Postoperative Coronary Artery Bypass Graft Research Articles

Effect of nano-silver coated catheter combined with comprehensive care on postoperative infection and rehabilitation in patients after coronary artery bypass grafting (CABG)

Coronary artery bypass grafting (CABG) is an effective treatment method for coronary atherosclerosis, aiming to improve patients’ quality of life and facilitate their return to normal activities after surgery. This study examines the effects of comprehensive nursing intervention and application of nano-silver coated catheter on postoperative infection and rehabilitation among patients who have undergone coronary artery bypass grafting. The study included 72 patients, randomly assigned into an intervention group and a control group, with 36 patients in each. The control group received standard care, while the intervention group received comprehensive care along with postoperative application of nano-silver coated catheter. The study compared various factors, including the Hamilton Anxiety Scale (HAMA) score, quality of life score, postoperative recovery, postoperative infection, satisfaction, and adverse reactions between the two groups. The intervention group exhibited better scores in HAMD, HAMA, PSQI and quality of survival score when compared to the control group. Moreover, the intervention group experienced an earlier time to first bowel movement and first defecation after surgery. The intervention group also demonstrated lower rates of urinary protein detection, pathogen detection, and serum inflammatory factor levels compared to the control group. Additionally, the overall incidence of complications in the control group was higher at 27.8% compared to 8.3% in the intervention group. Furthermore, the satisfaction level in the intervention group was significantly higher at 97.2%, in contrast to 83.3% in the control group. Overall, comprehensive care combined with the postoperative application of a nano-silver coated catheter can effectively address patients’ emotional needs and accelerate recovery. It also reduces the incidence of infection, ultimately enhancing the quality of life and satisfaction levels among patients. This study provides a good nursing plan for the postoperative recovery of CABG patients, which is conducive to promoting the speed of postoperative recovery and improving the quality of life of patients.

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.

A Study to Assess the Effectiveness of Self Instructional Module on Knowledge regarding Lifestyle Modifications among Post-operative Coronary Artery Bypass Graft patients at selected Hospital, Secunderabad, Telangana

A pre-experimental research design was adopted to assess the effectiveness of self-instructional module on lifestyle modifications among post-operative coronary artery bypass graft patients of Sunshine Hospital, Secunderabad. 50 samples were selected using non-probability convenient sampling technique. The study’s conceptual framework was built on Imogene King’s goal Attainment theory for achieving the study’s objective. Self-structured questionnaires was used to collect the data. The study shows that the pre-test knowledge scores was 7.52 and the post-test knowledge scores was 21.96. The paired “t” value was 15.13, p&lt;0.05 level of significance. The study shows a significant increase in the knowledge of the patients after the administration of the self-instructional module. There was a significant association between occupation and post-test knowledge scores. The study will be useful in helping to create more awareness regarding lifestyle modifications among post-operative coronary artery bypass graft and researchers can conduct similar study on a large scale basis and comparative basis to add to the existing literature.

Safety and Efficacy of Surgical Correction of Anomalous Aortic Origin of Coronary Arteries: Experiences from two Tertiary Cardiac Centers.

This study aims to describe the outcomes of surgical correction for anomalous aortic origin of coronary artery (AAOCA) with regard to symptom relief. We performed a retrospective multicentre study including surgical patients who underwent correction for AAOCA between 2009 and 2022. Patients who underwent concomitant cardiac procedures were also included. However, to analyze symptom relief we only assessed the subgroup of symptomatic patients who underwent isolated correction for AAOCA. A total of 71 consecutive patients (median age 55, range 12-83) who underwent surgical correction for AAOCA were included in the study. Right-AAOCA was present in 56 patients (79%), left-AAOCA in 11 patients (15%), single coronary ostium AAOCA in 4 patients (6%). Coronary unroofing was performed in 72% of the patients, coronary reimplantation in 28% and an additional neo-ostium patchplasty in 13% of the patients. In 39% of the patients a concomitant cardiac procedure was performed. During follow-up, no cardiovascular-related death was observed. Three patients (4.2%) had a myocardial infarction and underwent postoperative coronary artery bypass grafting. Six patients (8.5%) needed postoperative temporary mechanical circulatory support. Among the 34 symptomatic patients who underwent isolated AAOCA correction, 70% were completely asymptomatic after surgery, 12% showed symptom improvement and no symptom improvement was observed in 18% of the patients (median follow-up 3.5 years, range 0.3-11.1). Correction for AAOCA can be safely performed with or without concomitant cardiac procedures. Performing AAOCA correction leads to a significant improvement in symptoms for most patients.

Phase I Cardiac Rehabilitation Intervention in Patients Undergoing Coronary Artery Bypass Grafting

Patients undergoing coronary artery bypass grafting (CABG) have a risk of postoperative complications that result in prolonged hospitalization and even death. Interventions in the form of phase I cardiac rehabilitation are needed to help speed up the postoperative recovery process and prevent complications after CABG. Although a lot of research has been carried out, it is necessary to conduct further studies of research articles regarding interventions that can be carried out in cardiac rehabilitation programs that are safe and easy to perform in postoperative CABG patients. The purpose of this literature review was to examine safe and effective interven- tions in phase I cardiac rehabilitation in patients undergoing CABG. The implementation of phase I cardiac rehabilitation in patients undergoing CABG started from the preoperative phase and continued postoperatively until the patient was discharged. Phase I cardiac rehabilitation interventions, both pre and postoperative, consist of education and counselling, physical exercise, breathing exercises, effective coughing exercises, inspiratory muscle training, and chest physiotherapy. The results of this literature review can be used as a basis for determin- ing standard operating procedures for the implementation of phase I cardiac rehabilitation for hospitals that provide CABG services.

Developing a Clinical Decision Support System for Prediction Postoperative Coronary Artery Bypass Grafting Infection in Diabetic Patients.

Postoperative infection in Coronary Artery Bypass Graft (CABG) is one of the most common complications for diabetic patients, due to an increase in the hospitalization and cost. To address these issues, it is necessary to apply some solutions. The study aimed to the development of a Clinical Decision Support System (CDSS) for predicting the CABG postoperative infection in diabetic patients. This developmental study is conducted on a private hospital in Tehran in 2016. From 1061 CABG surgery medical records, we selected 210 cases randomly. After data gathering, we used statistical tests for selecting related features. Then an Artificial Neural Network (ANN), which was a one-layer perceptron network model and a supervised training algorithm with gradient descent, was constructed using MATLAB software. The software was then developed and tested using the receiver operating characteristic (ROC) diagram and the confusion matrix. Based on the correlation analysis, from 28 variables in the data, 20 variables had a significant relationship with infection after CABG (P<0.05). The results of the confusion matrix showed that the sensitivity of the system was 69%, and the specificity and the accuracy were 97% and 84%, respectively. The Receiver Operating Characteristic (ROC) diagram shows the appropriate performance of the CDSS. The use of CDSS can play an important role in predicting infection after CABG in patients with diabetes. The designed software can be used as a supporting tool for physicians to predict infections caused by CABG in diabetic patients as a susceptible group. However, other factors affecting infection must also be considered for accurate prediction.

Effectiveness of Acapella along with institutional based chest physiotherapy techniques on pulmonary functions and airway clearance in post-operative CABG patients.

Patients undergoing Coronary Artery Bypass Graft (CABG) surgery often develop pulmonary complications in the early post-operative period as result of decreased lung function and impaired cough. Conventional physiotherapy in early post-operative period aims at increasing lung volumes and airway clearance. This study aimed to determine the effectiveness of the addition of Acapella to conventional chest physiotherapy in improving lung volumes and secretion clearance in early post-operative CABG patients. Twenty patients of both genders (40-70 years) who had undergone CABG and were in Phase I of Cardiac Rehabilitation were involved in this pilot randomized control trial (9 control, 11 experimental). Post-surgery intervention commenced on post-operative day 2 (POD 2) and continued till POD 6. Patients in the control group were given conventional physiotherapy that included breathing exercises, incentive spirometry and manual techniques. Patient in the experimental group used an Acapella device along with the conventional intervention. Outcome measures considered were pulmonary function parameters (FVC, FEV1 & PEFR) and amount of sputum expectorated. A significant increase in lung volumes was observed in both the groups on POD 6 as compared to POD 2 (). However, the increase was significantly greater on POD 6 in experimental group than the control group [mean difference (95% CI) FVC: 0.44 L (0.24-0.63), FEV1: 0.43 L (0.19-0.66), PEFR: 0.86 L/s (0.57-1.14)]. The amount of sputum expectoration significantly greater in the experimental group as compared to the control group [2.71 mL (0.53-4.90)]. The addition of Acapella enhanced the effect conventional physiotherapy in improving lung volumes and airway clearance in the early post-operative period for CABG patients.

A systematic review and meta-analysis of coronary artery disease and revascularization in lung transplant patients.

Coronary artery disease (CAD) is common in candidates for lung transplantation (LTx) and has historically been considered a relative contraindication to transplantation. We look to review the outcomes of LTx in patients with CAD and determine the optimum revascularization strategy in LTx candidates. PubMed, Medline and Web of Science were systematically searched by three authors for articles comparing the outcomes of LTx in patients with CAD and receiving coronary revascularization. In total 1668 articles were screened and 12 were included in this review.Preexisting CAD in LTx recipients was not associated with significantly increased postoperative morbidity or mortality. The pooled estimates of mortality rate at 1, 3 and 5 years indicated significantly inferior survival in LTx recipients with a prior history of coronary artery bypass grafting (CABG) [odds ratio (OR), 1.84; 95% confidence interval (CI), 1.53-2.22; P < 0.00001; I2 = 0%; OR, 1.52; 95% CI, 1.21-1.91; P = 0.0003; I2 = 0%; OR, 1.62; 95% CI, 1.13-2.33; P = 0.008; I2 = 71%, respectively). However, contemporary literature suggests that survival rates in LTx recipients with CAD that received revascularization either by percutaneous coronary intervention (PCI), previous or concomitant CABG, are similar to patients who did not receive revascularization. Trends in postoperative morbidity favored CABG in the rates of myocardial infarction and repeat revascularization, whereas rates of stroke favored PCI. The composite results of this study support the consideration of patients with CAD or previous coronary revascularization for LTx. Prospective, randomized controlled trials with consistent patient populations and outcomes reporting are required to fully elucidate the optimum revascularization strategy in LTx candidates.

Perceived stress level of the postoperative coronary artery bypass graft patients in the intensive care unit

Objective: The purpose of this study was to measure the level of stress perceived by postoperative coronary artery bypass graft (CABG) patients. Coronary artery bypass graft is the most used surgical intervention to treat patients with coronary artery disease (CAD). Many patients consider CABG surgery as life threatening and stressful. There is a need for nurses to be aware of the patient’s perception of stress to create a more therapeutic environment within the intensive care unit (ICU).Methods: The research method was a quantitative descriptive survey design and descriptive statistics were used for data analysis. A convenience sampling method was used resulting in a sample size of 60 participants who had recently undergone a CABG surgical procedure. The participants completed the Intensive Care Unit Environmental Stressor Scale (ICUESS) survey.Results: The results of the ICUESS survey were analyzed according to rank order and mean with standard deviation scores for each of the 40 items. Findings showed the following stressors were ranked as the highest level of stress: “Being in pain”, “missing your husband or wife”, “having tubes in your nose or mouth”, and “only seeing family and friends for a few minutes each day”.Conclusions: The participants in this study were not highly stressed. Pain was the highest ranked stressor. Nurses need to be aware of the perceived level of stress by the postoperative CABG patients to reduce stressors and enhance recovery. The Neuman Systems Model was appropriate for this study.

Changes in heart rate variability pre and postoperative coronary artery bypass grafting

Introduction and objectives: Previous studies have shown that after coronary artery bypass grafting (CABG), heart rate variability (HRV) becomes decreased. The loss of the peripheral autonomic sympathetic and parasympathetic control in Sinoatrial Node in the form of an autonomic cardioneuropathy syndrome is the predictor of the pre and postoperative complications after CABG. The aim of this study was to establish the temporal pattern of change in the decrease of HRV observed after CABG. Methods: The study involved 119 consecutive patients who underwent the first CABG operation with sinus rhythm. All subjects underwent assessed with 24-hour Holter recordings 2 days preoperative and 7 days, 3 months, 6 months postoperative at Hanoi Heart Hospital from 6/2016 to 8/2018. Main results: All indicators of heart rate variability decreased to the lowest level after surgery 7 days, recovers to the preoperative values within three to six months of the procedure. The incidence of pre and postoperative low HRV varies from 28.6% (preop) to 51.8% (postop 7 days), 19.6% (postop 3 months) and 12.7% (postop 6 months). Conclusions: This study have showed that CABG surgery generally leads to significant reduction in HRV. HRV gradually recovers to the preoperative values within three to six months of the procedure.

Association of Atrial Fibrillation With Patient Characteristics in Postoperative Coronary Artery Bypass Grafting Surgery.

IntroductionAtrial fibrillation (AF) after coronary artery bypass grafting (CABG) is correlated with poor patient outcomes. The study evaluated the association of patients' clinical and sociodemographic characteristics with the incidence of atrial fibrillation, postoperatively. MethodologyA longitudinal study was performed in the cardiology department of a tertiary care unit, Sindh, Pakistan between October 2019 and November 2020. All patients who underwent CABG surgery irrespective of gender aged 30 to 75 years were included in the study. Patients with a history of atrial fibrillation or severe left ventricular dysfunction were excluded from the study. The incidence of atrial fibrillation was determined by observing an irregular pattern on electrocardiography (ECG) with no definite P-wave and irregular R-R interval. The patients were monitored for seven postoperative days. The final outcome was measured on the seventh postoperative day. ResultsA total of 247 patients with a mean age of 63.43 ± 9.72 were enrolled in the study. Out of the 247 patients, 9.7% developed new-onset atrial fibrillation, postoperatively. Age above 65 years was associated with the occurrence of AF but it was not statistically significant (p>0.05). Similarly, patients who developed AF were more likely to have a left ventricle ejection fraction (LVEF) of less than 35% than those without AF (66.67% vs 43.95%; p=0.033). ConclusionA high rate of AF was observed in the study. Older age and impaired ventricular function were significantly associated with atrial fibrillation. It is recommended that hospitals should devise guidelines and protocols for the prevention and management of atrial fibrillation in patients undergoing cardiothoracic surgeries in order to minimize patient mortality and improve patient outcomes.

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

Ibutilideis less frequently used drug for atrial fibrillation (AF) in postoperative coronary artery bypass grafting (CABG) patients as compare to amiodarone. We therefore investigated the comparative efficacy of ibutilde and amiodarone for cardioversion in atrial fibrillation after CABG.To compare the efficacy of ibutilide and amiodarone for cardioversion of AF in post CABG patients.Narayana Multispeciality Hospital, Jaipur.Single center, randomized, double blind, comparative prospective study.Total 80 post CABG patients who developed AF were divided into two groups (Group A) Ibutilde and (Group B) Amiodarone respectively. The cardioversion time and cardioversion rate were measured.Unpaired t-test, Paired t-test, Chi square test / Fisher exact test. P value &amp;#60;0.05The cardioversion rate at 4hrs in group A was 42.5% and in group B was 50% (p value &amp;#62; 0.001). At 24 hrs cardioversion rate in group A was 95% and in group B was 87.5% (p value &amp;#62; 0.001). The mean time of conversion to sinus rhythm in group A was 382.85 minutes and in group B was 492.30 minutes. (p value= 0.235)Ibutilide was as effective as amiodarone for restoration of sinus rhythm in postoperative coronary bypass grafting patients who developed atrial fibrillation in their postoperative intensive care unit stay. Ibutilide may be superior to amiodarone in terms of hemodynamics and systemic side effects.

Factors associated with return to work after coronary artery bypass grafting (CABG)

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative CABG patients will generally experience improvement in symptoms and functional capacity. Post-CABG patients are expected to be productive again in order to have a positive impact on both patient and the society socio-economically, in addition to other parameters such as morbidity, mortality and serious adverse events. Purpose to determine the factors that associated with return to work in CABG patients in one General Hospital. Methods. We analyzed data from Adam Malik Hospital registry of 68 patients who had undergone CR after coronary artery bypass graft (CABG) in 2017-2020. The outcomes assessed were work status in 6 month after CABG. Patients’ characteristics, sociodemographic, clinical parameters of functional capacity using 6 minutes of walk test (6MWT), T2DM, Hypertension and cholesterol level were assessed. Factors associated with return to work were identified using multivariable logistic regression. Results We identified 68 patients undergoing isolated CABG (2017–2020). One year after discharge for CABG, 40 (58.8%) patients had returned to the workforce. Factors associated with return to work were identified using bivariate logistic regression. Diabetes mellitus (odds ratio, 10.192; 95% confidence interval, 0.063–0.515). Conclusion Almost 2 from 3 patients after CABG returned to work within 6 months. Diabetes mellitus and functional capacity were associated with a lower likelihood of returning to work.

To Assess the Effectiveness of Video-Assisted Teaching on Knowledge Regarding Lifestyle Modifications and Drug Regimen in Postoperative Coronary Artery Bypass Graft (CABG) Patients Attending OPD

Background:In patients suffering from coronary heart disease ( CHD) after coronary artery bypass grafting(CABG), non-adherence to dietary guidelines, exercise, and prescription medication regimens is a majorhealth care concern worldwide. Aim of the Study:To assess the effectiveness of video-assisted teachingon adherence to lifestyle modifications and drug regimen among postoperative coronary artery bypassgraft (CABG) patients attending the outpatient department. Objectives:1. Assess the knowledge regardinglifestyle modifications and drugregimen among post-operative CABG patients attending OPD.2. Evaluatethe effectiveness of video-assisted teaching on knowledge regarding lifestyle modifications and drugregimenamong post-operative CABG patients attending cardiac and medicine OPD.3. Associate post-test knowledgescore with selected demographic variables of CABG patients. Material and Methods: A hospital-basedinterventional study was used one group pre-test and post-test study design with a Quantitative researchapproach. This study was conducted among 100postoperative CABGattending outpatient departments ofthe age group from 55 years to 70 and above in Wardha city of Maharashtra state. The demographic datasuch asage, sex, educational status, monthly income, dietary pattern and duration after CABGalong with30 knowledge questionnaire regarding lifestyle modifications and drugregimen in postoperativecoronaryartery bypass graftwas obtained using a structured pre-tested questionnaire.Data collected were enteredinto the Microsoft Excel sheet. The statistical analysis was done using SPSS software. Frequencies andpercentages were presented for categorical variables. Result: The pre-test findings show that 0-20%had apoor level of knowledge,21-40%had average knowledge,41-60% had good knowledge,61-80 % had verygood knowledge. Aftervideo-assistedteaching the post-test scorewas26-50%had average knowledge,51-75%had good knowledgeand76-100 %had very good knowledge, thus it shows that after post-test the knowledgescore was increased, applied to find the efficacy of video-assisted teaching’t’ test was applied and’t’ valuewas calculated, The post-test score was considerably higher at 0.05 level than that of pretest score. Hence itindicates that video-assistedefficient teaching.Conclusion:In general, knowledge of lifestyle changes and drug regimen in post-operative patients(CABG) has been average in the pretest and after video-assisted knowledge of adherence to drug regimenand regulation of lifestyle factors like high fat, high cholesterol diet, obesity, smoking and lack of regularexercise has been increased and understanding of the disease dimension has therefore been generated.

Correlation Between the 6-Min Walk Test and Exercise Tolerance Test in Cardiac Rehabilitation After Coronary Artery Bypass Grafting: A Cross-sectional Study.

IntroductionExercise capacity and quality of life are the main outcomes in cardiac rehabilitation (CR). Exercise capacity is one of the important prognostic and diagnostic measures acquired by the exercise tolerance test (ETT). The 6-min walk test (6MWT), as a functional walking test, is another tool for assessing exercise capacity.MethodsEighty postoperative coronary artery bypass grafting (CABG) participants admitted to three CR units were recruited for this cross-sectional and multicenter study, based on convenient non-probability sampling. All participants performed an ETT and two repeated 6MWTs. Maximum heart rate (HR), maximum blood pressure (BP), maximal oxygen uptake (VO2max), and peak metabolic equivalents of tasks (MET) during the tests and also the 6-min walk distance (6MWD) were the outcome measures.ResultsThe mean age of all participants was 62.13 (7.12) years and 80% were male. Pearson correlation showed that maximum HR (r(78) = 0.67, P < 0.001) and maximum systolic BP (r(78) = 0.57, P < 0.001) during the 6MWT correlated moderately with those achieved during ETT. Maximum HR in the 6MWT corresponded to 86% of that achieved during ETT. The 6MWD showed a strong positive correlation with peak MET estimated during ETT as a measure of exercise capacity (r = 0.77, P < 0.001).ConclusionsThe results from this study suggest that the 6MWT is a valid tool for assessing functional capacity for prescribing exercise in a group of postoperative CABG participants admitted to CR units. This finding is helpful for healthcare professionals and for patients, as the test is easy to administer and also well tolerated by patients.Trial Registration NumberPHT-9923.

Plasma Neutrophil Gelatinase-Associated Lipocalin and Interleukin-9 as Acute Kidney Injury Predictors After Coronary Artery Bypass Graft Following Cardiopulmonary Bypass

Background: Acute Kidney Injury (AKI) incidence of postoperative Coronary Artery Bypass Graft (CABG) with Cardipulmonary Bypass (CPB) at Dr. Soetomo General Academic Hospital reached 69.8%, higher than the global average of 5-20%. Predictors of postoperative AKI are needed; potential biomarkers include plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Interleukin-9 (IL-9). This study aims to analyze the predictive ability of these two biomarkers. Methods: This is a prospective observational study in CABG patients with CPB without previous renal abnormalities at Dr. Soetomo in September-December 2020. Examination of plasma NGAL and IL-9 was carried out before, during, and after the CPB procedure. Results: 21 patients were included in the study, 17 people (81.0%) were male. AKI experienced 14 people (66.7%); 3 people (14.3%) died. Patients without AKI had higher plasma NGAL results at preinduction (17.9±10.3 vs 17.1±15.5), durante (20.5±8.2 vs 16.9±7.8), and early ICU (24.0±8.6 vs 22.9±10.4). Patients with AKI had higher plasma IL-9 results at preinduction (63.3±23.2 vs 55.7±15.8), durante (45.2±11.0 vs 44.2±9.2), and early ICU (49.6±11.3 vs 46.2±15.6). There was no statistically significant relationship between plasma NGAL and IL-9 results. Conclusion: Most CABG patients undergoing CPB have AKI. Patients without AKI had higher NGAL results and lower IL-9 in plasma. Statistically, neither of them can be used as predictive biomarkers of the incidence of AKI so far.

Predicting risk factors for postoperative coronary artery bypass grafting using logistic regression and CHAID

Non-fatal postoperative complications are postoperative morbidity that can affect the patient’s functional status and quality of life. Evaluation of postoperative morbidity is the step needed to assess and improve the quality of patient care. Therefore, a method is required in order to predict risk factors in evaluating a patient’s postoperative morbidity. After this the results will be used to determine the insurance premiums. In this research, the Logistic Regression are used to know the risk factors that would occur in patients who had undergone Coronary Artery Bypass Grafting (CABG) surgery. Then we use the CHAID method to classify readmission based on patient characteristics. Based on the two analyzes, it can be concluded that the CHAID analysis supports the Logistics analysis, there are two risk factors significantly influence the complications of patients after Coronary Artery Bypass Graft (CABG), namely Sex and Ejection Fraction.

Comparative effectiveness of metoprolol, ivabradine, and its combination in the management of inappropriate sinus tachycardia in coronary artery bypass graft patients

BACKGROUND:Inappropriate sinus tachycardia (IST) is an arrhythmic complication observed after coronary artery bypass graft (CABG) surgery which left untreated, commonly increases chances of postoperative stroke. The primary study objective was comparing effectiveness of beta blocker-metoprolol; a specific If blocker-ivabradine and its combination in patients who develop IST as a complication following CABG.MATERIALS AND METHODS:An open-labeled, investigator initiated, clinical study was conducted on 150 patients who developed IST (heart rate [HR] >100 beats/min) following elective CABG surgery. The patients were randomized into three treatment groups. Group I – received ivabradine (5 mg), Group II – metoprolol (25 mg), and Group III – ivabradine (5 mg) and metoprolol (25 mg). Treatment was given orally, twice a day for 7 days in all the three groups postoperatively. Primary endpoints were comparative effectiveness in HR and blood pressure reduction following treatment.RESULTS:IST was diagnosed by an electrocardiogram (12-lead) considering morphological features of P-wave and with 32% increase from baseline HR in all the three groups. Compared to IST arrthymic rate, HR was reduced in all groups following respective treatment (P = 0.05). Reduction in HR was significant (P < 0.05) in combination group followed by ivabradine which was significantly greater than metoprolol treated group. None of the treatments clinically changed the systolic, diastolic and mean blood pressure till discharge. No surgery/treatment-related complications were observed in any groups.CONCLUSION:Ivabradine stands as a pharmacological option for controlling HR and rhythm without associated side effects in postoperative CABG patients with IST.

Analysis of Pre-and Post-operative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Acute Kidney Injury After Coronary Artery Bypass Grafting Surgery

Acute Kidney Injury (AKI) remains a common complication of post-operative Coronary Artery Bypass Grafting (CABG)related to high morbidity and mortality. Systemic inflammation has been known as a part of the pathogenesis of acute kidneyinjury. This study aimed to analyze the Neutrophil Lymphocyte (N/L) ratio and Platelet Lymphocyte (P/L) ratio in post-operativeAKI. This research was a retrospective study involving 76 patients who underwent CABG surgery in Dr. Wahidin SudirohusodoCentral Hospital, Makassar, between January 2015 and May 2019. The diagnosis of AKI was based on Kidney Disease ImprovingGlobal Outcomes (KDIGO) 2012 criteria. The N/L ratio and P/L ratio were calculated respectively as a neutrophil count ratio tolymphocyte count and platelet count to lymphocyte count. Twenty-five (32.9%) patients developed AKI in the first 48 hours ofthe post-operative period. There was no difference in pre-operative N/L ratio and the P/L ratio between AKI and non-AKIgroups (p &gt; 0.05). Both ratios increased after surgery and were significantly different between the two groups with higher meanratio in non-AKI (16.93±9.16 vs. 21.86±11.13, p=0.040 and 239,24±184,36 vs. 314,49±143,73, p=0.011). Both pre-operativeand post-operative N/L ratio and P/L ratio could not distinguish AKI after CABG.

EFFECTS OF STRUCTURED MANUAL HYPERINFLATION FOR IMPROVING RESPIRATORY PARAMETRS IN POST-OPERATIVE CORONARY ARTERY BYPASS GRAFT PATIENTS

Purpose: Cardiopulmonary physiotherapy plays a crucial role in cardiac rehabilitation after surgeries. The deterioration of respiratory parameters occurs after coronary artery bypass grafting (CABG) procedure. Manual hyperinflation (MHI) is done according to clinical experiences and there are no specific guidelines for it. The objectives were to determine the effects of structured manual hyperinflation for improving respiratory parameters in post-operative CABG patients.&#x0D; Methodology: Duration of study was 6 months (January 2019-June 2019) with a sample size of 76 post-operative CABG patients. Non-probability purposive sampling technique was used. Patients were divided into two groups’ i-e MHI and VHI depending upon the treatment protocol. In protocol, endotracheal tube (ETT) suctioning was done followed by MHI and VHI in assigned group in randomized controlled trial design. Respiratory parameters were measured by ABG’S, equations for static lung compliance and alveolar-arterial oxygen tension difference. Data was recorded pre and post ETT suctioning, immediately, 30 min and 60 min post intervention. Both males and females were included. Inclusion criteria involves patient must be intubated, hemodynamically and vitally stable, and age range 55-77 years. Those were excluded who have past medical history of diagnosed pulmonary pathology and any post-operative complications. Patient was withdrawn from the study if any subject who have unstable cardiovascular status and high levels of respiratory support. Data was analyzed on SPSS 21.&#x0D; Findings: All the respiratory parameters showed significant differences (p&lt;0.05) in pre and post values of structured MHI. Significant difference (p&lt;0.05) was observed immediately after intervention in terms of acidity (pH), partial pressure of carbon oxide (PaCO2), partial pressure of oxygen (PaO2), oxygen saturation and arterial oxygen to fraction of inspired oxygen ratio between the groups with scores higher for experimental group. HCO3 showed significant difference (p&lt;0.05) immediately after intervention and 30 min and 60 min post intervention with the scores higher for control group. Static lung compliance showed significant difference (p&lt;0.05) at 30 min and 60 min post intervention with scores higher for control group. Alveolar-arterial oxygen tension showed no significant difference (p&gt;0.05) between the groups at any point. No significant difference (p&gt;0.05) was observed between the groups at any other point of measurement for all respiratory parameters. MHI and VHI are both effective in improving respiratory parameters in post-operative CABG patients but the values were more significant in MHI group. But the difference between the groups was not significant and conclusive.&#x0D; Recommendations: This study should be conducted in different patient populations having different pulmonary conditions and other types of cardiac surgeries and in other patients who are intubated and mechanically ventilated. Moreover, the effects of both techniques on different variables must be studied after multiple numbers of sessions during the whole period of intubation. &#x0D;