Post Coronary Artery Bypass Graft Research Articles

Drug-eluting balloon to treat immediate post-coronary artery bypass grafting (CABG) ST-elevation myocardial infarction (STEMI) - A case report

Abstract Background Coronary artery bypass graft (CABG) surgery represents a major cardiovascular operation and may be associated with post-operative ST-elevation myocardial infarction (STEMI) due to graft failure. This is challenging to diagnose and treat as the implanted grafts may be prone to complications when treated percutaneously with drug-eluting stents. Case Summary A man in his 60 s underwent CABG and developed new persistent ST elevations of 2 mm in anterior leads with no significant chest pain, although, administered with intravenous opiates post-operatively. Transthoracic echocardiography was non-diagnostic. Invasive angiography performed emergently showed a thrombotic occlusion of the mid-left anterior descending artery at the site of the anastomosis with the left internal mammary artery (LIMA) graft. Intervention via the graft was considered high risk of complications, therefore, native coronary arteries were used to approach the occlusion, which was successfully cleared with a combination balloon angioplasty with a semi-compliant and then a drug-eluting balloon. The LIMA started working again with the resolution of ST elevation and no immediate complications. Conclusion Early post-operative ST elevations in continuous leads should not be ignored as they often may be the only feature of new-onset ST-elevation myocardial infarction (STEMI). Drug-eluting balloons represent a feasible and possibly safer option than drug-eluting stents to treat these conditions.

Study of Factors Influencing Early Kinesiophobia in Older Patients after Coronary Artery Bypass Grafting in China

Background: Kinesiophobia is highly prevalent among postoperative cardiac patients. Early identification of kinesiophobia in patients who have undergone coronary artery bypass grafting (CABG) can improve their ability to participate in physical activities. However, there is limited research on the factors influencing kinesiophobia in older patients during the early stages after CABG. To investigate the factors influencing early kinesiophobia in older patients after coronary artery bypass grafting and to examine the correlation between these factors and social support and rehabilitation exercise self-efficacy. Methods: Using convenience sampling, 117 older patients who underwent coronary artery bypass grafting in the cardiac surgery ward of a tertiary grade A hospital in Bengbu City from October 2022 to September 2023 were analyzed. The survey was conducted on-site using a general information questionnaire, the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Cardiac Exercise Self-Efficacy Instrument (CESEI), the Social Support Rating Scale (SSRS), and the pain assessment scale. Single-factor analysis, multifactor regression analysis, and Spearman's correlation analysis were employed. Results: Among the 117 older patients in the early postoperative phase following coronary artery bypass grafting, the incidence of kinesiophobia was 73.5%. Single-factor analysis revealed that education level, medical expense coverage, place of residence, and pain scores were significantly associated with kinesiophobia (p < 0.05). Multifactor regression analysis identified age and monthly income as factors influencing cardiac exercise self-efficacy (p < 0.05). Age, education level, medical expense coverage, and monthly income affected patient social support (p < 0.05). Spearman's correlation analysis revealed significant negative correlations among cardiac exercise self-efficacy, social support, and kinesiophobia level (p < 0.001). Conclusion: The incidence of early kinesiophobia is relatively high among older patients after coronary artery bypass grafting. Educational level, medical expense coverage, place of residence, and postoperative pain were influential factors. Both cardiac exercise self-efficacy and social support have a significant impact on kinesiophobia in patients. Therefore, clinical healthcare professionals should prioritize older patients undergoing postcoronary artery bypass grafting with lower educational levels and monthly incomes. Effective and evidence-based clinical interventions can be tailored based on these influencing factors and their correlations to promote active participation in rehabilitation exercises and improve patient outcomes in the early postoperative phase.

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.

Sex differences in surgical site infections following coronary artery bypass grafting: a retrospective observational study

Surgical site infection (SSI) following cardiac surgery poses a significant challenge for healthcare providers. Despite advances in surgical techniques and infection control measures, SSI remains a leading cause of morbidity and mortality, in addition to being a significant economic burden on healthcare services. Current literature suggests there is a reproducible difference in the incidence of SSI following cardiac surgery between sexes. We aim to assess the sex-specific predictive risk factors for sternal SSI following coronary artery bypass grafting (CABG) in addition to identifying any differences in the causative organisms between groups. Adult patients undergoing isolated CABG between January 2012 and December 2022 in one UK hospital organization were included. In this 10-year, retrospective observational study, a total of 10,208 patients met the inclusion criteria. Pre-operative risk factors were identified using univariate analysis. To assess dependence between sex and organism or Gram stain, a Pearson Chi-squared test with Yates correction for continuity was performed. In total there were 8457 males of which 181 developed a sternal SSI (2.14%) and 1751 females, 128 of whom had a sternal SSI (7.31%). Male patients were found to be significantly more likely to develop an SSI secondary to a Gram-positive organism, whereas female patients were more likely to have a Gram-negative causative organism (P<0.00001). Staphylococcus was statistically more likely to be the causative organism genus in male patients. Pseudomonas aeruginosa was found to be twice as common in the female cohort compared with the male group. In our study, we found a statistically significant difference in the causative organisms and Gram stain for post-CABG sternal SSIs between males and females. Male patients predominately have Gram-positive associated SSIs, whereas female SSI pathogens are more likely to be Gram negative. The preoperative risk profiles of both cohorts are similar, including being an insulin-dependent diabetic and triple vessel coronary artery disease. Given these findings, it prompts the question, should we be tailoring our SSI treatment strategies according to sex and associated risk profiles?

Outcomes after surgical revascularization in diabetic patients.

Patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) have been repeatedly demonstrated to have worse clinical outcomes compared to patients without DM. The objective of this study was to evaluate the impact of DM on 1-year clinical outcomes after isolated CABG. The European DuraGraft registry included 1130 patients (44.6%) with and 1402 (55.4%) patients without DM undergoing isolated CABG. Intra-operatively, all free venous and arterial grafts were treated with an endothelial damage inhibitor. Primary end point in this analysis was the incidence of a major adverse cardiac event (MACE), a composite of all-cause death, repeat revascularization or myocardial infarction at 1 year post-CABG. To balance between differences in baseline characteristics (n = 1072 patients in each group), propensity score matching was used. Multivariable Cox proportional hazards regression was performed to identify independent predictors of MACE. Diabetic patients had a higher cardiovascular risk profile and EuroSCORE II with overall more comorbidities. Patients were comparable in regard to surgical techniques and completeness of revascularization. At 1 year, diabetics had a higher MACE rate {7.9% vs 5.5%, hazard ratio (HR) 1.43 [95% confidence interval (CI) 1.05-1.95], P = 0.02}, driven by increased rates of death [5.6% vs 3.5%, HR 1.61 (95% CI 1.10-2.36), P = 0.01] and myocardial infarction [2.8% vs 1.4%, HR 1.99 (95% CI 1.12-3.53) P = 0.02]. Following propensity matching, no statistically significant difference was found for MACE [7.1% vs 5.7%, HR 1.23 (95% CI 0.87-1.74) P = 0.23] or its components. Age, critical operative state, extracardiac arteriopathy, ejection fraction ≤50% and left main disease but not DM were identified as independent predictors for MACE. In this study, 1-year outcomes in diabetics undergoing isolated CABG were comparable to patients without DM.

The role of postoperative trimetazidine therapy in on-pump coronary artery bypass surgery.

Coronary artery bypass surgery remains the gold standard in the treatment of patients with ischemic heart disease. However, the increased oxidative stress caused by the release of free radicals during the ischemia-reperfusion time is a well-known pathophysiological process during and after coronary revascularization procedures. It may lead to reversible and irreversible myocardial injury.

Effects of Respiratory Physiotherapy in Pulmonary Dysfunction after Cardiac Surgery

Background: Cardiovascular system diseases are a leading cause of death globally. Heart surgeries, performed worldwide to treat these conditions, are often followed by high rates of postoperative complications. Objective: The study aimed to compare the effects of pulmonary physiotherapy on respiratory dysfunction following cardiac surgery. Methods: Forty patients with pulmonary dysfunction post-coronary artery bypass grafting (CABG) participated in the study. They were randomly assigned to receive either postoperative pulmonary physical therapy, including breathing exercises and respiratory muscle training, or conventional physical therapy exercises. Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and inspiratory capacity (IC) were measured using spirometry. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS), with paired t-tests comparing all variables. Results were considered significant at a p-value &lt; 0.05. Results: The study included 21 participants in each group, with a mean age of 55.37 ± 8.72 years. Mean vital capacity in Group A was 2.40 ± 0.46 pre-treatment, increasing to 2.97 ± 0.43, while in Group B it was 2.34 ± 0.41 at baseline, increasing to 2.98 ± 0.36, with a p-value &gt; 0.05 indicating no significant pre- and post-test effects in Group A. Significant pre-post differences in spirometry values were observed within both groups, but no significant differences were noted when compared across the groups following CABG. Conclusion: The study concluded that pulmonary rehabilitation post-cardiac surgery is highly recommended to minimize postoperative complications of heart surgery. It contributes significantly to the prognosis of these patients, emphasizing the importance of preoperative procedures focused on preventing pulmonary system complications and facilitating recovery in the postoperative period after major cardiac surgeries.

Post-Coronary Artery Bypass Grafting Outcomes of Patients with/without Type-2 Diabetes Mellitus and Chronic Kidney Disease Treated with SGLT2 Inhibitor Dapagliflozin: A Single-Center Experience Analysis.

Increasingly, SGLT2 inhibitors save patients with heart failure and comorbidities such as type-2 diabetes mellitus (T2DM) and chronic kidney disease (CKD); the inhibition of sodium-glucose cotransporter 2 (SGLT2) was first studied in patients with diabetes as a solution to lower glucose levels by preventing glucose reabsorption and facilitating its elimination; in the process, researchers took notice of how SGLT2 inhibitors also seemed to have beneficial cardiovascular effects in patients with both diabetes and cardiovascular disease. Our single-center prospective study assesses outcomes of post-coronary artery bypass grafting (CABG) rehabilitation and SLGT2 inhibition in CABG patients with/without T2DM and with/without CKD. One hundred twenty consecutive patients undergoing CABG were included in the analysis. Patients were divided into four subgroups: diabetes patients with chronic kidney disease (T2DM + CKD), diabetes patients without chronic kidney disease (T2DM-CKD), prediabetes patients with chronic kidney disease (PreD+CKD), and prediabetes patients without chronic kidney disease (PreD-CKD). Echocardiographic and laboratory investigations post-surgery (phase I) and 6 months later (phase II) included markers for cardiac ischemia, glycemic status, and renal function, and metabolic equivalents were investigated. One hundred twenty patients participated, mostly men, overweight/obese, hypertensive, smokers; 65 had T2DM (18 with CKD), and 55 were prediabetic (17 with CKD). The mean ejection fraction increased by 8.43% overall but significantly more in the prediabetes group compared to the T2DM group (10.14% vs. 6.98%, p < 0.05). Overall, mean heart-type fatty-acid-binding protein (H-FABP) levels returned to normal levels, dropping from 68.40 ng/mL to 4.82 ng/mL (p = 0.000), and troponin data were more nuanced relative to an overall, strongly significant decrease of 44,458 ng/L (p = 0.000). Troponin levels in patients with CKD dropped more, both in the presence of T2DM (by 82,500 ng/L, p = 0.000) and in patients without T2DM (by 73,294 ng/L, p = 0.047). As expected, the overall glycated hemoglobin (HbA1c) levels improved significantly in those with prediabetes (from 6.54% to 5.55%, p = 0.000); on the other hand, the mean HbA1c changed from 7.06% to 6.06% (p = 0.000) in T2DM, and the presence or absence of CKD did not seem to make any difference: T2DM+CKD 7.01-6.08% (p = 0.000), T2DM-CKD 7.08-6.04% (p = 0.000), PreD+CKD 5.66-4.98% (p = 0.014), and PreD-CKD 6.03-4.94% (p = 0.00). Compared to an overall gain of 11.51, the GFRs of patients with CKD improved by 18.93 (68.15-87.07%, p = 0.000) in the presence of established diabetes and 14.89 (64.75-79.64%, p = 0.000) in the prediabetes group. Regarding the patients' cardiac statuses, the results from our single-center analysis revealed a significant decrease in ischemic risk (H-FABP and hs-cTnI levels) with improvements in mean ejection fraction, glycemic status, and renal function in patients post-CABG with/without T2DM, with/without CKD, and with SGLT2 inhibitor dapagliflozin treatment while undergoing cardiac rehabilitation.

Role of Integrated Intracoronary Imaging to Identify Surgical Clip as a Trigger for ACS-NSTE

An 80-year-old post–coronary artery bypass graft (CABG) patient had an acute coronary syndrome with non–ST-segment elevation myocardial infarction (ACS-NSTE) with saphenous vein graft (SVG)–obtuse marginal stenosis. High-definition intravascular ultrasound revealed an underexpanded SVG stent with a hyperechoic structure. Optical coherence tomography confirmed surgical clip causing compression, resolved by post-dilation. This case underscores ACS-NSTE complexity post-CABG and the critical role of coronary imaging in optimizing interventions by addressing surgical clip–induced compression.

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

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 &gt;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&lt;0.001, Physical activity was low at baseline but after exercise training, the Tai Chi group showed great improvement P&lt; 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&lt;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 (&gt;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.

Post-coronary Artery Bypass Graft Complications; Potential Causes and Risk Factors

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide despite the coexistence of the current COVID-19 pandemic. Current emergency management involves revascularization of the coronary arteries. Aims: Retrospectively evaluate the association between the used number of shunts and postoperative complications. Objectives: Several complications are reported after coronary artery bypass graft (CABG) surgery, such as postoperative arrhythmia and postoperative stroke. However, the risk factors for the development remain not elaborated. Materials and Methods: A retrospective cohort study involved 290 patients for the period 2017-2021 treated surgically for ischemic heart disease. The surgery includes shunts of the internal thoracic arteries with the post-occlusion coronary arteries. The number of shunts is varied depending on the size and number of occluded arteries. According to the number of shunts, the patient may be operated on with artificial circulation (CPB; cardiopulmonary bypass), or without a working heart (OFF pump; without artificial circulation. For statistical analysis, T-test, one-way ANOVA test, X2 test, COX proportional hazards, and Pearson correlation test were used by using the Statistica program. Results: The most frequently reported complication is postoperative hydrothorax, in 28 (11.20%) patients. Patients with post-CABG LV aneurysm had a longer CPB time and aortic cross-clamp time, t-value -5.58113, p &lt; 0.000000; t-value -4.72802, p &lt; 0.000004, respectively. Patients with postoperative hydrothorax with low BMI and longer CPB and Aortic cross-clamp time, t-value of-2.33929, p &lt;0.020021; t-value 3.83233, P &lt; 0.000157; t-value 2.71109, p &lt; 0.007119, respectively. Subsequently, post-operative hydrothorax increases the intensive care unit (ICU) and total hospitalization days, t-value 5.80811, p &lt; 0.000000; t-value 7.37431, p &lt; 0.000000, respectively. Patients who have preoperative progressive angina have a higher number of complications, t-value of 2.108504, p &lt; 0.035866. Post-myocardial infarction patients with myocardial sclerosis (PMIMS) have a higher number of complications, t value of 2.516784, p &lt; 0.012396. A direct correlation between the number of complications and age/CPB time/ aortic cross-clamp time/ICU hospitalization days/total hospitalization days, r= 0.138565, 0.204061, 0.162078, 0.487048, 0.408381; respectively. Conclusion: Postoperative complication rate associated with the pre-existence of progressive angina and PMIMS. Elderly people undergoing CABG are at higher risk of psychosis, arrhythmia, longer total and ICU hospitalization days, and stroke. Advanced age, longed CPB time, prolonged aortic cross-clamp time, long ICU hospitalisation, and long total hospitalization days are risks of more frequent post-CABG complications. Others: The number of complications is not associated with the dead and alive status of patients or with the number of shunts.

Association of carotid artery stenosis and ischemic stroke in patients undergoing coronary artery bypass grafting

Background. The incidence of stroke after Coronary artery bypass grafting (CABG) and the effect of carotid artery stenosis for risk assessment of stroke was strongly needed. This study compared the relation of ischemic stroke in the patients posted for CABG with varying degree of carotid artery stenosis (CAS) as measured by carotid artery Doppler. Patients and methods. This prospective cross-sectional study enrolled 422 patients with coronary artery disease (CAD) who underwent CABG. Out of them 170 patient with concomitant CAD were selected and divided into three groups such as mild, moderate and severe CAS. The occurrence of stroke was measured. Results. Unilateral CAS was common than bilateral CAS (71.2% vs 28.8%). Mild CAS was more than moderate and severe CAS (72.4% vs 21.2% vs 6.5%). Stroke observed in 1.2%, in which one patient had moderate CAS and other had severe CAS on the side of clinical stroke post CABG. Right carotid disease was frequent among 3 groups (51.8% vs 47.6%; 11.8% vs 10.6%; 4.1% vs 3.5%). Patient with old stroke showed significant correlation with the severity of CAD (p=0.02). Post-surgery stroke had significant correlation with previous history of stroke (p=0.001), severity of CAD (p=0.01) and bilateral CAS (p=0.02). Post-operative low volume state requiring prolonged ionotropic support showed significant correlation to stroke (p=0.02). Conclusion. Screening of patients for CAS in patients age &gt;65 years with previous stroke, and comorbidities aids the surgeon to take required measures to prevent stroke as a complication intraoperative or postoperative and decrease morbidity to the patient.

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.

Clinical and laboratory characteristics of perioperative patient's and follow-up after coronary artery bypass graft surgery with extracorporeal circulation

Objectives: Course of hospital stay post-coronary artery bypass graft (CABG) procedure has become increasingly shorter over the last few decades. However, after coronary artery bypass surgery, there is a certain rate of adverse events related to surgery and resuscitation. Therefore, we conducted this study with the goal of evaluating the clinical and subclinical characteristics of patients undergoing CABG surgery with extracorporeal circulation.&#x0D; Methods: A prospective method was used to study 171 consecutive patients undergoing CABG Surgery at Hanoi Heart Hospital from June 2016 to August 2018.&#x0D; Results: The group of stable coronary artery disease 119 (69.6%) patients, the group of acute coronary syndrome 52 (30.4%) patients. The men was 3.6 times higher than that of women (p&lt;0.05). The Euroscore II score (0.6 – 6.42) and typical chest pain were higher in the acute coronary syndrome group (p&lt;0.05). Acute coronary syndrome patient's had a higher rate of postoperative EF reduction than stable coronary artery disease patients (p &lt; 0.05). Stable coronary artery disease patients had CK, CKMB, Troponin T hs increased postop than acute coronary syndrome patient's, ProBnP increased postop in both groups (p&lt;0.05). The time of mechanical ventilation, use of inotropic drugs, and re-operating hemostasis were increased in the acute coronary syndrome group compared with stable coronary artery disease (p&lt;0.05). The rate of reoperation for hemostasis (3.5%), the group of acute coronary syndromes patients was higher (7.7% vs 1.7%), the postoperative mortality rate was 2.3% up to 30 days.&#x0D; Conclusion: The men was higher than that of women, and heart failure increased postop than preop in both echocardiography and laboratory tests. Acute coronary syndrome patients had a higher rate of bleeding re-operating hemostasis than stable coronary artery disease patient's.