A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries

Context and Aims: Off-pump coronary artery bypass graft (OPCABG) is a form of CABG surgery. It is performed without the use of cardiopulmonary bypass machine as a surgical treatment for coronary heart disease. Acute kidney injury (AKI) is one of the common postoperative complications of OPCABG. Previous studies suggest important differences related to intravenous fluid (IVF) chloride content and renal function. We hypothesize that perioperative use of chloride restricted IVFs may decrease incidence and severity of postoperative AKI in patients undergoing OPCABG. Methods: Six hundred patients were randomly divided into two groups of 300 each. In Group A (n = 300), chloride liberal IVFs, namely, hydroxyethyl starch (130/0.4) in 0.9% normal saline (Voluven), 0.9% normal saline, and Ringer's lactate were used for perioperative fluid management. In Group B (n = 300), chloride-restricted IVFs, namely, hydroxyethyl starch (130/0.4) in balanced colloid solution (Volulyte) and balanced salt crystalloid solution (PlasmaLyte A), were used for perioperative fluid management. Serum creatinine values were taken preoperatively, postoperatively at 24 h and at 48 h. Postoperative AKI was determined by AKI network (AKIN) criteria. Results: In Group A, 9.2% patients and in Group B 4.6% patients developed Stage-I AKI determined by AKIN criteria which was statistically significant (P < 0.05). Conclusion: Perioperative use of chloride restricted IVF was found to decrease incidence of postoperative AKI. The use of chloride liberal IVF was associated with hyperchloremic metabolic acidosis.

Multiple factors analysis on the recovery of left ventricular ejection fraction in the revascularized patients with ischaemic cardiomyopathy / 中国胸心血管外科临床杂志

@#Objective We probed how to predict left ventricular ejection fraction (LVEF) of the ischaemic cardiomyopathy (ICM) patients would be improved apparently after revascularization. Methods Between July 2010 and December 2015, 245 ICM patients (30%≤LVEF≤40%) with coronary bypass grafting (CABG) were retrospectively observed. Among them, 146 patients were accompanied by ischemic mitral regurgitation (IMR) (146/245, 59.6%), and 41 patients underwent mitral valvuloplasty or replacement because of more than moderate IMR. There were 13 patients early death, and other 232 patients who were followed up over 6 months were divided into two groups based on whether or not post-operative LVEF increased by 10%: a LVEF recovered group (group A, 124 patients) and a non-recovered group (group B, 108 patients). Results Preoperative NT-proBNP in the group A was significantly higher than that in the group B (P=0.036). There were less patients with myocardial infarction in the group A than that in the group B (P=0.047), and more with angina pectoris in the group A than that in the group B (P=0.024). There was no significant difference in the extent of mitral regurgitation or mitral surgery between the groups A and B (P>0.05). There were lower left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic volume (LVEDV) in the group A than those in the group B (P<0.05). Multivariate analysis revealed that preoperative LVEDD dilated apparently and no angina pectoris existed before surgery were independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. The LVEDD of 245 patients (including 13 early deaths) was 41-71 mm. We found that the ICM patients with LVEDD ≥60 mm were more likely to signify the unfavourable prognosis (χ2=8.63, P=0.003, OR=2.21, 95% confidence interval 1.25 to 3.91). Conclusion Preoperative LVEDD dilated and no angina pectoris before surgery are independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. LVEDD≥60 mm can be regarded as the preoperative forecasting factors for the unfavourable prognosis in the ICM patients (30%≤LVEF≤40%) after revascularization.

Alternativas para lograr la revascularización arterial total usando una o ambas arterias mamarias y el remanente distal de una de ellas como únicos injertos / Alternatives to achieve total arterial revascularization using one or both mammary arteries and distal remnant of them as unique grafts

Introducción: Toda cirugía de revascularización miocárdica debe estar dirigida a lograr que el paciente permanezca el mayor tiempo posible sin necesidad de una nueva revascularización. La revascularización arterial total contribuye a alcanzar este propósito. Objetivo: Demostrar que ambas arterias mamarias pueden ser utilizadas, en varias configuraciones, para lograr la revascularización arterial total. Métodos: Se incluyeron 35 pacientes, 29 de género masculino y 6 del femenino, con edad promedio de 54,2 años, a quienes se les revascularizaron una o ambas arterias mamarias, en el período entre enero de 2012 y septiembre de 2014, para un seguimiento medio de 13,1 meses. El valor del Euroscore aditivo fue de 0 para los hombres y 1 para las mujeres. Resultados: Se describieron siete configuraciones para lograr la revascularización arterial total, usando una o ambas arterias mamarias y el remanente distal de una de las arterias mamarias como únicos injertos. No hubo fallecimientos ni complicaciones mayores en los pacientes revascularizados. Seis meses después todos permanecían asintomáticos y sin nuevos signos de isquemia en los territorios revascularizados. Conclusiones: La revascularización arterial total, utilizando una o ambas arterias mamarias y el remanente distal de una de ellas es posible y arroja buenos resultados en pacientes seleccionados.

Introduction: The aim of all coronary artery bypass grafts should be to allow patients to stay as long as possible without the need to repeat revascularization. Total arterial revascularization contributes to achieving these purposes. Objective: To demonstrate that both mammary arteries can be used in various configurations to achieve total arterial revascularization. Methods: 35 patients were included, 29 male and 6 female, with age average of 54.2 years, who were revascularized with one or both mammary arteries in the period between January 2012 and September 2014, with a mean follow-up time of 13.1 months. The additive EuroSCORE was 0 for men and 1 for women. Results: Seven configurations are described to achieve total arterial revascularization using one or both mammary arteries and the distal remnant of a mammary arteries as single grafts. There were no deaths or major complications in patients revascularized. Six months later, all were asymptomatic with no new signs of ischemia in revascularized territories. Conclusions: Total arterial revascularization using one or both mammary arteries and distal remaining one is possible and gives good results in selected patients.

Physical Therapy Program Improves the Physiological Impact Towards Better Quality of Life and Low Cardiac Risk Factors in Patients Following Coronary Artery Bypass Grafting. Systematic Review.

Introduction: Studies suggest that exercise therapy may enhance heart rate variability in myocardial infarction, chronic heart failure and revascularization patients by increasing vagal tone and decreasing sympathetic activity. This review addressed the impact of cardiac rehabilitation programs (CRPs) in post CABG patients on the quality of life, in terms of physical function and cardiac risk factors. Methods: OVID, Science direct, Embase, AMED and Cochrane controlled Trial Register were searched for studies published from 2005 up to 2015. Two reviewers assessed the eligibility of each study based on predefined inclusion criteria. Results: Of 35 abstracts reviewed, 9 studies met the inclusion criteria. All studies compared CRPs of different interventions to a control (non-intervention) group. From the selected 9 studies, 6 studies included interventions compared with control groups (usual or standard care) while 3 studies compared two different intervention strategies with groups and included a no-intervention control group. Conclusion: This systematic review concludes that all types of CRPs lead to improvements in the quality of life and reduction of cardiac risk factors in post CABG patients. However, these improvements were quite varied between the 9 studies according to variations in the components of CRPs.

Left Anterior Descending Coronary Endarterectomy for a Patient with Dextrocardia and Situs Inversus / 日本心臓血管外科学会雑誌

An 80-year-old woman with dextrocardia and situs inversus was admitted with chest pain. She successfully underwent off-pump coronary artery bypass grafting. The free left internal mammary artery (IMA) was anastomosed to the posterior lateral branch and the <i>in-situ </i>right IMA to the left anterior descending artery (LAD). The reconstruction of the LAD was performed with endarterectomy due to a diffusely diseased LAD with severe calcification. Except for the mirror-image anatomy, the surgical technique was similar to that used for patients with situs solitus.

Retiro de "Stents" intracoronarios y cirugía de revascularización miocárdica / Retirada de "Stents" intracoronários e irurgia de revascularização miocárdica / Intracoronay “stents” removal and coronary artery Bypass grafting surgery

Introducción: es cada vez más frecuente la necesidad de retirar “stents” en la cirugía de revascularización. Material y métodos: serie de casos en los que se realiza endarterectomía y retiro de “stents” de vasos coronarios entre el 1 de enero y el 30 de abril del 2011. Se analizó morbilidad, antecedentes y evolución. Resultados: tres pacientes requirieron remoción de “stents”, dos de la descendente anterior y uno de la coronaria derecha, un paciente con infarto del miocardio falleció por choque cardiogénico. Conclusión: La remoción de “stents” en cirugía de revascularización debe considerar se como opción terapéutica en casos bien determinados.

Introdução: Cada vez é mais frequente a necessidade de retirar “stents” na cirurgia de revascularização. Material e métodos: série de casos onde são realizadas endarterectomia e retirada de“stents” de artérias coronárias entre 1 de janeiro e 30 de abril de 2011. Analisou-se morbilidade, antecedentes e evolução. Resultados: três pacientes tiveram remoção de “stents”, dois da artéria descendente anterior e um da coronária direita, um paciente com infarto do miocárdio faleceu por choquecardiogênico. Conclusão: A remoção de “stents” em cirurgia de revascularização deve considerar-se como opção terapêutica em casos bem determinantes.

Introduction: Stent removal is associated to coronary artery by-pass surgery is a more fre-quent procedure. Material and Methods: We present the cases that required endarterectomy, stent removal and coronary artery by-pass surgery between January 1, 2011, and April 30, 2011. We analyzedmedical history, morbidity, and evolution.Results: Three patients required stents removal, two in coronary anterior descending artery and one on right coronary artery. One patient with acute myocardial infarction died, due tocardiogenic shock. Conclusion: It was concluded that stent removal in coronary artery by-pass surgery shouldbe considered as a surgical option in selected cases.

A case report of a carbon dioxide embolism caused by endoscopic vein harvesting during cardiac surgery: A case report / 대한마취과학회지

A carbon dioxide (CO2) embolism during endoscopic vein harvesting is a rare but potentially fatal complication. Early and accurate diagnosis is crucial for limiting the extent of the embolism and stabilizing the resulting cardiovascular compromise. We report a case of CO2 embolization during endoscopic vein harvesting. Transesophageal echocardiography was instrumental in the diagnosis and management of this patient by further improving the decision making process, which resulted in the best outcome. Mid-esophageal bicaval view is the best view to determine whether a CO2 embolism is coming from the upper or lower extremities.

The Hemodynamic Effects of MgSO4 during Coronary Artery Bypass Surgery with Cardiopulmonary Bypass / 대한마취과학회지

BACKGROUND: Reperfusion injury often develops after cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG), and MgSO4 is known to be related to such injury. The goal of this study was to determine the hemodynamic and oxygen metabolic effects of administering MgSO4 after cessating cardiopulmonary bypass during coronary bypass surgery in control and nicardipine infusion groups. METHODS: After obtaining hospital ethics committee clearance, we studied 29 patients with coronary artery disease scheduled for CABG, who were randomly assigned to receive nicardipine (0.5 microgram/kg/min, n = 11) or placebo (n = 18). All patients were administered MgSO4 (60 mg/kg) after the cessation of CPB. The hemodynamic variables and oxygen parameters were recorded and calculated by continuous cardiac output and mixed venous oxygen saturation monitoring, through a thermodilution Swan-Ganz catheter before and 20 minutes after MgSO4 administration. RESULTS: Heart rate was reduced after administering MgSO4 in both groups, and the mean arterial pressure was also reduced in the nicardipine group. The cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, right and left stroke work indices were well-maintained after administering MgSO4. Mixed venous oxygen saturation and other oxygen parameters were maintained without change after MgSO4 administration. CONCLUSIONS: The present study shows that MgSO4 can be used without inducing any significant oxygen metabolism or hemodynamic derangements during CABG. But further work is needed to elucidate the myocardial protective effects of MgSO4.