Inflammatory prognostic index predicts new-onset atrial fibrillation and mortality after on-pump coronary artery bypass grafting.

OBJECTIVE: This study aimed to analyze its predictive role in incipient postoperative atrial fibrillation by constructing an inflammatory prognostic index based on hematological and biochemical parameters in patients undergoing elective isolated coronary artery surgery accompanied by cardiopulmonary bypass. METHODS: The data of 343 patients who underwent coronary bypass surgery between May 2021 and July 2022 were evaluated. Multivariate logistic regression and recipient study characteristic curve analyses were studied by comparing the patients' hematological indices and basic clinical features between the two groups. RESULTS: Logistic regression analysis showed that age (p<0.001), hypertension (p=0.01), and inflammatory prognostic index (p<0.001) were independent predictors of new-onset postoperative atrial fibrillation. To predict the development of postoperative atrial fibrillation, a cutoff value of 0.25 (77.8% sensitivity and 69.3% specificity) was determined for inflammatory prognostic index in the receiver-operating characteristic curve analysis (area under curve=0.798, 95% confidence interval 0.752-0.840). CONCLUSION: Inflammatory prognostic index can be a noninvasive, easily available marker for predicting new-onset atrial fibrillation after coronary artery bypass surgery.

Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting.

OBJECTIVE: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). METHODS: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. RESULTS: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. CONCLUSION: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.

Does perivascular fibrin glue application have a preventive effect for the endothelial damage on saphenous vein graft? An experimental model.

BACKGROUND: The effect of tissue adhesives on coronary grafts in cardiac surgery is a controversial issue. OBJECTIVE: The aim of this study is to investigate the effect of fibrin glue (FG) applied around the saphenous vein grafts (SVG) in preventing cellular damage resulting from intraluminal pressure increase. METHODS: Twenty volunteer patients were included in this ex vivo study. The SVGs remained after coronary artery bypass grafting were connected to the arterial line of the cardiopulmonary bypass circuit. The grafts were divided into two segments and one segment received perivascular FG applied whereas the other part was used plain. SVGs were kept in circulation at 120 mmHg pressure 250 mL/min flow rate for 60 min. The tissues were sent for histopathological examination to determine the endothelial damage. RESULTS: Endothelial damage was more pronounced in the control group when compared with the FG group. In the FG group, no damage was seen in 13 samples and no Type 3 endothelial damage was observe whereas Type 1 injury was detected in seven specimens, Type 2 injury was observed in seven specimens, and Type 3 injury was detected in two specimens in the control group. CONCLUSION: Perivascular application of FG on the SVG showed a protective effect against endothelial damage resulting from increased intraluminal pressure.

ANTECEDENTES: El efecto de los adhesivos tisulares sobre los injertos coronarios en cirugía cardíaca es un tema controvertido. OBJETIVO: Investigar el efecto del pegamento de fibrina aplicado alrededor de los injertos de vena safena para prevenir el daño celular resultante del aumento de la presión intraluminal. MÉTODO: En este estudio ex vivo fueron incluidos 20 pacientes voluntarios. Los injertos de vena safena que quedaron después del injerto de derivación de la arteria coronaria se conectaron a la línea arterial del circuito de derivación cardiopulmonar. Los injertos se dividieron en dos segmentos y a uno de ellos se le aplicó pegamento de fibrina perivascular, mientras que la otra parte se usó sola. Los injertos de vena safena se mantuvieron en circulación a una presión de 120 mmHg y una velocidad de flujo de 250 ml/min durante 60 minutos. Los tejidos se enviaron para examen histopatológico para determinar el daño endotelial. RESULTADOS: El daño endotelial fue más pronunciado en el grupo de control que en el grupo de pegamento de fibrina. Se observó lesión de tipo 2 en siete muestras del grupo de pegamento de fibrina y lesión de tipo 3 en dos muestras del grupo de control. CONCLUSIONES: La aplicación perivascular de pegamento de fibrina en los injertos de vena safena mostró un efecto protector contra el daño endotelial resultante del aumento de la presión intraluminal.

Inflammatory prognostic index predicts new-onset atrial fibrillation and mortality after on-pump coronary artery bypass grafting

SUMMARY OBJECTIVE: This study aimed to analyze its predictive role in incipient postoperative atrial fibrillation by constructing an inflammatory prognostic index based on hematological and biochemical parameters in patients undergoing elective isolated coronary artery surgery accompanied by cardiopulmonary bypass. METHODS: The data of 343 patients who underwent coronary bypass surgery between May 2021 and July 2022 were evaluated. Multivariate logistic regression and recipient study characteristic curve analyses were studied by comparing the patients' hematological indices and basic clinical features between the two groups. RESULTS: Logistic regression analysis showed that age (p<0.001), hypertension (p=0.01), and inflammatory prognostic index (p<0.001) were independent predictors of new-onset postoperative atrial fibrillation. To predict the development of postoperative atrial fibrillation, a cutoff value of 0.25 (77.8% sensitivity and 69.3% specificity) was determined for inflammatory prognostic index in the receiver-operating characteristic curve analysis (area under curve=0.798, 95% confidence interval 0.752-0.840). CONCLUSION: Inflammatory prognostic index can be a noninvasive, easily available marker for predicting new-onset atrial fibrillation after coronary artery bypass surgery.

Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting

ABSTRACT Objective: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). Methods: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. Results: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. Conclusion: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

SUMMARY OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.