Post-coronary Artery Bypass Graft Surgery Research Articles

Effect of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers After Coronary Artery Bypass Graft Surgery: A Population-Based Cohort Study.

The effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) on major adverse cardiovascular events (MACE) in patients who undergo coronary artery bypass graft surgery is equivocal. This retrospective, population-based cohort study evaluated effect of exposure to an ACEI/ARB on MACE using linked administrative databases that included all cardiac revascularization procedures, hospitalizations, and prescriptions for the population of British Columbia, Canada. All adults who underwent coronary artery bypass graft surgery between 2002 and 2020 were eligible. The primary outcome was time to MACE, defined as a composite of all-cause death, myocardial infarction, and ischemic stroke using Cox proportional hazards models with inverse probability treatment weighting. Included were 15 439 patients and 6191 (40%) were prescribed an ACEI/ARB. Mean age was 66 years, 83% were men, and 16% had heart failure (HF). Median exposure time was 40 months. Over the 5-year follow-up, 1623 MACE occurred. Impact of exposure was different for patients with and without HF (P <0.0001 for interaction). After probability-weighting and adjustment for relevant covariates, exposure to ACEI/ARBs was associated with a lower hazard of MACE in patients with HF at 1 year (hazard ratio, 0.13 [95% CI, 0.09-0.19]) and 5 years (hazard ratio, 0.36 [95% CI, 0.30-0.44]). In patients without HF, ACEI/ARBs had a lower hazard of MACE at 1 year (hazard ratio, 0.35 [95% CI, 0.27-0.46]) and 5 years (hazard ratio, 0.66 [95% CI, 0.58-0.76]). In this population-based study, ACEI/ARBs were associated with a lower hazard of MACE in a cohort of patients post-coronary artery bypass graft surgery irrespective of HF status.

Nurse-Led Cardiac Rehabilitation Care Coordination Program: Improving Functional Outcomes for Patients Through Automatic Referral and Effective Care Coordination.

The aim of this investigation was to evaluate the impact of automated cardiac rehabilitation (CR) referral and nurse care coordination on patient and program outcomes. Specifically, the aim was to identify whether differences exist in physical and psychological function at CR Phase 2 enrollment and completion and CR Phase 2 participation and completion for hospitalized patients who receive in-person CR nurse visits versus phone consultation. Using a retrospective pre-/post-intervention descriptive design, a purposive sampling technique was used to select groups with matching clinical attributes. Dates were selected to mitigate the impact of COVID-19 on CR program enrollment and completion. Data were abstracted from the patient electronic medical record, telemetry documentation, and CR referral tracking tool. Patient descriptors included age, sex, cardiac diagnosis/procedure (post-coronary artery bypass graft surgery, myocardial infarction, percutaneous coronary intervention, heart failure, and aortic valve repair and replacement) and cardiac risk stratification category. Patient functional outcomes included the 6-min walk test and metabolic equivalents of task levels for functional capacity; psychological function was measured by the Patient Health Questionnaire assessment. Program outcomes included discharge to CR Phase 2 enrollment, CR sessions, and completion. Each group had 52 patients. Age was 64 ± 12yr, 68% were male. Perhaps indications for CR included coronary artery bypass graft surgery (44%), myocardial infarction (19%), percutaneous coronary intervention (20%), heart failure (10%), aortic valve repair and replacement (8%). Cardiac risk was low in 30%, intermediate in 65%, and high in 5%. The post-intervention group compared with the pre-intervention group had a shorter discharge to CR Phase 2 enrollment (35 ± 18 d vs 41 ± 28 d, P = .078) and significantly fewer sessions required for CR completion. Automated CR referral and nurse care coordination visits for hospitalized patients decreased the transition period between CR Phase 1 and 2. Patients were physically and psychologically prepared for earlier CR Phase 2 enrollment and successfully completed the program in fewer days than the pre-intervention group.

Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery.

Thirty-day readmission is associated with increased morbidity and mortality among postoperative coronary artery bypass graft (CABG) surgery patients. Interventions such as case management and follow-up care may reduce 30-day readmission. The purpose of this article is to report a study on modifiable factors that may have significant implications for case management in the prevention of readmission after CABG surgery. The study population included all the adult patients who underwent first-time CABG surgery from January 1, 2013, to January 1, 2016, from a Mid-South hospital. A retrospective case-control study was employed to examine 1,712 patients who underwent CABG surgery. The results revealed that patients readmitted within 30 days had a significantly shorter length of stay (LOS) (6 days vs. 10 days; p < .0001), more days in intensive care unit (6 days vs. 4 days; p = .0391), and significantly higher diabetes/renal (4% vs. 1%), infection (17% vs. 2%), and respiratory-related diagnoses (10% vs. 1%; p < .0001). Among these factors, hospital LOS is a major factor that can be addressed through case management in addition to other modifiable risk factors. Understanding modifiable factors associated with higher readmission risk is crucial for effective intervention and case management planning.

Cardiac related pleural effusions: a narrative review.

Pleural effusions (PEs) are commonly seen in various pathologies and have a significant impact on patient health and quality of life. Unlike for malignant PEs, non-malignant PEs (NMPEs) do not have well-established guidelines. Much of the evidence base in this field is from a handful of randomised controlled trials (RCTs) and the majority are from retrospective cohort analyses and cases series. Cardiac related PEs fall within the entity of NMPEs and the aim of this narrative review is to gather the existing evidence in the field of congestive heart failure (CHF), pericarditis and post-cardiac injury syndrome (PCIS). This narrative review investigates the pathophysiology, diagnostic criteria and treatment options for the various cause of cardiac related PEs. This narrative review is based on a comprehensive literature search analysing RCTs, prospective and retrospective cohort analyses and published case series. CHF related PEs have a substantial mortality rate and carry a worse prognosis if the PEs are bilateral and transudative in nature. Light's criteria have often shown to misclassify transudative effusions in CHF (pseudo-exudates) and hence measuring serum-pleural albumin gradient is an invaluable tool to accurately identify transudates. Elevated serum and pleural N-terminal pro-B type natriuretic peptide (NT-proBNP) has shown increasing evidence of correctly identifying PEs secondary to CHF. However, they should be considered with the pre-test probability of CHF. Therapeutic thoracentesis and indwelling pleural catheter (IPC) placement may be necessary if medical management has failed. PEs can also occur secondary to pericarditis and are often small, bilateral and exudative. PCIS also results in PEs and are commonly seen in post-coronary artery bypass graft (CABG) surgery. Both entities need management of the underlying cause first, but in cases where PEs are refractory, individualised pleural interventions may be necessary. This comprehensive narrative review provides valuable insights into the aetiology, diagnosis and management of PEs secondary to CHF, pericarditis and PCIS. The aim is to enhance the clinicians' knowledge of this complex and controversial topic to improve patient care of cardiac-related PEs. Ongoing trials in this field will be able to provide valuable insights.

1473. Procedural risk factors for deep and organ/space surgical site infection post-coronary artery bypass graft surgery

Abstract Background Advances in coronary artery bypass graft (CABG) surgery have improved graft patency and survival. Our prior work suggested a reduction in deep and organ/space surgical site infection (SSI) with single versus bilateral internal mammary arteries and a skeletonized approach. Even for the same number of arterial grafts used, specific artery type may impact SSI incidence. We aim to assess the effect of potentially modifiable risk factors on post-CABG deep and organ/space SSI, including number and type of vessel grafts, and closure method. Methods This was a single-center retrospective cohort study of post-CABG surgery patients from 01/01/19-12/31/22. SSIs were identified during routine surveillance using National Healthcare Safety Network criteria. Data on demographics, comorbidities, surgical technique and surgeon were obtained from hospital and cardiac surgery databases. A sub-analysis evaluated the risk of SSI in patients with two arterial grafts by type of artery used, specifically bilateral internal mammary (BIMA) graft versus single internal mammary artery plus radial graft (SIMA-R). We performed univariate analyses to determine association of risk factors with SSI. Results Of the 2050 included patients, 23 developed an SSI . In univariate analyses, diabetes mellitus (OR 5.6, p &amp;lt; 0.001) and negative pressure wound therapy (NPWT) versus surgical adhesive (OR 19.82, p&amp;lt; 0.001) were associated with SSI. There was no significant association between SSI and the total number of arteries or combination of vessel grafts used. In the sub-analysis, 281 patients underwent SIMA-R and 154 underwent BIMA. None of the SIMA-R, versus 4 of the BIMA developed SSI (p=0.02). There were other differences between the groups, including a greater proportion with a skeletonized (versus pedicled) arterial harvest (OR 2.19, p=0.003) and longer case duration (238 vs 217 minutes, p=0.003) in the BIMA group, which could confound this relationship. Conclusion In the overall cohort, NPWT was associated with SSI on univariate analysis, though notably this closure method is often used in patients with higher pre-operative risk. Amongst those patients who received two arterial grafts, there was a reduced SSI risk with SIMA-R approach. Future studies should explore the impacts of graft choice and wound care. Disclosures All Authors: No reported disclosures

A realistic approach to evaluating the effect of baseline lipid profile in postcoronary artery bypass grafting surgery.

There are still many uncertainties in the association between lipid profile and postcoronary artery bypass grafting (CABG) outcomes. Although simplifying the association to linear equations makes it understandable but cannot explain many findings. There is a nonlinear associatin between lipid profile indices and adverse outcomes after CABG. A total of 17 555 patients who underwent isolated CABG between 2005 and 2016 were evaluated. During the median follow-up of 75.24 months, the Restricted Cubic Splines (RCS) estimated from the Cox regression model adjusted for all possible confounders was applied to show a nonlinear relationship of lipid profile contents with the "ln hazard ratio" of mortality and major cerebro-cardiac events (MACCE). The relationship between LDL-C and HDL-C with all-cause mortality was nonlinear (nonlinear p were .004 and <.001, respectively). The relationship between remnant cholesterol and all-cause mortality was linear (linearity p = .023). Among men, those in the highest LDL-C level (Q4, LDL-C > 114) and those in the lowest HDL-C level (Q1, HDL-C < 30) showed a significantly higher risk of all-cause mortality compared to other groups (compared with Q3, LDL-C Q4, HR = 1.16, 95% confidence interval [CI]:1.02-1.26, p = .014; HDL-C Q1, HR = 1.14, 95% CI: 1.01-1.31, p = .041). Female patients in the lowest HDL-C level (Q1, HDL-C < 30) showed a significantly higher (compared with Q3, HR = 1.14, 95% CI:1.01-1.31, p = .028) and those in the highest HDL-C level (Q4, HDL-C > 43) showed a significantly lower (compared with Q3, HR = 0.74, 95% CI:0.58-0.98, p = .019) risk of all-cause mortality. Determining a universal cut off for components of lipid profile may be misleading and should better be revised. Extreme values (very low or very high) for HDL-C and LDL-C have different effects on cardiovascular outcomes.

Arteriovenous shunt status post-coronary artery bypass graft surgery treated with microcoil placement: A case report

Accidental cardiac arteriovenous (AV) anastomoses is a rare but severe complication of coronary artery bypass grafting. This can result in high output heart failure if left untreated. Little research has been done on the mainstays of treatment for this condition. Our patient is an 82-year-old male with a history of known coronary artery disease, status post-coronary bypass grafting surgery, presented with increasing shortness of breath, which was initially determined clinically to be due to high output heart failure, which was later confirmed during cardiac catheterization procedure. Coronary cardiac catheterization was carried out 2 weeks prior at an outside hospital for which the graft, which is supposed to be anastomosed of the circumflex, inadvertently anastomosed to the coronary sinus. The patient returned to the cardiac catheter lab and repeat angiography was performed. The left to right shunt was subsequently embolized using microcoils. He tolerated the procedure well. No recurrent anginal and/or heart failure symptoms were present. Interventional cardiology began the procedure by gaining right common femoral access. Next the saphenous vein graft to the coronary sinus was engaged with a 6 French JRy (Medtronic Inc., Minneapolis, MN) guide catheter and a 0.014” coronary wire was placed into the graft. Then interventional radiology advanced a 2.4 French microcatheter (Terumo, Ann Arbor, MI USA) over the 0.014” wire (Abbott Vascular Devices, Plymouth MN) into the mid to distal aspect of the bypass graft. Four detachable 0.018” microcoils (Terumo, Ann Arbor, MI USA) were carefully placed within the bypass graft. Subsequent angiogram demonstrated complete occlusion of the bypass graft with resolution of the AV shunt. Due to the acuity of the patient’s symptoms and the long timeframe from originally attempting stenting, no additional attempts to stent the circumflex were performed. Follow-up angiogram through the base catheter demonstrates complete occlusion of the bypass graft with resolution of the AV shunt. No contrast was seen entering the coronary sinus. The patient tolerated the procedure well with no immediate complications. Estimated blood loss was &lt;10 mL. The patient was admitted overnight for further evaluation. No shortness of breath noted. He was discharged in good condition the following day. Accidental cardiac AV anastomosis is a rare complication of coronary artery bypass grafting that could lead to high output heart failure. In such cases, catheter directed embolization with microcoils can be done to occlude the AV shunt created by the previously placed cardiac catheter with resolution of heart failure symptoms.

Effectiveness of Cardiac Rehabilitation With mHealth Through Smartphone Functionalities: A Systematic Review Protocol

Cardiovascular diseases are the leading cause of mortality worldwide, requiring support to manage symptoms and improve prognosis. Home-based cardiac rehabilitation is a realistic resource for this purpose, but it requires patients’ self-management skills in order to change behaviours. Smartphones are considered mHealth technology (mobile technological resources in healthcare) and have the potential to provide modalities for delivery of cardiac rehabilitation. This systematic review aims to examine these modalities and identify those that are most effective for improving exercise capacity, quality of life, and patient compliance. Randomized controlled trials (1994 to 2022) performed with adults with coronary artery disease (post-myocardial infarction, angina, post-coronary artery bypass graft surgery) or heart failure eligible for home-based cardiac rehabilitation (mHealth) will be selected. Studies published in English, Spanish, or Portuguese that compare rehabilitation-specific mobile apps or smartphone-based features with conventional cardiac rehabilitation will be included. Searches will be conducted in MEDLINE, CENTRAL, EMBASE, LILACS, PEDro, grey literature, and ongoing or recently completed studies. Data and risk of bias will be assessed, and if appropriate, a meta-analysis will be carried out.

Fluorine 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Cardiac Viability Risk Stratification in Comparison with EuroSCORE II for Revascularization in Patients with Left Ventricular Dysfunction.

Diagnostic value of fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT) in the assessment of myocardial viable segments is well known; hence, it can identify patients with left ventricular (LV) systolic dysfunction who may benefit from revascularization. The presence of significant myocardial viable segments before revascularization will offer better prognosis with reduced mortality and morbidity. However, the usage of F18-FDG PET/CT myocardial viability study in the presurgical risk stratification is limited. The objective of the study is to predict perioperative mortality with hibernating viable myocardial (HVM) segments established by F18-FDG PET/CT in comparison with EuroSCORE II in patients with LV dysfunction undergoing coronary artery bypass grafting surgery. A prospective, observational study included 75 patients of chronic ischemic coronary artery disease with ejection fraction ≤40%. Tc-99m sesta-methoxyisobutylisonitrile myocardial perfusion single photon emission CT/CT and myocardial viability with F18-FDG PET/CT at rest were performed. Mortality risk stratification was done according to the EuroSCORE II. Patients were followed for post-coronary artery bypass graft surgery (CABG) 30-day mortality. Mortality observed by HVM segment groups were compared with EuroSCORE II predicted mortality. Receiver operating curve for 30-day mortality prediction with HVM segments and EuroSCORE II was constructed. It showed that a cutoff of <4 HVM segments (area under the curve [AUC] = 0.7) had a sensitivity of 85%, whereas EuroSCORE II (AUC = 0.4) had only 28.6% sensitivity. EuroSCORE II underestimated perioperative risk in patients with <4 viable segments, that is 5 times higher risk was observed in patients with <4 viable segments. HVM segments established by F18-FDG PET/CT had independently predicted mortality postoperatively. Hence, including F18-FDG PET/CT for viability assessment along with EuroSCORE II in preoperative risk assessment for revascularization by CABG in patients with LV dysfunction provided better risk stratification.

Effects of Melatonin on Cardiac Injury and Inflammatory Biomarkers in Patients Undergoing Coronary Artery Bypass Graft Surgery: a Meta-analysis.

The antiinflammatory and antioxidative effects of melatonin have been established in recent years. Several studies indicate that oxidative stress and inflammation are key drivers of post-coronary artery bypass graft (CABG) surgery complications. In the present study, we aimed to investigate the effects of melatonin on cardiac injury and inflammatory biomarkers in CABG candidates. Embase, Medline/PubMed, Web of Science, Scopus, and the Cochrane library were searched up to 5 June 2022. All randomized controlled trials examining cardiac injury and inflammatory biomarkers of CABG patients who received melatonin were included. The random-effects model was utilized to perform the analysis. A total of 947 citations were retrieved through database searches. Finally, five articles (six trials with 342 patients) were included after the screening. Melatonin supplementation led to a significant reduction in cardiac troponin I (CTnI) [weighted mean difference(WMD): -2.28ng/ml; 95% CI -2.87, -1.69; P < 0.01; I2: 91.25%] and high sensitivity-C reactive protein (hs-CRP) levels (WMD: -0.62mg/L; 95% CI -0.73, -0.5; P < 0.01; I2: 99.98%) in patients undergoing CABG surgery. We found a nonsignificant decrease in creatine kinase isoenzyme muscle/brain (CK-MB) levels (WMD: -2.87ng/ml; 95% CI -5.97, 0.23; P = 0.07; I2: 99.98%) after melatonin supplementation. No publication bias was found according to Egger's test. Melatonin supplementation may be useful in reducing cardiac injury and inflammatory biomarkers in CABG candidates. Future studies should investigate the clinical significance of these findings.

Efficacy of Acapella versus Power Lung on relieving dyspnea after coronary artery bypass graft

Purpose. This study was conducted to compare the efficacy of Acapella versus Power lung on relieving dyspnea after coronary artery bypass graft (CABG) surgery. Methods. Sixty patients of both sex who underwent CABG surgery with age ranged from 40-50 years old participated in this study, They were randomly assigned into two equal experimental groups (n = 30), group (A) and group (B), (Group (A) received Acapella while Group (B) received Power Lung, each device conducted through a supervised session of three sets each one of 10 repetitions, two times daily from first day postoperative until the seventh day, in addition to routine physiotherapy program, Modified Borg scale was assessed for all patients before the beginning and after the end of this study. Results. there was a significant decrease in Modified Borg Scale score in both groups (A) and (B) by 44.07 % and 23.09 % respectively. Between-groups analysis showed a significant difference between both groups in favor of group (A) (p &lt; 0.001). Conclusion. Acapella and Power Lung were most effective devices for improving dyspnea post CABG surgery with superiority for Acapella device.

ACTIVE CYCLE OF BREATHING TECHNIQUES IMPROVES POST-OPERATIVE PULMONARY COMPLICATIONS IN CORONARY ARTERY BYPASS GRAFT SURGERY PATIENTS

Objectives: To determine effects of active cycle breathing technique (ACBT) on pulmonary function of post coronary artery bypass Graft surgery (CABG) patients. Methodology: A randomized control trial was conducted with a sample size of 40 post CABG patients from September 2018 to January 2020. Vitally stable both male and female post CABG Consecutive patients of age bracket 30-65 years were included in study. Two groups were made by randomization through sealed envelope method. Patients in ACBT group (n=20) did ACBT whereas control group (n=20) performed deep breathing exercises along with conventional treatment. Lung volumes &amp; capacities, vitals (heart rate, respiratory rate, oxygen saturation and blood pressure) and chest expansion were assessed at baseline and on fifth post-operative day. Data was analyzed using SPSS version 21. Results: Out of all the 40 patients 26 (65%) were males and 14 (35%) were females with the mean age of 53±7.9 years in conventional and 56±5.9 years in group performing ACBTs. There was significant improvement in Forced Expiratory Volume (FEV1) and chest expansion (p≤0.05) of ACBT group. However, within group analysis revealed significant improvement in all parameters of both groups (p&lt;0.01). Conclusion: Active cycle breathing technique has beneficial effects in improving FEV1 and chest expansion as compared to traditional physical therapy in post CABG patients during phase I of cardiac rehabilitation.

Trends in cardiac rehabilitation enrollment post-coronary artery bypass grafting upon implementation of automatic referral in Southeast Asia: A retrospective cohort study.

Introduction: Cardiac rehabilitation (CR) is an effective but underutilized intervention. Strategies have been identified to increase its use, but there is paucity of data testing them in low-resource settings. We sought to determine the effect of automatic referral post-coronary artery bypass graft (CABG) surgery on CR enrollment. Methods: This is a retrospective cohort study assessing cardiac patients referred to CR at a tertiary center in Southeast Asia from 2013 to 2019. The paper-based pathway was introduced at the end of 2012. The checklist with automatic CR referral on the third day post-operation prompted a nurse to educate the patient about CR, initiate phase 1 and encourage enrollment in phase 2. Patients who were not eligible for the pathway for administrative or clinical reasons were referred at the discretion of the attending physician (i.e., usual care). Enrollment was defined as attendance at≥1 CR visit.Results: Of 4792 patients referred during the study period, 394 enrolled in CR. Significantly more patients referred automatically enrolled compared to usual care (225 [11.8%] vs. 169 [5.8%]; OR=2.2, 95% CI=1.8-2.7), with increases up to 23.4% enrollment in 2014 (vs. average enrollment rate of 5.9% under usual referral). Patients who enrolled following automatic referral were significantly younger and more often employed (both P<0.001); no other differences were observed.Conclusion: In a lower-resource, Southeast Asian setting, automatic CR referral is associated with over two times greater enrollment in phase 2 CR, although efforts to maintain this effect are required.

Intensivist -Driven Ventilator Management Shortens Duration of Mechanical Ventilation in Coronary Artery Bypass Graft Surgery Patients.

Prolonged mechanical ventilation in post Coronary Artery Bypass Graft Surgery (CABG) is associated with deleterious effects including, increased ICU and hospital length of stay (LOS), infectious complications, and mortality. Standardized ventilator weaning protocols and the utilization of critical care physicians in post CABG patient care vary substantially among institutions. The purpose of this study was to evaluate if intensivist consultation in conjunction with a multidisciplinary, standardized ventilator weaning protocol improves outcomes in CABG patients. We performed a single-center, retrospective, before-after cohort analysis at Miami Valley Hospital in Dayton, OH, a 970-bed community hospital. Patients were divided into two arms: the before cohort or delayed-consult group (critical care consult after six hours on ventilator) and after cohort or immediate-consult group (immediate critical care consult). All patients were weaned from ventilator using a standardized weaning protocol. A total of 764 patients were enrolled, 411 in the delayed-consult group and 353 in the immediate-consult group. The immediate-consult group had less time on initial mechanical ventilation than the delayed-consult group (5.86 ± 4.75 h vs. 6.00 ± 6.64 h, P = 0.038). The small advantages to immediate critical care consultation for higher percent of early extubations, fewer re-intubations, shorter ICU LOS, and lower rate of ICU readmission were not statistically significant. The two groups had similar ventilator free days, prolonged mechanical ventilation, hospital LOS, and in-hospital mortality. Our study suggests that intensivist-driven ventilator management in conjunction with a multidisciplinary standardized weaning protocol shortens duration of mechanical ventilation in coronary artery bypass graft surgery patients.

Home-Based Versus Outpatient-Based Cardiac Rehabilitation Post-Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial.

The prevalence of coronary heart disease continues to increase in the Kingdom of Saudi Arabia (KSA). Despite advances in cardiac surgery, there are no established outpatient cardiac rehabilitation programs in the KSA. The aim of this study was to investigate the effectiveness of home-based cardiac rehabilitation compared with outpatient-based cardiac rehabilitation and usual care for patients who are post-coronary artery bypass graft surgery. This 3-arm, single-blind, randomized controlled trial was carried out at the King Faisal Specialist Hospital, Riyadh, KSA. A total of 82 patients post-coronary artery bypass graft surgery were randomized and 73 patients completed the study. Recruited patients were distributed to home-based cardiac rehabilitation (n = 24), outpatient-based cardiac rehabilitation (n = 25), or usual care (control group) (n = 24). Participants in the intervention groups completed an individualized exercise program for 2 hours, 3 times a week for 8 weeks. The control group followed usual care (no intervention). The incremental shuttle walk test (ISWT), metabolic equivalence task, Short Form-36, and Hospital Anxiety and Depression Scale (HADS) were measured at baseline, postintervention, and after a 4-week follow-up period. Postintervention, there was an increase in mean ISWT score from baseline in both the home-based cardiac rehabilitation and outpatient-based cardiac rehabilitation groups (66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in the control group. At the 4-week follow-up, both intervention groups showed statistically significant improvements in all outcome measures (ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36) compared with baseline (all P < .001). The home-based cardiac rehabilitation group showed statistically continuous improvement compared with the outpatient-based cardiac rehabilitation group. The control group did not show any significant changes across time in outcome measures. Home-based cardiac rehabilitation is as effective as outpatient-based cardiac rehabilitation. Home-based cardiac rehabilitation appears to be more effective at maintaining improvements follow the end of the intervention.

Saphenous vein graft harvesting site dermatoses among CABG patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronary artery bypass grafting (CABG) is a cardiac surgical procedure in which the greater saphenous vein graft is most often used to bypass the narrowed coronary artery segments. The side effects of leg vein harvesting include a variety of cutaneous changes. We report the cutaneous effects at the saphenous vein harvesting sites in 32 patients who underwent CABG. To study the dermatoses occurring at the saphenous vein harvest site post CABG surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective observational study on prevalence of saphenous vein harvesting site dermatoses in patients with CABG attending a tertiary care centre in Kanyakumari, for a period of 6 months from March 2021 to September 2021. The cutaneous changes on and around the saphenous vein (SV) graft donor site were noted in all patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 200 patients underwent CABG during the period of study, out of which 32 patients developed dermatitis at the vein harvesting site. At the donor site, Pruritus was the most common symptom seen in 14 (44%) patients, followed by eczema in 11 (34%) patients, xerosis in 9 (28%), hyperpigmentation in 6 (20%), depigmentation in 2 (3%), anesthesia in 3 (10%), neuralgic pain in 3 (8%), burning sensation in 2 (6%), hypertrophic scar in 3 (10%), and infections in 3 (9%) patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; To minimize the donor site complications following CABG, we recommend proper cutaneous and vascular evaluations, identifying the best graft site, employing meticulous surgical technique, recognizing complications early, and starting treatment without delay.&lt;/p&gt;

The effect of intraoperative glycemic control on surgical site infections among diabetic patients undergoing coronary artery bypass graft (CABG) surgery

ObjectivePerioperative poor glycemic control in diabetic patients undergoing Coronary Artery Bypass Graft (CABG) surgery has been associated with infectious complications, particularly surgical site infections that are linked with adverse health surgical outcomes. The purpose of this study was to investigate the effect of two different intraoperative glycemic control protocol, tight and conventional, on thirty-day postoperative surgical site infection (SSI) rates among diabetic patients undergoing CABG surgery. DesignA randomized controlled trial (RCT) design was employed in the study, with a convenience sample of 144 adult patients who were scheduled to undergo coronary artery bypass grafting surgery. SettingA main referral heart institute in Amman, Jordan. ParticipantsSubjects were randomly assigned to either the tight glycemic control group (n = 72), which maintained an intraoperative blood glucose level of 110–149 mg/dl via continuous intravenous insulin infusion, or the conventional glycemic control group (n = 72), which maintained an intraoperative blood glucose level of 150–180 mg/dl via continuous intravenous insulin infusion. The postoperative SSIs among both groups were evaluated and compared by independent blinded physicians. ResultsThe primary findings of this study indicated no statistically significant difference between the two treatment groups in terms of SSI rates and their potential adverse surgical outcomes (p = 0.512). ConclusionNurses should consider the glycemic stability and glycemic control approach to minimize adverse surgical outcomes post CABG surgery. Healthcare providers should also carefully consider diabetic patients who have undergone CABG surgery and are at risk of developing postoperative SSIs. Clinicaltrials.gov identifierNCT04451655 was retrospectively registered in 30/06/2020.

M11. Magnesium Sulfate as Atrial Fibrillation Prophylaxis post Coronary Artery Bypass Graft Surgery: A Meta-analysis

Abstract Background and Aims Arrhythmia, especially atrial fibrillation (AF), is a common complication post coronary artery bypass graft (CABG) surgery and a major source of morbidity and mortality. This meta-analysis aims to evaluate the use of magnesium sulfate (MgSO4) as AF prophylaxis post CABG surgery. Method and Results A total of 10 studies enrolled 1,371 patients (1,114 males and 257 females) were retrieved from Pubmed, Cochrane, and Medline until July 2021 to identify studies about the association between MgSO4 and AF occurrence post CABG surgery. All suitable full text must accomplish Jadad score ≥2 for assessing study quality. Data were analyzed using Review Manager 5.3. Mantel-Haenszel formula was used for dichotomous variables to calculate the odds ratio (OR). Our results showed MgSO4 group (n = 711) compared to the placebo group (n = 660) were at decreased odds of having AF post CABG surgery (OR 0.59; 95%CI 0.39 to 0.91; p = 0.03) with AF occurrence in 134 patients and 188 patients, respectively. Data were derived from the random-effects model due to the heterogenous result between studies (Tau2=0.22, Chi2=18.99, df = 9 [p = 0.03], I2 = 53%). Conclusion This meta-analysis showed that administration of MgSO4 decreased the occurrence of AF occurrence post CABG surgery. Further research is needed to determine the optimal MgSO4 dose and time of administration.

A Comparative Study of the efficacy of preoperative of oral Pregabalin and placebo on acute Postoperative Pain After Coronary Artery Bypass Graft Surgery

Abstract Background Pain that pursues coronary artery bypass graft (CABG) surgery is usually associated with increased both recovery duration and hospital stay. Patient outcome could be worsened owing to large doses of opioids for pain control through over sedation, and prolonged mechanical ventilation. This study was designed to evaluate the effect of preemptive pregabalin on post CABG surgery pain control. Objective To study the effect of pregabalin administration before surgery in the treatment of acute postoperative pain after coronary artery bypass surgery. To study the effect of pregabalin on the consumption of opioids for acute postoperative pain. Patients and Methods Type of Study: Prospective double – blinded, randomized controlled Trial. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Study Setting: National Heart Institute, Egypt. Study Period: 6 months. Study Population: adult undergoing coronary artery bypass graft surgeries. Results Analysis of VAS in the first 24 hours after extubation showed significant difference between Groups 1 and 2. Analysis of systolic blood pressure and heart rate in the first 24 hours showed no significant difference between Groups 1 and 2. It is important to note that because the observed “average” differences in systolic blood pressure and heart rate between groups were small, the clinical significance of such differences can be questioned. Furthermore, it would not be realistic to expect a big, dramatic benefit from a single intervention in a complex, multifactorial care process, such as in cardiac surgery. Given the complexity of these cases, we believe that even a small reduction in pain intensity is a meaningful improvement as we all try to improve care for these patients. Conclusion Pregabalin can be effective for reduction of post CABG pain and have better patient satisfaction if given preemptively with single dose preoperatively.

A Comparative Study of Preemptive Effect of Pregabalin and Gabapentin on Postoperative Pain After Coronary Artery Bypass Graft Surgery

Abstract Background Pain that pursues coronary artery bypass graft (CABG) surgery is usually associated with increased both recovery duration and hospital stay. Patient outcome could be worsened owing to large doses of opioids for pain control through over sedation, and prolonged mechanical ventilation. This study was designed to evaluate the effect of preemptive gabapentinoids on post CABG surgery pain control. Objective to evaluate the effect of pre-operative administration of pregabalin and gabapentin in limiting the post-operative pain in coronary artery bypass surgeries. Patients and Methods Type of Study: Prospective double – blinded, randomized controlled Trial. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Study Setting: National Heart Institute, Egypt. Study Period: 6 months. Study Population: adult undergoing coronary artery bypass graft surgeries. Results The primary outcome of this study was to compare the effect of gabapentinoids on post CABG pain as reflected by morphine consumption. The secondary outcome was to address the influence of gabapentinoids on patient satisfaction post CABG, the incidence of respiratory depression, nausea, vomiting, ventilatory hours and length of hospital stay. Conclusion Pregabalin, and gabapentin both can be effective for reduction of post CABG morphine consumption and have better patient satisfaction if given preemptively with single dose preoperatively.