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Gogayeva OK. Algorithms of Perioperative Management of High-Risk Cardiac Surgery Patients with Coronary Artery Disease and Polymorbidity. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2023. [DOI: 10.30702/ujcvs/23.31(01)/g005-1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
The aim. To analyze the effectiveness of the developed algorithms for the perioperative management of high-risk cardiac surgery patients with coronary artery disease (CAD) and polymorbidity.
Materials and methods. We analyzed perioperative management of 354 high-risk cardiac surgery patients with CAD with EuroSCORE II predicted mortality >5%, among which 194 (54.8%) underwent isolated coronary artery bypass grafting, and 160 (45.2%) had surgical myocardial revascularization with accompanying valvular pathology correction or left ventricular postinfarction aneurysm resection. All the patients were discharged after cardiac surgery performed at the Department of Surgical Treatment of CAD of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2009 to 2019. As part of the study, general clinical examinations, electrocardiography, echocardiography, coronary angiography, cardiosurgical treatment were provided, and perioperative patient management protocols were developed and implemented.
Results. Based on the conducted detailed analysis, it was established that the success of surgical revascularization of the myocardium depends not only on cardiac factors, but also on the compensation of concomitant diseases, the work of an experienced cardiac team consisting of a cardiologist, an interventionist, an anesthesiologist, a cardiac surgeon, and an intensivist. Treatment and prevention measures should be personalized and aimed at timely response to changes in laboratory and hemodynamic indicators of patients at all stages of their management, as well as stabilization of concomitant diseases. An important point in the preoperative preparation of cardiac surgery patients is verification of concomitant diseases with the aim of their timely compensation. The implemented algorithm for searching for comorbid conditions made it possible to improve the diagnosis of initial disorders of glucose metabolism, abnormal uric acid levels and cerebrovascular disease. Lowering the glucose level according to the developed algorithm of management of patients with impaired glucose metabolism in the perioperative period made it possible to reduce the number of postoperative wound infections by 3.4% and arrhythmological complications by 19.4%. Correction of drug therapy taking into account the glomerular filtration rate made it possible to avoid postoperative hemodialysis. Preventive prescription of therapeutic doses of proton pump inhibitors against the background of dual antiplatelet therapy, according to the developed protocol, led to a decrease in postoperative gastroduodenal complications from 5.1% to 0.3%.
Conclusions. Implementation of the system of personalized treatment and preventive management of patients in the perioperative period made it possible to reduce postoperative complications from 16.7% to 4% (p=0.0190).
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Ruel M, Williams A. A New Effect Modifier of the Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention Decision: Physical and Mental Functioning. Circulation 2022; 146:1281-1283. [PMID: 36279416 DOI: 10.1161/circulationaha.122.059731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (Ruel)
| | - Anne Williams
- Division of Cardiology, Department of Medicine, Memorial University, St. John's, NL, Canada (Williams)
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Zaabalawi A, Renshall L, Beards F, Lightfoot AP, Degens H, Alexander Y, Hasan R, Bilal H, Graf BA, Harris LK, Azzawi M. Internal Mammary Arteries as a Model to Demonstrate Restoration of the Impaired Vasodilation in Hypertension, Using Liposomal Delivery of the CYP1B1 Inhibitor, 2,3',4,5'-Tetramethoxystilbene. Pharmaceutics 2022; 14:2046. [PMID: 36297480 PMCID: PMC9611804 DOI: 10.3390/pharmaceutics14102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
A significant number of patients with severe cardiovascular disease, undergoing coronary artery bypass grafting (CABG), present with hypertension. While internal mammary arteries (IMAs) may be a better alternative to vein grafts, their impaired vasodilator function affects their patency. Our objectives were to (1) determine if inhibition of the cytochrome P450 enzyme CYP1B1, using liposome-encapsulated 2,3′,4,5′-tetramethoxystilbene (TMS), can potentiate vasodilation of IMAs from CABG patients, and (2) assess mechanisms involved using coronary arteries from normal rats, in an ex vivo model of hypertension. PEGylated liposomes were synthesized and loaded with TMS (mean diameter 141 ± 0.9 nm). Liposomal delivery of TMS improved its bioavailability Compared to TMS solution (0.129 ± 0.02 ng/mL vs. 0.086 ± 0.01 ng/mL at 4 h; p < 0.05). TMS-loaded liposomes alleviated attenuated endothelial-dependent acetylcholine (ACh)-induced dilation in diseased IMAs (@ACh 10−4 M: 56.9 ± 5.1%; n = 8 vs. 12.7 ± 7.8%; n = 6; p < 0.01) for TMS-loaded liposomes vs. blank liposomes, respectively. The alleviation in dilation may be due to the potent inhibition of CYP1B1 by TMS, and subsequent reduction in reactive oxygen species (ROS) moieties and stimulation of nitric oxide synthesis. In isolated rat coronary arteries exposed to a hypertensive environment, TMS-loaded liposomes potentiated nitric oxide and endothelium-derived hyperpolarization pathways via AMPK. Our findings are promising for the future development of TMS-loaded liposomes as a promising therapeutic strategy to enhance TMS bioavailability and potentiate vasodilator function in hypertension, with relevance for early and long-term treatment of CABG patients, via the sustained and localized TMS release within IMAs.
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Affiliation(s)
- Azziza Zaabalawi
- Department of Life Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Lewis Renshall
- Division of Pharmacy and Optometry, University of Manchester, Manchester M13 9PL, UK
- Maternal & Fetal Health Research Centre, University of Manchester, Manchester M13 9WL, UK
- Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Frances Beards
- Division of Pharmacy and Optometry, University of Manchester, Manchester M13 9PL, UK
- Maternal & Fetal Health Research Centre, University of Manchester, Manchester M13 9WL, UK
- Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - Adam P. Lightfoot
- Department of Life Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AP, UK
| | - Hans Degens
- Department of Life Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK
- Institute of Sport Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Yvonne Alexander
- Department of Life Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Ragheb Hasan
- Department of Cardiothoracic Surgery, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - Haris Bilal
- Department of Cardiothoracic Surgery, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - Brigitte A. Graf
- Faculty of Health and Education, Manchester Metropolitan University, Manchester M15 6BG, UK
| | - Lynda K. Harris
- Division of Pharmacy and Optometry, University of Manchester, Manchester M13 9PL, UK
- Maternal & Fetal Health Research Centre, University of Manchester, Manchester M13 9WL, UK
- Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK
| | - May Azzawi
- Department of Life Sciences, Manchester Metropolitan University, Manchester M1 5GD, UK
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Sabik JF, Bakaeen FG, Ruel M, Moon MR, Malaisrie SC, Calhoon JH, Girardi LN, Guyton R. The American Association for Thoracic Surgery and The Society of Thoracic Surgeons Reasoning for Not Endorsing the 2021 ACC/AHA/SCAI Coronary Revascularization Guidelines. Ann Thorac Surg 2022; 113:1065-1068. [PMID: 34954249 DOI: 10.1016/j.athoracsur.2021.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc R Moon
- Washington University School of Medicine, St Louis, Missouri
| | | | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas
| | - Leonard N Girardi
- New York Presbyterian/Weil Cornell Medical Center, New York, New York
| | - Robert Guyton
- Cardiothoracic Surgery, Emory Clinic, Atlanta, Georgia
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Sabik JF, Bakaeen FG, Ruel M, Moon MR, Malaisrie SC, Calhoon JH, Girardi LN, Guyton R. The American Association for Thoracic Surgery and The Society of Thoracic Surgeons reasoning for not endorsing the 2021 ACC/AHA/SCAI Coronary Revascularization Guidelines. J Thorac Cardiovasc Surg 2022; 163:1362-1365. [PMID: 35164950 DOI: 10.1016/j.jtcvs.2021.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc R Moon
- Washington University School of Medicine, St Louis, Mo
| | | | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Tex
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Implications of the ISCHEMIA trial on the practice of surgical myocardial revascularization. J Thorac Cardiovasc Surg 2021; 162:90-99. [DOI: 10.1016/j.jtcvs.2020.07.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/09/2023]
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Sellke FW. Secondary prevention after coronary artery bypass grafting: Anticoagulation and antiplatelet therapy is only one factor. J Card Surg 2021; 36:1100-1102. [PMID: 33506999 DOI: 10.1111/jocs.15286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel/ticagrelor/prasugrel does not lead to improved graft patency rates or clinical outcomes after coronary artery bypass grafting (CABG) over aspirin monotherapy, at least for on pump CABG. The protective effects of DAPT tended to be observed to be greater extent in patients undergoing off pump CABG. In general, the addition of the potent thienopyridines increased the risk of major bleeding, although the incidence of major bleeding is relatively low after either on pump or off pump surgical revascularization. There is a lack of evidence that anticoagulation post-CABG provides any protection against graft failure, but it may decrease the incidence of major adverse cardiovascular events. However, antiplatelet and anti thrombotic therapy after CABG is only one component of secondary prevention that needs to be taken into consideration when optimizing the long-term outcomes of patients after CABG.
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Affiliation(s)
- Frank W Sellke
- Division of Cardiothoracic Surgery, Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, Rhode Island, USA
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Yepanchintseva OA, Mikhaliev KA, Shklianka IV, Zharinov OJ, Todurov BM. The Role of Adherence to Basic Pharmacotherapy of Heart Failure for Prevention of Late Adverse Events in Patients with Coronary Artery Disease and Left Ventricular Dysfunction After Surgical Revascularization of Myocardium. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-10-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To determine the role of adherence to the basic drug treatment of heart failure (HF) in prevention of late major adverse events (MAEs) after isolated coronary artery bypass grafting (CABG) in patients with stable coronary artery disease (CAD) and left ventricular (LV) dysfunction at three-year follow-up.Material and methods. A prospective non-controlled single-center study included 125 consecutive patients with stable CAD and LV EF<50% (62±8 years; 114 [91.2%] males), after isolated CABG. At three-year follow-up MAЕs occurred in 40 (32.0%) patients. The data on pharmacotherapy at followup were obtained in 124 patients: 85 (68.6%) patients without MAEs and 39 (31.4%) patients with MAEs.Results. The enrolled sample of patients was characterized by high discharge prescription rate of renin-angiotensin system (RAS; 86.3%) blockers (angiotensin-converting enzyme inhibitors or angiotensin-II receptors blockers), beta-blockers (BBs; 97.6%) and mineralocorticoid receptors antagonists (MRAs; 79.0%), being comparable in MAEs and non-MAEs groups. The total coverage of basic HF pharmacotherapy (the combination of RAS blockers, BBs and MRAs) at discharge was 66.1%. At follow-up, about one third of patients in both groups withheld previously prescribed triple HF therapy. The MAEs were associated with more frequent withhold of previously prescribed RAS blockers, as opposed to patients without MAEs (20.5% and 7.1%, respectively; р=0.009). The majority of patients in both groups continued BBs therapy at follow-up (95.0% and 92.9%, respectively; p=0.187). Additionally, we observed the decline of MRAs intake frequency at follow-up (to 43.6% and 49.4%, respectively; p=0.547).Conclusion. During 3-year follow-up after isolated CABG, about one third of patients with stable CAD and baseline LVEF<50% interrupted triple basic HF therapy (including RAS blockers, BBs and MRAs), mainly due to decrease of RAS blockers and MRAs usage. MAEs in patients with stable CAD and baseline LVEF<50% after CABG were associated with suboptimal use and more frequent interruption of RAS blockers.
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Affiliation(s)
- O. A. Yepanchintseva
- Shupyk National Medical Academy of Postgraduate Education;
Heart Institute of the Ministry of Healthcare of Ukraine
| | - K. A. Mikhaliev
- State Institution of Science "Research and Practical Center of Preventive and Clinical Medicine' State Administrative Department
| | | | - O. J. Zharinov
- Shupyk National Medical Academy of Postgraduate Education
| | - B. M. Todurov
- Heart Institute of the Ministry of Healthcare of Ukraine
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The SYNTAX score according to diabetic status: What does it mean for the patient requiring myocardial revascularization? J Thorac Cardiovasc Surg 2020; 159:857-860. [DOI: 10.1016/j.jtcvs.2019.04.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022]
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Kruger H, Zumwalt C, Guenther R, Jansen R, Warne D, Dyke C. Disparities in Secondary Prevention of Atherosclerotic Heart Disease After Coronary Artery Bypass Grafting in Northern Plains American Indians. Health Equity 2019; 3:520-526. [PMID: 31656939 PMCID: PMC6814079 DOI: 10.1089/heq.2019.0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction: Cardiovascular disease has become the leading cause of death in American Indians (AIs). For patients with severe disease requiring coronary artery bypass grafting (CABG), AIs have been demonstrated to present with increased risk factors. Guideline-directed medical therapy after CABG effectively reduces mortality and recurrent ischemic events in all patients and is especially important in high-risk populations such as AIs. Methods: Isolated CABG patients between 2012 and 2017 were studied and 74 AI patients were identified. Propensity matching was performed and the resulting 148 patients were followed for a year after surgery. Guideline-directed medical therapy (GDMT) for secondary prevention of atherosclerotic disease after CABG was detailed in all patients. Results: GDMT was similar between groups (85% AI vs. 89% non-AI; p=NS), and the incidence of prescribed antiplatelet medications, beta-blockers, and statins was similar. AIs were more likely to receive insulin therapy (p=0.002) and opioids (p=0.03) at discharge, while non-AIs were more likely to receive anti-arrhythmic medications (p=0.002). One year after discharge, GDMT trended lower in AIs (75% AI vs. 85% non-AI; p=0.2) and AIs were less likely to be on a statin 1 year after surgery (81% AI vs. 93% non-AI; p=0.04). Opioid use trended higher after 1 year in AIs (28% AI vs. 18% non-AI; p=NS) and fewer AI patients participated in cardiac rehabilitation (CR) after CABG. Conclusions: Disparities in GDMT for secondary prevention of coronary artery disease after CABG exist, with fewer AI patients receiving statins and undergoing CR 1 year after surgery. Increased use of opioids in AIs is troubling and deserves further investigation. Improved adherence to GDMT would be expected to improve long-term outcomes after CABG in this high risk population.
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Affiliation(s)
- Hannah Kruger
- University of North Dakota School of Medicine and Health Sciences-Southeast Campus, Fargo, North Dakota
| | - Christopher Zumwalt
- University of North Dakota School of Medicine and Health Sciences-Southeast Campus, Fargo, North Dakota
| | - Rory Guenther
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Rick Jansen
- Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Donald Warne
- University of North Dakota School of Medicine and Health Sciences-Southeast Campus, Fargo, North Dakota
| | - Cornelius Dyke
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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Ruttmann E, Dietl M, Feuchtner GM, Metzler B, Bonaros N, Taggart DP, Gaudino M, Ulmer H, Gaudino M, Taggart DP, Benedetto U, Buxton B, Di Franco A, Fremes S, Girardi LN, Goldman S, Habib R, Holman WL, Puskas JD, Ruttmann-Ulmer E, Schwann TA, Tatoulis J, Tranbaugh R, Speciale G, Nasso G, Moat N, Hayward P, Hare DL, Mao J, Peric M, Petrovic I, Yoo KJ. Long-term clinical outcome and graft patency of radial artery and saphenous vein grafts in multiple arterial revascularization. J Thorac Cardiovasc Surg 2019; 158:442-450. [DOI: 10.1016/j.jtcvs.2018.10.135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/18/2018] [Accepted: 10/13/2018] [Indexed: 11/26/2022]
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