Investigating preoperative myoglobin level as predictive factor for acute kidney injury following cardiac surgery with cardiopulmonary bypass: a retrospective observational study

Abstract Background: Early identification of patients at risk of AKI after cardiac surgery is of critical importance for optimizing perioperative management and improving outcomes. This study aimed to identify the association between preoperative myoglobin levels and postoperative acute kidney injury (AKI) in patients undergoing valve surgery or coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Methods: This retrospective study included 293 patients aged over 17 years who underwent valve surgery or CABG with cardiopulmonary bypass. We excluded 87 patients as they met the exclusion criteria. Therefore, 206 patients were included in the final analysis. The patients' demographics as well as intraoperative and postoperative data were collected from electronic medical records. AKI was defined according to the Acute Kidney Injury Network classification system. Results: Of the 206 patients included in this study, 77 developed AKI. The patients who developed AKI were older, had a history of hypertension, underwent valve surgery with concomitant CABG, had lower preoperative hemoglobin levels, and experienced prolonged extracorporeal circulation (ECC) times. Multivariate logistic regression analysis revealed that preoperative myoglobin levels and ECC time were correlated with the development of AKI. A higher preoperative myoglobin level was an independent risk factor for the development of cardiac surgery-associated AKI. Conclusions: Higher preoperative myoglobin levels may enable physicians to identify patients at risk of developing AKI and optimize management accordingly.

Perioperative Dexmedetomidine Reduces Delirium after Coronary Artery Bypass Graft Surgery: A Prospective, Single?blind, Observational Study

Background:Delirium is a commonly seen complication of cardiac surgery. Dexmedetomidine, by its anti?inflammatory properties and other effects, can attenuate postoperative delirium. Aims: The aim of this work was to study the incidence of delirium after coronary artery bypass graft surgery, and to compare the effects of dexmedetomidine and propofol on the incidence of postoperative delirium in coronary artery bypass graft surgery patients. Materials and Methods: A prospective, observational study was conducted on 180 consecutive patients undergoing off?pump or on?pump coronary artery bypass graft surgery. The patients were administered either intravenous dexmedetomidine (n = 90) or propofol (n = 90) after hemostasis was achieved, till they were ready for weaning from the ventilator. The Confusion Assessment Method was used to assess the incidence of postoperative delirium. Measurements and Main Results: A total of 25 (13.8%) patients developed delirium after coronary artery bypass graft surgery. Sedation with dexmedetomidine was associated with a significantly reduced incidence of postoperative delirium (8.9% v 18.9% propofol, P = 0.049). Subgroup analyses showed reduced incidence of postoperative delirium in off?pump patients compared to on?pump coronary artery bypass graft patients (3.3% vs. 20%, P = 0.009 dexmedetomidine group and 11.6% vs. 33.3%, P = 0.047 propofol group respectively). The mean age of the patients who had delirium was significantly more (64.9 ± 8.1 years vs. 52.5 ± 5.8 years, P = 0.046) compared to those who did not have delirium. Conclusion: Administration of dexmedetomidine?based sedation resulted in the reduced incidence of postoperative delirium compared to propofol?based sedation in patients after coronary artery bypass graft surgery

Factores predictores de mortalidad en pacientes con enfermedad coronaria y compromiso del tronco principal izquierdo / Predictors of mortality in patients with coronary artery disease and involvement of the left main artery

Resumen: Introducción: el compromiso del tronco principal izquierdo no protegido (TPInp) en pacientes con enfermedad arterial coronaria (EAC) conlleva alto riesgo de eventos cardiovasculares. La cirugía de revascularización coronaria (CABG) ha sido el estándar de tratamiento; sin embargo, estudios recientes proponen la intervención coronaria percutánea (PCI) como alternativa. Objetivo: evaluar los desenlaces intrahospitalarios y durante el seguimiento del tratamiento de pacientes con compromiso del TPInp. Método: estudio observacional multicéntrico de cohorte retrospectivo, se evaluaron pacientes con EAC y afección del TPI. Muerte de cualquier causa, infarto de miocardio no fatal, accidente cerebrovascular, reintervención y/o readmisión hospitalaria fueron valorados como un desenlace compuesto e individualmente durante la hospitalizacioì n y el tiempo de seguimiento. Resultados: se incluyeron 82 pacientes, con edad promedio 71 ± 9.9 años; 35 recibieron PCI, 31 CABG y 16 manejo meìdico (MM). La mortalidad intrahospitalaria fue del 16%. En el seguimiento medio de 12.3 meses la tasa de mortalidad fue del 20%, la de reinfarto del 6% y la de readmisioìn hospitalaria del 4%. La tasa de incidencia de muerte para MM fue 5.19 por 10.000 personas/diìa, para PCI de 2.3 por 10.000 personas/diìa y para CABG de 1.06 por 10.000 personas/diìa; en el seguimiento la mortalidad fue mayor en el grupo de PCI (HR: 3.6; IC 95% 1.13-11.9; p = 0.02). La frecuencia cardiaca elevada al ingreso se asocioì con mayor mortalidad (0.05). Conclusión: el compromiso del TPI se asocia con alto riesgo de muerte y se presenta con anatomiìa coronaria compleja.

Abstract: Introduction: involvement of the unprotected left main coronary artery (TPInp) in patients with coronary artery disease (CAD) leads to a high risk of cardiovascular events. Coronary artery bypass grafting (CABG) has been the standard of management; however, recent studies propose percutaneous coronary intervention (PCI) as an alternative treatment. Objective: to evaluate the in-hospital and follow-up outcomes of patients with compromised TPInp. Method: retrospective multicenter observational cohort study, we evaluated patients with CAD and TPI involvement. Death from any cause, nonfatal myocardial infarction, stroke, reoperation, and/or hospital readmission were assessed as a composite endpoint and individually during hospitaliza- tion and follow-up time. Results: 82 patients were included, mean age 71 ± 9.9 years; 35 received PCI, 31 CABG, and 16 medical management (MM). In-hospital mortality was 16%. In the mean follow-up of 12.3 months, mortality was 20%, rein- farction 6% and hospital readmission 4%. The incidence rate of death was 5.19 per 10,000 people/day for MM, 2.3 per 10,000 people/day for PCI, and 1.06 per 10,000 people/day for CABG; at follow-up, mortality was higher in the PCI group (HR 3.6; 95%CI 1.13-11.9; p = 0.02). Elevated heart rate on admission was associated with higher mortality (p < 0.05). Conclusion: TPInp involvement is associated with a high risk of death and presents with complex coronary anatomy.

Comparative Study of Cardiac Output Measurement by Regional Impedance Cardiography and Thermodilution Method in Patients Undergoing off Pump Coronary Artery Bypass Graft Surgery

Background:An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries. Aim: The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). Settings and Design: We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaSHemodynamicNavigator systemand the gold standardTDmethod using pulmonary artery catheterin patients undergoingOPCAB.Atotal of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery. Patients and Methods: We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman.The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve. Results: Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres.The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%. Conclusion: A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.

The effects of preoperative coronary collateral circulation on cardiac-related events after coronary artery bypass graft surgery

Abstract Introduction: This study aimed to evaluate the effects of coronary collateral circulation (CCC) in patients who had undergone coronary artery bypass grafting (CABG). Methods: A total of 127 patients who had undergone CABG (2011-2013) were enrolled into this study and follow-up was obtained by phone contact. Patients were categorized into two groups according to preoperative CCC using the Rentrop method. Percutaneous coronary intervention (PCI), recurrent myocardial infarction (MI), stroke, heart failure (HF), and mortality rates were compared between groups. Clinical outcome was defined as combined end point including death, PCI, recurrent MI, stroke, and HF. Results: Sixty-two of 127 patients had poor CCC and 65 had good CCC. There were no differences in terms of PCI, recurrent MI, and HF between the groups. Stroke (seven of 62 [11.3%] and one of 65 [1.5%], P=0.026) and mortality (19 of 62 [30.6%] and 10 of 65 [15.4%], P=0.033) rates were significantly higher in poor CCC group than in good CCC group. In Kaplan-Meier analysis, survival time was not statistically different between the groups. Presence of poor CCC resulted in a significantly higher combined end point incidence (P=0.011). Conclusion: Stroke, mortality rates, and combined end point incidence were significantly higher in poor CCC patients than in the good CCC group.

Revascularización coronaria híbrida: un punto de encuentro entre cardiólogos intervencionistas y cirujanos cardíacos / Hybrid coronary revascularization: a meeting point between interventional cardiologists and cardiac surgeons

Resumen: La revascularización coronaria híbrida busca combinar el beneficio de las técnicas quirúrgicas y percutáneas para un manejo óptimo de pacientes seleccionados con enfermedad coronaria obstructiva multivaso. Esto permite asociar el beneficio del puente de arteria mamaria interna izquierda a la arteria descendente anterior (ADA) y combinarlo con el implante de stents en lesiones no-ADA. El objetivo de este trabajo es hacer una revisión de la literatura disponible con énfasis en sus resultados clínicos comparados con la estrategia convencional.

Abstract: Hybrid coronary revascularization seeks to combine the benefit of surgical and percutaneous techniques for optimal management of selected patients with multivessel coronary artery disease. This allows combining the benefit of the left internal mammary artery bypass to the anterior descending artery (LAD) and stent deployment in non-LAD lesions. The objective of this manuscript is to review the available literature with emphasis on its clinical results compared to the conventional strategy.

Recurrencia clínica en pacientes con puentes secuenciales en cirugía de revascularización coronaria / Clinical recurrence in patients with sequential bridges in coronary artery bypass grafting

Resumen Objetivo: Comparar las tasas de recurrencia de revascularización coronaria (cirugía o intervención coronaria percutánea), nuevo evento isquémico o muerte en pacientes con puentes secuenciales y con puentes simples. Método: Cohortes ambispectivas de pacientes sometidos a cirugía de revascularización coronaria secuencial (n = 111) o simple (n = 145) entre el 1 de enero de 2013 y el 31 de diciembre de 2017. Pacientes mayores de 18 años en un primer procedimiento de revascularización, con circulación extracorpórea. Para el seguimiento se realizó revisión del expediente o comunicación telefónica hasta el 9 de febrero de 2019. Se investigaron los siguientes desenlaces: reintervención por isquemia coronaria, nuevo evento isquémico documentado o muerte atribuida a cardiopatía isquémica; también se obtuvieron curvas de sobrevida. Resultados: La proporción de recurrencia según la técnica quirúrgica no fue estadísticamente diferente: secuencial 6.5% (intervalo de confianza del 95% [IC95%]: 2.6-12.6%) contra simple 4.8% (IC95%: 2-9.7%; p = 0.60; análisis bayesiano BF10 = 0.37; evidencia moderada a no diferencia), todos por nuevo evento isquémico y un fallecimiento por grupo. No hubo diferencias en el tiempo de seguimiento: secuencial 59 meses (IC95%: 56-62) y simple 66 meses (IC95%: 64-68). No encontramos diferencia en las tasas de incidencia de recurrencia: secuencial 1.99 eventos/103 meses-paciente contra simple 1.47 (hazard ratio: 1.34; IC95%: 0.47-3.8; p = 0.58). El tiempo promedio de pinzamiento y de circulación extracorpórea por puente fue menor en el grupo de puentes combinados (41.44 minutos de circulación extracorpórea y 24.69 minutos de pinzamiento/puente) que en el de puentes simples (43 minutos en circulación extracorpórea y 26.4 minutos de pinzamiento/puente) cuando se ajusta al promedio de puentes colocados (simples 2.7 y secuencial 3.25; p < 0.001); sin embargo, no se encontró significancia estadística (p = 0.7). Conclusión: Ambos procedimientos tuvieron una baja incidencia de recurrencia de eventos clínicos, sin diferencias entre las técnicas quirúrgicas.

Abstract Objective: To compare the recurrence rates of revascularization (redo CABG or PCI), new ischemic event or death in patients with simple grafts and patients with sequential grafts. Method: Study design is an ambispective cohort of patients that underwent CABG by sequential grafting (n = 111) or simple grafting (n = 145) between January 1st, 2013 and December 31st, 2017. Patients had to be 18 years old at the time of surgery, undergoing their first on-pump CABG. The clinical record of every patient was carefully reviewed and patients who had incomplete follow-up in external consultation were contacted by telephone in order to obtain data about ischemia related reintervention (CABG or PCI), new documented ischemic event or death caused by coronary artery disease, Kaplan-Meier estimators were calculated. Results: The proportion of recurrence depending on technique was not statistically different: sequential (6.5% [CI95% 2.6-12.6%] versus simple 4.8% [CI95% 2-9.7%], p = 0.60, Bayesian analysis BF10 = 0.37; moderate evidence to no difference), each one related to new ischemic event and one death per group. There were no differences in follow-up time (sequential 59m [CI95% 56-62] simple 66m [CI95% 64-68]). No difference was found regarding recurrence incidence rates; sequential 1.99 events x 103 months-patient, versus simple 1.47 (HR=1.34; CI95% 0.47-3.8, p = 0.58). Pump and cross-clamping times were lower for sequential technique (41.44 min; 24.69 min respectively) versus simple technique (43 min; 26.4 min respectively) with a p = 0.7 after adjusting to mean grafts per surgery (2.7 simple; 3.25 sequential, p < 0.001). Conclusions: Both techniques had a low incidence of clinical recurrence, without significant differences between procedures.

Covid-19 - endothelial axis and coronary artery bypass graft patency: a target for therapeutic intervention?

Abstract It has been reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces endothelial inflammation, therefore facilitating the progression of endothelial and vascular dysfunction in coronavirus disease 2019 (COVID-19) patients. Coronary artery bypass grafting (CABG) involves mainly the use of the saphenous vein (SV) and internal mammary artery as graft material in the stenosed coronary arteries. Unfortunately, graft patency of the SV is low due to endothelial dysfunction and inflammation. We propose that SARS-CoV-2 might cause vascular inflammation, endothelial dysfunction, and thrombosis in coronary artery bypass graft vessels by binding angiotensin-converting enzyme 2 receptor. Therefore, in this Special Article, we consider the potential influence of COVID-19 on the patency rates of coronary artery bypass graft vessels, mainly with reference to the SV. Moreover, we discuss the technique of SV graft harvesting and the therapeutic potential of focusing on endothelial dysfunction, vascular inflammation, and thrombosis for protecting coronary artery bypass grafts in COVID-19 infected CABG patients.

Disección de la arteria mamaria interna en cirugía cardíaca: Una historia no siempre bien contada / Internal mammary artery harvesting in cardiac surgery: an often mistold story

RESUMEN La arteria mamaria interna es el hemoducto de elección para injertar en la arteria coronaria descendente anterior. Un enorme cuerpo de evidencia demuestra que los resultados de la cirugía de revascularización miocárdica en el corto y largo plazo dependen de determinados factores relacionados con la preparación de la arteria, como su flujo y el grado de vascularización esternal residual. Por ese motivo, en las últimas décadas el procedimiento de disección de la arteria mamaria interna ha recibido tanta atención como la técnica de construcción de los injertos. Sin embargo, la historia de su origen y posterior evolución no ha sido siempre adecuadamente contada y muchas imprecisiones se han trasmitido a lo largo de los años.

ABSTRACT The left internal mammary artery is the conduit of choice for left anterior descending coronary artery grafting. A huge body of evidence shows that the short and long-term outcomes of coronary artery bypass grafting depend on specific factors related to the preparation of the artery, namely, its blood flow and residual sternal vascularization degree. Accordingly, the internal mammary artery harvesting has received as much attention as the grafting construction technique in recent decades. However, the story of its origins and subsequent progress has not always been properly told as many inaccuracies have been passed on over the years.

A randomized, double-blinded trial comparing the effectiveness of tranexamic acid and epsilon-aminocaproic acid in reducing bleeding and transfusion in cardiac surgery

Objectives: To compare the effectiveness of epsilon aminocaproic acid (EACA) to tranexamic acid (TA) in reducing blood loss and transfusion requirements in patients undergone cardiac surgery under cardiopulmonary bypass. Design: Randomized, double blinded study. Outcome variables collected included; baseline demographic characteristics, type of surgery, amount of 24 hour chest tube drainage, amount of 24 hour blood products administered, 30 day mortality and morbidity and length of stay. We analyzed the data using parametric and non-parametric tests as appropriate. Setting: Single center tertiary-care university hospital setting. Participants: 114 patients who had undergone cardiac surgery under cardiopulmonary bypass. Interventions: Standard dose of intra-operative EACA or TA was compared in patients undergone cardiac surgery under cardiopulmonary bypass. Results: There was no statistically significant difference between groups when analyzing chest tube drainage. However, there was a significant difference in the administration of any transfusion (PRBC's, FFP, platelets) intra-operatively to 24 hours postoperatively, with less transfusion in patients receiving EACA compared to TA (25% vs. 44.8%, respectively P = 0.027). Additionally, there was no significant difference in terms of adverse events during the one month follow up period. Conclusion: The findings of this study suggest that EACA and TA have similar effects on chest tube drainage but EACA is associated with fewer transfusions in CABG alone surgeries. Our results suggest that EACA can be used in a similar fashion to TA which may result in a cost and morbidity advantage.

The Effect of Obesity on Cardiac Rehabilitation in Patients who have Undergone Coronary Artery Bypass Graft Surgery at the National Hospital of Sri Lanka

Background: Coronary artery disease (CAD) is one of the most prevalent non-communicable diseases in Sri Lanka. Coronary Artery Bypass Graft Surgery (CABG) is considered as the main revascularization procedure in patients with CAD. Cardiac rehabilitation is a multiphasic and multi-disciplinary program and is considered as a significant component of postoperative management after CABG. Objective: To study the effect of obesity on Cardiac Rehabilitation Program II (CRPII), a 1-month period of cardiac rehabilitation following discharge from the hospital, in patients who have undergone CABG. Methods: This was a prospective analytical study involving a convenient sample of 100 patients after CABG surgery. The patients (age: 40-70 years, both males and females) were selected from the cardiac rehabilitation program of the Cardiology Unit at the National Hospital of Sri Lanka. Data collection was done using 5 interviewer based questionnaires: socio-demographic characteristics using socio-demographic questionnaire, cardio-vascular endurance and fatigue levels using 6 minute-walk test (6MWT) and Borg scale (BS), anxiety and depression levels using Hospital anxiety and depression scale (HAD) and overall quality of life using quality of life questionnaire cardiac version (QOL). Data collection 1 was done on the first day of CRPII and data collection 2 was done on the final day of the program. Results: There were 33% obese and 67% non-obese patients in the study population. Both groups showed a statistically significant improvement (p<0.0001) of 6MWT, BS, HAD and QOL after CRPII. There was a significant difference (p<0.05) in the improvement of 6MWT in the non-obese group compared to the obese group and there was no difference in BS, HAD and QOL between obese and non-obese groups. Conclusions: CRPII led to an improvement in cardiovascular endurance, anxiety/depression and overall quality of life in patients who underwent CABG. Non-obese patients showed a better improvement in cardiovascular endurance compared to obese patients after CRPII.

Outcome of Diabetic and Non-Diabetic Patients who underwent Coronary Artery Bypass Graft Surgery (CABG) at Chinese General Hospital and Medical Center from January 2010 to December 2016

Introduction@#Several studies have shown that diabetes mellitus increases the risk of having adverse events after CABG. This study was conducted to compare outcome of diabetic and non-diabetic patients after CABG and to test if diabetes mellitus is the strongest predictor of adverse outcomes.@*Methods@#This is a retrospective cohort study using charts review of CABG patients from January 2010 to December 2016. Odds ratio were computed to evaluate which risk factors have the strongest association with the occurrence of complications and mortality after CABG.@*Results@#Our study population consists 107 non-diabetic (48%) and 114 diabetic (52%) patients. Diabetic patients have higher post-operative complications at 47% (54) than nondiabetics with 30.8% (33/107) (p-0.012). The most significant risk factor for complication occurrence was hypertension (p-0.015) (OR: 4.123). Every year added above 37 years old has a corresponding six percent increase in the odds of developing morbidity for both groups (p-0.001, OR: 1.06). Advanced age (p-0.000) (OR: 1.07), male gender (p-0.030) (OR: 3.10) and diabetes (p-0.043) (OR: 0.043) increase the risk of arrhythmia. The odds of developing pneumonia is higher among males (p-0.005) (OR:0.18) and smokers (p0.041)(OR: 3.50) in both groups. The odds of developing acute kidney injury was increased by 12% for every year added above 37 years old (p-0.035)(OR: 1.12).There is a two percent increase risk for developing acute kidney injury for mean post operative blood glucose above 110mg/dL (p0.030) (OR: 1,025).@*Discussion@#Hypertension and age are significant predictors of morbidity in this study. Age related changes in cardiac physiology can be contributory. Male smokers have a higher risk of developing pneumonia in both groups pointing the significance of this risk factor. Elevated post-operative blood glucose must be addressed fully because of its association with acute kidney injury.@*Conclusion@#More complications are encountered among diabetic patients. However, diabetes mellitus is not the strongest predictor of mortality. Instead, age and hypertension showed higher association with adverse outcome.

Ticagrelor plus aspirin versus clopidogrel plus aspirin on graft patency after coronary artery bypass graft surgery: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To compare the effect of aspirin+ticagrelor and aspirin+clopidogrel on graft patency one year after coronary artery bypass grafting (CABG). Methods    A total of 67 patients who received CABG in our department from January 2014 to September 2017 were included in this study (52 males and 15 females). They were randomly divided into a group A (aspirin+clopidogrel) and a group B (aspirin+ticagrelor). There were 34 participants in the group A (28 males and 6 females) and 33 patients in the group B (24 males and 9 females). All patients were invited for clinical follow-up and 64-slice multislice computed tomography angiography (MSCTA) analysis in 1 year postoperatively. Cardiovascular events, bleeding events and other adverse events were followed up. Results    Four patients were lost to follow-up. Two patients died. A total of 61 patients (48 males and 13 females) completed coronary CTA, and 31 in the group A (25 males and 6 females) and 30 in the group B (23 males and 7 females). The total number of bridged vessels was 156 (59 internal thoracic artery bridges and 97 great saphenous vein bridges), including 79 in the group A (31 internal thoracic artery bridges and 48 great saphenous vein bridges) and 77 in the group B (28 internal thoracic artery bridges and 49 great saphenous vein bridges). Graft patency rate 1 year post CABG was 82.3% (65/79) in the group A and 92.2%(71/77) in the group B (P>0.05). Artery graft patency rate 1 year post CABG was 96.8% (30/31) in the group A and 96.4%(27/28) in the group B (P>0.05). Saphenous vein graft patency rate 1 year post CABG was 72.9% (35/48) in the group A  and 89.8% (44/49) in the group B (P<0.05). Multivariable analysis with binary logistic regression showed ticagrelor use reduced graft occlusion (OR=0.282, 95%CI 0.093 to 0.862, P<0.05). There was no significant difference in adverse events between the two groups. Conclusion    Compared with clopidogrel plus aspirin, ticagrelor added to aspirin after CABG may enhance the saphenous graft patency without the excess risk of bleeding 1 year post CABG.

Immediate Effect Of Incentive Spirometry On Arterial Blood Gases Analysis After Coronary Bypass Graft Surgery Patients

Background:The patients who have done CABG are prone to pulmonary complications. Various physiotherapy man-agement is present for prevention of lung complication. Literature shows lots of technique as treatment of choice, incentive spirometry is one of them. AIM: To asses immediate effect of incentive spirometry on arterial blood gas analysis in patient recently underwent coronary artery bypass surgery. Method:There was 30 patients. Blood was drawn from arterial line for pre-treatment ABG. Incentive spirometry was given 10 reps and 3 sets. Patient was prop up 30-40 degree. Romsons tri colour volume spirometry is used. Mouthpiece was placed in patient’s mouth and made a good seal over the mouthpiece with lips. Exhaled through nose normally then breathe in slowly through mouth. Ball in the incentive spirometer will go up. The patient to hold or rise the ball as high as possible and hold it for 3 or 5 seconds the slowly exhale. This was done for 10 to 15 times. Blood was drawn from arterial line for post treatment ABG. Result: There was statistically extremely significant change in value of PaO2 (112.54 ±39.46 vs133.01 ±42.13) p value <0.0001, PaCO2 (38.75 ±4.2 vs 36.9 ±3.7) p value 0.0003 and SaO2 (96.8 ±1.84 vs 98.93 ±1.11) p val-ue <0.0001 Conclusion:This study shows that there is immediate effect of Incentive Spirometry on ABG analysis in CABG surgery patient by significant improvement of PaO2 and SaO2 and decrease in PaCO2

Cirugía de revascularización de miocardio usando arteria mamaria interna bilateral. Resultados a corto plazo / Coronary artery bypass graft surgery with bilateral internal mammary artery. Short-term results

Resumen Introducción: La cirugía de revascularización de miocardio (RVM) sigue siendo el gold standard en el tratamiento de la enfermedad coronaria multiarterial. Se ha demostrado que la RVM con ambas arterias mamarias internas (AMI) tiene mejor resultado de sobrevida a largo plazo. Metodología: Investigación retrospectiva de las cirugías de RVM con AMI bilateral, realizadas en el Instituto Nacional Cardiovascular-INCOR-EsSalud entre enero de 2012 a diciembre de 2015. Los objetivos fueron determinar la mortalidad por cualquier causa y los eventos cardiovasculares mayores a 30 días de seguimiento. Resultados: Treinta y seis pacientes fueron operados con AMI bilateral. No tuvimos mortalidad a 30 días. Los eventos cardiovasculares mayores se presentaron en el 5.56% de los pacientes (stroke 0%, infarto de miocardio posquirúrgico 5.56%, necesidad de nueva intervención coronaria 0%). La incidencia de mediastinitis y/o reconstrucción esternal fue de 0%. Siete pacientes tuvieron infección superficial de la herida, no hubo diferencia significativa entre los diabéticos y los no diabéticos (25% vs. 16.66%, OR: 3.3, p = 0.88) o entre los pacientes con o sin sobrepeso (19.23% vs. 20%, respectivamente, OR: 0.95, IC 95%, p = 0.68) para presentar infección de herida. Conclusiones: La RVM con AMI bilateral es un procedimiento seguro, con bajas tasas de mortalidad y de eventos cardiovasculares mayores a corto plazo. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Introduction: Coronary artery bypass graft (CABG) surgery remains the reference standard in the treatment of multivessel coronary disease. Several studies have shown that CABG with bilateral internal mammary arteries (BIMA) has better results in long-term survival. Methodology: A retrospective study was conducted on CABG surgeries with BIMA from January 2012 to December 2015 in the National Cardiovascular Institute, INCOR, EsSalud, Peru. The objectives were to determine the mortality and major cardiovascular events at 30 days followup. Results: Of the 36 patients subjected to CABG surgery with BIMA, the 30-day mortality was 0%, with major cardiovascular events occurring in 5.56% of patients (Stroke 0%, postoperative myocardial infarction 5.56%, need of new coronary intervention 0%). The incidence of mediastinitis and/or sternal reconstruction was 0%. Superficial wound infection was observed in 7 patients, with there being no significant difference between diabetics and non-diabetics (25% vs. 16.66%, OR = 3.3, P = .88), or between patients with or without overweight (19.23% vs. 20%, respectively,OR = .95; 95% CI, P = .68). Conclusions: CABG surgery with BIMA is a safe procedure, with low rates of mortality and major cardiovascular events in the short-term. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

No-touch technique in coronary artery bypass grafting: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective To compare the patency of the postoperative vessel bridge grafts between the notouch technique and the conventional technique for saphenous vein harvest in the coronary artery bypass grafting. Methods A total of 70 patients underwent coronary artery bypass grafting from January 2014 to January 2015 in the First Affiliated Hospital of Zhengzhou University. They were randomly divided into a conventional technique group (saphenous vein obtained by traditional technique) and a no-touch technique group (saphenous vein obtained by notouch technique). There were 34 patients in the conventional technique group, including 16 males and 18 females with an average age of 61.6±6.4 years. There were 36 patients in the no-touch technique group, including 16 males and 20 females with an average age of 62.2±6.6 years. The 1-year postoperative coronary CT angiography (CTA) results were compared. Results Seventy patients underwent coronary CTA examination 1 year postoperatively. The patency rate of the conventional technique group and no-touch technique group were 83/116 (71.6%) and 113/122 (92.6%). Logistic regression analysis showed a statistical difference between the non-touch technique and the conventional technique (P<0.05). Conclusion The short-term patency rate of vessel bridge grafts is higher when the no-touch technique is used.

Mid-term outcome of coronary artery bypass graft surgery in patients aged≤40 years with coronary heart disease / 复旦学报（医学版）

Objective To investigate the clinical characteristics,surgical experience and mid-term outcome of coronary artery bypass graft surgery in patients aged ≤ 40 years.Methods From Jan.,2009 to Dec.,2015,12 patients with median age of (37.9 ± 2.5) years (range 32-40 years,10 males) were diagnosed with coronary artery disease and underwent coronary artery bypass graft surgery at Zhongshan Hospital,Fudan University.The clinical characteristics included five cases with hypertension,three cases with diabetes mellitus,four cases with hyperlipemia,eight cases with smoking history,seven cases with myocardial infarction.Six cases had at least one branch totally occluded.Two cases once underwent percutaneous coronary intervention surgery and implanted with five and three stents respectively.The perioperative data and follow-up results were retrospectively analysed.Results There was no in-hospital death and no death during follow-up period.Surgical techniques included bilateral internal mammary arteries combined with radial artery were operated in six cases,bilateral internal mammary arteries combined with great saphenous vein in two cases,left internal mammary arteries combined with great saphenous vein in four cases,off-pump in nine cases and on-pump in three cases.The mean follow-up time was (47.8 ± 24.3) months.During the follow-up one case suffered with saphenous vein graft restenosis 5 years after the surgery and underwent percutaneous coronary intervention.Other cases were all alive and assessed New York Heart Association's function class Ⅰ-Ⅱ.Conclusions Younger patients usually suffer with severe coronary artery disease when diagnosed because they often have excellent compensative capacity and the pathogenesis is concealed.The mid-term results of coronary artery bypass graft surgery in patients aged ≤40 years are satisfactory.

Cardiac Magnetic Resonance Predictor of Ventricular Function after Surgical Coronary Revascularization

We evaluated echocardiographic changes of left ventricular (LV) function in coronary artery bypass grafting (CABG) patients with LV dysfunction, and examined cardiac magnetic resonance (CMR) parameters associated with improved LV function. Seventy-seven CABG patients presenting with decreased LV ejection fraction (LVEF, ≤ 35%) and who underwent preoperative gadolinium-enhanced CMR were enrolled. A 16-segment model was used to analyze CMR imaging. A viable myocardial segment was defined as ≤ 50% transmural extent of late gadolinium enhancement. Serial echocardiographic examinations were performed preoperatively, pre-discharge (median 6 days), and during postoperative year 1 (median 11 months) in 70 patients. Predictors of absolute increase in LVEF (≥ 5%) and proportional changes in LVEF were analyzed. Serial echocardiography demonstrated that LVEF measured 28.6% ± 5.4% preoperatively, 31.5% ± 8.0% median 6 days, and 42.1% ± 10.5% median 11 months postoperatively. Absolute increase of LVEF was observed in 27 patients at pre-discharge and in 24 patients by median 11 months. Proportional changes in LVEF at postoperative median 6 days and 11 months were 14% ± 28% and 57% ± 45%, respectively. The median number of viable myocardial segments was 14 (range, 9–16) in the 16 segment CMR model. Multivariable models demonstrated that the median number of overall viable myocardial segments (≥ 14) in preoperative CMR was associated with absolute increase (P = 0.046) and proportional changes (P = 0.005) in LVEF. In conclusion, the number of viable myocardial segments (≥ 14) in preoperative CMR predicted LV function improvement after CABG in patients with LV dysfunction.

Establishment of a minimally invasive cardiac surgery programme in Singapore

Although minimally invasive cardiac surgery is available in Singapore, it is not widely practised. Local surgeons have pioneered and introduced technologies in Singapore that were launched in the West to address various heart pathologies. However, in spite of the possibilities, the unique position and function of Singapore in the region, the structure and dynamics of cardiothoracic surgery practice in government centres and private practice, and the overall small volume of patients in the country may pose limitations in the thriving and sharing of such new technologies. Herein, we give an account of our progress and accomplishments with regard to minimally invasive cardiac surgery in Singapore and indicate areas of improvement that have further potential for synergy and growth.

Right ventricle perforation after Swan-Ganz catheterization in a patient undergoing CABG surgery: A case report

We report an extremely rare case of right ventricle perforation by a Swan-Ganz catheter during open heart surgery. Even when pulmonary artery catheters are inserted with the utmost care, serious complications such as hematoma formation, pneumothorax, hemothorax, perforation of the cardiac chambers, and rupture of the pulmonary artery may occur. We present a case of primary closure of a right ventricle perforation discovered during coronary artery bypass graft surgery. In this case, the Swan-Ganz catheter was found penetrating the anterior wall of the right ventricle during the surgery. The location of the Swan-Ganz catheter, the stiffness of the catheter caused by hypothermia, and excessive surgical manipulation were supposed to be the etiologies. Therefore, the location of the Swan-Ganz catheter and increased stiffness from hypothermia should be taken into consideration during heart surgery.