HF) in this age group tend to have more intricacies than in younger age groups owing to the presence of multiple comorbidities. The normal aging biology includes progressive disruption at cellular and genetic levels and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities. Older adults with HF secondary to ischemic or valvular heart disease may benefit from surgical therapy, valve replacement or repair for valvular heart disease and coronary artery bypass grafting for coronary artery disease. While referring these patients for surgery, patient and family expectations and life expectations should be taken into account. In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity.

Reproducibility of Hospital Rankings Based on Centers for Medicare & Medicaid Services Hospital Compare Measures as a Function of Measure Reliability

Unreliable performance measures can mask poor-quality care and distort financial incentives in value-based purchasing. To examine the association between test-retest reliability and the reproducibility of hospital rankings. In a cross-sectional design, Centers for Medicare & Medicaid Services Hospital Compare data were analyzed for the 2017 (based on 2014-2017 data) and 2018 (based on 2015-2018 data) reporting periods. The study was conducted from December 13, 2020, to September 30, 2021. This analysis was based on 28 measures, including mortality (acute myocardial infarction, congestive heart failure, pneumonia, and coronary artery bypass grafting), readmissions (acute myocardial infarction, congestive heart failure, pneumonia, and coronary artery bypass grafting), and surgical complications (postoperative acute kidney failure, postoperative respiratory failure, postoperative sepsis, and failure to rescue). Measure reliability based on test-retest reliability testing. The reproducibility of hospital rankings was quantified by calculating the reclassification rate across the 2017 and 2018 reporting periods after categorizing the hospitals into terciles, quartiles, deciles, and statistical outliers. Linear regression analysis was used to examine the association between the reclassification rate and the intraclass correlation coefficient for each of the classification systems. The analytic cohort consisted of 28 measures from 4452 hospitals with a median of 2927 (IQR, 2378-3160) hospitals contributing data for each measure. The hospitals participating in the Inpatient Prospective Payment System (n = 3195) had a median bed size of 141 (IQR, 69-261), average daily census of 70 (IQR, 24-155) patients, and a median disproportionate share hospital percentage of 38.2% (IQR, 18.7%-36.6%). The median intraclass correlation coefficient was 0.78 (IQR, 0.72-0.81), ranging between 0.50 and 0.85. The median reclassification rate was 70% (IQR, 62%-71%) when hospitals were ranked by deciles, 43% (IQR, 39%-45%) when ranked by quartiles, 34% (IQR, 31%-36%) when ranked by terciles, and 3.8% (IQR, 2.0%-6.2%) when ranked by outlier status. Increases in measure reliability were not associated with decreases in the reclassification rate. Each 0.1-point increase in the intraclass correlation coefficient was associated with a 6.80 (95% CI, 2.28-11.30; P = .005) percentage-point increase in the reclassification rate when hospitals were ranked into performance deciles, 4.15 (95% CI, 1.16-7.14; P = .008) when ranked into performance quartiles, 1.47 (95% CI, 1.84, 4.77; P = .37) when ranked into performance terciles, and 3.70 (95% CI, 1.30-6.09; P = .004) when ranked by outlier status. In this study, more reliable measures were not associated with lower rates of reclassifying hospitals using test-retest reliability testing. These findings suggest that measure reliability should not be assessed with test-retest reliability testing.

Withdrawal: Characteristics of early pleural effusions after orthotopic heart transplantation: comparison with coronary artery bypass graft surgery.

Anant Jain (2021) Characteristics of early pleural effusions after orthotopic heart transplantation: comparison with coronary artery bypass graft surgery, (https://doi.org/10.4081/monaldi.2021.1740). The above article from the Monaldi Archives for Chest Disease published online on 24 November 2021, has been withdrawn by agreement between the journal's Editors-in-Chief, the Authors and PAGEPress Scientific Publications. This action has been agreed upon due to an administrative error by the publisher which caused the article to be published as an Accepted Article. The author is not responsible for this error. The publisher regrets any confusion this error may have caused.

Humanoids for teaching and training coronary artery bypass surgery to the next generation of cardiac surgeons.

OBJECTIVESTechnical skills are an essential component of cardiac surgery, and the operating room is becoming an even more challenging environment for trainees who want to acquire such skills. Simulation, which partially overcomes this limitation, represents a valid adjunct to surgical education. We describe an original simulator and provide results in terms of trainees’ evaluations and ratings.METHODSWe used a humanoid that is a silicone replica of the chest of an adult human that provides a complete anatomical platform for hands-on skin-to-skin practice of surgical techniques in arrested heart coronary artery bypass graft (CABG) surgery cases. Learners were residents in cardiac surgery. The teaching sessions included 2 full three-vessel CABG procedures using both mammary arteries and a hydrogel vein. Five board-certified cardiovascular surgeons scored the surgical activity of all trainees. The trainees were asked to complete an exit questionnaire to evaluate their course.RESULTSOverall, 16 residents participated in the simulation, including 5 women and 11 men, with a mean age of 30 ± 4 years, all of whom had at least 2 years of cardiac surgery training. All participants completed the 2 CABG operations. Three mammary arteries (4.6%) were seriously damaged during harvesting. In 1 case (3.1%), an aortic tear occurred during aortic cannulation. Each trainee performed overall 6 distal and 2 proximal coronary anastomoses. All participants agreed that the ‘humanoid reproduces real-life situations, the feeling is realistic, and they are now more confident in performing coronary anastomosis’.CONCLUSIONSTrainees involved in this simulation curriculum acquired and refined technical skills that could be applied directly to human patients. In addition, we were able to foster a higher level of teamwork within the operating room team.

Comparison of risk factors for coronary event in people with unattributed and non-coronary chest pain: an electronic health record cohort study

Abstract Background Patients presenting to primary care with chest pain are often not given a cause. Patients with such unattributed chest pain have an increased risk of future cardiovascular disease (CVD) compared to patients with diagnosed non-coronary chest pain. It is unknown whether risk factors for CVD determined in the general population are the same for the population with unattributed or non-coronary chest pain. Purpose To determine if key risk factors for a coronary event in patients with unattributed chest pain are similar to those for patients with non-coronary chest pain and previously identified in the general population. Methods The study used primary care information from the Clinical Practice Research Datalink Aurum linked to hospital inpatient and mortality data. Patients aged ≥18 years with an incident record of unattributed or non-coronary chest pain in 2002–2018 and no diagnosis of CVD were included. We included as potential risk factors those established for CVD in the general population and non-coronary explanations for chest pain. Flexible parametric models estimated hazard ratios (95% confidence intervals (CI)) between factors and incident coronary event (defined as myocardial infarction, angina, coronary heart disease, percutaneous intervention, and coronary artery bypass graft surgery). Results There were 375,240 patients with unattributed chest pain (53% female: mean age 49; 47% male: mean age 47) and 245,329 patients with non-coronary chest pain (58% female: mean age 47; 42% male: mean age 44). Median duration of follow-up was 5 years. In the unattributed chest pain group, there were 111 (95% CI: 109, 112) and 140 (138, 142) coronary events per 10,000 person-years in females and males, respectively. Lower rates of coronary event were observed in the non-coronary chest pain group (females: 73 (72, 75); males: 96 (94, 98)). Within females (Figure), in both chest pain groups the strongest risk factors were type I and type II diabetes, atrial fibrillation, and hypertension whereas no associations were observed for migraine and chronic kidney disease. Whilst alternative explanations for non-coronary chest pain also increased the risk of coronary events, associations were less strong than for established general population risk factors. Similar findings were found in males although family history of coronary event was a stronger risk factor in the non-coronary chest pain group compared to the unattributed chest pain group. Conclusions The pool of factors found to increase the risk of coronary events in patients presenting with recorded unattributed or non-coronary chest pain are similar but not identical to those identified for the general population. Further research is needed to develop prognostic models to identify patients at the most risk of a coronary event as models developed in the general population are unlikely to be applicable given the increased underlying risk of coronary events in these populations. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Study funded by the British Heart Foundation, reference PG/19/46/34307. KJ also supported by matched funding awarded to the NIHR Applied Research Collaboration (West Midlands). Risk factors for coronary event

On-pump beating heart versus off-pump myocardial revascularization-a propensity-matched comparison.

On-pump beating heart (OP-BH) coronary artery bypass grafting (CABG) is often undertaken as an alternative between off-pump coronary artery bypass (OPCAB) and conventional on-pump coronary artery bypass grafting (On-pump CABG), especially in India. However, outcome data following OP-BH surgery is sparse. The aim of this study was to compare the outcomes of OP-BH CABG with OPCAB. From our institutional database, all patients undergoing OP-BH CABG (n = 531) were identified. A propensity-matched cohort undergoing OPCAB (n = 531) was identified from the database. Nearest neighbor matching technique was used and the groups were matched for variables including age, gender, body mass index, EuroSCORE, history of recent myocardial infarction or unstable angina, hypertension, peripheral vascular disease, chronic obstructive airway disease, diabetes, pre-op renal impairment, pre-op neurological events, and left ventricular function. The propensity-matched groups were well matched in terms of baseline characteristics. The mean EuroSCORE was 3.17 and 3.20 in the OP-BH and the OPCAB groups. The unadjusted 30-day mortality in the propensity-matched OPCAB group was 2.07% (11/531) while mortality in the on-pump beating heart group was significantly higher at 6.9% (37/531). Multivariate analysis showed that OP-BH CABG was an independent risk factor for 30-day mortality as well as major adverse post-operative outcomes including renal, neurological, and respiratory outcomes and post-operative atrial fibrillation. OP-BH CABG is associated with worse clinical outcomes compared to patients undergoing OPCAB.

Clinical Significance and Prognostic Factors of Simultaneous Heart Valve Surgery and Coronary Artery Bypass Grafting in Treating Patients with Valvular Heart Disease Complicated by Coronary Heart Disease

This study was designed to evaluate the clinical significance of simultaneous heart valve surgery and coronary artery bypass grafting for patients with valvular heart disease complicated by coronary heart disease and its influence on their prognosis. A total of 121 patients with valvular heart disease complicated by coronary heart disease who were surgically treated in our hospital from January 2013 to March 2017 were selected. The observation group (OG) (64 patients) underwent simultaneous valvular heart surgery and coronary artery bypass grafting. The control group (CG) (57 patients) underwent non-synchronous heart valve surgery and coronary artery bypass grafting. The operation, hospitalization, occurrence of adverse events and changes of cardiac function indexes of patients from the two groups were compared, and the factors affecting their prognosis were confirmed in multivariate analysis. The ventilator application time, postoperative ICU monitoring time, postoperative general ward time and total incidence of adverse events in the OG were lower than those in the CG (P<0.05). After treatment, the cardiothoracic ratio, left ventricular end-diastolic volume and BNP content in the two groups were markedly higher than before treatment, and the increase in the OG was more obvious (P<0.05); the left ventricular ejection fraction in both groups was markedly lower than that before treatment (P<0.05), and the decrease in the OG was more obvious (P<0.05). Multivariate analysis showed that hypertension, treatment methods, course of disease and age were independent risk factors affecting the prognosis of patients with valvular heart disease complicated by coronary heart disease. Simultaneous heart valve surgery and coronary artery bypass grafting can reduce the occurrence of adverse events and improve cardiac function indexes, which is worthy of clinical application. Hypertension, treatment methods, course of disease and age are independent risk factors affecting the prognosis of those patients.

On-pump beating heart versus conventional on-pump coronary artery bypass grafting on clinical outcomes: a meta-analysis.

BackgroundA hybrid surgery method, on-pump beating heart coronary artery bypass graft (ON-BH CABG), is supposed to be a promising technology for coronary artery revascularization. Here, we conducted a comprehensive meta-analysis of the data derived from published studies on ON-BH CABG and conventional on-pump coronary artery bypass graft (C-CABG) to compare their short-term and long-term clinical outcomes.MethodsWe searched major electronic databases and 24 studies incorporating 6,862 patients (1,847 ON-BH CABG and 5,015 C-CABG) were included eventually, and 9 studies of them were focusing on high-risk patients.ResultsCompared with ON-BH CABG, C-CABG was associated with a higher risk in early mortality [odds ratio (OR), 1.45; 95% confidence interval (CI), 1.09 to 1.93; P=0.01], myocardial infarction (MI) (OR, 2.60; 95% CI, 1.41 to 4.78; P<0.01), low output syndrome (LOS) (OR, 2.56; 95% CI, 1.55 to 4.23; P<0.01), renal failure (OR, 1.84; 95% CI, 1.38 to 2.44; P<0.01). In contrast, there was no significant difference in long-term survival [hazard ratio (HR), 1.08; 95% CI, 0.81 to 1.43; P=0.60]. In systematic analysis of the studies in high-risk patients, ON-BH CABG showed a lower risk in terms of early mortality, intra-aortic balloon pump (IABP) usage, renal failure, hemodialysis, MI and pulmonary complication. No significant difference was observed in the long-term survival between ON-BH CABG and C-CABG.ConclusionsWith experienced and adept surgical team and mature ON-BH technology, ON-BH CABG may reduce the risk of postoperative death and complications in some patients. It might be an attractive alternative for high-risk patient populations.

Systematic Review and Pooled Meta-analysis of the Current Status of Coronary Revascularization Surgery in Bangladesh

Background: There is no consensus on the role of beating heart coronary artery bypass graft surgery (BECAB) in adult Bangladeshi patients requiring coronary revascularization surgery. We aimed to conduct a systematic review on all literature related to BECAB and/or conventional (CCAB) to determine the comparability of the patient outcomes of BECAB with that of a controlled cohort.&#x0D; Method: We carried out a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A meta-analysis was conducted to compare clinical outcomes between the BECAB and CCAB cohorts. Pooled analyses were also performed to determine the incidence rates of any adverse outcomes related to CABG.&#x0D; Results: We observed significantly lower rates of operation time (MD: -52.30, CI: -67.73 to -36.86, p&lt;0.0001), ventilation time (MD: -8.64, CI: -9.47 to -7.82, p&lt;0.0001) and ICU stay (MD: -17.47, CI: -33.57 to -1.38, p=0.03) associated with BECAB. From our pooled analyses of the BECAB cohort, we observed that the average blood loss was 500.303 [352.099, 648.507], while the average rates of perioperative MI (0.020 [0.002, 0.049]), stroke/TIA (0.015 [0.000, 0.042]), AKI (0.006 [0.002, 0.012]), respiratory complications (0.020 [0.000, 0.058]) and low output syndrome (0.123 [0.106, 0.141]) were all lower than the averages observed in the CCAB cohort.&#x0D; Conclusion: In an adult Bangladeshi CABG population, the clinical outcomes of patients that underwent BECAB were non-inferior to, if not better than, patients who underwent CCAB.&#x0D; Bangladesh Heart Journal 2020; 35(2) : 87-99

On-Pump Beating Heart versus Off-Pump Coronary Artery Bypass Graft Surgery: Short-Term Follow-up Outcomes of a Single Center

Abstract Background and Aim: Novel surgical approaches are gaining attention in an attempt to overcome possible adverse events following coronary artery bypass graft (CABG) surgery. This single-center study aimed to evaluate and compare the early postoperative outcomes of on-pump beating-heart (OPBH-CABG) versus off-pump CABG surgery in similar risk groups with a total number of 1–2 grafts. Methods: The records of a total of 229 patients who underwent non-emergency, primary, isolated, either OPBH-CABG (n = 32) or off-pump CABG (n = 197) surgery were retrospectively evaluated. Reported outcome measures included baseline data, the number of coronary artery grafts, prophylactic intra-aortic balloon pump, time of extubation from mechanical ventilation, duration of stay in the coronary ICU and hospital, as well as early postoperative complications, in-hospital and early postoperative mortality. Results: The groups were identical with regards to age and BMI. The patients in the off-pump group received a higher number of grafts (1.84 ± 0.36 vs. 1.18 ± 0.39, p &lt;0.0001). The OPBH-CABG group had a higher Euroscore II score (2.514 ± 1.68 vs. 1.706 ± 1.93, p = 0.021). The time to extubation after the surgery, postoperative length of ICU stay, and total length of hospital stay were similar between the groups (p = 0.2228; p = 0.098; p = 0.717, respectively). The incidence of arrythmia and atrial fibrillation was higher in the on-pump group (12.5% vs. 2.53%, p &lt;0.05). One patient in the on-pump, and four patients in the off-pump groups deceased due to postoperative complications. Conclusions: OPBH-CABG surgery is comparable to off-pump CABG in terms of early postoperative outcomes. In patients who underwent OPBH-CABG, the risk of arrythmia and atrial fibrillation should be of concern and solved with optimal strategies.

Comparative assessment of the frequency and risk factors of purulent-septic infections in adult patients after various types of open and closed heart surgery

BACKGROUND: The widespread increase in the number and types of cardiac surgery necessitate the study of frequency and risk factors of postoperative purulent-septic infections (PSIs).&#x0D; AIM: to provide a comparative assessment of the PSI frequency and risk factors in adult patients after various types of cardiac surgery.&#x0D; MATERIALS AND METHODS: Based on the cardiac surgery hospital materials, medical records of 4.815 patients over 18 years of age, who underwent open (n = 1.540) and closed (n = 3.275) heart surgeries within 1 year, were analyzed. The typical and prenosological forms of PSIs were taken into account in accordance with the epidemiological standard of case definition.&#x0D; RESULTS: The incidence rates for typical and prenosological PSI forms amounted to 39.6 and 72.7 per 1000 surgeries after open heart surgery, respectively, and 3.1 and 3.9 after minimally invasive endovascular surgical interventions, respectively. The main clinical forms of PSI after open and closed heart surgeries were surgical site infections, nosocomial pneumonia, urinary tract infection, and bloodstream infection. In an open heart surgery, the maximum incidence rates for typical and prenosological forms of PSIs were recorded after surgeries on the aorta and less often after heart valve replacement or coronary artery bypass grafting. The increased incidence rate after aortic surgery was mainly due to urinary tract infection and nosocomial pneumonia. In the case of closed heart surgery, no statistically significant differences were detected between the incidence rates of PSIs after coronary artery stenting, cardiac arrhythmia and carotid artery stenosis surgery, and other interventions. The duration of both the surgery itself and the subsequent patient stay in the intensive care unit was found to be important as risk factors for PSIs after cardiac surgery.&#x0D; CONCLUSION: The incidence rate of PSIs after open heart surgery is significantly higher than after closed heart surgery, which is mostly associated with the duration of surgical intervention and the subsequent patient stay in the intensive care unit.

Cirugía coronaria asistida con circulación extracorpórea sin pinzamiento aórtico en pacientes con disfunción ventricular severa: resultados a corto y medio plazo

Introduction and objectivesThe current study analyzed and compared early and midterm outcomes of on-pump beating heart versus conventional coronary artery bypass grafting technique that requires aortic cross-clamping among patients with low ejection fraction. MethodsFrom January 2012 to January 2019, a total of 64 patients with low ejection fraction (<30%) underwent isolated first-time elective coronary artery bypass surgery: 32 patients underwent myocardial revascularization using on-pump beating heart, while 32 patients had on-pump with cardioplegic arrest procedures. ResultsGroups were statistically similar with regard to baseline clinical characteristics. The predicted risk for surgery, according to EuroSCORE was slightly higher in the on-pump beating heart group without reaching statistical significance. No statistically significant differences were detected between the groups with respect to number of distal bypass, atrial fibrillation or cerebrovascular accidents. There was a significant reduction in intensive care unit stay (3.28±0.99 vs. 4.13±1.54, p=0.04) and lower length of hospital stay (7.25±1.22 vs. 8.84±3.53, p=0.042) in the on-pump beating heart group. The incidence of hospital and 5-year mortality was fewer in the on-pump beating heart, but the difference was not significant. ConclusionsOur study suggested that on-pump beating heart is associated with fewer intensive care unit and hospital stay and there was a trend towards less mortality at early and midterm follow. This technique may be an acceptable alternative in patients with severe ventricular dysfunction.

Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting.

Coronary artery bypass grafting may be associated with several cardiac complications, including ischemia, acute myocardial infarction, arrhythmias, or hemodynamic instability. Accumulating evidence suggests that well-developed coronary collateral circulation may protect against adverse effects, including myocardial ischemia. Assessment of myocardial microvascular perfusion is, therefore, of great clinical interest in beating heart surgery. In this paper, myocardial microvascular perfusion is continuously assessed on the beating heart using laser Doppler flowmetry in consecutive patients who underwent coronary artery bypass grafting procedures. No significant (p = 0.110) differences were found between the averaged perfusion signal (n = 42) at the baseline, during artery occlusion, or after reperfusion (732.4 ± 148.0 vs. 711.4 ± 144.1 vs. 737.0 ± 141.2, respectively). In contrast, significantly different (p < 0.001) mean perfusion signals (n = 12) were found (805.4 ± 200.1 vs. 577.2 ± 212.8 vs. 649.3 ± 220.8) in a subset of patients who presented with hemodynamic instability and myocardial ischemia. Additionally, a strong positive correlation between the plasma levels of high-sensitivity troponin I and perfusion decrease level after artery occlusion was found (r = 0.854, p < 0.001). This study argues that myocardial microvascular perfusion remains constant during coronary artery bypass grafting on the beating heart in advanced coronary artery disease. This phenomenon is most likely due to an extensive coronary collateral circulation.

Sandwich Technique to Manage Right Ventricular Perforation During Beating Heart Coronary Artery Bypass Grafting

Identification of an intramyocardial left anterior descending artery remains challenging and many techniques have been proposed for its identification. The exposure technique depends on the surgeon's familiarity and experience with it, and inadvertent right ventricular perforation during exposure on off-pump surgery results in bleeding, which requires urgent cardiopulmonary support and repair. Inadequate repair may result in continued bleeding, closure of the left anterior descending artery, and myocardial infarction. We describe a sandwich technique using the native left anterior descending artery and the bypass graft to repair right ventricular perforation, avoiding closure of this main artery and preserving graft patency.

Peculiarities of the cognitive functioning of patients with cardiovascular disease preparing for heart transplantation and coronary artery bypass grafting

«Вестник Санкт-Петербургского университета. Психология» — научно-теоретический рецензируемый журнал, публикующий оригинальные статьи по различным отраслям психологической науки и адресованный профессиональному психологическому сообществу, а также ученым, работающим в смежных областях.