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Bağiş MZ, Amaç B. The Efficacy of Tranexamic Acid in Reducing Perioperative Drainage in Cardiac Surgery with Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2024; 39:e20230181. [PMID: 38630021 PMCID: PMC11021030 DOI: 10.21470/1678-9741-2023-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/13/2023] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Although cardiopulmonary bypass procedures remain a critical treatment option for heart disease, they come with risks, including hemorrhage. Tranexamic acid is known to reduce morbidity and mortality in surgical hemorrhage. OBJECTIVE This study aimed to evaluate the efficacy of tranexamic acid, which is routinely used to treat hemorrhage, in decreasing the amount of intraoperative and postoperative drainage. METHOD A total of 80 patients who underwent cardiac surgery with cardiopulmonary bypass were included in this retrospective study. Forty patients who received tranexamic acid during the operation were assigned to Group 1, while 40 patients who did not receive tranexamic acid were assigned to Group 2. Patient data were collected from the hospital computer system and/or archive records after applying exclusion criteria, and the data were recorded. Statistical analyses were then performed to compare the data. RESULTS Age, sex, height, weight, body surface area, flow, and ejection fraction percentages, preoperative hematological parameters, and intraoperative variables (except tranexamic acid) were similar between the groups (P>0.05). However, there were statistically significant differences between the groups in terms of intraoperative (through the heart-lung machine) and postoperative red blood cell transfusion rates, intraoperative and postoperative bleeding drainage amounts, as well as postoperative hematocrit, hemoglobin, platelet, and red blood cell levels (P<0.05). CONCLUSION We concluded that intraoperative and postoperative use of tranexamic acid in patients who underwent coronary artery bypass grafting with cardiopulmonary bypass has positive effects on hematological parameters, reducing blood product use, and bleeding drainage amount.
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Affiliation(s)
- Murat Ziya Bağiş
- Clinic of Cardiovascular Surgery, Health Sciences University,
Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Bişar Amaç
- Department of Perfusion, Health Sciences University, Sanliurfa
Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
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Ramos RS, Rocco IS, Viceconte M, Santo JADE, Berwanger O, Santos RHN, Kalil RAK, Jatene FB, Cavalcanti AB, Zilli AC, Pimentel WDS, Hossne Junior NA, Branco JNR, Trimer R, Evora PRB, Gomes WJ, Guizilin S. Association Between Body Mass Index, Obesity, and Clinical Outcomes Following Coronary Artery Bypass Grafting in Brazil: An Analysis of One Year of Follow-up of BYPASS Registry Patients. Braz J Cardiovasc Surg 2024; 39:e20230133. [PMID: 38569010 PMCID: PMC10987126 DOI: 10.21470/1678-9741-2023-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. METHODS A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. RESULTS Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. CONCLUSION Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness.
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Affiliation(s)
- Rodrigo Santin Ramos
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Isadora Salvador Rocco
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcela Viceconte
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Otavio Berwanger
- Instituto de Pesquisa - IP, Hospital do Coração -
HCor, São Paulo, São Paulo, Brazil
| | | | - Renato Abdala Karam Kalil
- Instituto de Cardiologia do Rio Grande do Sul,
Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande
do Sul, Brazil
| | - Fabio B. Jatene
- Instituto de Pesquisa - IP, Hospital do Coração -
HCor, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Division, Instituto do Coração
- InCor, Hospital das Clínicas da Faculdade de Medicina da Universidade de
São Paulo - HCFMUSP, São Paulo, São Paulo, Brazil
| | | | - Alexandre Cabral Zilli
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Walace de Souza Pimentel
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Nelson Américo Hossne Junior
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - João Nelson Rodrigues Branco
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Renata Trimer
- Department of Physical Therapy, Universidade Federal de São
Carlos, São Carlos, São Paulo, Brazil
| | - Paulo Roberto Barbora Evora
- Department of Surgery and Anatomy, Escola de Medicina de
Riberão Preto, Universidade de São Paulo, Ribeirão Preto,
São Paulo, Brazil
| | - Walter J. Gomes
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Solange Guizilin
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Björklund E, Enström P, Nielsen SJ, Tygesen H, Martinsson A, Hansson EC, Lindgren M, Malm CJ, Pivodic A, Jeppsson A. Postdischarge major bleeding, myocardial infarction, and mortality risk after coronary artery bypass grafting. Heart 2024; 110:569-577. [PMID: 38148160 PMCID: PMC10982629 DOI: 10.1136/heartjnl-2023-323394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE To investigate the incidence and mortality risk associated with postdischarge major bleeding after coronary artery bypass grafting (CABG), and relate this to the incidence of, and mortality risk from, postdischarge myocardial infarction. METHODS All patients undergoing first-time isolated CABG in Sweden in 2006-2017 and surviving 14 days after hospital discharge were included in a cohort study. Individual patient data from the SWEDEHEART Registry and five other mandatory nationwide registries were merged. Piecewise Cox proportional hazards models were used to investigate associations between major bleeding, defined as hospitalisation for bleeding, with subsequent mortality risk. Similar Cox proportional hazards models were used to investigate the association between postdischarge myocardial infarction and mortality risk. RESULTS Among 36 633 patients, 2429 (6.6%) had a major bleeding event and 2231 (6.1%) had a myocardial infarction. Median follow-up was 6.0 (range 0-11) years. Major bleeding was associated with higher mortality risk <30 days (adjusted HR (aHR)=20.2 (95% CI 17.3 to 23.5)), 30-365 days (aHR=3.8 (95% CI 3.4 to 4.3)) and >365 days (aHR=1.8 (95% CI 1.7 to 2.0)) after the event. Myocardial infarction was associated with higher mortality risk <30 days (aHR=20.0 (95% CI 16.7 to 23.8)), 30-365 days (aHR=4.1 (95% CI 3.6 to 4.8)) and >365 days (aHR=1.8 (95% CI 1.7 to 2.0)) after the event. CONCLUSIONS The increase in mortality risk associated with a postdischarge major bleeding after CABG is substantial and is similar to the mortality risk associated with a postdischarge myocardial infarction.
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Affiliation(s)
- Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Southern Älvsborg Hospital, Borås, Sweden
| | - Philip Enström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Tygesen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Southern Älvsborg Hospital, Borås, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl-Johan Malm
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aldina Pivodic
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
- APNC Sweden, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jucá FG, de Freitas FL, Goncharov M, Pes DDL, Jucá MEC, Dallan LRP, Lisboa LAF, Jatene FB, Mejia OAV. Difference Between Cardiopulmonary Bypass Time and Aortic Cross-Clamping Time as a Predictor of Complications After Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2024; 39:e20230104. [PMID: 38426431 PMCID: PMC10903005 DOI: 10.21470/1678-9741-2023-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/19/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Along with cardiopulmonary bypass time, aortic cross-clamping time is directly related to the risk of complications after heart surgery. The influence of the time difference between cardiopulmonary bypass and cross-clamping times (TDC-C) remains poorly understood. OBJECTIVE To assess the impact of cardiopulmonary bypass time in relation to cross-clamping time on immediate results after coronary artery bypass grafting in the Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) II. METHODS Analysis of 3,090 patients included in REPLICCAR II database was performed. The Society of Thoracic Surgeons outcomes were evaluated (mortality, kidney failure, deep wound infection, reoperation, cerebrovascular accident, and prolonged ventilation time). A cutoff point was adopted, from which the increase of this difference would affect each outcome. RESULTS After a cutoff point determination, all patients were divided into Group 1 (cardiopulmonary bypass time < 140 min., TDC-C < 30 min.), Group 2 (cardiopulmonary bypass time < 140 min., TDC-C > 30 min.), Group 3 (cardiopulmonary bypass time > 140 min., TDC-C < 30 min.), and Group 4 (cardiopulmonary bypass time > 140 min., TDC-C > 30 min.). After univariate logistic regression, Group 2 showed significant association with reoperation (odds ratio: 1.64, 95% confidence interval: 1.01-2.66), stroke (odds ratio: 3.85, 95% confidence interval: 1.99-7.63), kidney failure (odds ratio: 1.90, 95% confidence interval: 1.32-2.74), and in-hospital mortality (odds ratio: 2.17, 95% confidence interval: 1.30-3.60). CONCLUSION TDC-C serves as a predictive factor for complications following coronary artery bypass grafting. We strongly recommend that future studies incorporate this metric to improve the prediction of complications.
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Affiliation(s)
- Fabiano Gonçalves Jucá
- Department of Cardiovascular Surgery, Hospital de Messejana Dr.
Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabiane Letícia de Freitas
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Maxim Goncharov
- Instituto de Pesquisa Hcor, Hospital do Coração,
São Paulo, São Paulo, Brazil
| | - Daniella de Lima Pes
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Luis Roberto Palma Dallan
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Luiz Augusto Ferreira Lisboa
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio B. Jatene
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Omar Asdrúbal Vilca Mejia
- Department of Cardiovascular Surgery, Instituto do
Coração, Hospital das Clínicas, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Karaarslan M, Beyazal OF, Yanartaş M. Comparison of Early and Mid-Term Outcomes After Classic and Modified Morrow Septal Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy. Braz J Cardiovasc Surg 2024; 39:e20230205. [PMID: 38315100 PMCID: PMC10836913 DOI: 10.21470/1678-9741-2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION The aim of our study is to compare the early and mid-term outcomes of patients with hypertrophic obstructive cardiomyopathy who underwent classic and modified Morrow septal myectomy. METHODS Between 2014 and 2019, 48 patients (24 males; mean age 49.27±16.41 years) who underwent septal myectomy were evaluated. The patients were divided into two groups - those who underwent classic septal myectomy (n=28) and those who underwent modified septal myectomy (n=20). RESULTS Mitral valve intervention was higher in the classic Morrow group than in the modified Morrow group, but there was no significant difference (P=0.42). Mortality was found to be lower in the modified Morrow group than in the classic Morrow group (P=0.01). In both groups, the mean immediate postoperative gradient was significantly higher than the mean of the 3rd and 12th postoperative months. The preoperative and postoperative gradient difference of the modified Morrow group was significantly higher than of the classic Morrow group (P<0.001). CONCLUSION Classic Morrow and modified Morrow procedures are effective methods for reducing left ventricular outflow tract obstruction. The modified Morrow procedure was found to be superior to the classic Morrow procedure in terms of reducing the incidence of mitral valve intervention with the reduction of the left ventricular outflow tract gradient.
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Affiliation(s)
- Mustafa Karaarslan
- Department of Cardiovascular Surgery, Kartal Koşuyolu High
Specialization Training and Research Hospital, İstanbul, Turkey
| | - Osman Fehmi Beyazal
- Department of Cardiovascular Surgery, Başakşehir
Çam and Sakura City Hospital, İstanbul, Turkey
| | - Mehmed Yanartaş
- Department of Cardiovascular Surgery, Kartal Koşuyolu High
Specialization Training and Research Hospital, İstanbul, Turkey
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Mostafa MM, AlKhawaga MA, ELminshawy A. [Amélioration précoce de la fraction d'éjection chez les patients ayant une fraction d'éjection réduite après un pontage coronarien]. Ann Cardiol Angeiol (Paris) 2024; 73:101674. [PMID: 37988889 DOI: 10.1016/j.ancard.2023.101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Despite advancements in surgical technique, myocardial shield, and postoperative care, Coronary artery bypass grafting (CABG) among patients with reduced ejection fraction (EF) remains a surgical challenge due to their greater postoperative morbidity and mortality. This study aims to determine the early outcome of patients with reduced LVEF undergoing CABG and the improvement in the ejection fraction after revascularization. METHODS A total of 62 patients with impaired Left Ventricular (LV) systolic function (LVEF = 35-40 %) who underwent isolated On-pump CABG at the Department of Cardiothoracic Surgery in Assiut University Hospitals and who had met the listed inclusion and exclusion criteria were eligible for the study. Different variables (preoperative, intraoperative, and postoperative) were collected, studied, and compared. RESULTS The mean age of the patients was 57.81 ± 7.57 years, 66.1 % were male and 33.9 % were female. 44 (71.0%) patients were administered antegrade cardioplegia, whereas 18 (29.0%) patients were administered antegrade plus retrograde cardioplegia. Mean LVEF increased significantly from 37.97 ± 1.38% before surgery to 51.87 ± 3.54% after surgery (P ˂ 0.05). Post-operative low cardiac output syndrome occurred in 37 (59.7 %) of patients, pulmonary complications in 15 (24.2%), neurological complications in 10 (16.1%), sternal wound infection in 9 (14.5%), atrial fibrillation in 5 (8.1%) and acute kidney injury in 5 (8.1 %) of patients. In-hospital mortality was 16.1% (10 patients). CONCLUSION Based on the findings, CABG in patients with reduced preoperative LVEF improves the postoperative LVEF and NYHA functional class.
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Affiliation(s)
| | - Mahmoud A AlKhawaga
- Cardiothoracic Surgery Department, Faculty of Medicine, Assiut University, Assiut 71526, Egypt
| | - Ahmed ELminshawy
- Cardiothoracic Surgery Department, Faculty of Medicine, Assiut University, Assiut 71526, Egypt
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Nurzhanova M, Musagaliyeva A, Zhakypova R, Senkibayeva D, Rakisheva A. Use of sacubitril/valsartan early after CABG. Open Heart 2024; 11:e002492. [PMID: 38238027 PMCID: PMC10806467 DOI: 10.1136/openhrt-2023-002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Heart failure (HF) remains a major public health problem with a high mortality and morbidity worldwide. Currently, there is no optimal revascularisation strategy for patients with ischaemic cardiomyopathy despite suggestions that coronary artery bypass graft (CABG) may be superior to medical therapy in improving survival. However, CABG may be associated with substantial risk in HF subjects. We therefore aimed to evaluate the safety and efficacy of the early initiation of sacubitril/valsartan in haemodynamically stabilised patients with HF with reduced ejection fraction (HFrEF) after early CABG. METHODS This was an open-label study in which ~80 patients after CABG were randomised either to the early or late initiation of the sacubitril-valsartan. The study included patients >40 years with left ventricular ejection fraction <45% and New York Heart Association (NYHA) class II-IV at the early stage after CABG. Patients underwent intervention, the starting dose of sacubitril/valsartan (24/26 mg or 49/51 mg two times per day). The follow-up took place every 4 weeks except the first visit, which took place in 2 weeks after initiation. The primary endpoint assessed the key safety outcomes, the secondary endpoints were: the quality of life measured, the N-terminal pro-B-type natriuretic peptide (NT-proBNP) changes and 6 min walk test (6MWT). RESULTS In total, 83 patients were screened and 77 patients were enrolled. The majority of patients (84.4%) were in the NYHA class III at randomisation. The number of patients who discontinued the study was low in both groups (2.5%, 5.2%), and renal function, hyperkalaemia and symptomatic hypotension rarely seen in both groups did not differ significantly. The improvement in quality of life and distance at the 6MWT in both groups was significant (p<0.001). The NT-proBNP concentration decreased in both groups, the significant reduction was in the early group (p<0.001) versus the postdischarge group. CONCLUSIONS The early initiation of sacubitril/valsartan in patients after CABG with HFrEF is safe and effective. Adverse events and permanent discontinuation were low. The NT-proBNP concentration reduced significantly with the early in-hospital initiation.
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Affiliation(s)
- Madina Nurzhanova
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
- Kazakhstan Medical University 'Graduate School of Public Health', Almaty, Kazakhstan
| | - Aisulu Musagaliyeva
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Raushan Zhakypova
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Daniya Senkibayeva
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Amina Rakisheva
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
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Mazaheri-Tehrani S, Haghighatpanah MA, Abhari AP, Fakhrolmobasheri M, Shekarian A, Kieliszek M. Dynamic changes of serum trace elements following cardiac surgery: A systematic review and meta-analysis. J Trace Elem Med Biol 2024; 81:127331. [PMID: 37897922 DOI: 10.1016/j.jtemb.2023.127331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/11/2023] [Accepted: 10/21/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Cardiac surgeries are known to induce an inflammatory response. Besides, dietary factors such as trace elements contribute to promoting cardiovascular health by maintaining oxidative balance. Here we systematically review the literature about alterations in serum concentrations of zinc (Zn), copper (Cu), and selenium (Se) in response to cardiac surgeries. METHODS A systematic search was performed on databases until the end of December 2022. Studies assessing the changes of mentioned elements in adult patients undergoing cardiac surgery were included. Changes in the means and standard deviations of the elements before and after the cardiac surgery were utilized as desired effect sizes. RESULTS Among 1252 records found in the primary search, 23 and 21 articles were included in the systematic review and meta-analysis respectively. Seventeen studies evaluated the changes in serum Zn and Cu levels, and fifteen studies assessed Se levels. According to the results of quantitative analysis, Zn, Cu, and Se concentrations, one day after the surgery were significantly lower than preoperative values (WMD for Zn: 4.64 µmol/L [3.57-5.72], WMD for Cu: 1.62 µmol/L [0.52-2.72], and WMD for Se: 0.1 µmol/L [0.03-0.16]). The concentration of trace elements recovered gradually during the first-week post-operation and reached preoperative levels or even higher. CONCLUSION Serum trace elements dropped significantly soon after the cardiac surgery, but they reached their baseline levels mostly during the first week after the surgery. Future studies are warranted to elucidate the impact of alterations in serum concentration of trace elements on the outcomes and complications of open-heart surgeries.
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Affiliation(s)
- Sadegh Mazaheri-Tehrani
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Ali Haghighatpanah
- Department of Cardiovascular Surgery, Chamran Heart Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Amir Parsa Abhari
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arman Shekarian
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marek Kieliszek
- Department of Food Biotechnology and Microbiology, Institute of Food Sciences, Warsaw University of Life Sciences -SGGW, Nowoursynowska 159C, 02-776 Warsaw, Poland.
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Butz M, Gerriets T, Sammer G, El-Shazly J, Tschernatsch M, Braun T, Meyer R, Schramm P, Doeppner TR, Böning A, Mengden T, Choi YH, Schönburg M, Juenemann M. Twelve-month follow-up effects of cognitive training after heart valve surgery on cognitive functions and health-related quality of life: a randomised clinical trial. Open Heart 2023; 10:e002411. [PMID: 38011994 PMCID: PMC10685926 DOI: 10.1136/openhrt-2023-002411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Postoperative cognitive decline (POCD) or decreased health-related quality of life (HQL) have been reported after cardiac surgery. A previous investigation showed beneficial effects of postoperative cognitive training on POCD and HQL 3 months after heart surgery. Here, we present the 12-month follow-up results. METHODS This bicentric, 1:1 randomised and treatment-as-usual controlled trial included elderly patients scheduled for elective heart valve surgery. The training consisted of paper-and-pencil-based exercises practising multiple cognitive functions for 36 min/day 6 days/week over a period of 3 weeks. Neuropsychological tests and questionnaires assessing HQL (36-Item Short Form Health Survey (SF-36)) and cognitive failures in daily living (Cognitive Failures Questionnaire) were performed presurgery and 12 months after training. RESULTS Twelve months post training, the training group (n=30) showed improvements in HQL compared with the control group (n=28), especially in role limitations due to physical health (U=-2.447, p=0.015, η2=0.109), role limitations due to emotional problems (U=-2.245, p=0.025, η2=0.092), pain (U=-1.979, p=0.049, η2=0.068), average of all SF-36 factors (U=-3.237, p<0.001, η2=0.181), health change from the past year to the present time (U=-2.091, p=0.037, η2=0.075), physical component summary (U=-2.803, p=0.005, η2=0.138), and mental component summary (U=-2.350, p=0.018, η2=0.095). Furthermore, the training group (n=19) showed an improvement compared with the control group (n=27) in visual recognition memory (U=-2.137, p=0.034, η2=0.099). POCD frequency was 22% (n=6) in the control group and 11% (n=2) in the training group (χ²(1) =1.06, p=0.440; OR=2.43, 95% CI 0.43 to 13.61). CONCLUSION In conclusion, postoperative cognitive training shows enhancing effects on HQL in cardiac surgery patients after 12 months.
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Affiliation(s)
- Marius Butz
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Tibo Gerriets
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Gebhard Sammer
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Psychology, University of Giessen, Giessen, Germany
| | - Jasmin El-Shazly
- Department of Psychocardiology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Marlene Tschernatsch
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Tobias Braun
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Rolf Meyer
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Patrick Schramm
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Thomas Mengden
- Department of Rehabilitation, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Markus Schönburg
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Martin Juenemann
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
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10
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Razuk Filho M, dos Santos SL, dos Reis FP, Abdalla LG, Fernades LM, Pêgo-Fernandes PM. Use of Octopus™ Tissue Stabilizer for Minimal Manipulation Approach of Bronchial Anastomosis in Lung Transplant. Braz J Cardiovasc Surg 2023; 38:e20220413. [PMID: 37801400 PMCID: PMC10550104 DOI: 10.21470/1678-9741-2022-0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/16/2023] [Indexed: 10/08/2023] Open
Abstract
Bronchial anastomotic complications are a cause of grave concern for surgeons that perform lung transplantations. There are several risk factors that may lead to this complication, being inadequate surgical technique one of them, specifically regarding adequate exposure and manipulation of the bronchial stump and anastomosis. Here we report the use of Octopus™ Tissue Stabilizer as a mean to allow for a better exposure of the stump and facilitate a "no-touch" approach towards anastomosis. Systematic application of devices that facilitate the employment of the correct surgical techniques can have an effect in reducing the incidence of bronchial anastomotic complications.
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Affiliation(s)
- Mauro Razuk Filho
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Samuel Lucas dos Santos
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Flavio Pola dos Reis
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Luis Gustavo Abdalla
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Lucas Matos Fernades
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
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11
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Apaydin Z, Ozturk S, Kilinc AY, Gurbuz AS, Biter HI, Gumusdag A. Could We Predict POAF With a Simple Ambulatory Oscillometry Evaluating Aortic Stiffness? Braz J Cardiovasc Surg 2023; 38:e20230017. [PMID: 37797089 PMCID: PMC10548832 DOI: 10.21470/1678-9741-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/12/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To investigate the relationship between aortic stiffness and postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). METHODS This study included 110 patients undergoing elective isolated CABG. Aortic stiffness was measured using a noninvasive oscillometric sphygmomanometer before surgery. Characteristics of patients with and without POAF were compared. RESULTS POAF developed in 32 (29.1%) patients. Patients with POAF were older (63.7±8.6 vs. 58.3±8.4; P=0.014). Chronic obstructive pulmonary disease (COPD) was more common in patients with POAF (11.5% vs. 37.5%; P=0.024), whereas the frequency of hypertension, diabetes mellitus, smoking, and previous coronary artery disease did not differ. C-reactive protein and cholesterol levels were similar between patients with and without POAF. Left atrial diameter was greater in patients with POAF (35.9±1.6 vs. 36.7±1.7; P<0.039). Peripheral (p) and central (c) systolic and diastolic blood pressures were also similar between the groups, whereas both p and c pulse pressures (PP) were greater in patients with POAF (pPP: 44.3±11.9 vs. 50.3±11.6; P=0.018, cPP: 31.4±8.1 vs. 36.2±8.9; P=0.008). Pulse wave velocity (PWV) was significantly higher in POAF (8.6+1.3 vs. 9.4+1.3; P=0.006). PWV, pPR and COPD were independent predictors of POAF in multivariate regression analysis. In receiver operating characteristic analysis, PWV and pPP have similar accuracy for predicting POAF (PWV, area under the curve [AUC]: 0.661, 95% confidence interval [CI] [0.547-0.775], P=0.009) (pPP, AUC: 0.656, 95% CI [0.542-0.769], P=0.012). CONCLUSION COPD, PWV, and PP are predictors of POAF. PP and PWV, easily measured in office conditions, might be useful for detecting patients with a higher risk of POAF.
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Affiliation(s)
- Ziya Apaydin
- Department of Cardiology, Haseki Training and Research Hospital,
Istanbul, Turkey
| | - Semi Ozturk
- Department of Cardiology, Istanbul Bakirkoy Dr Sadi Konuk Training
and Research Hospital, Istanbul, Turkey
| | - Ali Yasar Kilinc
- Department of Cardiology, Arnavutkoy State Hospital, Arnavutkoy,
Istanbul, Turkey
| | - Ahmet Seyfeddin Gurbuz
- Department of Cardiology, Meram Faculty of Medicine, Necmettin
Erbakan University, Konya, Turkey
| | - Halil Ibrahim Biter
- Department of Cardiology, Haseki Training and Research Hospital,
Istanbul, Turkey
| | - Ayca Gumusdag
- Department of Cardiology, Haseki Training and Research Hospital,
Istanbul, Turkey
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12
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Almeida MAD, Arcêncio L, Giuliani GB, Poli OB, Rodrigues AJ, Vicente WVDA, Évora PRB. Coronary Artery Bypass Grafting: A Comparative Exercise between Patients from the BYPASS Registry and Patients from a University Hospital. Braz J Cardiovasc Surg 2023; 38:e20220026. [PMID: 37540149 PMCID: PMC10399587 DOI: 10.21470/1678-9741-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION The coronary artery bypass grafting (CABG) data provided by the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS) Registry is a Brazilian reality. OBJECTIVE To carry out a comparative exercise between the BYPASS Registry published data and data from patients operated on in a randomly chosen period (2013-2015) at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). METHODS This is a retrospective study reviewing 173 electronic medical records of CABG patients from the HCFMRP-USP. These data were compared with the BYPASS Registry published data. Chi-square test was used to verify the changes within the prevalence of adequate/inadequate biochemical tests before and after surgery. The sample was divided into groups consistent with cardiopulmonary bypass (CPB) time (CPB ≤ 120 minutes and CPB > 120 minutes). For the complications, prevalence by the chi-square test was adopted. Significant P-values are < 0.05. RESULTS The comparative operative data of the BYPASS Registry and the HCFMRP-USP patients were quite similar, except for the isolate use of only arterial grafts, which was more frequent on HCFMRP-USP patients (30.8% vs. 15.9%), and the use of radial artery, also more frequent on HCFMRP-USP patients (48.8% vs. 1.1%). CONCLUSION The comparative study suggested that the BYPASS Registry should be a reference for CABG quality control.
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Affiliation(s)
- Marcela Accari de Almeida
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Livia Arcêncio
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Gabriel B Giuliani
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Omero Benedicto Poli
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Alfredo José Rodrigues
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Walter Vilella de Andrade Vicente
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Paulo Roberto Barbosa Évora
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, São Paulo, Brazil
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13
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Orlandi BMM, Mejia OAV, Trindade EM, Jatene FB. Financial Impact of Deep Sternal Wound Infections After Coronary Surgery: A Microcosting Analysis. Braz J Cardiovasc Surg 2023; 38:e20220261. [PMID: 37540182 PMCID: PMC10399584 DOI: 10.21470/1678-9741-2022-0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Deep sternal wound infections (DSWI) are so serious and costly that hospital services continue to strive to control and prevent these outcomes. Microcosting is the more accurate approach in economic healthcare evaluation, but there are no studies in this field applying this method to compare DSWI after isolated coronary artery bypass grafting (CABG). This study aims to evaluate the incremental risk-adjusted costs of DSWI on isolated CABG. METHODS This is a retrospective, single-center observational cohort study with a propensity score matching for infected and non-infected patients to compare incremental risk-adjusted costs between groups. Data to homogeneity sample was obtained from a multicentric database, REPLICCAR II, and additional sources of information about costs were achieved with the electronic hospital system (Si3). Inflation variation and dollar quotation in the study period were corrected using the General Market Price Index. Groups were compared using analysis of variance, and multiple linear regression was performed to evaluate the cost drivers related to the event. RESULTS As expected, infections were costly; deep infection increased the costs by 152% and mediastinitis by 188%. Groups differed among hospital stay, exams, medications, and multidisciplinary labor, and hospital stay costs were the most critical cost driver. CONCLUSION In summary, our results demonstrate the incremental costs of a detailed microcosting evaluation of infections on CABG patients in São Paulo, Brazil. Hospital stay was an important cost driver identified, demonstrating the importance of evaluating patients' characteristics and managing risks for a faster, safer, and more effective discharge.
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Affiliation(s)
- Bianca Maria Maglia Orlandi
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Omar Asdrúbal Vilca Mejia
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Service, Hospital Paulistano, São Paulo, São Paulo, Brazil
| | - Evelinda Marramon Trindade
- Rede Paulista de Avaliação de Tecnologias de Saúde, Coordenação de Ciência, Tecnologia e Inovação da Secretaria de Estado da Saúde de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
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14
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Badem S, Yuksel A, Kilic AO, Pekcolaklar A, Binicier NA, Cetintas D, Coskun M, Ozgoz HM, Velioglu Y. Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2023; 38:e20220378. [PMID: 37403893 DOI: 10.21470/1678-9741-2022-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). METHODS A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. RESULTS When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. CONCLUSION Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.
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Affiliation(s)
- Serdar Badem
- Cardiovascular Surgery Department, Bursa City Hospital, Bursa, Turkey
| | - Ahmet Yuksel
- Cardiovascular Surgery Department, Bursa City Hospital, Bursa, Turkey
| | - Ali Onder Kilic
- Cardiovascular Surgery Department, Bursa City Hospital, Bursa, Turkey
| | | | | | - Demir Cetintas
- Cardiovascular Surgery Department, Bursa City Hospital, Bursa, Turkey
| | - Mehmet Coskun
- Cardiovascular Surgery Department, Bursa City Hospital, Bursa, Turkey
| | - Haluk Mevre Ozgoz
- Cardiovascular Surgery Department, Yalova State Hospital, Bursa, Turkey
| | - Yusuf Velioglu
- Cardiovascular Surgery Department, Bursa City Hospital, Bursa, Turkey
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Ozcan S, Dönmez E, Ziyrek M, Mert B, Şahin I, Okuyan E, Özkaynak B. The Predictive Ability of MAGGIC Score After Coronary Artery Bypass Grafting: A Comparative Study. Braz J Cardiovasc Surg 2023; 38:e20220355. [PMID: 37402290 DOI: 10.21470/1678-9741-2022-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II and the Society of Thoracic Surgeons (STS) are validated scoring systems for short-term risk estimation after coronary artery bypass grafting (CABG). The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score is originally aimed to estimate mortality in heart failure patients; however, it has showed a similar power to predict mortality after heart valve surgery. In this study, we sought to evaluate whether MAGGIC score may predict short and long-term mortality after CABG and to compare its power with EuroSCORE II and STS scoring systems. METHODS Patients who underwent CABG due to chronic coronary syndrome at our institution were included in this retrospective study. Follow-up data were used to define the predictive ability of MAGGIC and to compare it with STS and EuroSCORE-II for early, one-year, and up to 10-year mortality. RESULTS MAGGIC, STS, and EuroSCORE-II scores had good prognostic power, moreover MAGGIC was better for predicting 30-day (area under the curve [AUC]: 0.903; 95% confidence interval [CI]: 0.871-0.935), one-year (AUC: 0.931; 95% CI: 0.907-0.955), and 10-year (AUC: 0.923; 95% CI: 0.893-0.954) mortality. MAGGIC was found to be an independent predictor to sustain statistically significant association with mortality in follow-up. CONCLUSION MAGGIC scoring system had a good predictive accuracy for early and long-term mortality in patients undergoing CABG when compared to EuroSCORE-II and STS scores. It requires limited variables for calculation and still yields better prognostic power in determining 30-day, one-year, and up to 10-year mortality.
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Affiliation(s)
- Sevgi Ozcan
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Esra Dönmez
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Murat Ziyrek
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Bülent Mert
- Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Irfan Şahin
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Ertuğrul Okuyan
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Berk Özkaynak
- Department of Cardiovascular Surgery, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
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Magalhães DMS, Deininger MO, Oliveira OGD, Freitas JAD, Deininger EDG. Deep Sternal Wound Infection After Beating Heart Coronary Artery Bypass Surgery with Routine Use of Skeletonized Bilateral Internal Thoracic Artery. Braz J Cardiovasc Surg 2023; 38:e20210607. [PMID: 37402236 DOI: 10.21470/1678-9741-2021-0607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Despite its survival benefits, bilateral internal thoracic artery (BITA) grafting is not commonly utilized due to concerns over deep sternal wound infection (DSWI). We observed the role of routine use of BITA and off-pump coronary artery bypass grafting (OPCABG) in the incidence of DSWI and associated risk factors. METHODS Between January 2010 and December 2020, 1,207 patients were treated with isolated coronary artery bypass grafting. In all cases, OPCABG was attempted, and BITA was used whenever there was a need for a second arterial graft for the left coronary artery. DSWI was defined as a wound infection requiring surgical intervention and/or the administration of antibiotics. Multiple linear regression analysis was employed to model the risk of DSWI. RESULTS The incidence of DSWI was 0.58%. Mortality rate was higher in DSWI group than in no-DSWI group (28.57% vs. 1.25%; P<0.001). No significant difference in DSWI incidence was observed when BITA (70.6%) or single internal thoracic artery (29.4%) were used (P=0.680). The prevalence of diabetes (100% vs. 40.7%; P=0.001), hyperlipidemia (100% vs. 85.9%; P=0.045), and obesity (71.4% vs. 26.8%; P-0.017) was significantly elevated in DSWI group, when compared with no-DSWI group. Diabetes (P=0.0001), unstable angina (P=0.0064), previous myocardial infarction > 30 days (P=0.0009), left ventricular ejection fraction < 50% (P=0.0074), and emergency surgery (P=0.0002) were independent risk factors. CONCLUSION The results of routine use of skeletonized BITA after OPCABG were satisfactory regarding DSWI incidence and operative mortality in a single-center experience.
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Affiliation(s)
- Daniel M S Magalhães
- Hospital Unimed João Pessoa - Alberto Urquiza Wanderley, João Pessoa, Paraíba, Brazil
- Hospital Memorial São Francisco, João Pessoa, Paraíba, Brazil
| | - Maurilio O Deininger
- Hospital Unimed João Pessoa - Alberto Urquiza Wanderley, João Pessoa, Paraíba, Brazil
- Hospital Memorial São Francisco, João Pessoa, Paraíba, Brazil
| | - Orlando Gomes de Oliveira
- Hospital Unimed João Pessoa - Alberto Urquiza Wanderley, João Pessoa, Paraíba, Brazil
- Hospital Memorial São Francisco, João Pessoa, Paraíba, Brazil
| | - John Allexander de Freitas
- Hospital Unimed João Pessoa - Alberto Urquiza Wanderley, João Pessoa, Paraíba, Brazil
- Hospital Memorial São Francisco, João Pessoa, Paraíba, Brazil
| | - Eugênia di Giuseppe Deininger
- Hospital Unimed João Pessoa - Alberto Urquiza Wanderley, João Pessoa, Paraíba, Brazil
- Hospital Memorial São Francisco, João Pessoa, Paraíba, Brazil
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17
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Lotter K, Yadav S, Saxena P, Vangaveti V, John B. Predictors of atrial fibrillation post coronary artery bypass graft surgery: new scoring system. Open Heart 2023; 10:e002284. [PMID: 37316327 DOI: 10.1136/openhrt-2023-002284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) is common and results in significant increases in hospital stay and financial encumbrance. OBJECTIVE Determine and use the predictors of postoperative AF (POAF) following CABG to develop a new predictive screening tool. METHOD A retrospective case-control study evaluated 388 patients (98 developed POAF and 290 remained in sinus rhythm) who undertook CABG surgery at Townsville University Hospital between 2016 and 2017. The demographic profile, risk factors for AF including hypertension, age≥75 years, transient ischaemic attack or stroke, chronic obstructive pulmonary disease (HATCH) score, electrocardiography features and perioperative factors were determined. RESULTS Patients who developed POAF were significantly older. On univariate analysis HATCH score, aortic regurgitation, increased p-wave duration and amplitude in lead II and terminal p-wave amplitude in lead V1 were associated with POAF; as were increased cardiopulmonary bypass time (103.5±33.9 vs 90.6±26.4 min, p=0.001) and increased cross clamp time. On multivariate analysis age (p=0.038), p-wave duration ≥100 ms (p=0.005), HATCH score (p=0.049) and CBP Time ≥100 min (p=0.001) were associated with POAF. Receiver operating characteristic curve demonstrated that with a cut-off of ≥2 for HATCH score, POAF could be predicted with a sensitivity of 72.8% and a specificity of 34.7%. Adding p-wave duration in lead II >100 ms and cardiopulmonary bypass time >100 min to the HATCH score increased the sensitivity to 83.7% with a specificity of 33.1%. This was termed the HATCH-PC score. CONCLUSION Patients with HATCH scores ≥2, and those with p-wave duration >100 ms, or cardiopulmonary bypass time >100 min were at greater risk of developing POAF following CABG.
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Affiliation(s)
- Kian Lotter
- Intensive Care, Townsville Hospital and Health Service, Townsville, Queensland, Australia
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
| | - Sumit Yadav
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
- Cardiothoracic Surgery, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Pankaj Saxena
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
- Cardiothoracic Surgery, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Venkat Vangaveti
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
| | - Bobby John
- James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
- Cardiology, Townsville Hospital and Health Service, Townsville, Queensland, Australia
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18
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Akbayrak H, Tekumit H. Comparison between Vacuum-Assisted Closure Technique and Conventional Approach in Patients with Mediastinitis After Isolated Coronary Artery Bypass Graft Surgery. Braz J Cardiovasc Surg 2023; 38:353-359. [PMID: 36692043 PMCID: PMC10159076 DOI: 10.21470/1678-9741-2022-0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/16/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Median sternotomy is the most preferred approach in heart surgery. Post-sternotomy mediastinitis is a catastrophic and potentially life-threatening complication with an incidence rate of 0.15% to 5%, and its overall mortality rate reaches 47%. In this study, we aimed to compare the results of vacuum-assisted closure technique and the conventional methods on the management of mediastinitis following isolated coronary artery bypass graft surgery. METHODS Between February 2001 and July 2013, 32,106 patients who underwent cardiac operations were evaluated retrospectively. One hundred and fourteen patients who developed post-sternotomy mediastinitis were included in this study. The patients were divided into two groups and compared - vacuum-assisted closure group (n=52, 45.6%) and conventional treatment group (n=62, 54.4%). RESULTS There were no differences between the two groups according to the patients' characteristics, surgical data, and mediastinal cultures. However, we found that total treatment duration for post-sternotomy mediastinitis, time interval from diagnosis to negative culture, hospitalization time, and in-hospital mortality were statistically significantly lower in the vacuum-assisted closure group than in the conventional treatment group (P<0.001, P<0.001, P<0.001, and P=0.03, respectively). CONCLUSION This study demonstrates that the vacuum-assisted closure technique improves the medical outcome of patients with post-sternotomy mediastinitis compared with the conventional treatment. The vacuum-assisted closure is a safe and more effective treatment modality for patients with post-sternotomy mediastinitis after cardiac surgery with reasonable morbidity and mortality.
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Affiliation(s)
- Hakan Akbayrak
- Department of Cardiovascular Surgery, Selçuk University
Faculty of Medicine, Konya, Turkiye
| | - Hayrettin Tekumit
- Department of Cardiovascular Surgery, Bandırma Onyedi Eylul
University Faculty of Medicine, Balıkesir, Turkiye
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Özkara T, Kayğın MA, Ergün S, Limandal HK, Diler MS, Dayı HIÇ, Yıldız Z, Dağ Ö. Myocardial Protection in Isolated Coronary Artery Bypass Grafting: Del Nido versus Blood Cardioplegia. Braz J Cardiovasc Surg 2023; 38:259-264. [PMID: 36459478 PMCID: PMC10069256 DOI: 10.21470/1678-9741-2022-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Our study aimed to examine the impacts of blood cardioplegia (BC) and del Nido cardioplegia (DNC) solutions - which we used in isolated coronary artery bypass grafting (CABG) - on early mortality and major adverse events (MAE). METHODS We retrospectively analyzed 329 consecutive patients who underwent CABG in our clinic between January 2016 and January 2020. Myocardial infarction, reoperation, cardiac tamponade, stroke, renal failure, extracorporeal membrane oxygenation requirement, and cardiopulmonary resuscitation were defined as MAE. The group in which DNC was used was Group D (181 [55%] patients), and the group in which BC was used was Group B (141 [45%] patients). RESULTS No statistically significant difference was determined between the groups regarding age, weight, body surface area, gender, or European System for Cardiac Operative Risk Evaluation score (P=0.615, P=0.560, P=0.934, P=0.365, P=0.955, respectively). Although there was no statistically significant difference between the groups in terms of aortic cross-clamping time (P=0.712), cardiopulmonary bypass duration was longer in Group B (P=0.001). Even though the incidence of stroke was higher in Group B (P=0.030), no statistically significant difference was observed between the groups regarding total incidence of MAE, mortality, mechanical ventilation time, length of stay in the intensive care unit, or length of hospital stay (P=0.153, P=0.130, P=0.689, P=0.710, P=0.613, respectively). CONCLUSION We found no significant difference in MAE, mortality, duration of mechanical ventilation, intensive care unit stay, or hospital stay between the DNC and BC groups. We believe that both solutions can be used safely for cardiac protection in the adult patient population.
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Affiliation(s)
- Taha Özkara
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Mehmet Ali Kayğın
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Servet Ergün
- Department of Pediatric Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Hüsnü Kamil Limandal
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | | | - Hatice Işıl Çüçen Dayı
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Ziya Yıldız
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Özgür Dağ
- Department of Cardiovascular Surgery, Erzurum Regional Education and Research Hospital, Erzurum, Turkey
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Gasperi RD, Bodanese LC, Guaragna JCVDC, Wagner MB, Albuquerque LC. Proposed Risk Score in Patients with Aortic Stenosis Submitted to Valve Replacement Surgery. Braz J Cardiovasc Surg 2023; 38:219-226. [PMID: 36592072 PMCID: PMC10069247 DOI: 10.21470/1678-9741-2022-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Due to Brazilian population aging, prevalence of aortic stenosis, and limited number of scores in literature, it is essential to develop risk scores adapted to our reality and created in the specific context of this disease. METHODS This is an observational historical cohort study with analysis of 802 aortic stenosis patients who underwent valve replacement at Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, from 1996 to 2018. With the aid of logistic regression, a weighted risk score was constructed based on the magnitude of the coeficients β of the logistic equation. Two performance statistics were obtained: area under the receiver operating characteristic curve and the chi-square (χ2) of Hosmer-Lemeshow goodness-of-fit with Pearson's correlation coeficient between the observed events and predicted as a model calibration estimate. RESULTS The risk predictors that composed the score were valve replacement surgery combined with coronary artery bypass grafting, prior renal failure, New York Heart Association class III/IV heart failure, age > 70 years, and ejection fraction < 50%. The receiver operating characteristic curve area was 0.77 (95% confidence interval: 0.72-0.82); regarding the model calibration estimated between observed/predicted mortality, Hosmer-Lemeshow test χ2 = 3,70 (P=0.594) and Pearson's coeficient r = 0.98 (P<0.001). CONCLUSION We propose the creation of a simple score, adapted to the Brazilian reality, with good performance and which can be validated in other institutions.
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Affiliation(s)
- Ricardo de Gasperi
- Department of Interventional Cardiology, Associação Dr. Bartholomeu Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil
| | - Luiz Carlos Bodanese
- Department of Cardiology, Hospital São Lucas, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - João Carlos Vieira da Costa Guaragna
- Department of Cardiology, Hospital São Lucas, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Cardiology, Hospital Divina, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mario Bernardes Wagner
- Department of Postgraduate Program Stricto Sensu in Medicine and Health Sciences, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciano Cabral Albuquerque
- Department of Cardiac Surgery, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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21
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Silva RRE, Goncharov M, Freitas FLD, Mejia OAV. Long-Term Radial Artery Grafts with Previous Midterm Proven Patency. Braz J Cardiovasc Surg 2023; 38:244-247. [PMID: 36692045 PMCID: PMC10069250 DOI: 10.21470/1678-9741-2021-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of coronary artery bypass grafting (CABG). This grafting has led to an increased use of other arterial conduits, of which the radial artery (RA) is the most popular. Whether RA can have the same long-term patency as LITA is controversial. The objective of this study is to access the long-term clinical follow-up and, when available, the patency rate of RA grafts. METHODS Twenty-six patients from a previous study with critical stenosis in all target vessels underwent complete arterial CABG with LITA and RA grafts from 1996 to 2003. They all underwent midterm multidetector computed tomography after surgery with the association of at least one patent LITA and one patent RA graft. RESULTS Twelve patients (46%) are alive with no angina symptoms. Six patients underwent a second image exam 12 to 16 years (average of 14 years) after surgery, with a total of six LITA-LADA and 14 RA grafts with 100% patency rate. Clinical follow-up five to 23 years after surgery (average of 14 years) showed only one death 12 years after surgery related to coronary artery disease (CAD) (3,8%). Another 12 patients died of non-CAD. CONCLUSION Patients with midterm associated LITA and RA patent grafts show similar optimal long-term patency rates of both types of grafts with excellent clinical outcome.
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Affiliation(s)
- Roberto Rocha E Silva
- Department of Cardiovascular Surgery, Instituto do Coração, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Maxim Goncharov
- Department of Cardiovascular Surgery, Instituto do Coração, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabiane Letícia de Freitas
- Department of Cardiovascular Surgery, Instituto do Coração, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Omar Asdrúbal Vilca Mejia
- Department of Cardiovascular Surgery, Instituto do Coração, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Kim JS, Kang Y, Sohn SH, Hwang HY. Comparative effectiveness of clopidogrel versus aspirin as a maintenance monotherapy 1 year after coronary artery bypass grafting. Eur J Cardiothorac Surg 2023; 63:7114037. [PMID: 37039835 DOI: 10.1093/ejcts/ezad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVES Data on the safety and efficacy of clopidogrel monotherapy after coronary artery bypass grafting (CABG) are limited. We compared the clinical outcomes and graft patency rates during four years in CABG patients who maintained clopidogrel or aspirin after one year of dual antiplatelet therapy (DAPT) use. METHODS A total of 671 patients who maintained 1-year DAPT after CABG with all grafts patent on one-year follow-up angiography and switched to single antiplatelet therapy (SAPT) using clopidogrel (n = 272) or aspirin (n = 399) between January 2009 and December 2015 were enrolled. Propensity score matching (PSM) analysis was used, and 227 pairs were matched in a 1:1 ratio. Overall mortality, cardiac mortality, and major adverse events (MAE), including all-cause mortality, acute myocardial infarction, coronary reintervention or reoperation, ischaemic stroke, and major bleeding, were compared. Graft patency was evaluated using graft angiography five years post-surgery. RESULTS Overall survival and the incidence of MAEs during the 4-year follow-up did not differ significantly between the groups when un-matched (hazard ratio [HR], 95% confidence interval [CI]=1.24, 0.71 to 2.15, P = 0.46 and HR, 95% CI = 1.22, 0.77 to 1.92, P = 0.41, respectively) or matched (HR, 95% CI = 1.05, 0.55 to 2.01, P = 0.89 and HR, 95% CI = 1.01, 0.60 to 1.73, P = 0.96, respectively). In the postoperative 5-year graft angiography, new graft occlusion was found in 3.2% and 4.7% of patients and newly occurred graft occlusion rates of distal anastomoses were 1.2% and 1.6% in the clopidogrel and aspirin groups, respectively, and were not statistically different between the two groups (P = 0.39 and 0.63, respectively). Changes of antiplatelet regimen were needed in 22.8% (91 of 399) of aspirin group and in 2.2% (6 of 272) of clopidogrel group from the initiation of SAPT (P < 0.001). CONCLUSIONS In this series of patients undergoing CABG who received DAPT and remained stable for 1 year, SAPT maintenance with clopidogrel or aspirin did not show any significant differences in 4-year outcomes such as all-cause mortality, major adverse events, and newly occurring graft occlusion. However, more patients taking aspirin required changes in antiplatelet regimens to other antiplatelet or anticoagulation therapies.
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Affiliation(s)
- Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Cui X, Xu C, Chen C, Su Y, Li J, He X, Wang D. New-Onset Post-Operative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting Surgery - A Retrospective Case-Control Study. Braz J Cardiovasc Surg 2023; 38:149-156. [PMID: 35436075 PMCID: PMC10010719 DOI: 10.21470/1678-9741-2021-0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION New-onset postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting (CABG) surgery. OBJECTIVE To explore predictive factors and potential mechanisms of new-onset POAF in isolated off-pump CABG patients. METHODS Retrospective observational case-control study of 233 patients undergoing isolated off-pump CABG surgery between August 2018 and July 2020 at the Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School. Associations between predictor variables and new-onset POAF were identified. The main outcome was new-onset POAF after CABG surgery. RESULTS A total of 75 (32.19%) patients developed new-onset POAF after CABG surgery. The new-onset POAF patients had advanced age, higher baseline systolic blood pressure, more preoperative use of diuretic drug, more transfusion of blood products, atrial dilation and postoperative positive inotropic drug treatment. Nineteen variates entered the multivariable logistic regression model with a Hosmer-Lemeshow test score of 7.565 (P=0.477). Postoperative left atrial enlargement, postoperative drainage in the first 24 hours and total length of hospital stay were statistically significant, while postoperative right atrial enlargement (OR and 95% CI, 7.797 [0.200, 304.294], P=0.272) and left atrial enlargement (3.524 [1.141, 10.886], P=0.029) assessed by echocardiography had the largest OR value. CONCLUSION Atrial enlargement is strongly associated with new-onset POAF in patients with isolated off-pump CABG, thus it highlights the advantage of echocardiography as a useful tool for predicting new-onset POAF. Careful monitoring and timely intervention should be considered for these patients.
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Affiliation(s)
- Xuehui Cui
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Can Xu
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Cheng Chen
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yunyan Su
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Li
- Department of Cardiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaojun He
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shangai, China
| | - Dongjin Wang
- Department of Thoracic and Cardiovascular Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Yilmaz Y, Kelesoglu S, Elcik D, Ozmen R, Kalay N. Predictive Values of Systemic Immune-Inflammation Index in New-Onset Atrial Fibrillation Following Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2023; 38:96-103. [PMID: 35657307 PMCID: PMC10010712 DOI: 10.21470/1678-9741-2021-0278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We investigated the relationship between the newly-defined systemic immune-inflammation index and the new-onset atrial fibrillation in patients undergoing coronary artery bypass grafting. METHOD This study included 392 patients who underwent coronary artery bypass grafting. We divided the participants into two groups as those with and without new-onset atrial fibrillation. Prior to coronary artery bypass grafting, we evaluated blood samples, including systemic immune-inflammation index, and other laboratory parameters of the patients. We formulized the systemic immune-inflammation index score as platelet × neutrophil/lymphocyte counts. RESULTS The findings revealed that new-onset atrial fibrillation occurred in 80 (20.4%) of 392 patients during follow-ups. Such patients had higher systemic immune-inflammation index, neutrophil/lymphocyte ratio, and C-reactive protein levels than those who did not develop new-onset atrial fibrillation (P<0.001, P<0.001, P=0.010, respectively). In receiver operating characteristic curve analysis, systemic immune-inflammation index levels > 712.8 predicted new-onset atrial fibrillation with a sensitivity of 85% and a specificity of 61.2% (area under the curve: 0.781, 95% confidence interval: 0.727-0.835; P<0.001). CONCLUSION Overall, systemic immune-inflammation index, a novel inflammatory marker, may be used as a decisive marker to predict the development of atrial fibrillation following coronary artery bypass grafting.
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Affiliation(s)
- Yucel Yilmaz
- Department of Cardiology, Ministry of Health, Kayseri City Hospital, Kayseri, Turkey
| | - Saban Kelesoglu
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Deniz Elcik
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Rifat Ozmen
- Department of Cardiovascular Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Nihat Kalay
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Fan J, Luo SL, Pan YC, Wu TY, Chen Y, Li WJ. The Effect of Female Sex on Short-Term Outcomes of Patients Undergoing Off-Pump Versus On-Pump Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2023; 38:110-123. [PMID: 35895983 PMCID: PMC10010711 DOI: 10.21470/1678-9741-2021-0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION According to the American Heart Association guideline for coronary artery bypass grafting (CABG), female patients undergoing on-pump CABG (ONCAB) are at higher risk of short-term adverse outcomes than male patients. However, whether off-pump CABG (OPCAB) can improve the short-term outcome of female patients compared to ONCAB remains unclear. METHODS We conducted a meta-analysis to study the effect of the female sex on short-term outcomes of OPCAB vs. ONCAB. A total of 31,115 patients were enrolled in 12 studies, including 20,245 females who underwent ONCAB and 10,910 females who underwent OPCAB. RESULTS The in-hospital mortality in female patients who underwent OPCAB was significantly lower than in those in the ONCAB group with (2.7% vs. 3.4%; odds ratio [OR] 0.76; 95% confidence interval [CI] 0.65-0.89) and without (OR 0.68; 95% CI 0.52-0.89) adjustment for cardiovascular risk factor. The incidence of postoperative stroke in female patients who underwent OPCAB was lower than in those in the ONCAB group (1.2% vs. 2.1%; OR 0.59; 95% CI 0.48-0.73) before cardiovascular risk factor adjustment but was not significant (OR 0.87; 95% CI 0,66-1.16) after adjustment. There was no significant difference in the incidence of postoperative myocardial infarction between women who underwent OPCAB and those in the ONCAB group (1.3% vs. 2.3%; OR 0.88; 95% CI 0.54-1.43). CONCLUSION In contrast to the American Heart Association CABG guideline, female patients who had OPCAB don't have unfavorable outcomes compared with the ONCAB group.
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Affiliation(s)
- Jun Fan
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Shao-Ling Luo
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Yi-Chao Pan
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Tian-Yuan Wu
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Yu Chen
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Wei-Jie Li
- Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
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Salihi S, Erkengel Hİ, Saçlı H, Kara İ. The Effectiveness of Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction. Braz J Cardiovasc Surg 2023; 38:132-138. [PMID: 35675492 PMCID: PMC10010734 DOI: 10.21470/1678-9741-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction (LVD) remains a surgical challenge and is still controversial. The aim of this study was to evaluate the effectiveness of CABG in patients with LVD. METHODS This retrospective study included a total of 160 consecutive patients (133 males, 27 females, mean age 62.1±10.12 years [range 37 to 86 years]) who had a left ventricular ejection fraction (LVEF) ≤ 45% determined by echocardiography and underwent elective isolated CABG between September 2013 and December 2018. Preoperative echocardiographic data, such as ejection fraction, left ventricular (LV) end-systolic diameter, and LV end-diastolic diameter, were collected and evaluated. Preoperatively, 85 (53.13%) patients were in New York Heart Association functional class III or IV and the mean LVEF was 38.65±5.72% (range 20 to 45). RESULTS The overall hospital mortality was 5% (eight patients). Late follow-up was obtained in 152 (90%) cases (median follow-up time was 56,5 [3-87] months postoperatively). During follow-up, mortality developed in 11.3% (16 patients). Mean LVEF increased significantly from 38.78±5.59% before surgery to 43.29±8.46% after surgery (P<0.01). Mean late survival, freedom from coronary reintervention, and congestive heart failure rates were 86.3±3.3%, 88.7±3.9%, and 89.4±3.1%, respectively. CONCLUSION In patients with LVD, CABG can be performed with low postoperative morbidity and mortality rates. Patients with LVD could benefit from coronary bypass surgery regarding postoperative LV systolic function and higher quality of life.
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Affiliation(s)
- Salih Salihi
- Department of Cardiovascular Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
| | - Halil İbrahim Erkengel
- Department of Cardiovascular Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
| | - Hakan Saçlı
- Department of Cardiovascular Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
| | - İbrahim Kara
- Department of Cardiovascular Surgery, Sakarya University, Faculty of Medicine, Sakarya, Turkey
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Dayani A, Faritous SZ, Amniati S, Bakhshande H, Zamani A, Ghanbari M. Anesthesia Management for the Patient with Chronic Decompensated Heart Failure and Low Cardiac Output Undergoing CABG with Advanced Cardiac Monitoring: A Case Report. Anesth Pain Med 2023; 13:e133796. [PMID: 37404260 PMCID: PMC10317024 DOI: 10.5812/aapm-133796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 07/06/2023] Open
Abstract
Introduction Heart failure (HF) is a complex clinical syndrome caused by a structural or functional heart disorder. One of the most important challenges for anesthesiologists is the management of anesthesia in patients with severe heart failure, which has been facilitated by advanced monitoring systems. Case Presentation The patient was a 42-year-old man with a history of hypertension (HTN) and HF with involvement of the three coronary arteries (3VD) with ejection fraction (EF) 15%. He was also a candidate for elective CABG. In addition to the insertion of arterial line in the left radial artery and the Swan-Ganz catheter in the pulmonary artery, the patient was also monitored by the Edwards Lifesciences Vigilance II for cardiac index (CI) and intravenous mixed blood oxygenation (ScvO2). Hemodynamic changes during and after surgery, as well as during inotrope infusion, were controlled, and the amount of fluid therapy was calculated by gold direct therapy (GDT) method. Conclusions Using PA catheter with advanced monitoring and GDT-based fluid therapy guaranteed a safe anesthesia in this patient with severe heart failure and EF < 20%. Moreover, the postoperative complications and duration of ICU stays were significantly reduced.
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Affiliation(s)
- Abdolreza Dayani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Zahra Faritous
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saied Amniati
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshande
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Afarin Zamani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghanbari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Lin RZ, Gallagher C, Tu SJ, Pitman BM, Nelson AJ, Roberts-Thomson RL, Worthley MI, Lau DH, Sanders P, Wong CX. Trends in myocardial infarction and coronary revascularisation procedures in Australia, 1993-2017. Heart 2023; 109:283-288. [PMID: 36344268 DOI: 10.1136/heartjnl-2022-321393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Prior data have shown rising acute myocardial infarction (MI) trends in Australia; whether these increases have continued in recent years is not known. This study thus sought to characterise contemporary nationwide trends in MI hospitalisations and coronary procedures in Australia and their associated economic burden. METHODS The primary outcome measure was the incidence and time trends of total MI, ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) hospitalisations from 1993 to 2017. The incidence and time trends of coronary procedures were additionally collected, alongside MI hospitalisation costs. RESULTS Adjusted for population changes, annual MI incidence increased from 216.2 cases per 100 000 to a peak of 270.4 in 2007 with subsequent decline to 218.7 in 2017. Similarly, NSTEMI incidence increased from 68.0 cases per 100 000 in 1993 to a peak of 192.6 in 2007 with subsequent decline to 162.6 in 2017. STEMI incidence decreased from 148.3 cases per 100 000 in 1993 to 56.2 in 2017. Across the study period, there were annual increases in MI hospitalisations of 0.7% and NSTEMI hospitalisations of 5.6%, and an annual decrease in STEMI hospitalisations of 4.8%. Angiography and percutaneous coronary intervention increased by 3.4% and 3.3% annually, respectively, while coronary artery bypass graft surgery declined by 2.2% annually. MI hospitalisation costs increased by 100% over the study period, despite a decreased average length of stay by 45%. CONCLUSIONS The rising incidence of MI hospitalisations appear to have stabilised in Australia. Despite this, associated healthcare expenditure remains significant, suggesting a need for continual implementation of public health policies and preventative strategies.
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Affiliation(s)
- Richard Z Lin
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Celine Gallagher
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Samuel J Tu
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Bradley M Pitman
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Adam J Nelson
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Ross L Roberts-Thomson
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I Worthley
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
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Zotov A, Borisov D, Troitskiy A, Khabazov R. Novel Technique for Box-Lesion Ablation of Atrial Fibrillation Combined with Off-Pump Coronary Surgery. Braz J Cardiovasc Surg 2023; 38:326-330. [PMID: 36692049 PMCID: PMC10159072 DOI: 10.21470/1678-9741-2022-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION We propose a new technique for box-lesion ablation combined with off-pump coronary artery bypass grafting for the treatment of patients with coronary artery disease and paroxysmal or persistent atrial fibrillation. METHODS Eight male patients with paroxysmal (n=2) or persistent atrial fibrillation (n=6) and coronary artery disease underwent box-lesion ablation combined with off-pump coronary artery bypass grafting. Box-lesion ablation was performed using a bipolar flexible clamping device with irrigated electrodes which was originally designed for thoracoscopic epicardial ablation. RESULTS Complete revascularization was performed in all patients. There were no deaths or major complications. At a median follow-up of 14 months, seven patients (87.5%) were in sinus rhythm. CONCLUSION Box-lesion ablation can be easily and effectively combined with coronary artery surgery in an off-pump setting.
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Affiliation(s)
- Aleksandr Zotov
- Department of Cardiac Surgery, Federal Research Clinical Centre, Moscow, Russia
| | - Daniil Borisov
- Adult Congenital Heart Disease Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aleksandr Troitskiy
- Department of Cardiac Surgery, Federal Research Clinical Centre, Moscow, Russia
| | - Robert Khabazov
- Department of Cardiac Surgery, Federal Research Clinical Centre, Moscow, Russia
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Vásquez Loarte T, Piña Reyna Y, Peña Duque M, Ortiz Zegarra CA. [The SYNTAX Revascularization Index and major cardiovascular events in patients with multivessel coronary artery disease in the Instituto Nacional de Cardiología Ignacio Chávez - Mexico]. Arch Peru Cardiol Cir Cardiovasc 2023; 4:7-12. [PMID: 37583449 PMCID: PMC10424548 DOI: 10.47487/apcyccv.v4i1.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/29/2023] [Indexed: 08/17/2023]
Abstract
Objective To evaluate the degree of incomplete revascularization in patients with multiarterial coronary artery disease who underwent percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) using the Syntax revascularization index (SRI) and its relationship to major cardiovascular events during follow-up. Materials and Methods Observational, retrospective study with 4-year follow-up of patients with multiarterial coronary artery disease who underwent surgical or percutaneous coronary revascularization, in whom the baseline Syntax score (SSb) and the residual Syntax score (SSr) were calculated. The Syntax Revascularization Index (SRI) was determined with the following formula: SRI = (1- [SSr/SSb]) x 100, and major cardiovascular events at 4-year follow-up were compared. Results Two hundred patients (100 in each group) were evaluated. Mean SSr in group 1 was 83.2%, and in group 2, 79.0% (p=0.88). Mean complete revascularization was 41% in the first group and 35% in the second. A cutoff point of ≤90% of IRS had the best accuracy for predicting major cardiovascular events (area under the curve of 0.60; 95% CI: 0.49-0.71, p<0.05). In multivariate analysis IRS was an independent predictor of major cardiovascular events (HR 2.6; 95%CI: 1.32-3.22, p= 0.043). Conclusions The Syntax Revascularization Index may be useful for measuring the degree of revascularization in patients with multiarterial coronary artery disease treated percutaneously or surgically. An SRI ³90% may be an acceptable target for revascularization.
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Affiliation(s)
- Tania Vásquez Loarte
- Universidad de San Martín de Porras, Lima, Perú. Universidad de San Martín de Porres Universidad de San Martín de Porras Lima Peru
| | - Yigal Piña Reyna
- Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México. Instituto Nacional de Cardiología «Ignacio Chávez Ciudad de México México
| | - Marco Peña Duque
- Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México. Instituto Nacional de Cardiología «Ignacio Chávez Ciudad de México México
| | - César Antonio Ortiz Zegarra
- Instituto Nacional Cardiovascular INCOR. EsSalud, Lima, Perú. Instituto Nacional Cardiovascular INCOR. EsSalud Lima Perú
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31
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Jung RG, Abdel-Razek O, Di Santo P, Gillmore T, Stotts C, Makwana D, Soriano J, Moreland R, Verreault-Julien L, Goh CY, Parlow S, Sypkes C, Ramirez DF, Sadek M, Chan V, Toeg H, Simard T, Froeschl MPV, Labinaz M, Hibbert B. Impact of atrial fibrillation on the risk of major adverse cardiac events following coronary revascularisation. Open Heart 2022; 9:openhrt-2022-002012. [PMID: 36150746 PMCID: PMC9511650 DOI: 10.1136/openhrt-2022-002012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/05/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) remains a highly prevalent arrhythmia with significant burden on morbidity and mortality. The impact of AF in the revascularised population remains incompletely described. Given the high prevalence of AF in the revascularised population, we sought to evaluate the incidence and prognosis in patients with pre-existing and new-onset AF following revascularisation. METHODS We used the University of Ottawa Heart Institute Revascularisation Registry to identify patients who underwent revascularisation between August 2015 and March 2020, who were prospectively followed for an average of one year. We conducted a retrospective cohort study analysing the association between AF and clinical outcomes. The primary outcome of interest was 1-year major adverse cardiac events (MACE) defined as a composite of death, myocardial infarction, unplanned revascularisation and cerebrovascular accidents. Moreover, secondary outcomes include the individual components of MACE and bleeding. RESULTS A total of 6704 patients underwent revascularisation and completed 1-year clinical follow-up. Median time to follow-up was 12.8 (IQR 11.2-15.9) months. One-year MACE occurred in 166 (21.8%) and 683 (11.5%) patients in AF and non-AF groups, respectively (adjusted HR, 1.61; 95% CI 1.29 to 2.01; p<0.0001). AF was independently predictive of 1-year mortality, myocardial infarction, unplanned revascularisation, cerebrovascular accident and bleeding. Within 1 year, 299 (4.5%) episodes of new-onset AF was observed. New-onset AF following revascularisation was also associated with 1-year MACE, mortality, myocardial infarction, cerebrovascular accident and unplanned revascularisation. CONCLUSIONS Preprocedural and new-onset AF following revascularisation remains highly predictive 1-year MACE. AF should be considered in addition to traditional risk factors for adverse outcomes following revascularisation.
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Affiliation(s)
- Richard G Jung
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | | | | | - Robert Moreland
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Cheng Yee Goh
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Daniel F Ramirez
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mouhannad Sadek
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vincent Chan
- Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hadi Toeg
- Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Michael P V Froeschl
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Mirmohammadsadeghi A, Afzali Arani M, Zavar R. Comparison of the effect of 1:1 and 1:2 frequencies of intra-aortic balloon pump on hemodynamics of the patients undergoing coronary artery bypass graft surgery. ARYA Atheroscler 2022; 18:1-4. [PMID: 36817346 PMCID: PMC9937668 DOI: 10.48305/arya.v18i0.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/08/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Some patients require intra-aortic balloon pump (IABP) after coronary artery bypass graft (CABG) surgery. IABP can be adjusted to different frequencies such as 1:1, 1:2, or 1:3. In this study, we tried to compare the effect of 1:1 and 1:2 frequencies of IABP on hemodynamic status of the patients after CABG surgery. METHODS In this experimental study, all patients using IABP after CABG surgery were entered the study as pretest and posttest groups. The study could not be blinded because of the clearness of posttest group for the same echocardiographist. The pretest group included patients using a 1:1 frequency of IABP device. The posttest group included patients in the pretest group who were exposed to a 1:2 frequency for 20 minutes. In both groups, on the moderate dose of inotropic support, hemodynamic parameters of patients including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume (SV), and velocity time integral (VTI) in the aorta during systole were measured. Both groups were compared using Wilcoxon signed rank test. SPSS software was used for analysis and P < 0.05 was considered to be statistically significant. RESULTS Twelve patients were entered into the study. Three patients were excluded because of open chest and instability of vital signs. Nine patients completed the study. 3 patients were men and 6 were women. The mean age was 58.32 ± 13.18 years. MAP in 1:1 frequency was significantly higher than 1:2 (P = 0.043); however, there was no significant difference between 1:1 and 1:2 in other hemodynamic parameters, namely CO, CI, SV, HR, and VTI. CONCLUSION In patients on moderate dose of inotropes, IABP frequencies of 1:1 and 1:2 have the same effect on hemodynamic parameters such as CI, SBP, DBP, HR, and left ventricular outflow tract (LVOT) VTI; meanwhile, MAP remains higher in 1:1 frequency.
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Affiliation(s)
- Amir Mirmohammadsadeghi
- Department of Cardiovascular Surgery, Chamran Cardiovascular and Medical Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Amir Mirmohammadsadeghi; Department of Cardiovascular Surgery, Chamran Hospital, School of
Medicine, Isfahan University of Medical Sciences, Isfahan, Iran;
| | - Moniresadat Afzali Arani
- Department of Cardiovascular Surgery, Chamran Cardiovascular and Medical Research Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reihaneh Zavar
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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33
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Gunn J, Morris PD. Revascularisation for the proximal left anterior descending artery: special case or part of the package? Heart 2022; 108:1754-1755. [PMID: 35768190 DOI: 10.1136/heartjnl-2022-321218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Julian Gunn
- Department of Infection, Immunity and Cardiovascular Disease, Sheffield Teaching Hospitals and University of Sheffield, Sheffield, UK
| | - Paul D Morris
- Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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34
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Ono M, Hara H, Gao C, Kawashima H, Wang R, O'Leary N, Wykrzykowska JJ, Piek JJ, Mack MJ, Holmes D, Morice MC, Head S, Kappetein AP, Noack T, Davierwala PM, Mohr FW, Garg S, Onuma Y, Serruys PW. Mortality after multivessel revascularisation involving the proximal left anterior descending artery. Heart 2022; 108:1784-1791. [PMID: 35732441 PMCID: PMC9626917 DOI: 10.1136/heartjnl-2022-320934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
Objective We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD). Methods This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed. Results Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality. Conclusions Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG. Trial registration number SYNTAXES: NCT03417050; SYNTAX: NCT00114972.
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Affiliation(s)
- Masafumi Ono
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Hironori Hara
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.,Department of Cardiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Rutao Wang
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland.,Department of Cardiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Neil O'Leary
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Joanna J Wykrzykowska
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jan J Piek
- Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - David Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stuart Head
- Department of Cardiothoracic Surgery, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Thilo Noack
- University Department of Cardiac Surgery, Leipzig Heart Center University Hospital, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Leipzig Heart Center University Hospital, Leipzig, Germany.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Friedrich W Mohr
- University Department of Cardiac Surgery, Leipzig Heart Center University Hospital, Leipzig, Germany
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
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Cardoso LF, Dias RR, Demarchi LMMF, Silveira LMVD, Mady C, Jatene FB. Nonatherosclerotic Giant Right Coronary Artery Aneurysm. Braz J Cardiovasc Surg 2022; 37:271-272. [PMID: 35503700 PMCID: PMC9054151 DOI: 10.21470/1678-9741-2020-0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present an unusual case of a 67-year-old woman with an incidental finding of a cardiac mass on a chest computed tomography. Coronary angiotomography confirmed the diagnosis of right coronary artery aneurysm, with 5.7×5.7 cm. The patient underwent aneurysm resection and coronary bypass surgery, with subsequent histologic study suggestive of arteritis sequelae. Giant coronary artery aneurysms have a high risk of complications and aneurysm exclusion must be beneficial. This is a rare condition that can also be part of a systemic inflammatory disease.
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Affiliation(s)
- Lucas Figueredo Cardoso
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ricardo Ribeiro Dias
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lea Maria Macruz Ferreira Demarchi
- Laboratory of Anatomic Pathology, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Lucas Molinari Veloso da Silveira
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Charles Mady
- Department of Cardiology, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Stanisz-Kempa J, Gąsior Z, Kułach A. Proadrenomedullin in Patients with Preserved Left Ventricular Systolic Function Undergoing Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2022; 37:219-226. [PMID: 35522058 PMCID: PMC9054142 DOI: 10.21470/1678-9741-2020-0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction A potentially new marker of cardiovascular diseases — proadrenomedullin is the precursor of adrenomedullin, which is a multifunctional peptide hormone, produced in most of the tissues in response to cellular stress, ischemia, and hypoxia. Methods Ninety-three people, aged 51-79 years, were included in the study. Exclusion criteria were severe or corrected valvular disease, acute coronary syndrome, age ≥ 80 years, glomerular filtration rate < 45 ml/min, active infectious diseases, and cancer. The subjects were observed for adverse events, including reduced left ventricular ejection fraction (LVEF) by ≥ 10%, first incidence of atrial fibrillation (AF), and the necessity of using dopamine during hospitalization. Results Use of pressure amines, occurrence of the first AF episode, and left ventricular dysfunction defined by a decrease in LVEF by at least 10% compared to the value before surgery were reported in the perioperative period. No death, sudden cardiac arrest with effective resuscitation, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, or heart failure were observed. Significantly higher proadrenomedullin concentration was observed in the group with reduced postoperative LVEF (1.68 vs. 0.77 nmol/l, P=0.005). The relative risk of a decrease in ejection fraction in the group of patients with proadrenomedullin concentration ≥ 0.77 nmol/l was more than twelve-fold higher (95% confidence interval 1.69-888.33; P=0.013) than in the group of patients with a concentration of proadrenomedullin < 0.77 nmol/l. Conclusion The higher baseline concentration of proadrenomedullin has a predominantly predictive value of postoperative left ventricular systolic dysfunction.
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Affiliation(s)
| | - Zbigniew Gąsior
- 2nd Department of Cardiology, Upper Silesian Medical Center, Katowice, Poland
| | - Andrzej Kułach
- 2nd Department of Cardiology, Upper Silesian Medical Center, Katowice, Poland
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37
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Al-Lamee R, Aubiniere-Robb L, Berry C. The British Cardiovascular Society and clinical studies in ischaemic heart disease: from RITA to ORBITA, and beyond. Heart 2022; 108:800-806. [PMID: 35459731 DOI: 10.1136/heartjnl-2021-320150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/28/2022] [Indexed: 01/10/2023]
Abstract
In this article, we provide a historical view of key aspects of British Cardiovascular Society (BCS) influence in clinical trials of ischaemic heart disease (IHD) followed by key research and developments, notable publications and future perspectives. We discuss the role of the BCS and its members. The scope of this article covers clinical trials in stable IHD and acute coronary syndromes, including interventions relating to diagnosis, treatment and management. We discuss the role of the BCS in supporting the original RITA trials. We highlight the changing face of angina and its management providing contemporary and future insights into microvascular disease, ischaemic symptoms with no obstructive coronary arteries and, relatedly, myocardial infarction with no obstructive coronary arteries. The article is presented as a brief overview of the BCS in IHD research, relationships with stakeholders, patient and public involvement and clinical trials from the perspective of past, present and future possibilities.
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Affiliation(s)
- Rasha Al-Lamee
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Cardiology, Golden Jubilee National Hospital, Clydebank, UK
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38
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Edin V, Geijer H, Jakuszewski P, Souza D. A Case of Using No-Touch Saphenous Vein Graft in Redo CABG after Multiple Failed Percutaneous Coronary Interventions. Braz J Cardiovasc Surg 2022; 37:135-138. [PMID: 35274524 PMCID: PMC8973143 DOI: 10.21470/1678-9741-2021-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The modality of repeat revascularization due to late graft failure is a debated topic. The latest available European guidelines recommend redo coronary artery bypass graft (CABG) for cases of extensively diseased and/or occluded grafts and those with diffuse native vessel disease. We present the case of a patient being relieved of recurrent unstable angina pectoris with redo CABG using no-touch saphenous vein grafts after repeated and unsuccessful attempts with percutaneous coronary intervention (PCI). This could be an alternative to PCI in patients with a complex medical history. Teamwork between cardiologists and surgeons is pivotal in deciding the best treatment modality.
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Affiliation(s)
- Victor Edin
- Department of Vascular and Cardiothoracic Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Håkan Geijer
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Piotr Jakuszewski
- Department of Nephrology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Domingos Souza
- Department of Vascular and Cardiothoracic Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Güney MR, Güler E, Albay E, Kehlibar T, Yilmaz M, Ketenci B. Coexisting Coronary and Carotid Artery Disease: What We Did, What Happened. Braz J Cardiovasc Surg 2022; 37:648-653. [PMID: 35244376 DOI: 10.21470/1678-9741-2021-0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade. METHODS Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data. RESULTS In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004). CONCLUSION Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, "most threatened organ priority'' was considered as clinical parameter.
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Affiliation(s)
- Mehmet Raşit Güney
- Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Erhan Güler
- Department of Cardiovascular Surgery, Cleveland Clinic Miller Family Heart and Vascular Institute, Cleveland, Ohio, United States of America
| | - Erkan Albay
- 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
| | - Mehmet Yilmaz
- Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Bülend Ketenci
- Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Jan A, Hayat MK, Khan MAA, Ullah R. Trends in per-operative parameters and postoperative complications associated with coronary artery bypass graft surgery (CABG); A four-year retrospective study. Pak J Med Sci 2021; 37:1734-1739. [PMID: 34912387 PMCID: PMC8613026 DOI: 10.12669/pjms.37.7.4315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the patterns of per-operative parameters and early outcomes of patients that underwent CABG surgery during a four-year period. Methods: This is a cross-sectional descriptive study conducted in a tertiary care of hospital from November 2020 to January 2021. All the patients that underwent the isolated coronary artery bypass grafting (CABG) procedure were included in the study from June 2017 till June 2020. Data was collected on a data extraction form and stored in SPSS format which was analyzed for qualitative statistics keeping p<0.05 as significant. All the results were represented in the form of tables. Results: A total of 1,613 patients were operated upon for Coronary Artery Bypass Grafting (CABG) procedure during the study period with 1,222 (75.8%) males and 391 (24.2%) females. Dyslipidemia (71.8%) was the most common risk factor. The average perfusion time decreased only slightly (~1 minute) from 96.01 minutes to 95.07 minutes (2017 to 2020). This change however was not significant (p=0.301). The rate of Left Internal Mammary Artery (LIMA) use stayed relatively stable over the 4-year period fluctuating between 88.7% and 92.9% (p=0.360). The average initial ICU stay (in hours), drain at 12 hours and 24 hours stays almost the same. The rate of mortality peaked in 2018 (4.76%) and subsequently fell to 3.57% by 2020. Conclusion: More males underwent CABG surgery at this tertiary care hospital and the overall complication rate and per-operative parameters improved over the years. The non-risk stratified mortality in this study was found to be higher than developed nations.
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Affiliation(s)
- Azam Jan
- Dr. Azam Jan, MD, Diplomate American Board of General Surgery (USA), Diplomate American Board of Thoracic (Cardiothoracic) Surgery (USA) Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Khizar Hayat
- Dr. Muhammad Khizar Hayat, MBBS Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mohammad Ahmed Arsalan Khan
- Dr. Mohammad Ahmed Arsalan Khan, MBBS Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Rafi Ullah
- Dr. Rafi Ullah, MD. Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
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Emami-Sigaroudi A, Salari A, Nourisaeed A, Ahmadnia Z, Ashouri A, Modallalkar SS, Javadzadeh-Moghtader A, Parvinroo S, Dadkhah-Tirani H. Comparison between the effect of aromatherapy with lavender and damask rose on sleep quality in patients undergoing coronary artery bypass graft surgery: A randomized clinical trial. ARYA Atheroscler 2021; 17:1-9. [PMID: 34703485 PMCID: PMC8519621 DOI: 10.22122/arya.v17i0.2064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 06/10/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Numerous studies have investigated the effect of lavender and damask rose aromatherapy on sleep quality. There is, however, little research to compare the impact of them over each other. The aim of current study was to compare the effect of aromatherapy with lavender and damask rose on sleep quality in patients after coronary artery bypass graft (CABG) surgery in Guilan Province, Iran, in 2017-2018. METHODS In this randomized clinical trial (RCT) study, 97 patients undergoing CABG were randomly assigned to intervention or control groups. In the intervention groups, the patients were asked by the researcher to inhale the lavender or damask rose randomly every night for 5 consecutive nights at 22:00. The control group received routine nursing care in compliance with the hospital procedure. Data were obtained by demographic-clinical and Beck Depression Inventory (BDI) questionnaires. To analyze the data, chi-square test, t-test, Kruskal-Wallis test, and Wilcoxon test were used. RESULTS During the 5-night intervention period, despite a relative improvement of sleep quality in intervention groups compared to the control group, none of the two aromatherapies had a statistically significant effect on any of delayed sleep (P = 0.514), sleep duration (P = 0.839), sleep efficiency (P = 0.067), sleep disturbances (P = 0.061), and daily functional disorders (P = 0.114) except for subjective sleep quality (P = 0.016) and use of sleep medications (P = 0.031). CONCLUSION Using both aromatherapies with lavender and damask rose indicated positive effects on sleep quality of the CABG patients, but we could not find a superiority over each other.
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Affiliation(s)
- Abdolhossien Emami-Sigaroudi
- Associate Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Azam Nourisaeed
- PhD Candidate, Cardiovascular Diseases Research Center AND Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Ahmadnia
- Cardiovascular Diseases Research Center AND Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Asieh Ashouri
- Assistant Professor, Research Center of Health and Environment AND Department of Health Education and Promotion, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyede Shiva Modallalkar
- Cardiovascular Diseases Research Center AND Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arezoo Javadzadeh-Moghtader
- Cardiovascular Diseases Research Center AND Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Shirin Parvinroo
- Assistant Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Heidar Dadkhah-Tirani
- Associate Professor, Cardiovascular Diseases Research Center AND Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Enginoev S, Rad AA, Ekimov S, Kondrat'ev D, Magomedov G, Amirhanov A, Tsaroev B, Ziankou A, Motreva A, Chernov I, Tarasov D, Kadyraliev B, Sá MPBO. Risk Factors for Deep Sternal Wound Infection after Off-Pump Coronary Artery Bypass Grafting: a Case-Control Study. Braz J Cardiovasc Surg 2021; 37:13-19. [PMID: 34673508 PMCID: PMC8973134 DOI: 10.21470/1678-9741-2020-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction The objective of this study was to identify risk factors for deep sternal
wound infection (DSWI) after off-pump coronary artery bypass (OPCAB)
grafting surgery. Methods A total of 8,442 patients undergoing OPCAB from April 1, 2009 to December 31,
2018 were retrospectively analyzed. A total of 956 were eventually enrolled
on this study based on our exclusion criteria. All subjects were divided
into two groups: group 1 (n=63) - DSWI; group 2 (n=893) - without DSWI.
Patients were excluded if they had one of the following: acute coronary
syndrome, conversion to OPCAB grafting surgery, redo procedure, concomitant
cardiac surgery procedures. Results The prevalence of body mass index (BMI) ≥40 kg/m2 (7.9%
vs. 1.9%, respectively; P=0.01), lower
extremity atherosclerotic artery disease (23.8% vs. 7.2%,
respectively; P=0.001) and use of bilateral internal
thoracic artery (19.5% vs. 2.5%, respectively;
P=0.008) was significantly higher in patients with
DSWI. The incidence of morbidities, including reoperation for bleeding
(26.4% vs. 2.1%, respectively;
P<0.001), stroke (4.8% vs. 0.8%,
respectively; P=0.02), acute renal failure (7.9%
vs. 0.8%, respectively; P=0.001),
delirium (7.9% vs. 1.7%, respectively;
P=0.008) and blood transfusion (30.6% vs.
9.8%, respectively; P<0.001) was significantly higher in
patients with DSWI. Conclusions A BMI of >40 kg/m2, lower extremity artery disease, use of
bilateral internal thoracic artery (BITA) graft, postoperative stroke,
sepsis, reoperation due to postoperative complications and blood product
requirement significantly increased the risk of sternal infection after
OPCAB.
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Affiliation(s)
- Soslan Enginoev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia.,Astrakhan State Medical University, Astrakhan, Russia
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Sergey Ekimov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Dmitry Kondrat'ev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Gasan Magomedov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Alan Amirhanov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Bashir Tsaroev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Alexander Ziankou
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Anna Motreva
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Igor Chernov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | - Dmitry Tarasov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Astrakhan, Russia
| | | | - Michel Pompeu B O Sá
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil
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Abelaira Filho A, Avanci LE, Almeida TF, Witchtendahl R, Leal JCF. Patients Submitted to Myocardial Revascularization with the Use of Bilateral Internal Thoracic Arteries: Diabetics vs. Non-Diabetics. Braz J Cardiovasc Surg 2021; 36:500-505. [PMID: 33656831 PMCID: PMC8522316 DOI: 10.21470/1678-9741-2020-0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Use of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time. The primary objective of this study is to evaluate in-hospital mortality and mortality within 30 days from discharge. The secondary objective is to evaluate the occurrence of deep sternal wound infection in a 90-day follow-up. METHODS This is a retrospective review of the medical records of 152 patients undergoing elective CABG with the use of BITA and cardiopulmonary bypass (CPB). These patients were divided into two groups, diabetics and non-diabetics. Patients with acute myocardial infarction and concomitant valvular disease were not included in the sample. RESULTS Preoperative characteristics did not show significant differences between the groups, which allowed a comparative analysis. The variables electrocardiography time and aortic clamping time were higher in the diabetic group, with a significant statistical difference (P<0.0001). In-hospital mortality occurred in three patients, and there was no mortality up to 30 days in both groups. There was no significant difference in the primary end point between groups (P=0.56). Deep sternal wound infection was present in only one patient and showed no significant difference in the secondary outcome between groups (P=0.40). CONCLUSION We did not observe a higher mortality and occurrence of deep sternal wound infection with the use of BITA in diabetic patients compared to non-diabetics, even with greater CPB and aortic clamping times in diabetics.
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Affiliation(s)
- Achilles Abelaira Filho
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Luis Ernesto Avanci
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Thiago Faria Almeida
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - Rodolfo Witchtendahl
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
| | - João Carlos Ferreira Leal
- Department of Cardiovascular Surgery, Hospital Sociedade Portuguesa de Beneficência de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
- Department of Cardiovascular Surgery, Faculdade Estadual de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
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Tarasova IV, Trubnikova OA, Syrova ID, Barbarash OL. Long-Term Neurophysiological Outcomes in Patients Undergoing Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2021; 36:629-638. [PMID: 34236795 PMCID: PMC8597617 DOI: 10.21470/1678-9741-2020-0390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction This study aims to evaluate late postoperative neurophysiological outcomes in patients after coronary artery bypass grafting (CABG). Methods Forty-five male patients with stable coronary artery disease aged 45-69 years underwent extended neuropsychological assessment using the software Status PF and electroencephalographical examination 3-5 days before CABG and 5-7 years after CABG. Postoperative decline in cognitive functions was determined by a 20% decrease in the cognitive indicator compared to that at baseline on 20% of the tests included in the Status PF battery. Statistical analysis was performed using the software STATISTICA 10.0. Multiple regression was used to identify demographic, clinical, and electroencephalographical variables associated with adverse cognitive outcomes. Results Cognitive decline was observed in 54% of the patients in the long-term postoperative period. Five to seven years after CABG, all patients have shown an increase in the theta rhythm power compared to the preoperative values, which is most pronounced in the frontal and temporal areas of the right hemisphere (P=0.04), along with a decrease in the alpha rhythm in the posterior areas of the cortex (P=0.005). Multiple regression has reported that the main predictors of cognitive impairment are slower mean alpha frequency, decreased theta-2 rhythm with eyes closed in the right temporal area, and increased theta-2 rhythm with eyes open in the left temporal area (F(5.39)=8.81; P<0.00007; adjusted R-squared=0.57). Conclusion Our findings indicate that 54% of the patients suffer from postoperative cognitive decline associated with increased theta and decreased alpha rhythms 5-7 years after CABG.
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Affiliation(s)
- Irina V Tarasova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Olga A Trubnikova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Irina D Syrova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Olga L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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Paiva PP, Leite FM, Antunes PE, Antunes MJ. Risk-Prediction Model for Transfusion of Erythrocyte Concentrate During Extracorporeal Circulation in Coronary Surgery. Braz J Cardiovasc Surg 2021; 36:323-330. [PMID: 33656832 PMCID: PMC8357385 DOI: 10.21470/1678-9741-2020-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Our objective was to identify preoperative risk factors and to develop and validate a risk-prediction model for the need for blood (erythrocyte concentrate [EC]) transfusion during extracorporeal circulation (ECC) in patients undergoing coronary artery bypass grafting (CABG). METHODS This is a retrospective observational study including 530 consecutive patients who underwent isolated on-pump CABG at our Centre over a full two-year period. The risk model was developed and validated by logistic regression and bootstrap analysis. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow (H-L) test, respectively. RESULTS EC transfusion during ECC was required in 91 patients (17.2%). Of these, the majority were transfused with one (54.9%) or two (41.8%) EC units. The final model covariates (reported as odds ratios; 95% confidence interval) were age (1.07; 1.02-1.13), glomerular filtration rate (0.98; 0.96-1.00), body surface area (0.95; 0.92-0.98), peripheral vascular disease (3.03; 1.01-9.05), cerebrovascular disease (4.58; 1.29-16.18), and hematocrit (0.55; 0.48-0.63). The risk model developed has an excellent discriminatory power (AUC: 0,963). The results of the H-L test showed that the model predicts accurately both on average and across the ranges of deciles of risk. CONCLUSIONS A risk-prediction model for EC transfusion during ECC was developed, which performed adequately in terms of discrimination, calibration, and stability over a wide spectrum of risk. It can be used as an instrument to provide accurate information about the need for EC transfusion during ECC, and as a valuable adjunct for local improvement of clinical practice. Key Findings: Risk factors with the greatest prediction for EC transfusion. Take-Home Message: The implementation of this model would be an important step in optimizing and improving the quality of surgery.
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Affiliation(s)
- Patrícia Pinheiro Paiva
- Department of Clinical Pharmacology, Hospital and University Centre of Coimbra, Coimbra, Portugal.,Department of Clinical Pharmacology, University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Filipe Miguel Leite
- Department of Cardiothoracic Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Pedro E Antunes
- Department of Cardiothoracic Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Manuel J Antunes
- Department of Cardiothoracic Surgery, University of Coimbra Faculty of Medicine, Coimbra, Portugal
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Uysal D, Ibrisim E. A Retrospective Study of Coronary Artery Bypass Grafting with Low-Thermal Plasma Dissection Device Compared to Conventional Monopolar Electrosurgery. Braz J Cardiovasc Surg 2021; 36:379-387. [PMID: 34236794 PMCID: PMC8357391 DOI: 10.21470/1678-9741-2020-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: The objective of this study is to compare the effects of conventional monopolar electrosurgery (CMES) and low-thermal plasma kinetic cautery (PKC) on complications such as bleeding, abnormal wound healing, pain, and drainage in patients who underwent on-pump coronary artery bypass grafting (CABG). Methods: This retrospective clinical study included 258 patients undergoing CABG; the patients were randomized to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients’ clinical data were examined retrospectively for biochemical variables, postoperative drainage, post-surgery erythrocyte suspension transfusion count, surgical site pain examined with visual analogue scale (VAS), and wound healing. Two-sided P-value > 0.05 was considered as statistically significant. Results: The median post-surgery erythrocyte suspension transfusion number was significantly lower with PKC compared to CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative drain output and time until removal of drain tubes were significantly lower with PKC compared to CMES (300±113 vs. 547±192 and 1.95±1.5 vs. 2.44±1.8; P<0.001 and P=0.025, respectively). Mean VAS score for spontaneous and cough-induced pain were significantly lower with PKC compared to CMES (1.98±1.51 vs. 3.94± 2.09 and 3.76±1.46 vs. 5.6±1.92; P<0.001 for both comparisons). Reoperation due to bleeding was significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001). Conclusion: Use of PKC during CABG considerably reduces postoperative drainage, need for blood transfusion, reoperation due to bleeding, and postoperative pain. PCK appears to be a good alternative to CMES for CABG.
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Affiliation(s)
- Dincer Uysal
- Department of Cardiovascular Surgery, Suleyman Demirel Universitesi Tip Fakultesi, Isparta, Turkey
| | - Erdogan Ibrisim
- Department of Cardiovascular Surgery, Suleyman Demirel Universitesi Tip Fakultesi, Isparta, Turkey
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Parlar H, Arıkan AA, Önmez A. Dynamic Changes in Perioperative Cellular Inflammation and Acute Kidney Injury after Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2021; 36:354-364. [PMID: 34387973 PMCID: PMC8357379 DOI: 10.21470/1678-9741-2020-0163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: This study investigated the role of the neutrophil-lymphocyte ratio (NLR), the perioperative changes in NLR (delta-NLR), the platelet-lymphocyte ratio (PLR), and the platelet count in predicting acute kidney injury (AKI) following coronary artery bypass grafting (CABG) during hospital stay. Methods: The records of 396 patients with preoperative creatinine < 1.5 mg/dl undergoing isolated CABG between October 2015 and October 2019 were reviewed retrospectively. Diagnosis of AKI was based on the Kidney Disease Improving Global Outcomes definition. Demographic data, operative data, in-hospital mortality, preoperative NLR, PLR, and platelet counts were compared between patients with (AKI group) and without (non-AKI group) postoperative AKI. Additionally, NLR, delta-NLR, and PLR values were calculated daily for the first four postoperative days. A “subsequent AKI group” was formed for the first four postoperative days by excluding patients diagnosed with AKI. The daily and overall predictivity of the markers for AKI are investigated. Results: AKI was present in 86 patients during the postoperative period, while 310 patients had normal postoperative renal functions. NLR, delta-NLR, and PLR on the first four postoperative days (P<0.001 for all) were significantly associated with the development of AKI in subsequent days. Multivariate analysis identified postoperative NLR (odds ratio 1.17, 95% confidence interval 1.11-1.23; P<0.001) as an independent predictor of AKI. PLR lost its significant association with AKI at the values measured at discharge from hospital (P>0.05). Conclusion: NLR values measured on the first four days postoperatively are a useful tool in predicting AKI during hospital stay following CABG.
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Affiliation(s)
- Hakan Parlar
- Department of Cardiovascular Surgery, Derince Research and Training Hospital, Kocaeli, Turkey
| | - Ali Ahmet Arıkan
- Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Attila Önmez
- Department of Internal Medicine, Düzce University Medical Faculty, Düzce, Turkey
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Gomes WJ, Gomes EN, Bertini A, Reis PH, Hossne NA. The Anaortic Technique with Bilateral Internal Thoracic Artery Grafting - Filling the Gap in Coronary Artery Bypass Surgery. Braz J Cardiovasc Surg 2021; 36:397-405. [PMID: 34387975 PMCID: PMC8357393 DOI: 10.21470/1678-9741-2020-0451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Coronary artery bypass grafting (CABG) has consolidated its role as the most effective procedure for treating patients with advanced atherosclerotic coronary artery disease, reducing the long-term risk of myocardial infarction and death compared to other therapies and relieving angina. Despite the recognized benefits afforded by surgical myocardial revascularization, a subset of higher-risk patients bears a more elevated risk of perioperative stroke. Stroke remains the drawback of conventional CABG and has been strongly linked to aortic manipulation (cannulation, cross-clamping, and side-biting clamping for the performance of proximal aortic anastomoses) and the use of cardiopulmonary bypass. Adoption of off-pump CABG (OPCAB) is demonstrated to lower the risk of perioperative stroke, as well as reducing the risk of short-term mortality, renal failure, atrial fibrillation, bleeding, and length of intensive care unit stay. However, increased risk persists owing to the need for the tangential ascending aorta clamping to construct the proximal anastomosis. The concept of anaortic (aorta no-touch) OPCAB (anOPCAB) stems from eliminating ascending aorta manipulation, virtually abolishing the risk of embolism caused by aortic wall debris into the brain circulation. The adoption of anOPCAB has been shown to further decrease the risk of postoperative stroke, especially in higher-risk patients, entailing a step forward and a refinement of outcomes provided by the primeval OPCAB technique. Therefore, anOPCAB has been the recommended technique in patients with cerebrovascular disease and/or calcification or atheromatous plaque in the ascending aorta and should be preferred in patients with high-risk factors for neurological damage and stroke.
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Affiliation(s)
- Walter J Gomes
- Cardiovascular Surgery Discipline, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eduardo N Gomes
- Affiliated Hospitals of Associação Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo, São Paulo, Brazil
| | - Ayrton Bertini
- Affiliated Hospitals of Associação Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo, São Paulo, Brazil
| | - Pedro H Reis
- Affiliated Hospitals of Associação Paulista para o Desenvolvimento da Medicina (SPDM), São Paulo, São Paulo, Brazil
| | - Nelson A Hossne
- Cardiovascular Surgery Discipline, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Özmen R, Bozguney M, Tekin Aİ, Eroglu T, Tuncay A. Impact of Single versus Double Clamp Technique on Blood Lactate Levels and Postoperative Complications in Coronary Artery Bypass Surgery. Braz J Cardiovasc Surg 2021; 37:55-64. [PMID: 33656827 PMCID: PMC8973127 DOI: 10.21470/1678-9741-2020-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Cardiopulmonary bypass (CPB) is associated with hyperlactatemia, which leads
to adverse clinical outcomes. No study has examined the effect of different
clamping techniques on postoperative hyperlactatemia (PHL). Thus, we aimed
to evaluate the impact of two different techniques on PHL and the clinical
outcomes in patients undergoing isolated coronary artery bypass surgery. Methods This retrospective study included 100 patients who underwent isolated CPB
either with single clamp technique (SCT, n=47) or double clamp technique
(DCT, n=53). Demographic and preoperative laboratory data, as well as
operative features and arterial blood lactate levels at the onset and at the
end of CPB, were collected from patient charts. Results Blood lactate levels collected at the end of CPB did not differ significantly
between groups whereas intraoperative lactate increased significantly in
both groups (P<0.005). PHL developed in 16 patients
(32%). There was no meaningful difference in SCT and DCT in this regard.
Left internal mammary artery was used more frequently in the DCT group than
in the SCT group. While the cross-clamp time was significantly longer in the
SCT group, there was no difference regarding CPB time. Among postoperative
complications, only the incidence of stroke was significantly higher in the
DCT group than in the SCT group (10.6% vs. 0%,
P=0.020). CPB time, cross-clamp time and numbers of
proximal saphenous graft and distal anastomosis showed a significant
positive correlation with the postoperative lactate level. In the regression
analysis, CPB time emerged as the only independent predictor of PHL (OR
1.04, CI 95% 1.01-1.07, P=0.011). Conclusion There was no difference in postoperative blood lactate levels between SCT and
DCT groups.
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Affiliation(s)
- Rifat Özmen
- Department of Cardiovascular Surgery, Erciyes Universitesi Tip Fakultesi, Kayseri, Turkey
| | - Muhammet Bozguney
- Department of Cardiovascular Surgery, Kayseri Egitim ve Arastirma Hastanesi, Kayseri, Turkey
| | - Ali İhsan Tekin
- Department of Cardiovascular Surgery, Kayseri Egitim ve Arastirma Hastanesi, Kayseri, Turkey
| | - Tamer Eroglu
- Department of Cardiovascular Surgery, Ömer Halisdemir University, Nigde, Turkey
| | - Aydin Tuncay
- Department of Cardiovascular Surgery, Erciyes Universitesi Tip Fakultesi, Kayseri, Turkey
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Dallan LRP, Dallan LAO, Mejía OV, Dallan LAP, Lisboa LAF, Jatene FB. Pericardial-Peritoneal Window as an Alternative Treatment for Large and Recurrent Pericardial Effusion Post-Pericardiotomy. Braz J Cardiovasc Surg 2021; 36:581-583. [PMID: 33656833 PMCID: PMC8522315 DOI: 10.21470/1678-9741-2020-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The presence of mild to moderate pericardial effusion after cardiac surgery is common and oral medical therapy is usually able to treat it. Larger effusions are less frequent and surgical intervention is usually necessary. However, there are some rare cases of large effusions that are recurrent even after intervention and become challenging to treat. METHODS We describe the case of a patient submitted to coronary artery bypass grafting (CABG) without any intraoperative complications, who was regularly discharged from the hospital. She was referred to our emergency department twice after surgery with large pericardial effusion that was drained. Even after those two interventions and with adequate oral medication, the large effusion recurred. RESULTS During follow-up, the patient had her symptoms resolved, with no need for further hospital admission. Her echocardiograms after the last intervention showed no pericardial effusion. The present surgical technique demonstrated to be easy to perform, thus it should be considered as a treatment option for these rare cases of large and repetitive effusions, which do not respond to the traditional methods. CONCLUSIONS In challenging cases of recurrent and large pericardial effusions, the pericardial-peritoneal window is an alternative surgical technique that brings clinical improvement and diminishes the risk of cardiac tamponade.
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Affiliation(s)
- Luis Roberto Palma Dallan
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Luis Alberto Oliveira Dallan
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Omar Vilca Mejía
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Luis Augusto Palma Dallan
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Luiz Augusto Ferreira Lisboa
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
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