Evaluation of the effect of preoperative HbA1c value on development of postoperative atrial fibrillation in diabetic patients with on-pump coronary artery bypass graft.

BACKGROUND: We aimed to determine the relationship between hemoglobin A1c (HbA1c) levels and the development of postoperative atrial fibrillation (PoAF). METHODS: Two hundred and eighty-eight patients diagnosed with diabetes mellitus and undergoing on-pump coronary bypass were included in the study. Those with serum HbA1c levels between 5.5% and 7.0% were defined as Group 1, those with serum HbA1c levels between 7.1% and 8.9% were defined as Group 2, while those with serum HbA1c levels 9.0% and above formed Group 3. Data between groups were compared. The predictive values of the independent variables for the development of PoAF were measured. RESULTS: We did not find a difference between groups in terms of development PoAF (p = .170). The presence of hypertension was determined as an independent predictor for the development of PoAF (p = .003), but not HbA1c levels (p = .134). There was 50.5% sensitivity and 61.1% specificity for HbA1c values of 9.06% and above to predict PoAF (area under curve: 0.571, p = .049). CONCLUSIONS: HbA1c levels were not an independent predictor of PoAF development. However, we think that high HbA1c levels may be a risk factor for the development of PoAF.

Comparison of Del Nido Cardioplegia and Blood Cardioplegia in Terms of Development of Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting.

OBJECTIVE: Del Nido cardioplegia (DNC) has been used in pediatric cardiac surgery for many years with a single dose application and its usage in adult cardiac surgery has been increasing in recent years, with results being published. In this study, we aimed to investigate the effect of DNC on the development of postoperative atrial fibrillation (PoAF). METHODS: In this retrospective observational comparative study, 255 patients who underwent isolated on-pump coronary artery bypass grafting, between January 2019 and November 2019, were enrolled. The patients were divided into two groups: DNC (n=132) and blood cardioplegia (BC) (n=123). Intraoperative and postoperative data were evaluated and compared in terms of the development of PoAF. RESULTS: We found that the development of PoAF and the length of hospital stay remain significantly higher in the BC group (P=0.044, P<0.001, respectively). In addition, the aortic cross-clamp time and the cardioplegia volume delivered were significantly lower in the DNC group (P=0.042, P<0.001, respectively). In multivariate logistic regression analysis, only higher cardioplegia volume was determined as an independent predictor for PoAF development (OR 1.001; 95% CI 1.000-1.001; P=0.033). We did not found difference between groups in terms of troponin T, inotropic drug support, need for intraaortic balloon pump and mortality. CONCLUSION: This study showed that DNC can be used safely in adult coronary bypass surgery and PoAF development effect is reduced.

Comparison of del nido cardioplegia and blood cardioplegia in terms of development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting

Abstract Objective: Del Nido cardioplegia (DNC) has been used in pediatric cardiac surgery for many years with a single dose application and its usage in adult cardiac surgery has been increasing in recent years, with results being published. In this study, we aimed to investigate the effect of DNC on the development of postoperative atrial fibrillation (PoAF). Methods: In this retrospective observational comparative study, 255 patients who underwent isolated on-pump coronary artery bypass grafting, between January 2019 and November 2019, were enrolled. The patients were divided into two groups: DNC (n=132) and blood cardioplegia (BC) (n=123). Intraoperative and postoperative data were evaluated and compared in terms of the development of PoAF. Results: We found that the development of PoAF and the length of hospital stay remain significantly higher in the BC group (P=0.044, P<0.001, respectively). In addition, the aortic cross-clamp time and the cardioplegia volume delivered were significantly lower in the DNC group (P=0.042, P<0.001, respectively). In multivariate logistic regression analysis, only higher cardioplegia volume was determined as an independent predictor for PoAF development (OR 1.001; 95% CI 1.000-1.001; P=0.033). We did not found difference between groups in terms of troponin T, inotropic drug support, need for intraaortic balloon pump and mortality. Conclusion: This study showed that DNC can be used safely in adult coronary bypass surgery and PoAF development effect is reduced.

Levels of Ischemia: Modified Albumin in Patients Undergoing On-pump Coronary Artery Bypass.

OBJECTIVE: To investigate the effect of ischemia-modified albumin (IMA) during cardiopulmonary bypass (CPB). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Cardiovascular Surgery, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January and April 2018. METHODOLOGY: Patients, who underwent on-pump coronary bypass surgery, were inducted. IMA levels were measured in the preoperative period (IMA-T1), 30 minutes after removal of aortic X-clamp (IMA-T2) (ischemic period) and 6th hours (IMA-T3) after surgery. The groups were formed according to the average value of IMA-T2 levels measured in the ischemic period. Those with a value above the mean (0.76 U/mL) were grouped as group 1 and those below the mean were grouped as group 2. Postoperative data of the patients were recorded. RESULTS: There were significant differences between measured IMA levels in different periods of on-pump CABG (p <0.001). The development of postoperative atrial fibrillation (PoAF) was higher in Group 1 and this result was statistically significant (p=0.004). High IMA-T2 levels were detected as an independent parameter in predicting the PoAF development (p=0.04, logistic regression analysis). ROC curve analysis demonstrated  IMA-T2 values of 0.73 or above could predict development PoAF with 82.6% sensitivity and 66.7% specificity (AUC: 0.777, log rank p=0.001). CONCLUSION: Increased IMA levels during ischemic period may be predictive in PoAF development. Key Words: Cardiopulmonary bypass, Myocardial ischemia, Ischemia-modified albumin.

Appropriate Surgical Repair of Ventricular Free Wall Rupture after Infarction: a Case Report.

Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.

Appropriate surgical repair of ventricular free wall rupture after infarction: a case report

Abstract Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.

The effect of thiol-disulfide homeostasis in patients undergoing on-pump coronary artery bypass grafting.

BACKGROUND: In this study, we aimed to investigate the effects of thiol-disulfide homeostasis in patients undergoing on-pump coronary artery bypass grafting. METHODS: Between January 2018 and October 2018, a total of 51 patients (43 males, 8 females; mean age 61.8±8.7 years; range, 38 to 78 years) who underwent isolated on-pump coronary artery bypass grafting were included. Thiol-disulfide homeostasis parameters were studied in the preoperative period (T1), 30 min after the removal of cross-clamp (T2), and postoperative sixth h (T3). Hemodynamic parameters such as atrial fibrillation and inotropic support requirement of the patients were evaluated in the postoperative period. RESULTS: There were significant differences in the measured thiol-disulfide homeostasis parameters at different time points of surgery (p<0.001). Binary logistic regression analysis showed that T2-disulfide/native thiol ratio was an independent predictor of the development of postoperative atrial fibrillation (p=0.042). There were positive and significant correlations between the T2-disulfide levels and cross-clamp time (r:0.307, p=0.029). CONCLUSION: Thiol-disulfide homeostasis in patients undergoing on-pump coronary artery bypass grafting changes toward to disulfide. Disulfide levels increase in parallel with prolonged ischemia time. Decreased native thiol and increased disulfide levels during ischemic period may be predictive of postoperative atrial fibrillation.

Effect of Plasma Level of Vitamin D on Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting.

OBJECTIVE: Postoperative atrial fibrillation (PoAF) is a common complication after coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the association between development of PoAF and vitamin D levels in patients undergoing isolated CABG. METHODS: This prospective randomized clinical trial was conducted on the patients with isolated CABG. The study was terminated when 50 patients in both PoAF(+) group and PoAF(-) group were reached. Development of AF until discharge period was assessed. Vitamin D level was measured immediately after AF; it was measured on the discharge day for the patients without PoAF. Predictive values of the independent variables were measured for the development of PoAF. RESULTS: The groups were separated as PoAF(-) group (66% male, mean age 58.18±10.98 years) and PoAF(+) group (74% male, mean age 61.94±10.88 years). 25(OH) vitamin D level (OR=0.855, 95% CI: 0.780-0.938, P=0.001) and > 65 years (OR=3.525, 95% CI: 1.310-9.483, P=0.013) were identified as an independent predictor of postoperative AF after CABG surgery in multivariate analysis. The cut-off level for 25(OH) vitamin D level in receiver-operating characteristic curve analysis was determined as 7.65 with sensitivity of 60% and specificity of 64% for predicting PoAF (area under the curve: 0.679, P=0.002). CONCLUSION: Vitamin D level is considered an independent predictor for development of PoAF. Lower vitamin D levels may be one of the reasons for PoAF.

Effect of plasma level of vitamin d on postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting

Abstract Objective: Postoperative atrial fibrillation (PoAF) is a common complication after coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the association between development of PoAF and vitamin D levels in patients undergoing isolated CABG. Methods: This prospective randomized clinical trial was conducted on the patients with isolated CABG. The study was terminated when 50 patients in both PoAF(+) group and PoAF(-) group were reached. Development of AF until discharge period was assessed. Vitamin D level was measured immediately after AF; it was measured on the discharge day for the patients without PoAF. Predictive values of the independent variables were measured for the development of PoAF. Results: The groups were separated as PoAF(-) group (66% male, mean age 58.18±10.98 years) and PoAF(+) group (74% male, mean age 61.94±10.88 years). 25(OH) vitamin D level (OR=0.855, 95% CI: 0.780-0.938, P=0.001) and > 65 years (OR=3.525, 95% CI: 1.310-9.483, P=0.013) were identified as an independent predictor of postoperative AF after CABG surgery in multivariate analysis. The cut-off level for 25(OH) vitamin D level in receiver-operating characteristic curve analysis was determined as 7.65 with sensitivity of 60% and specificity of 64% for predicting PoAF (area under the curve: 0.679, P=0.002). Conclusion: Vitamin D level is considered an independent predictor for development of PoAF. Lower vitamin D levels may be one of the reasons for PoAF.

The influence of priming solutions used in cardiopulmonary bypass on blood viscosity in hypothermic conditions.

Vessel diameter, flow velocity, temperature, and viscosity are among the factors determining blood flow in vessels. To assess the influence of arterial blood flow on veins in a cardiac operation, the viscosity of blood diluted with priming solutions must be known. This study aimed to demonstrate the alteration of blood viscosity following dilution with priming solutions: hydroxyethyl starch (HES), gelatin, albumin, and Ringer's lactated solution (RL). Sixty volunteers were (15 female, 45 male) included in the study. Using a 50-ml syringe containing heparin, 40-ml fasting blood was drawn from antecubital veins. Six milliliters of blood was added to glass tubes previously filled with 2 ml of HES 6%, gelatin 4%, albumin, and RL solutions. Relative viscosity values of these mixtures were measured with an Ostwald viscometer device while the temperature was kept constant at 15 degrees C and 30 degrees C by means of a water bath. Measured viscosity values were compared with the calculated viscosity values and corrected values were obtained. All mixtures demonstrated decreased viscosity; however, it was evident that the mixtures containing HES and gelatin presented a lesser degree of decrease in viscosity when compared with the mixtures containing albumin and RL solution. Viscosity of all mixtures except RL decreased significantly at deep hypothermia (15 degrees C).