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Lesouhaitier M, Belicard F, Tadié JM. Cardiopulmonary bypass and VA-ECMO induced immune dysfunction: common features and differences, a narrative review. Crit Care 2024; 28:300. [PMID: 39256830 PMCID: PMC11389086 DOI: 10.1186/s13054-024-05058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 08/06/2024] [Indexed: 09/12/2024] Open
Abstract
Cardiopulmonary bypass (CPB) and veno-arterial extracorporeal membrane oxygenation are critical tools in contemporary cardiac surgery and intensive care, respectively. While these techniques share similar components, their application contexts differ, leading to distinct immune dysfunctions which could explain the higher incidence of nosocomial infections among ECMO patients compared to those undergoing CPB. This review explores the immune modifications induced by these techniques, comparing their similarities and differences, and discussing potential treatments to restore immune function and prevent infections. The immune response to CPB and ECMO involves both humoral and cellular components. The kinin system, complement system, and coagulation cascade are rapidly activated upon blood contact with the circuit surfaces, leading to the release of pro-inflammatory mediators. Ischemia-reperfusion injury and the release of damage-associated molecular patterns further exacerbate the inflammatory response. Cellular responses involve platelets, neutrophils, monocytes, dendritic cells, B and T lymphocytes, and myeloid-derived suppressor cells, all of which undergo phenotypic and functional alterations, contributing to immunoparesis. Strategies to mitigate immune dysfunctions include reducing the inflammatory response during CPB/ECMO and enhancing immune functions. Approaches such as off-pump surgery, corticosteroids, complement inhibitors, leukocyte-depleting filters, and mechanical ventilation during CPB have shown varying degrees of success in clinical trials. Immunonutrition, particularly arginine supplementation, has also been explored with mixed results. These strategies aim to balance the inflammatory response and support immune function, potentially reducing infection rates and improving outcomes. In conclusion, both CPB and ECMO trigger significant immune alterations that increase susceptibility to nosocomial infections. Addressing these immune dysfunctions through targeted interventions is essential to improving patient outcomes in cardiac surgery and critical care settings. Future research should focus on refining these strategies and developing new approaches to better manage the immune response in patients undergoing CPB and ECMO.
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Affiliation(s)
- Mathieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.
- SITI, Pole de Biologie, Pontchaillou University Hospital, Etablissement Français du Sang Bretagne, 2 rue Henri Le Guilloux, 35033, Rennes, France.
- UMR 1236, Univ Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France.
- CIC-1414, INSERM, Rennes, France.
| | - Félicie Belicard
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France
- SITI, Pole de Biologie, Pontchaillou University Hospital, Etablissement Français du Sang Bretagne, 2 rue Henri Le Guilloux, 35033, Rennes, France
- UMR 1236, Univ Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Jean-Marc Tadié
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes, France.
- SITI, Pole de Biologie, Pontchaillou University Hospital, Etablissement Français du Sang Bretagne, 2 rue Henri Le Guilloux, 35033, Rennes, France.
- UMR 1236, Univ Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France.
- CIC-1414, INSERM, Rennes, France.
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Sampon F, Ter Woorst J, Dekker L, Akca F. Thoracoscopic-assisted, minimally invasive versus off-pump bypass grafting for single vessel coronary artery disease - A propensity matched analysis. Int J Cardiol 2024; 409:132175. [PMID: 38754586 DOI: 10.1016/j.ijcard.2024.132175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE This study compared perioperative outcomes after off-pump revascularization through a thoracoscopic-assisted (non-robotic) minimally invasive approach (Endo-CAB) or sternotomy approach (OPCAB) for patients with single vessel left anterior descending (LAD) disease. METHODS In this retrospective, propensity matched cohort study, 266 consecutive patients were included in the Endo-CAB group (n = 136) and OPCAB group (n = 130). After propensity score matching 116 Endo-CAB and 116 OPCAB patients were compared. 'Textbook outcome' was defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischemia, cardiac tamponade, cerebrovascular events, wound infection, new-onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (> 7 days). Multivariable regression analysis was performed to identify independent predictors for textbook outcome. RESULTS Textbook outcome occurred significantly more frequent in the Endo-CAB group compared to the OPCAB group (81.9% vs. 59.5%, p < 0.001). Patients undergoing Endo-CAB surgery had shorter hospital admission (3.0 [3.0-4.0] vs. 5.0 [4.0-6.0] days, p < 0.001), less blood loss (225 [150-355] vs. 450 [350-600] mL, p < 0.001). Other perioperative outcomes were comparable for both groups. Regression analysis demonstrated that Endo-CAB approach was an independent positive predictor for textbook outcome (OR 3.02, 95% CI 1.61-5.66, p < 0.001). CONCLUSIONS Our study suggests that patients undergoing Endo-CAB surgery have improved perioperative outcome resulting in higher rates of textbook outcome for the treatment of single vessel CAD. This technique could be widely available since routine thoracoscopic instruments are used.
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Affiliation(s)
- Fleur Sampon
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Joost Ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Lukas Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Departments of Biomedical Technology, Eindhoven University of Technology, the Netherlands
| | - Ferdi Akca
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands.
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Antony H, Chouhan S, Wakode S, Singh R, Niwariya Y, Javed D. Assessment of Upper Limb Nerves in Coronary Artery Disease Patients Undergoing Coronary Artery Bypass Graft. Cureus 2024; 16:e66598. [PMID: 39258077 PMCID: PMC11383639 DOI: 10.7759/cureus.66598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2024] [Indexed: 09/12/2024] Open
Abstract
Background Many patients experience pain in their upper limbs following surgical procedures involving median sternotomy, particularly those undergoing coronary artery bypass grafting (CABG). This type of pain, commonly reported by CABG patients, is often overlooked in hospital settings. Our study aims to address this issue by utilizing electrodiagnostic studies to understand this postoperative discomfort better. Objectives Cardiovascular procedures are standard and are trending toward endovascular interventions. Through this study, we aim to assess the occurrence of neurological issues in the upper limbs after CABG by comparing patients' preoperative and postoperative electrophysiological studies of the upper limb nerves. Materials and methods A prospective study was performed on 32 coronary artery disease (CAD) patients undergoing CABG to determine the effects of surgery on the upper limb nerves (median and ulnar nerves). We performed nerve conduction studies (NCS) and analyzed different parameters of both median and ulnar nerves pre and post-surgery. Results A change was noted in different NCS parameters of the median and ulnar nerves when we compared the pre and post-surgical values. The mean latency of the median nerve sensory increased from a minimum of 3.01 milliseconds at the preoperative level to a maximum of 3.60 milliseconds when assessed two weeks post-surgery. The mean amplitude decreased from 16.49 microvolts to a minimum of 12.30 microvolts when assessed two weeks post-surgery. The mean velocity decreased from 55.83 m/s at the preoperative value to a minimum of 45.03 m/s at the two weeks post-surgery assessment. The ulnar nerve also underwent similar changes. Conclusion The observed changes in latency, amplitude, and velocity might be attributed to various factors, including surgical trauma, inflammation, or alterations in the physiological state post-surgery. The sternotomy technique and the position and extent of opening the sternal retractor determine the prevalence of complications by causing injury to the medial and lateral cords of the brachial plexus after CABG. Careful preoperative and postoperative assessments of patients may aid in preventing, minimizing, and treating these often undiagnosed complications.
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Affiliation(s)
- Hitha Antony
- Physiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Sunil Chouhan
- Physiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Santosh Wakode
- Physiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ruchi Singh
- Physiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Yogesh Niwariya
- Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Danish Javed
- AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Rigpa, and Homoeopathy), All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Yan Y, Zhao C, Niu J, Yan P, Li J, Wang D, Li G. Rationale and Design of the IMPROVE Trial: A Multicenter, Randomized, Controlled, Open-label, Blinded-endpoint Trial Assessing the Efficacy of Remote Ischemic Conditioning in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. Adv Ther 2024; 41:3003-3012. [PMID: 38616242 DOI: 10.1007/s12325-024-02836-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/07/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Despite the appearance of off-pump coronary artery bypass grafting (CABG), ischemia-reperfusion injury (IRI) in the perioperative period still arouses concerns of clinicians. Remote ischemic conditioning (RIC) is the process of repeated ischemia and reperfusion in the peripheral vessels, which is proven to reduce IRI in vital organs. However, the effect of RIC in patients undergoing off-pump CABG is still unclear. METHODS This IMPROVE trial is a national, multicenter, randomized, controlled, open-label, blinded-endpoint clinical trial designed to assess whether RIC intervention can improve short-term prognosis of patients undergoing off-pump CABG. It plans to enroll 648 patients who will be randomly assigned into a RIC group or control group. Patients in the RIC group will receive four cycles of 5 min of pressurization (about 200 mmHg) and 5 min of rest in the 3 days before and 7 days after the surgery. PLANNED OUTCOMES The primary outcome is the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) within the 3-month follow-up. MACCE is defined as all-cause death, myocardial infarction, stroke, and coronary revascularization surgery. CLINICAL TRIAL REGISTRATION NCT06141525 (ClinicalTrials.gov).
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Affiliation(s)
- Yang Yan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Changying Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jialan Niu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pengyun Yan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Cardiovascular Surgery, People's Hospital of Qinghai Province, Xining, China
| | - Duolao Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
- Department of Neurology, Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Guoliang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Hadebe N, Cour M, Imamdin A, Petersen T, Pennel T, Scherman J, Snowball J, Ntsekhe M, Zilla P, Swanevelder J, Lecour S. Cardioprotection with Intralipid During Coronary Artery Bypass Grafting Surgery on Cardiopulmonary Bypass: A Randomized Clinical Trial. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07594-w. [PMID: 38864969 DOI: 10.1007/s10557-024-07594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB) is associated with myocardial ischemia-reperfusion injury (IRI), which may limit the benefit of the surgery. Both experimental and clinical studies suggest that Intralipid, a lipid emulsion commonly used for parenteral nutrition, can limit myocardial IRI. We therefore aimed to investigate whether Intralipid administered at reperfusion can reduce myocardial IRI in patients undergoing CABG on CPB. METHODS We conducted a randomized, double-blind, pilot trial in which 29 adult patients scheduled for CABG were randomly assigned (on a 1:1 basis) to receive either 1.5 ml/kg Intralipid 20% or Ringer's Lactate 3 min before aortic cross unclamping. The primary endpoint was the 72-h area under the curve (AUC) for troponin I. RESULTS Of the 29 patients randomized, 26 were included in the study (two withdrew consent and one was excluded before surgery). The 72-h AUC for troponin I did not significantly differ between the control and Intralipid group (546437 ± 205518 versus 487561 ± 115724 arbitrary units, respectively; P = 0.804). Other outcomes (including 72-h AUC for CK-MB, C-reactive protein, need for defibrillation, time to extubation, length of ICU and hospital stay, and serious adverse events) were similar between the two groups. CONCLUSION In patients undergoing CABG on CPB, Intralipid did not limit myocardial IRI compared to placebo. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02807727 (registration date: 16 June 2016).
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Affiliation(s)
- Nkanyiso Hadebe
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
- Department of Anaesthesia, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Martin Cour
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
| | - Aqeela Imamdin
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
| | - Tarra Petersen
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
| | - Timothy Pennel
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Jacques Scherman
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Jane Snowball
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Peter Zilla
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
| | - Justiaan Swanevelder
- Department of Anaesthesia, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sandrine Lecour
- Cardioprotection Group, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa.
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Richter M, Moschovas A, Bargenda S, Freiburger S, Mukharyamov M, Caldonazo T, Kirov H, Doenst T. Off-Pump Reduces Risk of Coronary Bypass Grafting in Patients with High MELD-XI Score. Thorac Cardiovasc Surg 2024. [PMID: 38781984 DOI: 10.1055/s-0044-1786039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND This study aimed to assess the influence of the model of end-stage liver disease without International Normalized Ratio (INR) (MELD-XI) score on outcomes after elective coronary artery bypass surgery (CABG) without (Off-Pump) or with (On-Pump) cardiopulmonary bypass. METHODS We calculated MELD-XI (5.11 × ln serum bilirubin + 11.76 × ln serum creatinine in + 9.44) for 3,535 consecutive patients having undergone elective CABG between 2009 and 2020. A MELD-XI threshold was determined using the Youden Index based on receiver operating characteristics. Propensity score matching and logistic regression was performed to identify risk factors for inhospital mortality and Major Adverse Cardiac and Cerebrovascular Event (MACCE). RESULTS Patients were 68 ± 10 years old (76% male). Average MELD-XI was 10.9 ± 3.25. The MELD-XI threshold was 11. Patients below this threshold had somewhat lower EuroSCORE II than those above (3.5 ± 4 vs. 4.1 ± 4.7, p < 0.01), but mortality was almost four times higher above the threshold (below 1.5% vs. above 6.2%, p < 0.001). Two-thirds of patients received Off-Pump CABG. There was a trend towards higher risk in Off-Pump patients. Mortality was numerically but not statistically different to On-Pump below the MELD XI threshold (1.3 vs. 2.2%, p = 0.34) and was significantly lower above the threshold (4.9 vs. 8.9%, p < 0.02). Off-Pump above the threshold was also associated with less low-output syndrome and fewer strokes. Equalizing baseline differences by propensity matching verified the significant mortality difference above the threshold. Multivariable regression analysis revealed MELD-XI, On-Pump, atrial fibrillation, and the De Ritis quotient (Aspartate aminotransferase (ASAT)/Alanine Aminotransferase (ALAT)) as independent predictors of mortality. CONCLUSION Elective CABG patients with elevated MELD-XI scores are at increased risk for perioperative mortality and morbidity. This risk can be significantly mitigated by performing CABG Off-Pump.
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Affiliation(s)
- Markus Richter
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Steffen Bargenda
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Sebastian Freiburger
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
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Kim S, Song SW, Jeon YG, Song SA, Hong S, Park JH. Evaluating the Efficacy of the Erector Spinae Plane Block as a Supplementary Approach to Cardiac Anesthesia during Off-Pump Coronary Bypass Graft Surgery via Median Sternotomy: A Randomized Clinical Trial. J Clin Med 2024; 13:2208. [PMID: 38673480 PMCID: PMC11051109 DOI: 10.3390/jcm13082208] [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: 03/01/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Pain control after off-pump coronary artery bypass graft (OPCAB) facilitates mobilization and improves outcomes. The efficacy of the erector spinae plane block (ESPB) after cardiac surgery remains controversial. Methods: We aimed to investigate the analgesic effects of ESPB after OPCAB. Precisely 56 patients receiving OPCAB were randomly divided into ESPB and control groups. The primary outcome was visual analog scale (VAS) pain scores at 6, 12, 24, and 48 h postoperatively. Secondary outcomes were the dose of rescue analgesics in terms of oral morphine milligram equivalents, the dose of antiemetics, the length of intubation time, and the length of stay in the intensive care unit (ICU). Results: The VAS scores were similar at all time points in both groups. The incidence of severe pain (VAS score > 7) was significantly lower in the ESPB group (50% vs. 15.4%; p = 0.008). The dose of rescue analgesics was also lower in the ESPB group (19.04 ± 18.76, 9.83 ± 12.84, p = 0.044) compared with the control group. The other secondary outcomes did not differ significantly between the two groups. Conclusions: ESPB provides analgesic efficacy by reducing the incidence of severe pain and opioid use after OPCAB.
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Affiliation(s)
- Sujin Kim
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Seung Woo Song
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Yeong-Gwan Jeon
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Sang A. Song
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Soonchang Hong
- Department of Cardiovascular Surgery, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea;
| | - Ji-Hyoung Park
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
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Zhang Y, Tan S, Chen S, Fan X. Risk factors associated with surgical site infections in patients undergoing cardiothoracic surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14573. [PMID: 38102858 PMCID: PMC10961885 DOI: 10.1111/iwj.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
Surgical site infections (SSIs) following cardiothoracic surgery can pose significant challenges to patient recovery and outcome. This systematic review and meta-analysis aim to identify and quantify the risk factors associated with SSIs in patients undergoing cardiothoracic surgery. A comprehensive literature search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and based on the PICO paradigm was conducted across four databases: PubMed, Embase, Web of Science and the Cochrane Library, without any temporal restrictions. The meta-analysis incorporated studies detailing the risk factors for post-operative sternal infections, especially those reporting odds ratios (OR) or relative risks with 95% confidence intervals (CI). Quality assessment of the studies was done using the Newcastle-Ottawa Scale. Statistical analysis was executed using the chi-square tests for inter-study heterogeneity, with further analyses depending on I2 values. Sensitivity analyses were performed, and potential publication bias was also assessed. An initial dataset of 2442 articles was refined to 21 articles after thorough evaluations based on inclusion and exclusion criteria. Patients with diabetes mellitus have an OR of 1.80 (95% CI: 1.40-2.20) for the incidence of SSIs, while obese patients demonstrate an OR of 1.63 (95% CI: 1.40-1.87). Individuals who undergo intraoperative blood transfusion present an OR of 1.13 (95% CI: 1.07-1.18), and smokers manifest an OR of 1.32 (95% CI: 1.03-1.60). These findings unequivocally indicate a pronounced association between these factors and an elevated risk of SSIs post-operatively. This meta-analysis confirms that diabetes, obesity, intraoperative transfusion and smoking heighten the risk of SSIs post-cardiac surgery. Clinicians should be alert to these factors to optimise patient outcomes.
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Affiliation(s)
- Yanfei Zhang
- Department of Cardiovascular SurgeryGuangdong Provincial Hospital of Chinese MedicineGuangzhouGuangdong ProvinceChina
| | - Songtao Tan
- Department of Cardiovascular SurgeryGuangdong Provincial Hospital of Chinese MedicineGuangzhouGuangdong ProvinceChina
| | - Suning Chen
- Department of CardiologyShengjing Hospital of China Medical UniversityShenyangLiaoning ProvinceChina
| | - Xiaoping Fan
- Department of Cardiovascular SurgeryGuangdong Provincial Hospital of Chinese MedicineGuangzhouGuangdong ProvinceChina
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Jin L, Shan L, Yu K, Pan Y, Sun Y, Chen J, Han L, Li W, Li Z, Zhang Y. Postoperative acute kidney injury increases short- and long-term death risks in elderly patients (≥ 75 years old) undergoing coronary artery bypass graft surgery. Int Urol Nephrol 2024; 56:1497-1508. [PMID: 37878200 PMCID: PMC10923977 DOI: 10.1007/s11255-023-03845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE To explore the incidence of postoperative acute kidney injury (AKI) after coronary artery bypass grafting (CABG) in elderly Chinese patients (≥ 75 years old) and its impacts on the short- and long-term prognosis. METHODS A total of 493 patients aged 75-88 years old who underwent CABG from two medical centers between January 2006 and October 2021 were involved. Perioperative (preoperative and 7 days after operation) serum creatinine (Scr) levels were measured in all the enrolled patients. Univariate and multivariate logistic regression analyses were conducted to explore the independent risk factors of postoperative in-hospital mortality. Kaplan-Meier curves and COX model were used to test the risk factors of all-cause death during follow-up. Propensity score matching was used to balance differences between AKI and control groups. The primary outcome event was in-hospital death, and the secondary outcome was all-cause death during follow-up. RESULTS The 198 patients were diagnosed with postoperative AKI. Intra-aortic balloon pump (IABP), cardiopulmonary bypass, and postoperative AKI were independent risk factors of in-hospital death. Gender, New York Heart Association Classification, preoperative eGFR, last eGFR within 7 days after operation, postoperative AKI, and postoperative renal function all impacted long-term prognosis. After 1:1 matching, 190 patients were included in the AKI and control groups. Use of IABP, use of cardiopulmonary bypass, and occurrence of postoperative AKI were still independent risk factors of in-hospital death. Preoperative eGFR, last eGFR within 7 days after operation, postoperative AKI and postoperative renal function all impacted long-term prognosis. CONCLUSION The incidence of postoperative AKI in elderly patients undergoing CABG is high, and postoperative AKI is an independent risk factor of both short- and long-term postoperative prognosis.
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Affiliation(s)
- Lei Jin
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, China
| | - Kaiyan Yu
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yilin Pan
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Yangyang Sun
- The First Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Jiapeng Chen
- Xinglin College, Nantong University, Nantong, China
| | - Lixiang Han
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Wei Li
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai Road, Shanghai, 200030, China.
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai Road, Shanghai, 200030, China.
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Wester ML, Sampon F, Olsthoorn JR, Soliman-Hamad MA, Houterman S, Maas AHEM, Roefs MM, Meesters MI, Ter Woorst JFJ. Gender is Independently Associated With Red Blood Cell and Platelet Transfusion in Patients Undergoing Coronary Artery Bypass Grafting: Data From the Netherlands Heart Registration. J Cardiothorac Vasc Anesth 2024; 38:924-930. [PMID: 38246823 DOI: 10.1053/j.jvca.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the incidence of transfusions, including red blood cells (RBC), platelets, and fresh frozen plasma (FFP) during and after coronary artery bypass grafting (CABG) in the Netherlands. Furthermore, the authors aimed to identify the impact of sex on blood product transfusion. DESIGN A retrospective multicenter cohort study. Data were collected from January 2013 to December 2021 from the Netherlands Heart Registration (NHR) database. SETTING The NHR receives its data from 16 heart centers in the Netherlands. PARTICIPANTS Patients older than 18 years who underwent CABG in the Netherlands. INTERVENTIONS Coronary artery bypass grafting with extracorporeal circulation or off-pump coronary artery bypass grafting. MEASUREMENTS AND MAIN RESULTS The incidence of blood transfusion, defined as transfusions intraoperatively and during the length of the hospital admission after CABG. In addition, a differentiation was made according to the type of transfusion (packed RBC, platelets, and FFP). In the overall cohort (N = 42,388), the number of patients who received a transfusion of any type was 27.0% (n = 11,428). Women received more often RBC transfusions compared with men (45.4% v 15.6%, respectively, p < 0.001). There was a significant difference between the 2 sexes regarding platelet transfusion (women 10.0% v men 11.1%, p = 0.005) but not in FFP transfusion. Female sex was independently associated with RBC transfusion, using the multivariate logistic regression analysis. CONCLUSIONS The incidence of any blood transfusion was 27.0%, and was higher in women than in men. The female sex was independently associated with receiving RBC during and after CABG.
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Affiliation(s)
- Mara-Louise Wester
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Fleur Sampon
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Mohamed A Soliman-Hamad
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Netherlands Heart Registration, Utrecht, the Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maaike M Roefs
- Netherlands Heart Registration, Utrecht, the Netherlands
| | - Michael I Meesters
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Joost F J Ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
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Jiang Y, Xie Y, Fang P, Shang Z, Chen L, Zhou J, Yang C, Zhu W, Hao X, Ding J, Yin P, Wang Z, Cao M, Zhang Y, Tan Q, Cheng D, Kong S, Lu X, Liu X, Sessler DI. Cognitive Training for Reduction of Delirium in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e247361. [PMID: 38652478 PMCID: PMC11040409 DOI: 10.1001/jamanetworkopen.2024.7361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/20/2024] [Indexed: 04/25/2024] Open
Abstract
IMPORTANCE Postoperative delirium is a common and impactful neuropsychiatric complication in patients undergoing coronary artery bypass grafting surgery. Cognitive training may enhance cognitive reserve, thereby reducing postoperative delirium. OBJECTIVE To determine whether preoperative cognitive training reduces the incidence of delirium in patients undergoing coronary artery bypass grafting. DESIGN, SETTING, and PARTICIPANTS This prospective, single-blind, randomized clinical trial was conducted at 3 university teaching hospitals in southeastern China with enrollment between April 2022 and May 2023. Eligible participants included those scheduled for elective coronary artery bypass grafting who consented and enrolled at least 10 days before surgery. INTERVENTIONS Participating patients were randomly assigned 1:1, stratified by site, to either routine care or cognitive training, which included substantial practice with online tasks designed to enhance cognitive functions including memory, imagination, reasoning, reaction time, attention, and processing speed. MAIN OUTCOMES AND MEASURES The primary outcome was occurrence of delirium during postoperative days 1 to 7 or until hospital discharge, diagnosed using the Confusion Assessment Method or the Confusion Assessment Method for Intensive Care Units. Secondary outcomes were postoperative cognitive dysfunction, delirium characteristics, and all-cause mortality within 30 days following the operation. RESULTS A total of 218 patients were randomized and 208 (median [IQR] age, 66 [58-70] years; 64 female [30.8%] and 144 male [69.2%]) were included in final analysis, with 102 randomized to cognitive training and 106 randomized to routine care. Of all participants, 95 (45.7%) had only a primary school education and 54 (26.0%) had finished high school. In the cognitive training group, 28 participants (27.5%) developed delirium compared with 46 participants (43.4%) randomized to routine care. Those receiving cognitive training were 57% less likely to develop delirium compared with those receiving routine care (adjusted odds ratio [aOR] 0.43; 95% CI, 0.23-0.77; P = .007). Significant differences were observed in the incidence of severe delirium (aOR, 0.46; 95% CI, 0.25-0.82; P = .01), median (IQR) duration of delirium (0 [0-1] days for cognitive training vs 0 [0-2] days for routine care; P = .008), and median (IQR) number of delirium-positive days (0 [0-1] days for cognitive training vs 0 [0-2] days for routine care; P = .007). No other secondary outcomes differed significantly. CONCLUSIONS AND RELEVANCE In this randomized trial of 208 patients undergoing coronary artery bypass grafting, preoperative cognitive training reduced the incidence of postoperative delirium. However, our primary analysis was based on fewer than 75 events and should therefore be considered exploratory and a basis for future larger trials. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2200058243.
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Affiliation(s)
- Yu Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Yanhu Xie
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Panpan Fang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Zixiang Shang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Lihai Chen
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Chao Yang
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Wenjie Zhu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Xixi Hao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Jianming Ding
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Panpan Yin
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Zan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Mengyuan Cao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Yu Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Qilian Tan
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dan Cheng
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Siyu Kong
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Xianfu Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Xuesheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical, University, Hefei, Anhui, China
| | - Daniel I. Sessler
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio
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12
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Zhu J, Wu Z, Huang G, Zhong Y, Peng C. Nomogram for predicting major bleeding after off-pump coronary artery bypass grafting. J Cardiothorac Surg 2024; 19:23. [PMID: 38263139 PMCID: PMC10807166 DOI: 10.1186/s13019-024-02499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE The purpose of this investigation is to develop a novel nomogram for predicting major bleeding following off-pump coronary artery bypass grafting (CABG). METHODS Between January 2012 and December 2022, 541 patients who underwent off-pump isolated primary CABG were included in a retrospective analysis. The primary outcome measure after off-pump CABG was major bleeding. Based on the outcomes of a multivariate analysis, nomograms were constructed. Using receiver operating characteristic analysis and calibration, the predictive accuracy of the nomograms was assessed. Using decision curve analysis (DCA), the clinical benefit of the nomograms was determined. RESULTS We categorized 399 and 142 patients in the "no major bleeding group" and "major bleeding group", respectively. Age (odds ratio (OR) 1.038; 95% confidence interval (CI) 1.009-1.068; p = 0.009), body mass index (OR 0.913; 95% CI 0.849-0.982; p = 0.014), hemoglobin (OR 0.958; 95% CI 0.945-0.971; p < 0.001), sodium (OR 0.873; 95% CI 0.807-0.945; p = 0.001), blood urea nitrogen (OR 1.198; 95% CI 1.073-1.338; p = 0.001), and operation time (OR 1.012; 95% CI 1.008-1.017; p < 0.001) were independent predictors for major bleeding after off-pump CABG. The model based on independent predictors exhibited excellent discrimination and calibration, with good agreement between actual and nomogram-estimated probabilities of generalization. DCA demonstrated that nomogram-assisted decisions have a greater positive benefit than treating all patients or none. CONCLUSIONS The plotted nomogram accurately predicted major bleeding outcomes following off-pump CABG and may therefore contribute to clinical decision-making, patient treatment, and consultation services.
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Affiliation(s)
- Jianqin Zhu
- Department of Sleep Medicine, Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Zhenjun Wu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, 530023, China
| | - Guiming Huang
- Department of Anesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, China
| | - Yuting Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China
| | - Cheng Peng
- Department of Anesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, China.
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Udzik J, Pacholewicz J, Biskupski A, Walerowicz P, Januszkiewicz K, Kwiatkowska E. Alterations to Kidney Physiology during Cardiopulmonary Bypass-A Narrative Review of the Literature and Practical Remarks. J Clin Med 2023; 12:6894. [PMID: 37959359 PMCID: PMC10647422 DOI: 10.3390/jcm12216894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION According to different authors, cardiac surgery-associated acute kidney injury (CSA-AKI) incidence can be as high as 20-50%. This complication increases postoperative morbidity and mortality and impairs long-term kidney function in some patients. This review aims to summarize current knowledge regarding alterations to renal physiology during cardiopulmonary bypass (CPB) and to discuss possible nephroprotective strategies for cardiac surgeries. Relevant sections: Systemic and renal circulation, Vasoactive drugs, Fluid balance and Osmotic regulation and Inflammatory response. CONCLUSIONS Considering the available scientific evidence, it is concluded that adequate kidney perfusion and fluid balance are the most critical factors determining postoperative kidney function. By adequate perfusion, one should understand perfusion with proper oxygen delivery and sufficient perfusion pressure. Maintaining the fluid balance is imperative for a normal kidney filtration process, which is essential for preserving the intra- and postoperative kidney function. FUTURE DIRECTIONS The review of the available literature regarding kidney function during cardiac surgery revealed a need for a more holistic approach to this subject.
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Affiliation(s)
- Jakub Udzik
- Department of Cardiac Surgery, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (J.P.); (A.B.); (P.W.)
| | - Jerzy Pacholewicz
- Department of Cardiac Surgery, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (J.P.); (A.B.); (P.W.)
| | - Andrzej Biskupski
- Department of Cardiac Surgery, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (J.P.); (A.B.); (P.W.)
| | - Paweł Walerowicz
- Department of Cardiac Surgery, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland; (J.P.); (A.B.); (P.W.)
| | - Kornelia Januszkiewicz
- Department of Anesthesiology, Intensive Care and Acute Intoxications, Pomeranian Medical University, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Ewa Kwiatkowska
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland;
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14
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Tang X, Wang T, Shi H, Zhang M, Yin R, Wu Q, Pan C. Artificial Intelligence and Big Data Technologies in the Construction of Surgical Risk Prediction Model for Patients with Coronary Artery Bypass Grafting. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2023; 2023:9575553. [PMID: 37455771 PMCID: PMC10348861 DOI: 10.1155/2023/9575553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 07/18/2023]
Abstract
The objective of this work was to predict the risk of mortality rate in patients with coronary artery bypass grafting (CABG) based on the risk prediction model of CABG using artificial intelligence (AI) and big data technologies. The clinical data of 2,364 patients undergoing CABG in our hospital from January 2019 to August 2021 were collected in this work. Based on AI and big data technology, business requirement analysis, system requirement analysis, complication prediction module, big data mining technology, and model building are carried out, respectively; the successful CABG risk prediction system includes case feature analysis service, risk warning service, and case retrieval service. The commonly used precision, recall, and F1-score were adopted to evaluate the quality of the gradient-boosted tree (GBT) model. The analysis proved that the GBT model was the best in terms of precision, F1-score, and area under the receiver operating characteristic curve (ROC). According to the CABG risk prediction model, 1,382 patients had a score of <0, 463 patients had a score of 0 ≤ score ≤ 2, 252 patients had a score of 2 < score ≤ 5, and 267 patients had a score of >5, which were stratified into four groups: A, B, C, and D. The actual number of in-hospital deaths was 25, and the in-hospital mortality rate was 1.05%. The mortality rate predicted by the CABG risk prediction model was 2.67 ± 1.82% (95% confidential interval (CI) (2.87-2.98)), which was higher than the actual value. The CABG risk prediction model showed the credible results only in group B with AUC = 0.763 > 0.7. In group B, 3 patients actually died, the actual mortality rate was 0.33%, and the predicted mortality rate was 0.96 ± 0.78 (95% CI (0.82-0.87)), which overestimated the mortality rate of patients in group B. It successfully constructed a CABG risk prediction model based on the AI and big data technologies, which would overestimate the mortality of patients with intermediate risk, and it is suitable for different types of heart diseases through continuous research and development and innovation, and provides clinical guidance value.
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Affiliation(s)
- Xiaoqiang Tang
- Radiology Department, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu, China
| | - Tao Wang
- Radiology Department, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu, China
| | - Haifeng Shi
- Radiology Department, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu, China
| | - Ming Zhang
- Radiology Department, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu, China
| | - RuoHan Yin
- Radiology Department, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu, China
| | - Qiyong Wu
- Cardio Thoracic Department, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu, China
| | - Changjie Pan
- Radiology Department, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213164, Jiangsu, China
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15
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Ibrahim RZ, Joyo EO. Intensive care unit length of stay and mortality comparison between on-pump and off-pump coronary artery bypass graft: a retrospective study. Egypt Heart J 2023; 75:48. [PMID: 37306794 DOI: 10.1186/s43044-023-00374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Recently, coronary artery bypass graft (CABG) techniques, both on-pump (ONCABG) and off-pump (OPCABG), were compared to seek the most effective approach to reduce the cost of prolonged intensive care unit length of stay (ICU LOS) and mortality. This study aims to compare ICU LOS and mortality in ONCABG and OPCABG. RESULTS Demographic data of 1569 patients show the variance of characteristics. The analysis shows significant and longer ICU LOS in OPCABG than ONCABG (2.151 ± 0.100 vs. 1.573 ± 0.246 days; p = 0.028). Similar results were demonstrated after adjustment of covariates effects (3.146 ± 0.281 vs. 2.548 ± 0.245 days; p = 0,022). Logistic regression shows no significant difference in mortality in OPCABG and ONCABG, both in the unadjusted (OR [CI 95%] 1.133 [0.485-2.800]; p = 0.733) and the adjusted models (OR [CI 95%] 1.133 [0.482-2.817]; p = 0,735). CONCLUSION ICU LOS was significantly longer in OPCABG patients than in ONCABG patients in the author's centre. There was no significant difference in mortality between the two groups. This finding highlights a discrepancy between recently published theories and the practices observed in the author's centre.
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Affiliation(s)
- Rita Zahara Ibrahim
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Letjen S. Parman Kav 87 Slipi, West Jakarta, Jakarta, 11420, Indonesia
| | - Ericko Ongko Joyo
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Letjen S. Parman Kav 87 Slipi, West Jakarta, Jakarta, 11420, Indonesia.
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16
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Sevuk U, Bahadir MV. Symptom progression following on-pump versus off-pump coronary artery bypass graft surgery in patients with peripheral arterial disease. Gen Thorac Cardiovasc Surg 2023; 71:158-166. [PMID: 35943642 DOI: 10.1007/s11748-022-01855-x] [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: 04/13/2022] [Accepted: 07/18/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aims to examine whether cardiac surgery leads to symptom progression in the early postoperative period in patients with the peripheral arterial disease (PAD) and evaluate the difference between on-pump (OPCAB) and off-pump (ONCAB) coronary artery bypass graft surgery with regard to the symptom progression. METHODS This retrospective study included one hundred consecutive adult patients with PAD at Fontaine stage 2b (pain-free walking distance less than 100 m) undergoing ONCAB and one hundred consecutive adult patients with PAD at Fontaine stage 2b (pain-free walking distance less than 100 m) undergoing OPCAB. Symptom progression was defined as the development of ischemic rest pain (Fontaine stage 3). RESULTS In the first week after surgery, 12 patients in the OPCAB group and 53 patients in the ONCAB group had postoperative symptom progression (p < 0.001). Rest pain resolved in most of these patients on the 15th postoperative day. At the end of the second month, rest pain resolved in all patients. Logistic regression analysis revealed that cardiac surgery with CPB, ABI < 0.5, postoperative nadir hct levels ≤ 25%, and intraoperative tissue hypoxia were independently associated with postoperative symptom progression. CONCLUSIONS In summary, we found that cardiac surgery may lead to symptom progression in patients with severe claudication in the early postoperative period. Our results suggest that OPCAB may lead to lower rates of symptom progression compared to ONCAB.
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Affiliation(s)
- Utkan Sevuk
- Department of Cardiovascular Surgery, Bower Hospital, Diyarbakir, 21300, Turkey
| | - Mehmet Veysi Bahadir
- Division of Transplantation, Dicle University, Organ Nakli Klinigi, Yenişehir, Silvan Yolu, Diyarbakir, 21100, Turkey.
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Pan R, Li X, Han J, Li Q, Lei Z, Huang H, Chen Y. Preoperative frailty assessment could be a predictive factor for the prognosis of elderly patients undergoing coronary artery bypass grafting: a retrospective case-control study. BMC Anesthesiol 2023; 23:63. [PMID: 36855100 PMCID: PMC9972799 DOI: 10.1186/s12871-023-02024-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Frailty has been considered to be associated with major mortality and increased length of stay after cardiac surgery. This study aimed to explore the predictive potential of frailty assessment in the prognosis of elderly patients undergoing bypass surgery. METHODS This study assessed the preoperative frailty according to the Fried's frailty phenotype, and included 150 frail and 150 non-frail elderly patients (≥ 65 y) who underwent bypass surgery. The present study evaluated the prognosis of elderly patients based on sequential organ failure assessment (SOFA) score, and collected clinical indicators to construct logistic regression models with the prognosis as the dependent variable, to explore the potential predictive ability of preoperative frailty. Moreover, this study focused on the complications and analyzed the relationship between preoperative frailty and postoperative complications. RESULTS In the present study, 244 patients were divided into the favorable prognosis group and 56 patients were divided into the unfavorable prognosis group. Logistic regression analysis showed that increased myoglobin and high cardiac function classification were independent risk factors for unfavorable prognosis in elderly patients undergoing bypass surgery. The discrimination of the clinical prediction model was determined by the receiver operating characteristic (ROC) curve, and the area under curve (AUC) was 0.928. After adding preoperative frailty assessment, the AUC was improved to 0.939. This study found a significant correlation between preoperative frailty and postoperative complications, mainly in the circulatory system. CONCLUSION Preoperative frailty assessment could be a predictive factor for the prognosis of elderly patients undergoing coronary artery bypass grafting. According to our study, frailty assessment and appropriate intervention before bypass surgery may be beneficial to the enhanced recovery after cardiac surgery. TRIAL REGISTRATION The clinical study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (2021-SR-393). All patients signed an informed consent form.
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Affiliation(s)
- Rui Pan
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China
| | - Xiaohui Li
- Department of Anesthesiology, the Fourth People's Hospital of Taizhou, 99 Gulou North Road, Hailing District, Taizhou City,, 225399, Jiangsu Province, China
| | - Jingjing Han
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China
| | - Qian Li
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China
| | - Zheng Lei
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China
| | - He Huang
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China.
| | - Yu Chen
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China.
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Tempe DK, Gandhi DA. Time for Judicious Application of Off-Pump CABG. J Cardiothorac Vasc Anesth 2023; 37:6-7. [PMID: 36319563 DOI: 10.1053/j.jvca.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Deepak K Tempe
- Visiting Professor, Institute of Liver and Biliary Sciences, New Delhi, India; Professor of Excellence and Former Dean, Maulana Azad Medical College, New Delhi, India.
| | - Dr Ashish Gandhi
- Consultant, Department of Cardiothoracic Anesthesia, The Essex Cardiothoracic Centre, United Kingdom
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19
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Aeen FB, Pakzad R, Tayebi Z, Kashkooli RI, Abdi F. Clinical outcomes of off-pump coronary artery bypass graft in patients with diabetes and non-diabetics: A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102643. [PMID: 36279703 DOI: 10.1016/j.dsx.2022.102643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/18/2022] [Accepted: 10/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Diabetes mellitus is a prevalent risk factor for developing coronary artery disease which worsens the clinical outcomes of patients undergoing coronary artery bypass grafting (CABG). This study aimed to determine the clinical outcomes of patients with diabetes and non-diabetic patients who underwent off-pump CABG surgery. METHOD Medline, Scopus, Proquest, Embase, Web of Science, and Google scholar were searched until September 10, 2021. The effect sizes including unstandardized mean difference and odds ratio with 95% confidence interval were calculated using "Metan" package. The Cochran's Q-test and I2 statistic were used to assess heterogeneity, a random-effects model was applied to estimate the pooled effect sizes, and meta-regression was used to investigate the factors affecting heterogeneity between studies. RESULTS 10 studies with 6200 sample sizes were included in the study. In groups with diabetes, Summary odds ratio (SOR) and 95% confidence interval of infection was 2.18 more than non-diabetic groups. Also, odds renal complication was 1.74 more than non-diabetic groups, and the odds cardiovascular complication in groups with diabetes was 1.30 more than non-diabetics. There were no differences in mortality, neurologic, respiratory and surgical complications between groups with diabetes and non-diabetics. Based on meta-regression results, age (Coefficient: 0.942; p = 0.009) had a significant direct relationship and sample size (Coefficient: 0.001; p = 0.009) had an indirect significant relationship with heterogeneity of neurologic outcomes. There was no significant publication bias in our results. CONCLUSION Our study revealed that off-pump CABG led to some significant outcomes in patients with diabetes compared to non-diabetics. Renal and infection complications were higher in patients with diabetes but no significant differences were seen in most of other postoperative outcomes between the two groups.
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Affiliation(s)
- Fatemeh Behesht Aeen
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Zahra Tayebi
- Faculty of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Razie Iloon Kashkooli
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Abdi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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20
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Gong J, Wei Y, Zhang Q, Tang J, Chang Q. Nomogram predicts atrial fibrillation after coronary artery bypass grafting. BMC Cardiovasc Disord 2022; 22:388. [PMID: 36042409 PMCID: PMC9429785 DOI: 10.1186/s12872-022-02824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/16/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Using the nomogram to intuitively predict atrial fibrillation after coronary artery bypass grafting. Identify high-risk patients with atrial fibrillation and provide preoperative protective therapy. Methods A total of 397 patients that underwent coronary artery bypass grafting were consecutively enrolled. Independent predictors of patients were analyzed by multivariate logistic regression. Two nomograms were constructed to predict postoperative atrial fibrillation. Results The incidence of postoperative atrial fibrillation in this study was 29% (115/397). Multivariate Logistic showed that Age, Operative Time > 4 h, Left Atrial Diameter > 40 mm, Mean Arterial Pressure, Body Mass Index > 23 kg/m2, Insulins, and Statins were independently associated with atrial fibrillation after isolated coronary artery bypass grafting. The nomogram of postoperative atrial fibrillation in patients was constructed using total predictor variables (AUC = 0.727, 95% CI 0.673–0.781). The model was internally validated (AUC = 0.701) by K-fold Cross-validation resampling (K = 5, Times = 400). To make an early intervention, the intraoperative information of the patients was excluded. Only 6 variables before surgery were used to establish the brief nomogram to predict postoperative atrial fibrillation (AUC = 0.707, 95% CI 0.651–0.764). The brief model was internally validated (AUC = 0.683) by resampling with K-fold Cross-validation resampling. Conclusions These two nomograms could be used to predict patients at high risk for atrial fibrillation after isolated coronary artery bypass grafting.
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Affiliation(s)
- Jingshuai Gong
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Yangyan Wei
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Qian Zhang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Jiwen Tang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Qing Chang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China.
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Ciğerci Y, Yaman F, Çekirdekçi A, Küçük İ, Ayva E, Kısacık ÖG. Does the technique used in coronary artery bypass graft surgery affect patients' anxiety, depression, mental and physical health? First 3-month outcomes. Perspect Psychiatr Care 2022; 58:518-526. [PMID: 34902162 DOI: 10.1111/ppc.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study was aimed at investigating the effect of coronary artery bypass graft surgery conducted with different techniques on patients' anxiety, depression, mental and physical health. DESIGN AND METHODS This cross-sectional study included 60 patients who completed the Beck Anxiety Inventory, the Beck Depression Inventory, and the 36-Item Short-Form Health Survey. FINDINGS Anxiety, depression, and mental health showed significant differences in different time measurements, and combined effects of surgical technique and time factor. PRACTICE IMPLICATIONS Preoperative routine evaluations can speed up recovery, reduce cost, and improve quality of life by preventing the possible negative effects of anxiety and depression.
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Affiliation(s)
- Yeliz Ciğerci
- Department of Nursing, Faculty of Health Science, Afyonkarahisar Health Science University, Afyonkarahisar, Turkey
| | - Fatıma Yaman
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kütahya Health Science University, Kütahya, Turkey
| | - Ahmet Çekirdekçi
- Department of Cardiovascular Surgery, Faculty of Medicine, Kütahya Health Science University, Kütahya, Turkey
| | - İlyas Küçük
- Hatay Mustafa Kemal University, Hatay, Turkey
| | - Ercüment Ayva
- Department of Cardiovascular Surgery, Private Fuar Hospital, Afyonkarahisar, Turkey
| | - Öznur Gürlek Kısacık
- Department of Nursing, Faculty of Health Science, Afyonkarahisar Health Science University, Afyonkarahisar, Turkey
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22
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Amr MA, Fayad E. Predictors of perioperative myocardial infarction in patients undergoing off-pump coronary artery bypass grafting. THE CARDIOTHORACIC SURGEON 2022. [DOI: 10.1186/s43057-021-00066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Perioperative myocardial infarction (PMI) increases morbidity and mortality after off-pump coronary artery bypass grafting (CABG). The objective of the current study was to characterize patients with PMI after off-pump CABG and identify its predictors.
Results
We included 1181 patients who had off-pump CABG from 2010 to 2020; 59 patients (5%) had PMI. We compared patients with PMI to those without PMI. Patients with PMI were older (57 (25th–75th percentiles: 51–63) vs. 54 (48–60) years; P = 0.01) and had higher NYHA class (28 (47.46%) vs. 326 (29.06%): P = 0.01). The distal anastomosis time was longer in patients with PMI (28 (23–35) vs. 24 (16–30) min; P ˂ 0.001). Patients with PMI had higher postoperative low cardiac output (10 (18.18%) vs. 1 (0.1%): P ˂ 0.001), prolonged ventilation (12 (8–39) vs. 8 (6–10) h, P ˂ 0.001), ICU (71 (46–138) vs. 24 (23–42) h; P ˂ 0.001), and hospital stay (9 (6–15) vs. 7 (6–8) days; P ˂ 0.001). Mortality was significantly higher in patients with PMI (20 (33.9%) vs. 6 (0.53%); P ˂ 0.001). Older age (OR: 1.05 (95% CI: 1.01–1.1); P = 0.02), increased number of distal anastomoses (OR: 1.74 (95% CI: 1.20–2.50); P = 0.003), preoperative congestive heart failure (OR: 10.27 (95% CI: 2.58–40.95); P = 0.001), and thrombolysis within 24 h of surgery (OR: 15.34 (1.93–121.9); P = 0.01) were associated with increased PMI, while PMI was lower in male patients (OR: 0.42 (95% CI: 0.19–0.93); P = 0.03) and with higher body surface area (BSA) (OR: 0.08 (95% CI: 0.07–0.86); P = 0.04).
Conclusions
Post-off-pump CABG PMI was associated with increased morbidity and mortality. Risk factors for PMI were older age, lower BSA, females, increased distal anastomoses, preoperative heart failure, and thrombolysis.
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Urbanowicz T, Michalak M, Olasińska-Wiśniewska A, Witkowska A, Rodzki M, Błażejowska E, Gąsecka A, Perek B, Jemielity M. Monocyte-to-Lymphocyte Ratio as a Predictor of Worse Long-Term Survival after Off-Pump Surgical Revascularization-Initial Report. Medicina (B Aires) 2021; 57:medicina57121324. [PMID: 34946269 PMCID: PMC8706717 DOI: 10.3390/medicina57121324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective: Coronary artery disease is one of the leading causes of deaths nowadays and the trends in diagnosis and revascularization are still in plateau despite well-known factors. Simple whole blood count parameters may be used to measure inflammatory reactions that are involved in processes of atherosclerosis progression. The aim of our study was to analyse the association between simply available hematologic indices and long-term mortality following off-pump coronary artery bypass grafting (OPCAB). Material and Methods: The study group comprised 129 consecutive patients (16 females and 113 males, mean age 66 ± 6 years) who underwent surgical revascularization with off-pump technique between January 2014 and September 2019. The mean follow-up was 4.7 +/−1.9 years. A receiver operating characteristics curve was applied to estimate demographical and perioperative parameters including MLR for mortality. Results: Cox regression analysis revealed chronic pulmonary obstructive disease (HR = 2.86, 95%CI 1.05–7.78), MLR (HR = 3.81, 95%CI 1.45–10.06) and right coronary artery blood flow (HR = 1.06, 95%CI 1.00–1.10) as significant factors predicting increased mortality risk. In the presented model, the MLR > 1.44 on 1st postoperative day was a significant predictor of late mortality after the OPCAB procedure (HR = 3.82, 95%CI 1.45–10.06). Conclusions: Pronounced inflammatory reaction after off-pump surgery measured by MLR > 1.44 can be regarded as a worse long-term prognostic factor.
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Affiliation(s)
- Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (A.W.); (M.R.); (B.P.); (M.J.)
- Correspondence: ; Tel.: +48-61-854-9210
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (A.W.); (M.R.); (B.P.); (M.J.)
| | - Anna Witkowska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (A.W.); (M.R.); (B.P.); (M.J.)
| | - Michał Rodzki
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (A.W.); (M.R.); (B.P.); (M.J.)
| | - Ewelina Błażejowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (E.B.); (A.G.)
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (E.B.); (A.G.)
| | - Bartłomiej Perek
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (A.W.); (M.R.); (B.P.); (M.J.)
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (A.W.); (M.R.); (B.P.); (M.J.)
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Grützner H, Flo Forner A, Meineri M, Janai A, Ender J, Zakhary WZA. A Comparison of Patients Undergoing On- vs. Off-Pump Coronary Artery Bypass Surgery Managed with a Fast-Track Protocol. J Clin Med 2021; 10:jcm10194470. [PMID: 34640488 PMCID: PMC8509448 DOI: 10.3390/jcm10194470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to compare patients who underwent on- vs. off-pump coronary artery bypass surgery managed with a fast-track protocol. Between September 2012 and December 2018, n = 3505 coronary artery bypass surgeries were managed with a fast-track protocol in our specialized post-anesthesia care unit. Propensity score matching was applied and resulted in two equal groups of n = 926. There was no significant difference in ventilation time (on-pump 75 (55-120) min vs. off-pump 80 (55-120) min, p = 0.973). We found no statistically significant difference in primary fast-track failure in on-pump (8.2% (76)) vs. off-pump (6% (56)) groups (p = 0.702). The secondary fast-track failure rate was comparable (on-pump 12.9% (110) vs. off-pump 12.3% (107), p = 0.702). There were no significant differences between groups in regard to the post-anesthesia care unit, the intermediate care unit, and the hospital length of stay. Postoperative outcome and complications were also comparable, except for a statistically significant difference in PACU postoperative blood loss in on-pump (234 mL) vs. off-pump (323 mL, p < 0.0001) and red blood cell transfusion (11%) and (5%, p < 0.001), respectively. Our results suggest that on- and off-pump coronary artery bypass surgery in fast-track settings are comparable in terms of ventilation time, fast-track failure rate, and postoperative complications rate.
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Affiliation(s)
- Henrike Grützner
- Section for Pediatrics and Youth Medicine, Public Health Department, Leipzig City Government, Friedrich-Ebert-Straße 19 a, 04109 Leipzig, Germany;
| | - Anna Flo Forner
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (A.F.F.); (M.M.); (A.J.); (J.E.)
| | - Massimiliano Meineri
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (A.F.F.); (M.M.); (A.J.); (J.E.)
| | - Aniruddha Janai
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (A.F.F.); (M.M.); (A.J.); (J.E.)
| | - Jörg Ender
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (A.F.F.); (M.M.); (A.J.); (J.E.)
| | - Waseem Zakaria Aziz Zakhary
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (A.F.F.); (M.M.); (A.J.); (J.E.)
- Correspondence:
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Saxena S, Kruys V, De Jongh R, Vamecq J, Maze M. High-Mobility Group Box-1 and Its Potential Role in Perioperative Neurocognitive Disorders. Cells 2021; 10:2582. [PMID: 34685561 PMCID: PMC8533835 DOI: 10.3390/cells10102582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022] Open
Abstract
Aseptic surgical trauma provokes the release of HMGB1, which engages the innate immune response after binding to pattern-recognition receptors on circulating bone marrow-derived monocytes (BM-DM). The initial systemic inflammation, together with HMGB1, disrupts the blood-brain barrier allowing penetration of CCR2-expressing BM-DMs into the hippocampus, attracted by the chemokine MCP-1 that is upregulated by HMGB1. Within the brain parenchyma quiescent microglia are activated and, together with the translocated BM-DMs, release proinflammatory cytokines that disrupt synaptic plasticity and hence memory formation and retention, resulting in postoperative cognitive decline (PCD). Neutralizing antibodies to HMGB1 prevents the inflammatory response to trauma and PCD.
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Affiliation(s)
- Sarah Saxena
- Department of Anesthesia, University Hospital Center (CHU de Charleroi), 6000 Charleroi, Belgium;
| | - Véronique Kruys
- ULB Immunology Research Center (UIRC), Laboratory of Molecular Biology of the Gene, Department of Molecular Biology, Free University of Brussels (ULB), 6041 Gosselies, Belgium;
| | - Raf De Jongh
- Department of Anesthesia, Fondation Hopale, 62600 Berck-sur-Mer, France;
| | - Joseph Vamecq
- Inserm, CHU Lille, Université de Lille, CHRU Lille, Center of Biology and Pathology (CBP) Pierre-Marie Degand, EA 7364 RADEME, 59000 Lille, France;
- Laboratory of Hormonology, Metabolism-Nutrition & Oncology (HMNO), Department of Biochemistry and Molecular Biology, University of North France, 59000 Lille, France
| | - Mervyn Maze
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA 94143, USA
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Choi HJ, Seo EJ, Choi JS, Oh SJ, Son YJ. Perioperative risk factors for new-onset postoperative atrial fibrillation among patients after isolated coronary artery bypass grafting: A retrospective study. J Adv Nurs 2021; 78:1317-1326. [PMID: 34519375 DOI: 10.1111/jan.15045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
AIMS Incidence of atrial fibrillation is considerably high after open heart surgery, which may prolong hospitalization and increase mortality. The aim of the present study is to investigate the perioperative risk factors for the occurrence of new-onset atrial fibrillation following isolated coronary artery bypass grafting. DESIGN A retrospective study. METHODS A total of 327 Korean patients recorded to have undergone first-time isolated coronary artery bypass grafting and no preoperative history of atrial fibrillation were included. The data were obtained from electronic health record from January 2010 to December 2019 at a tertiary care hospital. Predictors of new-onset atrial fibrillation after the surgery were identified by multivariate logistic regression analysis. RESULTS The incidence rate of new-onset atrial fibrillation after coronary artery bypass grafting was approximately 28.4%, and the highest occurrence rate was 44.1% on postoperative day 2. Our main finding showed that advanced age was the strongest predictor of atrial fibrillation after coronary artery bypass grafting. In addition, history of stroke and depression, chronic obstructive pulmonary disease and intraoperative use of intra-aortic balloon pump were shown to be the risk factors. CONCLUSION Our findings showed that approximately 28% patients had new-onset atrial fibrillation after the surgery. Healthcare professionals should proactively assess risk factors for postoperative atrial fibrillation and focus more on older adults with pre-existing comorbidities, such as stroke, depression and chronic obstructive pulmonary disease. IMPACT Older adults with history of stroke, depression and comorbid chronic obstructive pulmonary disease should be carefully monitored closely during perioperative period. The study highlights that early assessment of new-onset postoperative atrial fibrillation can contribute to promote the quality of nursing care and frontline nurses may be a vital role in timely detection of atrial fibrillation after surgery. Prospective studies are required to identify the mechanisms connecting perioperative risk factors for atrial fibrillation after cardiac surgery.
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Affiliation(s)
- Hong-Jae Choi
- Graduate School of Nursing, Chung-Ang University, Seoul, South Korea
| | - Eun Ji Seo
- College of Nursing, Research Institute of Nursing Science, Ajou University, Suwon, South Korea
| | - Jae-Sung Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Se Jin Oh
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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Urbanowicz TK, Olasińska-Wiśniewska A, Michalak M, Gąsecka A, Rodzki M, Perek B, Jemielity M. Cardioprotective Effect of Low Level of LDL Cholesterol on Perioperative Myocardial Injury in Off-Pump Coronary Artery Bypass Grafting. MEDICINA-LITHUANIA 2021; 57:medicina57090875. [PMID: 34577798 PMCID: PMC8466423 DOI: 10.3390/medicina57090875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 12/30/2022]
Abstract
Background and Objectives: Coronary artery disease is still a major cause of death in developed countries. Low-density lipoprotein cholesterol (LDL-C) lowering with statin therapy is a key strategy in major acute coronary events' prevention. The aim of the study was to establish if there is a cardioprotective effect of pre-operative LDL lowering therapy on perioperative myocaridal injury in patients undergoing off-pump coronary artery bypass grafting (CABG). Moreover, the impact of pre-operative LDL level on long term outcome was analysed. Materials and Methods: The retrospective single center analysis included 662 consecutive patients (431 (65%) males and 231 (35%) female, mean age of 65 ± 8) referred for cardiac surgery due to stable chronic coronary syndrome between 2012-2018. The follow up was 9 years. Results: A statistically significant difference was found in postoperative serum Troponin-I for LDL thresholds of 1.8 mmol/L (p = 0.009), 2.6 mmol/L (p = 0.03) and 3.0 mmol/L (p = 0.001). The results indicate that cardioprotective role of LDL is achieved within LDL concentration rate below 1.8 mmol/L (<70 mg/dL). Five patients died perioperatively, whereas 1-year and 9-year overall mortality rates were 4% (n = 28) and 18.6% (n = 123), respectively. Comparing the survival group with diseased, Mann-Whitney U test showed a statistically significant difference in HDL-C (p = 0.007), Troponin (p = 0.009), Castelli index (p = 0.001) and atherogenic index (p = 0.004). Preoperative levels of total cholesterol, LDL-C and HDL-C did not significantly differ between survivors and diseased. The 9-year mortality risk did not differ significantly between subgroups divided according to LDL-C thresholds of 1.4 mmol/L (55 mg/dL), 1.8 mmol/L (70 mg/dL), 2.6 mmol/L (100 mg/dL) and 3.0 mmol/L (116 mg/dL). Conclusions: Preoperative low level of LDL-C cholesterol (below 1.83 mmol/L, 70 mg/dL) has a cardioprotective effect on perioperative myocardial injury in off-pump coronary artery bypass grafting.
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Affiliation(s)
- Tomasz Kamil Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-848 Poznań, Poland; (A.O.-W.); (M.R.); (B.P.); (M.J.)
- Correspondence: ; Tel.: +48-61-854-9210
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-848 Poznań, Poland; (A.O.-W.); (M.R.); (B.P.); (M.J.)
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-529 Poznań, Poland;
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-106 Warsaw, Poland;
| | - Michał Rodzki
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-848 Poznań, Poland; (A.O.-W.); (M.R.); (B.P.); (M.J.)
| | - Bartłomiej Perek
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-848 Poznań, Poland; (A.O.-W.); (M.R.); (B.P.); (M.J.)
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-848 Poznań, Poland; (A.O.-W.); (M.R.); (B.P.); (M.J.)
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28
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Krakowski JC, Hallman MJ, Smeltz AM. Persistent Pain After Cardiac Surgery: Prevention and Management. Semin Cardiothorac Vasc Anesth 2021; 25:289-300. [PMID: 34416847 PMCID: PMC8669213 DOI: 10.1177/10892532211041320] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Persistent postoperative pain (PPP) after cardiac surgery is a significant complication that negatively affects patient quality of life and increases health care system burden. However, there are no standards or guidelines to inform how to mitigate these effects. Therefore, in this review, we will discuss strategies to prevent and manage PPP after cardiac surgery. Adequate perioperative analgesia may prove instrumental in the prevention of PPP. Although opioids have historically been the primary analgesic approach to cardiac surgery, an opioid-sparing strategy may prove advantageous in reducing side effects, avoiding secondary hyperalgesia, and decreasing risk of PPP. Implementing a multimodal analgesic plan using alternative medications and regional anesthetic techniques may offer superior efficacy while reducing adverse effects.
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Affiliation(s)
| | | | - Alan M Smeltz
- University of North Carolina at Chapel Hill, NC, USA
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29
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Challenges in Patient Blood Management for Cardiac Surgery: A Narrative Review. J Clin Med 2021; 10:jcm10112454. [PMID: 34205971 PMCID: PMC8198483 DOI: 10.3390/jcm10112454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
About 15 years ago, Patient Blood Management (PBM) emerged as a new paradigm in perioperative medicine and rapidly found support of all major medical societies and government bodies. Blood products are precious, scarce and expensive and their use is frequently associated with adverse short- and long-term outcomes. Recommendations and guidelines on the topic are published in an increasing rate. The concept aims at using an evidence-based approach to rationalize transfusion practices by optimizing the patient's red blood cell mass in the pre-, intra- and postoperative periods. However, elegant as a concept, the implementation of a PBM program on an institutional level or even in a single surgical discipline like cardiac surgery, can be easier said than done. Many barriers, such as dogmatic ideas, logistics and lack of support from the medical and administrative departments need to be overcome and each center must find solutions to their specific problems. In this paper we present a narrative overview of the challenges and updated recommendations for the implementation of a PBM program in cardiac surgery.
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Bastopcu M, Sargın M, Kuplay H, Erdoğan SB, Yapıcı N, Aka SA. Risk factors for vasoplegia after coronary artery bypass and valve surgery. J Card Surg 2021; 36:2729-2734. [PMID: 34018257 DOI: 10.1111/jocs.15663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/26/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Vasoplegia denotes a state of low tissue perfusion characterized by hypotension, tachycardia, and low systemic vascular resistance. This state results in increased mortality and morbidity following cardiac surgery. A better understanding of the associated risk factors will guide the surgical team in patient management. The aim of this study is to determine which risk factors are involved in its emergence. METHODS This prospective observational study included adult cardiac surgery patients between February - September 2018 at a single cardiothoracic surgery center. Patients were evaluated for cardiac contractility, surgical drainage, inotrope, and vasopressor requirement perioperatively. The groups were compared for demographic, echocardiographic, and operative variables. Variables significant in univariate analysis were carried on to binary logistic regression for risk factor analysis. RESULTS A total of 31 patients were vasoplegic among a total of 487 included patients, resulting in a 6.37% incidence. In the vasoplegia group, chronic kidney failure, use of angiotensin-converting enzyme (ACE) inhibitors, use of angiotensin receptor blockers, and use of diuretics were more frequent, cardiopulmonary bypass (CPB) and aortic cross-clamp durations were longer, and mean Euroscore II was higher. Vasoplegia was more frequent in valve surgery and resternotomy patients. CPB duration, use of ACE inhibitors, use of angiotensin receptor blockers, and chronic renal failure were independent risk factors. CONCLUSION Patients with long CPB duration, preoperative use of ACE inhibitors or Angiotensin receptor blockers, and a history of renal failure requiring dialysis are under increased risk of vasoplegia. Vasoplegia necessitates large-scale studies for a better understanding of its risk factors.
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Affiliation(s)
- Murat Bastopcu
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Sargın
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hüseyin Kuplay
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sevinç Bayer Erdoğan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Nihan Yapıcı
- Department of Anesthesiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Serap Aykut Aka
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Bastopcu M, Özhan A, Erdoğan SB, Kehlibar T. Factors associated with excessive bleeding following elective on-pump coronary artery bypass grafting. J Card Surg 2021; 36:1277-1281. [PMID: 33484200 DOI: 10.1111/jocs.15364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Excessive bleeding following cardiac surgery is associated with worse outcomes. We aimed to analyze preoperative and operative factors associated with excessive bleeding in coronary artery bypass patients to better understand which patients are under increased risk. METHODS The study was conducted as an observational study in a tertiary center for cardiac surgery by retrospective analysis of the hospital database. Patients were grouped according to chest tube output within the postoperative 24 h. Patients in the 4th percentile of chest tube output per kilogram were categorized as having excessive bleeding. Patients with excessive bleeding were compared with the other patients for preoperative and operative factors. Factors significant in univariate analysis were carried onto the multivariate analysis. RESULTS Patients with excessive bleeding were more likely to be males (91.4% vs. 78.7%, p = .002), have lower body mass index (BMI) (27.4 vs. 29.2, p < .001), and low platelets (6.9% vs. 1.5%, p = .006). Cardiopulmonary bypass (101.8 vs. 110.9 min, p = .022) time was longer in the excessive bleeding group. Patients with excessive bleeding were more likely to have more than three vessels revascularized. Male sex, lower BMI, low platelets, and longer cardiopulmonary bypass time were independently associated with increased bleeding. CONCLUSION Male sex, lower BMI, low platelet count, and longer cardiopulmonary bypass time are associated with extensive bleeding after elective coronary artery bypass surgery (CABG). Patients with higher bleeding risk should be identified preoperatively to account for adverse outcomes after CABG.
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Affiliation(s)
- Murat Bastopcu
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Abdulkerim Özhan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sevinç B Erdoğan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tamer Kehlibar
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Ferraris VA. Why Is MIDCAB the Least Likely Option for Coronary Revascularization? Ann Thorac Surg 2020; 111:1484-1485. [PMID: 33098880 DOI: 10.1016/j.athoracsur.2020.07.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Victor A Ferraris
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, A301 Kentucky Clinic, 740 S Limestone Ave, Lexington, KY 40536-0284.
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Costa D, Muzzio M, Saglietti L, Budelli S, Gonzalez CL, Catena E, Córsico L, Iturralde LG, Esperón G, Gregorietti V, Coronel R. Fluid Status After Cardiac Surgery Assessed by Bioelectrical Impedance Vector Analysis and the Effects of Extracorporeal Circulation. J Cardiothorac Vasc Anesth 2020; 35:2385-2391. [PMID: 34219659 DOI: 10.1053/j.jvca.2020.09.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/06/2020] [Accepted: 09/20/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Hydration status after cardiac surgery can be difficult to assess, often requiring invasive measurements. Bioelectrical impedance vector analysis (BIVA) is based on patterns of resistance (R) and reactance (Xc), corrected by height, and has been used in various clinical scenarios to determine body composition and monitor its changes over time. The purpose of the present study was to apply this method in cardiac surgery patients to assess the variation in hydration status and to compare its changes according to the use of extracorporeal circulation. DESIGN Single-center, observational, prospective study including patients older than 18 years undergoing elective or urgent cardiac surgery. SETTING Intensive cardiac care unit of a tertiary center in a metropolitan area. PARTICIPANTS The study comprised 76 patients with a median age of 60 years and mostly undergoing coronary artery bypass grafting (CABG) (n = 47 [61.8%]) with extracorporeal circulation (n = 54 [73%]). INTERVENTIONS Bioimpedance was measured with a standard tetrapolar single-frequency bioimpedance meter using a standardized procedure and plotted in an R-Xc graph. MEASUREMENTS AND MAIN RESULTS The study demonstrated an increase in total body water immediately after surgery that was sustained until producing hyperhydration 24 hours later. Off-pump CABG was associated with a normal hydration status after surgery, whereas on-pump CABG produced a significant increase in total body water. CONCLUSIONS Fluid status assessment with BIVA in cardiac surgery showed an increase in total body water up to 24 hours after surgery. Off-pump surgery prevented overhydration, which partially could explain the reduction in some of the postoperative complications. BIVA could serve as a useful method for monitoring fluid status in the setting of goal-directed therapy to assist in maintaining euvolemia in cardiac surgical patients.
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Affiliation(s)
- Diego Costa
- Coronary Care Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina.
| | | | - Luciano Saglietti
- Coronary Care Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Silvina Budelli
- Cardiac Anesthesiology, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Carlos L Gonzalez
- Coronary Care Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Enzo Catena
- Coronary Care Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Luciana Córsico
- Coronary Care Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | | | | | - Vanesa Gregorietti
- Heart Transplant and Pulmonary Hypertension Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | - Roberto Coronel
- Cardiac Processes, Sanatorio Sagrado Corazón, Buenos Aires, Argentina
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Ali M, Moeen M, Paras I, Hamid W, Khan S, Chaudhary MH. Cardio-Protective Effects of Multiport Antegrade Cold Blood Cardioplegia Versus Antegrade Cold Blood Cardioplegia in Patients With Left Ventricular Systolic Dysfunction Undergoing Conventional Coronary Artery Bypass Grafting. Cureus 2020; 12:e10308. [PMID: 33052270 PMCID: PMC7544548 DOI: 10.7759/cureus.10308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction The aim of this study was to compare the in-hospital outcomes of multiport antegrade cold blood cardioplegia through vein grafts versus conventional antegrade cold blood cardioplegia in patients with left ventricle systolic dysfunction who underwent coronary artery bypass grafting (CABG). Methods This prospective, randomized clinical study was comprised of patients undergoing on-pump CABG at the Ch. Pervaiz Elahi Institute of Cardiology in Multan, Pakistan from November 18, 2018 to December 17, 2019. Patients with multivessel coronary artery disease and left ventricular systolic dysfunction (ejection fraction < 50%) were included. In Group A (N = 73), multiport antegrade cold blood vein graft cardioplegia was given after every distal anastomosis completed for myocardial preservation. In Group B (N = 73), conventional antegrade cold blood cardioplegia was given for myocardial preservation. Results Spontaneous rhythm (without defibrillation applied) after cross-clamp removal was higher in Group A than in Group B (93.3% vs. 85.2%, p < 0.05). Duration of support, ventilation time, and hospital stay were also significantly lower in Group A than in Group B with p = 0.00001, p = 0.03, and p = 0.002, respectively. Intra-aortic balloon pump insertion (4.1% vs. 23.0%, p = 0.02) and operative mortality (0.5% vs. 4.0%, p = 0.35) were also lower in Group A than in Group B. Postoperative left ventricular ejection fraction (LVEF) increased more in Group A than in Group B, and the postoperative LVEF mean value was 44.68% in Group A versus 41.26% in Group B (p = 0.02). Conclusion Multiport vein graft blood cardioplegia provides superior myocardial protection in patients with left ventricular systolic dysfunction who underwent CABG. It is also easy to administer, so this technique can be adopted as a routine method for myocardial protection in patients with left ventricular dysfunction planned for on-pump CABG.
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Affiliation(s)
- Muhammad Ali
- Cardiac Surgery, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Muhammad Moeen
- Cardiac Surgery, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Iftikhar Paras
- Cardiac Surgery, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, PAK
| | - Waqas Hamid
- Cardiac Surgery, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, PAK
| | - Saadat Khan
- Echocardiography, Tabba Heart Institute, Karachi, PAK
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Comprehensive Study of Different Expressed Genes and Their Functional Modules in Anesthesia for Off-Pump Coronary Artery Bypass Grafting. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8062902. [PMID: 32695821 PMCID: PMC7361873 DOI: 10.1155/2020/8062902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
Purpose The effect of preoperative anesthesia on coronary artery bypass grafting without extracorporeal circulation is not apparent. We want to investigate the effects and molecular mechanisms of two anesthesia methods on the treatment of coronary artery bypass grafting (OPCABG) under extracorporeal circulation. Patients and Methods. The data of inhaled anesthesia and intravenous anesthesia before coronary artery bypass grafting were downloaded from the GEO database, and the differences were analyzed with the control group. The combination of multiple analytical methods can decipher the mechanism of anesthesia on surgery, including protein interaction network analysis, enrichment analysis, and regulatory subprediction. Results This study obtained 6699 differential genes under two kinds of anesthesia before OPCABG. By constructing a protein interaction network of differentially expressed genes, we obtained 14 functional module networks. By predicting regulators of functional module genes, we revealed a series of ncRNAs (miR-129-5p, miR-340-5p, and miR-410-3p) and transcription factors (VHL and YBX1). Conclusion Based on functional module network analysis, we identified the effects of preoperative inhalation anesthesia and intravenous anesthesia on OPCABG, which provides a valuable theoretical reference for subsequent clinical studies.
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Evans AS, Weiner MM, Shaefi S, Patel PA, Townsley MM, Kumaresan A, Feinman JW, Fritz AV, Martin AK, Steinberg TB, Renew JR, Gui JL, Radvansky B, Bhatt H, Subramani S, Sharma A, Gutsche JT, Augoustides JG, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2019; 34:1-11. [PMID: 31759862 DOI: 10.1053/j.jvca.2019.10.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022]
Abstract
This highlights in our specialty for 2019 begin with the ongoing major developments in transcatheter valve interventions. Thereafter, the advances in left ventricular assist devices are reviewed. The recent focus on conduit selection and robotic options in coronary artery bypass surgery are then explored. Finally, this special articles closes with a discussion of pulmonary hypertension in noncardiac surgery, anesthetic technique in cardiac surgery, as well as postoperative pneumonia and its outcome consequences.
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Affiliation(s)
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine Beth Israel, Deaconess Medical Center, Boston, MA
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Abirami Kumaresan
- Department of Anesthesiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Ashley V Fritz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Toby B Steinberg
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - J Ross Renew
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jane L Gui
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian Radvansky
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Himani Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Tiquet B, Blossier JD, Orsel I, Pihan F, Piccardo A, Marsaud JP, Vandroux D. Short-Term Outcomes After Off-Pump or On-Pump Coronary Artery Bypass Grafting in the Octogenarian Patients. J Cardiothorac Vasc Anesth 2019; 33:2100-2102. [PMID: 31060936 DOI: 10.1053/j.jvca.2019.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Bérénice Tiquet
- Department of Anesthesiology, Academic Teaching Hospital of Limoges, Limoges, France
| | - Jean David Blossier
- Department of Cardiothoracic Surgery, Academic Teaching Hospital of Limoges, Limoges, France
| | - Isabelle Orsel
- Department of Anesthesiology, Academic Teaching Hospital of Limoges, Limoges, France
| | - Frank Pihan
- Department of Anesthesiology, Academic Teaching Hospital of Limoges, Limoges, France
| | - Alessandro Piccardo
- Department of Cardiothoracic Surgery, Academic Teaching Hospital of Limoges, Limoges, France
| | | | - David Vandroux
- Cardio-Surgical Intensive Care Unit, Academic Teaching Hospital of Limoges, Limoges, France
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Abstract
Purpose of Review An overview of recent literature regarding pathophysiology, risk factors, prophylaxis, and treatment of new-onset atrial fibrillation (AF) in post-cardiac surgical patients. Recent Findings AF is the most frequent adverse event after cardiac surgery with significant associated morbidity, mortality, and financial cost. Its causes are multifactorial, and models to stratify patients into risk categories are progressing but a consistent, evidence-based system has not yet been developed. Pharmacologic and surgical interventions to prevent and treat this complication have been an area of ongoing research and recent societal guidelines reflect this. Summary Inconsistencies remain surrounding how to best identify higher-risk AF patients, which interventions should be used to prevent and treat AF, and which patient groups should receive these interventions. The evidence for these available strategies and their place in contemporary guidelines are summarized.
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Ramakrishna H. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting: Should This Debate Even Continue? J Cardiothorac Vasc Anesth 2019; 33:1195-1196. [PMID: 30685154 DOI: 10.1053/j.jvca.2018.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
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Benjamin MM, Joyce DL, Mohammed AA. Partial outflow pump dehiscence following off-pump HeartWare left ventricular assist device implantation in a patient with the Marfan syndrome. Proc AMIA Symp 2019; 32:105-106. [PMID: 30956599 PMCID: PMC6442881 DOI: 10.1080/08998280.2018.1514843] [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: 06/30/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 10/27/2022] Open
Abstract
A 30-year-old man with Marfan syndrome, biventricular heart failure, and an earlier left ventricular assist device placement presented to the emergency department with chest discomfort. Computed tomography with contrast showed contrast extravasation from the anterior aspect of the ascending aorta. The patient was immediately taken to the operating room, where re-exploration of the mediastinum disclosed two needle holes from the distal anastomosis at the toe of the graft that were no longer hemostatic, and it appeared that the patient's heart had dilated in the interim to the point that the outflow graft was too snug. In the operating room, it appeared that a markedly dilated right ventricle was stretching the graft. The patient underwent lengthening of the left ventricular outflow graft and fully recovered.
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Affiliation(s)
- Mina M. Benjamin
- Department of Internal Medicine, Medical College of WisconsinMilwaukeeWisconsin
| | - David L. Joyce
- Department of Cardiovascular Surgery, Medical College of WisconsinMilwaukeeWisconsin
| | - Asim A. Mohammed
- Section of Cardiovascular Medicine, Department of Internal Medicine, Medical College of WisconsinMilwaukeeWisconsin
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