Myocardial Revascularization Surgery Research Articles

Characteristics of Akinetic and Dyskinetic Left Ventricular Aneurysms in the Context of Echocardiographic Diagnosis and Treatment Selection.

Background and Objectives. Distinct pressure curve differences exist between akinetic (A-LVA) and dyskinetic (D-LVA) aneurysms. In D-LVA, left ventricular (LV) ejection pressure decreases relative to the aneurysm size, whereas A-LVA does not impact pressure curves, indicating that the decrease in stroke volume (SV) and cardiac output is proportional to the size of dyskinesia. This study aimed to assess the frequency of A-LVA and D-LVA, determine aneurysm size parameters (volume and surface area), and evaluate predictive parameters using echocardiography in A-LVA and D-LVA. Furthermore, it aimed to compare individual echocardiographic parameters, according to ejection fraction (EF) and SV, with hemodynamic events shown in experimental models of A-LVA and D-LVA and their significance in everyday clinical practice. Materials and Methods. This clinical study included patients with post-infarction left ventricular aneurysm (LVA) admitted to the cardiovascular institute ''Dedinje", Serbia. Echocardiographic volume and surface area of LV and LVA were determined (by the area-length method) along with EF (by Simpson's method). Results. A-LVA was present in 62.9% of patients, while D-LVA was present in 37.1%. Patients with D-LVA had significantly higher systolic aneurysm volume (LVAVs) (94.07 ± 74.66 vs. 51.54 ± 53.09, p = 0.009), systolic aneurysm surface area (LVAAs) (23.22 ± 11.73 vs. 16.41 ± 8.58, p = 0.018), and end-systolic left ventricular surface areas (LVESA) (50.79 ± 13.33 vs. 42.76 ± 14.11, p = 0.045) compared to patients with A-LVA. The ratio of LVA volume to LV volume was higher in the D-LVA in systole (LVAVs/LVESV). The end-diastolic volume of LV (LVEDV) and end-systolic volume of LV (LVESV) did not significantly differ between D-LVA and A-LVA. EF (21.25 ± 11.92 vs. 28.18 ± 11.91, p = 0.044) was significantly lower among patients with D-LVA. Conclusions. Differentiating between A-LVA and D-LVA using echocardiography is crucial since D-LVA causes greater hemodynamic disturbances in LV function, and thus surgical resection of the aneurysm or LV reconstruction must have a positive effect regardless of myocardial revascularization surgery.

Complete surgical myocardial revascularization in patients with declined renal functions: 12-month outcomes

IntroductionThis retrospective observational study aimed to evaluate the feasibility and effectiveness of complete revascularization coronary artery bypass grafting (CABG) in patients with multi-vessel disease (MVD)-CAD and declined renal functions, addressing the knowledge gap regarding optimal treatment strategies and outcomes in this specific patient population.MethodsBetween 2020 and 2022, a total of 58 patients underwent on-pump coronary artery bypass grafting surgery for complete myocardial revascularization in this study. To assess overall survival, Kaplan–Meier with the log-rank test was conducted for statistical analysis.ResultsThe mean age of cohort was 60.7. The findings showed a high prevalence of medical conditions such as hypertension (50.0%), diabetes (50.0%), and anaemia (41.4%) among the participants. Intraoperatively, low cardiac output syndrome was reported in 5.2% of cases, while perioperative outcomes indicated a need for transfusions in 53.5% of cases and an in-hospital mortality rate of 3.4%. At the 12-month follow-up, no redo revascularization or renal replacement therapy was required, but cardiac mortality was 5.2% and all-cause mortality was 6.9%.ConclusionsThe study concluded that complete revascularization is safe for these patients and highlights the potential benefits, emphasizing the need for further research in optimizing revascularization techniques for this population.

ANALYSIS OF APPROACHES AND RESULTS IN MYOCARDIAL REVASCULARIZATION SURGERY: AN INTEGRATIVE REVIEW

ANALYSIS OF APPROACHES AND RESULTS IN MYOCARDIAL REVASCULARIZATION SURGERY: AN INTEGRATIVE REVIEW

Effectiveness of Early Mobilization in Prevention and Rehabilitation of Functional Impairment After Myocardial Revascularization Surgery: A Systematic Review

Effectiveness of Early Mobilization in Prevention and Rehabilitation of Functional Impairment After Myocardial Revascularization Surgery: A Systematic Review

Analysis of cardiac surgeries and operative mortality at the National Cardiovascular Institute during 2022

To describe cardiac surgeries, their approaches, and determine operative mortality according to the type of surgery and the main complications recorded within 30 days postoperatively, performed at the National Cardiovascular Institute of Peru. A descriptive study was conducted on all patients over 18 years of age who underwent cardiovascular surgery at the National Cardiovascular Institute "Carlos Alberto Peschiera Carrillo". During the year 2022, a total of 503 cardiac surgeries were performed. Of the patients undergoing surgery, 63.6% (320) were males. Isolated valvular surgery, primarily aortic or mitral valve replacement, was the most frequent surgical procedure, with 136 surgeries (27.0%). This was followed by myocardial revascularization surgery with 110 procedures (21.9%). Throughout the year, there were 23 deaths, resulting in an overall mortality rate of 4.5%. The mortality rate for elective surgeries was 2.8%, while for emergency surgeries, it was 14.3%. The most common complication was paroxysmal atrial fibrillation (14.0%), followed by surgical site infection with 52 cases (10.3%). Valvular surgery, whether isolated or combined with other procedures, was the most frequently performed. The obtained mortality rate is considered acceptable for a reference center.

Analysis of the clinical and sociodemographic characteristics of patients undergoing Myocardial Revascularization Surgery

Introduction: The occurrence of cardiovascular diseases has been encouraging all over the world, and Myocardial Revascularization Surgery (CABG), when indicated, has been showing good results. Objective: To identify the clinical and sociodemographic characteristics of patients admitted to CABG. Methods: Cross-sectional, retrospective, descriptive and analytical study of the electronic medical records of a University Hospital. Results: The sample consisted of 57 patients, 77.2% male and 22.8% female, 50.9% were married, and 40.3% were overweight. The main comorbidities were cardiovascular (82.5%) and metabolic (77.2%). The mean length of stay on MV (Mechanical Ventilation) was 1.40 ± 3.87 days, length of stay in the Coronary Unit (CCU) 6.26 ± 4.07 days, and length of hospital stay of 26.88 days ± 24.48 days. Conclusion: Most patients who underwent CABG were men, married and overweight. The most prevalent comorbidities were cardiovascular and metabolic. As for the days on MV, men spent more days intubated than women, but the latter stayed longer in the CCU and hospitalized.

Coronary artery and congenital heart diseases in adult patients: a case series

Background: The relevance of coronary artery disease treatment in congenital heart disease is related to the increasing number of older patients with congenital conditions, predisposing factors and continuous silent ischemia.Objective: To analyze clinical data and results of surgery in patients with a combination of congenital heart disease and hemodynamically significant coronary artery lesions.Methods: 17 patients (7 women (41.2%), 10 men (58.8%)) were included in the study. All of them underwent myocardial revascularization and congenital heart disease corrective surgery from 2003 to 2020. The mean age at the time of surgery was 57.2 years. The congenital diagnosis was an atrial septal defect (14 patients), partial anomalous pulmonary vein connection (1 patient), recanalization of atrial septal defect (1 patient), recanalization of ventricular septal defect (1 patient). In 7 cases congenital and coronary pathology correction were performed percutaneously — coronary stenting as the first stage, defect closure at an interval of 4 to 10 days as the second. One patient underwent stenting 7 months prior to an open-heart surgery. In 9 cases one-staged open-heart surgery was performed simultaneously. Results: At the hospital 1 patient died after surgery due to multiple organ dysfunction syndrome. In all other cases there were no symptoms of ischemia on discharge, the patients were in NYHA class I–II (New York Heart Association).Conclusion: The tactics of coronary revascularization is determined by the necessity of percutaneous or open-heart intervention. Myocardial revascularization may be preferable as the first stage, or a one-stage correction may be performed and proved by good results. Received 14 October 2022. Revised 25 November 2022. Accepted 27 November 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsLiterature review: A.V. MinaevDrafting the article: A.V. Minaev, A.V. Sobolev, I.V. ZemlyanskayaCritical revision of the article: V.P. PodzolkovSurgical treatment: M.R. Chiaureli, V.N. Cheban, E.P. Golubev, K.V. PetrosyanFinal approval of the version to be published: V.P. Podzolkov, A.V. Minaev, M.R. Chiaureli, V.N. Cheban, E.P. Golubev, K.V. Petrosyan, A.V. Sobolev, I.V. Zemlyanskaya

Prevalence of Surgical Myocardial Revascularization in Diabetics and Non-diabetics After Acute Myocardial Infarction

Background Diabetes mellitus (DM) is a metabolic disorder characterized by persistent hyperglycemia. The main cause of death among diabetics is cardiovascular disease (CVD), which is a precursor to acute myocardial infarction (AMI). Approximately 30% of diabetic patients with AMI require myocardial revascularization surgery (MRS). Objective To evaluate the prevalence of MRS in diabetic and non-diabetic patients after AMI in a hospital in the city Criciúma, Brazil, during the period from 2016 to 2019. Methods A cross-sectional study was carried [...]

Investigation of Platelet Apoptosis in Patients after Surgical Myocardial Revascularization.

Platelets are one of the main participants in vascular accidents in cases of coronary heart disease (CHD). In this study, we sought to detect platelet apoptosis in patients with coronary artery disease who underwent scheduled myocardial revascularization surgery. To identify apoptotic events, we analyzed phosphatidylserine (PS) expression on the surface of platelets and mitochondrial membrane potential (ΔΨm) by flow cytometry in two groups of 30 patients aged 45-60 years: Group 1-patients before myocardial revascularization surgery and group 2-patients after myocardial revascularization surgery. The control group consisted of 10 healthy volunteers aged 45-60 years. According to our data, the percentage levels of PS expression in patients greatly decreased after surgery. We confirmed platelet apoptosis by recording depolarization of ΔΨm in pre- and postoperative patients. ΔΨm readings were considerably improved after surgery. Our data indicated that the functional parameters of platelets in patients with coronary heart disease differed from the characteristics of platelets in patients who underwent myocardial revascularization, and from those of patients in a control group. Future studies of platelet phenotypic characteristics and platelet apoptosis biomarkers should greatly advance our understanding of the pathophysiology of coronary heart disease, and further promote the development of methods for predicting adverse outcomes after surgery.

The Prognostic Value of Previous Coronary Stent Implantation in Patients Undergoing Myocardial Revascularization Surgery.

Currently, studies are underway to determine whether coronary stent implantation with percutaneous transluminal coronary angioplasty before a coronary artery bypass graft (CABG) influences the prognosis of surgery. This study aimed to assess the need for future revascularisation or all-cause mortality as a composite endpoint after CABG surgery among patients with previous stent implantation. A retrospective, non-randomised study was performed on 721 patients who underwent CABGin our centre between 2012 and 2017. This single-centre study compared two groups: 1) the previous stent group, patients with previous stent implantation (n=144), and 2) the non-previous stent group, patients without previous stent implantation (n=577). After a median follow-up of 36 months, the previous stent group presented a decreased combined event-free survival at 1, 3 and 5 years compared with the non-previous stent group (67.4, 43.5 and 23.0% vs. 91.0, 80.3 and 63.0%, respectively; p<0.01). There was also higher mortality in the previous stent group than in the non-previous stent group (96.1, 90.5 and 79.4 vs. 91.9, 75.9 and 51.0, respectively; p=0.01). The multivariable analysis of demographics, baseline comorbidity and surgical data showed previous stent implantation as an independent predictor of the composite endpoint (Hazard Ratio=3.00 and 95% confident interval=2.09-4.32; p<0.01). Patients with percutaneous coronary intervention before CABG present higher comorbidities and clinical events during follow-up than those who do not undergo stenting.

Fatores associados à infecção de sítio cirúrgico em revascularização miocárdica: estudo longitudinal retrospectivo

ABSTRACT Objectives: to analyze the influence of sociodemographic and clinical variables, as well as the surgical checklist adherence score, on the occurrence of surgical site infection among patients undergoing myocardial revascularization. Methods: an observational, longitudinal, retrospective study was conducted at a university hospital, involving 266 medical records of patients who underwent myocardial revascularization surgery. Instruments containing sociodemographic, clinical, and infection-related variables were used, along with the Perioperative Surgical Safety Checklist. Descriptive, bivariate, and logistic regression analyses were employed. Results: surgical site infection occurred in 89 (33.5%) patients. There was a statistically significant association between body temperature outside the range of 36 degrees Celsius to 36.5 degrees Celsius (p=0.01), the presence of invasive devices (p=0.05), surgical procedures with the anticipation of critical events (p&lt;0.001), and the occurrence of infection. Conclusions: body temperature, the presence of invasive devices, and surgical procedures with the anticipation of critical events were significant factors contributing to an increased risk of infection.

Identification of factors related to complications in myocardial revascularization surgery: an approach with multi-target association rules networks

Myocardial revascularization surgery is one of the recommended approaches for the treatment of chronic coronary disease. Several complications related to mortality, sequelae, length of stay, and hospital costs are also associated with this procedure. Death rates and complications depend on the characteristics of each patient. Knowing the factors related to hospital mortality and complications is paramount to improving outcomes. Association Rules Mining may support the discovery of those factors. In this work we propose a new approach, called Multi-target Association Rules Network (MTARN), to analyze association rules based on networks with a simultaneous focus on two parameters. The use of association rules networks aids the analysis of a high number of association rules and the multi-target strategy allows a complete exploration, explaining which factors directly influence the analyzed set. We evaluated our approach in conjunction with domain experts and compared it to two other approaches: Decision Trees and Filtered-ARNs, a single target approach based on networks for pattern visualization. The results indicates that MTARNs optimize the discovery of knowledge directly linked to complication and death factors in patients undergoing coronary artery bypass grafting. These parameters may be used in the construction of an intelligent monitoring system to aid myocardial revascularization patients.

Myocardial revascularization surgery with bilateral internal mammary artery

Introduction: The internal mammary artery is the only graft with a long-term impact on mortality in patients with coronary artery disease. Some questions limit the use of both arteries simultaneously, such as prolonged surgical time, risk of sternal infections, especially in diabetic and obese patients. This study sought to describe the 5-year experience in patients revascularized with bilateral internal mammary artery (BIMA). Methods: Descriptive cohort follow-up study. 42 patients underwent myocardial revascularization with BIMA between 2015-2020, Manuel-Uribe-Ángel Hospital, Envigado-Colombia. Secondary and primary information sources. Univariate analysis was developed for the description of variables. Results: Mean age of 55.2 years, 19% were diabetic, mean body mass index (BMI) 24.5 kg/sq.mt; severe coronary artery disease 90.5%, 95.2% with complete revascularization. No patient presented surgical site infection. Median follow-up of 5.1 years during which 5.4% suffered an acute myocardial infarction, 13.5% required percutaneous coronary intervention, 16.2% died, 33.3% of which were attributed to a cardiac cause. Discussion: The participants had a normal average BMI, 19% were diabetic; they had adequate metabolic control, presenting mean glycosylated hemoglobin of 7.09%. In the studied population there were no cases of surgical site infection and 16.2% of the cohort presented angina, which is lower than that described in other studies. Incidence of acute myocardial infarction and percutaneous coronary intervention was similar to the ones reported in other studies. Conclusion: In the studied population, patients with BMI in the normal range and glycemia with adequate metabolic control, myocardial revascularization with BIMA was a safe technique with acceptable medium-term cardiovascular outcomes.

Surgical site infection in adult patients after heart procedures: an integrative review

Objective: to identify the risk factors for surgical site infection in patients after heart procedure. Methods: integrative literature review by searching the Medical Literature Analyses and Retrieval System online, Latin American and Caribbean Literature on Health Sciences, Scientific Electronic Library Online, Nursing Database. The search for the articles occurred during the month of February 2022. Results: 24 articles were eligible for the review. In all studies, the population was mostly male, aged between 51 and 70 years, who underwent elective myocardial revascularization surgery. The main comorbidities presented were diabetes mellitus, hypertension, and obesity. The infection rates ranged from 2.4% to 38.9%, and the main pathogen identified was Staphylococcus aureus. Conclusion: the main comorbidities present in patients who manifested surgical site infection were diabetes, hypertension, obesity, and smoking. The risk factors were gender, age, and prolonged preoperative hospitalization. Antibiotic prophylaxis, trichotomy, nasal decolonization, and adequate skin antisepsis were the most adopted prophylactic measures. Contributions to practice: knowing the profile of patients who developed infection may favor planning risk control actions.

Long-Term Exposure to Ozone and Fine Particulate Matter and Risk of Premature Coronary Artery Disease: Results from Genetics of Atherosclerotic Disease Mexican Study.

Simple SummaryEpidemiological studies have identified associations between fine particulate matter (with an aerodynamic diameter of less than 2.5 μm (PM2.5)) and ozone exposure with cardiovascular disease; however, studies linking ambient air pollution and premature coronary artery disease (pCAD) in Latin America are nonexistent. We leveraged data from the Genetics of Atherosclerotic Disease (GEA) Mexican study to address the question of the extent to which long-term exposure to ozone and PM2.5 exposure was associated with the risk of pCAD. We showed for the first time a higher risk of pCAD associated with 1 ppb increase in ozone (1-year, 2-year, 3-year, and 5-year) and 5μg/m3 of PM2.5 (5-year) compared to controls. This study provides evidence that ozone and PM2.5 may be a modifiable risk factor for pCAD.(1) Background: Epidemiological studies have identified associations between fine particulate matter (PM2.5) and ozone exposure with cardiovascular disease; however, studies linking ambient air pollution and premature coronary artery disease (pCAD) in Latin America are non-existing. (2) Methods: Our study was a case–control analysis nested in the Genetics of Atherosclerotic Disease (GEA) Mexican study. We included 1615 participants (869 controls and 746 patients with pCAD), recruited at the Instituto Nacional de Cardiología Ignacio Chávez from June 2008 to January 2013. We defined pCAD as history of myocardial infarction, angioplasty, revascularization surgery or coronary stenosis > 50% diagnosed before age 55 in men and age 65 in women. Controls were healthy individuals without personal or family history of pCAD and with coronary artery calcification equal to zero. Hourly measurements of ozone and PM2.5 from the Atmospheric Monitoring System in Mexico City (SIMAT in Spanish; Sistema de Monitero Atmosférico de la Ciudad de México) were used to calculate annual exposure to ozone and PM2.5 in the study participants. (3) Results: Each ppb increase in ozone at 1-year, 2-year, 3-year and 5-year averages was significantly associated with increased odds (OR = 1.10; 95% CI: 1.03–1.18; OR = 1.17; 95% CI: 1.05–1.30; OR = 1.18; 95% CI: 1.05–1.33, and OR = 1.13; 95% CI: 1.04–1.23, respectively) of pCAD. We observed higher risk of pCAD for each 5 µg/m3 increase only for the 5-year average of PM2.5 exposure (OR = 2.75; 95% CI: 1.47–5.16), compared to controls. (4) Conclusions: Ozone exposure at different time points and PM2.5 exposure at 5 years were associated with increased odds of pCAD. Our results highlight the importance of reducing long-term exposure to ambient air pollution levels to reduce the burden of cardiovascular disease in Mexico City and other metropolitan areas.

Myocardial condition in overweight patients at different stages of rehabilitation after revascularization

The aim of the study was to study the dynamics of myocardial function indicators in overweight patients at different stages of rehabilitation after coronary revascularization.Material and methods. This article presents the interim results of prospective study which was conducted at the Tulpar cardiorehabilitation center (Karaganda, Kazakhstan). The study included 135 patients after restoration of blood flow in the coronary arteries (coronary artery bypass grafting, stenting). The average age was 58 ± 6 years. Exclusion criteria: acute myocardial infarction; chronic heart failure, functional class III–IV; acute disorders of cerebral circulation; diabetes mellitus in a state of decompensation; obesity I–III degree. We observed patients in dynamics at three stages of rehabilitation. 41 patients were included in the study at the first stage, 43 – at the second stage and 51 – at the third stage. Patients were included from different stages of rehabilitation. The groups were comparable in terms of the parameters of the structural and functional state of the myocardium, the same age range.Results. Considering the size of the interventricular septum, the posterior wall of the left ventricle, the relative thickness of the myocardium and the myocardial mass index, it can be noted that statistically significant hypertrophy of the left ventricle was observed in all observation periods (p &lt; 0.05).Conclusions. In overweight patients who underwent myocardial revascularization surgery, persistent changes in the myocardium remain at the 3rd stage of rehabilitation

SÍNDROME CORONARIANA AGUDA COMO PRIMEIRA MANIFESTAÇÃO DE MÚLTIPLOS ANEURISMAS EM ARTERIAS CORONÁRIAS: RELATO DE CASO

The study reports the case of a patient with multiple aneurysms and ectasias of the coronary arteries whose first manifestation was acute coronary syndrome. This is a 42-year-old male patient who was diagnosed with acute myocardial infarction without ST segment elevation. Cineangiocoronariography showed a three-vessel lesion with aneurysmatic and ectatic coronary dilations. Myocardial revascularization surgery was chosen, but he refused to undergo surgical treatment. He was discharged with optimized clinical treatment with outpatient follow-up. Months after diagnosis, the patient died and was being followed up in another service. Coronary artery aneurysm is a rare entity. The ideal management is still not well established, with doubts and disagreements about surgical and interventional treatment and when to indicate them.

Динамика показателей качества жизни при проведении хирургической реваскуляризации миокарда

Coronary heart disease (CHD), being one of the most common cardiovascular diseases, has a negative impact on patients’ quality of life. The purpose of the work was to study the dynamics of quality of life indicators in patients with CHD during surgical revascularization of myocardium depending on the presence or absence of old myocardial infarction. 68 patients with CHD were examined, including 57 (83.8%) patients with old myocardial infarction (old MI) and 11 (16.2%) patients in the absence of old MI. There was a statistically significant improvement in quality of life, both in the physical and psychoemotional spheres, in patients with stable coronary heart disease including those with a history of myocardial infarction. No effect of old MI on quality of life in patients after myocardial revascularization surgery was observed.

Динамика показателей качества жизни при проведении хирургической реваскуляризации миокарда

Coronary heart disease (CHD), being one of the most common cardiovascular diseases, has a negative impact on patients’ quality of life. The purpose of the work was to study the dynamics of quality of life indicators in patients with CHD during surgical revascularization of myocardium depending on the presence or absence of old myocardial infarction. 68 patients with CHD were examined, including 57 (83.8%) patients with old myocardial infarction (old MI) and 11 (16.2%) patients in the absence of old MI. There was a statistically significant improvement in quality of life, both in the physical and psychoemotional spheres, in patients with stable coronary heart disease including those with a history of myocardial infarction. No effect of old MI on quality of life in patients after myocardial revascularization surgery was observed.

Pituitary Apoplexy after Myocardial Revascularization Surgery in Patient with Unknown Macroadenoma: A Case Report

Pituitary Apoplexy after Myocardial Revascularization Surgery in Patient with Unknown Macroadenoma: A Case Report