Epidemiological and pathogenetic mechanisms of atrial fibrillation depending on concomitant pathology, coronary bypass grafting and post-new coronavirus infection

Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, including coronary artery bypass grafting, which has great clinical and economic importance for the healthcare system. Despite the improvement of surgical tactics, anesthetic and care benefits, POAF incidence has been increasing over the past decade. The mechanisms of POAF are different. Chronic coronary artery disease and its frequent comorbidities such as arterial hypertension, obesity, diabetes mellitus and heart failure, - are associated with various structural and functional changes in the heart, contributing to electrical atrial remodeling. Today, such risk factors for POAF as age, enlarged left atrium, post heart valve surgery, and obesity are well known. A new coronovirus infection that occurred in the early postoperative period can also be a trigger for atrial fibrillation. Postoperative arrhythmias can worsen both hospital and long-term results of treatment, increase the length of the patient's stay in the hospital, and the risk of complications. This review updates the data on the pathogenesis, incidence and complications of POAF, taking into account the current epidemiological situation.Copyright © 2022 Authors. All rights reserved.

Cold Agglutinin Detected in the Intraoperative Period: A Case of Coronary Bypass.

Cold agglutinin disease(CAD) is an autoimmune disease that occurs against erythrocyte antigens. It is usually idiopathic, but some infections can also be a trigger. CAD becomes active in the peripheral circulation at lower temperatures more easily when exposed to cold, causing hemolysis or agglutination. In this article, the management of a coronary bypass case with CA formation in intraoperative period is presented. A 46-year-old diabetic and hypertensive male patient had COVID-19 2 months ago. Cardiopulmonary bypass(CPB) was initiated with adequate heparinization, and the patient was cooled to 32degreeC. It was noticed that there were clots in the cardioplegia delivery line(+1degreeC). Agglutinations were observed in the autologous blood of the patient whose ACT values were normal. After CPB, the operation was completed without any problems and the patient was discharged on the 5th day with recovery. A diagnosis of CAD was made with the results of peripheral smear and immunologic tests. Determination of antibody concentration and thermal amplitude in the preoperative period in patients with CAD is very important. While preparing such patients for surgery, heating of room, patient, fluids, planning of normothermic CPB, and using warm cardioplegia are required. The relationship between CAD and COVID has started to take place in the literature. The patient we presented had a COVID 2 months ago, cold agglutinin may have been induced by COVID or may have arisen idiopathic. Considering that many people may have had a COVID nowadays, care should be taken especially in the perioperative period of cardiac surgery.Copyright © Telif hakki 2022 Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi - Available online at www.gkdaybd.org.

Post-COVID Double Valve and Bypass Surgery One of 1st in World

Aim and objective: Post COVID double valve and bypass surgery in Covid pandemic. Materials and methods: We have done 260 cardiac surgery in our hospital out of which 10 case are post COVID case 8 case CABG I case CABG and DVR and one case MVR. All cases we have done 6 weeks after COVID report negative. We have a bundle of pre anaesthasia investigations for all patients, RT PCR negative report, CPP, ESR SGOT SGPT PTI total protein urea creatine HB TLC DLC platelet count MCV C MCH COK MB TROPI HS ECG X-ray chest CT scan - chest echo angiography and complete systemic body evaluation by team of cardiac anaesthesiologist all CABG we have done on beating heart DVR and CAGB on cardiopulmonary bypass all case discharge on 8th day there is no mortality in all our case in non-COVID CABG we got to post bypass surgery patient become positive one PT we lost she was 75-year-old female on 23rd day. We recommend for all cardiac surgery patients should undergo complete PAC and beating heart surgery for coronary artery surgery and all team member should use COVID precaution protocol. Results: We have done total 260 cardiac surgery from may 2020 till August 2021 10 case are post COVID 8 case CABG and 1 mitral valve surgery 1 case double valve surgery and bypass surgery one of 1st in world all post COVID patient discharge on 8th day no mortality in our post COVID case out of 260 cardiac case two patient become covid positive one patient we lost. We advise post-COVID case we should do cardiac elective case 6 week after COVID negative report and complete PAC is very important and every one take all COVID preventive protocol every time. Conclusion: All post COVID case we should do cardiac surgery 6 week after COVID complete PAC evaluation is very important every time COVID prevention protocol for every in hospital for coronary artery bypass surgery beating heart surgery is safe technique.

Predictors of poor exercise self-efficacy improvements after cardiac rehabilitation

Background/Introduction: Building confidence to exercise regularly (exercise self-efficacy (ESE)) in the face of constraints and barriers, is a key goal of cardiac rehabilitation (CR) because such self-efficacy beliefs are predictors of sustained exercise behaviours. Therefore, identifying patient subgroups at risk of poor ESE enables tailoring of CR and appropriate targeting of support interventions. Purpose: To identify independent predictors of poor ESE and poor improvements in ESE in CR participants. Methods: The study used a prospective observational cohort design and recruited patients with coronary heart disease at CR entry across four sites in Metropolitan Sydney, Australia (2019-2020). Data were also compared for traditional in-person and remote-delivered CR during COVID-19 pandemic restrictions. The Exercise Self Efficacy Scale was used to measure ESE at CR entry and completion, and General Linear Models were used for analyses. Results: Participants (n=194) had a mean age of 65.94 (SD 10.46) years, with 80.9% males;and 80.0% were married or partnered, with 23.6% from an ethnic minority background. Referral diagnosis included elective percutaneous coronary intervention (PCI) (40.2%), coronary artery bypass surgery (26.3%), and myocardial infarction with or without PCI (33.5%). At CR entry, the mean ESE score was 24.93 (SD 5.99) points, which improved significantly by completion (p=.027). The GLM of ESE change (Adjusted R2=.247) identified that predictors of less change in ESE scores by CR completion included ethnic minorities (β=2.96, p=.003), not having a spouse or an intimate partner (β=-2.42, p=.023), and attending in-person CR (β=1.75, p=.036). Having higher ESE scores at entry was also associated with less ESE change on completion, such that for every point increase in ESE at entry, there was a reduction of .37 points in change (p<.001). These variables were also the same predictors of poor ESE at CR completion. Conclusions: Confidence to exercise improves in CR, and screening for ESE at CR entry enables identification of patients at-risk of poor improvements. Tailoring of interventions to provide appropriate support such as extending CR should be considered for patients from ethnic minorities and those who are single/widowed. Exploring the reasons for differences in outcomes from in-person and remote-delivered CR using appropriate methods should be the focus of future research.

Charlson comorbidity index in predicting deaths in COVID-19 patients

Aim. To assess the clinical performance and factors associated with inhospital mortality in patients with coronavirus disease 2019 (COVID-19). Material and methods. Our results are based on data from hospital charts of inpatients hospitalized in the Asinovskaya District Hospital in the period from March 11, 2020 to December 31, 2020, with a verified COVID-19 by polymerase chain reaction. The study included 151 patients, the median age of which was 66,2 (5092) years (women, 91;60,3%). The study endpoints were following hospitalization outcomes: Discharge or death. Depending on the outcomes, the patients were divided into 2 groups: The 1st group included 138 patients (survivors), while the 2nd one included 13 patients (death). To objectify the severity of multimorbidity status, the Charlson comorbidity index was used. The final value was estimated taking into account the patient age by summing the points assigned to a certain nosological entity using a calculator table. Results. Hypertension was recorded in the majority of patients — 79,5%, chronic kidney disease — in 61,1%. The prevalence of type 2 diabetes and coronary artery disease was high — 31,8% each. Prior myocardial infarction was diagnosed in 11,3% of cases. The prevalence of percutaneous coronary intervention and coronary bypass surgery was 5,3% and 3,3%, respectively. Stroke was detected in 9,3% of participants. Prior chronic pulmonary pathologies in COVID-19 patients were rare (asthma — 3,3%, chronic obstructive pulmonary disease — 2,0%). In order to predict the death risk in COVID-19 patients, a logistic regression analysis was performed, which showed that age and Charlson comorbidity index were the most significant predictors. Conclusion. Independent factors of inhospital mortality were age and Charlson’s comorbidity index. The risk assessment model will allow clinicians to identify patients with a poor prognosis at an earlier disease stage, thereby reducing mortality by implementing more effective COVID-19 treatment strategies in conditions with limited medical resources.

Noteworthy Cardiac Literature From 2021: Coronary Guideline Change Without New Data, Heart Transplant Donation After Cardiac Death, Covid Effects on Global Cardiac Surgery, and Attempt to Improve Dissection Remodeling.

Cardiac surgery continues to evolve. The last year has been notable for many reasons. The guidelines for coronary revascularization introduced significant discord. The pandemic continues to affect the care on a global scale. Advances in organ procurement and dissection care move forward with better understanding and better technology.

Treatment Approach to Coronavirus Disease (COVID-19) Seen Early After Open Heart Surgery. Case Report.

SARS-CoV-2 was reported for the first time in China on December 31, 2019, as the cause of some pneumonia cases characterized by fever, cough, dyspnea, myalgia, and fatigue. Here, we present our approach to a 54-year-old male patient who had coronary artery bypass (CABG) surgery diagnosed as high probability coronavirus disease 2019 (COVID-19) in early postoperative period.