Post Coronary Artery Bypass Graft Research Articles

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.
 Methods: A prospective method was used to study 171 consecutive patients undergoing CABG Surgery at Hanoi Heart Hospital from June 2016 to August 2018.
 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<0.05). The Euroscore II score (0.6 – 6.42) and typical chest pain were higher in the acute coronary syndrome group (p<0.05). Acute coronary syndrome patient's had a higher rate of postoperative EF reduction than stable coronary artery disease patients (p < 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<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<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.
 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.

Does previous asbestos exposure increase the risk of a post coronary artery bypass graft (CABG) pleural effusion – a routine data study?

BackgroundDevelopment of pleural effusion (PE) following CABG is common. Post-CABG PE are divided into early- (within 30 days of surgery) and delayed-onset (30 days–1 year) which are likely due to distinct pathological processes. Some experts suggest asbestos exposure may confer an independent risk for late-onset post-CABG PE, however no large studies have explored this potential association.Research questionTo explore possible association between asbestos exposure and post-CABG PE using routine data.MethodsAll patients who underwent CABG 01/04/2013–31/03/2018 were identified from the Hospital Episode Statistics (HES) Database. This England-wide population was evaluated for evidence of asbestos exposure, pleural plaques or asbestosis and a diagnosis of PE or PE-related procedure from 30 days to 1 year post-CABG. Patients with evidence of PE three months prior to CABG were excluded, as were patients with a new mesothelioma diagnosis.Results68,150 patients were identified, of whom 1,003 (1%) were asbestos exposed and 2,377 (3%) developed late-onset PE. After adjusting for demographic data, Index of Multiple Deprivation and Charlson Co-morbidity Index, asbestos exposed patients had increased odds of PE diagnosis or related procedure such as thoracentesis or drainage (OR 1.35, 95% CI 1.03–1.76, p = 0.04). In those with evidence of PE requiring procedure alone, the adjusted OR was 1.66 (95% CI 1.14–2.40, p = 0.01). Additional subgroup analysis of the 518 patients coded for pleural plaques and asbestosis alone revealed an adjusted OR of post-CABG PE requiring a procedure of 2.16 (95% CI 1.38–3.37, p = 0.002).InterpretationThis large-scale study demonstrates prior asbestos exposure is associated with modestly increased risk of post-CABG PE development. The risk association appears higher in patients with assigned clinical codes indicative of radiological evidence of asbestos exposure (pleural plaques or asbestosis). This association may fit with a possible inflammatory co-pathogenesis, with asbestos exposure ‘priming’ the pleura resulting in greater propensity for PE evolution following the physiological insult of CABG surgery. Further work, including prospective studies and clinicopathological correlation are suggested to explore this further.

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.

Dual Antiplatelet Therapy: A Concise Review for Clinicians.

Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for patients taking DAPT for established cardiovascular diseases. Short-term dual DAPT of 3-6 months, or even 1 month in high-bleeding risk patients, is equivalent in terms of efficacy and effectiveness compared to long-term DAPT for patients who experienced percutaneous coronary intervention in an acute coronary syndrome setting. Prolonged DAPT beyond 12 months reduces stent thrombosis, major adverse cardiovascular events, and myocardial infarction rates but increases bleeding risk. Extended DAPT does not significantly benefit stable coronary artery disease patients in reducing stroke, myocardial infarction, or cardiovascular death. Ticagrelor and aspirin reduce cardiovascular events in stable coronary artery disease with diabetes but carry a higher bleeding risk. Antiplatelet therapy duration in atrial fibrillation patients after percutaneous coronary intervention depends on individual characteristics and bleeding risk. Antiplatelet therapy is crucial for post-coronary artery bypass graft and transcatheter aortic valve implantation; Aspirin (ASA) monotherapy is preferred. Antiplatelet therapy duration in peripheral artery disease depends on the scenario. Adding vorapaxar and cilostazol may benefit secondary prevention and claudication, respectively. Carotid artery disease patients with transient ischemic attack or stroke benefit from antiplatelet therapy and combining ASA and clopidogrel is more effective than ASA alone. The optimal duration of DAPT after carotid artery stenting is uncertain. Resistance to ASA and clopidogrel poses an incremental risk of deleterious cardiovascular events and stroke. The selection and duration of antiplatelet therapy in patients with cardiovascular disease requires careful consideration of both efficacy and safety outcomes. The use of combination therapies may provide added benefits but should be weighed against the risk of bleeding. Further research and clinical trials are needed to optimize antiplatelet treatment in different patient populations and clinical scenarios.

Validity and reliability of a Thai version of the Body Image Scale among patients with post-coronary artery bypass graft.

Body image is a significant concern for patients who have undergone a coronary artery bypass graft (CABG) surgery, as the presence of scars on the chest, arms, and legs can impact their self-perception. Difficulty accepting these scars may lead to negative body image, non-compliance with prescribed treatments, and potentially poorer health outcomes. However, the Body Image Scale, commonly used to assess body image, has not been validated for Thai patients. This study aimed to evaluate the validity and reliability of the Body Image Scale in Thai post-CABG patients. This instrument validation study was conducted between April and July 2022. A total of 320 post-CABG patients were randomly selected to participate in the study. The scale was translated from English to Thai and adapted to address the concerns of CABG patients specifically. Validity and reliability were assessed using Principal Component Analysis and Cronbach's alpha. The Thai version of the Body Image Scale demonstrated satisfactory internal consistency, as indicated by a Cronbach's alpha coefficient of 0.88. The factor analysis revealed a single-factor structure, and each component had communalities ranging from 0.63 to 0.76, explaining 70.07% of the variance in body image. The Thai version of the Body Image Scale exhibited good validity and reliability for assessing body image in Thai patients undergoing CABG surgery. Nurses and other healthcare professionals can effectively utilize this measurement tool to evaluate the body image concerns of Thai patients following a CABG procedure.

The Investigation of Lectin-Like Oxidized LDL Receptor 1 (LOX-1) K167N Polymorphism, Inflammation, and Lipid Status in Patients with Coronary Artery Bypass Grafting

Objective: Coronary artery disease (CAD) is a pathological condition resulting from atherosclerosis in the coronary arteries. Besides traditional risk factors, genetic factors such as single nucleotide polymorphs (SNPs) can be involve in disease process. Inflammation plays a role in pathological changes throughout atherosclerosis, from initiation to progress. In this study, we aimed to evaluate the effects of lectin-like oxidized LDL receptor 1 (LOX-1) K167N polymorphism, inflammation, and lipid status in patients with coronary artery bypass grafting (CABG). Material and Methods: The study population consisted of 129 CAD patients who had undergone CABG, and 71 healthy controls. The LOX-1 K167N polymorphism was genotyped using PCR-RFLP technique. Plasma interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-33 (IL-33) levels were determined by enzyme-linked immunosorbent assay (ELISA) kits. Results: The distribution of the LOX-1 K167N genotypes and alleles did not differ significantly between CAD patients with CABG and controls. There were no significant differences in plasma IL-1β, TNF- α, IL-33, HDL-C, and LDL-C levels between the patients and controls. IL-1β and systolic blood pressure values were significantly higher in KK genotype patients compared to the same genotype controls(P&lt;0.05). Similarly, systolic blood pressures were higher in NK genotype patients compared with NK genotype controls (P&lt;0.01). Conclusions: IL-1β and systolic blood pressure values were found to be higher in post CABG CAD patients with the KK genotype compared to healthy controls with the same genotype while inflammatory markers and lipid profiles selected according to LOX-1 K167N polymorphism genotype and allele distributions did not differ between groups. Although we couldn’t find an assocation between LOX-1 K167N polymorphism and CAD other than high BP in our study, studies with larger sample sizes might reveal such a relation.

Predictors of atrial fibrillation post coronary artery bypass graft surgery: new scoring system

BackgroundAtrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) is common and results in significant increases in hospital stay and financial encumbrance.ObjectiveDetermine and use the predictors of postoperative AF...

Assessment of the Heart's Left and Right Ventricles (EF and TAPSE) in CABG Surgery Patients before and after Cardiac Rehabilitation.

Post-coronary artery bypass grafting (post-CABG) is a beneficial procedure for cardiac patients. However, without an appropriate cardiac rehabilitation (CR) program, patient care may be inadequate, leading to recurrent hospitalizations and heart failure. This study aims to assess the effects of a CR program on left ventricular ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) measures in post-CABG patients at Amir-almomenin, kordkuy Hospital, Golestan, Iran. This descriptive-analytic study included 100 patients who underwent post-CABG surgery in the second half of 2020, and whose complete information was available in their medical files. An echocardiologist assessed the LVEF and TAPSE of the patients. After one month of CR procedures, these measures were reevaluated and recorded. The CR program consisted of 5 to 10 sessions of physiotherapy per patient, with 2 or 3 sessions conducted per week. It involved a four-phase therapy that included light sports activities such as running and jogging on a treadmill at a CR clinic. Data analysis was performed using SPSS software version 18. The data analysis of this study suggests that implementing a CR program for post- CABG patients can have beneficial effects. CR significantly increased the patients' LVEF, but the increase in TAPSE was not statistically significant. Furthermore, both male and female patients showed improved LVEF after the CR program. There was a non-significant inverse relationship between hospitalization duration and LVEF. Statistically, older patients had a significantly longer duration of hospitalization compared to younger patients. Completion of a cardiac rehabilitation program leads to significant improvement in left ventricular function, while the improvement in right ventricular function is relatively modest. Moreover, a significant proportion of patients were able to resume their normal daily activities after completing the rehabilitation phase.

Subclavian coronary steal syndrome in a post coronary artery bypass grafting patient: A case report

Subclavian coronary steal syndrome in a post coronary artery bypass grafting patient: A case report

PO-01-084 HIDING IN PLAIN SIGHT

Substrate based scar modification requires accurate detection and characterization of myocardial scar in sinus rhythm or using different wavefronts of activation. Mapping during ventricular tachycardia can be performed only in about 30% to 40% cases. We describe a challenging case of scar VT with discrepancy in the delineation of scar between voltage mapping and cardiac MRI and the role of Decremental Evoked Potential Mapping as a guide to a more focussed ablation in such circumstances. N/A N/A 56 year diabetic female status post Coronary artery bypass grafting in 2016 and moderate left ventricular dysfunction with recurrent episodes of hemodynamically unstable ventricular tachycardia and patient's refusal for ICD was evaluated and cardiac MRI revealed subendocardial scar in the anterior wall and patent grafts on coronary angiogram. Patient was taken up for 3D mapping and ablation using 3.5 mm tip non force sensing unidirectional irrigation ablation catheter.In view of hemodynamically unstable VT, activation mapping was not possible, hence substrate mapping was planned. Endocardial bipolar voltage mapping didnot delineate any scar in sinus rhythm and after changing the wavefront of activation to right ventricular paced rhythm. Unipolar voltage map didnot show any scar. While mapping the anterior wall , abnormal local electrograms were seen superimposed into the far field electrograms. To do a foccussed ablation we applied the concept of Decremental Evoked Potential Mapping and identified the slow conduction zone - the most critical component of the scar for initiation and maintainence of re-entry. We identified and ablated only the points with abnormal local electrograms with absolute value of decrement more than 10 ms as part of slow conduction zone. Post ablation, VT was not inducible despite induction protocol using triple extrastimuli from two different sites. Activation mapping is not possible in hemodynamically unstable VT. Substrate based mapping needs accurate delineation of myocardial scar. As the 3D mapping system is an automated system and annotates only the largest amplitude signals for color coded voltage mapping, in cases without dense scar, voltage mapping doesnot reliably identify and delineate the scar when compared to cardiac MRI, particularly with a larger tip diameter ablation catheter. Novel mapping techniques like Decremental Evoked Potential Mapping enable limited ablation in such cases.

PO-05-146 AN UNUSUAL ATRIOVENTRICULAR REENTRY TACHYCARDIA: SUCCESSFUL ABLATION OF NOVEL SLOW PATHWAY AT SUPERIOR SEPTAL PERIMITRAL LEFT ATRIUM

Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia (SVT), treated with catheter ablation of slow pathway. The right and left inferior slow pathway (SP) extensions of the AV node are widely recognized, but other SPs are very rare. We present a case of atypical AVNRT that was successfully ablated at the superior septal perimitral left atrium. N/A A 75-year-old man with history of coronary artery disease status post coronary artery bypass grafting and recurrent episodes of symptomatic SVT despite diltiazem and metoprolol presented for catheter ablation. Mid RP SVT (cycle length, CL 350 ms) with concentric atrial activation was inducible with atrial and ventricular extrastimulation. Synchronized premature ventricular complexes and ventricular entrainment excluded AV reentry. Very late coupled premature atrial complex from coronary sinus (CS) delivered synchronous to septal A activation delayed next A and reset SVT indicating AVNRT and excluding ectopic junctional (JT) or atrial tachycardia (AT). Further, AH interval during SVT was much longer than AH with atrial pacing at same CL excluding AT. We concluded mechanism to be atypical AVNRT. On activation mapping of right atrium, earliest A was recorded in the fast pathway region, earlier than locations of right and left slow pathways in the triangle of Koch and CS respectively. Radiofrequency ablation lesions anatomically targeting both slow pathways were delivered at base of triangle of Koch and inside CS without affecting SVT. High density activation maps of both right and left atria were created during SVT using Orion basket catheter and Rhythmia (Boston Scientific) mapping system. Earliest A was recorded in the superior septal perimitral left atrium, superior to the location of His bundle electrogram, and anatomically adjacent to aortic sinuses of Valsalva (not mapped). We concluded this to be an unusual left superior extension of the AV node. Radiofrequency ablation lesion using IntellaNav MiFi catheter at this site promptly terminated SVT. Consolidation lesions were delivered and anchored to the mitral annulus. The tachycardia was no longer inducible on programmed electrical stimulation despite isoproterenol. The patient has remained symptom free for 6 months since ablation. With activation mapping we identified the retrograde slow pathway participating in an unusual atypical AVNRT at superior septal perimitral left atrium.

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

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

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.

Benign Late T Wave Inversion Post Coronary Artery Bypass Grafting: Case Report of Myocardial Reperfusion Sign Appearing Late on ECG

The onset of new T wave inversion (TWI) on an electrocardiogram (ECG) has always been considered an alarming sign of myocardial ischemia. Successful myocardial infarction reperfusion is indicated by the presence of early TWI after revascularization. We report a case of benign late precordial TWI post-coronary artery bypass grafting (CABG) with no evidence of myocardial ischemia.

A study of the effects of intravenous magnesium sulphate on post-operative atrial fibrillation in patients undergoing off pump coronary artery bypass grafting (CABG)

Atrial fibrillation (AF) occurs in almost 30% of patients undergoing coronary artery bypass grafting (CABG). Around 80% of these patients have decreased levels of total and ionized serum magnesium postoperatively. The association between magnesium deficiency and post CABG AF is still undetermined. Therefore, a large variety of prophylactic strategies have been assessed including perioperative magnesium administration. However, the efficacy is still questionable. The aim of this study was to find out any correlation of serum magnesium levels with the incidence of post-operative atrial fibrillation in patients undergoing off pump CABG and whether magnesium supplementation modifies the incidence. One hundred fifty patients undergoing CABG were selected and divided into treatment and control groups. Perioperative serum magnesium assays were done, and patients were monitored in the postoperative period for occurrence of Atrial Fibrillation. The risk of post CABG atrial fibrillation was more among females, obese patients, patients with EF &amp;#60; 50% and RWMA. Post-operative AF occurred in 5 patients in the treatment group (n = 75) and 11 patients in the control group (n = 75). : The proportion of patients with post-operative atrial fibrillation among cases (6.7%) was lower than that of controls (14.7%) which may indicate an important role of magnesium in prevention of AF following cardiac surgeries. The results however didn’t reach a statistical significance which could be due to sample size, the duration and design of the study and the period of post-operative AF monitoring.

Challenges to Cardiac Rehabilitation Post Coronary Artery Bypass Grafting: A Qualitative Study in Pune.

Background Adherence to cardiac rehabilitation (CR) regimen is crucial in the post-coronary artery bypass grafting (CABG) period. Cardiac rehabilitation involves various lifestyle changes, including diet and exercise, regular follow-up in OPD, and implementing secondary prevention recommendations. This study aims to understand the challenges to CRpost-CABG. Methodology Seven in-depth interviews using aninterview guide were carried out in the outpatient section of the cardiothoracic vascular surgery (CTVS) department of a tertiary health care facility in Pune, India. A purposive sampling technique was followed. Results The qualitative study revealed that dietary restrictions were difficult to follow, that some patients could not quit smoking even after surgery, and that transportation costs were an issue regarding CR follow-up. The majority of the participants appreciated the importance of regular exercise in their post-surgery life. Conclusion Despite the hurdles, the majority of participants stated that the fact that CABG is a major treatment pushed them to attend routine CR follow-ups and adhere to the CR regimen. A solid CR team was one of the study's strengths, and the team established a routine of telephonic reminders for regular follow-up, which resulted in lower rates of loss to follow-up.

Role of a Whole Plant-Based Diet in a Patient's Journey to Healthy Living: A Case Report

Background: A plant-based diet is associated with lower cardiovascular disease and mortality incidence. This article reports a case of a post coronary artery bypass graft, morbidly obese, uncontrolled diabetic patient who was able to reduce weight, reduce blood pressure medications, and come off insulin with a strictly plant-based diet. Case report: A 61-year-old man was seen in follow-up post coronary artery bypass grafting. He had a history of hypertension, hyperlipidemia, diabetes, morbid obesity, coronary artery disease post-stenting in 2000, and heart failure preserved ejection fraction. Post-discharge, he felt tired, had gained 7 lb with hemoglobin A1c (HbA1c) 10% on high-dose insulin, and had uncontrolled hypertension on amlodipine, bumetanide, and carvedilol. He was started on a strictly plant-based diet. He was compliant on subsequent visits. At six months follow-up, he had excellent blood pressure and glucose control. He was able to come off amlodipine, bumetanide, and insulin completely. He lost 70 lb and was more active. Discussion: A plant-based diet effectively reduces obesity, diabetes, hypertension, hyperlipidemia, and heart disease. Epidemiological studies have shown lower cardiovascular and all-cause mortality with a plant-based diet. Conclusion: A whole food, plant-based diet should be recommended to prevent and control cardiovascular risk factors and overall cardiovascular morbidity and mortality.

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.