Post-coronary Artery Bypass Graft Patients Research Articles

EFFECTS OF TAI CHI EXERCISES ON PHYSICAL ACTIVITY AND PULMONARY FUNCTION IN PATIENTS WITH CORONARY ARTERY BYPASS GRAFTING

Objective: To determine the effects of Tai Chi exercises on physical activity, pulmonary function, and rate of perceived exertion in post-coronary artery bypass grafting patients. Material and Methods: A Randomized control trial was conducted in the Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan from January 2018 - July 2018. 50 post-coronary artery bypass grafting patients were calculated by the open epi tool and randomly allocated into two groups in equal halves through non-probability purposive sampling with the toss the coin method. 40-60 years males and females with >40% ejection fraction were included while vitally unstable patients were excluded. The experimental group was given Tai Chi exercises while the control group was given a bicycle. Levels of physical activity and pulmonary functions were assessed at baseline, 4thand 6th week of training. Results: Out of the total sample size only 39 were analyzed 11 were dropped off due to not following proper follow-up, and there was no statistical difference in heart rate P=0.095. Oxygen saturation shows a significant difference with P<0.001, Physical activity was low at baseline but after exercise training, the Tai Chi group showed great improvement P< 0.01. Pulmonary functions showed statistically insignificant results P=0.865. The rate of perceived exertion was high in 2nd week and gradually decreased with the mean of 3.20 and 3.37 while the time of exercise was improved with P<0.01. Conclusion: Tai Chi exercises have better improvement in pulmonary function, rate of perceived exertion, time of exercise, and physical activity in post-coronary artery bypass grafting patients. Keywords: Coronary artery bypass grafting, pulmonary functions, physical activity, rate of perceived exertion, Tai Chi

The effect of resistance training on PCSK9 levels in patients undergoing cardiac rehabilitation after coronary artery bypass grafting: a randomized study

BackgroundResistance training is commonly recommended as part of secondary prevention for post-coronary artery bypass graft (CABG) patients in conjunction with aerobic exercise. Despite its potential benefits, there is currently a lack of studies investigating the impact of resistance training on proprotein convertase subtilisin kexin 9 (PCSK9).AimTo evaluate the effect of intensive resistance training on proprotein convertase subtilisin kexin 9 (PCSK9) levels among post-CABG patients undergoing cardiac rehabilitation (CR).MethodsIn this prospective, open-label, randomized trial, 87 post-coronary artery bypass graft (CABG) patients were randomly assigned into two groups: moderate to high intensity resistance training and aerobic training (n = 44) or aerobic training alone (n = 43) for a total of 12 sessions. Changes in PCSK9 levels was determined as a primary endpoint, while secondary endpoints included changes in the six-minute walk test (6-MWT) results, aerobic capacity, WHO-5 well-being index, fasting blood glucose, and lipid profile. Both groups underwent intention-to-treat analysis.ResultsFollowing completion of cardiac rehabilitation program, the intervention group demonstrated a significant decrease in mean PCSK9 levels when compared to the control group (β = -55 ng/ml, 95% CI -6.7 to -103.3, p = 0.026), as well as significant improvements in the 6-MWT result (β = 28.2 m, 95% CI 2.4–53.9, p = 0.033), aerobic capacity (β = 0.9 Mets, 95% CI 0.1–1.7, p = 0.021), and WHO-5 well-being index (β = 8.1, 95% CI 2.0–14.4, p = 0.011) in patients who received resistance and aerobic training. No statistically significant changes were observed in fasting blood glucose, cholesterol, LDL-C, HDL-C, and triglyceride levels.ConclusionResistance training in CR significantly reduced PCSK­9 levels and increases patient’s functional capacity and quality of life. (NCT02674659 04/02/2016).

EFFECTS OF NURSING INTERVENTIONS ON SELF CARE AND WOUND MANAGEMENT AMONG POST- CORONARY ARTERY BYPASS GRAFTING PATIENTS

Coronary Artery Bypass Grafting (CABG) is a standard cardiac procedure with potential post-operative challenges, including wound management and self-care deficiencies. The role of nursing interventions in improving self-care among these patients remains crucial. This study aimed to determine the effects of nursing interventions on self-care and wound management among post-coronary artery bypass grafting patients. Employing a quasi-experimental design, the study conducted pre-post comparisons in a single group of 36 post-CABG patients. The participants, predominantly middle-aged with a mean age of 61, were profiled based on various demographic and health parameters. Nursing interventions were assessed using pre-defined scales and the Bates-Jensen Wound Assessment Tool to determine the pre- and post-intervention status of the individuals. The interventions revealed significant improvements in several care dimensions: Physical Care improved from a pre-intervention mean score of 51.61 (SD=1.82) to 61.97 (SD=2.55), witnessing a mean difference of -10.36 (95% CI: -10.79 to -9.93, p=0.000). Emotional care experienced a surge from 31.61 (SD=1.82) to 38.72 (SD=2.34), resulting in a mean difference of -7.11 (95% CI: -7.42 to -6.80, p=0.000). Spiritual care enhanced from 43.64 (SD=1.82) to 50.94 (SD=2.70) with a mean difference of -7.31 (95% CI: -7.78 to -6.84, p=0.000). Workplace Self-Care marked an increase from 36.61 (SD=1.82) to 45.06 (SD=2.03), having a mean difference of -8.44 (95% CI: -8.90 to -7.99, p=0.000). Balance scores bettered from 5.06 (SD=0.98) to 7.58 (SD=0.73), showing a mean difference of -2.53 (95% CI: -2.70 to -2.36, p=0.000). In contrast, Psychological Care saw a decline from 51.11 (SD=2.38) to 41.61 (SD=1.82) with a mean difference of 9.50 (95% CI: 9.06 to 9.94, p=0.000). The nursing interventions positively affected several self-care dimensions, aiding in the holistic recovery of post-CABG patients. However, a decrease in psychological care scores suggests the necessity for an integrated approach that equally addresses all care dimensions, including psychological care.

Risk factors associated with saphenous vein graft aneurysm after coronary artery bypass graft

Introduction: Saphenous vein graft aneurysm (SVGA) is a rare but life-threatening complication following coronary artery bypass grafting (CABG). The authors aim to identify the potential risk factors that lead to SVGA in post-CABG patients. Methods: A systematic review of original studies, observational studies, systematic reviews, meta-analyses, case studies, and case series was conducted using PubMed, Web of Science, Scopus, EMBASE, and Google Scholar involving adult patients (>18) with SVGA after CABG using MESH terminology in a broad search strategy. All searches were performed and analyzed according to PRISMA and duplicates were removed via Rayyan. Two independent investigators extracted and assessed the data involving demographics, and baseline data related to CABG and its manifestations. Results: Out of 487 finalized articles, 14 of them matched the inclusion requirements and reported 12 cases of SVGAs following CABG. Atherosclerosis with intimal calcification was the most common risk factor followed by infection. Others included hyperlipidemia, pneumonia, and cardiac pathologies mostly related to the ventricles and valves. Conclusion: Atherosclerosis associated with intimal calcification is the most common risk factor. Patient outcomes seem to improve upon early identification and regular follow-up imaging. The exclusion criteria indicated the study’s limits, and future studies that address these constraints may be able to better understand the risk variables involved in the genesis of SVGA.

Hesperidin reduces depressive symptoms in post-coronary artery bypass graft patients with mild depression.

Previous studies have shown that hesperidin may have beneficial effects on depression; however, to the best of our knowledge, no clinical trial has yet been conducted in this area. The aim of the present study was, therefore, to determine the effects of hesperidin on depression, serum brain-derived neurotrophic factor (BDNF), and serum cortisol levels in post-coronary artery bypass graft (CABG) patients. Toward this goal, 73 post-CABG patients with depression symptoms were enrolled. The participants were randomly divided into two groups to receive either 200 mg/day hesperidin (n = 38) or placebo (n = 35) for 12 weeks. Depressive symptoms, serum BDNF, and cortisol levels were then assessed at the baseline and after intervention. Beck Depression Inventory-II (BDI-II) was also used to determine the severity of depression. Sixty-six patients completed the trial. Hesperidin decreased depression severity after 12 weeks, as compared to placebo (p = .004), but serum BDNF and cortisol were not statistically significantly different in the two groups after the intervention. Subgroup analyses also showed that, while in the patients with mild depression, the score of BDI-II was significantly different in the hesperidin and placebo groups after intervention; there was no difference in the severity of depression between the two groups in patients with moderate-to-severe depression. To conclude, a dose of 200 mg/day hesperidin may reduce depressive symptoms after 12 weeks in post-CABG patients with mild depression.

Management of anxiety and depression in post coronary artery bypass graft surgery

Depression and anxiety are common events in 30-40 percent of post coronary artery bypass graft (CABG) surgery patients. Depression symptoms in patients with CAD are expected to be significantly more, comparing the public incidence rate. Impaired remedy after coronary artery events may partly be attributed to depression and anxiety. If anxiety continues, it may lead to elevate metabolism and oxygen consuming. High level of anxiety increases the pain sensation in post CABG patients. This paper aimed to review results and findings of previous studies in the field of anxiety and depression management of post coronary artery bypass graft surgery. Up to 78 credited studies collected and compared in this review. Findings revealed that depression and anxiety could more complicate medical post CABG remedy. In addition, preoperative depression and anxiety symptoms would be persisted in post CABG recovery. Therefore, prior patients training about depression and anxiety symptoms would be wise strategy to help them describe their psychological mood before and after surgery. Findings also suggest that anxiety amplified depression prevalence in post CABG patients. Among the other methods, Benson relaxation is the best complementary medicine to mitigate pre-CABG anxiety. In addition, massage and music therapy could influence on post CABG anxiety and depression. There are also some robust evidences, indicating that perceived social support could influence post CABG anxiety and depression. Furthermore, sedative (such as propofol) and opioid and non-opioid analgesics, which used in post CABG pain management, could directly reduce anxiety level. Antidepressants sertraline and citalopram are the best studied post CABG pharmacological treatments which influence on post CABG remedy and hospitalization. The results suggest that treatment for anxiety is essential for alleviating patient suffering. In addition, anxiety treatment could protect patient against depression before and after CABG surgery.

Efficacy of Buteyko Breathing Technique on Anxiety, Depression and Self Efficacy in Coronary Artery Bypass Graft Patients: A Randomised Clinical Trial

Introduction: Psychiatric issues, particularly depression and anxiety, have been observed in the proportions of patients undergoing cardiovascular surgery.Such findings provide a window of opportunity for integrating intervention, targeting psychological components into post-Coronary Artery Bypass Graft (CABG) patient management to provide effective care. The Buteyko Breathing Technique (BBT), which is named after its inventor Konstantin Pavlovich Buteyko, is one of the numerous breathing techniques that aims to regulate breathing. By alternating between periods of controlled breathing reduction and breath holding. Aim: To explore the effect of BBT as a psychological rehabilitation technique on anxiety, depression, and self-efficacy in postCABG subjects having anxiety and depression. Materials and Methods: This randomised clinical trial was performed at Cardiovascular and Thoracic Surgery Unit, Acharya Vinobha Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, from June 2021 to May 2022. Total 44 post CABG patients who all screened positive for anxiety and depression by General Anxiety Disorder-7 (GAD-7) questionnaire and Patient Health Questionnaire-9 (PHQ-9) were enrolled. They were randomly assigned using computed generated block randomisation. They were allocated using the Sequentially Numbered Opaque Sealed Envelope (SNOSE) method to group A Conventional group (n=22) and group B Experimental group (n=22). Both groups competed the in-hospital phase 1 cardiac rehabilitation as per American Association of Cardiovascular and Pulmonary Rehab (AACVPR) guidelines, whereas group B received additional BBT for psychosocial rehabilitation for 2 weeks post surgery. The evaluations were performed using the GAD-7 questionnaire, PHQ-9, General Self-Efficiency Scale (GSS), Breath Holding Test (BHT), and Borg Rate of Perceived Exertion Scale (RPE), at baseline on Post Operative Day (POD)1 and at their last rehabilitation session. Patients in both groups were given self management and education hand-outs at the time of discharge. Statistical Package for Social Sciences (SPSS) version 27.0 was used for statistical analysis. Results: The mean age of patients in A-group was 59.72±7.84 years and in B-group 60.81±7.42 years, respectively. The age, gender, height, weight, and BMI of the patients were similar between the groups. On intra group comparison ,there was statistically significant difference observed for GAD-7, PHQ-9, GSS, BHT, and RPE in group A and group B following the intervention, but the change was more pronounced in group B. The results for the inter group comparison showed a significant difference in group B on Anxiety, Depression, self-efficacy, BHT, and RPE as compared to the group A, i.e. group B showed a larger improvement in outcome measure scores than group A. Conclusion: The present study demonstrated that On intra group weeks of BBT along with phase 1 cardiac rehabilitation in post CABG patients brings favourable changes in levels of anxiety, depression and self-efficacy.

The Effectiveness of Cardiorehabilitation Programs in Returning to Work Post-CABG or PCI in Coronary Heart Disease

In developing countries, coronary heart disease (CHD) is one of the primary sources of disease burden. Cardiovascular rehabilitation is primarily used to help people recover after Coronary Artery Bypass Graft (CABG) or Percutaneous Coronary Intervention (PCI) and improve their quality of life, but still underutilized by public. The literature search was conducted in May 2018 through PubMed and Google Scholar using Boolean Operators. The search strategy used only articles in English from any years. The desired studies are randomized control trial, cohort, and systematic review. From one selected systematic review found that combined cardiac rehabilitation, physical conditioning with counseling and risk factor education, of cardiac rehabilitation programs are more effective than usual care. Combined cardiac rehabilitation programs may improve the rate of short-term return to work (RR 1.56, 95% CI 1.23-1.98; I2=20%; low certainty evidence). Combined cardiac rehabilitation probably reduce the average time needed to return to work (moderate-certainty evidence) by about 40 days when compared to receiving usual care. Combined cardiac rehabilitation is probably better than standar care in shorten rest time before return to work in post CABG or PCI patients

Bleeding complications in patients undergoing percutaneous coronary intervention in coronary artery bypass grafts: the impact of clinical presentation, access site and selection bias

Abstract Background Percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft (CABG) surgery is commonly done via the femoral approach. Relatively few cases are done via the radial approach. Purpose To assess bleeding complications in patients with either radial/brachial or femoral access when undergoing graft PCI, saphenous vein graft or internal mammary artery (IMA) graft. Method Data was collected for quality control on all patients that underwent PCI between 2010 and 2018 at 6 tertiary care hospitals in our system. Outcomes were classified and reported in accordance with the Bleeding Academic Research Consortium (BARC) criteria. BARC Type 4 (CABG-related) and BARC Type 5 (fatal) bleeds were excluded. Major bleeding was defined as BARC Type ≥3. Major adverse cardiac and cerebrovascular events (MACCE) was the combined endpoint of hospital death; post procedural myocardial infarction; cerebrovascular events (ischemic and hemorrhagic) and major bleeding complications. Due to the high intraclass correlation of procedures within patients, only the first procedure within the study period was selected from each patient for analysis. The two-sample t-test, Wilcoxon rank sum test, chi-square or Fisher's exact test were used as appropriate. Results A total of 1153 of 1196 patients who underwent graft intervention had BARC outcome data. Of these only 81 (7%) was via radial/brachial access. Baseline clinical characteristics are shown in the Table. A higher percentage of BARC ≥3 patients presented with NSTEMI/STEMI or had IMA graft intervention. Access site was not associated with bleeding complications. However, MACCE, post procedural heart failure (HF) and post procedural myocardial infarction (MI) rates were higher in patients who had femoral access (Figure). Conclusions In a large contemporary dataset of post CABG patients undergoing graft interventions: 1) the majority of patients (93%) underwent graft PCI via femoral access; 2) clinical presentation and acuity was associated with more severe bleeding complications; 3) access site did not seem to be associated with bleeding complications (possible selection bias); and 4) there was a trend towards higher MACCE rates in patients who had a femoral access. Additional analysis will be done to further investigate our findings. Funding Acknowledgement Type of funding sources: None.

Affirmative Outcome after Modified Cardiopulmonary Rehabilitation in Postpump Syndrome with Reduced Ejection Fraction following Coronary Artery Bypass Graft

In Coronary Artery Bypass Graft (CABG) patients’ Postoperative Pulmonary Complications (PPCs) like atelectasis, pleural effusion, pneumonia, pulmonary oedema, and pneumothorax are the leading cause of morbidity. Secondary prevention and Cardiac Rehabilitation (CR) are essential aspects of the postrevascularisation care approach. A 56-year-old male, diagnosed with triple vessel disease with reduced ejection fraction, underwent CABG surgery and developed Postpump Syndrome (PPS). There was pleural effusion secondary to the cardio-pulmonary bypass machine. Postoperatively, the patient complained of pain at the incision site, cough, and difficulty in breathing. He underwent two weeks of a precise, planned early phase I CR protocol with regular vital monitoring. Postrehabilitation, the two-minute walk test (MWT) and Borg’s scale showed improvement in the walking distance sequentially from 7th, 11th, and 14th-day postoperatively. There was a decrease in the perception of difficulty in breathing. He showed a tremendous level of recovery in vitals, functional capacity, pain, and quality of life seen postrehabilitation. It can be concluded that exercise-based CR is an important adjunct therapy for secondary complications in post CABG patients.

Panic disorder in general medical practice- A narrative review.

The under-or misdiagnosis, and symptomatic treatment of the panic disorder (PD), despite high prevalent medical illness, is common among non-psychiatric physicians. The non-psychiatrist physician’s role is vital in the care of PD as most patients initially approach general medical settings for medical help, including primary care. However, a significant proportion is undiagnosed and undergoes either unnecessary investigation, misdiagnosed, or mismanaged even among post-Coronary Artery Bypass Grafting patients, which profoundly affects the patients functioning and quality of life. This article aims to provide overviews of relevant epidemiological aspects, presenting features across medical specialties with respective diagnostic dilemmas, assessment, and management of the PD in their general medical settings, including emergency visits. Apart from psychiatrists, this will also assist non-psychiatrist physicians across all medical specialties, including general practitioners, to understand, identify, and provide the first line evidence-based pharmacotherapy and address the unmet need of patients with PD in their day-to-day busy clinical practice. This paper also provides a referral guide for non-psychiatrist physicians to refer to psychiatrists for further management after their first-line management.

Department of veterans affairs post-coronary artery bypass graft patients’ atrial fibrillation: 10-year outcomes

Aim: This Department of Veterans Affairs’ (VA) research project evaluated the impact of postoperative atrial fibrillation (POAF) upon 10-year outcomes for coronary artery bypass grafting (CABG) patients. Methods: Veterans enrolled in the “Randomized On-/Off-pump Bypass” (ROOBY) trial with new-onset POAF post-CABG were compared to those without POAF with respect to 10-year atrial fibrillation (AF) and mortality rates. Multivariable logistic regression examined whether AF was independently associated with 10-year survival after holding other preoperative risk factors constant. Results: Of the 2203 ROOBY veterans enrolled at 18 VA medical centers from 2002 to 2008, 100 patients with preoperative AF (n = 93) or unknown post-CABG POAF status (n = 7) were excluded. The POAF rate was 26.2% (n = 551/2103). The POAF patients were older and had more co-morbidities than the non-POAF patients (n = 1552). The AF rate among 10-year ROOBY POAF survivors was 18.9% (n = 64/338) compared to 5.8% (n = 61/1048) for non-POAF patients; P < 0.001. Compared to non-POAF patients’ 10-year survival of 70%, the ROOBY POAF veterans’ 10-year survival rate was 63%. Baseline risks inversely associated with 10-year survival included age, chronic obstructive pulmonary disease, serum creatinine > 1.5, peripheral vascular disease, and smoking. Holding these factors constant, POAF was not independently associated with 10-year survival. Conclusion: Post-CABG, ROOBY POAF veterans had higher rates of 10-year AF, which was negatively associated with 10-year survival; however, this association was not significant. Given that POAF may adversely impact 10-year AF rates, additional investigation appears warranted to improve future POAF patients’ care.

Management of Medication-Induced Psychiatric Disorders.

Management of Medication-Induced Psychiatric Disorders.

Non-invasive Ischaemia Testing in Patients With Prior Coronary Artery Bypass Graft Surgery: Technical Challenges, Limitations, and Future Directions.

Coronary artery bypass graft (CABG) surgery effectively relieves symptoms and improves outcomes. However, patients undergoing CABG surgery typically have advanced coronary atherosclerotic disease and remain at high risk for symptom recurrence and adverse events. Functional non-invasive testing for ischaemia is commonly used as a gatekeeper for invasive coronary and graft angiography, and for guiding subsequent revascularisation decisions. However, performing and interpreting non-invasive ischaemia testing in patients post CABG is challenging, irrespective of the imaging modality used. Multiple factors including advanced multi-vessel native vessel disease, variability in coronary hemodynamics post-surgery, differences in graft lengths and vasomotor properties, and complex myocardial scar morphology are only some of the pathophysiological mechanisms that complicate ischaemia evaluation in this patient population. Systematic assessment of the impact of these challenges in relation to each imaging modality may help optimize diagnostic test selection by incorporating clinical information and individual patient characteristics. At the same time, recent technological advances in cardiac imaging including improvements in image quality, wider availability of quantitative techniques for measuring myocardial blood flow and the introduction of artificial intelligence-based approaches for image analysis offer the opportunity to re-evaluate the value of ischaemia testing, providing new insights into the pathophysiological processes that determine outcomes in this patient population.

Abstract 14072: Long-Term Mortality Following 59253 Patients Who Underwent Coronary Artery Bypass Surgery in New South Wales, Australia: A Statewide Population-Linkage Study From 2001-2018

Purpose: To describe changes in long-term mortality following coronary artery bypass graft (CABG) in New South Wales (NSW), Australia, from 2001-2018. Methods: Patients who underwent CABG were identified from the NSW Admission-Patient-Data-Collection registry linked to the NSW death registry and were stratified into six, 3-year groups. Changes in comorbidities and procedural techniques over time were determined. Primary outcome was death (end of follow-up: 31-December-2018). Secondary outcome was time to first percutaneous coronary intervention (PCI) post-CABG, with death as the competing event. Outcomes analyses using Cox regression were adjusted for baseline and procedural differences and geographical clustering. Results: A total 59253 patients underwent CABG during the study period. From 2001-03 to 2016-18, procedural numbers fell (11875 vs 7606); however patient complexity increased (Charlson comorbidity index [CCI]>0: 40% vs 55%) as did male patients (77% vs 83%). During a median (interquartile range) follow-up of 7.7yrs (3.8-12.1yrs), 16,484 (27.8%) patients died. Factors associated with increased long-term mortality included older age (>75 vs ≤60: hazard ratio [HR]=6.69, 95% confidence interval [CI]=6.33-7.08), female sex (HR=1.06, 95%CI=1.02-1.11), acute myocardial infarction (HR=1.86, 95%CI=1.80-1.92), atrial fibrillation (HR=1.38, 95%CI=1.29-1.47), valvular heart disease (HR=1.84, 95%CI=1.56-2.18), and CCI (per-1-score increase: HR=1.31, 95%CI=1.26-1.35). Multivariable survival analysis showed that, compared to 2001-03, the risk of death reduced from 2004-06 to 2016-18: HR=0.96, 95%CI=0.93-1.00 to HR=0.61, 95%CI=0.54-0.70, respectively. Multivariable time-to-PCI analysis with death as the competing event showed no significant difference over the years. Conclusion: Between 2001 and 2018, though CABG volume has decreased, proportionally more males and higher comorbid patients had CABG in recent years. Female sex and other major comorbidities were expectedly related to an increased association with mortality. Overall, mortality has fallen significantly over time, with no significant trend of PCI undertaken over time in these post CABG patients.

Quality of life following Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCABG) versus Conventional Open-Heart Coronary Artery Bypass Grafting (CABG): A 3-year data from a single centre

Introduction: In Malaysia, MIDCABG started in 3 centers developing the technique. As the technique is gaining traction in the country, this study aims to compare the quality of life following MIDCABG compared with conventional CABG in one of the centers actively developing this technique. Methods: A retrospective cohort study was performed involving 30 post CABG patients which consists of 15 MIDCABG and 15 conventional CABG from January 2015 to May 2018. 15 from 21 post-MIDCABG patients were included and selected, based on EuroSCORE II less than 5. Modified Post-Operative Quality of Recovery Scale was used to assess and compare the quality of life following respective approaches. Data were analyzed using SPSS version software and comparison using mean rank with p 0.05. Conclusion: There is no significant difference in quality of recovery following MIDCABG compared to conventional CABG. Modified PostOPQRS system can be a useful assessment tool to evaluate the impact of an intervention in relation of quality of life.

Strain and strain rate echocardiographic imaging predict occurrence of atrial fibrillation in post-coronary artery bypass grafting patients

BackgroundAtrial fibrillation (AF) occurs very frequently after coronary artery bypass grafting (CABG); it occurs in about 20–edictors can be used for the dedicatio40% of patients. It is associated with several adverse events. This study aimed to extrapolate a predictor for postoperative atrial fibrillation (POAF) occurrence which is reproducible and simple to be a part of routine echocardiography screening before CABG. This study included 89 patients scheduled for isolated coronary artery bypass surgery. History, clinical examination, and complete 2D echocardiography with LA speckle tracking analysis were done preoperatively. Patients were then followed up post-surgery for incidence of AF till discharge from the hospital. The patients were divided into 2 groups according to POAF occurrence.ResultsPatients who developed postoperative AF had older age (P = 0.0032) and longer hospital stay (P = 0.021) and higher stroke incidence but statistically non-significant (14.3% vs 3.3%). The POAF patients showed less peak atrial longitudinal strain (PALS) value than non-POAF patients. The left atrial strain rate values showed a significant difference with the lower left atrial systolic strain rate and less negative (higher) early diastolic strain rate and late diastolic strain rate. After multivariate logistic regression analysis, the independent predictors for POAF were PALS (OR 0.770, 95% CI 0.627–0.946), late LA diastolic strain rate (LASRa) (OR 3.476, 95% CI 1.207–12.186), and age (OR 1.181, 95% CI 1.011–1.379).ConclusionPreoperative LA global strain assessed by 2D speckle tracking analysis could be helpful as a predictor for AF post-CABG surgery, and identification of these patients may reduce its morbidity and mortality. The study suggested PALS value less than 29.8 to be a predictor for the occurrence of POAF.

Comparing efficacy of ibutilide and amiodarone for cardioversion in atrial fibrillation after coronary artery bypass grafting- A prospective and randomized study

Ibutilideis less frequently used drug for atrial fibrillation (AF) in postoperative coronary artery bypass grafting (CABG) patients as compare to amiodarone. We therefore investigated the comparative efficacy of ibutilde and amiodarone for cardioversion in atrial fibrillation after CABG.To compare the efficacy of ibutilide and amiodarone for cardioversion of AF in post CABG patients.Narayana Multispeciality Hospital, Jaipur.Single center, randomized, double blind, comparative prospective study.Total 80 post CABG patients who developed AF were divided into two groups (Group A) Ibutilde and (Group B) Amiodarone respectively. The cardioversion time and cardioversion rate were measured.Unpaired t-test, Paired t-test, Chi square test / Fisher exact test. P value <0.05The cardioversion rate at 4hrs in group A was 42.5% and in group B was 50% (p value > 0.001). At 24 hrs cardioversion rate in group A was 95% and in group B was 87.5% (p value > 0.001). The mean time of conversion to sinus rhythm in group A was 382.85 minutes and in group B was 492.30 minutes. (p value= 0.235)Ibutilide was as effective as amiodarone for restoration of sinus rhythm in postoperative coronary bypass grafting patients who developed atrial fibrillation in their postoperative intensive care unit stay. Ibutilide may be superior to amiodarone in terms of hemodynamics and systemic side effects.

The role of cardiac rehabilitation after Streptococcus agalactiae Infective Endocarditis with Septic Embolic Complication in an Elderly Patient: Case Report

Introduction. In the past, Streptococcus agalactiae was known to be associated with invasive infections in pregnant women and newborns. More recently, given a more appropriate antibiotic prophylaxis and treatment, the incidence among pregnant women and infants diminished. However, an increasing number of cases with infective endocarditis with Streptococcus agalactiae has been reported in the recent years in older patients with underlying comorbidities. Case report. An 80-year-old female patient presented with dyspnea, weight loss, fever, fatigue, chills, dry cough and bilateral lower limb edema. The work-up revealed complicated infective endocarditis with Streptococcus agalactiae on the native aortic valve with severe aortic regurgitation as a result of the valvular destruction and a metastatic spleen abscess. Antibiotic treatment was started with resolution of the fever and chills. The patient however developed congestive heart failure due to the valvular regurgitation. A decision was made to proceed urgently with aortic valve replacement and splenectomy, which were performed at the same time, followed by a good recovery. Results and discussion. An increasing number of cases with IE with GBS in elderly patients has been reported in the recent years, with high rate of complications and mortality. The underlying comorbidities are important risk factors for S. agalactiae IE. Considering our case, a patient in her eighties with significant abdominal surgical history and multiple medical conditions could be a typical host. Recovery after cardiac surgery is one of the most important indications of physical training. This includes patients post-coronary artery bypass grafting, after valve prosthetic replacement, after surgery for congenital diseases and after heart transplantation. Early mobilization is particularly important in avoiding immobility and cardiac deconditioning. Conclusions. Despite the fact that mortality in Group B Streptococcus endocarditis is 40%, a combined medical and surgical strategy individualized to the specific situation of each patient have led to a positive outcome in a number of cases. We present such a combined treatment approach in a case of complicated infective endocarditis with metastatic spleen abscess in an elderly patient. The aortic valve replacement and splenectomy were performed at the same time. Keywords: endocarditis, septic emboli, valve replacement, splenectomy

Active Cycle Breathing Technique Terhadap Fungsional Paru Pasien Post CABG (Laporan Kasus Berbasis Bukti)

Coronary Artery Bypass Graft (CABG) is an operative action in cases of coronary heart disease (CHD) by cutting and replacing clogged coronary arteries from healthy vessels taken from the legs, arms, or chest. The main clinical problem that arises in post-CABG patients is decreased lung functional capacity, this is due to shortness of breath, pain, decreased thoracic expansion, sputum retention, and decreased pulmonary ventilation. Active Cycle of Breathing Technique (ACBT) is a physiotherapy modality that can be applied in cardiovascular cases. ACBT is a series of exercises that include breathing exercises, coughing exercises, and exercises to expand the chest. To determine the effectiveness of ACBT in increasing lung functional capacity in Post CABG patients, an electronic database search was performed, namely Pubmed, Cochrane, and Google Schoolar. From the search results, 6 articles were selected that met the criteria, namely 1 article on Pubmed and 5 articles on Google scholar. Based on the results of the research that has been presented, it can be concluded that ACBT can increase the functional capacity of the lungs in post CABG patients as evidenced by the evaluation of the results of the 6 minutes walking test, borg scale, and breath holding time.