Vein patch angioplasty with internal mammary artery grafting of the left anterior descending coronary artery

Objective@#To describe the treatment outcomes of patients who underwent coronary artery bypass grafting (CABG) with vein patch angioplasty with internal mammary artery (IMA) grafting of the diffusely diseased left anterior descending (LAD) coronary artery.@*Methods@#This is a retrospective observational study of 26 patients who have undergone vein patch angioplasty of the LAD coronary artery with IMA grafting in three centers by a single surgeon from January 2012 to August 2017. The demographic profile, intraoperative data, and postoperative outcome (including in-hospital mortality and morbidity, perioperative myocardial infarction, and NYHA functional classification) were recorded. Continuous variables were expressed as means with standard deviation and categorical variables summarized as frequencies and percentages. Student’s t-test was used to compare the preoperative versus postoperative mean NYHA functional class.@*Results@#There were 22 (85%) males and 4 (15%) females with a mean age of 62 years (range: 34 to 82). Twentyfive patients (96%) had a three-vessel disease, and one (4%) had a two-vessel disease. Nine patients (35%) had a preoperative myocardial infarction. The mean cardiopulmonary bypass and aortic-cross clamp times were 156 and 118 minutes, respectively. The mean number of vessels grafted was 4.12. Multiple arterial grafting was used in seven patients (27%). There were two in-hospital mortalities (7.7%) and three morbidities (11.5%), including reoperation for bleeding, acute kidney injury, and leg wound infection. Six patients (23%) developed postoperative atrial fibrillation. No patient developed perioperative myocardial infarction. The mean ICU stay was three days, and the mean hospital stay was 10.27 days. The mean NYHA functional class improved from 2.85 preoperatively to 1.5 postoperatively (p<0.00001). Among patients with improvement, postoperative NYHA improved by two functional classes in 38% and by one functional class in 62%. @*Conclusion@#Vein patch angioplasty is a valuable technique for diffuse coronary stenosis of the LAD artery with acceptable early results.

Development of a machine learning model to estimate length of stay in coronary artery bypass grafting

ABSTRACT OBJECTIVE: To develop and validate a predictive model utilizing machine-learning techniques for estimating the length of hospital stay among patients who underwent coronary artery bypass grafting. METHODS: Three machine learning models (random forest, extreme gradient boosting and neural networks) and three traditional regression models (Poisson regression, linear regression, negative binomial regression) were trained in a dataset of 9,584 patients who underwent coronary artery bypass grafting between January 2017 and December 2021. The data were collected from hospital discharges from 133 centers in Brazil. Algorithms were ranked by calculating the root mean squared logarithmic error (RMSLE). The top performing algorithm was validated in a never-before-seen database of 2,627 patients. We also developed a model with the top ten variables to improve usability. RESULTS: The random forest technique produced the model with the lowest error. The RMLSE was 0.412 (95%CI 0.405-0.419) on the training dataset and 0.454 (95%CI 0.441-0.468) on the validation dataset. Non-elective surgery, admission to a public hospital, heart failure, and age had the greatest impact on length of hospital stay. CONCLUSIONS: The predictive model can be used to generate length of hospital stay indices that could be used as markers of efficiency and identify patients with the potential for prolonged hospitalization, helping the institution in managing beds, scheduling surgeries, and allocating resources.

Cirugía coronaria sin circulación extracorpórea / Coronary artery revascularization performed without extracorporeal circulation

La cirugía de revascularización coronaria (CABG) es el estándar de tratamiento para la revascularización de la enfermedad de la arteria coronaria izquierda y/o de tres vasos. La cirugía coronaria sin bomba (OPCAB) evita el uso de derivación cardiopulmonar y puede mejorar los resultados a largo plazo al reducir las tasas de lesión miocárdica perioperatoria, accidente cerebrovascular (ACV), deterioro neurocognitivo y mortalidad de causa cardiaca. En la actualidad, se han llevado a cabo diversos ensayos clínicos desde la popularización del OPCAB en la década de los 90. Sin embargo, hasta el momento no se ha demostrado ningún beneficio del OPCAB en comparación con la cirugía tradicional a pesar de las reducciones favorables a corto plazo en los requerimientos de transfusión y otras complicaciones postoperatorias. Además, OPCAB se asocia con una revascularización miocárdica menos eficaz y no previene por completo las complicaciones tradicionalmente asociadas con la circulación extracorpórea (CEC). Este artículo revisa la evidencia actual de OPCAB en comparación con CABG tradicional en cuanto a los resultados clínicos a corto y largo plazo. Se analizan los resultados de la cirugía coronaria sin circulación extracorpórea (CEC) , comparándola con la cirugía convencional (con CEC). La revascularización coronaria sin CEC presenta resultados similares a la convencional, siempre que se cumplan determinadas condiciones en la selección de los pacientes. Una de ellas, muy importante, es la mayor experiencia del cirujano con el procedimiento.

The results of coronary artery revascularization performed without extracorporeal circulation (off pump) are compared to those of the traditional ("on pump") procedure. Compliance with selective conditions are required to obtain similar results. The most important being the experience of the surgeon performing the off pump procedure.

Cirugía coronaria: evolución de las características de la enfermedad coronaria y resultados inmediatos de la cirugía de revascularización miocárdica en una década / Coronary artery bypass grafting: evolution of coronary disease characteristics and immediate surgical outcomes over a decade

INTRODUCCIÓN: En la evolución de las características de la cirugía coronaria (CC) intervienen factores como cambios demográficos, técnica quirúrgica y cuidados perioperatorios. Nuestro objetivo es analizar la evolución de las características de la enfermedad coronaria en pacientes tratados con CC y sus resultados inmediatos. MATERIAL Y MÉTODO: Estudio analítico. Cohorte de pacientes operados con CC aisladas entre enero de 2006 y diciembre de 2008, y entre enero de 2016 y diciembre de 2018 en Hospital Clínico Regional de Concepción, Chile. Revisión bases datos y protocolos quirúrgicos, previa autorización comité de ética. Se utilizó SPSSv25® y pruebas estadísticas Chi-cuadrado y U Mann-Whitney, considerando significativo p < 0,05. Resultados: Total 1.400 CC aisladas, 658 primer período y 742 segundo período. Edad promedio: 62,0 ± 8,7 y 64,6 + 9,3 años según períodos (p < 0,001). Aumentaron significativamente en el segundo período: diabetes mellitus, enfermedad pulmonar obstructiva crónica, infarto agudo al miocardio (IAM), disfunción ventricular grave dentro de subgrupo con disfunción ventricular. Disminución significativa de la cirugía sin circulación extracorpórea, y aumento significativo del uso ≥ 2 puentes arteriales en el segundo período. EuroSCORE I aditivo aumentó de 3,6 ± 2,5 a 4,4 ± 2,7 (p = 0,001). Subgrupo de alto riesgo: 137 (20,8%) a 236 (31,8%), p < 0,001. Mortalidad de 13 (1,98%) y 16 (2,2%) según períodos, p = 0,813. DISCUSIÓN: Se observó aumento significativo del riesgo operatorio estimado, sin embargo, la mortalidad se mantuvo sin variación. El aumento del riesgo operatorio se condice con el aumento de la edad promedio y de la prevalencia de comorbilidades, así como del aumento de disfunción ventricular grave dentro del grupo de pacientes con disfunción ventricular e IAM reciente en el segundo período.

INTRODUCTION: Several factors intervene in the evolution of the characteristics of Coronary artery bypass grafting (CABG), such as demographic changes, surgical technique, and perioperative care. Our objective was to analyze the evolution of the characteristics of coronary artery disease in patients treated with CABG and its immediate results. METHODS: In an analytical study, we analyzed a cohort of patients with isolated CABG from January 2006 to December 2008 and from January 2016 to December 2018 in Hospital Clínico Regional Concepción, Chile. After the ethics committee's approval, we reviewed the database and surgical protocols. We used Chi-square and U Mann Whitney tests for statistical analysis (SPSSv25®), considering significant p < 0,05. RESULTS: We analyzed 1,400 isolated CABG, 658 from the first period and 742 from the second, with a mean age of 62.0 ± 8.7 and 64.6 ± 9.3 respectively (p < 0.001). The subgroup with ventricular dysfunction in the second period showed a significant increase in diabetes mellitus, chronic obstructive pulmonary disease, acute myocardial infarction (AMI), and severe ventricular dysfunction. The second group decreased off-pump surgery and increased the use of ≥ 2 arterial grafts (p < 0.05). The Additive EuroSCORE I increased from 3.6 ± 2.5 to 4.4 ± 2.7 (p = 0.001). High-risk subgroup: 137 (20.8%) to 236 (31.8%), p < 0.001. Mortality of 13 (1.98%) and 16 (2.2%) in the first and second group respectively, p = 0.813. CONCLUSION: There was a significant increase in the estimated surgical risk; however, mortality remained unchanged. The increase in surgical risk is consistent with the increase in mean age and prevalence of comorbidities, as well as the increase in severe ventricular dysfunction in the group ofpatients with ventricular dysfunction and recent AMI in the second period.

Cirugía de revascularización miocárdica: comparación de supervivencia a 10 años de la cirugía coronaria con y sin circulación extracorpórea mediante Propensity Score Matching / Ten-year survival after off-pump coronary artery bypass grafting compared with traditional bypass grafting

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.

Predictive value of the proportion of hibernating myocardium in total perfusion defect on reverse remodeling in patients with HFrEF underwent coronary artery bypass graft / 中华心血管病杂志

Objective: To evaluate the predictive value of the proportion of hibernating myocardium (HM) in total perfusion defect (TPD) on reverse left ventricle remodeling (RR) after coronary artery bypass graft (CABG) in patients with heart failure with reduced ejection fraction (HFrEF) by 99mTc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with 18F-flurodeoxyglucose (FDG) gated myocardial imaging positron emission computed tomography (PET). Methods: Inpatients diagnosed with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2016 to January 2022 were prospectively recruited. MPI combined with 18F-FDG gated PET was performed before surgery for viability assessment and the patients received follow-up MPI and 18F-FDG gated PET at different stages (3-12 months) after surgery. Δ indicated changes (post-pre). Left ventricular end-systolic volume (ESV) reduced at least 10% was defined as RR, patients were divided into reverse remodeling (RR+) group and the non-reverse group (RR-). Binary logistic regression analysis was used to identify predictors of RR. Receiver operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated to assess the cut-off value for predicting RR. Additionally, we retrospectively enrolled inpatients with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2021 to January 2022 as the validation group, who underwent MPI and 18F-FDG gated PET before surgery. Echocardiography was performed before CABG and after CABG (3-12 months). In the validation group, the reliability of obtaining the cut-off value for the ROC curve was verified. Results: A total of 28 patients with HFrEF (26 males; age (56.9±8.7) years) were included in the prospective cohort. HM/TPD was significantly higher in the RR+ group than in the RR- group ((51.8%±17.9%) vs. (35.7%±13.9%), P=0.016). Binary logistic regression analysis revealed that HM/TPD was an independent predictor of RR (Odds ratio=1.073, 95% Confidence interval: 1.005-1.145, P=0.035). ROC curve analysis revealed that HM/TPD=38.3% yielded the highest sensitivity, specificity, and accuracy (all 75%) for predicting RR and the AUC was 0.786 (P=0.011). Meanwhile, a total of 100 patients with HFrEF (90 males; age (59.7±9.6) years) were included in the validation group. In the validation group, HM/TPD=38.3% predicted RR in HFrEF patients after CABG with the highest sensitivity, specificity and accuracy (82%, 60% and 73% respectively). Compared with the HFrEF patients in the HM/TPD<38.3% group (n=36), RR and cardiac function improved more significantly in the HM/TPD≥38.3% group (n=64) (all P<0.05). Conclusions: Preoperative HM/TPD ratio is an independent factor for predicting RR in patients with HFrEF after CABG, and HM/TPD≥38.3% can accurately predict RR and the improvement of cardiac function after CABG.

Application of radial artery in total arterial coronary revascularization in elderly patients / 中华危重病急救医学

OBJECTIVE@#To summarize the application experience and clinical effect of radial artery in total arterial coronary revascularization (TAR) in elderly patients.@*METHODS@#Retrospectively analyzed the clinical data of patients who underwent TAR at the University of Hong Kong Shenzhen Hospital from July 1, 2020 to May 30, 2022. Patients were divided into ≥ 65-year-old group and < 65-year-old group according to age. The radial artery blood flow, diameter, intimal integrity and Allen test were evaluated by ultrasound before operation. The distal ends of radial artery were collected for pathological examination during operation. Coronary artery CT angiography (CTA) was examined postoperatively and follow up. The safety and reliability of ultrasonic assessment of radial artery and application of radial artery in elderly patients with TAR were summarized and analyzed.@*RESULTS@#A total of 101 patients received TAR, including 35 cases aged ≥ 65 years old, 66 cases aged < 65 years old; 78 cases used bilateral radial arteries, and 23 cases used unilateral radial arteries. 4 cases of bilateral internal mammary arteries. All the proximal ends of the radial artery were anastomosed to the proximal end of the ascending aorta, 34 cases were performed of "Y" grafts, and 4 cases were sequential anastomoses. There was no in-hospital death and perioperative cardiovascular events. Perioperative cerebral infarction occurred in 3 patients. 1 patients was reoperated for bleeding. Intra-aortic balloon pump (IABP) assistance was used in 21 patients. Poor wound healing occurred in 2 cases and healed well after debridement. Follow-up of 2 to 20 months after discharge showed no internal mammary artery occlusion and 4 radial artery occlusions; no major adverse cardiovascular and cerebrovascular event (MACCE) occurred, and the survival rate was 100%. There was no significant difference in the above perioperative complications and follow-up endpoints between the two age groups.@*CONCLUSIONS@#By adjusting the order of bypass anastomosis and optimizing the preoperative evaluation method, radial artery combined with internal mammary artery can obtain better outcome early in TAR, and can be safely and reliably applied to elderly patients.

Acute cerebral infarction following extracorporeal membrane oxygenation treatment in patients with cardiogenic shock: 2 cases report and review of the literature / 中华危重病急救医学

OBJECTIVE@#To explore the diagnosis and treatment of acute cerebral infarction following extracorporeal membrane oxygenation (ECMO) therapy in patients with cardiogenic shock to review the literature.@*METHODS@#The clinical data of two patients with cardiogenic shock treated with veno-arterial ECMO (VA-ECMO) complicated with acute cerebral infarction admitted to department of intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University were retrospectively analyzed and the treatment experience was shared.@*RESULTS@#Case 1 was a 46-year-old male patient who was admitted to the hospital on September 16, 2021, due to "repeated chest tightness, shortness of breath, syncope for 2+ years, and worsened for 15 days. Coronary artery angiography showed 3-vessel coronary artery disease lesions. On October 15, 2021, coronary artery bypass grafting (CABG), pericardial fenestration and drainage, thoracic closed drainage, femoral bypass, thoracotomy exploration, and sternal internal fixation were performed under support of extracorporeal circulation. After surgery, the heart rate was 180-200 bpm, the blood pressure could not be maintained, and the improvement was not obvious after active drug treatment. The right femoral artery and femoral vein were intubated, VA-ECMO support treatment was performed, and the patient was transferred to the ICU. Intra-aortic balloon pump (IABP) was treated on the day of transfer because the circulation could not be maintained. Due to acute cerebral infarction in the left hemisphere and right parieto-occipital lobe, subfalcine herniation, tentorial herniation, the patient ultimately died after withdrawing from ECMO. Case 2 was a 43-year-old male patient who was admitted to the hospital on June 29, 2021, with "fever for 8 days and vomiting for 4 days". Bedside ultrasound showed cardiac enlargement and diffuse wall motion reduction in the left and right ventricles. On June 30, 2021, the patient underwent catheterization through the right femoral artery and femoral vein, VA-ECMO support, and was transferred to ICU for treatment. Acute cerebral infarction on both sides of the cerebellum occurred, and after treatment, the patient was discharged with mild impairment of daily living ability.@*CONCLUSIONS@#Strengthen monitoring of anticoagulation; regular neurological examination of patients undergoing ECMO therapy; ECMO under light sedation or awake can be performed if the condition permitsif the condition permits, perform light sedation or awake ECMO, which helpful for the early detection of nervous system injury.

Comparison of haemodynamic response to tracheal intubation with two different videolaryngoscopes: A randomized clinical trial

Abstract Background: Endotracheal intubation (ETI), which is the gold standard in coronary artery bypass grafting (CABG), may cause myocardial ischaemia by disturbing the balance between haemodynamic changes and oxygen supply and consumption of the myocardium as a result of sympathetic stimulation. In this study, we aimed to compare two different videolaryngoscopes (C-MAC and Airtraq) in the hemodynamic response to ETI. Methods: Fifty ASA II-III CABG surgery patients were randomly assigned to C-MAC or Airtraq. The hemodynamic data included arterial blood pressure [systolic (SAP), diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at six different points in time: before laryngoscopy-T1, during laryngoscopy-T2, immediately after intubation-T3, and 3 (T4), 5 (T5) and 10 (T6) minutes after intubation. Intraoperative complications were recorded. Patients were questioned about postoperative complications 2 and 24hours following extubation. Results: The hemodynamic response to ETI was significantly greater with C-MAC. The increase in HR started with the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started immediately after ETI (p = 0.024; p = 0.012; p = 0.030; p = 0.009, respectively). In group analyses, T1-T2, T2-T3 and T1-T3 comparisons did not show any significant differences in HR with Airtraq. However, with C-MAC, HR after intubation increased significantly compared to the pre-laryngoscopy values (T1-T3) (p = 0.004). The duration of laryngoscopy was significantly reduced with C-MAC (p < 0.001), but the duration of intubation and total intubation were similar (p = 0.36; p = 0.79). Conclusions: Compared to C-MAC, the hemodynamic response to ETI was less with Airtraq. Thus, Airtraq may be preferred in CABG patients for ETI.

Enfermedad coronaria: factores de riesgo y supervivencia a 10 años en la cirugía coronaria / Risk factors associated with 10-year survival after coronary artery bypass grafting

Background: Coronary artery bypass grafting (CABG) is the treatment of choice for a broad spectrum of patients with coronary disease. Aim: To describe global survival and factors associated with lower long-term survival in patients operated with isolated CABG. Material and Methods: Analysis of a cohort of patients who underwent CABG between January 2006 and December 2008 at a public hospital. The database and operation records of 1.003 cardiac surgeries were reviewed. Of these, an isolated CABG was performed in 658 patients aged 62 ± 9 years including 516 male (78%). Survival data were obtained from the Chilean Civil Registry Office and a complete ten-year follow up was accomplished. Survival was analyzed with Kaplan-Meier method with log-rank test and Cox regression. Results: Operative mortality occurred in 13 patients (2%). Survival at 1, 3, 5 and 10 years was 97, 94, 91 and 76%, respectively. One, 3, 5 and 10-year free of cardiovascular death survival was 98, 97, 95 y 89%, respectively. Factors associated with long-term survival were chronic kidney disease in hemodialysis (Hazard ratio (HR) 7.9; 95% confidence intervals (CI) 4.6-13.6), chronic obstructive pulmonary disease (HR 2.3; 95% CI 1.4-3.7), chronic arterial occlusive disease (HR 2.2; 95% CI 1.4-3.4) and diabetes mellitus (HR 1.9; 95% CI 1.4-2.6). According to EuroSCORE, 10-year survival was 86, 75 and 62% (p < 0.01) in low, medium and high-risk patients, respectively. Conclusions: These patients had a 10-year survival comparable to large international series. Groups associated with lower 10-year survival were identified.

Comparison of the effectiveness of home visits and telephone follow-up on the self-efficacy of patients having undergone coronary artery bypass graft surgery (CABG) and the burden of their family caregivers: A randomized controlled trial / Comparación de la efectividad de las visitas domiciliarias y el seguimiento telefónico sobre la autoeficacia de los pacientes sometidos a cirugía de derivación arterial coronaria con injerto y la carga para sus cuidadores familiares: Un ensayo controlado aleatorio / Comparação da efetividade das visitas domiciliares e o seguimento telefónico sobre a autoeficácia dos pacientes submetidos a cirurgia de derivação arterial coronária com enxerto e a carga para seus cuidadores familiares: Um ensaio controlado aleatório

Objective. This study aimed to compare home visits and telephone follow-up effectiveness on patients' self-efficacy undergoing Coronary Artery Bypass Graft Surgery -CABG- and caregivers' burden. Methods. In this randomized clinical trial, 114 patients undergoing CABG were assigned to the three groups of home visits, telephone follow-up, and control based on the stratified block randomization. The self-management program of the home visit group included four face-to-face 60-minute training sessions once a week, and for the telephone follow-up group, four 30-minute telephone counseling sessions twice each week for a month. The control group received routine care. Data were collected using the cardiac rehabilitation self-efficacy questionnaire and the caregiver burden scale before and after the intervention. Results. Before the study, there were no statistically significant differences between the three groups in terms of the means of self-efficacy and caregiver burden scores. However, there was a statistically significant difference between the home visit and control groups (p<0.001) and between the telephone follow-up and control groups (p<0.001) after the intervention, with increased self-efficacy and reduced caregiver burden reported. In contrast, there was no significant difference between the home visit and telephone follow-up groups regarding self-efficacy and caregiver burden scores. Conclusion. Both methods of self-management education have similar effectiveness in increasing self-efficacy and reducing the caregiver burden after discharge for patients who have undergone CABG.

Objetivo. Comparar la eficacia de las visitas domiciliarias y del seguimiento telefónico sobre la autoeficacia de los pacientes sometidos a cirugía de derivación arterial coronaria con injerto (CABG en inglés) y la carga de sus cuidadores. Métodos. En este ensayo clínico aleatorio, 114 pacientes sometidos a CABG se asignaron a uno de los tres grupos de investigación: visitas domiciliarias, seguimiento telefónico y control sobre la base de la aleatorización en bloque estratificada. El programa de educación en autoeficacia en el grupo de visitas domiciliarias incluía cuatro sesiones presenciales de formación de 60 minutos una vez a la semana, y para el grupo de seguimiento telefónico, cuatro sesiones de asesoramiento telefónico de 30 minutos dos veces por semana por un mes. El grupo de control recibió atención rutinaria. Los datos se recogieron mediante el cuestionario de autoeficacia de la rehabilitación cardíaca y la escala de carga del cuidador antes y después de la intervención. Resultados. Antes del estudio, no hubo diferencias entre los tres grupos en cuanto a las medias de las puntuaciones de las escalas de autoeficacia y carga del cuidador. Sin embargo, se encontró una diferencia estadísticamente significativa entre los grupos de visitas domiciliarias y de control (p<0.001) y entre los grupos de seguimiento telefónico y de control (p<0.001) después de la intervención, con un aumento de la autoeficacia y una reducción de la carga del cuidador. Es de anotar que no hubo diferencias significativas entre los grupos de visita domiciliaria y de seguimiento telefónico en cuanto a las puntuaciones de autoeficacia y de carga del cuidador. Conclusión. Ambos métodos de educación en este estudio tuvieron una efectividad similar en el aumento de la autoeficacia y la reducción de la carga de los cuidadores tras el alta de los pacientes sometidos a CABG.

Objetivo. Comparar a eficácia das visitas domiciliares e do seguimento telefónico sobre a autoeficácia dos pacientes submetidos a cirurgia de derivação arterial coronária com enxerto (CABG em inglês) e a carga dos seus cuidadores. Métodos. Neste ensaio clínico aleatório, 114 pacientes submetidos a CABG foram designados a um dos três grupos de investigação: visitas domiciliares, seguimento telefónico e controle sobre a base aleatorizada em blocos estratificada. O programa de educação em autoeficácia no grupo de visitas domiciliares incluía quatro sessões de formação presenciais de 60 minutos uma vez por semana, e para o grupo de seguimento telefónico, quatro sessões de assessoramento telefónico de 30 minutos duas vezes por semana durante um mês. O grupo de controle recebeu atenção rotineira. Os dados se recolheram mediante o questionário de autoeficácia da reabilitação cardíaca e a escala de carga do cuidador antes e depois da intervenção. Resultados. Antes do estudo, não houve diferenças entre os três grupos enquanto às médias das pontuações das escalas de autoeficácia e carga do cuidador. Porém, se encontrou uma diferença estatisticamente significativa entre os grupos de visitas domiciliares e de controle (p<0.001) e entre os grupos de seguimento telefónico e de controle (p<0.001) depois da intervenção, com um aumento da autoeficácia e uma redução da carga do cuidador. É importante anotar que não houve diferenças significativas entre os grupos de visita domiciliar e de seguimento telefónico enquanto às pontuações de autoeficácia e de carga do cuidador. Conclusão. Ambos os métodos de educação neste estudo tiveram uma efetividade similar no aumento da autoeficácia e a redução da carga dos cuidadores após a alta dos pacientes submetidos a CABG.

Aterosclerosis en puente venoso aorto-coronario: hallazgos del OFDI: caso clínico / Findings of optical coherence tomography in saphenous grafts failure: report of one case

Atherosclerosis is the main cause of late saphenous vein graft (SVG) failure. Intracoronary images using optical coherence tomography (OCT) in addition to angiography allow a detailed analysis of the lesion beyond the degree of stenosis. We report a 67 years old diabetic male who underwent coronary surgery in 2009, consulting for an acute coronary syndrome. Angiography showed two different lesions on one aortocoronary venous grafts. OCT demonstrates atherosclerosis in different stages identifying the culprit lesion. Stent placement were successfully carried out.

Elevation of C-reactive protein early after cardiopulmonary bypass surgery is associated with occurrence of postoperative atrial fibrillation / 南方医科大学学报

OBJECTIVE@#To explore the association between postoperative C-reactive protein (CRP) levels and the occurrence of postoperative atrial fibrillation in patients undergoing cardiopulmonary bypass surgery.@*METHODS@#We retrospectively analyzed the data of 550 patients undergoing cardiopulmonary bypass surgery in our hospital from September, 2018 to May, 2021, and after screening against the exclusion criteria, 363 patients were selected for further analysis. Univariate analysis was used to analyze the correlation of age and early postoperative CRP level with the occurrence of postoperative atrial fibrillation, and Chi-square test was used to explore the correlation of gender, disease type, and comorbidity with postoperative atrial fibrillation followed by multivariate analysis of the data using a binary logistic regression model.@*RESULTS@#The 363 patients enrolled in this study included 247 with valvular disease, 42 with aortic dissection, 37 with coronary heart disease, and 37 with congenital heart disease, with a median postoperative CRP level of 88.65 mg/L and a median age of 57 years (range 5-77 years). Postoperative atrial fibrillation occurred in 101 (27.82%) of the patients, who were subsequently divided into atrial fibrillation group and sinus group. Univariate and multivariate correlation analyses showed that early postoperative elevation of CRP level was an important factor contributing to the occurrence of postoperative atrial fibrillation.@*CONCLUSION@#Early postoperative elevation of CRP level is associated with the occurrence of atrial fibrillation following cardiopulmonary bypass surgery.

Application of SYNTAX and its Derivative Scores in the Selection of Revascularization Strategies for Complex Coronary Heart Disease / 中国医学科学杂志(英文版)

Complex coronary heart disease (CHD) has become a hot spot in medicine due to its complex coronary anatomy, variable clinical factors, difficult hemodynamic reconstruction, and limited effect of conservative drug treatment. Identifying complex CHD and selecting optimal treatment methods have become more scientific as revascularization technology has improved, and coronary risk stratification scores have been introduced. SYNTAX and its derivative scores are decision-making tools that quantitatively describe the characteristics of coronary lesions in patients based on their complexity and severity. The SYNTAX and its derivative scores could assist clinicians in rationalizing the selection of hemodynamic reconstruction treatment strategies, and have demon-strated outstanding value in evaluating the prognosis of patients with complex CHD undergoing revascularization treatment. The authors in this article summary the practical application of SYNTAX and its derivative scores in complex CHD in order to deepen the understanding of the relationship between the choice of different revascularization strategies and SYNTAX and its derived scores in complex CHD and provide a further reference for clinical treatment of complex CHD.

A randomized controlled trial of indobufen versus aspirin in the prevention of bridging restenosis after coronary artery bypass grafting / 中华心血管病杂志

Objective: To compare the efficacy and safety between indobufen and aspirin in the prevention of restenosis of bridge vessels at 1 year after off-pump coronary artery bypass grafting. Methods: This study was a prospective cohort study. We selected 152 patients who received coronary artery bypass grafting in Beijing Anzhen Hospital from December 2016 to December 2018. Patients were divided into the indobufen group and the aspirin group. Patients in the aspirin group were treated with aspirin and clopidogrel, and patients in the indobufen group were treated with indobufen and clopidogrel. During the 1-year follow-up, the rate of restenosis of saphenous vein bridge and internal mammary artery bridge, the rate of adverse cardiac events and adverse reactions were compared between the two groups. The levels of fibrinogen (FIB), D-dimer (D-D), thrombomodulin (TM) and thrombin-activatable fibrinolysis inhibitor (TAFI) were compared before and after antiplatelet therapy. Results: There were 76 cases in the indobufen group, including 57 males (75.0%), aged (60.3±6.6) years. There were 76 cases in the aspirin group, including 62 males (81.6%), aged (59.7±7.2) years. Baseline data were comparable between the two groups (P>0.05). During the follow-up, 3 cases were lost to follow up. Follow-up was completed in 74 patients in the indobufen group and 75 in the aspirin group. A total of 268 bridging vessels were grafted in the indobufen group and 272 in the aspirin group. One year after surgery, the patency rates of great saphenous vein bridge and internal mammary artery bridge were 94.5% (189/200) and 97.1% (66/68) in the indobuphen group, and 91.3% (189/207) and 96.9% (63/65) in the aspirin group, respectively. There was no significant difference in patency rate of great saphenous vein bridge and internal mammary artery bridge between the two groups (χ²=0.282, 0.345, P>0.05). The total incidence of adverse cardiac events was 5.4% (4/74) in the indobufen group and 6.7% (5/75) in the aspirin group (χ²=0.126, P>0.05). The overall incidence of gastrointestinal adverse reactions was significantly lower in the indobufen group than in the aspirin group (4.1% (3/74) vs. 13.3% (10/75), χ²=4.547, P<0.05). The levels of FIB, D-D, TM and TAFI in the two groups were lower than those before surgery (P<0.05), and there was no statistical significance between the two groups at baseline and post-operation (P>0.05). Conclusion: The efficacy of indobufen combined with clopidogrel in the prevention of 1-year restenosis after coronary artery bypass graft is similar to that of aspirin combined with clopidogrel, but the incidence of adverse reactions is lower, and the safety is higher in patients treated with indobufen combined with clopidogrel compared to aspirin combined with clopidogrel strategy.

Evaluations of antioxidant enzyme activities, total sialic acid and trace element levels in coronary artery bypass grafting patients

Abstract Introduction: In this study, patients before and after cardiac surgery with cardiopulmonary bypass (CPB) and control subjects were evaluated for erythrocyte glutathione peroxidase, catalase and superoxide dismutase enzyme activities, in addition to glutathione, malondialdehyde, serum total sialic acid, lipid-bound sialic acid, total antioxidant status, trace elements and mineral levels. The correlation of these variables with coronary artery disease (CAD) was also assessed. Methods: A total of 30 CAD patients and 30 control subjects were included in the study. CAD patients were divided into three groups: before surgery (BS), first day after surgery (1st day AS) and seventh day after surgery (7th day AS). Results: Malondialdehyde (MDA) and total sialic acid (TSA) levels were significantly higher in CAD (BS) than in the control group (P<0.05, P<0.05). In addition, GSH and TAS levels were significantly lower in the 1st day AS group than in the control group (P<0.001, P<0.01). Moreover, Co, Cu, Mg, Se, V and Zn levels were significantly lower in CAD (BS) group than in the control group (P<0.01, P<0.01, P<0.01, P<0.01, P<0.05, P<0.001). Conclusions: It was concluded that the levels of LDL-C, total cholesterol, triglycerides and CRP significantly associated with parameters, as well as Cu, Ca and SOD activity, should be measured together to monitor CAD. It is also considered that measuring TSA and MDA might be an appropriate choice for biomarkers of CAD.

Is Vasoactive-Inotropic Score a Predictor for Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Surgery?

Abstract Introduction: We aimed to investigate whether vasoactive-inotropic score (VIS) is a predictor for early postoperative morbidity and mortality. Methods: This study was planned as a prospective cohort study, between Nov 20 2018 and May 15 2019, including a total of 290 patients aged 20 years or older who underwent elective on-pump coronary artery bypass grafting (CABG). Patients' demographic data, aortic cross-clamp and cardiopulmonary bypass times, European System for Cardiac Operative Risk Evaluation (EuroSCORE) score, cardiac ejection fraction (EF), VIS, intubation duration, and intensive care unit length of stay were recorded. Postoperative mortality and morbidity were recorded. Hourly doses of inotropes for VIS were recorded for each patient, and VIS was calculated. Results: Among the cases, 222 (77%) were male and 68 (23%) were female. The mean age of our patients was 62.5 years (37-86). Combined morbidity and mortality rates of our patients were 23.8%. An optimal cutoff point for VIS of 5.5 could predict combined morbidity and mortality with 90% sensitivity and 88% specificity. Low EF, prolonged operation time, high EuroSCORE, and high VIS are independent factors in the early postoperative period for the development of combined morbidity and mortality in patients who underwent elective CABG. Conclusion: VIS is the most critical and EuroSCORE is the second most important scoring systems. They independently predict combined morbidity and mortality in undergoing elective coronary artery bypass surgery.

Multivessel woven coronary artery disease

Abstract Woven coronary disease is a rare pathology with unknown etiology. Although initially considered benign, recent publications report myocardial ischemia caused by the affected vessel. Since most patients are asymptomatic, long-term follow-up to understand its behavior is mandatory. We report a multivessel woven disease case with documented ischemia that was submitted to coronary artery bypass grafting and remained asymptomatic for two years of follow-up.

Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis

Abstract Introduction: In this study, we aimed to evaluate the anatomical deformations of the major vascular structures in the retrosternal area caused by adhesions following coronary artery bypass grafting (CABG). Methods: This single-center, retrospective study included a total of 40 patients with a previous CABG who were admitted to our emergency unit for any reason and underwent a contrast-enhanced chest computed tomography (patient group) and 40 patients without previous cardiac surgery (control group) between January 2018 and November 2019. The retrosternal area was compared between the groups using the statistical shape analysis method. The distance between the sternum and the ascending aorta and pulmonary artery was measured and anatomical deformations of the retrosternal area were examined. Results: There was a statistically significant difference in the anatomical structures of the retrosternal area between the patient and control groups (P<0.001). The distance from the midsternal line to the highest point of the pulmonary artery was statistically significantly shorter in the patient group, compared to the control group (P=0.013). The distance from the sternum to the ascending aorta was also shorter in the patient group, although it did not reach statistical significance (P>0.05). Conclusions: Our study results showed narrowing of the retrosternal area following CABG and a shorter distance from the sternum to the pulmonary artery than the ascending aorta. Based on these findings, surgeons should be cautious about possible injuries in patients requiring cardiac surgery with repeated median sternotomy.