Short-Term Results of Ivabradine versus Metoprolol: The Effects on Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

ABSTRACT Introduction: Classic coronary artery bypass grafting (CABG) surgery involves diastolic cardiac arrest under cardiopulmonary bypass, while off-pump CABG (OPCABG) has become widespread in recent years. Methods: 174 patients who underwent OPCABG were included in the study. Patients were divided into two groups. Group I (n=90) received ivabradine and Group M (n=84) received metoprolol before surgery until postoperative day 10. Intraoperative arrhythmias and hypotension were recorded. Postoperative atrial fibrillation (AF) and arrhythmia, mortality and morbidity rates were assessed based on the 30-day postoperative follow-up. Results: There were no significant differences in the intraoperative amount of inotropic support and red blood cell transfusion between groups (P=0.87 and P=0.31). However, the rates of intraoperative arrhythmias and hypotension were not significantly higher in Group M (P=0.317 and P=0.47). Ventricular tachycardia/ventricular fibrillation (VT/VF) was observed in 2 patients in both groups. Postoperative AF occurred in 7 patients (7.7%) in Group I and in 10 patients (11.9%) in Group M. Although there was a trend towards a higher prevalence of AF in Group M patients, this did not reach statistical significance. In addition, mortality and morbidity rates were comparable between groups.

Predictors of Pacemaker-Induced Cardiomyopathy and Importance of Nutritional Status and Prognostic Nutritional Index.

Background: Long-term right ventricular (RV) pacing may cause progressive left ventricular systolic dysfunction, and malnutrition is related to adverse cardiovascular outcomes in patients with heart failure. We aimed to evaluate the relationship between immunonutritional status and the development of pacing-induced cardiomyopathy (PICMP). Methods: This study included 434 patients who underwent permanent pacemaker (PPM) implantation and had preserved left ventricular ejection fraction (LVEF) of > 40%. At six months of follow-up, the patients with LVEF < 40% were defined as having PICMP. Baseline prognostic nutritional index (PNI) was calculated based on serum albumin and lymphocyte count. Results: Overall, 16.5% of the our study patients developed PICMP. The PICMP group had more males (p = 0.013), lower baseline LVEF values (p = 0.014) and lower baseline PNI levels (p < 0.001). RV pacing ratios and paced QRS intervals were higher in the PICMP group (p < 0.001 for both), but the types of implanted pacemakers were similar for all patients (p = 0.709). According to regression analyses, baseline LVEF (p = 0.020), PNI (p < 0.001), C-reactive protein level (p = 0.012), RV pacing ratio (p < 0.001) and paced QRS interval (p = 0.001) were independent predictors of PICMP development. A cut-off PNI value ≤ 43.2 at the time of PPM implantation could predict PICMP development with a sensitivity of 85.5% and specificity of 86.7% (p < 0.001). Conclusions: Identifying poor nutritional status using the PNI may be an important concept to predict PICMP development, and optimizing nutritional status might help to reduce adverse outcomes in these patients.

Short-Term Results of Ivabradine versus Metoprolol: The Effects on Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting.

INTRODUCTION: Classic coronary artery bypass grafting (CABG) surgery involves diastolic cardiac arrest under cardiopulmonary bypass, while off-pump CABG (OPCABG) has become widespread in recent years. METHODS: 174 patients who underwent OPCABG were included in the study. Patients were divided into two groups. Group I (n=90) received ivabradine and Group M (n=84) received metoprolol before surgery until postoperative day 10. Intraoperative arrhythmias and hypotension were recorded. Postoperative atrial fibrillation (AF) and arrhythmia, mortality and morbidity rates were assessed based on the 30-day postoperative follow-up. RESULTS: There were no significant differences in the intraoperative amount of inotropic support and red blood cell transfusion between groups (P=0.87 and P=0.31). However, the rates of intraoperative arrhythmias and hypotension were not significantly higher in Group M (P=0.317 and P=0.47). Ventricular tachycardia/ventricular fibrillation (VT/VF) was observed in 2 patients in both groups. Postoperative AF occurred in 7 patients (7.7%) in Group I and in 10 patients (11.9%) in Group M. Although there was a trend towards a higher prevalence of AF in Group M patients, this did not reach statistical significance. In addition, mortality and morbidity rates were comparable between groups.

The effectiveness of vacuum-assisted closure therapy in patients with infected venous leg ulcers.

AIM: In this study, we aimed to investigate the effect of vacuum-assisted closure therapy on venous stasis wound healing in patients with chronic venous leg ulcers. METHODS: Vacuum-assisted closure therapy was applied on a total of 14 venous leg ulcers. All patients had post-thrombotic syndrome. Quantitative wound culture samples were obtained before the procedure and local wound assessments were performed. The primary outcome measures included wound healing as assessed by a local wound examination during each dressing change and the rate and velocity of ulcer reduction. Wound healing was defined as the complete closure of the ulcer, while rapid wound healing was defined as a ≥ 30% reduction in the ulcer size by week four. RESULTS: No surgical debridement or surgical corrective procedure was applied in any patient. The mean length of hospital stay was 32.3 days. The mean number of vacuum-assisted closure therapies for each case was 17.8 and the mean time to dressing change was 72.3 hours. Multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were detected in three and four patients, respectively. Wound culture results became negative after a mean duration of vacuum-assisted closure therapy of 12.1 days. None of the patients needed antibiotic therapy until the procedure was completed. Compared to baseline, the mean ulcer reduction rates were 46.4% for the first six applications and 72.8% for the subsequent applications. CONCLUSIONS: Our study results suggest that vacuum-assisted closure therapy promotes rapid wound healing in patients with severe post-thrombotic syndrome with venous stasis leg ulcers, and reduces the need for antibiotics by reducing the biological burden.

The effect of single aortic cross-clamp technique versus multiple clamp technique on postoperative stroke in octogenarians undergoing coronary artery bypass grafting.

AIM: In this study, we aimed to investigate the effect of the single aortic cross-clamp technique (SCT) (aortic cross-clamp only) versus the multiple-clamp technique (MCT) (aortic cross-clamp + side-biting clamp) on postoperative stroke in octogenarians undergoing coronary artery bypass grafting (CABG). METHODS: A total of 171 patients aged 80 years and older who underwent isolated CABG were retrospectively analysed. The patients were divided into two groups according to the technique used during surgery: group 1 (n = 88) received the SCT, and group 2 (n = 83) received the MCT. Postoperative stroke was evaluated. RESULTS: Of the patients, 127 were men and 44 were women. The mean age was 83.05 ± 8.81 years in group 1 and 82.14 ± 8.92 years in group 2. There was no statistically significant difference in the rate of postoperative stroke between the two techniques (p > 0.05). CONCLUSIONS: Postoperative stroke in octogenarians may result from not only the cross-clamp technique used but also several other factors. We found that both techniques yielded similar outcomes.

Clinical Outcomes of Extrapleural Closure of a Patent Ductus Arteriosus Concomitant with Aortic Coarctation Repair.

BACKGROUND: The aim of this study was to present an extrapleural approach for the closure of patent ductus arteriosus (PDA), with the repair of aortic coarctation (CoA) in the same session, in critically ill newborns and infants as an alternative to the transpleural surgical technique. METHODS: Between December 2007 and November 2010, 44 critically ill patients with PDA and coarctation of the aorta were operated on during the same session with the extrapleural approach. The diagnoses of the patients were made by transthoracic echocardiography (TTE). We investigated the aortic arch, the length of the coarctation segment, peak-to-peak gradients, the aortic valve, and intracardiac defects prior to the surgery using TTE. Cardiac angiography was performed to determine whether the patients were suitable for an interventional approach in hemodynamically stable patients. Twenty-eight patients had congestive heart failure with mild to moderate pulmonary and systemic hypertension. The median gestational age and weight of neonates were 2.1 kg (range: 1.4 to 2.9 kg), and 31.4 weeks (range, 28.6 to 37 weeks), respectively. During the operations, PDA was closed using double clips. Resection of coarctation with an extended end-to-end anastomosis was performed in 27 patients. Subclavian flap angioplasty was performed in four patients, and an aortic patch repair was performed in two infants. Postoperative PDA flow and residual aortic gradient were evaluated using echocardiography prior to discharge from the hospital and during the follow-up period. RESULTS: There were three in-hospital deaths (6.8%). During the follow-up period, two patients died (4.8%). The mean follow-up period was 48.3±21.5 months (range: 29-56 months). Patent foramen ovale, atrial septal defect, and ventricular septal defect were the additional cardiac pathologies. These were hemodynamically insignificant. We detected that the intracardiac defects closed spontaneously. During the follow-up period, recoarctation developed in six patients (20%). We found that the risk factors for recoarctation in patients were to have a gradient from coarctation area, which was higher than ≥ 50 mmHg, and the length of coarctation segment that was longer than 1 cm in their first operation (P = 0.033). The median time from the first surgery to recoarctation was 25.4±13.2 months (range: 16-36 months). Balloon dilatation was performed in four patients. We performed redo-surgery in the remaining two patients with recoarctation. The mean intubation time was 9.1±13.4 hours (range: 5.8-19.8 hours). Transthoracic echocardiography showed normal left ventricular dimensions and systolic function in 34 patients during follow up (87.1%). CONCLUSION: Our experiences show that surgical repair of aortic coarctation and PDA closure at the same session may be performed safely and with acceptable mortality and morbidity via an extrapleural approach. Interventional approach as a less invasive method may be used in patients who have developed recoarctation.