Post-coronary Artery Bypass Graft Patients Research Articles

Care of the Post-CABG Patient.

An estimated 400,000 coronary artery bypass graft operations are performed annually in the United States. Saphenous vein grafts are the most commonly used conduits; however, graft failure is common. In contrast, left internal mammary artery grafts have more favorable long-term patency rates. Guidelines recommend aggressive secondary prevention. In the 2 decades following surgery, 16% of patients require repeat revascularization, and percutaneous coronary intervention accounts for 98% of procedures performed. Post-coronary artery bypass graft patients presenting with symptoms of acute coronary syndrome or progressive heart failure should undergo early coronary angiography given the high likelihood that such a presentation represents graft failure. Percutaneous coronary intervention in degenerated saphenous vein grafts is associated with embolization that may cause the "no-reflow phenomenon," which can be avoided with the use of embolic protection devices. Hybrid revascularization procedures are a promising emerging strategy to avoid the placement of vein grafts.

Long-term outcomes of percutaneous coronary intervention in grafts and native vessels in coronary artery bypass grafting patients with diabetes mellitus.

Atherosclerosis in diabetic patients progresses fast. Evidence on how to choose target vessels of percutaneous coronary interventions (PCIs) in diabetic patients post-coronary artery bypass graft (post-CABG) is insufficient. One hundred and fifty-seven patients with diabetes and previous CABG, who underwent PCI of either a graft vessel (GV) (n=44) or a native vessel (NV) (n=113) in the National Center for Cardiovascular Disease, China, were studied. In-hospital and long-term clinical outcomes were compared between the groups. Diabetic patients with prior CABG had more PCI to native arteries, but the proportion of grafts PCI increased as time went on. Both groups had similar baseline characteristics. Group GV patients compared with group NV had more totally occluded NVs, less totally occluded grafts and more in-stent restenosis. However, there was no difference in in-hospital mortality and long-term incidence of major adverse cardiac event (MACE), cardiac death, nonfatal myocardial infarction (MI), or revascularization. Multivariate logistic regression analysis showed that PCI success [hazard ratio (HR), 11.488; 95% confidence interval (CI), 1.135-116.303; P<0.05] was independent predictor of MACE. It suggested similar long-term clinical outcomes after PCI in GV or NV in prior CABG patients with diabetes. Thus, the vessel with higher estimated PCI success rate should be prioritized by operators.

Comparison of Left Radial Versus Femoral Approaches for Coronary Procedures in Patients with Previous Coronary Artery Bypass Grafts

Aims: Radial approach is gaining the momentum as a default technique for coronary procedures. Limited trails are available for post coronary artery bypass graft (CABG) patients to compare the merits of femoral &amp; radial access.&#x0D; Methods: It is a single-center study conducted in between January, 2013 to December, 2015. During this study period, post CABG patients were blindly assigned to its five high volume operators. Coronary angiography &amp; intervention procedures were performed by left radial or femoral approach as per assigned operator's choice. Contrast volume was the primary endpoint whereas the procedure &amp; fluoroscopy time, procedural success, access site major bleeding, pre discharge major adverse cardiac event (MACE) were the secondary endpoint both for coronary angiogram (CAG) &amp; percutaneous coronary intervention (PCI).&#x0D; Results: Total 380 post CABG patients were included in this study period. Radial access (n=155) was lower than femoral access (n=225). Compared with femoral access, diagnostic CAG required relatively lower contrast volume though statistically not significant via radial access (70±34 vs. 72±40 ml, p=0.267). Procedure time (25.2±10.7 vs. 26.9±6.8 min, p=0.735), fluoroscopy time (10.7±5.5 vs. 9.5±4.7 min, p=0.424) were almost similar in both access for CAG. Other secondary clinical endpoints were similar among both groups. Interestingly, adhoc PCI was more frequent in radial group (n=54 out of 155, 34.8%) than in femoral group (n=44 out of 225, 19.6%) with p=0.01. Contrast volume in between two groups was pretty similar with p=0.226. The incidence of other secondary endpoints was also not statistically significant.&#x0D; Conclusion: Coronary angiography for post CABG patients through left radial approach seems to be effective, non-inferior in terms of contrast volume, procedure &amp; fluoroscopy time &amp; other clinical end points comparing to femoral access.&#x0D; Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 11-16

Frequency of neck pain and its associated factors among Post CABG patients

Background: Chronic postoperative pain (CPOP) is a well-recognized problem in Post-Coronary artery bypass grafting (CABG) patients. Post CABG upper extremity pain is found to be common among these patients effecting quality of life and hinders with the routine activities. The aim of this study was to identify the frequency of neck pain and its associated factors among post-operative CABG patients.&#x0D; Methodology: A cross-sectional study was conducted in Dow University of Health Science, Karachi between April 2018 to November 2018. The sample size 78 was calculated by open epi calculator. Both male and female Postoperative CABG patients with a one-year follow-up were selected with or without neck pain aged between 30-75 years from Outpatient Department. Patients below &lt;30 years of age and those with any other surgeries before or any malignant disease were excluded from the study sample. A questionnaire was given to grade their overall experience of pain on Visual Analogue Scale (VAS) and to fill out Neck Disability Index (NDI) for their neck pain. The data was analysed using SPSS version 21 and Chi square T-test was applied to evaluate the significance.&#x0D; Results: Out of 78 patients there were 32 (41%) females and 46 (58%) males with a mean age range between 30-75 years. 51.3% had neck pain presented within 12 hours of onset of symptoms while 48% had no complaint of neck pain. After CABG, 40 (51.2%) patients developed pain in their neck within 1 year of follow up. The mean VAS score was 5.32 out of 10 points on the basis of which 38 patients didn’t experienced any pain while 20 suffered from moderate pain, 12 from severe pain and 8 patients from mild pain.&#x0D; Conclusion: Patients following CABG surgery develop neck pain within one-year follow-up associated with restricted neck and shoulder range of motion. They also experienced muscle tenderness in their trapezius and sternocleidomastoid muscles followed by frequent headaches.

Health Related Quality of Life of Patients after Cardiac Surgery

Introduction: Cardiovascular disease (CVD) is the primary cause of disability and morbidity in many developed countries around the world. But timely management with cardiac surgery can reduce the mortality.&#x0D; Objectives: To assess the health related quality of life (HRQOL) of the CVD patients after coronary artery bypass grafting (CABG).&#x0D; Materials and Methods: This cross-sectional observational study was carried out among purposively selected CABG patients from January to December 2013. A total of 78 post CABG patients were interviewed with short form health survey (SF-36) questionnaire at different hospitals in Dhaka.&#x0D; Results: The study patients age ranged from 40 to 82 years and the proportion were higher among those of more than 60 years (38.5%) of age. Majority (48.7%) were educated up to HSC level. Explaining the characteristics of illness, the average duration of sufferings was 121.91±115.31 days and Post treatment duration in month was 14.97±19.25. The study findings showed a good level of QOL; with an average score of 78.2. The mental and physical components scores were 79.9 &amp; 77.1 respectively. There were statistically significant (p&lt;0.001) negative association between age and total component of quality of life of patients. In relation with sex, average total quality of life scores of male and female were 80.5±10.5 and 74.4±14 respectively which was statistically significant (p&lt;0.001). Similarly, comparing to pre-treatment state, statistically significant (p&lt;0.001) difference was found between groups quality of life. Similarly statistically significant difference was found with occupation in relation to total quality of life (p&lt;0.001), physical component (p&lt;0.01) and with mental component (p&lt;0.05) of participants.&#x0D; Conclusion: Subjective perceptions of physical and psychological well-being changed significantly from before treatment to at least 3 months after treatment and better HRQOL noticed to the patients treated with CABG.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 50-53

Adiposity in relation to readmission and all-cause mortality following coronary artery bypass grafting: A systematic review and meta-analysis.

This study systemically reviewed evidence linking adiposity to readmission and all-cause mortality in post-coronary artery bypass grafting (CABG) patients. Keyword/reference search was performed in PubMed, Web of Science, CINAHL, and Cochrane Library for articles published before June, 2018. Eligibility criteria included study designs: experimental/observational studies; subjects: adult patients undergoing CABG; and outcomes: hospital/clinic readmissions, and short-term (≤30days) and mid-to-long-term (>30days) all-cause mortality. Seventy-two studies were identified. Meta-analysis showed that the odds of post-CABG readmission among patients with overweight was 30% lower than their normal-weight counterparts and the odds of mid-to-long-term post-CABG mortality among patients with overweight were 20% lower than their normal-weight counterparts. In contrast, no difference in post-CABG readmission rate was found between patients with obesity and their nonobese counterparts; no difference in short-term or in-hospital post-CABG mortality rate was found between patients with overweight or obesity and their normal-weight counterparts; and no difference in mid-to-long-term post-CABG mortality rate was found between patients with obesity and their normal-weight counterparts. In conclusion, patients with overweight but not obesity had a lower readmission and mid-to-long-term mortality rate following CABG relative to their normal-weight counterparts. Preoperative weight loss may not be advised to patients with overweight undergoing CABG.

The Effect of Preoperative Neutrophil-Lymphocyte Ratio On Quality of Life After Coronary Artery Bypass Graft (CABG) Surgery

Neutrophil-lymphocyte ratio (NLR) is an inexpensive and easily accessible inflammatory biomarker. Studies have shown the ability of NLR to predict poor outcome in many diseases. This study aimed to determine the relationship between NLR and cardiovascular risk factors, and duration of ICU and hospital stay in post CABG patients. 137 patients who underwent CABG between 2013 and 2017 with available preoperative neutrophil and lymphocyte counts were included in the study. NLR was found to be increased in patients who had prolonged intensive care unit (ICU) stay and hospital/ ward stay. Thus NLR can potentially be used to predict worse outcome.Keywords: Neutrophil-lymphocyte ratio; coronary artery bypass graft (CABG); mortality; length of stay (maximum 4 keywords) eISSN: 2398-4287 © 2019. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &amp; Surveying, Universiti Teknologi MARA, Malaysia.DOI: https://doi.org/10.21834/e-bpj.v4i10.1628

Initial T wave morphology in the chest leads in patients presenting with anterior ST-segment elevation myocardial infarction and its correlation with spontaneous reperfusion of the left anterior descending coronary artery

Background: T wave inversion in leads with ST-segment elevation after reperfusion therapy is considered a sign of reperfusion. However, the significance of T wave inversion on presentation before the initiation of reperfusion therapy is unclear. Aim of the Work: The current study aimed to assess whether the initial T wave morphology in the electrocardiographic (ECG) at presentation can predict patency of the left anterior descending artery (LAD) in patients with acute anterior ST segment elevation myocardial infarction (STEMI) before undergoing primary percutaneous coronary interventions (PCIs). Methods: This study included ninety patients who presented to the emergency department with acute anterior ST-elevation MI. We excluded patients with bundle branch block, postcoronary artery bypass grafting patients, patients with paced rhythm, and patients who received thrombolytic therapy. The T wave morphology in the 2 leads with maximal ST-segment elevation on the presenting ECG was identified as one of the three morphologies, positive T waves (T+; initial positive deflection ≥0.5 mm above the isoelectric line), biphasic T waves (T+/−; where the T wave initially showed a positive deflection above the ST segment afterward followed by a negative deflection ≥0.5 mm below the isoelectric line), and negative T waves (T−; where the T wave initially showed a negative deflection ≥0.5 mm below the isoelectric line without showing any initial positive deflection). Then, according to the results of the initial angiography, patients were classified into spontaneous reperfusion (SR) (those with thrombolysis in MI [TIMI] II or TIMI III flow in the infarct-related artery [IRA] prior to intervention) or non-SR (those with TIMI 0 or TIMI I flow in the IRA prior to intervention). Results: Ninety consecutive patients (77 males and 13 females) presented by STEMI and treated by primary PCI at cath lab of Ainshams University Hospitals (a 24/7 tertiary referral center for primary PCI) between January 2015 and March 2016 were included in this study, of which 40 patients (44.4%) had positive T waves (T+), 34 patients (37.8%) had negative T waves (T−), and 16 patients (17.8%) had biphasic T waves (T+/−). Initial angiogram showed that 18 patients had SR and 72 patients had no SR. With regard to T wave morphology, negative T waves were significantly present in SR group (66.7% vs. 30.6%, P = 0.004), whereas positive T waves were predominantly present in non-SR (50% vs. 22.2%, P = 0.033). Conclusions: For SR of LAD in anterior STEMI patients, prior to primary PCI, T wave inversion had a good sensitivity of 66.7%, a specificity of 69.4%, and a good negative predictive value of 89.29%.

Effect of self-care interventions on sleep quality in post-coronary artery bypass grafting patients: A single-center, randomized-controlled study.

This study aims to evaluate the effect of self-care interventions based on sleep hygiene practices, nutrition, and physical activity on sleep quality in post-coronary artery bypass grafting patients. This randomized-controlled study included a total of 146 patients (109 males, 37 females; mean age 55.31 years; range, 41 to 65 years) who underwent isolated coronary artery bypass grafting at Seyyed Al- Shohada Hospital of Urmia Medical Sciences University, between September 2017 and May 2018. The patients were divided into two groups as the self-care intervention group (n=73) and as the control group (n=73). The self-care intervention group received six educational courses on sleep hygiene, nutrition, and physical activity. Then they received individualized consulting weekly for three months. The control group was instructed to continue their normal life and routine care and received no education. The Demographic Information Form and the Pittsburgh Sleep Quality Index were used for data collection. The mean Pittsburgh Sleep Quality Index scores in the self-care intervention group decreased to 7.1±2.3 after the intervention, while it increased to 9.5±2.1 in the control group. There was no significant difference between the two groups in terms of the mean global Pittsburgh Sleep Quality Index scores before the study (p=0.91); however, the scores were statistically significantly higher after the self-care intervention (p=0.001). Patients undergoing coronary artery bypass grafting may benefit from self-care interventions based on sleep hygiene, nutrition, and physical activity to improve the quality of sleep.

EFFECT OF PHASE I CARDIAC REHABILITATIONON QUALITY OF LIFE IN POST CABG PATIENTS

Coronary artery bypass grafting (CABG) is one of the most frequently performed surgical procedures. Supervised exercise program has been recommended to facilitate recovery immediately after surgery. Cardiac rehabilitation services are administered in 3 phases of which Phase I mean the immediate post-operative period in an acute care hospital. The aim of the present study was to demonstrate the effect of the phase I CR on post CABG patients. 30 post CABG patients were taken, which were divided into control and experimental groups of 15 patients each. The patients were free from post-operative complications and medically stable. The SF36 is a widely used valid generic health related QOL questionnaire. It was used to assess the patients after phase I CR. The major domain of the physical component of the health in SF36 comprised of PF, BP, RP and GH. The experimental group scored higher in all these components except BP. The mental health component included vitality, social function, role emotional and mental health. When physical component score and mental component scores in both groups were compared, the difference was found to be significant in favour of the experimental group in both the scores. In the present study, the incorporation of CR has not resulted in any post-operative complications over and above the control group. None of the patients of the exercise group developed any adverse effect during hospital stay. This indicates the protocol used in the study is feasible and safe to be applied .Limitations of the study included a relative small sample size and lack of follow up.

Assessment of Adherence with Lifestyle Modification and Drug Regimen: To Develop a Mobile App

Introduction: WHO (2003) estimates that only about 50% of patients with chronic diseases follow treatment recommendations. Non-adherence to lifestyle modification and medication regimen among Coronary Heart disease CHD patients post Coronary Artery Bypass Grafting (CABG) is a major area of concern. It is essential for post CABG patients to adhere with the prescribed regimen to prevent complications and to save their life. Smart phone applications have the potential to address the complexity of non-adherence behaviour regarding both medical treatments and lifestyle modification. Objectives: The objectives of the study were to assess the level of adherence with lifestyle modifications and drug regimen, to identify factors contributing to adherence with lifestyle modifications and drug regimen among post CABG patients to establish association between adherence with lifestyle modification and drug regimen and selected socio-demographic variables i.e. age, sex, education, income and marital status and to develop and disseminate mobile application for modifying lifestyle and improving adherence to drug regimen. Methodology: A descriptive research design included 50 post CABG patients who were attending cardiac surgery OPD during data collection period and were selected by purposive sampling technique. Data was gathered through interview schedule and was analysed using descriptive and inferential statistics using software SPSS 10. Results: It showed that more than half of the subjects (52%) were non-adherent to lifestyle modification and only (48%) were adherent to lifestyle modification. Study also revealed that majority of subjects (80%) were adherent to drug regimen and only (20%) were non-adherent to drug regimen. Among factors contributing to adherence, knowledge about importance of adherence to diet and exercise were having most significance. Busy schedule found to be an important factor affecting adherence to exercise regimen. Motivational factors like support from family member or partner in following diet exercise and drug regimen were found very significant. There were no significant association found between selected variables i.e. age, sex, education, income, marital status of subjects and their level of adherence. Conclusion: The study concluded that the majority of the subjects were non-adherent to lifestyle modification but majority of them are adherent to drug regimen. Among factors contributing to adherence, knowledge, time, motivation, beliefs and forgetfulness were significant. There were no significant association found between level of adherence and selected socio-demographic variables.

Hypotheses, rationale, design, and methods for evaluation of a randomized controlled trial using Tocotrienol, an isomer of Vitamin E derived from palm oil, on the prevention of atrial fibrillation after coronary artery bypass grafting surgery

Background: One of the most common complications following coronary artery bypass grafting (CABG) surgery is atrial fibrillation (AF), which contributes towards increasing morbidity and mortality, length of hospital stay (LoHS) and reduced quality of life (QoL) of patients. Objectives: To determine whether the intake of Tocotrienol, a Vitamin E isomer derived from palm oil, before and immediately following CABG prevents AF, reduces LoHS, and improves the QoL of patients. Protocol: The study is registered with the National Medical Research Register with a trial number NMRR-17-1994-34963 and designed as a prospective, randomized controlled trial (RCT) with parallel groups. The experimental group will receive two 200mg Tocotrienol capsules each day, while the control group will receive two identical placebo (palm Super Olein) capsules per day. ECG readings will be used to detect AF post operatively, LoHS will be measured by checking the records from the National Heart Institute Hospital register, and the health-related Quality of Life (HRQoL) analysis (the Malay version of the Short Form 36 Questionnaire) will be used to analyse QoL. The sample size was calculated to be 140 in each arm of the RCT for a power of 0.8 and a significance level of 0.05. Funding: HOVID Berhad funds this research project. Expected outcomes: The primary endpoint is the development of postoperative AF, whilst the secondary endpoints are the LoHS and HRQoL of patients post CABG. Future implications: Prevention of AF and its complications such as cardiovascular or cerebrovascular events, especially stroke, is an important output. Malaysia is one of the biggest producers and exporters of palm oil and palm oil products. Thus, the possibility of marketing Tocotrienol, in reducing AF post CABG surgery, is a very important proposition indeed. Trial number: NMRR-17-1994-34963

Utility of Timed Up and Go in Outpatient Cardiology Clinics.

The aim of the study was to examine if the Timed Up and Go (TUG) Test would be a feasible, reproducible, and valid measure in patients post-coronary artery bypass grafting (CABG). Cross-sectional study, controls and patients post-CABG, outpatient clinic. Participants performed the TUG Test and the 6-Minute Walking Distance (6MWD) Test. Reliability was measured within observer on two occasions. Patients and controls were similar in age. The patients had greater TUG mean (SD) of 14.4 seconds (4.9 seconds) and lower 6MWD of 358 m (76 m) compared with TUG of 8.2 seconds (2.7 seconds) and 6MWD of 487 m (56 m) in controls. In patients, intraclass correlation for the TUG was .98 (95% CI [.96, .98]) between the measurements. In patients, there was a high correlation between the TUG Test and the 6MWD Test, r = -.70, p < .001. The TUG Test demonstrated to be a feasible, reproducible, and valid measure in patients post-CABG. The TUG Test could serve as a screening tool for physical performance in clinics.

P-wave duration is a predictor for long-term mortality in post-CABG patients.

Risk stratification in secondary prevention has emerged as an unmet clinical need in order to mitigate the Number-Needed-to-Treat and make expensive therapies both clinically relevant and cost-effective. P wave indices reflect atrial conduction, which is a sensitive marker for inflammatory, metabolic, and pressure overload myocardial cell remodeling; the three stimuli are traditional mechanisms for adverse clinical evolution. Accordingly, we sought to investigate the predictive role of P-wave indices to estimate residual risk in patients with chronic coronary artery disease (CAD). The cohort included 520 post-Coronary Artery Bypass Grafting patients with a median age of 60 years who were followed for a median period of 1025 days. The primary endpoint was long-term all-cause death. Cubic spline model demonstrated a linear association between P-wave duration and incidence rate of long-term all-cause death (p = 0.023). P-wave >110ms was a marker for an average of 425 days shorter survival as compared with P-wave under 80ms (Logrank p = 0.020). The Cox stepwise regression models retained P-wave duration as independent marker (HR:1.37; 95%CI:1.05–1.79,p = 0.023). In conclusion, the present study suggests that P-wave measurement may constitute a simple, inexpensive and accessible prognostic tool to be added in the bedside risk estimation in CAD patients.

Hypotheses, rationale, design, and methods for evaluation of a randomized controlled trial using Tocotrienol, an isomer of Vitamin E derived from palm oil, on the prevention of atrial fibrillation after coronary artery bypass grafting surgery

Background: One of the most common complications following coronary artery bypass grafting (CABG) surgery is atrial fibrillation (AF), which contributes towards increasing morbidity and mortality, length of hospital stay (LoHS) and reduced quality of life (QoL) of patients. Objectives: To determine whether the intake of Tocotrienol, a Vitamin E isomer derived from palm oil, before and immediately following CABG prevents AF, reduces LoHS, and improves the QoL of patients. Protocol: The study is registered with the National Medical Research Register with a trial number NMRR-17-1994-34963 and designed as a prospective, randomized controlled trial (RCT) with parallel groups. The experimental group will receive two 200mg Tocotrienol capsules each day, while the control group will receive two identical placebo (palm Super Olein) capsules per day. ECG readings will be used to detect AF post operatively, LoHS will be measured by checking the records from the National Heart Institute Hospital register, and the health-related Quality of Life (HRQoL) analysis (the Malay version of the Short Form 36 Questionnaire) will be used to analyse QoL. The sample size was calculated to be 140 in each arm of the RCT for a power of 0.8 and a significance level of 0.05. Funding: HOVID Berhad funds this research project. Expected outcomes: The primary endpoint is the development of postoperative AF, whilst the secondary endpoints are the LoHS and HRQoL of patients post CABG. Future implications: Prevention of AF and its complications such as cardiovascular or cerebrovascular events, especially stroke, is an important output. Malaysia is one of the biggest producers and exporters of palm oil and palm oil products. Thus, the possibility of marketing Tocotrienol, in reducing AF post CABG surgery, is a very important proposition indeed. Trial number: NMRR-17-1994-34963

A study protocol for a randomized controlled trial on the prevention of atrial fibrillation after coronary artery bypass grafting surgery using Tocotrienol, an isomer of Vitamin E derived from palm oil

Background: One of the most common complications following coronary artery bypass grafting (CABG) surgery is atrial fibrillation (AF), which contributes towards increasing morbidity and mortality, length of hospital stay (LoHS) and reduced quality of life (QoL) of patients. Objectives: To determine whether the intake of Tocotrienol, a Vitamin E isomer derived from palm oil, before and immediately following CABG prevents AF, reduces LoHS, and improves the QoL of patients. Protocol: The study is registered with the National Medical Research Register with a trial number NMRR-17-1994-34963 and designed as a prospective, randomized controlled trial (RCT) with parallel groups. The experimental group will receive two 200mg Tocotrienol capsules each day, while the control group will receive two identical placebo (palm Super Olein) capsules per day. ECG readings will be used to detect AF post operatively, LoHS will be measured by checking the records from the National Heart Institute Hospital register, and the health-related Quality of Life (HRQoL) analysis (the Malay version of the Short Form 36 Questionnaire) will be used to analyse QoL. The sample size was calculated to be 140 in each arm of the RCT for a power of 0.8 and a significance level of 0.05. Funding: HOVID Berhad funds this research project. Expected outcomes: The primary endpoint is the development of postoperative AF, whilst the secondary endpoints are the LoHS and HRQoL of patients post CABG. Future implications: Prevention of AF and its complications such as cardiovascular or cerebrovascular events, especially stroke, is an important output. Malaysia is one of the biggest producers and exporters of palm oil and palm oil products. Thus, the possibility of marketing Tocotrienol, in reducing AF post CABG surgery, is a very important proposition indeed. Trial number: NMRR-17-1994-34963

The Effect of Negative Pressure Applied on Chest Tubes in the Amount of Pleural Effusions in Postcoronary Artery Bypass Grafting Patients

Background: Application of negative pressure on chest tubes is one of the most common methods for management of chest tubes drainage after cardio-thoracic surgeries. However, the effect of this measure on long-term outcome of these patients and especially on postoperative pleural effusions is not thoroughly evaluated. For this reason, we designed a clinical randomized trial for the evaluation of the effect of negative pressure application on early and late pleural effusions after coronary artery bypass grafting (CABG) operations. Methods: A total of 440 patients entered in this study and divided into two groups: 220 patients, their chest tubes managed by application of −10–−20 cmH2O negative pressure (negative pressure drainage group) and those who managed conventionally by simple under-water seal method (control group, n = 220). Evaluation for pleural effusion performed by signs and symptoms and chest X-rays at 3rd and 7th postoperative days and for those became symptomatic after 30th day of operation. Results: The occurrence of moderate and massive effusions at 3rd and 7th days after operation was the same in both groups. The most striking difference was in patients' required pleural tap or chest tube insertion, late after surgery due to pleural effusion. This was significantly more common in patients in control group (P

Acute hemodynamic response to pranayama in postcoronary artery bypass graft patients

Background: Pranayama is a science of breathing which involves prolongation and control of breath. It is known through various studies that yogic practices improve respiratory and cardiovascular function, reduce stress, anxiety and enhance overall well-being and quality of life. However, hemodynamic effects of short term yoga are not well known. Objective: To study the acute hemodynamic effects of pranayama in stable post coronary artery bypass grafting (CABG) patients. Study Design: Case control study. Methods: 60 post CABG patients were divided into - a) study group and b) control group (30 patients each). Cardiorespiratory parameters were noted in control group without pranayama and in study group, 5, 10, 15, 20 and 30 minutes after pranayama. Results were analyzed statistically. Results: There was a reduction in systolic blood pressure (126.10 ± 14.54 to 118.67 ± 13.74; p<0.05), diastolic blood pressure (63.1 ± 10.08 to 58.5 ± 8.1; p<0.05), respiratory rate (27.4 ± 5.1 to 22.7 ± 3.5; p<0.05) and systemic vascular resistance (1164.2 ± 189.8 to 1056.4 ± 153.2; p<0.05) after short term pranayama in the intervention group. The reduction was statistically significant when compared to control group. The heart rate, peripheral capillary oxygen saturation, cardiac output, cardiac index and pulmonary vascular resistance also changed but the change was not statistically significant in comparison to control group. Conclusion: Pranayama leads to decrease in systolic blood pressure, diastolic blood pressure, respiratory rate and systemic vascular resistance.

Prevalence of depression and its associated factors in patients post-coronary artery bypass graft surgery.

This research aimed to determine the depression level and its correlation experienced by post-coronary artery bypass graft patients after being discharged from cardiac intensive care units. A cross-sectional design was employed for assessing variables. The Self-rating Depression Scale, as proposed by Zung, was used by the researchers on a convenience sample of Jordanian patients (N = 143) who were approached soon after their discharge from the targeted units. The results suggested that the level of depression among Jordanian patients was relatively high (M = 62.7, SD = 5.6). Moreover, depression was significantly higher among female, unmarried and unemployed patients. Patients who received their information about coronary artery bypass graft surgery from nurses had a lower level of depression. Age, length of stay in the cardiac intensive care unit and hospital type significantly predicted the level of depression. The research concluded that the post-coronary artery bypass graft patients who experienced an early onset depression required more attention to highlight the importance of supportive interventions.

Review: Prevalence of depression and its associated factors in patients post-coronary artery bypass graft surgery.

Review: Prevalence of depression and its associated factors in patients post-coronary artery bypass graft surgery.