Time Of Coronary Artery Bypass Grafting Research Articles

BMI modifies the effect of HDL on outcomes after coronary artery bypass grafting surgery

Abstract Background While the important role of both high-density lipoprotein cholesterol (HDL-C) and body mass index (BMI) in the prognosis of coronary artery disease (CAD) is well known, the impact of BMI on the association between HDL-C and cardiovascular outcomes remains unclear. Purpose In this regard, we aimed to investigate whether BMI can modify the correlation between HDL-C levels and outcomes in patients who underwent coronary artery bypass grafting (CABG). Methods The present registry-based cohort study included patients who underwent isolated, elective, and first time CABG with 18≤BMI<35 kg/m2. The median follow-up period was 76.62 (75.71–77.52) months. The participants categorized into three groups based on BMI: 18.5≤BMI<25 kg/m2, 25≤BMI<30 kg/m2, and 30≤BMI<35 kg/m2. The Cox proportional hazards models and Restricted Cubic Splines (RCS) in the Cox models were applied to evaluate the association between HDL-C and all-cause mortality and occurrence of major adverse cardio-cerebrovascular events (MACCE) in different BMI categories. Results From 2006 to 2016, a total of 17309 patients (73% male, mean age 66.17±9.98) were included. Compared to other groups, diabetes, hypertension, dyslipidemia, and family history of coronary disease were more prevalent in patients with 30≤BMI<35 kg/m2 (P<0.05). Cox proportional hazards models did not show a significant correlation between each 1 mg/dl increase in HDL-C and risk of all-cause mortality and MACCE. In contrast, the results of RCS in the Cox models demonstrated a non-linear relationship between HDL-C and outcomes in patients with 30≤BMI<35 kg/m2, with higher levels of HDL-C, were paradoxically associated with a higher risk of all-cause mortality and MACCE in this BMI category. In the 3D presentation of the association between BMI, HDL-C and all-cause mortality, the highest risk of all-cause mortality was seen in low levels of HDL-C (HDL-C <20 mg/dl) and low or very high levels of BMI. Conclusions Very high HDL-C levels could be associated with a higher risk of adverse outcomes after CABG, in patients with 30≤BMI<35 kg/m2. These findings suggest a role of obesity in the function and properties of HDL-C thereby, it seems necessary to consider the concomitant conditions such as BMI when evaluating the risk of cardiovascular events. Funding Acknowledgement Type of funding sources: None.

Relation of quantitative flow ratio with transit time coronary artery bypass graft flow measurement.

BackgroundQuantitative flow ratio (QFR) is a new functional index to assess the functional significance of coronary stenosis. While whether there is an association between QFR and transit-time flow measurement (TTFM) parameters of the target coronary artery has not been well addressed.MethodsA total of 89 patients receiving the in situ left internal thoracic artery (LITA) grafts to the left anterior descending artery (LAD), and 19 patients undergoing the saphenous vein grafts (SVG) were enrolled in this retrospective study. The QFR value of the LAD was evaluated preoperatively. According to the QFR values, patients with the LITA to the LAD bypass grafts were divided into two groups (group A1: QFR < 0.75, group A2: QFR ≥ 0.75), and SVG patients were divided into two groups (V1 group: QFR < 0.75, V2 group: QFR ≥ 0.75).ResultsIn groups A1 and A2, respectively, median graft flow (Qm) was 44 (34) mL/minute and 26.5 (30.0) ml/minute; median pulsatility index (PI) was 2.00 (1.00) and 2.65 (0.90). Significant differences were observed in Qm (P = 0.034) and PI (P = 0.030). And the correlation coefficients of the TTFM variables with QFR were Qm: r = r = −0.226, (P = 0.036), PI: r = 0.265 (P = 0.012) among the LITA to LAD population.ConclusionTTFM variables, especially the PI, of the LITA in situ graft to the LAD during Coronary artery bypass grafting (CABG) are strongly affected by preoperative QFR values. Moreover, in functionally mild coronary stenosis, the chance of competitive flow increases.

458 Blood Loss Following First Time Coronary-Artery-Bypass-Graft (CABG)

Abstract Introduction Blood loss following cardiac surgery is a recognised complication associated with post-operative mortality and morbidity. Aim To identify parameters associated with blood loss and need for blood transfusion following first time coronary-artery-bypass-graft (CABG). Method Data was collected retrospectively on 50 patients who underwent a first time CABG between 12/02/2020 – 21/09/2020 at the Golden Jubilee National Hospital (GJNH). Parameters included pre-operative and post-operative haemoglobin, platelets, INR, calcium levels, patient age, body-mass-index (BMI), creatinine clearance (CrCl), presence of co-morbidities, anti-coagulant drug use, cross-clamp time, bypass time, re-exploration rates and number of grafts. Patients who required a blood transfusion post-operatively were compared with those who did not require transfusion. Results Seventeen of the 50 patients required a blood transfusion. This group had a lower mean post-operative haemoglobin levels (90.82 vs 107.82, p = &amp;lt;0.001), lower mean post-operative platelet levels (138.47 vs 187.09, p = 0.02), higher post-operative INR (1.25 vs 1.15, p = 0.15), higher mean BMI (27.93 vs 30.433, p = 0.063), higher mean renal dysfunction severity grades (0.7 vs 0.3, p = 0.044) and lower mean CrCl (78 vs 97, p = 0.025). The transfused patient group had older mean age (68.29 vs 64.84, p = 0.065) and a longer mean post-operative hospital stay (9.38 vs 6.67 days, p = 0.043). More patients had pre-operative haemoglobin &amp;lt;120 (p = 0.26), post-operative haemoglobin &amp;lt;90 (p = &amp;lt;0.0001) and post-operative platelets &amp;lt;100 (p = 0.0029). One patient in the transfused group died post-operatively. Conclusions Sub-optimal peri-operative blood levels, renal dysfunction, patient age and patient BMI can influence blood loss and requirement for transfusion following first time CABG.

462 Factors Associated with Longer Post-Operative Hospital Stay Following First Time Coronary-Artery-Bypass-Graft (CABG)

Abstract Prolonged post-operative hospital stay is associated with worse patient healthcare outcomes. Aim To identify parameters which correlate with longer post-operative hospital stay (POHS) following first time Coronary-Artery-Bypass-Graft (CABG) Method Data was collected retrospectively on 50 patients who underwent a first time CABG between 12/02/2020 – 21/09/2020 at the Golden Jubilee National Hospital (GJNH). Data included patient demographics, body-mass-index (BMI), presence of co-morbidities, peri-operative blood results, pre-operative renal dysfunction, left ventricular systolic dysfunction (LVSD), severity of left main stem disease, New York Heart Association (NYHA) Functional Classification score, number of grafts, cross-clamp time and bypass time. Results The mean POHS was 7.5 days. Patients with a POHS&amp;gt;7.5 days had a total mean POHS twice as long (12.07 vs 5.7 days, p &amp;lt; 0.001). They spent more time in intensive care unit (2.6 vs 0.97 days, P = 0.05), high dependency unit (2.5 vs 1.2 days, p = 0.005) and ward (7 vs 3.5 days, p = 0.001) compared to the shorter POHS group. They had a higher mean age (69 vs 65, p = 0.036), lower mean CrCl (80.32 vs 95.14, p = 0.141), higher mean renal dysfunction severity grades (0.8 vs 0.28, p = 0.014), higher mean LVSD severity grades (0.33 vs 0.17, p = 0.35) and higher mean NYHA scores (2.2 vs 1.88, p = 0.17). More of the patients had renal dysfunction (p = 0.01), were on ≥ 2 anticoagulants (p = 0.028), had sub-optimal pre-operative bloods (p = 0.075) and required blood transfusion post-operatively (p = 0.02). One patient in the longer POHS group died. Conclusions Longer POHS was associated with older age, worse renal function, presence of co-morbidities, sub-optimal peri-operative blood levels and requirement for post-operative blood transfusions.

A Single Center Study of Donor Age & Lung Transplant Type in Idiopathic Pulmonary Fibrosis

<h3>Purpose</h3> Idiopathic pulmonary fibrosis (IPF) accounts for the largest proportion of diagnoses on the US lung transplant (LTx) list. LTx type (single vs double) and donor age are associated with differences in outcomes, yet their independent and combined effects in patients with IPF remain unclear and are investigated in this study. <h3>Methods</h3> This study retrospectively analyzed survival of patients with IPF receiving LTx at a single center from Feb-2012 to Mar-2020. LTx recipients were grouped by single (SLT) or double (DLT) LTx type and donor lung age <50 or 50≥ years. Survival outcomes were measured using Kaplan-Meier (KM) survival analysis and compared by log-rank test. Cox proportional hazards modeling was used to control for significantly associated variables, including lung allocation score, surgical approach, pump, warm ischemic time (avg), donor height, and prior percutaneous coronary intervention and coronary artery bypass grafting. <h3>Results</h3> Of 742 LTx patients, 305 (41%) were diagnosed with IPF, of which 204 (67%) were SLT and 97 (32%) were DLT (4 patients underwent either heart-lung transplant or single-sequential LTx and were excluded). There was no significant difference in survival due to LTx type (p=0.368). Similarly, no significant difference in survival was found for patients with donor age <50 or 50≥ years (p=0.298). Of grouped patients with IPF, there were 12 DLT and donor age 50≥, 35 SLT and donor age 50≥, 85 DLT and donor age <50, and 169 SLT and donor age <50. KM analysis showed no significant difference (p=0.455) in survival between the four groups, though DLT and donor age 50≥ had increased mean and median survival days comparatively. Cox regression suggested none of the covariates significantly affected survival. <h3>Conclusion</h3> Demand for donor lungs far exceeds supply, and with IPF accounting for a large percentage of this need, finding effective sources of supply has become increasingly important. Use of SLT and donors aged 50≥ can serve as important supply sources with non-inferior survival outcomes.

Renin-angiotensin system inhibition and outcome after coronary artery bypass grafting: A population-based study from the SWEDEHEART registry

BackgroundRenin-angiotensin system (RAS) inhibitors are recommended postoperatively to coronary artery bypass grafting (CABG) patients with reduced left ventricular function, diabetes, hypertension or previous myocardial infarction, but not to remaining patients. The aim of the study was to assess the long-term utilization of RAS inhibitors after CABG in patients with and without indication for treatment, and its association with outcome. MethodsAll patients (n = 28,782) not meeting exclusion criterion in Sweden who underwent isolated first time CABG from 2006 to 2015 were included using nationwide registries. The association between treatment and outcome was assessed using adjusted Cox regression models with time-updated data on medications. The primary outcome was major adverse cardiovascular events (MACE), defined as all-cause mortality, stroke and/or myocardial infarction. ResultsAt baseline 26,284 (91.3%) of the patients had at least one indication for RAS inhibition while 2498 (8.7%) had not. RAS inhibitors were dispensed to 77.0% and 29.7% of patients with and without indication respectively. Dispense declined over time. RAS inhibition was associated with a reduction in MACE in the whole study population (adjusted hazard ratio (aHR) 0.88, 95% confidence interval (95% CI) 0.83–0.93, p < 0.0001), and in patients with (aHR 0.87 95% CI: 0.82–0.93, p < 0.0001) and without indication (aHR 0.75, 95% CI: 0.58–0.98, p = 0.034). ConclusionsRAS inhibition is underutilized after CABG. The use of RAS inhibitors was associated with a reduction in MACE, both in patients with and without indication for treatment. The results suggest that RAS inhibition is beneficial for all CABG patients. Randomized controlled trials are necessary to confirm this hypothesis.

Predictiveness of different preoperative risk assessments for postoperative bleeding after coronary artery bypass grafting surgery.

Postoperative bleeding is a significant cause of morbidity and mortality in patients undergoing cardiac surgery. Studies have been conducted, and guidelines have been published regarding patient blood management and aiming to prevent blood loss in the perioperative period. Various bleeding risk assessments were developed for preoperative period. We aimed to examine the correlations of scoring systems in the literature with the amount of postoperative bleeding in patients undergoing first time coronary artery bypass graft surgery, and to show the most suitable preoperative bleeding risk assessment for coronary artery bypass graft patients. The study included 550 consecutive patients who underwent coronary artery bypass graft operation. The inclusion criteria were considered as patients to be older than 18 years old and to undergo elective or emergent myocardial revascularization using cardiopulmonary bypass. All variables required for scoring systems were recorded. The initial results of the study were determined as the amount of chest tube drainage, the use of blood products, the change in hematocrit level, reoperation due to bleeding, duration of ventilation, duration of intensive care unit stay, and hospital stay. Mortality which occurred during first 30 days after operation was considered as operative mortality. Operative mortality was accepted as the primary endpoint. Secondary endpoints were massive bleeding and high amount of transfusion. Data were obtained from a series of 550 consecutive patients treated with isolated coronary artery bypass graft. It was seen that PAPWORTH and WILL-BLEED risk assessments responded better for E-CABG grade 2 and 3 bleeding compared to other risk assessments. TRACK, TRUST, and ACTA-PORT scales were found to have low ability to distinguish patients with E-CABG bleeding grade 2 and 3. Predicting postoperative bleeding and transfusion rates with preoperative risk scores in patients undergoing coronary artery bypass graft surgery will provide valuable information to physicians for establishing a proper patient blood management protocol and this will decrease excessive transfusions, unnecessary reoperations as well as improve postoperative outcomes.

Relation of Fractional Flow Reserve With Transit Time Coronary Artery Bypass Graft Flow Measurement

Transit-time flow measurement (TTFM) is frequently used for intraoperative graft flow analysis during coronary artery bypass grafting (CABG). Although the TTFM results may be influenced by fractional flow reserve (FFR) of the target coronary artery as a determinant of coronary lesion-specific ischemia, the data have been limited. We retrospectively investigated the relationships between the intraoperative TTFM variables and preoperative FFR values of the target coronary arteries in 40 in situ left internal thoracic artery (LITA) grafts to the left anterior descending artery (LAD), which were revealed to be patent on postoperative computed tomographic angiography. The Spearman correlation coefficients of the TTFM variables with FFR were maximum flow,-0.12 (P= .301); minimum flow (Qmin),-0.43 (P= .004); mean flow (Qm),-0.30 (P= .036); pulsatility index, 0.37 (P= .012); diastolic filling,-0.36 (P= .012); percentage insufficiency, 0.45 (P= .002); and fast Fourier transform (FFT) ratio,-0.07 (P= .329). While Min and Qm showed significant negative correlation, the pulsatility index and percentage insufficiency showed significant positive correlation with FFR. Most TTFM variables, including Qm, of the LITA graft to the LAD during CABG are strongly affected by preoperative FFR values. Because the FFT ratio is not influenced by FFR, FFT analysis of the TTFM may be recommend in the case of the in situ LITA graft to the LAD with moderate stenosis with a higher FFR exceeding 0.75.

Mortality and Readmissions After On-Pump Versus Off-Pump Redo Coronary Artery Bypass Surgery

IntroductionLarge institutional and administrative datasets that have compared on pump versus off pump first time coronary artery bypass grafting (CABG). However, comparison of off-pump vs on-pump outcomes in patients undergoing redo CABG are limited in current literature. MethodsAll patients who underwent redo CABG for coronary artery disease from 2011 to 2017 at our institution were included in the study. Cox regression analysis was performed to identify variables associated with 5-year mortality and readmission. ResultsThree hundred and fifty patients underwent redo CABG; of which, 309 underwent on-pump CABG and 41 underwent off-pump CABG. Blood product transfusion (31.7% vs 58.9%; p = 0.001) and new onset atrial fibrillation (17.1% vs 35.6%; p = 0.018) were higher in the on-pump cohort. There was no difference in 30-day (2.4% vs 8.1%; p = 0.209), 1-year (4.9% vs 16.5%; p = 0.074), or 5-year mortality (31.7% vs 35.6%; p = 0.213) for off vs on pump redo CABG. There was no difference in 30-day or 1- hospital readmissions between groups. Five-year all cause readmissions (76.9% vs 55.3%; p = 0.037) was significantly higher in the off-pump redo CABG group. On multivariable analysis, on vs. off pump CABG was not significantly associated with mortality or readmission at 5 years. ConclusionThere was no short or long-term survival advantage for on-pump vs off-pump CABG despite risk adjustment. Hospital readmissions at 5-years were higher in the off-pump group.

Female Gender is not a Risk Factor for Early Mortality after Coronary Artery Bypass Grafting.

Background:The female gender is considered as a risk factor for morbidity and mortality after coronary artery bypass grafting (CABG).Aim:In this analysis, we assessed the impact of female gender on early outcome after CABG.Study Design:This is a retrospective analysis of data from our center situated in South India.Statistical Analysis:Patients were categorized according to gender and potential differences in pre-operative and post-operative factors were explored. Significant risk factors were then built in a multivariate model to account for differences in predicting gender influence on surgical outcome.Methods:773 consecutive patients underwent first time CABG between January 2015 and December 2016. 96.77% of cases were performed using off-pump technique. 132 (17.07%) patients were females. These patients formed the study group.Results:The in-house/ 30-day mortality in females was similar to that of males (3.03% vs. 3.12%, p value 0.957). Mediastinitis developed more commonly in females (5.35% vs. 1.30%; p value 0.004) compared to males. There were more re-admissions to hospital for female patients (21.37% in females vs. 10.14% in males, p value <0.001). In multivariate analysis using logistic regression; there was a significant association between age (OR 1.08), chronic obstructive airway disease (OR 4.315), and use of therapeutic antibiotics (OR 6.299), IABP usage (OR 11.18) and renal failure requiring dialysis (OR 28.939) with mortality.Conclusions:Early mortality in females was similar to that of males. Females were associated with higher rate of wound infection and readmission to hospital.

A randomised controlled techniques saphenous vein harvest; morbidity lowering with minimally invasive technique

Background: The long incision is associated with significant intra-operative and postoperative complications. The use of minimal invasive saphenous vein harvesting has been advocated in an effort to minimize such wound related problems. The objective of this study was to compare the morbidity associated with long saphenous vein harvesting using the traditional open technique (A) against a minimally invasive technique using the Mayo vein stripper (B) that involves multiple short incisions.Methods: Authors conducted a prospective randomized controlled study in 80 patients undergoing first time coronary artery bypass grafting. Pain and healing was assessed on each postoperative day. Rings of long saphenous vein were subjected to organ-bath evaluation of endothelium-dependent and endothelium-independent relaxation. Three patients were excluded from the study, leaving 38 patients in Group A and 39 in Group B.Results: With respect to operative procedure, Group A had a greater length of vein harvested than Group B. There was no statistical difference in pain scores and endothelium-dependent or endothelium-independent relaxation between the two groups. However, there were significantly more infections in Group A compared with Group B.Conclusions: Harvesting vein through multiple incisions using the Mayo vein stripper is quicker, results in fewer infections and has no deleterious effect on endothelial function compared to open technique.

Impact of Clopidogrel Loading for Coronarography on Bleeding After Urgent First Time CABG.

Background:Excessive bleeding impairs outcome after coronary artery bypass grafting (CABG). Clopidogrel in combination with aspirin, given before percutaneous coronary intervention, have become the standard for stent thrombosis prevention. Some premedicated patients, however, are found to need surgical treatment, thus platelet inhibition caused by clopidogrel becomes a concern for post operation major bleeding.Aims:This study was designed to evaluate the impact of preoperative clopidogrel on bleeding and outcomes after coronary artery bypass graft surgery (CABG).Methods:The study represent a observational retrospective analysis of collected data. The follow up of 223 treated with clopidogrel and aspirin and 77 patients not receiving treatment with platelet antagonist 7 days before CABG are analyzed.Results:The groups were comparable in age, gender, body surface area, preoperative hematocrit, preoperative prothrombin time and prior myocardial infarction. The clopidogrel group had higher12h and 24h mean chest tube output (at 12h mean 519.7ml vs 353.1 ml, p < 0.05, at 24h mean 756.6 ml vs 563.5 ml, p<0.05). Moreover, reoperation for bleeding was 4.5-fold higher in the clopidogrel group (5.9% vs. 1.3%, p <0.01), and more transfusions of red blood cells (3.23U vs 2.6 U, p<0.05), platelets (1.53U vs 1.23U, p<0.01) and fresh frozen plasma (0.84U vs 0.36 U, p<0.01). The clopidogrel group also showed a longer mechanical ventilation time (16.9h vs 12.9 h p = 0.03) and trend towards more prolonged stay in ICU (2.08 days vs 1.7 days p= 0.048).Conclusions:Clopidogrel in combination with aspirin before CABG is associated with higher postoperative bleeding, exposure to blood products and morbidity. These findings raise concern regarding the routine administration of clopidogrel before anticipated but undecided coronary stent implantation.

Does Baseline Pao2/Fio2 Affect the In-Hospital Outcome in Patients Undergoing Coronary Artery Bypass Grafting?

Background: Oxygen saturation and the PaO2 are the direct risk factors for post -operative respiratory outcome in patients undergoing prolonged surgery under general anaesthesia. However the effect of preoperative PaO2 and PaO2 /FiO2 ratio on the postoperative course of the patient undergoing coronary artery bypass grafting is not known. Hypothesis: Pre-operative PaO2 and PaO2 /FiO2 ratio have a significant effect on the postoperative outcome among the patients undergoing coronary artery bypass grafting. Study design: Prospective clinical study Setting: Tertiary health care centre Materials and Methods: One hundred and fifty eight consecutive patients with a EURO Score of <6 undergoing routine first time coronary artery bypass grafting were selected for this study. Patients with ventricular dysfunction, Chronic Obstructive Pulmonary Disease (COPD), renal or hepatic dysfunction, patients on mechanical ventilation, on preoperative Intra Aortic Ballon Pump (IABP) and those who had to undergo emergency surgery were excluded from the study. All patients were managed by the same anaesthesia and surgical team and the anaesthesia management protocol was similar for all the patients. The pre-operative PaO2 /FiO2 ratio (base line) for all patients was noted before anaesthesia induction in room air. The primary outcome measures were duration of mechanical ventilation, ICU stay and hospital stay. The secondary outcome measures were requirement of inotropes, arrhythmias, requirement of IABP, cardiogenic shock, perioperative myocardial infarction, sepsis, respiratory failure , any other organ dysfunction and death .The total duration of follow up period was one month. Statistical analysis: Seventeen subjects were subsequently dropped because of incomplete data. Consequently, the data for 141 subjects were used for the analysis. The various methods used were Student T test, Spearman’s coefficient correlation, bi-variate and univariate logistic regression analysis. In each case a p value of <0.05 was considered to be significant. Results: There exists a positive correlation between preoperative PaO2 /FiO2 ratio and duration of intubation (r = -0.5607, p = 0.001) as well as Intensive Care Unit (ICU) stay (r = -0.2564, p = 0.002). PaO2 /FiO2 ratio also has a positive correlation with the use of inotropes (p=0.03) and frequency of death (p=0.014) in the patients undergoing CABG . Conclusion: Low pre-operative PaO2 /FiO2 ratio has a direct impact on the in-hospital outcome among the patients undergoing coronary arterybypass grafting. Submit Your Manu Script at: https://symbiosisonlinepublishing.com/submitManuscript.php

Use of short-term steroids in the prophylaxis of atrial fibrillation after cardiac surgery

ObjectivesTo assess the effectiveness of corticosteroids in the prophylaxis of postoperative atrial fibrillation (AF) in patients undergoing elective coronary artery bypass grafting or valvular heart surgery in terms of reducing its incidence and decreasing the length of hospital stay. MethodsThis prospective double blinded randomized study was conducted at Queen Alia Heart Institute (Amman, Jordan) from June 2014 to June 2015 on 340 patients who underwent their first on-pump elective coronary artery bypass grafting (CABG) alone or combined with valvular surgery. Inclusion criteria consisted of elective first time CABG or combined with valvular surgery, use of β-adrenergic blockade, and normal sinus rhythm. Exclusion criteria included a history of heart block, previous episodes of AF or flutter, uncontrolled diabetes mellitus, history of peptic ulcer disease, systemic bacterial or mycotic infection, permanent pacemaker, and any documented or suspected supraventricular or ventricular arrhythmias. Patients were randomized into two equal groups (n=170 each), then each group was subdivided into patients who underwent CABG alone (n=120), and patients underwent valvular heart surgery with or without CABG (n=50). In the treatment group, patients were given 1g of methylprednisolone before cardiopulmonary bypass then 100mg of hydrocortisone every 8 hours for the first 3days postoperatively. The primary endpoint was the overall occurrence of postoperative AF. ResultsAF developed in 21.1% (36 patients) in the treatment group in contrast to 38.2% (65 patients) in the control group (p<0.05). In the subdivided groups (CABG only), approximately 20% (24 patients) developed AF in the treatment group in contrast to 35% (42 patients) in the control group (p<0.05). In the other group, (CABG+VALVE) 24% (12 patients) developed AF compared with 46% (23 patients) in the control group (p<0.05). The length of hospital stay was 6.02±11.23days in the treatment group while it was 5.98±1.86days in the control group, which was found to be statistically nonsignificant. No statistical significant difference in the rate of postoperative complications including mediastinitis as well superficial wound infections was observed between the two groups. ConclusionProphylactic short-term use of steroids both intraoperatively and postoperatively proved to be safe and effective in reducing the incidence of postoperative AF in patients undergoing CABG alone or combined with valve surgery.

Does addition of a pericardial drain in patients undergoing isolated aortic valve replacement reduce post-operative complication: A comparative study of single versus two drains in the early post-operative period?

Does addition of a pericardial drain in patients undergoing isolated aortic valve replacement reduce post-operative complication: A comparative study of single versus two drains in the early post-operative period?

EFFECTS OF PREOPERATIVE ENOXAPARIN ON BLEEDING AFTER CORONARY ARTERY BYPASS SURGERY.

Low molecular weight heparins are replacing unfractionated heparin in practice prior to cardiac surgery. This study examines postoperative (post-op) bleeding indicators in patients who received enoxaparin and underwent elective isolated first time coronary artery bypass graft. A total of 125 consecutive patients who underwent this procedure between 2009 and 2011 at one tertiary center were reviewed and divided into three groups: Group A (n = 50) received the last dose of enoxaparin between 12 and 24 hours before surgery, Group B (n = 25) received the last dose before 24 hours and Group C (n = 50) did not receive enoxaparin. Perioperative bleeding indicators and transfusion rates were compared. Preoperative patients' characteristics were comparable between the three groups. There were no perioperative deaths, return to the operating room for any reason, nor major bleeding. Post-op bleeding indicators were similar in the three groups. The average chest tube drainage at 24 hours post-op was 880 mL, 695 mL and 830 mL in Group A, B and C respectively (p = 0.71). Transfusion rates of red blood cells were not statistically different (Group A 56%, B 64% & C 62%; p = 0.747). In multivariate analysis, female gender, older age, and preoperative clopidogrel intake (stopped 5 days prior to surgery) were associated with higher transfusion rates. In elective first time coronary artery bypass graft patients who had no aspirin or clopidogrel intake 5 days prior to surgery, the use of enoxaparin up to 12 hours prior to skin incision does not increase the risk of post-op bleeding.

Influence of Two Colloidal Extracorporeal Primes on Coagulation of Cardiac Surgical Patients: A Prospectively Randomized Open-Label Pilot Trial

The search for the ideal priming fluid continues as more evidence is discovered about side effects of volume expanders. With the availability of modern, balanced hydroxyethyl starch (HES) solutions with less side effects than former HES solutions, we considered to replace our gelatin- (modified gelatin) based extracorporeal circuit prime for a HES (130/.42) prime. Therefore, we studied the influence of two colloidal priming fluids on postoperative coagulation in patients undergoing cardiac surgery. The primary endpoint was to compare clot formation time between the HES group and the gelatin group with rotational thromboelastometry (ROTEM). Additionally we compared colloid osmotic pressure and fluid balance of both groups. Forty patients, undergoing elective first time coronary artery bypass grafting or single-valve surgery, were included in this prospectively randomized open-label pilot study. Laboratory data and ROTEM data were collected and analyzed for differences between the two groups. ROTEM data show significantly more prolongation in Extem clot formation time and significant more decrease in Extem alpha in the HES group. Fibtem maximum clot firmness was significantly smaller in the HES group; this was consistent with fibrinogen concentration measurement, which decreased more in the HES group than in the gelatin group and recovered more over time in the gelatin group. We found no significant difference in colloid osmotic pressure between the groups. In this trial, HES (130/.42) impairs coagulation significantly more compared with gelatin. These differences in influence on coagulation did not lead to a difference in blood loss or fluid balance, so clinical relevance could not be proven.

Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery.

To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS). An observational study. The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009. Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline. One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 ± 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline. Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time.

KURĮ ANESTETIKĄ RINKTIS KARDIOCHIRURGINIŲ OPERACIJŲ METU?

Žurnalas „Sveikatos mokslai / Health sciences“ yra recenzuojamas tarptautinis mokslinis žurnalas, skirtas skleisti naujas žinias ir informaciją apie visuomenės sveikatą, sveikatos ugdymą, ligas, klinikinius tyrimus ir klinikinius atvejus, naujas technologijas, slaugą, reabilitaciją, sveikatos ekonomiką ir vadybą. Žurnalas spausdina mokslinius straipsnius lietuvių, anglų ir rusų kalbomis, kasmet išeina 1 tomas (6 numeriai) spausdintiniu ir elektroniniu variantais. Daugiau nei 140 mokslinių straipsnių publikuojami per metus. Žurnalas priklauso Lietuvos mokslo periodikos asociacijai.

Minimised closed circuit coronary artery bypass grafting in the elderly is associated with lower levels of organ-specific biomarkers

Restrictive fluid management may protect organ function and improve postoperative outcome in elderly coronary artery bypass grafting (CABG) patients. We assessed organ-specific biomarker release to study the contribution of a fluid restrictive closed circuit concept to organ protection in elderly CABG patients. Cardiac, respiratory and abdominal organ injury was measured during and following minimal fluid coronary artery bypass grafting (mCABG), off-pump coronary artery bypass (opCAB) surgery and conventional CABG with high volume prime and cold crystalloid cardioplegia (cCABG). The results were related to differences in clinical outcome. Prospective randomised trial. Dutch tertiary single centre study. Sixty patients over 70 years of age (38 men and 22 women) were randomised to one of the three different techniques. Inclusion criteria were as follows: first time CABG, elective surgery, ejection fraction more than 30% and multivessel disease. Acetylsalicylic acid and clopidogrel administration or requiring less than three distal anastomoses were an exclusion. Organ-specific markers of the heart--heart fatty acid binding protein (HFABP), troponin T, pro-brain natriuretic peptide (pro-BNP) and creatinine phosphokinase (CPK), lung clara cell 16 protein, pneumoprotein (CC16), intestinal fatty acid binding protein (IFABP) and liver glutathione S-transferase (α-GST)--were measured perioperatively. Postoperative PaO2 levels, ventilation time, blood product consumption and adverse events were noted. Myocardial organ-specific biomarker troponin T showed significantly lower median levels during mCABG compared with the cCABG and opCAB groups [troponin 0.25 mg l(-1) (interquartile range, IQR 0.18 to 0.40), 0.39 mg l(-1) (IQR 0.23 to 0.49) and 0.36 mg l(-1) (IQR 0.23 to 0.50), respectively (P<0.003)]. HFABP, IFABP and α-GST levels were significantly higher during cCABG compared with opCAB and mCABG [HFABP 38.6 mg l(-1) (IQR 29.6 to 47.1), 23.3 mg l(-1) (IQR 16.5 to 31.0) and 21.1 mg l(-1) (IQR 15.7 to 28.8; P<0.001), IFABP 0.57 mg l(-1) (IQR 0.37 to 1.11), 0.44 mg l(-1) (IQR 0.16 to 0.74) and 0.37 mg l(-1) (IQR 0.13 to 1.05; P<0.02) and α-GST 11.5 mg l(-1) (IQR 7.7 to 15.7), 7.0 mg l(-1) (IQR 4.5 to 13.8) and 7.3 mg l(-1) (IQR 6.2 to 11.2), respectively (P<0.009)]. There was a trend towards higher median CC16 levels in the cCABG group (P<0.07). CPK and pro-BNP were not significantly different. On the first postoperative day, PaO2 levels and duration of mechanical ventilation were significantly improved, and there was lower use of blood products in the mCABG group than in the cCABG and opCAB groups (P<0.05). Following mCABG with low volume myocardial preservation and restrictive fluid management, early respiratory performance was improved and consumption of blood products reduced compared with opCAB and cCABG.