ABSTRACT
Cardiovascular disease is the leading reason of morbidity in older people. Coronary artery bypass graft [CABG] surgery is the most common type of operations in world. This study was designed to characterize comparison of early clinical outcome following on pump vs. off pump in patients over 70 years old with triple vessels disease and severe left ventricle dysfunction. 80 patients were divided into two groups: In group A [n=40] on pump CABG was performed with hypothermic cardiopulmonary bypass and cold blood cardioplegic arrest and in group B [n=40] the patients had off pump coronary artery bypass [OPCAB] surgery. Exclusion criteria included emergency or urgent operation, combined valve surgery, history of renal insufficiency [Cr >2 mg/dl], stroke. Early postoperative complications such as occurrence, duration and frequency of recurrence of atrial fibrillation were recorded. All patients underwent Holter monitoring after ICU discharge during their hospital stay. The average age of patients was 79.5 +/- 7.5 years. Post operative atrial fibrillation [POAF] occurred in 24 cases [30%]; 17 cases [42.5%] related to on pump CABG group and 7 cases [17.5%] related to OPCAB group [P=0.03]. The frequency of the recurrence of AF in the on pump group was 3.8 +/- 1.3 days and in the off pump group was 2.4 +/- 1.1 days [P=0.02]. ICU stay in on pump group was 3.6 +/- 1.80 days, while for the off pump was 2.5 +/- 0.6 days [P=0.001]. Also hospital stay duration was 8.5 +/- 2.1 days for the on pump group compared to the other group that was 6.34 +/- 1.06 days. Off pump in patients over 70 years old with triple vessels disease and severe LV dysfunction is safer than on pump and can reduce POAF, ICU and hospital stay and some early surgical complications
ABSTRACT
Forced expiratory volume in one second [FEV1] is a good predictor of chronic obstructive pulmonary disease [COPD]. COPD is characterized by a chronic limitation of airflow. This study was designed to compare the effects and complications of theophylline alone, N-acetylcysteine [NAC] alone, and a combination of the two drugs on the rates of FEV1 in patients with COPD who were candidates for off-pump coronary artery bypass graft [CABG] surgery. This clinical trial was performed on 100 patients who had a smoking history of 27 pack years with a range of 20 to 40 pack years but were not heavy smokers and were candidates for elective off-pump CABG surgery in Afshar Cardiovascular Hospital, Yazd, Iran. The patients with a history of asthma and bronchospasm and non-COPD respiratory disorders were excluded. There were three groups, that is, the theophylline group [n=33] that received theophylline 10 mg/kg TDS after consumption of food, NAC group [n=33] who received NAC 10-15 mg/kg BD after consumption of food, and the combined group [n=32] who received theophylline and NAC together. Data were analyzed by analysis of variance [ANOVA], Chi-square, and exact test for quantitative and qualitative variables. One hundred patients with COPD enrolled in this study as possible candidates for CABG surgery. Average age of the patients was 60.36 +/- 10.21 years. Of the participants, 83 [83.3%] were male and 17 [17%] were female. Rate of postoperative FEV1 to basal FEV1 was 0.76 +/- 0.32, 0.66 +/- 0.22, and 0.69 +/- 0.24 in the treatments with theophylline, NAC, and the combination, respectively. Theophylline, NAC, and a combination of these drugs can decrease the rate of postoperative FEV1 compared to basal FEV1 significantly. [P=0.0001] Theophylline alone, NAC alone, and a combination of these drugs improve pulmonary function, and there are no significant differences between these protocols. Stomach discomfort and cardiac complications in treatment with theophylline alone is significantly higher than NAC alone and the combination
Subject(s)
Humans , Female , Male , Coronary Artery Bypass, Off-Pump , Theophylline , Acetylcysteine , Cardiovascular Diseases/surgeryABSTRACT
Renal dysfunction is a risk marker in patients who candidate for coronary artery bypass graft [CABG]. Renal disorder is associated with prolonged stays in intensive care unit and hospital, morbidity and mortality. Aim of this study is specific evaluation of association between preoperative creatinine [Cr] with atrial fibrillation [AF] after elective off-pump CABG in non-diabetic male patients with normal ejection fraction. Two hundred non-diabetic male patients with normal ejection fraction undergoing elective off pump CABG surgery enrolled in this cross-sectional study and were stratified by present or absence of postoperative atrial fibrillation: patients with postoperative new-onset atrial fibrillation [n=100] as group 1 and patients without new-onset postoperative atrial fibrillation as group 2 [n=100]. Preoperative serological test of the participants, such as serum creatinine, were recorded in their medical dossiers. Data were analyzed in SPSS-16 software and tested for association between atrial fibrillation with creatinine level by using student t test, chi-square test or logistic regression. Cr level in patients with and without AF three days before surgery were 1.8 +/- 0.3 and 1.0 +/- 0.4 respectively [P value for Cr=0.00]. On surgical day, mean Cr level in patients with and without AF were 1.6 +/- 0.2 and 1.1 +/- 0.5 respectively [P value for Cr = 0.00]. Of the 100, male patients with postoperative AF, duration and frequency of recurrence of AF were not associated with Cr at three days before surgery and on surgical days [P>0.05]. Patients with postoperative AF had unsuitable status of renal function compare to patients without AF; however, preoperative serum creatinine cannot associate with duration and frequency of recurrence of AF
ABSTRACT
Atrial fibrillation [AF] occurs in 30% patients on the second or third day post operation; therefore, it is the most prevalent and complicated arrhythmia after open heart surgery. White blood cell [WBC] count seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate the exact relationship between preoperative WBC count and post-Coronary artery bypass graft [CABG] AF in patients with severe left ventricle [LV] dysfunction who underwent elective off-pump coronary artery bypass. This study was conducted on 104 patients from among 400 patients with severe LV dysfunction undergoing elective off-pump CABG surgery from February 2011 to February 2012, in Afshar Cardiovascular Center, Yazd, Iran. Patients with emergency surgery, unstable angina creatinine higher than 2.0 mg/dL, malignancy, or immunosuppressive disease were excluded. Preoperative serological tests of the participants, such as WBC counts, were saved in their medical dossiers. Of the 400 patients undergoing CABG, AF was found in 54 cases; these 54 male patients formed the experimental group and 60 other patients in the intensive care unit [ICU] and hospital stay without postoperative AF were part of the control group. The average age of the patients was 68.5 +/- 12.8 years. WBC counts in patients with and without AF three days before surgery were 12,340 +/- 155 and 8,950 +/- 170, respectively. On surgical day, WBC counts in the patients with and without AF were 13,188 +/- 140 and 9,145 +/- 255, respectively [P value three days before surgery: 0.04; P value on surgical day: 0.01]. Of the 54 male patients with postoperative AF [POAF], duration of AF was more in cases with elevated WBC count [12,000-14,000] than in those with lower elevated WBC count [10,000-12,000] [P=0.025], but there was no relationship between frequency of recurrence of AF and grading of elevation of WBC count [P=0.81]. These findings show that three days before surgery and on surgery day, there was a difference in WBC count between both groups. So, preoperative WBC count may predict the incidence and duration of AF; however, it cannot be a predictor of the frequency of recurrence of AF. Finally, WBC count is an independent marker for POAF and duration of AF
Subject(s)
Humans , Male , Leukocyte Count , Thoracic Surgery , Cardiac Surgical Procedures , Preoperative Care , Coronary Artery Bypass, Off-Pump , Cross-Sectional Studies , Prospective StudiesABSTRACT
Diabetic mellitus [DM] is a major risk factor of morbidity, mortality and economic cost to society. Diabetic patients are at risk of having microvascular or macrovascular disorders of diabetes. Postoperative anemia have wide spectrum of some early complications that require more care in hospitalization stays. Therefore, this study was designed to evaluate effect of preoperative anemia on short-term clinical outcomes in diabetic patients undergoing elective off-pump CABG. This study conducted on 86 diabetic patients underwent elective off-pump CABG surgery from August to October 2011, in Afshar Cardiovascular Center, Yazd, Iran. The patients had hemoglobin concentration between 10-12 mg/dl, patients with preoperative atrial fibrillation and renal and respiratory dysfunction were excluded from this study. Participants were randomly assigned into two groups; the normal group [n=42] that had hemoglobin concentration tilde 12-15 g/dl and the anemic group [n=44] had hemoglobin concentration tilde7-10 g/dl. We evaluated post-CABG variables including incidence of atrial fibrillation and early morbidity such as infection, vomiting, renal and respiratory dysfunctions, ICU or hospital stay and early mortality. Data were analyzed by ANOVA, Chi-square and Fisher's exact test for quantitative and qualitative variables. The mean age of the patients was 52.51 +/- 6.9 years, from all of patients 64 cases [74.4%] were male and 22 cases [445.6%] were female. Postoperative a trial fibrillation was observed in 17 cases [19.8%], 7 cases [16.7%] of whom were in normal group and 10 cases [22.7%] of whom were in anemia group. Anemia could significantly increase hospital stay [P=0.0001] but no ICU stay. Preoperative anemia did not affect the incidence of atrial fibrillation and early complications and mortality in patients undergoing off pump CABG. However, anemia could increase postoperative hospital stay and renal dysfunction significantly.
ABSTRACT
Atrial fibrillation [AF] is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. Mitral stenosis [MS] is a structural abnormality of the mitral valve apparatus that can be resulted from previous rheumatic fever or non-rheumatic fever such as congenital mitral stenosis, malignant carcinoid disease etc. This study was designed to test the hypothesis that type of mitral stenosis can affect the incidence, duration and frequency of AF post mitral valve replacement. We selected fifty patients with rheumatic mitral stenosis and 50 patients with non-rheumatic mitral stenosis who were candidates for mitral valve replacement [MVR] surgery. Pre-operative tests such as CRP, ESR, CBC, UA, ANA, APL [IgM, IgG], ANCA, RF were performed on participants' samples and the type of mitral stenosis, rheumatic or non-rheumatic, was determined clinically. Early post-operative complications such as infection, bleeding, vomiting, renal and respiratory dysfunction etc., were recorded. All patients underwent holter monitoring after being out of ICU to the time of discharge. The mean age of patients was 48.56 +/- 17.64 years. 57 cases [57%] were male, and 43 cases [43%] were female. Post-operative AF occurred in 14 cases [14%]; 3 cases [6%] in non-rheumatic mitral stenosis group, and 11 cases [22%] in the rheumatic mitral stenosis group. There was a significant relationship between the incidence of AF and type of mitral stenosis [P = 0.02]. Renal dysfunction after MVR was higher in rheumatic MS group than in non-rheumatic MS group [P = 0.026]. There was no relationship between the type of mitral stenosis [rheumatic or non-rheumatic] and early mortality after mitral valve replacement [P = 0.8]. We concluded that the type of mitral stenosis affect post-operative outcomes, especially the incidence of atrial fibrillation and some complications after mitral valve replacement
ABSTRACT
Atrial fibrillation [AF] is the most common type of arrhythmia following elective off-pump coronary bypass graft [CABG] surgery, occurring on the 2[nd] or 3[rd] postoperative day. Postoperative atrial fibrillation and early complications may be the cause of long term morbidity and mortality after hospital discharge. High sensitive C-reactive protein [hsCRP] seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate whether preoperative hsCRP [>/=3 mg/dl] can predict post-elective off-pump CABG, AF, and early complications in patients with severe left ventricle dysfunction [Ejection Fraction [EF] < 30%]. This study was conducted on 104 patients with severe left ventriclar dysfunction [EF < 30%], undergoing elective off-pump CABG surgery during April to September 2011 at the Afshar Cardiovascular Center in Yazd, Iran. Patients undergoing emergency surgery and those with unstable angina, creatinine higher than 2.0 mg/dl, malignancy, or immunosuppressive disease were excluded from the study. The subjects were divided into two groups: Group I with preoperative increased hsCRP [> 3 mg/dl] [n=51] and group N with preoperative normal hsCRP [< 3 mg/dl] [n=53]. We evaluated post-CABG variables including incidence, duration, and frequency of AF, early morbidity [bleeding, infection, vomiting, renal and respiratory dysfunctions], ICU or hospital stay and early mortality. Data were then analyzed by Analysis of Variance [ANOVA], Chi-square and Fisher exact test for quantitative and qualitative variables. The average age of the patients was 62.5 years, 75 cases [72.1%] were male, and 39 [37.5%] were female. Postoperative AF occurred in 19 cases [18.2%]; 17 cases [33.3%] had hsCRP >/= 3 mg/dl and 2 cases [3.8%] had hsCRP 0.05]. Preoperative hsCRP >/= 3 mg/dl can predict incidence of postoperative atrial fibrillation and early complications such as midsternotomy infection, respiratory dysfunction, and hospital stay following elective off-pump CABG