ABSTRACT
Objective:The study aimed to evaluate the effect of mild and moderate hemodilution during CPB on the neurocognitive dysfunction in patients undergoing coronary artery bypass grafting. Design: A randomized clinical study. Setting: Cardiac center. Patients: 186 patients scheduled for cardiac surgery with cardiopulmonary bypass. Intervention: The patients were classified into 2 groups (each = 93), Mild hemodilution group: The hematocrit value was maintained >25% by transfusion of packed?red blood cells plus hemofiltration during CPB. Moderate hemodilution group: the hematocrit value was maintained within the range of 21?25%. Measurements: The monitors included the hemofiltrated volume, number of transfused packed red blood cells, and the incidence of postoperative cognitive dysfunction. Main Results: The hemofiltrated volume during CPB was too much higher with mild hemodilution compared to the moderate hemodilution (p = 0.001). The number of the transfused packed red blood cells during CPB was higher with mild hemodilution compared to the moderate hemodilution (p = 0.001), but after CPB, the number of the transfused packed red blood cells was lower with the mild hemodilution group than the moderate hemodilution (p = 0.001). The incidence of total postoperative neurological complications was significantly lower with the mild hemodilution group than moderate hemodilution (p = 0.033). The incidence of neurocognitive dysfunction was significantly lower with mild hemodilution group than moderate hemodilution (p = 0.042). Conclusions: The mild hemodilution was associated with a significant decrease in the incidence of neurocognitive dysfunction compared to moderate hemodilution in patients undergoing coronary artery bypass grafting. Also, the transfused packed red blood cells increased during CPB and decreased after CPB with the mild hemodilution than moderate hemodilution.
ABSTRACT
Aims: This study aims to evaluate benefit and safety compared dual antiplatelet therapy with single aspirin therapy after coronary artery bypass grafting. Study Design: A systematic review and Meta-analysis. Place and Duration of Study: Medline, Embase, ScienceDirect and Cochrane Library databases were searched for randomized controlled trials or observational studies focusing on anticoagulant therapy after coronary artery bypass grafting until December 2014. Methodology: Endpoints included postoperative mortality, bleeding events, myocardial infraction, stroke, repeat revascularization and graft occlusion. All these endpoints were compared between dual antiplatelet therapy and single aspirin therapy. Newcastle-Ottawa and Jadal scale were used to assess the quality of observational studies and randomized controlled trials respectively. Software R2.15.2 was utilized for Meta-analysis. Results: 15 studies composed of 31,365 patients were included. Compared with single aspirin therapy, dual antiplatelet therapy resulted in reducing risk of vein graft occlusion (OR=0.53, 95%CI 0.36-0.81, P=0.001), but no significant difference for artery graft occlusion (OR=0.91, 95%CI 0.39-2.12, P=0.882), Risk of postoperative mortality (OR=0.57, 95%CI 0.38-0.85, P=0.006) and repeat revascularization (OR=0.15, 95%CI 0.05-0.45, P=0.001) was also reduced. There were no significant difference for MI (OR=0.77, 95%CI 0.55-1.09, P=0.137), Stroke (OR=0.85, 95%CI 0.60-1.19, P=0.330) and bleeding (OR=0.95, 95%CI 0.82-1.09, P=0.465). In subgroup analysis of off-pump CABG, dual antiplatelet therapy reduced risk of graft occlusion (OR=0.49, 95%CI 0.30-0.82, P=0.006), MI (OR=0.28, 95%CI 0.11-0.72, P=0.009), mortality (OR=0.39, 95%CI 0.25-0.60, P<0.001), and did not increase risk of bleeding (OR=0.75, 95%CI 0.55-1.02, P=0.066). Conclusions: Dual antiplatelet therapy reduced risk of postoperative graft occlusion and mortality in the early and late postoperative phase after CABG. It appeared to be more beneficial for off-pump CABG.
ABSTRACT
Objective To analyze the risk factors of hypoxemia after coronary artery bypasses grafting (CABG) along with cardiopulmonary bypasses and to understand the regular pattern and characteristics of hypoxemia after CABG. Methods The risk factors of hypoxemia were studied by one way analysis and multivariate logistic regression analysis in 86 patients with hypoxemia after CABG along with cardiopulmonary bypass. Results One way analysis indicated that hypoxemia after CABG along with cardiopulmonary bypass was related to senility ( ≥ 65 years ), smoking history, diabetes mellitus, chronic obstructive pulmonary disease ( COPD), left ventricular ejection fraction ( LVEF ＜ 45 % ), obesity before operation, transfusion ( ≥ 1000 ml );multivariate analysis indicated that pulmonary dysfunction before operation, longer extracorporeal circulation time ( ≥2 h), hypoalbuminemia and pulmonary infection were independent risk factors of hypoxemia after CABG along with cardiopulmonary bypass. Conclusion Multiple risk factors contributed to hypoxemia after CABG along with cardiopulmonary bypass. Increase the awareness of risk factors of perioperative hypoxemia may guide the prevention and treatment, even alleviate or avoid the hypoxemia postoperatively.