Undergoing Coronary Artery Bypass Graft Surgery Research Articles

A Retrospective Study to Evaluate the Association Between the Glasgow Prognostic Score and Atrial Fibrillation, Stroke, and Mortality at 30 Days and at 1 Year After Coronary Artery Bypass Graft Surgery.

BACKGROUND The Glasgow prognostic score (GPS) consists of a combination of serum C-reactive protein and albumin levels as indicators of systematic inflammatory response and nutritional status, respectively. The present retrospective study aimed to evaluate the association between the GPS and atrial fibrillation, stroke, and mortality at 30 days and 1 year after coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS Patients with chronic coronary syndromes who underwent CABG surgery between 2012 and 2019 in a single center were included. Preoperative GPS was calculated. Then, patients were grouped according to postoperative atrial fibrillation (POAF) development. Further, groups were formed to evaluate the relationship between GPS and 30-day and 1-year cardiovascular mortality as well as stroke development. RESULTS Patients who developed POAF had higher GPS, higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) score, advanced age, lower angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use, lower left ventricular ejection fraction, and were more likely to be female and to have a history of carotid artery disease (P<0.05, for all). Additionally, GPS, EuroSCORE II, advanced age, and lower left ventricular ejection fraction were detected as independent risk factors for POAF development. When adverse outcomes were assessed, cardiovascular mortality at 30 days or 1 year, and stroke development at 1 year, were more frequent in patients with POAF. Moreover, POAF development was found to be an independent risk factor for adverse outcomes. Also, GPS was established as an independent risk factor both for 30-day and 1-year cardiovascular mortality (P<0.0001 and P=0.001, respectively). CONCLUSIONS GPS is an easy-to-calculate score that has reasonable diagnostic accuracy in determining the risk of POAF and stroke as well as 30-day and 1-year cardiovascular mortality.

Could uric acid to high-density lipoprotein cholesterol ratio be used to predict late-stage saphenous vein graft disease after coronary artery bypass graft surgery?

Objectives: Various vascular grafts are used in coronary artery bypass graft (CABG) surgeries, however, the most commonly used one is the saphenous vein graft (SVG). Various studies conducted on this topic have found a relationship between uric acid to HDL-C (UHR) and cardiovascular diseases. In this current study, we aimed to investigate the predictive importance of UHR value in predicting long-term SVG disease in patients who underwent CABG surgery. Methods: Patients who had a history of CABG surgery at least one year prior, had stable angina pectoris, and underwent coronary angiography between January 01, 2016 and January 01, 2020, were included in the study retrospectively. Patients with open saphenous veins were defined as Group 1, and patients who had 50% or more stenosis in at least one SVG after coronary angiography, were defined as Group 2. Results: The median age of the 204 patients included in Group 1 and 292 patients in Group 2 were 65 (38-77) years and 66 (45-79) years, respectively (p = 0.251). The two groups were similar in terms of gender, hypertension, chronic obstructive pulmonary disease rates, history of cerebrovascular events, ejection fraction, body mass index, and current medical treatments. In univariate analysis, SVG disease was found to significantly correlate with diabeter mellitus (odds ratio [OR]: 1.644, 95% confidence interval [CI]: 1.190-1.985, p = 0.008), current smoking (OR: 0.875, 95% CI: 0.669-0.940, p = 0.030), number of patients with target artery diameter &amp;lt; 1.5 mm (OR: 1.945, 95% CI: 1.221-2.398, p &amp;lt; 0.001), age of SVG (OR: 2.960, 95% CI: 1.980-4.168, p &amp;lt; 0.001), uric acid (OR: 1.241, 95% CI: 1.078-1.592, p = 0.004), triglyceride (OR: 0.780, 95% CI: 0.569-0.935, p = 0.044) and UHR (OR: 1.894, 95% CI: 1.384-2.896, p &amp;lt; 0.001). Conclusions: In this study, we showed that we can predict saphenous vein graft occlusion with serum UHR value.

The Effect of Aloe Vera Gel on Saphenous Vein Harvest Wound Healing and Local Pain in Non-diabetic Patients Undergoing CABG Surgery: A Clinical Trial

Background: Coronary artery bypass graft (CABG) is a common surgical procedure in patients with heart disease associated with pain and problems with great saphenous veins (GSVs) wound healing. Objectives: We aimed to determine the effect of aloe vera gel on pain intensity, and GSVs wound healing in non-diabetic patients undergoing CABG. Methods: In this clinical trial, 35 CABG candidate patients fulfilling admission criteria were selected by convenience sampling, and their lower limbs were randomly assigned to the intervention or control group. The wound care for both groups was the same except for using aloe vera gel for the intervention group from the first to the fourth days after surgery. Pain intensity and GSVs wound healing data were collected by Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scale and Visual Analog Scale (VAS) questionnaires on the first, fourth, seventh, and fourteenth days and analyzed by SPSS software. Results: On the seventh day, the mean pain intensity in the intervention group was significantly lower (P = 0.01). The mean scores of wound healing in the intervention limb decreased faster; however, the wound healing score was not significantly different between the two groups at any time (P &gt; 0.05). Using aloe vera gel reduced ecchymosis on the seventh and fourteenth days and reduced pain on the seventh day compared to the control limb (P &lt; 0.001). Conclusions: Aloe vera gel can effectively reduce GSVs' pain intensity and ecchymosis from the seventh day. The topical application of this herb can have various degrees of effectiveness in decreasing pain and speeding up the healing of surgical wounds.

Effects of acupressure on intestinal function in patients with coronary artery bypass graft surgery: a randomized clinical trial.

This study aimed to determine the effects of acupressure on the intestinal function of patients undergoing Coronary Artery Bypass Graft (CABG) surgery. Studies indicated that cardiovascular patients are prone to constipation. Acupressure is one of the therapeutic and palliative approaches that can be used by doctors, nurses, and even patients themselves. The present three-group randomized clinical trial study was conducted on 90 patients undergoing CABG surgery. In the intervention group, 48 hours after surgery the patients received acupressure points LI4 and ST25 twice a day (10 am and 6 pm) for three sequential days. In the sham group, the patients received acupressure at a 1.5 cm distance from the LI4-ST25 points, and the patients in the control group received only the usual care. This research used a demographic and medical information questionnaire, Rome IV scale, Bristol stool scale, symptom registration checklist, and daily excretion assessment checklist. The intestinal function indices were completed 24 hours after surgery (before intervention), 48, 72, 96, and 120 hours after surgery. All three intervention, sham, and control groups were without defecation in 24 hours (before intervention) and 48 hours after surgery. There was a significant difference between the three intervention, sham, and control groups in the number of stools after 72 hours, 96 hours, and 120 hours after the intervention (p<0.001). Also, a significant difference was observed among the three groups in terms of stool consistency 96 hours after the start of the intervention (p=0.032) and 120 hours after the start of the intervention (p<0.001). The results showed that patients had a significant improvement in the number of bowel movements and stool consistency in the intervention group. In acute conditions, acupressure on LI4-ST25 points can positively affect intestinal function when patients are hospitalized in the intensive care unit.

The effect of educational program based on the clinical practice protocol on treatment adherence, self-efficacy and quality of life of patients undergoing coronary artery bypass graft surgery.

Educating the patients undergoing coronary artery bypass graft (CABG) before and after surgery is one of the most important factors for success in this surgery, as it improves their treatment adherence, self-efficacy, and quality of life. The aim of this study was to determine the impact of the educational program based on clinical practice protocol upon treatment adherence, self-efficacy, and quality of life of patients undergoing CABG surgery in Tehran, Iran, during the period 2021-2022. This experimental study was conducted on 100 patients who were undergoing CABG and were hospitalized in a public hospital (Shahid Modarres Educational Hospital) in Tehran, Iran, in 2021-2022. Patients were randomly assigned to intervention (n = 50) and control (n = 50) groups. Four questionnaires (demographic-clinical questionnaire, Modanloo's adherence to treatment questionnaire, Sullivan's self-efficacy questionnaire, and McNew's quality of life questionnaire) were completed by both intervention and control groups before and 1 month after the educational intervention. The intervention group received an education program based on the clinical practice protocol. Data were analyzed using descriptive and inferential methods in Statistical Package for the Social Sciences (SPSS) 22 software. The results of the study showed that the intervention and control groups were similar in terms of demographic and clinical characteristics. The average scores of treatment adherence, self-efficacy, and quality of life 1 month after the intervention were significantly higher in the intervention group compared to the control group. Also, the average scores of treatment adherence, self-efficacy, and quality of life were significantly higher 1 month after the intervention than before in the intervention group (P < 0.001). The results of this study showed that education program based on the clinical practice protocol can be effective and useful for increasing the level of treatment adherence, self-efficacy, and quality of life of patients undergoing CABG.

Effect of Magnesium Sulfate in Prevention of Postoperative Atrial Fibrillation Arrhythmia among Candidates of CABG Surgery with Abnormal P-wave Duration

Background: Cardiac arrhythmias, especially atrial fibrillation, are among the most common early complications of open-heart surgery. Hypomagnesemia is one of the clinical mechanisms associated with the pathogenesis of postoperative atrial fibrillation. This study aimed to evaluate the effect of magnesium sulfate on the prevention of atrial fibrillation in patients with abnormal P-wave duration who underwent coronary artery bypass graft (CABG)surgery. Methods: In this clinical trial, 150 patients participated who had undergone CABG surgery at Imam Khomeini hospital in Ahvaz in 2014. According to the inclusion criteria, the intervention and control groups were randomly matched. The intervention group, consisting of 57 patients, received 2.4 g of magnesium sulfate daily for three days and 75 patients of the control group received a placebo. Prevention of postoperative atrial fibrillation by magnesium sulfate was evaluated in patients and data were analyzed using SPSS software. Results: The two groups did not have a significant difference in terms of gender, diabetes, hyperlipidemia, and hypertension. Also, mean P-wave duration, length of intensive care unit stay, the total length of hospitalization, left ventricular ejection fraction (LVEF), distribution of creatinine, atrial fibrillation, and aortic clamp time in intervention and control groups were not statistically significant. Only, the total pump duration difference was reported to be statistically significant between groups. Conclusion: The results of our study showed that the administration of magnesium sulfate alone cannot be helpful in the prevention of atrial fibrillation among patients with long P-wave duration. Trial Registration: https://www.irct.ir/, Identifier: IRCT2015092814190N9

Cost of a routine (planned) cardiac by-pass surgery at the National Hospital of Sri Lanka

Background: Non-communicable disease (NCD) has become a major challenge in Sri Lanka. Over the last 40 years, ischemic heart disease (IHD) has been identified as one of the leading causes of NCD deaths in Sri Lanka. Coronary artery bypass graft (CABG) is a revascularization procedure that has been identified as an effective method for managing a patient with IHD. Therefore, estimating the approximate cost of CABG surgery in a public hospital would help in economic evaluations and managerial decision-making in public sector investments.Objective: To estimate the approximate cost of an uncomplicated routine (planned) cardiac bypass surgery at the National Hospital of Sri Lanka (NHSL), Colombo.Methods: This study was primarily based on secondary data. The data required for costing the procedure was extracted from 52 BHTs of patients who underwent CABG surgery at the NHSL during the last three months of the year 2019. Extracted data was used to determine the costing elements of each cost center. Direct and indirect cost centers were identified, and the cost of each center was determined by apportioning the available cost data by the step-down method using a weighted factor where applicable.Results: The approximate cost of an uncomplicated CABG was Rs. 1.3 million per patient. Out of the total cost, 89% (Rs. 1.16 million) was expended on direct labor as salaries of different categories of staff. A major portion of it (56%) was spent on ICU care (Rs. 0.654 million) followed by post-surgical care at the ward settings (33.9%, Rs. 0.393 million). The highest cost of the material was recorded at the theatre which was 6% of the total cost (Rs. 78,960.00). The cost of total overheads was Rs. 29,517.00 which was about 2.2% of the total. Conclusion: Although the approximate cost of a routine uncomplicated CABG surgery was Rs.1.3 million ($ 7,027) as of December 2019 at the National Hospital of Sri Lanka, compared to more developed countries this is a fairly low cost. However, when the differences between health system organization and per capita health expenditure are concerned, this is quite evident to claim that the Sri Lankan health system has low-cost but effective models of delivering its care to people.

The plasma galectin-3 level has high specificity and sensitivity for predicting postoperative atrial fibrillation after coronary artery bypass surgery.

Postoperative new-onset atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) surgery. This study aimed to determine the utility of the preoperative netrin-1 and galectin-3 levels for predicting POAF following CABG surgery, as well as that of postoperative serial measurement for assessing these markers' patterns of expression. This prospective cohort study included 50 patients that underwent CABG surgery. The plasma netrin-1 and galectin-3 levels were measured via enzyme-linked immunosorbent assay (ELISA) before surgery (baseline) and at 6, 12, and 24 h after surgery. The patients were divided into two groups according to the occurrence of POAF; the POAF (+) group and the POAF (-) group. In total, 26 patients developed POAF, whereas 24 remained in sinus rhythm. Baseline galectin-3 levels were higher in the POAF (+) group than in the POAF (-) group (30.7 ± 10.1 pg mL-1 and 15.7 ± 3.6 pg mL-1, respectively). The post-CABG surgery galectin-3 level increased in both the POAF (+) and POAF (-) groups at 6 h (46.2 ± 26.3 pg mL-1 and 24.9 ± 5.9 pg mL-1, respectively), 12 h (45.2 ± 24.1 pg mL-1 and 26.6 ± 9.3 pg mL-1, respectively), and 24 h (54.2 ± 33.5 pg mL-1and 28.6 ± 7.7 pg mL-1, respectively). The plasma netrin-1 level did not differ between groups at baseline or at 6, 12, and 24 h post CABG surgery. Whereas netrin-1 does not appear to have any utility as a marker for the development of POAF in CABG surgery patients, the plasma galectin-3 level has high specificity and sensitivity for predicting POAF following CABG surgery and could be considered a marker for predicting POAF.

Factors Influencing Length of Stay in The Intensive Care Unit after Coronary Artery Bypass Graft in Duhok City – Kurdistan Region

Background: Long stays in the Intensive Care Unit (ICU) following coronary artery bypass graft (CABG) surgery are associated with higher hospital mortality, poor long-term prognosis, prolonged hospital admissions, and consequently, excessive cost and resource use. This study aimed to identify the individual and perioperative risk factors influencing ICU length of stay after coronary artery bypass graft surgery at Azadi Heart Center in Duhok city. Patients and Methods: This comparative cross-sectional study reviewed the medical records of 230 patients who underwent CABG surgery from 1st January 2019 to 31st December 2020. The patients were divided into two groups based on their length of stay in the ICU. The usual stay group (ICU length of stay &lt; 72 h), and the prolonged stay group (ICU length of stay ≥ 72 h). Results: Among the 230 patients studied, 53 (23.04%) patients had an ICU length of stay ≥ 72 hours and 177 (76.96%) patients had an ICU length of stay &lt; 72 hours and the mean duration of ICU stay was 2.45 days, ranging from 1 to 13 days. This study found that the factors increasing the ICU length of stay after CABG were; preoperative myocardial infarction (MI), elevated preoperative WBC counts, prolonged cardiopulmonary bypass (CPB) time, prolonged intubation, reintubation, reoperation, readmission, arrhythmia, receiving inotropic agents in the ICU, cardiac, pulmonary, and wound complications, and a higher postoperative troponin level. Conclusion: This study showed&nbsp;pre-, intra-, and post-operative clinical and surgical risk factors affect prolonged ICU stays

Abstract 14448: On-Table Extubation Associated With Lower Resource Utilization and Non-Inferior Outcomes After Coronary Bypass

Introduction: Minimizing the duration of postoperative ventilation facilitates early discharge from the intensive care unit (ICU) thus promoting enhanced recovery after cardiac surgery (ERAS). Hence, we sought to investigate the impact of on-table extubation on outcomes and resource utilization after coronary artery bypass graft (CABG) surgery. Methods: We performed a retrospective review of a prospectively collected local database, including all patients undergoing CABG surgery at a large academic center from January 2020 to December 2021. Patients were stratified into two groups, on-table (before leaving the operating room) extubation versus early (&lt; 6 hours after procedure) extubation. In-hospital mortality and postoperative complications were compared using univariate analyses. Length of stay (LOS), 30-day readmission and high resource utilization (HRU), a binary outcome defined as direct procedure cost of the highest quartile, were investigated. Results: A total of 691 patients were included in our analysis, 267 (38.6%) of which were extubated on-table. The two groups had similar median age and preoperative ejection fractions. However, on-table extubation patients were more likely to be males (86.9% vs 76.6%, p&lt;0.001) with smaller BMIs (27.7% vs 28.5%, p=0.002), lower STS risk scores (0.75% vs 0.95%, p=0.022) and lower cerebrovascular disease prevalence (8.2% vs 14.2%, p=0.017). Compared to early extubation, on-table extubation patients had similar rates of in-hospital mortality (0 % vs 1.4 %, p=0.051), postoperative blood transfusion (7.5% vs 9.0%, p=0.494), reintubation (2.6% vs 3.5%, p=0.499) and pneumonia (1.9% vs 3.3%, p=0.263). As hypothesized, on-table extubation patients had shorter ICU LOS (32hrs vs 39hrs, p=0.02), shorter postoperative LOS (4.9 days vs 5.9 days, p=0.003), and lower incidence of high resource utilization (18.0% vs 29.5%, p&lt;0.001). ICU readmission (3.8% vs 3.5%, p=0.887) and 30-day readmission (5.2% vs 7.3%, p=0.277) were similar in the two groups. Conclusions: On-table extubation is a safe and effective ERAS practice, that is associated with lower ICU LOS, postoperative LOS, and resource utilization, without affecting rates of reintubation, ICU readmission, 30-day readmission or operative mortality.

Triglyceride-glucose index in the prediction of major adverse cardiovascular events in patients with type 2 diabetes mellitus after coronary artery bypass surgery: A retrospective cohort study.

Insulin resistance (IR) is a significant risk factor for cardiometabolic diseases and a defining feature of type 2 diabetes mellitus (T2DM). This study aimed to examine the potential value of triglyceride-glucose (TyG) index as a predictor of prognosis in coronary heart disease (CHD) patients with T2DM after coronary artery bypass grafting (CABG) surgery and to facilitate the identification of those at high risk of major adverse cardiovascular events (MACEs) for closer monitoring or possible early intervention. This study enrolled 386 T2DM patients who underwent CABG surgery at Nanjing Drum Tower Hospital. Patients were separated into two groups according to the median preoperative TyG Index. The Kaplan-Meier plot was used to compare the rate of MACEs-free survival in T2DM patients after CABG. The independent risk factors for the occurrence of MACEs were investigated using multivariate analysis. Nomogram was used to depict the predictive model. Significantly more MACEs occurred in individuals with higher medians of the TyG index (65 (33.7%) vs. 39 (20.2%), p=0.003). TyG index [hazard ratio (HR) 12.926], LVEF [hazard ratio (HR) 0.916], and NYHA functional class III/IV [hazard ratio (HR) 4.331] were identified as independent predictors of MACEs incidence in post-CABG T2DM patients by multivariate analysis. The area under the curve (AUC) for predicting MACEs using the TyG index was 0.89 at five years. Combining the TyG index, LVEF, and NYHA functional class III/IV to build a novel risk assessment model for postoperative MACEs, the AUC climbed to 0.93 at five years. With AUCs, the nomogram comprised of the TyG index, LVEF, and NYHA functional class III/IV demonstrated strong specificity in the training and test sets. The incidence of MACEs is high among post-CABG T2DM patients with a high TyG index. TyG index improves the diagnostic accuracy of MACEs, especially at long-term follow-up. A high TyG index may serve as an early warning signal for individuals to undertake lifestyle adjustments that can reduce the progression or incidence of MACEs.

Left atrial reservoir strain predicts ischemic stroke after coronary artery bypass grafting independent of postoperative atrial fibrillation

Abstract Background Patients undergoing coronary artery bypass grafting (CABG) surgery face an elevated long-term risk of ischemic stroke. Left atrial (LA) mechanics including LA strain are known to predict both stroke and atrial fibrillation in other populations. Evidence is conflicting with regards to the clinical significance of postoperative atrial fibrillation (POAF) and its role in the association between LA mechanics and ischemic stroke is unclear. Purpose The aim of the study was to investigate the association between LA reservoir strain and long-term ischemic stroke in patients undergoing CABG surgery and whether the presence of POAF modified this relationship. Methods Patients undergoing isolated CABG were included from 2006–2011 as part of a retrospective cohort study. Echocardiography was performed prior to surgery. We included patients with available LA reservoir strain measurements, while patients with known atrial fibrillation and moderate to severe valvular disease were excluded. The primary endpoint was ischemic stroke. The association between LA reservoir strain and ischemic stroke was investigated in uni- and multivariable Cox proportional hazards regression models including adjustment for POAF. Poisson regression was used to create a restricted cubic spline model of the continuous association between LA reservoir strain and risk of ischemic stroke. Results We included 542 patients in the analysis. Mean age was 67.3±8.9 years, 89 (16.4%) were female, and median EuroSCORE II was 1.31 (IQR 0.93–1.96). Patients with LA reservoir strain &amp;lt;27.2% (median) were older, more likely to have diabetes, and had a higher EuroSCORE II. In total, 96 patients (17.7%) developed POAF. During a median follow-up period of 3.7 years (IQR 2.7–4.8 years), 21 (3.9%) patients experienced ischemic stroke. In univariable modeling, LA reservoir strain was significantly associated with ischemic stroke (HR 1.10 (95% CI 1.03–1.18, p=0.003) per 1% absolute decrease). After adjustment for EuroSCORE II, LA volume index (LAVi) and prior stroke, LA reservoir strain remained a significant predictor of ischemic stroke (HR 1.09 (95% CI 1.02–1.17, p=0.011) per 1% absolute decrease and HR 4.24 (95% CI 1.37–13.10, p=0.012) for &amp;lt; vs. &amp;gt;median). Adding POAF as a covariate did not alter the significance of LA reservoir strain in the model. In addition, POAF did not modify the association between LA reservoir strain and POAF (p for interaction = 0.07). The association between LA reservoir strain and ischemic stroke persisted in multiple sensitivity analyses including restricting the analysis to patients with normal left atrial volumes (LAVi &amp;lt;34 ml/m2), patients without POAF, and when excluding patients who developed atrial fibrillation during follow-up. Conclusion In patients undergoing CABG, LA reservoir strain was an independent long-term predictor of ischemic stroke. The predictive value of LA reservoir strain was unaffected by the presence of POAF. Funding Acknowledgement Type of funding sources: None.

Intimal hyperplasia, saphenous vein graft disease, and clinical outcomes: Insights from the CTSN VEST randomized trial

BackgroundDiffuse intimal hyperplasia and graft irregularity adversely affect the long-term patency of saphenous vein grafts (SVGs) and clinical outcomes of patients undergoing coronary artery bypass grafting (CABG). The VEST trial evaluated the efficacy of external graft support in limiting the development of intimal hyperplasia (IH) at 1 year postsurgery. In the present secondary analysis, we explored the associations between graft disease and IH and clinical events. We also examined risk factors for early graft occlusion. MethodsVEST is a within-patient randomized, multicenter trial that enrolled 224 patients with multivessel coronary disease undergoing CABG surgery, of whom 203 were evaluated by 1 year postsurgery. Intimal hyperplasia, lumen uniformity, graft stenosis, and graft perfusion were measured by intravascular ultrasound and angiography. Major cardiac and cerebrovascular events (MACCE; including death, myocardial infarction, stroke, and revascularization) were recorded over a median follow-up of 3 years. ResultsWorse lumen uniformity, greater stenosis, and worse graft perfusion were associated with higher IH values and an increased incidence of clinical events. Consistent with previous findings, we identified endoscopic vein harvesting, female sex, and transit time flow measurement of pulsatility index and flow as risk factors for SVG occlusion during the first year postsurgery. ConclusionsIn this secondary analysis of the VEST trial, we observed an association between intimal hyperplasia area and clinical measures of SVG disease at 1 year postsurgery. More severe SVG disease and larger areas of IH were associated with a higher incidence of 3-year MACCE. Ongoing follow-up to 5 years will further elucidate the impact of SVG disease on long-term clinical outcomes of CABG.

Performance of a novel risk model for deep sternal wound infection after coronary artery bypass grafting

Clinical prediction models for deep sternal wound infections (DSWI) after coronary artery bypass graft (CABG) surgery exist, although they have a poor impact in external validation studies. We developed and validated a new predictive model for 30-day DSWI after CABG (REPINF) and compared it with the Society of Thoracic Surgeons model (STS). The REPINF model was created through a multicenter cohort of adults undergoing CABG surgery (REPLICCAR II Study) database, using least absolute shrinkage and selection operator (LASSO) logistic regression, internally and externally validated comparing discrimination, calibration in-the-large (CL), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), trained between the new model and the STS PredDeep, a validated model for DSWI after cardiac surgery. In the validation data, c-index = 0.83 (95% CI 0.72–0.95). Compared to the STS PredDeep, predictions improved by 6.5% (IDI). However, both STS and REPINF had limited calibration. Different populations require independent scoring systems to achieve the best predictive effect. The external validation of REPINF across multiple centers is an important quality improvement tool to generalize the model and to guide healthcare professionals in the prevention of DSWI after CABG surgery.

Perioperative variation in serum FGF-23 level and its correlation with MACCE risk in unprotected left main coronary artery disease patients receiving coronary artery bypassing grafting.

ObjectiveFibroblast growth factor-23 (FGF-23) mediates vascular endothelial injury, inflammatory infiltration, and atherosclerosis, which could reflect major adverse cardiac and cerebrovascular event (MACCE) risk in several cardiovascular diseases. This study aims to further investigate the perioperative change of FGF-23, as well as its association with clinical characteristics and MACCE risk in unprotected left main coronary artery disease (ULMCAD) patients receiving coronary artery bypass grafting (CABG).MethodsA total of 226 ULMCAD patients who underwent CABG were enrolled. Serum samples of the patients were collected on the day before CABG, the third day (D3) after CABG, and at discharge; then, the FGF-23 level was determined by enzyme-linked immunosorbent assay. The MACCE rate was recorded during a median follow-up of 25.5 (range: 2.0–46.0) months.ResultsThe median, interquartile range (IQR), and range of FGF-23 level in ULMCAD patients receiving CABG were 717.0, 582.5–869.8, and 407.0–1765.0 pg/ml, respectively. FGF-23 level was increased in patients with both previous heart failure (P = 0.046) and chronic renal failure (P = 0.009) compared to those without. FGF-23 level increased from before surgery [median (IQR): 712.5 (574.5–879.8) pg/ml] to D3 [median (IQR): 844.0 (666.0–1072.5) pg/ml], then declined at discharge [median (IQR): 764.5 (569.3–986.8) pg/ml] (P < 0.001). Meanwhile, the preoperative FGF-23 level (P = 0.028), but not the FGF-23 level at discharge (P = 0.067) was positively correlated with the cumulative MACCE rate. Multivariable Cox's analyses found that preoperative FGF-23 level could independently predict cumulative MACCE rate [P = 0.015, hazards ratio (HR) = 2.940].ConclusionPreoperative FGF-23 level predicts higher MACCE risk in ULMCAD patients undergoing CABG surgery.

Barriers to prescribing proprotein convertase subtilisin-kexin type 9 inhibitors after coronary revascularisation.

Guidelines advocate for intensive lipid-lowering in patients with atherosclerotic cardiovascular disease (ASCVD). In May 2020, evolocumab, a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, became government subsidised in Australia for patients with ASCVD requiring further low-density lipoprotein cholesterol (LDL-C) lowering. To identify barriers to prescribing PCSK9 inhibitors in hospitalised patients with ASCVD. A retrospective 3-month, single-site, observational analysis was conducted in consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Lipid-lowering therapy prescriptions, including PSCK9 inhibitors, were assessed using electronic medical records, compared against the Australian Pharmaceutical Benefits eligibility criteria, and barriers to PCSK9 inhibitor use identified. Of 331 patients, 244 (73.7%) underwent PCI and 87 (26.3%) underwent CABG surgery. A lipid profile during or within 8 weeks of admission was measured for 202 (82.8%) patients undergoing PCI and 59 (67.8%) undergoing CABG surgery. In patients taking high-intensity statins on admission (n = 109), LDL-C ≥1.4, ≥1.8 and >2.6mmol/L was seen in 64 (58.7%), 44 (40.4%) and 19 (17.4%) patients respectively. High-intensity statin prescribing at discharge was high (>80%); however, ezetimibe was initiated in zero patients with LDL-C ≥1.4 mmol/L. There was variable advice given by clinicians for LDL-C targets. No patients met the criteria for subsidised PSCK9 inhibitor therapy, largely due to lack of qualifying lipid levels following combined statin and ezetimibe therapy. Prescribing of non-statin LDL-C-lowering therapies remains low in patients with ASCVD. Underprescribing of ezetimibe and suboptimal lipid testing rates are barriers to accessing subsidised PCSK9i therapy using current Australian eligibility criteria.

Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial

Background and ObjectiveHemodynamic changes are among the common complications after coronary artery bypass graft (CABG) surgery. Incentive spirometry (IS) and deep breathing exercises (DBEs) are widely used in patients undergoing CABG surgery. The aim of the present study was to compare the effect of IS and DBEs on hemodynamic and oxygenation parameters of patients undergoing CABG surgery. MethodsThis is a clinical trial that was performed on 40 patients with heart disease who were candidates for coronary artery bypass graft surgery. Participants were selected using convenience sampling and then randomly divided into two groups. One day before surgery, one group was taught how to perform DBE and the other group was taught how to use IS in practice. Hemodynamic and oxygenation indices were measured and recorded before the intervention, the first, second, and the third day after the intervention. Data analysis was carried out using SPSS ver.16 and descriptive and inferential statistical tests. ResultsThe mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the first day after the intervention in patients undergoing the IS group was significantly higher than the DBE group (p<0.05). On the third day after the intervention, the mean arterial oxygen saturation (SaO2) in patients of the IS group was significantly higher than the DBE group and the mean respiratory rate (RR) in patients in the IS group was significantly lower than the DBE group (p <0.05). However, there was no significant difference between the two groups in terms of other indices (p> 0.05). ConclusionThe results showed that IS has a greater effect on hemodynamic and oxygenation indices of patients undergoing CABG compared to DBE, so, it is recommended to use IS to improve hemodynamic and oxygenation indices in these patients.

Efficacy of Acapella versus Power Lung on relieving dyspnea after coronary artery bypass graft

Purpose. This study was conducted to compare the efficacy of Acapella versus Power lung on relieving dyspnea after coronary artery bypass graft (CABG) surgery. Methods. Sixty patients of both sex who underwent CABG surgery with age ranged from 40-50 years old participated in this study, They were randomly assigned into two equal experimental groups (n = 30), group (A) and group (B), (Group (A) received Acapella while Group (B) received Power Lung, each device conducted through a supervised session of three sets each one of 10 repetitions, two times daily from first day postoperative until the seventh day, in addition to routine physiotherapy program, Modified Borg scale was assessed for all patients before the beginning and after the end of this study. Results. there was a significant decrease in Modified Borg Scale score in both groups (A) and (B) by 44.07 % and 23.09 % respectively. Between-groups analysis showed a significant difference between both groups in favor of group (A) (p &lt; 0.001). Conclusion. Acapella and Power Lung were most effective devices for improving dyspnea post CABG surgery with superiority for Acapella device.

The effect of lavender oil inhalation on pain, anxiety, and sleep quality after coronary artery bypass graft: a randomized controlled trial protocol

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pain, anxiety, and sleep disorders are common side effects of coronary artery bypass graft (CABG) surgery. Although pharmacological agents are currently used in the treatment of these problems, in addition to their undesirable side effects, they increase healthcare costs, and their inadequate control leads to morbidities, prolonged hospital stay and increased burden of care. Therefore, supportive interventions are needed. The aim of this study is to determine the effect of lavender oil inhalation on the pain intensity, anxiety and sleep quality of patients that underwent CABG surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was planned as a prospective randomized controlled trial. Participants meeting the inclusion criteria will be randomly assigned to the intervention and control groups. During the hospitalization period after CABG surgery, 2% lavender oil (&lt;em&gt;Lavandula angustifolia&lt;/em&gt;) inhalation will be applied to the intervention group three times a day, while the control group will only receive routine care. The pain intensity of the groups will be evaluated with the numeric rating scale, anxiety levels with the state-trait anxiety inventory, and sleep quality with the Richards-Campbell sleep questionnaire.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There is a need for new approaches to improve the physiological and psychological health of patients after CABG surgery and help them return to their daily life activities and social lives in a shorter time. This trial will allow for the assessment of the effects of this intervention and provide valuable evidence to guide clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration:&lt;/strong&gt; This trial was registered in May, 2022 (NCT05377983).&lt;/p&gt;

Experiences of Patients Undergoing Bypass Surgery With Health Professionals During the Perioperative Care Process: A Hermeneutic Phenomenological Study

To determine the experiences and perceptions of patients who underwent Coronary Artery Bypass Graft (CABG) surgery with perioperative health care professionals. The study used a qualitative research design and was conducted by interviewing eight patients who underwent CABG surgery. Study data were collected between April 24, 2020 and February 25, 2021 via a demographic information form and a semi-structured interview form and analyzed by using Heidegger's phenomenological approach. The participants were between the ages of 51 and 70. They were patients who had undergone CABG surgery 2 months before data collection. Two themes were elicited from the interviews: "If you are bad, I am bad, too", which indicated negative experiences of CABG, and "If you are good, I am safe", which indicated positive patient experiences. In addition, eight sub-themes were determined under these two themes. In the perioperative process, patients may experience feelings of restlessness, fear, vulnerability, insecurity, and threat when ignored by health care professionals. The provision of interaction between the health professional and the patient, along with family support, changes the perceived care positively and makes patients feel cared for, well, and safe. Awareness of health care professionals about patient experiences during the CABG surgery process points to an important aspect of quality health care.