Post-coronary Artery Bypass Graft Surgery Research Articles

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.

Pearls of Exercise-based Cardiac Rehabilitation Frame in Post Coronary Artery Bypass Graft

Patients undergoing coronary artery bypass grafting (CABG) have a risk of postoperative complications resulting in long hospital stays and even death. In patients undergoing CABG, cardiac rehabilitation is recognized as an essential adjunct therapy for secondary prevention. Encouraging exercise-based cardiac rehabilitation might help speed up the postoperative recovery process, decrease in-hospital stay, prevent complications, and reduce public health costs. Exercise-based cardiac rehabilitation in both pre and post CABG surgery, consist of exercise or physical activity, education and counselling, inspiratory strength muscle conditioning, effective cough exercises, chest physiotherapy, breathing exercises, and gymnastics for respiratory muscle stretching. This literature review aims to analyze the exercise-based cardiac recovery of patients undergoing CABG and its effects in terms of physiological and clinical criteria, such as cardiovascular outcomes, aerobic ability, quality of life, and mortality. Key words: Cardiac rehabilitation; Coronary artery bypass grafting; Exercise; Physical activity Citation: Dewi IP, Dewi KP, Tanojo T, Mulia EPB, Adriana M. Pearls of exercise-based cardiac rehabilitation frame in post coronary artery bypass graft. Anaesth. pain intensive care 2021;25(3):367–375. DOI: doi.org/10.35975/apic.v25i3.1383 Received: November 2, 2020, Reviewed: February 22, 2021, Accepted: March 26, 2021

The relationship between diabetes and surgical site infection following coronary artery bypass graft surgery in current-era models of care

Although diabetes is a recognized risk factor for postoperative infections, the seminal Portland Diabetic Project studies in cardiac surgery demonstrated intravenous insulin infusions following open-cardiac surgery achieved near normal glycaemia and decreased deep sternal wound infection to similar rates to those without diabetes. We sought to examine a contemporary cohort of patients undergoing coronary artery bypass graft surgery (CABGS) to evaluate the relationship between diabetes, hyperglycaemia and risk of surgical site infection (SSI) in current-era models of care. Consecutive patients who underwent CABGS between 2016 and 2018 were identified through a state-wide data repository for healthcare-associated infections. Clinical characteristics and records of postoperative SSIs were obtained from individual chart review. Type 2 diabetes (T2D), perioperative glycaemia and other clinical characteristics were analysed in relation to the development of SSI. Of the 953 patients evaluated, 11% developed SSIs a median eight days post CABGS, with few cases of deep SSIs (<1%). T2D was evident in 41% and more prevalent in those who developed SSIs (51%). On multivariate analysis T2D was not significantly associated with development of SSI (odds ratio (OR) 1.35; P=0.174) but body mass index (BMI) remained a significant risk factor (OR 1.07, P<0.001). In patients with T2D, perioperative glycaemia was not significantly associated with SSI. In a specialist cardiac surgery centre using perioperative intravenous insulin infusions and antibiotic prophylaxis, deep SSIs were uncommon; however, approximately one in 10 patients developed superficial SSIs. T2D was not independently associated with SSI yet BMI was independently associated with SSI post CABGS.

The Malay version of SF-36 health survey instrument: testing data quality, scaling assumptions, reliability and validity in post-coronary artery bypass grafting (CABG) surgery patients at the National Heart Institute (Institut Jantung Negara\u2014IJN), Kuala Lumpur

BackgroundThe Short Form 36 (SF-36) is a scoring system comprising of 36 items categorized into eight constructs corresponding to patients’ health-related quality of life.It has been used extensively in various countries on different sub-populations and used to indicate the health status and help to ascertain the effect of clinical interventions on the particular population.ObjectiveTo examine the psychometric properties of the Malay version of SF-36 (Malay SF-36) summated rating scales and validate the scale among post-coronary artery bypass grafting surgery (CABG) patients at the National Heart Institute (IJN), Kuala Lumpur.MethodsFive hundred and nine post-CABG patients at the IJN, Malaysia completed the questionnaires between 1 July and 31 December 2017. Psychometric tests endorsed by the “International Quality of Life Assessment Project” were utilised.ResultsThe data quality was excellent with a high questionnaire completion rate (100%). As hypothesized, the ordering of item means within scales was clustered. In unison, scaling assumptions were satisfied. Good discriminant validity was shown between subsets of patients with various levels of health status. Notwithstanding, there were probably translation issues of the Physical Functioning scale which showed small ceiling effects. We clearly observed high ceiling and floor effects in both Role Physical and Role Emotional scale most probably attributed to the dichotomous style of their choice of responses. Cronbach alpha values of the eight scales ranged from 0.73 to 0.90, showing good internal consistency reliability. Confirmatory Factor Analysis (CFA) confirmed the 8-factor solution and Composite Reliability revealed internal consistency reliability except for Vitality and Social Functioning. Based on the Average Variance Extracted (AVE), convergent validity was adequate except for two domains. Discriminant Validity is good for the eight constructs as the √AVE are generally higher than the correlation coefficients between the latent constructs.ConclusionThe scoring for the Malay SF-36 based on the summated ratings method was proven to be valid to be applied in our local clinical population. The CFA, fitness estimates, reliability and validity assessments suggest that the Malay version of SF36 is a valid and reliable instrument. However, further work is warranted to further refine the convergent validity and reliability of some scales.

Is stealing still a crime? Comment on left internal mammary artery side branch intervention in the management of coronary steal syndrome following coronary artery bypass grafting

Post-coronary artery bypass graft surgery (CABG) angina has been attributed unligated thoracic side branches competing with LIMA-LAD flow. Case reports suggest thoracic branch occlusion can relieve angina. Phasic arterial blood flow and direct measurements argue against the existence of LIMA steal.

Frontal plane QRS-T angle may be a predictor for post-coronary artery bypass graft surgery atrial fibrillation

New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.

Graft Patency Rate and Risk Factors for Graft Failure among Symptomatic Post Coronary Artery Bypass Graft Surgery Patients

BACKGROUND Malaysia, a multiracial country, has been burdened by ischemic heart disease, the leading cause of death for the past 10 years. The success of coronary artery bypass grafting surgery (CABG) particularly depends on the continued patency of aortocoronary grafts. The study aims to identify the graft patency rate and risk factors of graft failure among symptomatic post CABG patients. METHODS Data were collected from 80 patients with a history of CABG, who underwent conventional coronary angiography for refractory angina in Hospital Sultanah Aminah Johor, Malaysia from January 2014 till December 2018. The graft patency was evaluated with conventional coronary angiography. Graft patency was assessed with the Kaplan-Meier method. Differences between graft patency were tested with log-rank test at a 5% significance level and result with p-value &lt;0.05 was considered statistically significant. RESULTS Among the 80 post CABG patients with cardiac symptoms, there were 2 patients with acute myocardial infarction (2.5%) and 24 patients with NSTEMI (30%). 22 patients (27.5%) were found to have all grafts patent despite being persistently symptomatic. Left internal mammary arterial (LIMA) graft remained as the best conduit with a significantly better short, medium, and long term patency (up to 20 years) compared to SVG graft (Log-rank test, p-value &lt; 0.05). Indian race and age less than 70 years had higher risk of SVG graft stenosis. CONCLUSION Type of conduits remains the most important factor in determining the coronary artery bypass graft patency, with LIMA produces the best patency rate in both short and long term.

Subjective and objective cognition 6-week post-coronary artery bypass graft surgery: A descriptive pilot study.

BackgroundCoronary artery bypass graft (CABG) surgery has been found to be associated with post-operative cognitive decline. Despite the large and growing numbers being conducted in South Africa, the associated or ensuing cognitive symptoms or impairment have received little research attention.AimThe aim of this pilot study was to describe the nature and extent of subjective cognitive complaints (SCCs) and objective cognitive impairments in patients 6-week post-CABG surgery in a clinical sample in KwaZulu-Natal (KZN) Province, South Africa.SettingA cross-sectional survey was conducted among outpatients attending their 6-week post-CABG surgical review at a cardiology clinic in a KZN provincial hospital.MethodSocio-demographic and clinical data were captured, with SCCs being determined by using standardised questions; cognition was assessed with the Montreal cognitive assessment (MoCA).ResultsThe mean age of the sample (n = 28) was 58.72 years. The mean MoCA score was 23.96 (SD = 4.32); 60.71% (n = 17) screening positive (< 25/30) and more likely to be older, male, hypertensive and diabetic. A third (n = 9; 35.71%) reported at least one new SCC; their mean age was 55.36 years which was lower than those without subjective complaints (59.81).ConclusionsSubjective and objective cognitive impairments were evident in patients 6-week post-CABG surgery identifying a need for longitudinal cognitive screening both pre- and post- operatively in patients undergoing CABG surgery.

The effect of remote patient monitoring on discharge outcomes in post-coronary artery bypass graft surgery patients.

Coronary artery bypass graft (CABG) surgery is a lifesaving procedure for patients with coronary artery disease but ranks highest (13.5%) for preventable hospital readmissions and second highest in average Medicare payment ($8,136) per readmission. Care transitions after hospital discharge warrant exploration to improve outcomes. The purpose of this brief report was to compare the effect of remote patient monitoring (RPM) on 30-day outcomes in Medicare beneficiaries after isolated CABG surgery. Results demonstrated no statistically significant difference in 30-day readmission (p = .568) or emergency department encounters (p = .785) between groups. However, time to achieve a cardiology follow-up appointment decreased from 19.8 to 13.7 days (p = .062) in the RPM group. Although the findings were not statistically significant, this study demonstrated a reduction in CABG readmissions and timely provider follow-up with RPM. In addition, study findings contribute to the body of nursing knowledge and support the need for further studies to identify high-risk CABG patients who may benefit from RPM after hospital discharge.

Long-Term Survival Outcomes after Coronary Artery Revascularization Surgery of Bangladeshi Population: A Single Centre Study

Background &amp; objective : Coronary artery bypass graft (CABG) surgery has given symptomatic and structural release of coronary atherosclerotic heart disease. CABG has been performed frequently for more than 30 years in Bangladesh. But there are no nationwide studies on the rate of survival in Bangladesh. The present study was undertaken to find the post CABG surgery survival outcomes and association between risk factors and survival over long time span.&#x0D; Methods: We studied 650 consecutive patients’ post-operative clinical data retrospectively and survival outcome data were collected prospectively who had CABG surgery from 2010 to 2015 in Ibrahim Cardiac Hospital &amp; Research Institute. Of the 650 patients, 84(12.9%) died after a median follow up of 4.9 years. Demographic, clinical, operative and postoperative characteristics were then compared between survived and died patients to find the factors associated with survival.&#x0D; Result: Analysis revealed that younger patients were more likely to survive [RR = 1.1(95% CI = 1.0-1.2)] longer than those who have had their CABG at or &gt; 55 years (p = 0.001). Males generally had a higher likelihood of survival [RR = 1.1(RR = 1.1(95% CI = 0.9-1.2)] than their female counterparts (p = 0.038). Non-diabetics tend to have a better survival [RR = 2.3(95% CI = 1.3-3.9)] than diabetics (p = 0.001). Non-smokers also have a higher chance of longer survival [RR = 1.5(95% CI = 0.9-2.2)] than the smokers. CABG patients without CKD enjoyed longer survival [RR = 1.4(95% CI = 0.9-2.2)] than CABG patients with CKD (p = 0.006). None of the operative and postoperative factors but hospital stay was associated with longer survival. The survived patients had a shorter mean hospital stay than the patients who died (p = 0.001). Analyses of the causes of death revealed heart disease to be the predominant cause (38%) followed by stroke (12%), CKD (8%) and other causes like cancer, liver disease etc. (42%).&#x0D; Conclusion: Younger, male, non-smoker, non-diabetic patients may enjoy long-term survival following CABG surgery. Prediction of long-term survival can be used to determine the most appropriate post-discharge care strategies. This would undoubtedly help both patients and doctors to implement behavioral and therapeutic modifications to optimize benefit from surgery.&#x0D; Ibrahim Card Med J 2019; 9 (1&amp;2): 8-15

SUN-015 VASCULAR STIFFNESS AS A PREDICTOR OF ACUTE KIDNEY INJURY FOLLOWING CABG – A PILOT STUDY

AKI following coronary artery bypass graft (CABG) is common, potentially preventable but there is no accepted method to identify those at risk. Arterial stiffness is a predictor of CVD, renal disease and stroke. This study examined arterial stiffness, assessed by pulse wave velocity, as a predictor of AKI post CABG surgery. The study recruited 63 patients (18-80 years) undergoing isolated elective CABG. Anthropometric variables, renal function and pulse wave velocity (PWV) were measured pre-operatively and renal function was assessed post-operatively for 5 days. Aortic tissue samples were obtained intra-operatively and were histologically analysed. AKI staging was based on the KDIGO definition. Statistical analysis was obtained using SPSS 25. Ethical approval for this study was granted by NRES Surrey Research Ethics committee. Baseline characteristics are as shown in table 1. Seven patients (11%) of patients developed AKI stage 1 following surgery. PWV was higher in patients who developed AKI compared to those who did not (12.2 ± 3.5 vs 9.9 ± 2.6 m/s; p=0.045). PWV increased with age (Pearson correlation 0.519; p=0.000) and was higher in diabetic patients (12.4 ± 2.5 vs 9.3 ± 2.4; p= 0.000). PWV was also high with high systolic BP, ≥140mmHg, (11.5 ± 2.5 vs 9.3 ± 2.6; p=0.001). Histological comparison of aortic samples of an AKI patient with high PWV compared to a non- AKI patient with low PWV (Figure 1) shows differences in calcification and elastin. PWV was higher in patients who developed AKI following CABG. The PWV was also higher in CABG patients with diabetes, older age and sBP. Further study will be needed with more patients to establish a link.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Lipid Control Post Coronary Artery Bypass Graft: One Year Follow-Up of a Middle-Eastern Cohort.

Background:Data on patient characteristics and provider practices in the management of lipids per the new guidelines in specific secondary prevention patients in the Middle East is limited.Objective:To explore patient characteristics and lipid management practices according to the new cholesterol guidelines in secondary prevention patients, up to one year following discharge for coronary artery bypass graft surgery (CABG).Methods:A retrospective chart review of patients discharged post CABG between February 2017 and February 2018 at a quaternary care centre in the Middle East. Patients were characterized by baseline demographics, comorbidities, and use of lipid lowering medications.Results:189 patients were included in the analysis. Most were diabetic (70.9%) and classified as very high risk per the ACC/AHA guidelines (84.1%) and as extremely high risk per the AACE guidelines (85.2%). Most patients (93.1%) were discharged on high intensity statin. About one third (28.6%) were never seen or only followed once within the first 2 weeks post discharge. Of those who continued to follow up beyond 3 months and within 1 year of discharge (44.4%), about half (51.2%) had follow-up lipid panels performed. Patients who followed up and were seen by a cardiologist were five times more likely to have lipid panels ordered than those seen solely by a CT surgeon. Of those with follow-up lipid panels beyond 3 months: 59.3% achieved LDL goal of <70 mg/dL and 29% achieved LDL <55 mg/dL based on their respective goals.Conclusions:Most patients undergoing CABG in a quaternary care centre in the Middle East are high risk ASCVD. Nonetheless, lipid goals are not commonly achieved nor routinely monitored. Providers will need to transition from the previous risk stratification and statin-only focused approach to adopt the most recent guidelines.

POST CABG SURGERY PAIN WITH THE USE OF SKELETONIZED VERSUS PEDICLED TECHNIQUE OF INTERNAL THORACIC ARTERY HARVESTING

Objective: To document post coronary artery bypass graft (CABG) surgery painwith the use of skeletonized technique versus pedicled technique of internalthoracic artery (ITA) harvesting in our population. Methodology: A cross sectional study was done from February 2014 toSeptember 2017. Patients who underwent elective on-pump coronary arterybypass graft surgery were included in the study. Patients ware subjected to twodifferent techniques for CABG surgery. Postoperatively CABG surgery painintensity was scored prior to discharge and at 01 month follow-up on a visualanalogue scale (VAS) ranging from 0 to 10. Chi square statistical test was utilized(p 0.05), whereas the Visual Analogue Score was significantlylower in the skeletonized left ITA group (p≤0.05) at one month follow up. Conclusion: There is decreased post CABG surgery pain with the use ofskeletonized technique of internal thoracic artery harvesting compared topedicled technique.

23 - Implementation of a Protocol to Transition Patients From Intravenous Insulin Infusion to Subcutaneous Therapy Postcoronary Artery Bypass Graft

At a tertiary cardiac care institution 32% of patients with diabetes undergoing cardiac surgery developed an infection. Hyperglycemia is often observed following cessation of standard intravenous insulin infusion (IVII) postoperatively. To treat hyperglycemia a protocol was developed to guide the transition to subcutaneous (SC) insulin postcoronary artery bypass graft surgery (CABG).

Occluded mammary graft post-coronary bypass surgery: do we need to look for the second one? A case report.

BackgroundAnatomic variations of the left internal mammary artery (LIMA) can influence coronary artery bypass surgical technique as well as posing definite difficulties in the interpretation of angiographic findings. We present an unusual anatomic variant of two LIMAs originating from the left subclavian artery discovered post-coronary artery bypass grafting surgery.Case summaryA 60-year-old man post-LIMA grafting of the left anterior descending (LAD) coronary artery underwent diagnostic cardiac catheterization. Selective angiography revealed occluded LIMA; therefore, it was decided to proceed with percutaneous coronary intervention (PCI) to the occluded native LAD. Once antegrade flow in the LAD was restored, retrograde filling of a vessel corresponding to the previously grafted LIMA was also detected. Additional contrast injection in the left subclavian artery (LSCA) showed a second patent LIMA originating from the distal segment of the LSCA.DiscussionThis patient has an unusual anatomic variant of two LIMAs originating from the LCSA. The proximal rudimentary LIMA was misinterpreted as an occluded arterial graft while the second, well-developed LIMA connected to the LAD had an unusually distal origin and had therefore been overlooked. This anatomical variant should be kept in mind when the internal mammary graft seems to be occluded.

SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449)

BackgroundSingle centre studies support No Touch (NT) saphenous vein graft (SVG) harvesting technique. The primary objective of the SUPERIOR SVG study was to determine whether NT versus conventional (CON) SVG harvesting was associated with improved SVG patency 1 year after coronary artery bypass grafting surgery (CABG).MethodsAdults undergoing isolated CABG with at least 1 SVG were eligible. CT angiography was performed 1-year post CABG. Leg adverse events were assessed with a questionnaire. A systematic review was performed for published NT graft patency studies and results aggregated including the SUPERIOR study results.ResultsTwo hundred and-fifty patients were randomized across 12-centres (NT 127 versus CON 123 patients). The primary outcome (study SVG occlusion or cardiovascular (CV) death) was not significantly different in NT versus CON (NT: 7/127 (5.5%), CON 13/123 (10.6%), p = 0.15). Similarly, the proportion of study SVGs with significant stenosis or total occlusion was not significantly different between groups (NT: 8/102 (7.8%), CON: 16/107 (15.0%), p = 0.11). Vein harvest site infection was more common in the NT patients 1 month postoperatively (23.3% vs 9.5%, p < 0.01). Including this study’s results, in a meta-analysis, NT was associated with a significant reduction in SVG occlusion, Odds Ratio 0.49, 95% Confidence Interval 0.29–0.82, p = 0.007 in 3 randomized and 1 observational study at 1 year postoperatively.ConclusionsThe NT technique was not associated with improved patency of SVGs at 1-year following CABG while early vein harvest infection was increased. The aggregated data is supportive of an important reduction of SVG occlusion at 1 year with NT harvesting.Trial registrationNCT01047449.

Pre-operative depression predicted longer hospital length of stay among patients undergoing coronary artery bypass graft surgery.

Purpose: Coronary artery bypass graft surgery (CABG) is a common and remarkably effective treatment for coronary heart disease, improving health status and enhancing quality of life. However, some outcomes after surgery remain unexplained, including psychological factors such as depression. The prevalence rates of pre- and post-operative depression among CABG patients are high, which is associated with negative short- and long-term outcomes. This study explores the impacts of pre-operative depressive symptoms on post-operative hospital length of stay (LOS) among patients undergoing CABG in Jordan.Patients and methods: This was a non-experimental, prospective observational study among 227 CABG patients recruited from 5 hospitals in Amman, Jordan. Depression was measured within an average of two weeks prior and one month after the operation using the Hospital Anxiety and Depression Scale. Length of stay was abstracted from medical records after discharge.Results: The average post-operative LOS was 11.40±10.41 days. The average pre-operative depression level was moderate; 12.76±6.80 and 42.47% complained of varying levels of depressive symptoms. The average post-operative depression level was moderate; 11.11±6.78 and 40.53% complained of varying levels of depressive symptoms. In stepwise regression models, depression scores and female gender were independent predictors that increased post-operative LOS. On the other hand, high income (≥1501$/month) and use of statins had protective effects and decreased post-operative LOS. The model explained 22.4% of the total variance regarding LOS.Conclusion: Pre-operative depressive symptoms increased post CABG LOS. Application of policies and depression assessment protocols prior to CABG by health care providers can identify high-risk groups (eg, females), so appropriate interventions can be designed and implemented to decrease morbidity and mortality.