On-pump Surgery Research Articles

Antithrombotic drug removal from whole blood using Haemoadsorption with a porous polymer bead sorbent.

To evaluate the ability of the DrugSorb™-AntiThrombotic Removal (ATR) haemoadsorption device utilizing porous polymer bead sorbent technology to remove three commonly used antithrombotic drugs from whole blood. We evaluated the removal of apixaban, rivaroxaban, and ticagrelor by the DrugSorb-ATR haemoadsorption device in a benchtop clinical scale model using bovine whole blood. Blood spiked at clinically relevant concentrations of an antithrombotic agent was continuously circulated through a 300-mL DrugSorb-ATR haemoadsorption device at a flow rate of 300mL/min. Drug concentration was monitored over 6h to evaluate drug removal. Results were compared with a control circuit without the haemoadsorption device. Removal rates at 30, 60, 120, and 360 minutes were: apixaban: 81.5%, 96.3%, 99.3% >99.8%; rivaroxaban: 80.7%, 95.1%, 98.9%, >99.5%; ticagrelor: 62.5%; 75%, 86.6%, >95% (all P<0.0001 vs. control). Blood pH and haematological parameters were not significantly affected by the DrugSorb-ATR haemoadsorption device when compared with the control circuit. DrugSorb-ATR efficiently removes apixaban, rivaroxaban, and ticagrelor in a clinical-scale benchtop recirculation circuit with the bulk of removal occurring in the first 60 minutes. The clinical implications of these findings are currently investigated in patients undergoing on-pump cardiothoracic surgery in two US pivotal trials (ClinicalTrials.gov Identifiers: NCT04976530 and NCT05093504).

MACHINE LEARNING PREDICTION MODELS FOR IN-HOSPITAL MORTALITY AFTER ISOLATED ON-PUMP CORONARY ARTERY BYPASS GRAFTING

TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: Study aims to develop prediction models for in-hospital mortality (IHM) after isolated on-pump coronary artery bypass grafting (CABG) based on modern machine learning (ML) methods and to compare their accuracy. METHODS: Data set obtained from 866 electronic medical records of coronary artery disease patients received isolated on-pump CABG surgery from 2008 to 2018. Preoperative clinical, laboratory and instrumental tests results were used as inputs. The overall IHM was 4%. Predictors were identified during multistep selection procedure of statistical hypotheses analysis and weight coefficients calculations. Logistic regression, random forest and artificial neural networks (ANN) were used for models construction and predictors verification. Models cross validation was performed on test samples and control validation - on samples, whose data were not used in models development. RESULTS: Highest predictive potential IHM risk factors were identified: 7 from the EuroSCORE II scale (age, LVEF, recent MI, extracardiac arteriopathy, urgency, NYHA class) and 5 additional (heart rate, systolic blood pressure, aortic stenosis, left ventricular (LV) relative wall thickness index, and LV relative mass index). Developed ML models showed higher AUC values and sensitivity compared to the classical EuroSCORE II scale with the maximal prognostic accuracy for ANN model (AUC 93 %, sensitivity 90 %, and specificity 96 %). The predictive robustness of the models was confirmed by results of the control validation. CONCLUSIONS: Modern ML technologies allowed to develop robust prediction models for IHM after isolated on-pump CABG. CLINICAL IMPLICATIONS: Developed model could be promising for medical decision-making support system and deserves further clinical validation. DISCLOSURE: Nothing to declare. KEYWORD: machine learning

Preoperative frailty based on laboratory data and postoperative health outcomes in patients undergoing coronary artery bypass graft surgery

BackgroundFrailty is associated with adverse surgical outcomes. Patients with cardiovascular diseases have many risk factors of frailty; thus, preoperative frailty evaluation is necessary to predict adverse outcomes after coronary artery bypass graft (CABG) surgery. Laboratory data based-frailty assessments are objective and not time-consuming, addressing the need for an accurate but simple frailty screening for patients awaiting CABG surgery. ObjectivesThis retrospective study aimed to determine the association between laboratory based-frailty and patient health outcomes after CABG surgery. MethodsWe evaluated 896 patients who underwent on-pump or off-pump CABG surgery between August 1, 2015 and July 31, 2020 at a tertiary hospital. The frailty index-laboratory (FI-LAB), which comprises 32 laboratory parameters and vital signs, was used for frailty assessment. ResultsThe patients were divided into three groups according to their preoperative FI-LAB level as low (FI-LAB <0.25, 23.0%), moderate (FI-LAB ≥0.25 to ≤0.4, 54.9%), and high (FI-LAB>0.4, 22.1%) frailty groups. In the confounder-adjusted analysis, the lengths of hospital stay and intensive care unit stay were longer by 2.20 days (p=.023) and by 0.89 days (p=.009), respectively, in the high frailty group than those in the low frailty group. The odds ratio for 30-day readmission was also 2.58 times higher in the high frailty group than that in the low frailty group. ConclusionA high preoperative FI-LAB score indicates increasing risks of adverse postoperative outcomes among CABG surgery patients. FI-LAB has potential strengths to capture the need for a more thorough frailty assessment for cardiac surgery patients.

Myocardial Protecting Role of Glutamine in Patients with Low Ejection Fraction Undergoing Elective On-Pump Coronary Artery Bypass Graft Surgery.

PurposeMyocardial injury due to on-pump coronary artery bypass grafting (CABG) in patients with low ejection fraction (EF) is associated with poor outcomes. This study determines whether intravenous glutamine could protect the myocardium during on-pump CABG in patients with low EF.Materials and MethodsThis was a double-blind, randomized controlled trial to assess glutamine as a myocardial protector during on-pump CABG in patients with left ventricle EF of 31–50%, conducted from January to October 2021. Patients in the glutamine group (n = 30) received 0.5 g/kg of 20% glutamine solution diluted with 0.9% NaCl up to 500 mL in total volume over a period of 24 hours. Patients in the control group (n = 30) received 0.9% NaCl over the same period. The primary outcomes were plasma troponin I and plasma glutamine levels. Secondary outcomes included α-ketoglutarate (α-KG) levels and histopathology scoring of the right atrial appendage tissue, plasma lactate levels, hemodynamic measurement, and morbidity.ResultsTwenty-nine patients from each group (58 in total) were included in the analysis. Plasma troponin I levels at 6 and 24 hours after cardiopulmonary bypass (CPB) were significantly lower in the glutamine than the control group (mean 3.43 ± 1.51 ng/mL vs mean 4.41 ± 1.89 ng/mL; p = 0.034; median 3.08 ng/mL [min–max: 1.30–6.59] vs median 3.77 ng/mL [min–max: 0.00–36.53]; p = 0.038, respectively). Plasma glutamine levels at 24 hours after CPB were significantly higher in the glutamine than the control group (mean 935.42 ± 319.10 μmol/L vs mean 634.79 ± 243.89 μmol/L, p = 0.001). Plasma lactate levels at 6 and 24 hours after CPB were significantly lower in the glutamine than the control group (median 5.30 mmol/L [min-max: 1.20–9.50] vs median 5.70 mmol/L [min-max: 2.80–11.30], p = 0.042; mean 2.08 ± 0.67 mmol/L vs mean 2.46 ± 0.69 mmol/L, p = 0.044, respectively). Myocardial injury score was significantly lower in the glutamine than the control group (mean 1.30 ± 0.24 vs mean 1.48 ± 0.26, p = 0.011).ConclusionPerioperative administration of 0.5 g/kg intravenous glutamine solution over the period of 24 hours has myocardial protection effect in patients with low EF who undergo elective on-pump CABG.

The Effect of Single Vessel Off-pump and On-pump Coronary Artery Surgery on Postoperative Complications

Giriş ve amaç: Günümüzde koroner bypass ameliyatları hala yaygın olarak on-pump CABG ve off-pump CABG tekniği ile yapılmaktadır. Bu retrospektif klinik çalışmada her iki cerrahi yöntemin kısa ve uzun dönem komplikasyonlarını araştırdık.&#x0D; Gereç ve Yöntemler: Bu çalışmaya 2011-2015 yılları arasında kliniğimizde Syntax skorlamasına göre izole tek damar koroner arter hastalığı olan; on-pump (Grup 1) ve off-pump (Grup 2) koroner arter cerrahisi geçiren toplam 43 hasta dahil edilmiştir. Bu hastalarda postoperatif erken dönem komplikasyonlar ve bir yıllık majör advers kardiyovasküler ve serebral olaylar karşılaştırılmıştır.&#x0D; Bulgular: Her iki grup arasında demografik verilerde istatistiksel olarak anlamlı fark saptanmadı. Postoperatif komplikasyonlar açısından atrial fibrilasyon off-pump cerrahi yapılan grupta anlamlı olarak daha az saptanmıştır. Yoğun bakımda ve hastanede kalış süreleri, pnömoni, sternal enfeksiyon ve postoperatif drenaj miktarları açısından anlamlı farklılık saptanmamıştır. Operasyon sonrası uzun dönemde majör adverse kardiyovasküler ve serebral olaylar (MACCE) açısından gruplar arasında farklılık saptanmamıştır.&#x0D; Sonuç: Sonuç olarak koroner bypass cerrahisinde uygulanacak yöntemin hastanın risk skorlamasına göre belirlenmesini öneriyoruz.

The Effect of Intraoperative Transesophageal Echocardiography Probe Placement on the Endotracheal Tube Cuff Pressure in Adult Patients Undergoing On-Pump Cardiac Surgery

The study was directed toward documentation of the effect of transesophageal echocardiography (TEE) probe insertion on the endotracheal tube cuff pressure (CP) in adult patients undergoing on-pump coronary bypass surgery. The primary objective of this study was to assess whether CP reaches supranormal pressures during the different stages of intraoperative TEE examination. The secondary objective was to observe the effect of TEE probe placement on the ventilation parameters. A prospective observational study. At a tertiary care cardiac center. Thirty-four cardiac surgical patients older than 18 years of age who required intraoperative TEE examination. TEE probe insertion. Following the induction of general anesthesia and tracheal intubation, a TEE probe was introduced. The endotracheal tube CP was recorded at 5 time zones: Before TEE probe insertion, during the insertion of the probe, during probe manipulation, probe in the transgastric position, and during removal of the probe. A nonparametric test was used for comparing intracuff pressure between pairs of time zones. There was a statistically significant difference in CP values between the baseline and those during different time zones (chi-square test=134.77, degrees of freedom=4, p=0.001). There was a statistically significant difference in the peak pressure between different time points compared to baseline (p=0.0001). TEE probe placement in patients with tracheal intubation may be associated with a significant increase in CP well above the baseline pressure. With the possibility of the mean arterial pressures during cardiopulmonary bypass being substantially lower than expected, the findings of the current study raised the concern of predisposing the tracheal mucosa to hypoperfusion, with subsequent temporary or permanent tracheal damage. Hence, at least a baseline estimation of the endotracheal tube CP at the time of tracheal intubation, with the help of a pressure gauge in the operating room, may be considered as a safe practice.

Estimated glomerular filtration rate decreased by Hydroxyethyl Starch in isolated coronary artery bypass graft surgery: A retrospective cohort study

Background/Aim: Hydroxyethyl starches have been widely used to replace the intravascular volume. They increase the risk of renal injury in critically ill patients. In cardiac surgery, patients are at risk for cardiac surgery-associated acute kidney injury. This study aims to analyze the renal functions in coronary surgery with hydroxyethyl starches and crystalloids. Methods: Patients who underwent isolated on-pump coronary artery bypass graft surgery between January 2017 and June 2019 were included in the study. They were categorized into two groups according to intraoperative volume replacement therapy. The non-HES group consisted of patients who had been given a balanced electrolyte solution; the HES group consisted of patients who were administered a balanced electrolyte solution and 500 ml of hydroxyethyl starch solution. A two-sided P-value of 0.05). In the HES group, the postoperative value of creatinine was significantly higher and estimated glomerular filtration rate level was significantly lower compared to the preoperative values (P

Impact of aspirin on bleeding and blood product usage in off-pump and on-pump coronary artery bypass graft surgery.

Major bleeding is linked to poorer outcomes following cardiac surgery. Current guidelines recommend continuation of aspirin prior to coronary artery by‐pass graft (CABG) but the effect of continuing aspirin in patients with prior indication for aspirin, in particular during off‐pump CABG (OPCABG), has not been systematically assessed. In this study, we analysed the effect of continuing aspirin prior to OPCABG and on‐pump CABG with respect to bleeding and blood product usage. We compared propensity‐matched cohorts of patients who continued aspirin until the day of OPCABG or CABG to controls (no antiplatelet) and to patients discontinuing aspirin 5–7 days prior. Length of hospital stay, 30‐day mortality and thromboembolism rates were similar for both OPCABG and CABG. During OPCABG, aspirin‐continued patients received more intraoperative red cell units compared to controls without difference in bleeding. Aspirin‐continued patients received more blood products perioperatively and bled more than aspirin‐discontinued patients undergoing OPCABG. The only difference during CABG was a small increase in the volume of cells salvaged among aspirin‐continued patients compared to controls. Current guidelines on the continuation of aspirin prior to CABG and OPCABG are safe. Continuation of aspirin prior to OPCABG may result in more bleeding and blood product usage.

Long-term Outcomes After On-Pump vs Off-Pump Coronary Artery Bypass Grafting for Ischemic Cardiomyopathy

BackgroundA post-hoc analysis of the Surgical Treatment for Ischemic Heart Failure (STICH) trial was performed to evaluate the perioperative and long-term outcomes after off-pump vs on-pump coronary artery bypass graft surgery in patients with ischemic cardiomyopathy (coronary artery disease with left ventricular ejection fraction 35% or less). MethodsPatients who underwent isolated coronary artery bypass graft surgery were enrolled from the STICH trial. Operative details, perioperative outcomes, and long-term outcomes were compared in a 1-to-2 propensity score matching cohort. The primary outcome was death from any cause. ResultsAmong 768 included patients operated on between July 2002 and May 2007, 152 (19.8%) received off-pump and 616 (80.2%) received on-pump coronary artery bypass graft surgery. In the 1-to-2 matched cohort (152 off pump and 304 on pump), off pump was associated with a higher prevalence of multiple arterial grafting (17.1% vs 8.6%, P = .01) and incomplete revascularization (34.2% vs 17.1%, P < .001). The overall 30-day mortality (3.3% vs 5.3%, P = .34) was comparable between the two groups. After a median follow-up of 8.7 years, off-pump surgery was associated with a similar risk of death from any cause (hazard ratio 0.82; 95% confidence interval, 0.61 to 1.09), with comparable estimated all-cause mortality at 1 year (12.5% vs 11.9%), 5 years (32% vs 32.8%), and 10 years (51.4% vs 62.3%). No significant interaction was detected in the subgroup analyses of incomplete revascularization, multiple arterial grafting, and three-vessel disease. ConclusionsIn patients with ischemic cardiomyopathy, off-pump coronary artery bypass graft surgery could be performed with comparable 30-day mortality and similar long-term survival, and appears to have a lower incidence of perioperative morbidities.

Stepwise Treatment for Heterotaxy Syndrome and Functional Single Ventricle Complicated by Infra-Cardiac Total Anomalous Pulmonary Venous Connection with Ductus Venosus Stent Placement and Subsequent Occlusion.

Even today, when the surgical outcome of congenital heart disease in the neonatal period has improved, the prognosis for heterotaxy syndrome and functional single ventricle complicated with total anomalous pulmonary venous connection (TAPVC), especially the infra-cardiac type, is catastrophic. We describe a strategy that combines percutaneous ductus venosus (DV) stent placement and occlusion after TAPVC repair to ensure survival from initial surgery to bidirectional cavopulmonary shunt (BCPS) procedure and facilitate subsequent treatment. Three consecutive patients with heterotaxy syndrome and functional single ventricle complicated by infra-cardiac TAPVC treated with our own strategy were retrospectively studied. In two infants, DV stent placement was performed on the day of birth. In one case at 11days of age. The risk of pulmonary vein obstruction was reduced, and on-pump surgery, including TAPVC repair, was performed on a standby basis. Since the rapid increase in hepatic enzymes occurred on postoperative day 0 to 1 in all cases, percutaneous stent occlusion was performed until postoperative day 3. The procedure improved liver function. One patient died due to severe atrioventricular valve regurgitation, one case underwent BCPS, and one patient was waiting to undergo. DV stent placement can avoid TAPVC repair in the early neonatal period. After TAPVC repair, the portosystemic shunt remained, resulting in hepatic dysfunction, but this could be improved by stent and vertical vein occlusion. A series of stepwise treatments can be useful to help such critically ill infants survive the high-risk neonatal period and achieve good BCPS circulation.

8-Isoprostanes and Asymmetric Dimethylarginine as Predictors of Mortality in Patients Following Coronary Bypass Surgery: A Long-Term Follow-Up Study.

Background: We previously demonstrated that enhanced oxidative stress and reduced nitric oxide bioavailability are associated with unfavorable outcomes early after coronary artery bypass grafting. It is not known whether these processes may impact long-term results. We sought to assess whether during long-term follow-up, markers of oxidative stress and nitric oxide bioavailability may predict cardiovascular mortality following bypass surgery. Methods: We studied 152 consecutive patients (118 men, age 65.2 ± 8.3 years) who underwent elective, primary, isolated on-pump bypass surgery. We measured plasma 8-iso-prostaglandin F2α and asymmetric dimethylarginine before surgery and twice after surgery (18–36 h and 5–7 days). We assessed all-cause and cardiovascular death in relation to these two biomarkers during a mean follow-up time of 11.7 years. Results: The overall mortality was 44.7% (4.7 per 100 patient-years) and cardiovascular mortality was 21.0% (2.2 per 100 patient-years). Baseline 8-iso-prostaglandin F2α was associated with cardiovascular mortality (HR 1 pg/mL 1.010, 95% CI 1.001–1.021, p = 0.036) with the optimal cut-off ≤ 364 pg/mL for higher survival rate (HR 0.460, 95% CI 0.224–0.942, p = 0.030). Asymmetric dimethylarginine > 1.01 μmol/L measured 18–36 h after surgery also predicted cardiovascular death (HR 2.467, 95% CI 1.140–5.340, p = 0.020). Additionally, elevated 8-iso-prostaglandin F2α measured at the same time point associated with all-cause mortality (HR 1 pg/mL 1.007, 95% CI 1.000–1.014, p = 0.048). Conclusions: Our findings indicate that in advanced coronary disease, increased oxidative stress, reflected by 8-iso-prostaglandin F2α before bypass surgery and enhanced asymmetric dimethylarginine accumulation just after the surgery are associated with cardiovascular death during long-term follow-up

Glycemic Control in Coronary Artery Bypass Graft Surgery: A Different Perspective.

BackgroundHyperglycemia during coronary artery bypass graft surgery (CABG) strongly predicts intra- and post-operative adverse consequences.ObjectivesThis study aimed to evaluate the quality of glycemic management during CABG in an academic center regarding peripheral blood and coronary sinus values.MethodsThis prospective descriptive study encompassed 55 eligible patients undergoing on-pump CABG surgery in 2020. Peripheral blood glucose (BG) was measured four times, before anesthesia induction (T0), before cardiopulmonary bypass pump (CPB) (T1), during CPB (T2), at the end of CPB (T3), and at the end of surgery (T4). The surgeon also took a sample of the coronary sinus BG.ResultsThe BG variations from T0 to T4 were statistically significant (P < 0.0001). The higher values detected in the ASA class III compared to ASA classes II were statistically significant at T1 (P = 0.01) and T2 (P = 0.025): patients with the higher BMI showed the higher levels of BG. In this regard, the differences were significant at T0 (P = 0.0001), T2 (P = 0.004), and T3 (P = 0.015). Regarding coronary sinus, the mean BG was 222.18 ± 75.74 mg/dL. It was also observed that the ASA class III (P = 0.001), longer duration of CPB (P = 0.021), higher IV fluid volume administrated during surgery (P = 0.023), higher BMI (P = 0.0001), and less urine volume at the end of surgery (P = 0.049) were significantly associated with the higher BG of the coronary sinus.ConclusionsThe existing glycemic management protocols on the CABG patients were acceptable in our hospital. However, the BG level of the coronary sinus was higher than the peripheral one.

Neuroprotective effect of memantine on serum S100-B levels after on-pump coronary artery bypass graft surgery: A randomized clinical trial.

Background:Brain injury is one of the complications of open heart surgery. Glutamate plays a key role in this process. In this study, we evaluated the neuroprotective effect of memantine as NMDAR inhibitor in patients undergoing on-pump coronary artery bypass graft surgery (CABG).Methods:From July 2019 to May 2020, thirty-four consecutive patients selected for elective isolated on-pump coronary artery bypass graft surgery (CABG) enrolled in the trial. Patients were randomly assigned into two groups; memantine and the control group. For the memantine group, 10 mg of memantine twice daily was administered at least 72 h before surgery. Venous blood samples were collected before surgery (T1), at the end of cardiopulmonary bypass (CPB) (T2), 6h and 24h after CPB (T3 and T4). Serum concentration of S100-B was measured by enzyme-linked immunosorbent assay (ELISA) technique.Results:Serum S100-B increased during CPB with a peak plasma concentration at the termination of CPB. Then it gradually decreased during the first 24 hours in both groups (P=0.001). The mean S100-B levels were significantly lower in the memantine group compared to the control group at the termination of CPB (0.863±0.203 μg/l vs 1.117±0.304 μg/l), at 6 hours post-CPB (0.731±0.168 μg/l vs 0.938±0.206 μg/l), and 24 hours post-CPB (0.595±0.189 μg/l vs 0.852±0.227 μg/l), respectively (P=0.023). The mean level of serum S100-B in memantine group was about 0.19 μg/l less than the control group during the study (CI, 0.07 to 0.30; P=0.001). One (6.2%) patient in the control group had post-operative left arm paresthesiaConclusion:Administration of memantine before on-pump CABG can attenuate the post-operative concentrations of serum S100-B, which may reduce cerebral damage during surgery.

Does the anatomical shape of the heart present as a risk factor for "off-pump" coronary surgery?

Aim: Emergency conversion to on-pump during coronary surgery is known to increase morbidity and mortality in patients undergoing off-pump coronary surgery. We aimed to investigate the relation between the anatomical position of the heart and the incidence of conversion to on-pump coronary surgery. Material and Methods: Four hundred patients, who underwent off-pump three-vessel coronary surgery during June 2010 and February 2020. The angle between the left anterior descending (LAD) artery and the left arm of the sternal retractor was used to identify the anatomical position of the heart intraoperatively after pericardiotomy. Patients were categorized as having either transvers (Position Angle&gt; 45°, n:200) or vertical (Position Angle &lt;45°, n:200) heart. Results: The conversion rate was 8.75% (35/400) in our study. Thirty-three of patients with transverse heart patients converted to on-pump surgery (16.5%), whereas the two patients(1%) in patients with vertical heart. The length of intensive care unit stay was longer in patients with conversion compared to the patients with no conversion (3.17±1.10 days and 1.11±0.11 days, respectively) (p=0.001). Inotropic support and blood transfusion requirements were higher in converted patients. The mortality rate was 14.2% in converted patients while non-converted patients had no mortality (p&lt;0.001). Conclusion: Conversion from off to on-pump during coronary surgery may cause high incidence of morbidity and mortality. Probable causes responsible for conversion should be predicted before making a decision for off-pump surgery. Anatomically transverse position of the heart may be considered as a potential predictor of conversion.

Predicting New-Onset Postoperative Atrial Fibrillation Following Isolated Coronary Artery Bypass Grafting: Development and Validation of a Novel Nomogram.

ObjectiveTo select variables associated with new-onset postoperative atrial fibrillation (POAF) following isolated coronary artery bypass grafting (CABG) and develop a nomogram for risk prediction in a Chinese population.MethodsThe study retrospectively enrolled 4854 consecutive patients undergoing isolated CABG from February 2018 to September 2019, they were divided into derivation cohort and validation cohort with a 3:1 ratio according to the order of operation date. In the derivation cohort, significant variables were selected by use of the multivariate logistic backward stepwise regression analysis and a nomogram model was built on the strength of the results. The model performance was assessed in terms of discrimination and calibration. Besides, we compared the discriminative ability for POAF of the nomogram with established prediction models (CHA2DS2-VASc and HATCH scores) in the two cohorts.ResultsPOAF occurred in 1025 (28.2%) out of 3641 patients in the derivation cohort, and in 337 (27.8%) out of 1213 patients in the validation cohort. A nomogram, composed of eight prognostic variables, namely age, sex, heart rate, hypertension, left ventricular ejection fraction (LVEF) <50%, left atrial diameter (LAD) > 40mm, estimated glomerular filtration rate (eGFR) level, and on-pump surgery, was constructed from the derivation cohort. The nomogram had substantial discriminative ability in derivation and validation cohorts with the area under the receiver operating characteristic curves (AUCs) of 0.661 (95% confidence interval, 0.642–0.681) and 0.665 (95% confidence interval, 0.631–0.699), respectively, and showed well-fitted calibration curves. Compared with CHA2DS2-VASc, HATCH and POAF scores, respectively, the nomogram had superior discrimination performance.ConclusionWe constructed a novel nomogram with improved accuracy for predicting the risk of POAF following isolated CABG, which might help clinicians predict individual probability of POAF and achieve effective prophylaxis.

Importance of anastomotic sequencing during off-pump coronary artery bypass surgery: a pilot strategy

Introduction: Off-pump coronary artery surgery is a method preferred by many surgeons today to avoid the adverse effects of cardiopulmonary bypass. However, this method was quite popular at first but was later abandoned by some surgeons due to unfavorable results. We think the anastomosis sequence is an essential issue when performing off-pump surgery. We aimed to examine the effects of this strategy on the results of off-pump coronary artery surgery. Methods: We included 601 patients with isolated coronary artery disease who underwent off-pump coronary artery bypass surgery between January 2020 and 2022. The main goal was to ensure sufficient blood was going through the myocardia while anastomosis was performed on one of the coronary arteries. We tried to create a strategy about the sequence in which we should do the coronary anastomosis. Results: In 2 patients, conversion to on-pump surgery was required in elective conditions due to hemodynamic instability during the operation (0.33%). Only 4 patients required surgical revision because of bleeding (0.67%) in the early postoperative period. We recorded wound infections that could be solved with medical therapy and routine wound dressing in 5 patients (0.83%). Discussion and Conclusion: After applying this strategy, we experienced much more minor and acceptable conversion rates than those reported in the literature. We believe this strategy will benefit other researchers who have just started practicing off-pump surgery.

Secondary neurological outcomes in patients with brachiocephalic and coronary artery disease in the early postoperative period after simultaneous and hybrid surgical treatment

Aim. To compare secondary neurological outcomes in patients with brachiocephalic and coronary artery disease in the early postoperative period after different surgical treatment strategies (simultaneous and hybrid).Methods. Secondary neurological outcomes were evaluated in 43 patients with coronary and brachiocephalic artery disease in the early postoperative period after (1) carotid endarterectomy and on-pump coronary artery bypass surgery; (2) percutaneous coronary intervention and carotid endarterectomy. Demographic, clinical, instrumental data were collected. Neuropsychological assessment was performed using the Mini-Mental State Examination and Frontal Assessment Battery. Memory, attention and neurodynamics were measured using the “Status-PF” software at days 2–3 before the surgery and at days 5–7 after it. The presence of postoperative cognitive dysfunction was estimated on the basis of criteria defined as a 20% decline on 20% of the tests. Statistical analysis was performed using the software package “Statistica 10.0”.Results. Patients who underwent hybrid intervention demonstrated improved attention and memory in the early postoperative period. Complex visual-motor reaction significantly increased in patients after simultaneous surgery. Attention differed significantly in both groups. Thus, patients from the hybrid group processed more characters per 1 and 4 minutes while completing the Bourdon proof reading test. The total number of processed characters prevailed in the hybrid group. Cognitive processing speed was higher in the hybrid group according to the brain performance test. The incidence of early postoperative cognitive dysfunction was 60% in patients after simultaneous surgery and 11% in patients after hybrid surgery (p = 0.006, OR±SE 12.5±3.2).Conclusion. Hybrid intervention has shown its superiority over simultaneous intervention in terms of low rate of early cognitive impairment, thereby confirming the necessity to take into account the obtained results while selecting the optimal surgical treatment in patients with coronary and brachiocephalic artery disease present with cognitive deficits at baseline.

Possibilities of neurocognitive rehabilitation using the dual tasks method in patients in the early postoperative period of coronary bypass surgery

Background. Previously, it has been demonstrated that the use of the dual-task method (performance cognitive and motor tasks simultaneously) in cognitive rehabilitation provides sustainable improvements in cognitive and motor functions. However, the effectiveness of the dual-task method in cardiac surgery patients has not been studied enough yet.&#x0D; Aim. To evaluate the effectiveness of the training for recovering cognitive function using a computer program of dual tasks in the early postoperative period of on-pump coronary artery bypass surgery (CABG).&#x0D; Material and methods. Sixty-two patients aged 64 [60; 69] years were examined before surgery and divided into two groups: with postoperative cognitive training (n=29) and without cognitive rehabilitation (n=33). The extended neuropsychological testing was performed 23 days before and 89 days after CABG to assess the psychomotor and executive functions (neurodynamic), attention and short-term memory, as well as the serum concentrations of markers of brain damage: neuron-specific enolase and S100 protein were measured.&#x0D; Results. The data of preoperative extended neuropsychological testing did not demonstrate between-group differences. At 810 days after CABG, 20% decrease of the cognitive indicators was detected in patients of both groups. In the group with cognitive training, the number of patients with impaired memory, attention and neurodynamics was significantly lower than in the group without training. Also, in patients who underwent cognitive rehabilitation, there was no increase in the concentrations of neuron-specific enolase and calcium-binding protein S100 compared to preoperative values, in contrast to patients without rehabilitation.&#x0D; Conclusion. The use of dual tasks computer program demonstrated a decrease in the severity of cognitive impairment after surgery.

Transapical off-pump mitral valve repair with NeoChord™ implantation: An early single-center Portuguese experience.

Transapical off-pump NeoChord DS1000™ implantation is a minimally invasive surgical mitral valve repair (MVr) procedure to treat degenerative mitral regurgitation (MR), which is performed using the NeoChord DS1000™ system with two and three-dimensional transesophageal echocardiographic guidance on a beating heart. It has been demonstrated to be safe and effective in carefully selected patients. The authors aim to analyze short-term clinical and echocardiographic results after mitral valve repair using the NeoChord™ system. All patients that underwent transapical off-pump mitral valve repair with NeoChord™ implantation at our center, between December 2017 and December 2019, were included. The procedure was performed by left minithoracotomy, under general anesthesia. All patients presented severe primary MR due to flail/prolapse of one leaflet (anterior or posterior). Eighteen patients were included in the analysis, the mean age was 65±15 years, 72% were male. The mean EuroSCORE II was 1.9±1.6. All patients had New York Heart Association (NYHA) class ≥ II. Mean effective regurgitant orifice area was 1.0±0.4 cm2, with a mean regurgitant volume 146±42 mL, and a mean leaflet-to-annulus index of 1.29±0.14. MR was due to leaflet prolapse in 50% (N=9), and flail leaflet in 50% (N=9). Anatomic type A (isolated P2 defect) was the predominant form in 66.5% (N=12). Successful repair, defined by none, trace or mild mitral regurgitation, by implantation of two to four neochordae, was achieved in all 18 patients. No major complications arose intra-procedurally. The median follow-up was 194 days. NYHA class was ≤II in 94.5% patients at six-month follow-up, which represented a significant improvement in symptomatic status (p=0.002). At follow-up, 72% of patients (N=13) had grade ≤2 MR. There was a significant reduction in mean indexed left atrium volume (63±7 mL/m2 vs. 45±6 mL/m2, p=0.038), mean indexed left ventricular end-diastolic volume (87±7 mL/m2 vs. 79±9 ml/m2, p=0.001), and pulmonary arterial systolic pressure (44±4 vs. 31±8 mmHg, p=0.002). The re-intervention rate was 11.1% (N=2, both patients underwent reintervention, either a re-do NeoChord™ or conventional MV repair on-pump surgery). No major adverse cardiac or cerebrovascular events were registered. In selected patients, minimally invasive MVr using the NeoChord™ system is safe, effective and reproducible. Early clinical and echocardiographic results suggest a significant symptomatic improvement, sustained MR grade decrease, and favorable left cardiac chamber remodeling, with low re-intervention rates. These results warrant further confirmation in larger cohorts, on longer period of follow-up.

Impact of anemia on outcomes in on-pump coronary artery bypass surgery patients.

Aim To study the contribution of preoperative anemia to the prognosis of adverse clinical events (mortality, complications, transfusion) in patients with ischemic heart disease (IHD) after myocardial revascularization in the conditions of artificial circulation.Material and methods This retrospective cohort study included 1 133 patients with IHD who had undergone isolated myocardial revascularization in the conditions of artificial circulation in 2019. The primary endpoints were mortality and a composite endpoint that included, in addition to mortality, cases of acute coronary syndrome, heart, respiratory and renal failure, neurological deficit, and infectious complications. The secondary endpoints were duration of artificial ventilation of more than 12 h, duration of stay in the resuscitation and intensive care unit (RICU) of more than one day, and duration of postoperative inpatient treatment of more than 7 days.Results Preoperative anemia was found in 196 (17.3 %) patients. The anemia was not associated with mortality but increased the risk of the composite endpoint, prolonged artificial ventilation, stay in RICU for more than one day, and red blood cell transfusion. Despite the absence of a relationship between red blood cell transfusion and mortality, the use of transfusion was associated with increased risks of the composite endpoint and prolonged stay in the RICU and hospital.Conclusion Preoperative anemia is a risk factor for adverse outcomes of myocardial revascularization in the conditions of artificial circulation. Timely treatment of preoperative anemia may improve outcomes of the treatment.