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Background: Recent studies have indicated that patients, both with and without diabetes with an increased HbA1c, have a higher rate of adverse outcomes following cardiac surgeries. Our study is focused on to evaluate the prognostic impact of admission value of HbA1c in non?diabetic patients for postoperative renal failure and infections. Materials and Methods: Plasma HbA1c levels were collected from 200 consecutive nondiabetic patients who got admitted for elective off pump coronary artery bypass graft (CABG) procedure over a 2?year period under two groups, Group A whose HbA1c was < 6% at admission and Group B whose HbA1c was ?6% and ?6.4% at admission. After surgery, patients were followed up to see if they have got infection or renal failure as postoperative complication. Student抯 unpaired t test was used to test the significance of difference between the quantitative variables, Yate抯 and Fisher抯 chi square tests were used for qualitative variables. Results: We found early postoperative renal failure in 14 (3/96 in Group A and 11/104 in Group B) out of 200 patients (7%) and infection in 21 (8/96 in Group A and 13/104 in Group B) out of 200 patients (10.5%). After data analysis, it was noted that there is a positive correlation between HbA1c and postoperative renal failure (P = 0.0213) whereas no association was found between HbA1c and postoperative infections (P = 0.175) in patients undergoing off?pump CABG surgery. Conclusion: In patients without diabetes, a plasma HbA1c ?6% was a significant independent predictor for early postoperative renal failure.
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ABSTRACT This short article discusses selected scanning electron microscope and transmission electron microscope features of vasa vasorum including pericytes and basement membrane of the human saphenous vein (SV) harvested with either conventional (CON) or no-touch (NT) technique for coronary artery bypass grafting. Scanning electron microscope data shows the general damage to vasa vasorum of CON-SV, while the transmission electron microscope data presents ultrastructural features of the vasa in more detail. Hence there are some features suggesting pericyte involvement in the contraction of vasa blood vessels, particularly in CON-SV. Other features associated with the vasa vasorum of both CON-SV and NT-SV preparations include thickened and/or multiplied layers of the basement membrane. In some cases, multiple layers of basement membrane embrace both pericyte and vasa microvessel making an impression of a "unit" made by basement membrane-pericyte-endothelium/microvessel. It can be speculated that this structural arrangement has an effect on the contractile and/or relaxing properties of the vessels involved. Endothelial colocalization of immunoreactive inducible nitric oxide synthase and endothelin-1 can be observed (with laser confocal microscope) in some of the vasa microvessels. It can be speculated that this phenomenon, particularly of the expression of inducible nitric oxide synthase, might be related to structurally changed vasa vessels, e.g., with expanded basement membrane. Fine physiological relationships between vasa vasorum endothelium, basement membrane, pericyte, and perivascular nerves have yet to be uncovered in the detail needed for better understanding of the cells'specific effects in SV preparations for coronary artery bypass grafting.
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Abstract Introduction: In this study, we aimed to investigate the relationship between postoperative mortality, morbidity, hospital stay and development of postoperative complications with the glycosylated hemoglobin (HbA1c) level and low left ventricular ejection fraction (LVEF) in diabetic and non-diabetic patients who underwent elective coronary artery bypass (CABG) surgery. Methods: The medical records of patients who underwent CABG at our clinic between January 2015 and December 2019 were retrospectively analyzed. All patients were divided into two groups according to their diabetes mellitus (DM) diagnosis. Diabetic patients were also divided into two groups according to their HbA1c levels. The HbA1c threshold value was 7%. All patients were divided into two groups in terms of LVEF. The LVEF threshold value was 40%. Results: We analyzed 393 patients, of which 304 (77.4%) were male and 177 (45.04%) patients were diabetic. For lower LVEF and HbA1c values, we found no relationship between postoperative mortality, prolonged intensive care unit (ICU) stay and development of postoperative complications. Deep surgical site infection (DSSI) was found to be more common in diabetic patients who had a higher HbA1c value. Length of hospital stay was longer in diabetic patients with HbA1c levels <7%. Conclusion: No statistically significant relationship was found between LVEF and HbA1c levels and postoperative mortality, prolonged ICU stay and postoperative complications.
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Background: Cardiac troponin I (cTnI) is reported to be very specific formyocardial cell damage without cross reactivity with skeletal muscle isoform.Evaluation of cTnI after CABG will be useful as an early marker of excessivepost operative myocardial damage when a specific therapeutic intervention canstill be efficient and improve outcome.Methodology: The study comprised of 50 patients who undergo Coronary arterybypass surgery at V.S group of Hospital. Blood sample were taken after 12 hour (T12) and 24 hour ( T24 ) of post CABG. The sample were analysed for cTnI.Results: Our results show that Troponin I levels after 2 hours, 12 hours and 24hours in patients who had better outcome after CABG was 9.2 ng/ml, 13.9 ng/mland 10.9 ng/ml respectively. Whereas, Troponin I levels after 2 hours, 12 hoursand 24 hours in patients who had adverse outcome like death of patients afterCABG was 10.6 ng/ml, 38.7 ng/ml and 28.9 ng/ml respectively.Conclusion: Routine measurement of cardiac troponin levels after cardiactroponin can identify group of patients at increased risk of complications ordeath.
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Purpose:The purpose of this study was to review the effect of the pre?operative use of clopidogrel and aspirin on peri?operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off?pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on?pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post?operatively, this was statistically significant. Re?exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre?operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.
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Background: through coronary artery bypass graft (CABG) or through utilization of percutaneous coronary intervention (PCI) with stenting, coronary revascularization can be achieved. Diabetics represents a particularly challenging group for both treatments. This work aimed to estimate clinical outcome in diabetic individuals with multiple vessels disease (MVD) who had either PCI or CABG over 30 days. Methods: This prospective research was conducted on 200 diabetic individuals with MVD established as severe stenosis. Into 2 equal groups, individuals were divided: Group (A) [underwent CABG], and group (B) [performed Drug Eluting Stents (DES) PCI]. All individuals underwent full history taking, resting twelve-leads electrocardiogram, complete clinical examination, transthoracic echocardiography, coronary angiographic, SYNTAX score and Euro score. Results: In CABG group, age, statin, ACE-I/ARB, ?- -blocker and dual antiplatelet therapy was significantly higher than PCI group. PCI group had significantly higher PCI, MI and repeated revascularization than the group of CABG. In PCI group, stroke and MI, death, myocardial infarction (MI), were significantly higher than in group of CABGS. Conclusions: DES have developed for the coronary artery disease (CAD) treatment and are increasingly being utilized for complex CAD treatment, such as multivessel or left main CAD. PCI is preferred over CABG in high surgical risk individuals due to the shorter hospital stay, faster time of recovery, and potentially decreased stroke rate
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We present herein the case of a 45-year-old man with a coronary artery aneurysm (diameter 19 mm) in the proximal part of the left anterior descending branch associated with eosinophilic granulomatosis with polyangiitis (EGPA). As coronary angiography showed #6 : 100% and #12-2 : 90%, and Tc-99 m myocardial scintigraphy showed exertional ischemia in the anterior septum, revascularization was considered to be indicated. Prednisolone and mepolizumab were administered preoperatively to suppress the activity of vasculitis due to eosinophilia, and surgery was performed when the eosinophil count normalized. The patient underwent off-pump coronary artery bypass grafting (LITA-LAD, SVG-OM2). The patient was discharged, and the postoperative course was uneventful. In coronary artery bypass grafting for EGPA, eosinophils may infiltrate the internal thoracic artery and result in vasculitis, which may affect the patency rate. Perioperative management of vasculitis may thus be important.
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A 75-year-old man with situs inversus totalis, presented to our hospital complaining of chest pain. ECG showed ST depression in the leads of Ⅰ, aVL, V5, and V6. Blood tests showed cardiac enzyme (Troponin I) elevation. Coronary angiography revealed severe calcification and stenosis of the anatomical left anterior descending artery (LAD) , and the anatomical right coronary artery (RCA). The Patient underwent coronary artery bypass grafting (CABG) using the right internal thoracic artery and saphenous vein graft. The postoperative course was uneventful. CABG in a patient with situs inversus totalis is very rare. We present this case with a review of the relevant literature.
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Objective To summarize the incidence of cardiac allograft vasculopathy (CAV) after heart transplantation and the effect on the long-term survival of recipients. Methods Clinical data of 1 006 heart transplant recipients were retrospectively analyzed. Of 48 CAV patients, 4 cases were not included in this analysis due to lack of imaging evidence. A total of 1 002 recipients were divided into the CAV group (n=44) and non-CAV group (n=958) according to the incidence of CAV. The incidence of CAV was summarized. Clinical data of all patients were statistically compared between two groups. Imaging diagnosis, coronary artery disease, drug treatment and complications, postoperative survival and causes of death of CAV patients were analyzed. Results Among 1 006 heart transplant recipients, 48 cases (4.77%) developed CAV. Compared with the non-CAV group, the proportion of preoperative smoking history, preoperative hypertension history, coronary artery disease and perioperative infection was significantly higher in the CAV group (all P < 0.05). Among 44 patients diagnosed with CAV by imaging examination, 24 cases were diagnosed with CAV by coronary CT angiography (CTA), 4 cases by coronary angiography (CAG), and 16 cases by coronary CTA combined with CAG. Among 44 patients, the proportion of grade Ⅰ CAV was 45% (20/44), 30% (13/44) for grade Ⅱ CAV and 25% (11/44) for grade Ⅲ CAV, respectively. All patients received long-term use of statins after operation, and 20 patients were given with antiplatelet drugs. Among 44 CAV patients, 11 patients underwent percutaneous coronary intervention, 6 cases received repeated heart transplantation, and 8 patients died. Kaplan-Meier survival analysis demonstrated that there was no significant difference in the long-term survival rate between the CAV and non-CAV groups (P > 0.05), whereas the survival rate of patients tended to decline after the diagnosis of CAV (at postoperative 6-7 years). The long-term survival rates of patients with grade Ⅰ, grade Ⅱ and grade Ⅲ CAV showed no significant difference (P > 0.05). Even for patients with grade Ⅰ CAV, the long-term survival rate tended to decline. Conclusions CAV is a common and intractable complication following heart transplantation, and the long-term survival rate of patients after the diagnosis of CAV tended to decline. Deepening understanding of CAV, prompt prevention, diagnosis and treatment should be delivered to improve the long-term survival rate of patients after heart transplantation.
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Background: Kinesiophobia has been reported as one of the most common factors that hinder the exercise based cardiac rehabilitation. According to the evidences in the literature and clinical observations, chest binder is prescribed post median sternotomy to reduce the postoperative complaints and complications. Till date no sufficient evidence has been reported regarding effectiveness of chest binder on kinesiophobia in CABG patients post median sternotomy. Purpose: To assess the effect of chest binder on the level of kinesiophobia; in CABG patients over a period of one month. Participants: Total 70 (50 – males; 20 – females) post CABG via median sternotomy, hemodynamically stable patients, aged between 40 – 70 years, with Tampa Scale for kinesiophobia – short version (TSK – SV) Heart scores > 37 were included. Methods: On the 4th post operative day, patients were assessed for level of kinesiophobia using TSK – SV Heart. The patients were divided in to two groups depending on the prescription of chest binder by their surgeons as Group A (with binder), Group B (without binder). One month post CABG, the patients in both the groups were asked to fill the TSK – SV Heart, via telephonic conversation. Analysis: Comparison of TSK – SV Heart score at baseline and after one month within Group A and Group B was done using Wilcoxon signed rank test with continuity correction. Comparison of difference of TSK – SV Heart score at baseline and after one month between Group A and Group B was done using Mann – Whitney test. The p value < 0.05 was considered to be statistically significant. Results: The mean of TSK –SV Heart score on 4th day post CABG in group A and group B was 43.42 (±7.717) and 43.45 (±4.64) respectively. The mean of TSK –SV Heart score on one month post CABG in group A and group B was 35.82 (±8.372) and 39.51 (± 6.03) respectively. A significant reduction in kinesiophobia was observed in group A and group B, p-value 0.00001188 and 0.00007886 respectively. The 95% Confidence Interval (CI) median estimate of group A and group B was 7.9 (5.0 – 10.5) and 4.5 (3.0 – 6.0) respectively. The mean of difference of TSK – SV Heart score in group A and group B was 7.6 (±8.24) and 3.94 (±4.82) respectively. The reduction in kinesiophobia in group A was significantly more than in group B, p-value = 0.00792. The 95% Confidence Interval (CI) median estimate of the mean of difference of TSK – SV Heart score in group A and group B was 3.7 (2.48 – 4.92) Conclusion: There was significant reduction in kinesiophobia irrespective of the use of chest binder post CABG via median sternotomy over a period of one month. There was marked reduction in kinesiophobia in patients who were using chest binder. Implications: Use of chest binder is recommended in patients who have kinesiophobia to encourage their participation in exercise based cardiac rehabilitation.
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Background: Acute kidney injury (AKI) following off pump coronary artery bypass grafting (OPCABG) within short interval from coronary angiography (CAG) has been well documented. This prospective study is aimed to delineate perioperative effects and effects of elective 7 days interval between CAG and off pump CABG, to observe its outcome on renal functions.Methods: The present study was conducted in a total of 1102 consecutive patients who underwent coronary angiography following coronary artery bypass surgery in Fortis hospital, Mohali. Patients were divided into 2 groups - group A (patients undergoing CABG within 7 days of CAG) and group B (patients undergoing CABG beyond 7 days of CAG). Comparison was made between the two groups, in relation to the timing between CAG and CABG, with its impact on perioperative renal functions.Results: Statistically it was found highly significant higher values of 1st and 3rd day serum creatinine and high incidence of postoperative AKI in patients of group A in comparison to patients of group B.Conclusions: Thus, our study confirms that patients with a shorter interval between CAG and subsequent OPCAB are more likely to present higher peak creatinine level as well as lower minimum eGFR. A gap of 7 days for elective cases is more likely to present less postoperative AKI.
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Abstract Objective: To investigate the effects of lidocaine oropharyngeal spray applied before endotracheal intubation on hemodynamic responses and electrocardiographic parameters in patients undergoing coronary artery bypass grafting. Methods: A total of 60 patients who underwent coronary artery bypass grafting surgery were included in this prospective randomized controlled study. Patients were randomly divided into two groups, the topical lidocaine group (administration of 10% lidocaine oropharyngeal spray, five minutes before laryngoscopy and endotracheal intubation) and the control group. Both groups were compared with each other in terms of main hemodynamic parameters including mean arterial pressure and heart rate, as well as P and QT wave dispersion durations, before and after endotracheal intubation. Results: The groups were similar in terms of age, gender, and other demographics and basic clinical characteristics. There was a statistically significant difference between the groups in terms of QT dispersion durations after laryngoscopy and endotracheal intubation. The increase in QT dispersion duration was not statistically significant in the topical lidocaine group, whereas the increase in QT dispersion duration was statistically significant in the control group. When the groups were compared in terms of P wave dispersion durations, there were significant decreases in both groups, but there was no significant difference between the groups. Conclusion: Our study revealed that the topical lidocaine administration before endotracheal intubation prevented increase of QT dispersion duration in patients undergoing coronary artery bypass grafting. Trial Registration: NCT03304431
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Humans , Male , Female , Middle Aged , Aged , Intubation, Intratracheal , Blood Pressure , Coronary Artery Bypass , Prospective Studies , Heart Rate , Hemodynamics , Laryngoscopy , LidocaineABSTRACT
Background: In acute coronary syndrome, prompt restoration of myocardial blood flow is essential to optimize myocardial salvage and decrease mortality. Coronary artery reperfusion, if performed in a timely manner improves clinical outcomes compared to no reperfusion. Fibrinolysis and percutaneous interventions can restore blood flow in an acutely occluded coronary artery in most of the patients; but in a few subset of patients coronary artery bypass grafting (CABG) is needed to effectively restore blood flow.Methods: A retrospective study was conducted among all CABGs performed during March 2016 - February 2018. During this period, 366 CABGs were performed and 57 patients underwent emergency CABG as per the inclusion criterias. Pre-operative, intra-operative and post-operative data was analysed of these patients. Patients were divided into four groups based on the time of surgery from the time of onset of myocardial infarction. Results: 57 patients underwent emergency CABG with males constituting 94.7% of the study population. 78.9% of them had an ejection fraction less than 35%. 52% presented with low cardiac output status, 10% needed intra-aortic balloon pump support and 15% required mechanical ventilation prior to surgery. All patients received an average of 2.8 grafts. Mortality was 5%Conclusions: Immediate surgical revascularisation of patients presenting with acute MI is feasible. Emergency CABG not only treats the culprit lesion but also achieves complete revascularization and offers a clear advantage for patients. The optimal timing of CABG for patients with acute MI remains difficult to establish.
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Introduction: Airway management is a crucial skill for theclinical anaesthesiologist. It is an integral part of generalanesthesia, allowing ventilation and oxygenation as wellas a mode for anesthetic gas delivery. The laryngeal maskairways(LMA) have become popular in airway managementas a missing link between facemask and tracheal tube interms of both anatomical position and degree of invasiveness.Haemodynamic stability is an important aspect to theanaesthesiologist for the benefit of the patients especiallyduring intubations, laryngeal mask insertion. Laryngoscopyand endotracheal intubation can cause striking changes inHaemodynamics as result of intense stimulation of sympatheticnervous system. The aim of this study was to evaluate thehemodynamic changes between endotracheal intubation andlaryngeal mask airway insertion.Material and Methods: This was a prospective observationalstudy on 46 patients of ASA I-II status divided into 2 groups of23 each. In the ETT (Endotracheal tube) group endotrachealintubation was done using Macintosh laryngoscope by usingportex cuffed endotracheal while in LMA (Laryngeal maskairway) group laryngeal mask airway was inserted accordingto the standard recommendation. Heart rate, Systolic, Diastolicand Mean arterial pressure and dysrhythmias were monitored.Results: The two groups were comparable in terms ofdemographic data as there were no significant differencesbetween the 2 groups in terms of age, sex, duration of surgery,ASA grades and MPC classification. Heart rate (HR), Systolicblood pressure (SBP), Diastolic blood pressure(DBP), Meanarterial pressure (MAP) remains on higher side in ETT groupthan LMA group which was statistically significant. P<0.05.Dysrhythmias were noted in 2 patients of ETT group whileLMA group did not notice any dysrhythmias.Conclusion: This study demonstrated that there is ahaemodynamic response consisting of an increase in Heartrate, SBP, DBP and MAP that comes with ETT insertion aswell as with LMA insertion. However, the response causedby ETT insertion is significantly greater than that caused byLMA insertion.
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The increase in prevalence of diabetes in India is one of the leading causes of blindness due to micro vascular and macro vascular complications. The complications in retina and kidney are due to damage of small vessels. Studies have shown significant association between diabetic retinopathy and diabetic nephropathy. In our study, we are discussing the complications during intra and post-operative period and also both anatomical and functional outcome in these patients after vitrectomy for proliferative diabetic retinopathy. Both eye and kidney share same vascular pattern. One pre-existing condition can be followed by the other condition due to similar microvascular damage. We wanted to evaluate the outcome of vitrectomy in proliferative diabetic retinopathy patients associated with chronic kidney disease.METHODSThis is a retrospective study done at Sarojini Devi Eye Hospital, Telangana State, South India, over a two-year period from June 2017 to June 2019. Data was collected from old medical records of our institute, from patients who presented to Retina Dept. with various complaints. They were examined in detail, documented and treated based on clinical presentation after clearance from physician. Patients presented with different ocular manifestations like non-resolving vitreous haemorrhage, focal tractional retinal detachment, multi focal tractional retinal detachment like broad based, table top, combined retinal detachment and tractional maculopathy. Patients underwent pars plana vitrectomy with or without silicone oil endotamponade.RESULTSPrognosis in these patients was good only in cases of non-resolving vitreous haemorrhage and focal tractional retinal detachment (47.61%) whereas in cases like multifocal retinal detachment cases outcome was favourable (42.82%) but patients with combined retinal detachment (9.52%) had poor anatomical and visual outcome.CONCLUSIONSManagement of these patients is very difficult when there is severe proliferative diabetic retinopathy with multiple broad vitreo retinal adhesions. Outcome is very poor particularly in patients of severe proliferative diabetic retinopathy associated with chronic kidney disease and coronary artery disease due to intra operative complications
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@#Objective To explore the predictive value of myocardial vitality in the improvement of cardiac function after coronary artery bypass grafting (CABG) in patients with ischemic heart failure. Methods From December 8, 2015 to November 12, 2018, 46 patients with ischemic heart failure who underwent CABG operation alone were collected retrospectively. There were 41 males and 5 females with an average age of 60.4±8.0 years. The myocardial vitality and number of different types of myocardium were measured. The clinical data of patients in the left ventricular ejection fraction (LVEF) improvement group (≥5%) and non-improvement group (<5%) were compared and analyzed. The correlation between each index and LVEF improvement was analyzed by logistic multivariate regression analysis, and the boundary value of hibernating myocardium between LVEF improvement and non-improvement was obtained by receiver operating characteristic (ROC) curve. Results There were significant differences in the number of hibernating myocardium (15.0%±12.3% vs. 4.3%±4.5%, P=0.000), the number of normal myocardium (74.7%±13.7% vs. 82.4%±8.6%, P=0.027), and cardiac function classification (NYHA) development (−0.7±0.7 vs. −0.3±0.5, P=0.047) between the two groups, but there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that the number of hibernating myocardium was an independent factor affecting the improvement of LVEF after CABG in patients with ischemic heart failure (OR=1.366, 95%CI 1.033-1.807, P=0.029). The ROC curve showed that the threshold value, sensitivity and specificity of hibernating myocardium were 15.0%, 43.8% and 100.0%, respectively. Conclusion The percentage of hibernating myocardium to left ventricular wall area ≥15.0% can accurately predict the improvement of LVEF in patients with ischemic heart failure after CABG. Preoperative myocardial vitality assessment has important diagnostic value in predicting the improvement of cardiac function in patients with ischemic heart failure after simple CABG.
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Inability to communicate can be a distressing problem for the patient who may be unable to speak because of the use of the paralyzing drugs or the endotracheal tube. The nursing management of the mechanically ventilated patient is challenging on many levels require acquisition of highly technical skills. Mechanically ventilated patient’s having more communication difficulties. Communicating effectively with ventilator-dependent patients is essential so that various basic physiological and psychological needs can be conveyed and decisions, wishes, and desires about the plan of care and end-of-life decision making can be expressed. Patient communication board improve communication, organize information and create a comfortable, attractive setting for patients, nurses, doctors, other care givers and visitors. Methods: The study subjects were 60 post operative CABG patients, 30 in each group; control group and experimental group selected through purposive sampling technique is often referred to as theoretical or judgmental sampling. Non equivalent control group design was used to assess the effectiveness of modified communication board on communication ability of post-operative CABG patients. Results: The obtained ‘t’ value is 12.15** is higher than the table value this indicates modified communication board is effective to enhance communication ability of post-operative CABG patients. Among experimental group about age and gender there was significant association found and in control group about gender association found, in clinical profile history of previous surgery strongly associated with communication ability of postoperative CABG patients. Conclusion: there was significant relation found between modified communication board and communication ability of post operative CABG patients. This type of studies helps the nurses working in intensive and critical care unit in communicating with the mechanically ventilated patients. It is important for nurses to assess communication needs; identify appropriate alternative communication strategies to promote effective communication with non-vocal patients.
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Abstract Introduction: Angiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts. Methods: Bypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I - 0-4 months (22 grafts), II - 5-8 months (23 grafts), III - 9-12 months (19 grafts) and IV - 13-16 months (13 grafts) after CABG. Student's t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study. Results: In period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038). Conclusion: IVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.
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Humans , Male , Female , Middle Aged , Saphenous Vein/transplantation , Coronary Artery Disease/etiology , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/adverse effects , Atherosclerosis/etiology , Atherosclerosis/diagnostic imaging , Time Factors , Retrospective Studies , Coronary Angiography/methods , Ultrasonography, Interventional/methods , Early DiagnosisABSTRACT
Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses.
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Background: Cardiac Surgery being the most modern and conceptualized surgery which involves cardiopulmonary bypass Clotting Mechanism, Temperature Control, Hemodilution, and Cardioplegic arrest, etc. The failure of any of these mechanisms ends up in a cascading effect of morbidity and mortality of the patients. The aim of the study: The present study was primarily undertaken to study the incidence off Reexploration in Cardiac Surgery among patients subjected to cardiopulmonary bypass, thereby identifying the factors contributing to Reexploration and adopting suitable measures to reduce the incidence of Reexploration. Materials and methods: Totally 25 patients who underwent cardiac surgery under cardiopulmonary bypass Department of Cardio-Thoracic Surgery, Government Mohan Kumaramangalam Medical College Hospital, Salem. Patients who had a problem of bleeding underwent Reexploration. Patients included in the study belonged to both sexes and age groups varying from 11 to 68 years. The patients were subjected to routine investigations. Results: It was as high as 25% among the patient belonging to three different age groups (20-30), (40-50) and (50-60). The incidence of Reexploration was 58.3% (14/24) among patients who were CPB time exceeded 120 minutes. The overall incidence of Reexploration following open heart surgery was 1.38% (7/25). Among the patients to underwent Reexploration. Patients who underwent open Heart Surgery accounted for 29.16% (7/25) of patients. The incidence of Mortality in this group Pon. A. Rajarajan. Incidence of reexploration in cardiac surgery under cardiopulmonary bypass at Government Mohan Kumaramangalam Medical College Hospital, Salem. IAIM, 2019; 6(4): 20-25. Page 21 was 28.57% (2/7) of patients. Among the 7 patients who had Reexploration 71.4% (5/7 of patients had an uneventful course after Reexploration). 7 Patients who had valve replacement surgery accounted for among the total of 25 patients who had an undergone Reexploration accounting for 29.1% of all cases of Reexploration. 71.4% (5/7) who had undergone Mitral Valve replacement patients accounted for 71.4% (5/7) of Reexploration. Aortic valve replacement patients accounted for 14.2% (1/7). Double Valve replacement patients accounted for 14.2% (1/7). Overall Mortality following Reexploration in this group was 71.42% (5/7). 7 Patients who had a Reexploration after Valve replacement Surgery 28.5% (2/7) of the patients were undergoing Mitral Valve Replacement for Restenosis. One patient who was Reexplored for Post-operative bleeding had a Left Ventricle Free Wall rupture following Mitral Valve Replacement. Conclusion: Attention towards meticulous hemostasis prior to closure is Mandatory. A sound surgical technique will reduce the incidence of bleeding from sites of Cannulation and Anastomosis. Adoption OFF PUMP CABG has shown to reduce the incidence of postoperative bleeding and Morbidity when compare to ON PUMPCABG.