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1.
J Cardiothorac Surg ; 16(1): 182, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167559

RESUMO

BACKGROUND: The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. CASE PRESENTATION: A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. CONCLUSION: The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.


Assuntos
Ponte de Artéria Coronária/métodos , Estenose Coronária/cirurgia , Endocardite/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Cirurgia Vídeoassistida/métodos , Idoso , COVID-19/epidemiologia , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/instrumentação , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Pandemias , Complicações Pós-Operatórias , Reoperação , SARS-CoV-2 , Toracotomia/efeitos adversos , Toracotomia/instrumentação , Toracotomia/métodos , Cirurgia Vídeoassistida/efeitos adversos
2.
J Cardiothorac Surg ; 16(1): 173, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127023

RESUMO

BACKGROUND: Despite the steady improvements in survival and operative safety, postoperative complications still remain a significant cause of morbidity and mortality after coronary artery bypass grafting (CABG). However, less is known on the impact of postoperative complications on health-related quality of life (QoL). The main objective of our study was to investigate the impact of postoperative complications on long-term QoL and survival after CABG surgery. METHODS: Data of 508 patients, who underwent isolated CABG was prospectively collected. The RAND-36 Health Survey (RAND-36) was used to evaluate patients' QoL status preoperatively, 1 year and 12 years after the surgery. Predefined postoperative complications were reported during primary and secondary hospital stay. QoL and survival analysis were performed primarily on three patient groups: patients with and without complications and patients with major adverse cardiac and cerebrovascular events (MACCE). RESULTS: In total 205(40%) of 508 patients had at least one postoperative complication and 73 (14%) experienced MACCE. Patients' thirty-day, 1-year and 10-year survival rates were, 99, 98, 84% without complications, 97, 95, 72% with complications, and 90, 89, 64% with MACCE, respectively (log-rank p < 0.001). Patients without complications showed significant(p < 0.05) improvements in seven and patients with complications in five out of eight RAND-36 QoL dimensions. All patient groups showed significant improvements in RAND-36 summary scores compared with preoperative values. Patients with complications and especially with MACCE had more profound decline in their RAND-36 summary scores while patients without complications maintained their health status best. CONCLUSIONS: Despite the constant deterioration, both patients with and without complications showed improvements even 12 years after CABG compared with preoperative state. Postoperative complications and especially MACCE were associated with impaired long-term QoL.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Complicações Pós-Operatórias , Qualidade de Vida , Idoso , Transtornos Cerebrovasculares/etiologia , Cardiopatias/etiologia , Cardiopatias/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos
3.
Angiol Sosud Khir ; 27(2): 114-120, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166351

RESUMO

Annually, up to 850 000 coronary aortic bypass graft operations are performed worldwide. Despite modern technical equipment ensuring a high level of safety of the procedure, currently important remains a problem related to intraoperative myocardial damage in using artificial circulation. Early detection and clinical assessment of myocardial ischaemia often present a difficult task. This article deals with clinical, instrumental and laboratory methods of diagnosis, aimed at verification of an intraoperative cardiac lesion associated with graft dysfunction in coronary artery bypass grafting. Isolated electrocardiographic and echocardiographic signs of myocardial ischaemia between the comparison groups did not differ significantly. Analysing the markers of myocardial lesions, statistically significant differences were obtained only after 48 hours which, from the point of view of saving viable myocardium, is an utterly long-term interval. Studying the findings of intraoperative flowmetry showed statistically significant dependence between velocity characteristics, pulse index of shunts and their patency on angiographic examination. Thus, only combination of diagnostic parameters makes it possible to detect myocardial damage related to shunt dysfunction. This enables early determination of indications for performing bypass angiography and selection of the required therapeutic policy. Timely coronary artery angiography makes it possible to reveal defects of shunts and to timely perform surgical correction, preventing myocardial infarction.


Assuntos
Infarto do Miocárdio , Isquemia Miocárdica , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Humanos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Reologia
4.
J Cardiothorac Surg ; 16(1): 123, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941221

RESUMO

BACKGROUND: Advantages of multiple arterial conduits for coronary artery bypass grafting (CABG) have been reported previously. We aimed to evaluate the mid-term outcomes of multiple arterial CABG (MABG) among patients with mild to moderate left ventricular systolic dysfunction (LVSD). METHODS: This multicenter study using propensity score matching took place from January 2013 to June 2019 in Jiangsu Province and Shanghai, China, with a mean and maximum follow-up of 3.3 and 6.8 years, respectively. We included patients with mild to moderate LVSD, undergoing primary, isolated multi-vessel CABG with left internal thoracic artery. The in-hospital and mid-term outcomes of MABG versus conventional left internal thoracic artery supplemented by saphenous vein grafts (single arterial CABG) were compared. The primary end points were death from all causes and death from cardiovascular causes. The secondary end points were stroke, myocardial infarction, repeat revascularization, and a composite of all mentioned outcomes, including death from all causes (major adverse events). Sternal wound infection was included with 6 months of follow-up after surgery. RESULTS: 243 and 676 patients were formed in MABG and single arterial CABG cohorts after matching in a 1:3 ratio. In-hospital death was not significantly different (MABG 1.6% versus single arterial CABG 2.2%, p = 0.78). After a mean (±SD) follow-up time of 3.3 ± 1.8 years, MABG was associated with lower rates of major adverse events (HR, 0.64; 95% CI, 0.44-0.94; p = 0.019), myocardial infarction (HR, 0.39; 95% CI, 0.16-0.99; p = 0.045) and repeat revascularization (HR, 0.42; 95% CI, 0.18-0.97; p = 0.034). There was no difference in the rates of death, stroke, and sternal wound infection. CONCLUSIONS: MABG was associated with reduced mid-term rates of major adverse events and cardiovascular events and may be the procedure of choice for patients with mild to moderate LVSD requiring CABG.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Disfunção Ventricular Esquerda/complicações , Idoso , Ponte de Artéria Coronária/efeitos adversos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Artéria Torácica Interna/transplante , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Pontuação de Propensão , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Veia Safena/transplante , Acidente Vascular Cerebral/etiologia , Infecção da Ferida Cirúrgica/etiologia , Sístole , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia
5.
JAMA ; 325(19): 1955-1964, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: covidwho-1258005

RESUMO

Importance: It is uncertain whether coronary artery bypass grafting (CABG) is associated with cognitive decline in older adults compared with a nonsurgical method of coronary revascularization (percutaneous coronary intervention [PCI]). Objective: To compare the change in the rate of memory decline after CABG vs PCI. Design, Setting, and Participants: Retrospective cohort study of community-dwelling participants in the Health and Retirement Study, who underwent CABG or PCI between 1998 and 2015 at age 65 years or older. Data were modeled for up to 5 years preceding and 10 years following revascularization or until death, drop out, or the 2016-2017 interview wave. The date of final follow-up was November 2017. Exposures: CABG (including on and off pump) or PCI, ascertained from Medicare fee-for-service billing records. Main Outcomes and Measures: The primary outcome was a summary measure of cognitive test scores and proxy cognition reports that were performed biennially in the Health and Retirement Study, referred to as memory score, normalized as a z score (ie, mean of 0, SD of 1 in a reference population of adults aged ≥72 years). Memory score was analyzed using multivariable linear mixed-effects models, with a prespecified subgroup analysis of on-pump and off-pump CABG. The minimum clinically important difference was a change of 1 SD of the population-level rate of memory decline (0.048 memory units/y). Results: Of 1680 participants (mean age at procedure, 75 years; 41% female), 665 underwent CABG (168 off pump) and 1015 underwent PCI. In the PCI group, the mean rate of memory decline was 0.064 memory units/y (95% CI, 0.052 to 0.078) before the procedure and 0.060 memory units/y (95% CI, 0.048 to 0.071) after the procedure (within-group change, 0.004 memory units/y [95% CI, -0.010 to 0.018]). In the CABG group, the mean rate of memory decline was 0.049 memory units/y (95% CI, 0.033 to 0.065) before the procedure and 0.059 memory units/y (95% CI, 0.047 to 0.072) after the procedure (within-group change, -0.011 memory units/y [95% CI, -0.029 to 0.008]). The between-group difference-in-differences estimate for memory decline for PCI vs CABG was 0.015 memory units/y (95% CI, -0.008 to 0.038; P = .21). There was statistically significant increase in the rate of memory decline after off-pump CABG compared with after PCI (difference-in-differences: mean increase in the rate of decline of 0.046 memory units/y [95% CI, 0.008 to 0.084] after off-pump CABG), but not after on-pump CABG compared with PCI (difference-in-differences: mean slowing of decline of 0.003 memory units/y [95% CI, -0.024 to 0.031] after on-pump CABG). Conclusions and Relevance: Among older adults undergoing coronary revascularization with CABG or PCI, the type of revascularization procedure was not significantly associated with differences in the change of rate of memory decline.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Transtornos da Memória/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Cognitivas Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos Retrospectivos
6.
Vasc Health Risk Manag ; 17: 211-226, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34040381

RESUMO

Background: In-hospital mortality after emergency coronary artery bypass grafting (CABG) remains an important issue that has needed considerable attention in recent years as the mortality rate is still high and prevention factors are not yet optimal. Our study presents the first largest cohort of emergency CABG from one large institution in Vietnam with the primary aim of comparing a large variety of pre-, intra-and post-operative parameters between in-hospital mortality patients and in-hospital survival patients and investigate risk factors of in-hospital mortality in patients undergoing emergency CABG. Methods: We conducted a retrospective evaluation of prospectively collected data in patients undergoing emergency CABG at the Hanoi Heart Hospital (Hanoi, Vietnam) from January 1, 2017, to December 31, 2019. Primary outcome variable was in-hospital mortality. Results: A total of 71 patients were included in final analysis. The mean age of the cohort was 68.68 years (± 9.28, range 38-86). The mean weight, height and body mass index were 54.35 kg (± 9.17, range 37-77), 158.96 (±7.64, range 145-179) and 21.48 kg/m2 (±3.08, range 13.59-30.08), respectively. In-hospital mortality rate was 9.86%. Preoperative risk factors for in-hospital mortality included diabetes, decreased ejection fraction (EF), EF below 30%, cardiogenic shock, elevated systolic pulmonary artery pressure (PAP), elevated NT-ProBNP, and Euroscore II. Without grafting with left internal thoracic artery, and prolonged cardiopulmonary bypass (CPB) time were increased intraoperative factors for in-hospital mortality risk. In-hospital mortality's postoperative risk factors were found to be postextubation respiratory failure requiring mechanical ventilation, ventricular fibrillation, dialysis-requiring acute renal failure, pneumonia, bacterial sepsis, gastrointestinal bleeding, and prolonged mechanical ventilation time. Significant predictors determining in-hospital mortality were known as prolonged CPB time in surgery and postoperative ventricular fibrillation. Conclusion: Our hospital mortality rate after emergency CABG was relatively high. An optimal preventive strategy in emergency CABG management should target significant factors combined with other previously identified risk factors to reduce in-hospital mortality.


Assuntos
Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/cirurgia , Países em Desenvolvimento , Recursos em Saúde/provisão & distribuição , Mortalidade Hospitalar , Adulto , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/mortalidade , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Vietnã
7.
J Cardiothorac Surg ; 16(1): 139, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022927

RESUMO

BACKGROUND: Management of patients treated with Ticagrelor is challenging, as stopping Ticagrelor prior to coronary bypass graft surgery (CABG) may increase the risk of acute stent thrombosis. The aim of the study was to compare bleeding complications in patients treated with ticagrelor combined with acetylsalicylic acid (ASA) versus ASA alone until 1 day before surgery. METHODS: Bleeding complications, defined as the composite of red blood cell transfusion ≥1000 ml, chest drainage ≥2000 ml, and bleeding requiring surgical re-exploration, were compared in 161 patients, with 101 on preoperative acetylsalicylic acid (ASA) alone (group A) and 65 on ticagrelor + ASA (group B). RESULTS: There were no differences in bleeding complications between the two groups (26% vs. 27% in group A and B, respectively), with similar chest drainage in the first 24 h (569 ± 393 ml and 649 ± 427 ml, respectively). CONCLUSIONS: Continuing ticagrelor until coronary artery bypass surgery was not associated with increased bleeding complications, suggesting that continued management with ticagrelor until surgery may be safe.


Assuntos
Aspirina/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Hemorragia Pós-Operatória/etiologia , Ticagrelor/uso terapêutico , Idoso , Drenagem , Quimioterapia Combinada , Transfusão de Eritrócitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/cirurgia , Estudos Retrospectivos , Stents/efeitos adversos , Cavidade Torácica , Trombose/etiologia , Trombose/prevenção & controle
8.
JAMA ; 325(19): 1955-1964, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34003225

RESUMO

Importance: It is uncertain whether coronary artery bypass grafting (CABG) is associated with cognitive decline in older adults compared with a nonsurgical method of coronary revascularization (percutaneous coronary intervention [PCI]). Objective: To compare the change in the rate of memory decline after CABG vs PCI. Design, Setting, and Participants: Retrospective cohort study of community-dwelling participants in the Health and Retirement Study, who underwent CABG or PCI between 1998 and 2015 at age 65 years or older. Data were modeled for up to 5 years preceding and 10 years following revascularization or until death, drop out, or the 2016-2017 interview wave. The date of final follow-up was November 2017. Exposures: CABG (including on and off pump) or PCI, ascertained from Medicare fee-for-service billing records. Main Outcomes and Measures: The primary outcome was a summary measure of cognitive test scores and proxy cognition reports that were performed biennially in the Health and Retirement Study, referred to as memory score, normalized as a z score (ie, mean of 0, SD of 1 in a reference population of adults aged ≥72 years). Memory score was analyzed using multivariable linear mixed-effects models, with a prespecified subgroup analysis of on-pump and off-pump CABG. The minimum clinically important difference was a change of 1 SD of the population-level rate of memory decline (0.048 memory units/y). Results: Of 1680 participants (mean age at procedure, 75 years; 41% female), 665 underwent CABG (168 off pump) and 1015 underwent PCI. In the PCI group, the mean rate of memory decline was 0.064 memory units/y (95% CI, 0.052 to 0.078) before the procedure and 0.060 memory units/y (95% CI, 0.048 to 0.071) after the procedure (within-group change, 0.004 memory units/y [95% CI, -0.010 to 0.018]). In the CABG group, the mean rate of memory decline was 0.049 memory units/y (95% CI, 0.033 to 0.065) before the procedure and 0.059 memory units/y (95% CI, 0.047 to 0.072) after the procedure (within-group change, -0.011 memory units/y [95% CI, -0.029 to 0.008]). The between-group difference-in-differences estimate for memory decline for PCI vs CABG was 0.015 memory units/y (95% CI, -0.008 to 0.038; P = .21). There was statistically significant increase in the rate of memory decline after off-pump CABG compared with after PCI (difference-in-differences: mean increase in the rate of decline of 0.046 memory units/y [95% CI, 0.008 to 0.084] after off-pump CABG), but not after on-pump CABG compared with PCI (difference-in-differences: mean slowing of decline of 0.003 memory units/y [95% CI, -0.024 to 0.031] after on-pump CABG). Conclusions and Relevance: Among older adults undergoing coronary revascularization with CABG or PCI, the type of revascularization procedure was not significantly associated with differences in the change of rate of memory decline.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Transtornos da Memória/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Cognitivas Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos Retrospectivos
9.
J Clin Anesth ; 72: 110309, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33915411

RESUMO

STUDY OBJECTIVE: Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac valve- or coronary artery bypass (CABG) surgery and is associated with increased mortality. While it is known that prolonged postoperative invasive ventilation triggers POAF, the impact of ventilatory settings on POAF development has not been studied yet. DESIGN: Prospective observational study. SETTING: Postoperative Intensive Care Unit. PATIENTS: Patients having undergone elective CABG and/or cardiac valve surgery. MEASUREMENTS: Screening for the development of POAF. Patients' clinical data and postoperative ventilatory settings (driving pressure, controlled pressure above positive endexpiratory pressure (PEEP), respiration rate, and FiO2) were investigated to elucidate their impact on POAF. MAIN RESULTS: Out of 441 enrolled individuals, a total of 192 participants developed POAF (43.5%). We observed that POAF patients received a higher peak driving pressure, and a higher peak respiration rate than non-POAF individuals. Within the multivariate regression model, plateau pressure (adjusted OR 1.199 [1.038-1.661], p = 0.019), driving pressure (adjusted OR 1.244 [1.103-1.713], p = 0.021), and peak respiration rate (adjusted OR 1.206 [1.005-1.601], p = 0.040) proved to be independently associated with the development of POAF. CART analysis revealed a cut-off of ≥17.5 cmH2O of plateau pressure, ≥11.5 cmH2O of driving pressure and ≥ 17 respirations per minute as high-risk for POAF development. CONCLUSIONS: The ventilatory settings of plateau pressure, driving pressure, and respiration rate after cardiac surgery influence POAF occurrence probability. Optimized postoperative care such as lung-protective ventilation and increased awareness towards postoperative ventilatory efforts should be considered to prevent POAF development and poor patient outcome.


Assuntos
Fibrilação Atrial , Procedimentos Cirúrgicos Cardíacos , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Fatores de Risco
10.
Nutr Metab Cardiovasc Dis ; 31(5): 1349-1356, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33812732

RESUMO

AIM: Coronary artery bypass graft (CABG) using autologous saphenous vein continues to be a gold standard procedure to restore the supply of oxygen-rich blood to the heart muscles in coronary artery disease (CAD) patients with or without type 2 diabetes mellitus (T2DM). However, CAD patients with T2DM are at higher risk of graft failure. While failure rates have been reduced through improvements in procedure-related factors, much less is known about the molecular and cellular mechanisms by which T2DM initiates vein graft failure. This review gives novel insights into these cellular and molecular mechanisms and identifies potential therapeutic targets for development of new medicines to improve vein graft patency. DATA SYNTHESIS: One important cellular process that has been implicated in the pathogenesis of T2DM is protein O-GlcNAcylation, a dynamic, reversible post-translational modification of serine and threonine residues on target proteins that is controlled by two enzymes: O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA). Protein O-GlcNAcylation impacts a range of cellular processes, including trafficking, metabolism, inflammation and cytoskeletal organisation. Altered O-GlcNAcylation homeostasis have, therefore, been linked to a range of human pathologies with a metabolic component, including T2DM. CONCLUSION: We propose that protein O-GlcNAcylation alters vascular smooth muscle and endothelial cell function through modification of specific protein targets which contribute to the vascular re-modelling responsible for saphenous vein graft failure in T2DM.


Assuntos
Glicemia/metabolismo , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus Tipo 2/complicações , Oclusão de Enxerto Vascular/etiologia , Processamento de Proteína Pós-Traducional , Veia Safena/transplante , Animais , Biomarcadores/sangue , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Glicosilação , Oclusão de Enxerto Vascular/metabolismo , Oclusão de Enxerto Vascular/patologia , Oclusão de Enxerto Vascular/prevenção & controle , Humanos , Processamento de Proteína Pós-Traducional/efeitos dos fármacos , Medição de Risco , Fatores de Risco , Veia Safena/metabolismo , Veia Safena/patologia , Falha de Tratamento , Remodelação Vascular
11.
J Cardiothorac Surg ; 16(1): 103, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882969

RESUMO

BACKGROUND: An estimated 20% of allogeneic blood transfusions in the United States are associated with cardiac surgery. It is estimated that 11% of red cell resources were used for transfusion support of patients undergoing coronary artery bypass grafting (CABG) with a documented wide variability in transfusion rate (7.8 to 92.8%). To address the issue of unnecessary transfusions within the CABG population, we developed a model to predict which patients are at low risk of bleeding for whom transfusion treatment might be considered unnecessary. Herein we present our "SHOULD-NOT-BLEED-SCORE" application developed for the Windows® software platform which is based on our previous research. METHODS: This study is aimed to develop a user-friendly application that stratifies patients with respect to bleeding risk. The statistical model we used in our previous research was focused on detection of CABG patients at low risk of bleeding. The rationale behind such an approach was to identify a CABG patient subgroup at low risk of bleeding. By identifying patients at low risk of bleeding we can define a subgroup of patients for whom transfusion treatment might be considered unnecessary. We developed a Windows platform application based on risk modelling which we previously calculated for 1426 patients undergoing elective CABG from January 2010 to January 2018. RESULTS: The SHOULD-NOT-BLEED-SCORE risk score is developed for the Windows software platform. A mathematical model that is based on multivariate analysis was used for app development. The variables that entered the scoring system were: Age; Body Mass Index; Chronic Renal Failure; Preoperative Clopidogrel Exposure; Preoperative Red Blood Cells Count; Preoperative Fibrinogen Level; Preoperative Multiplate ASPI test area under the curve (AUC) units. The SHOULD-NOT-BLEED-SCORE identifies/predicts patients without a risk for excessive bleeding with strong discriminatory performance (Receiver Operating Curve (ROC) analysis AUC 72.3%, p < 0.001). CONCLUSION: The SHOULD-NOT-BLEED risk scoring application may be useful in the preoperative risk screening process. The clinical and economic burden associated with unnecessary transfusions may be adequately addressed by a preoperative scoring system detecting patients at low risk of bleeding for whom transfusion treatment might be considered unnecessary.


Assuntos
Transfusão de Sangue , Procedimentos Cirúrgicos Cardíacos/métodos , Clopidogrel/uso terapêutico , Ponte de Artéria Coronária/efeitos adversos , Hemorragia , Hemorragia Pós-Operatória/etiologia , Adulto , Idoso de 80 Anos ou mais , Área Sob a Curva , Humanos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estados Unidos , Procedimentos Cirúrgicos Vasculares
12.
Angiol Sosud Khir ; 27(1): 143-150, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825741

RESUMO

BACKGROUND: According to a series of studies, performing coronary endarterectomy in direct myocardial revascularization increases the risk of myocardial infarction and in-hospital mortality. There are no commonly accepted indications for carrying out endarterectomy, and in clinical practice this technique is used in severe diffuse lesions of coronary arteries. AIM: The study was aimed at assessing in-hospital clinical outcomes of coronary artery bypass grafting (CABG) with the use of endarterectomy in patients with severe multiple diffuse lesions of coronary arteries. PATIENTS AND METHODS: This was a single-centre retrospective study enrolling a total of 205 patients presenting with multiple diffuse lesions and subjected to CABG procedures. Of these, after excluding those with severe concomitant pathology (n=28), 177 were enrolled and divided into 2 groups: 76 patients during formation of a coronary anastomosis were subjected to forced endarterectomy from the native channel (Group 1, n=76) and the remaining patients to prolonged anastomosis and/or bypass grafting of distal branches of the diffusely damaged artery (Group 2, n=101). In-hospital outcomes were analysed in both groups. RESULTS: The demographic and clinical characteristics were comparable by all parameters except for age: Group 1 patients were older (66.3±8.4 vs 63.0±8.5, p<0.05). The groups were comparable by severity of coronary lesions by both the SYNTAX Score and diffuse lesion index. The incidence of perioperative myocardial infarction during coronary endarterectomy (Group 1) amounted to 9.2% (7/71) and in the group without endarterectomy (Group 2) to 0. There were no cases of in-hospital mortality in either group. CONCLUSION: In severe diffuse coronary lesions, endarterectomy combined with CABG makes it possible to perform adequate myocardial revascularization. Performing endarterectomy from coronary arteries is associated with an increased risk for the development of myocardial infarction, but its use is justified if it is impossible to create an anastomosis by means of other techniques.


Assuntos
Doença da Artéria Coronariana , Vasos Coronários , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Endarterectomia/efeitos adversos , Hospitais , Humanos , Estudos Retrospectivos , Resultado do Tratamento
13.
Angiol Sosud Khir ; 27(1): 151-157, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825742

RESUMO

AIM: To assess in-hospital outcomes of coronary artery bypass grafting in patients with acute coronary syndrome, depending on the presence or absence of myocardial infarction. PATIENTS AND METHODS: Over the period from 2017 to 2018 within the framework of a single-centre register, the study enrolled a total of 166 consecutive patients admitted with non-ST segment elevation acute coronary syndrome and subjected to coronary artery bypass grafting. Depending on the outcome of acute coronary syndrome, the patients were divided into 2 groups: Group One included 98 (59%) patients with unstable angina pectoris and Group Two comprised 68 (41%) patients with myocardial infarction, who underwent surgery at an average of 16 (11; 20) days after manifestation of the clinical signs of myocardial infarction. The endpoints of the study were major adverse cardiovascular events during the in-hospital period: death, myocardial infarction, acute cerebral circulation impairment/transitory ischaemic attack, repeat revascularization, septic complications, multiple organ failure syndrome, wound infectious complications, requirement for repeated surgical debridement, remediastinotomy due to haemorrhage, the frequency of extracorporeal membrane oxygenation and renal replacement therapy. RESULTS: The mortality rate in the compared groups was similar: 3% (n=3) and 3% (n=2), respectively. Perioperative myocardial infarction occurred in 1 (1%) patient of the first group, with no cases of this complication observed in the second group. The frequency of reoperations due to haemorrhage in the early postoperative period in the group of unstable angina pectoris amounted to 3% (n=3) and was associated with administration of dual antithrombotic therapy, with no cases of this complication in the group of myocardial infarction. Wound complication in the second group were observed in 7.6% (n=5) and in the first group in 4% (n=4) (p=0.33). The differences turned out to be statistically insignificant for such postoperative complications as multiple organ failure syndrome, requirement for repeated surgical debridement, renal replacement therapy, and extracorporeal membrane oxygenation. The residual SYNTAX Score in the group of myocardial infarction amounted to 2.3±2.8, whereas in the group of unstable angina pectoris to 2.3±3, thus suggesting complete revascularization in the total sample of patients with acute coronary syndrome. The average length of hospital stay (including the postoperative period) in the first group amounted to 26.3±6.6 days and in the second group to 27.4±7.2 days (p=0.53). The postoperative bed-day in the group with unstable angina pectoris was 12.6±3.2 and in the myocardial infarction group - 14.9±5.3 (p=0.06). CONCLUSION: The obtained in-hospital outcomes suggest that coronary artery bypass grafting may be an efficient and safe method of complete revascularization for patients with non-ST-elevation acute coronary syndrome, including that resulting in myocardial infarction, performed averagely on day 16 (11; 20) after the onset of clinical manifestations of myocardial infarction.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Angina Instável/complicações , Angina Instável/diagnóstico , Ponte de Artéria Coronária/efeitos adversos , Hospitais , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico
14.
J Clin Anesth ; 71: 110235, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33774438

RESUMO

STUDY OBJECTIVE: To determine the prognostic value of the change in intraoperative BDNF (Brain-derived neurotrophic factor) levels during cardiac surgery with cardiopulmonary bypass (CPB) on early perioperative neurocognitive disorder (PND). DESIGN: Prospective observational pilot study. SETTING: The study was performed in the Medical Faculty Hospital, from January 2020 to August 2020. PATIENTS: 45 adult patients undergoing elective coronary artery bypass surgery (CABG) with CPB. INTERVENTIONS: None. MEASUREMENTS: Cognitive function was evaluated 1 day before and 4 days after the surgery. Serum BDNF levels were measured at four time points (T1: after induction; T2: with aortic cross-clamp; T3: without aortic cross-clamp; T4: 4 days after surgery) by enzyme-linked immunosorbent assay. MAIN RESULTS: The incidence of PND was 37.8% four days after surgery. Serum BDNF (T2 and T4) levels were significantly lower in PND group compared to non- PND group (p = 0.003 and p = 0.016, respectively). Moreover, lactate, rSO2 (regional cerebral oxygen saturation), aortic cross-clamp time, CPB duration, and the amount of blood transfusion differed between the groups. Logistic regression analysis identified serum BDNF-T2, age, cross-clamp time, and rSO2-T2 as independent risk factors for PND. Based on the ROC analysis, the area under curve (AUC) of BDNF-T2 concentration for prediction of PND was 0.759 with sensitivity of 71.4% and specificity of 64.7% (p < 0.01). CONCLUSION: Intraoperative BDNF serum levels may be a useful biomarker in predicting PND in patients undergoing CABG surgery. More comprehensive studies is needed in order to confirm the effect of decreasing intraoperative BDNF serum levels on the development of PND. TRIAL REGISTRATION NUMBER: NCT04250935 www.clinicaltrials.gov.


Assuntos
Fator Neurotrófico Derivado do Encéfalo , Ponte de Artéria Coronária , Adulto , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Humanos , Transtornos Neurocognitivos , Projetos Piloto , Estudos Prospectivos
15.
Clin Interv Aging ; 16: 487-495, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33762820

RESUMO

Background: Postoperative delirium (POD) is a serious complication of cardiac surgery. It is an acute neuropsychiatric syndrome. The aim of this study was to analyze the CARDEL Index, composed of advancing age, preoperative glycated hemoglobin and the platelet-to-WBC ratio (PWR) previously described and calculated, using a different patient database, to assess its usefulness as a marker for predicting postoperative delirium after coronary artery by-pass grafting (CABG). Methods: A retrospective analysis of 1098 patients who underwent, isolated CABG procedures between 2017 and 2019 was performed. Results: Within the study group, 164/1098 (14.93%) patients were diagnosed with delirium. Preoperative inflammatory parameters were elevated in patients with delirium: White Blood Cell count (p=0.003), Neutrophil count (p=0.016) and C-reactive protein (p<0.001). A decrease in preoperative PWR was shown in patients with delirium (p=0.008). Delirious patients spent more time mechanically ventilated (p<0.001) and had longer hospitalization times (p=0.002). Mortality at 1 year was significantly higher in patients with POD (p<0.001). The CARDEL Index in this study group for POD detection has the largest area under the curve (AUC) of 0.664 (p<0.001) and a cut-off value of 8.08. Conclusion: CARDEL Index may be treated as a potentially valuable tool for delirium prediction in patients after CABG.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Delírio/sangue , Delírio/etiologia , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
16.
ANZ J Surg ; 91(6): 1266-1270, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33724651

RESUMO

BACKGROUND: Coronary artery bypass grafting (CABG) is a common procedure performed commonly using left internal mammary artery (LIMA). We report a case of sternal wound dehiscence and breast necrosis following LIMA harvest in a 55-year-old obese lady with macromastia, diabetes mellitus, hypertension and end stage renal disease requiring dialysis. We also review the existing literature. METHODS: Publications were identified from Medline All, Web of Science Core Collection, Google Scholar and Cochrane Central Register of Controlled Trial between 1974 and 2 January 2020. We assessed patient co-morbidities, presentation time frame, quadrant of breast necrosis and reconstruction option utilized. RESULTS: There were 18 cases of breast necrosis reported post-CABG. The patients were aged 50 or over, morbidly obese and had large tubular breasts. Other risk factors included chronic renal insufficiency, diabetes and hypertension. The presentation was delayed with necrosis only evident 7 days or more after CABG. All the reported cases had necrosis at lower inner quadrant of the left breast with nipple-areola complex. CONCLUSION: Blood supply to the breast is segmental with considerable overlap, however, this overlap is reduced in large breasts. Patients with macromastia and multiple co-morbidities need preoperative imaging (computed tomography angiogram) to evaluate breast vascularity prior to CABG. Risk of breast necrosis needs to be explained during the informed consent. Surgical management of the hypermastia (breast reduction or amputation) may be a factor in facilitating the CABG procedure if indeed the LIMA is absolutely indicated considering the risks and benefits.


Assuntos
Artéria Torácica Interna , Obesidade Mórbida , Mama/diagnóstico por imagem , Mama/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Humanos , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Necrose/etiologia , Resultado do Tratamento
17.
Medicine (Baltimore) ; 100(10): e25057, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725893

RESUMO

BACKGROUND: The impact of time factor and patient characteristics on the efficacy of percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary-artery bypass grafting (CABG) for left main coronary disease is unclear. METHODS: We searched PubMed and Embase for related trials. Two outcomes of interest were major adverse cardiac or cerebrovascular events (MACCE, defined as a composite of all-cause mortality, myocardial infarction, stroke, or unplanned revascularization) and a composite of all-cause mortality, myocardial infarction, or stroke. We conducted random-effects meta-analysis stratified by follow-up duration and 7 factors of interest related to patient characteristics. Random-effects meta-regression was performed to calculate P values for trend and those for subgroup differences. RESULTS: We included 11 articles from 5 trials. Compared with CABG, PCI increased MACCE at the end of 3-year (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.04-1.40, I2 = 0) and 5-year (HR 1.33, 95% CI 1.20-1.48, I2 = 0) follow-up, but did not increase all-cause mortality, myocardial infarction, or stroke. The logarithm of HR of PCI vs CABG for MACCE increased as follow-up duration increased (ß = 0.057, P = .025). PCI vs CABG consistently increased 5-year MACCE across various subgroups defined by 7 factors of interest (Psubgroup ranged from .156 to .830). CONCLUSIONS: The long-term benefit of CABG vs PCI on MACCE in patients with left main coronary disease is consistent across patients with different clinical characteristics. The relative benefit of CABG on MACCE is driven by that of CABG on unplanned revascularization, and becomes greater as time goes on.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Stents Farmacológicos , Humanos , Intervenção Coronária Percutânea/instrumentação , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Heart Surg Forum ; 24(1): E194-E200, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33635250

RESUMO

BACKGROUND: Inflammation plays a significant role in the pathogenesis of many diseases as well as postoperative acute renal failure (ARF). Preoperative neutrophil to lymphocyte ratio (NLR) values have a prognostic value for postoperative ARF after cardiovascular surgeries. METHODS: Patients who underwent elective coronary artery bypass graft (CABG) with cardiopulmonary bypass in our clinic between December 15, 2015 and December 15, 2019, retrospectively were included in this study. Patients who did not develop ARF after the operation were categorized as Group 1, and patients who did were included in Group 2. NLR was calculated from the hemograms during three periods (Preoperative (Pre), Postcardiotomy (Pc), Postoperative Day 1 (Po1). DeltaNLR1 (PcNLR- PreNLR) and DeltaNLR2 (Po1NLR-PreNLR) values were obtained from these calculated values. RESULTS: The mean ages of patients in Group 1 (N = 274) and Group 2 (N = 61) were 60 ± 9.1 years and 67.7 ± 9.8 years, respectively (P < .001). In the multivariate analysis, being over 65 years of age (Odds ratio [OR]: 1.074, 95% confidence interval [CI]: 1.012-1.194, P = .030), postoperative inotropic need (OR: 0.678, CI 95%: 0.395-0.819, P = .021), increased blood product use (OR: 0.916, CI 95%: 0.779-0.986, P = .034), preoperative creatinine increase (OR: 1.974, CI 95%: 1.389-4.224, P = .007), PcNLR (OR : 1.988, CI 95%: 1.765-3.774, P <.001), Po1NLR (OR: 1.090, CI 95%: 1.007-2.116, P = .028), DeltaNLR1 (OR: 3.090, CI 95%: 1.698-6.430, P < .001) and DeltaNLR2 (OR: 1.676, CI 95%: 1.322-2.764, P = .003) were identified as independent predictors for predicting postoperative ARF. CONCLUSION: In this study, we have shown that peroperative NLR changes can be used as an effective parameter to predict ARF developing following CABG operations.


Assuntos
Injúria Renal Aguda/etiologia , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Linfócitos/patologia , Neutrófilos/patologia , Complicações Pós-Operatórias , Injúria Renal Aguda/sangue , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
19.
Asian Cardiovasc Thorac Ann ; 29(2): 77-83, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33530706

RESUMO

BACKGROUND: Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring. METHODS: This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 (n = 101) had a single dose of del Nido cardioplegia, group 2 (n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 (n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events. RESULTS: Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3. CONCLUSIONS: Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.


Assuntos
Temperatura Baixa , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Eletrólitos/uso terapêutico , Parada Cardíaca Induzida , Lidocaína/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Manitol/uso terapêutico , Cloreto de Potássio/uso terapêutico , Bicarbonato de Sódio/uso terapêutico , Soluções/uso terapêutico , Idoso , Biomarcadores/sangue , Temperatura Baixa/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Eletrólitos/efeitos adversos , Feminino , Glucose/efeitos adversos , Glucose/uso terapêutico , Parada Cardíaca Induzida/efeitos adversos , Humanos , Interleucina-6/sangue , Lidocaína/efeitos adversos , Sulfato de Magnésio/efeitos adversos , Masculino , Manitol/efeitos adversos , Pessoa de Meia-Idade , Readmissão do Paciente , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/terapia , Cloreto de Potássio/efeitos adversos , Procaína/efeitos adversos , Procaína/uso terapêutico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Bicarbonato de Sódio/efeitos adversos , Soluções/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Troponina/sangue
20.
J Stroke Cerebrovasc Dis ; 30(5): 105659, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33621823

RESUMO

BACKGROUND AND PURPOSE: Prior studies examining sex-related risk of readmission for ischemic stroke (IS) after coronary artery bypass grafting (CABG) did not adjust for preoperative comorbidities and used small study samples that were single-center or otherwise poorly generalizable. We assessed risk of readmission for IS after CABG for females compared to males in a nationwide sample. METHODS: The 2013 Nationwide Readmissions Database contains data on 49% of all U.S. hospitalizations. We used population weighting to determine national estimates. Using all follow-up data up to 1 year after discharge from CABG hospitalization, we estimated Kaplan-Meier cumulative risk of IS, stratified by sex, using the log-rank test for significance. We created Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for IS readmission, with sex as the main independent variable. We ran unadjusted models and models adjusted for age, vascular risk factors, estimated severity of illness and risk of mortality, hospital characteristics, and income quartile of patient's zip code. RESULTS: An estimated 53,270 females and 147,396 males survived index CABG admission in 2013. There was a consistently elevated cumulative risk of readmission for IS after CABG for females versus males (log-rank p-value = 0.0014). In the unadjusted Cox model, the HR of IS in females vs. males was 1.35 (95% CI 1.12-1.62, p = 0.0015). The elevated risk for females remained after adjusting for severity of illness (1.30 [1.08-1.56], p = 0.0056) and risk of mortality (1.28 [1.07-1.54], p = 0.0086). This elevated risk persisted after adjusting for multiple vascular risk factors, hospital characteristics, and income quartile of patient's zip code (1.23 [1.02-1.48], p = 0.03). CONCLUSIONS: We found a 23% increased risk of readmission for IS up to 1 year after CABG for females compared to males in a fully adjusted model utilizing a large, contemporary, nationwide database. Further research would clarify mechanisms of this increased risk among women.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , AVC Isquêmico/epidemiologia , Readmissão do Paciente , Idoso , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Bases de Dados Factuais , Feminino , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/mortalidade , Masculino , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
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