On-pump Coronary Artery Bypass Surgery Research Articles

Predictive Value of Preoperative Morphology Parameters in Patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Surgery.

Coronary heart disease is the most common cause of death worldwide. It is responsible for almost a third of deaths in patients over the age of 35. Various biomarkers are currently being studied in detail for their value in predicting postoperative mortality in patients undergoing CABG. The aim of this study is to analyze the predictive value of certain blood morphological parameters in CABG and off-pump coronary artery bypass grafting (OPCAB). A total of 520 patients who underwent surgery in two consecutive years and underwent CABG (404) or OPCAB (116) were included in this retrospective study. Gender, age, comorbidities, five-year survival rate, detailed information on hospitalization, surgery, intensive care unit parameters and preoperative blood samples from the cubital vein were recorded. Inverse propensity treatment weighting was applied to adjust for confounding factors at baseline. No differences were found between OPCAB and CABG as an isolated comparison. In the standardized population, patients with abnormal lymphocyte counts had an increased risk of death at one-year and five-year follow-up. In the standardized population, abnormal red blood cell distribution width (RDW-SD), neutrocyte-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were associated with increased mortality in each period analyzed. Abnormal PLR, RDW-SD and NLR are associated with increased early and late mortality in patients undergoing CABG and OPCAB. Abnormal lymphocytes are only associated with increased late mortality.

Does Chronic Obstructive Pulmonary Disease Impact Outcome after Coronary Artery Bypass Grafting? A Population-Based Retrospective Study in Germany.

Background: The interaction between chronic obstructive pulmonary disease (COPD) and coronary artery bypass grafting (CABG) is discussed controversial. Methods: In this population-based retrospective analysis including non-emergency CABG in Germany between 2015 and 2021, the aim was to compare in-hospital mortality, hospital length of stay (HLOS), and perioperative ventilation time (VT) in patients affected by COPD and not affected by COPD. In addition, we compared outcomes after off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB) surgery and outcomes after CABG with a minimally invasive technique with and without cardiopulmonary bypass (CPB) in COPD patients. Results: Of the 274,792 analyzed cases undergoing non-emergency CABG, 7.7% suffered from COPD. COPD patients showed a higher in-hospital mortality (6.0% vs. 4.2%; p < 0.001), a longer HLOS (13 days (10-19) vs. 12 days (9-16); p < 0.001), and a longer VT (33 h (11-124) vs. 28 h (9-94); p < 0.001). In subgroup analyses, COPD patients undergoing OPCAB surgery showed a lower in-hospital mortality (3.5% vs. 6.4%; p < 0.001), a shorter HLOS (12 days (9-16) vs. 13 days (10-19); p < 0.001) and a shorter VT (20 h (10-69) vs. 36 h (11-135); p < 0.001) compared to ONCAB surgery. Regression analyses confirmed that using cardiopulmonary bypass in COPD patients is associated with a higher risk of in-hospital mortality (OR, 1.86; 95% CI: 1.51-2.29, p < 0.001), a longer HLOS (1.44 days; 95% CI: 0.91-1.97, p < 0.001), and a longer VT (33.67 h; 95% CI: 18.67-48.66, p < 0.001). In further subgroup analyses, COPD patients undergoing CABG with a minimally invasive technique without CPB showed a lower in-hospital mortality (3.5% vs. 16.5%; p < 0.001) and a shorter VT (20 h (10-69) vs. 65 h (29-210); p < 0.001) compared to CABG with a minimally invasive technique and CPB. Regression analyses confirmed that using CPB in COPD patients undergoing CABG with a minimally invasive technique is associated with a higher risk of in-hospital mortality (OR, 4.80; 95% CI: 2.42-9.51, p < 0.001). Conclusions: COPD negatively impacts outcomes after non-emergency CABG. According to our results, OPCAB surgery and CABG with a minimally invasive technique without CPB seem to be beneficial for COPD patients. Further studies should be performed to confirm this.

Role of Intraoperative Left Ventricular Global Longitudinal Strain in Hemodynamic and Cognitive Outcomes in On-Pump Coronary Artery Bypass Surgery: A Prospective Observational Study

ABSTRACT Background: The role of left ventricular global longitudinal strain (LVGLS) in coronary artery bypass grafting (CABG) and outcomes such as low cardiac output syndrome (LCOS) is not well established. The authors investigated the relationship between LVGLS before and after induction of anesthesia, their differences, and their relationship with LCOS and other outcomes. Methodology: A prospective observational study was conducted in a public/private hospital with 50 adult patients scheduled for on-pump CABG with normal left ventricular ejection fraction (LVEF). Acoustic windows necessary to obtain the 2D-LVGLS were acquired with transthoracic echocardiography (TTE) before induction of anesthesia (LVGLSBI) and after with mechanical ventilation (LVGLSAI) using transesophageal echocardiography (TEE). LCOS was defined as the use of epinephrine, dobutamine, and/or milrinone at minimum IV doses of 1 μg/min-1, 2.5 μg/kg-1/min-1, and 0.375 μg/kg-1/min-1, respectively, for a minimum of 24 h after cardiopulmonary bypass. Results: A dedicated workstation (EchoPAC Software v203, GE) was used for offline calculation of LVGLS. LVGLSBI did not have a significant correlation with LCOS (mean difference, 1.66; 95% CI, −–3.63 to 3.05; P = 0.862), nevertheless, it was an independent risk factor of in-hospital mortality (OR, 0.74; 95% CI, 0.57–0.95; P = 0.02), 3-month mortality (OR, 0.80; 95% CI, 0.64–0.99; P = 0.05), and delirium (OR, 0.65; 95% CI, 0.43–0.97; P = 0.03) in the multivariate analysis. LVGLSAI was also an independent risk factor for 3-month mortality (OR, 0.78; 95% CI, 0.62–0.99; P = 0.04). Conclusions: In CABG surgeries, LVGLS was a predictor of adverse outcomes in both awake and anesthetized patients with normal LVEF.

Short-term and long-term outcomes of on-pump beating-heart coronary artery bypass surgery in dialysis and non-dialysis patients: a retrospective study in a single center

BackgroundThis study aimed to evaluate the short-term and long-term outcomes of dialysis and non-dialysis patients after On-pump beating-heart coronary artery bypass grafting (OPBH-CABG).MethodsWe retrospectively reviewed medical records of 659 patients underwent OPBH-CABG at our hospital from 2009 to 2019, including 549 non-dialysis patients and 110 dialysis patients. Outcomes were in-hospital mortality, length of stay, surgical complications, post-CABG reintervention, and late mortality. The median follow-up was 3.88 years in non-dialysis patients and 2.24 years in dialysis patients. Propensity matching analysis was performed.ResultsAfter 1:1 matching, dialysis patients had significantly longer length of stay (14 (11–18) vs. 12 (10–15), p = 0.016), higher rates of myocardial infarction (16.85% vs. 6.74%, p = 0.037) and late mortality (25.93% vs. 9.4%, p = 0.005) after CABG compared to non-dialysis patients. No significant differences were observed in in-hospital mortality, complications, or post-CABG reintervention rate between dialysis and non-dialysis groups.ConclusionsOPBH-CABG could achieve comparable surgical mortality, surgical complication rates, and long-term revascularization in dialysis patients as those in non-dialysis patients. The results show that OPBH-CABG is a safe and effective surgical option for dialysis patients.

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

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

High Preoperative Systemic Immune-Inflammation Index Values Significantly Predicted Poor Outcomes After on-Pump Coronary Artery Bypass Surgery.

On-pump coronary artery bypass grafting (CABG) is one of the most common revascularization surgical therapies for coronary artery disease (CAD). However, owing to the use of cardiopulmonary bypass ("on-pump"), the body develops systemic inflammatory response syndrome, which leads to the risk of morbidity and mortality. This study aimed to determine the perioperative outcomes of patients who underwent on-pump CABG surgery using the systemic immune-inflammation index (SII). This single-center retrospective study used secondary data from patients' electronic medical records and medical records archives at the National Cardiovascular Center Harapan Kita, who underwent on-pump CABG from January 2019 to December 2022. A total of 1056 on-pump CABG procedures were performed after exclusion. Lymphocyte, segmental neutrophil, and platelet counts from the preoperative data were used to calculate the SII values. An SII cutoff value of 528.715 × 103/mm3 divided the patients into two groups. The SII value of 1056 patients were calculated, among which 490 (46%) patients had a preoperative SII value of ≥528.715 × 103/mm3. Multivariate analysis showed that a high SII significantly prolonged the duration of surgery (OR 1.005, 95% CI 1.003-1.006) and cardiopulmonary bypass (CPB) time (OR 1.007, 95% CI 1.005-1.009). High SII values significantly predicted prolonged mechanical ventilation (OR 6.154, 95% CL 3.938-9.617), intensive care unit (ICU) stay (OR 6.332, 95% CL 4.232-9.474), and hospital stay (OR 3.517, 95% CL 2.711-4.562). Regarding other perioperative outcomes, a high SII significantly predicted the risk of postoperative atrial AF, cardiac arrest, acute myocardial infarction, and mortality. A high preoperative SII value can predict morbidity and mortality in patients undergoing on-pump CABG surgery.

The effects of on-pump and off-pump coronary artery bypass surgery on oxidative stress and cerebral oxygenation: a prospective observational study.

In this prospective observational study, our goal was to investigate the relationship between serum levels of oxidative stress (OS) parameters and regional cerebral oxygen saturation (rSO2) in addition to evaluating postoperative clinical outcomes among patients undergoing coronary artery bypass graft surgery (CABG). This study comprised 64 adult patients undergoing elective CABG (on-pump [n = 48] and off-pump [n = 16]) procedures. Serum OS levels and rSO2 values were measured intraoperatively at three specific time points: T1 (after induction), T2 (15 min before aortic cross-clamp removal or the final distal anastomosis), and T3 (15 min after aortic cross-clamp removal or the last distal anastomosis). Serum OS and lactate values demonstrated higher levels at T2 and T3 (p < 0.001), while rSO2 values were lower at T2 (p = 0.024) in the on-pump CABG group compared to the off-pump CABG group. The rSO2 values at T2 exhibited a negative correlation with OS parameters, lactate levels at T2 and T3, aortic clamp time, postoperative mechanical ventilation time, and intensive care unit stay length. In the multivariate linear regression analysis (R2 = 0.181, p = 0.001), lactate values at T2 emerged as the sole factor affecting the OS index at T2 (t = 2.843, p = 0.006). In our study, we observed elevated OS values and relatively low rSO2 values during on-pump CABG procedures, with rSO2 showing an association with increased OS parameters. Close monitoring of the OS response level and rSO2 during CABG could potentially enhance postoperative clinical outcomes.

The role of postoperative trimetazidine therapy in on-pump coronary artery bypass surgery.

Coronary artery bypass surgery remains the gold standard in the treatment of patients with ischemic heart disease. However, the increased oxidative stress caused by the release of free radicals during the ischemia-reperfusion time is a well-known pathophysiological process during and after coronary revascularization procedures. It may lead to reversible and irreversible myocardial injury.

Evaluation of Intraoperative Left-Ventricular Diastolic Function by Myocardial Strain in On-Pump Coronary Artery Bypass Surgery

Left ventricular (LV) diastolic function strongly predicts outcomes after cardiac surgery, but there is no consensus about appropriate intraoperative assessment. Recently, intraoperative diastolic strain-based measurements assessed by transesophageal echocardiography (TEE) have shown a strong correlation with LV relaxation, compliance, and filling, but there are no reports about evaluation through the entire perioperative period. Therefore, the authors describe the intraoperative course of this novel assessment technique in patients who underwent coronary artery bypass grafting, and compare it with conventional echocardiographic measures and common grading algorithms of LV diastolic dysfunction (LVDD). Prospectively obtained data. A single university hospital. Thirty adult patients scheduled for isolated on-pump coronary artery bypass grafting surgery with preoperative preserved left and right ventricular systolic function, without significant heart valve disease and pulmonary hypertension, and an uneventful intraoperative course were included. Transesophageal echocardiography was performed after induction of anesthesia (T1), after termination of cardiopulmonary bypass (T2), and after sternal closure (T3). Echocardiographic evaluation was performed in stable hemodynamic conditions, in sinus rhythm or atrial pacing, and vasopressor support with norepinephrine ≤0.1 µg/kg/min. Strain-based measurements of peak longitudinal strain rate during isovolumetric relaxation (SR-IVR) and during early (SR-E) and late (SR-A) LV filling were assessed using EchoPAC v204 software (GE Vingmed Ultrasound AS, Norway). Evaluation of conventional echocardiographic parameters included transmitral Doppler measures of early (E) and late (A) LV filling, as well as lateral-tissue Doppler velocity assessed during early (e´) and late (a´) LV filling, tricuspid regurgitation, and left atrial dilatation. Evaluation and grading of LV diastolic function by myocardial strain was feasible in all included patients at all time points of assessment. Using conventional grading algorithms, however, a substantial number of patients could not be sufficiently graded, falling into an indeterminate zone and not reliably estimating LVDD (T1, 40%; T2, 33%; T3, 36%). There was significant impairment of LV diastolic function after bypass, as measured by SR-IVR (T1 v T2, 0.28 s-1 [IQR 0.23; 0.31) v 0.18 s-1 [IQR 0.14; 0.22]; p < 0.001), SR-E (T1 v T2, 0.95 ± 0.34 s-1v 1.28 ± 0.36 s-1; p < 0.001), and E/SR-IVR (T1 v T2, 2.3 ± 1.0 m v 4.5 ± 2.1 m; p < 0.001]. Conventional echocardiographic measures remained unchanged during the same period (E/A T1 v T2, 1.27 [IQR 0.94; 1.59] v 1.21 [IQR 1.03; 1.47] [p = 1] and E/e´ T1 v T2, 7.0 [IQR 5.3; 9.6] v 6.35 [IQR 5.7; 9.9] [p = 0.9]). There were no significant changes in the values of SR-IVR, SR-E, SR-A, E/SR-IVR, E/A, and E/e´ before and after sternal closure (T2 v T3). Intraoperative assessment of strain-based measurements of LV diastolic function and strain-based LVDD grading was feasible in this group of selected patients, whereas conventional parameters failed to describe LVDD sufficiently in a substantial number of patients. Diastolic strain-based measurements showed impairment of LV relaxation and compliance after bypass, which was not detected by conventional echocardiographic parameters. Therefore, diastolic myocardial strain analysis might be more sensitive in detecting myocardial diastolic dysfunction by TEE in the perioperative setting, with its dynamic changes of loading conditions, and might provide valuable and additional information on the perioperative changes of LV diastolic function.

The effect of remifentanil and dexmedetomidine on dynamic thiol/disulfide balance in patients undergoing coronary artery bypass surgery: a prospective case-control study.

It is established that the balance of serum thiols is disrupted in favor of oxidants in coronary artery disease, and the cardiopulmonary bypass pump used during coronary artery bypass surgery disrupts this balance in favor of oxidants. In this study, we investigated the antioxidant effects of remifentanil or dexmedetomidine on thiol-disulfide balance and paraoxonase-1 (PON-1) levels during on-pump coronary artery bypass surgery. A total of 100 patients who underwent on-pump coronary artery bypass grafting surgery between May 2018 and December 2018 were included in the study. Patients were divided into two groups: the remifentanil group (Group R) and the dexmedetomidine group (Group D). Venous blood samples were obtained from the patients after induction of anesthesia [Time 1 (T-1)], then after cross-clamping of the aorta (T-2), after removal of the cross-clamp (T-3), 10 minutes after the end of protamine infusion (T-4), and 24 hours postoperatively (T-5). Serum total thiol, native thiol, disulfide, and PON-1 levels were evaluated. Total thiol, disulfide, PON-1, native thiol/total thiol, total thiol/disulfide, and native thiol/disulfide levels were similar between the two groups. Native thiol levels were statistically significantly higher in group D compared to group R at T-3 and T-5 (p = 0.017 and p = 0.027, respectively). When T-1 and T-5 times were compared in intragroup measurements, disulfide levels were significantly lower, and native thiol/total thiol ratios were significantly higher at T-5 (p < 0.001). In conclusion, in light of the data obtained from this study, it can be concluded that dexmedetomidine used during surgery has a better contribution to oxidant-antioxidant balance than remifentanil in patients undergoing coronary artery bypass surgery with the on-pump method.

Evaluation of Intraoperative Left Ventricular Diastolic Function by Myocardial Strain in Onpump Coronary Artery Bypass Surgery

Evaluation of Intraoperative Left Ventricular Diastolic Function by Myocardial Strain in Onpump Coronary Artery Bypass Surgery

Comparison of the effects of intravenous analgesic agents used in the intraoperative period on pentraxin-3 levels in patients undergoing on-pump coronary artery bypass surgery

Comparison of the effects of intravenous analgesic agents used in the intraoperative period on pentraxin-3 levels in patients undergoing on-pump coronary artery bypass surgery

Potentials of Acetylcholinesterase and Butyrylcholinesterase Alterations in On-Pump Coronary Artery Bypass Surgery in Postoperative Delirium: An Observational Trial.

Cardiac surgery is regularly associated with postoperative delirium (POD), affected by neuro-inflammation and changes in cholinergic activity. Therefore, this prospective observational study aimed to evaluate whether pre- and perioperative changes in blood acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity were associated with POD development in patients undergoing isolated elective coronary artery bypass graft (CABG) surgery. It included 93 patients. Pre- and postoperative blood AChE and BChE activities were measured with photometric rapid-point-of-care-testing. The Intensive Care Delirium Screening Checklist and the Confusion Assessment Method for the Intensive Care Unit were used to screen patients for POD. POD developed in 20 patients (21.5%), who were older (p = 0.003), had higher EuroSCOREs (p ≤ 0.001), and had longer intensive care unit stays (p < 0.001). On postoperative day one, BChE activity decreased from preoperative values more in patients with (31.9%) than without (23.7%) POD (group difference p = 0.002). Applying a cutoff of ≥32.0% for BChE activity changes, receiver operating characteristic analysis demonstrated a moderate prediction capability for POD (area under the curve = 0.72, p = 0.002). The risk of developing POD was 4.31 times higher with a BChE activity change of ≥32.0% (p = 0.010). Monitoring the pre- to postoperative reduction in BChE activity might be a clinically practicable biomarker for detecting patients at risk of developing POD after CABG surgery.

Predicting Determinants for Conversion of Off-Pump Coronary Revascularization to On-Pump Surgery: A Retrospective Analysis.

A global consensus has not yet been reached regarding the preference for off-pump versus on-pump coronary revascularization. Although the coronary trial indicates that the secondary endpoint outcomes favor on-pump surgery, the cost-effectiveness and significantly lower immediate and early complications in off-pump surgery make it favorable for the Indian population. To analyze patients who underwent coronary revascularization, specifically coronary artery bypass grafting (CABG), a retrospective five-year study was conducted. During the given duration, a total of 652 patients underwent CABG. The study revealed a positive correlation between diabetes, high body surface area (BSA), and preexisting renal dysfunction as strong predictors for converting off-pump coronary artery bypass surgery (OPCABG) to on-pump surgery coronary artery bypass surgery (ONCABG). Preoperative electrocardiographic (ECG) changes and the use of intra-aortic balloon pulsation (IABP) as a mechanical assist device were strongly associated with the incidence of conversion from OPCABG to ONCABG. Tight left main disease and ostial coronary disease indicate a progressive dysfunction during off-pump surgery, necessitating early conversion to on-pump surgery to avoid complications. The on-pump group had more adverse outcomes in regard to renal and neurological dysfunction, which can be attributed to pump-induced dysfunction. In such scenarios, a surgeon's preparedness to convert an OPCABG to an ONCABG can be swift and efficient. In anticipation of increased pump-related complications in the ONCABG group, a measured approach can be implemented to avoid adverse postoperative outcomes in high-risk patients.

Prospective analysis of cerebrovascular events in patients following coronary artery bypass surgery

Background: Cerebrovascular events are the most common cause of disability in adults and can be classified into two categories: ischemic stroke and hemorrhagic stroke. Risk factors for stroke include age, gender, race, family history of stroke, hypertension, smoking, heart disease, valvular heart disease, arrhythmias, diabetes, obesity, and dyslipidemia. Low cardiac output syndrome, myocardial infarction, and atrial fibrillation can also contribute to stroke. This study aims to investigate the incidence of stroke post-cardiac surgery and the risk factors contributing to it. Methods: A prospective observational study with a sample size of 516 patients was conducted. Patients over the age of 40 who were undergoing CABG (both off and on pump) were included. Patients were subjected to on-pump or off-pump coronary artery bypass surgery as per requirement, but preferably off-pump. Results: Out of 516 patients, 13 developed strokes, of which 8 (61.5%) had hypertension and 10 (76.9%) had diabetes, 4 (30.8%) were smokers, 6 (46.2%) had normal LDL values, 7 (53.8%) had high LDL levels, none had normal HDL values, 1 (7.7%) had normal LV function, 4 (30.8%) had mild LV dysfunction, 4 (30.8%) had moderate LV dysfunction, and 4 (30.8%) had severe LV dysfunction. 11 (84.6%) had COPD. 7 (53.8%) had no prior MI, 5 (38.5%) had a recent MI, and 1 (7.7%) had a prior MI that was more than ten years old. 8 (61.5%) had normal renal functions, while 5 (38.5%) had disturbed renal functions. Conclusions: In this study, the incidence of CVE after CABG is 2.52%. All the patients who developed stroke had multiple risk factors. High LDL, low LVEF, deranged renal functions, PVD, arrhythmia pre-op, anti-coagulation pre-op, on pump surgery, Cardioplegia usage, CCF pre-op, urgent surgery, LCOS post-operatively are risk factors for post-operative stroke.

Early and mid-term outcomes of off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel coronary artery disease: a randomized controlled trial

Background and aim of the studySeveral studies have compared early and late outcomes of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However, there is still an ongoing debate on this matter, especially in patients with triple-vessel coronary artery disease (3VD).MethodsWe randomly assigned 274 consecutive patients with 3VD to two equal groups to undergo on-pump CABG or off-pump CABG. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, acute coronary syndrome, stroke or transient ischemic attack, and the need for repeat revascularization. The secondary outcomes were postoperative infection, ventilation time, ICU admission duration, hospital stay length, and renal failure after surgery.ResultsThe median follow-up duration was 31.2 months (range 24.6–35.2 months). The mean age of patients was 61.4 ± 9.3 years (range: 38–86), and 207 (78.7%) were men. There were 15 (11.2%) and 9 (7.0%) MACCE occurrences in on-pump and off-pump groups, respectively (P value = 0.23). MACCE components including all-cause death, non-fatal MI, CVA, and revascularization did not significantly differ between on-pump and off-pump groups. We observed no difference in the occurrence of MACCE between off-pump and on-pump groups in multivariable regression analysis (HR = 0.57; 95% CI 0.24–1.32; P value = 0.192). There were no statistical differences in postoperative outcomes between the off-pump and on-pump CABG groups.ConclusionsOff-pump CABG is an equal option to on-pump CABG for 3VD patients with similar rates of MACCE and postoperative complications incidence when surgery is performed in the same setting by an expert surgeon in both methods. (IRCT20190120042428N1).

Prophylaxis of Atrial Fibrillation After Isolated On-pump Coronary Artery Bypass Surgery with Postoperative Intravenous Magnesium Sulfate Supplementation

Prophylaxis of Atrial Fibrillation After Isolated On-pump Coronary Artery Bypass Surgery with Postoperative Intravenous Magnesium Sulfate Supplementation

Effects of Bispectral Index Monitoring During On-pump Coronary Artery Bypass Surgery on Intraoperative Opioid Use and Postoperative Recovery

Effects of Bispectral Index Monitoring During On-pump Coronary Artery Bypass Surgery on Intraoperative Opioid Use and Postoperative Recovery

Circulating miRNA-770-5p and miRNA-30d-5p as potential biomarkers in vasoplegic syndrome after on-pump coronary artery bypass surgery – PREVENT trial

Abstract Introduction Vasoplegic syndrome (VS) is one of the most common unexpected complications following cardiothoracic surgery, approaching a 25% mortality rate. No standardized methods for diagnosing VS are available. A biomarker is a valuable tool in all fields of medicine, especially in cardiovascular disease when the patient has to undergo invasive surgery as on-pump CABG. MicroRNAs (miRNAs) have been studied and employed as biomarkers for numerous diseases, however, there are no studies regarding their expression in VS. Purpose To discover a new predictor of VS by comparing the miRNA profiles from patients who evolved to VS versus those who did not evolve after following Coronary artery bypass graft surgery (CABG). Methods A nested case-control study had an exploratory nature and involved an initial cohort of 87 patients who underwent on-pump CABG in elective or urgency procedures,considering the low surgical risk (STS score &amp;lt;2%). For this analysis, we compared 30 patients, divided into two groups: patients who evolved VS (VASO group, n=15) and who did not evolve VS (NONVASO group, n=15) after surgery. To perform the miRNA profiling, the target prediction, and identify the putative targets of the dysregulated miRNAs, the whole blood samples were collected after anesthetic induction and before incision in the chest (Figure 1A). Results We identified among the 754 screened miRNAs, eight differentially circulating miRNAs in the whole blood of VASO versus NONVASO groups (Figure 1B). Six miRNAs were increased (hsa-miR-548c-3p, hsa-miR-30d-5p, hsa-miR8 199b-5p, hsa-miR-183-3p, hsa-miR-571, hsa-miR-383-5p) and two were decreased (hsa-miR-1236-3p, hsa-miR-770-5p) and hsa-miR-1236-3p was not statistically significant (Figure 1C). The ROC curves for each single miRNAs yielded the top 2 highest AUC values of 0.8333 and 0.8178 for hsa-miR-770-5p and hsa-miR-30d-5p, respectively. The combination of these two miRNAs yielded an AUC value of 0.9615 with 84.6% sensitivity and 91.67% specificity in distinguishing patients from VASO from NONVASO groups showed a superior diagnostic power to that of a single miRNA (Figure 2). Computational analyses identified as the top enriched pathway the “Apelin Liver Signaling Pathway” with 14 out of 26 molecules within the pathway (53,8%) containing the higher number of targets of the dysregulated miRNAs. There was no statistical difference in preoperative, postoperative, EuroSCORE II, and variables comparing both groups. Conclusion(s) We showed that miRNA-770-5p and miRNA-30d-5p could be employed as potential biomarkers of VS, a new strategy to VS diagnosis since miRNAs expression could distinguish patients who could and could not evolve the disease. The capability of predicting VS with high accuracy would drastically change the clinical management and patient's referral to cardiac surgery by helping in decision-making once the clinical score risks proved to be unable to predict VS in low-risk patients. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo a Pesquisa de São Paulo - FAPESP

Neuroprotective effect of remote ischemic preconditioning in patients undergoing cardiac surgery: A randomized controlled trial.

BackgroundThe neuroprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing elective cardiopulmonary bypass (CPB)-assisted coronary artery bypass graft (CABG) or valvular cardiac surgery remains unclear.MethodsA randomized, double-blind, placebo-controlled superior clinical trial was conducted in patients undergoing elective on-pump coronary artery bypass surgery or valve surgery. Before anesthesia induction, patients were randomly assigned to RIPC (three 5-min cycles of inflation and deflation of blood pressure cuff on the upper limb) or the control group. The primary endpoint was the changes in S-100 calcium-binding protein β (S100-β) levels at 6 h postoperatively. Secondary endpoints included changes in Neuron-specific enolase (NSE), Mini-mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) levels.ResultsA total of 120 patients [mean age, 48.7 years; 36 women (34.3%)] were randomized at three cardiac surgery centers in China. One hundred and five patients were included in the modified intent-to-treat analysis (52 in the RIPC group and 53 in the control group). The primary result demonstrated that at 6 h after surgery, S100-β levels were lower in the RIPC group than in the control group (50.75; 95% confidence interval, 67.08 to 64.40 pg/ml vs. 70.48; 95% CI, 56.84 to 84.10 pg/ml, P = 0.036). Compared to the control group, the concentrations of S100-β at 24 h and 72 h and the concentration of NSE at 6 h, 24 h, and 72 h postoperatively were significantly lower in the RIPC group. However, neither the MMSE nor the MoCA revealed significant between-group differences in postoperative cognitive performance at 7 days, 3 months, and 6 months after surgery.ConclusionIn patients undergoing CPB-assisted cardiac surgery, RIPC attenuated brain damage as indicated with the decreased release of brain damage biomarker S100-β and NSE.Clinical trial registration[ClinicalTrials.gov], identifier [NCT01231789].