role of surface ECG and transthoracic echocardiography for predicting postoperative atrial fibrillation after coronary artery bypass surgery

To evaluate the roles of surface electrocardiogram ECG and transthoracic echocardiography ECHO for prediction of atrial fibrillation AF after coronary artery bypass grafting CABG. This study was conducted from 2002-2004 at the Cardiovascular Department of Hacettepe University, Ankara, Turkey. Seventy consecutive patients were enrolled in this study that underwent elective CABG. A 12-lead ECG was recorded one day before cardiac surgery and was repeated during the 5 days after CABG. P-wave dispersion PWD was defined as the difference between maximum and minimum P-wave duration. Differences in P-wave duration were compared between the pre- and postoperative 12-lead ECG measurements. Postoperative AF developed in 17 24% cases of 70 patients. The PWD was found to be significantly higher in patients with AF preoperatively 60 +/- 19 versus 47 +/- 13, p=0.003, postoperative first day 56 +/- 12 versus 44 +/- 11, p<0.002 and fifth day 51 +/- 29 versus 41 +/- 11, p<0.001. Patients with AF were significantly older, the mean age of the AF group was 68 +/- 7 years and of the sinus rhythm SR group was 59 +/- 10 years p<0.001. The AF group had left ventricular systolic dysfunction 56 +/- 13% versus 56 +/- 8%, p=0.042, preoperatively; 49 +/- 8% versus 60 +/- 10%, p=0.001, postoperatively and a larger left atrium 46 +/- 5 versus 39 +/- 5 mm, p<0.001, preoperatively and 44 +/- 7 versus 39 +/- 5 mm, p=0.046, postoperatively than the SR group. This prospective study demonstrated that PWD on surface ECG and additional echocardiographic parameters are simple and reliable indexes to predict the development of AF after CABG

Protective role of intracoronary shunt in off-pump coronary bypass operations

To investigate if there are any advantages in using intracoronary shunts compared to shuntless operations, in the context of whether it has a protective role for the myocardia. This prospective study, included 100 patients who underwent off-pump coronary bypass surgery at 2 different cardiovascular surgery departments, namely, the Social Security Ankara Ihtisas Hospital, and Hacettepe University Hospital, Turkey, between September 2002 and July 2006. Patients were divided into 2 groups. In group 1 [n=50] off-pump coronary bypass operations were performed with intracoronary shunts. In group 2 [n=50] shunts were not used during off-pump. Serum creatine kinase, myoglobin, and troponin were studied. There were significant increases in serum creatine kinase levels in group 2 at postoperative 6th, 12th, and 24th hours. In group 2, the increase of myoglobin was statistically significant at only the postoperative 24th hour. Troponin levels were significantly higher in group 2 at postoperative 6th, 12th, and 24th hours. There are some questions regarding myocardial protection while maintaining a bloodless secure surgical field in off-pump coronary surgery. However, use of intracoronary shunts provides distal coronary flow, and reduces the risk of myocardial ischemia, while maintaining a comfortable blood free anastomosis area