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Introduction Coronary revascularization is associated with better prognosis in multivessel coronary artery disease (MV-CAD) chronic kidney disease (CKD) patients. However, whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is better remains unknown. Aim of the study To compare outcome of multi-vessel PCI versus CABG in the group of patients with CKD regarding in-hospital and one-year major adverse cardiovascular and cerebrovascular events (MACCE). Methods A retrospective analysis of the data of patients with established CKD with eGFR less than 60 ml/min with MV-CAD who underwent PCI or CABG were compared as regards in-hospital and one-year MACCE. Results A total number of 565 patients were reviewed, 230 patients had PCI while 335 patients had CABG. Comparing both groups regarding in-hospital MACCE, patients who had mutli-vessel PCI had significantly lower in-hospital death, cerebrovascular events and total MACCE than patients who had CABG (P-value = 0.03, 0.01, 0.04 respectively). While comparing both groups regarding 1-year MACCE, patients who had mutli-vessel PCI had significantly lower cerebrovascular events and total MACCE than patients who had CABG (P-value = 0.02, 0.03 respectively). Conclusion On the contrary to previously published data, in a retrospective study to determine which is better in CKD MV-CAD patients, Multi-vessel PCI for CKD patients and MVCAD had advantages over CABG as regards in-hospital and 1-year cerebrovascular accidents (stroke/TIA) and total MACCE. Large randomized controlled trials are needed to confirm our findings. Funding Acknowledgement Type of funding source: None

Machine learning may enhance prediction of outcomes after coronary artery bypass grafting (CABG). We sought to develop and validate a dynamic machine learning model to predict CABG outcomes at clinically relevant pre- and postoperative time points.The Society of Thoracic Surgeons (STS) registry data elements from 2086 isolated CABG patients were divided into training and testing datasets and input into Extreme Gradient Boosting decision-tree machine learning algorithms. Two prediction models were developed based on data from preoperative (80 parameters) and postoperative (125 parameters) phases of care. Outcomes included operative mortality, major morbidity or mortality, high cost, and 30-day readmission. Machine learning and STS model performance were assessed using accuracy and the area under the precision-recall curve (AUC-PR).Preoperative machine learning models predicted mortality (accuracy, 98%; AUC-PR = 0.16; F1 = 0.24), major morbidity or mortality (accuracy, 75%; AUC-PR = 0.33; F1 = 0.42), high cost (accuracy, 83%; AUC-PR = 0.51; F1 = 0.52), and 30-day readmission (accuracy, 70%; AUC-PR = 0.47; F1 = 0.49) with high accuracy. Preoperative machine learning models performed similarly to the STS for prediction of mortality (STS AUC-PR = 0.11; P = .409) and outperformed STS for prediction of mortality or major morbidity (STS AUC-PR = 0.28; P.001). Addition of intraoperative parameters further improved machine learning model performance for major morbidity or mortality (AUC-PR = 0.39; P.01) and high cost (AUC-PR = 0.64; P.01), with cross-clamp and bypass times emerging as important additive predictive parameters.Machine learning can predict mortality, major morbidity, high cost, and readmission after isolated CABG. Prediction based on the phase of care allows for dynamic risk assessment through the hospital course, which may benefit quality assessment and clinical decision-making.

BACKGROUND: Autonomic function can be estimated non-invasively using heart rate variability (HRV). HRV of patients undergoing coronary artery bypass grafting (CABG) is investigated in time-domain and frequency-domain before and after CABG to study the effect of operation on the status of patients. OBJECTIVE: The main purpose of this work is to evaluate the effect of CABG surgery on patients with ischemic heart disease (IHD) before operation, and to monitor the status of patients on day 6 and day 30 after the CABG operation. METHODS: The statistical signal characterization (SSC) technique is used in this work in order to derive different morphology-based parameters to indirectly describe time-domain and frequency-domain HRV parameters in 24 patients undergoing CABG operation, before the operation (Group 1: G1), 6 days after operation (Group 2: G2) and 30 days after operation (Group 3: G3). The data is obtained from the Sultan Qaboos University Hospital in Oman. RESULTS: The SSC parameters Mean(mt) and Mean(dt) are reduced in all 24 patients and in 23 out of 24 patients in G2 compared to G1 (6-days after operation compared with before operation), respectively. Comparing G3 to G1 the reduction in Mean(mt) and Mean(dt) is noted in 18 of the 24 patients. CONCLUSIONS: The parameters Mean(mt) and Mean(dt) are successful parameters to follow the HRV for patients undergoing CABG surgery. A relation between those SSC parameters and the HRV time-domain and frequency-domain parameters is investigated in this paper to understand the physiological behavior of the patients.

Background The Society of Thoracic Surgeons (STS) Quality Measurement Task Force has developed risk models and composite performance measures for isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), isolated mitral valve replacement or repair (MVRR), AVR+CABG, and MVRR+CABG. To further enhance its portfolio of risk-adjusted performance metrics, STS has developed new risk models for multiple valve operations ± CABG procedures. Methods Using July 2011 to June 2019 STS Adult Cardiac Surgery Database data, risk models for AVR+MVRR (n = 31,968) and AVR+MVRR+CABG (n = 12,650) were developed with the following endpoints: Operative Mortality, major morbidity (any 1 or more of the following: cardiac reoperation, deep sternal wound infection/mediastinitis, stroke, prolonged ventilation, and renal failure), and combined mortality and/or major morbidity. Data were divided into development (July 2011 to June 2017; n = 35,109) and validation (July 2017 to June 2019; n = 9509) samples. Predictors were selected by assessing model performance and clinical face validity of full and progressively more parsimonious models. Performance of the resulting models was evaluated by assessing discrimination and calibration. Results C-statistics for the overall population of multiple valve ± CABG procedures were 0.7086, 0.6734, and 0.6840 for mortality, morbidity, and combined mortality and/or morbidity in the development sample, and 0.6953, 0.6561, and 0.6634 for the same outcomes, respectively, in the validation sample. Conclusions New STS Adult Cardiac Surgery Database risk models have been developed for multiple valve ± CABG operations, and these models will be used in subsequent STS performance metrics.

The optimal timing of coronary artery bypass grafting (CABG) in patients after an acute myocardial infarction (MI) is unknown. We performed a systematic review and meta-analysis of studies comparing mortality rates in patients who underwent CABG at different time intervals after acute MI. Bias assessments were completed for each study, and summary of proportions of all-cause mortality were calculated based on CABG at various time intervals after MI. A total of 22 retrospective studies, which included a total of 137,373 patients were identified. The average proportion of patients who died when CABG was performed within 6 hours of MI was 12.7%, within 6 to 24 hours of MI was 10.9%, within 1 day of MI was 9.8%, any time after 1 day of MI was 3.0%, within 7 days of MI was 5.9%, and any time after 7 days of MI was 2.7%. Interstudy heterogeneity, assessed using I2 values, showed significant heterogeneity in death rates within subgroups. Only 1 study accounted for immortal time bias, and there was a serious risk of selection bias in all other studies. Confounding was found to be a serious risk for bias in 55% of studies because of a lack of accounting for type of MI, MI severity, or other verified cardiac risk factors. The current publications comparing timing of CABG after MI is at serious risk of bias because of patient selection and confounding, with heterogeneity in both study populations and intervention time intervals.

Background The ratio of early mitral inflow velocity to early diastolic strain rate (E/e'sr) is a novel echocardiographic measure to estimate early left ventricular (LV) filling pressure. We hypothesize that E/e'sr is a predictor of outcome following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e'. Methods & results Consecutive patients undergoing isolated CABG at Gentofte Hospital (n = 652) were included. The mean age of the study population was 67 ± 9 years, 84% were male, mean LVEF was 50 ± 11%. Prior to surgery, all patients underwent an extensive echocardiographic examination. The outcome was all-cause mortality. During follow-up (median 3.8 years [IQR: 2.7; 4.9 years]), a total of 73 (11.2%) died. Both E/e' and E/e'sr were significant predictors in univariable models. In a multivariable model, E/e'sr remained an independent predictor of outcome (HR:1.05 [1.01–1.10], p = 0.049, per 10 cm increase) whereas E/e' did not (HR:1.05 [0.99–1.11], p = 0.053, per 1-unit increase). The relationship between E/e'sr, and the outcome was significantly modified by GLS (p for interaction = 0.043). In the multivariable model, E/e'sr was still significantly associated with the outcome in patients with high GLS (≥13.6%) (HR:1.18 [1.02–1.36], p = 0.029) but not in patients with low GLS (HR 1.04 CI95%: [0.99–1.10], p = 0.14). E/e' was not a significant predictor of all-cause mortality after multivariable adjustment in neither of the groups. E/e'sr improved net reclassification with 33% when added to EuroSCOREII. Conclusion Following CABG, preoperative E/e'sr is an independent predictor of all-cause mortality, especially in patients with preserved systolic function and superior to E/e'.

An 81-year-old female presented with chronic coronary disease (Canadian Cardiovascular Society angina severity grading III). The patient underwent coronary computed tomography angiography (CCTA) that revealed three-vessel coronary artery disease (3VD). This case illustrates that in a patient with 3VD, planning and execution of coronary artery bypass grafting (CABG) were successfully performed based solely on CCTA combined with fractional flow reserve derived from computed tomography angiography (FFRCT). Coronary artery bypass grafting (CABG) was planned and executed as follows: left internal mammary artery grafted to the left anterior descending artery (LAD), saphenous vein graft (SVG) to the right coronary artery (RCA), and SVG to the obtuse marginal artery (OM). Repeat imaging assessment with non-invasive CCTA and FFRCT at 30-day follow-up confirmed the safety of this approach. The FFRCT values of the RCA and LAD were normalized, whereas a borderline pressure drop was observed in the distal run-off of the OM (FFRCT=0.79). Notably, this is the first case in which post-CABG FFRCT assessment was performed. Post-CABG FFRCT is an investigational novel non-invasive tool for assessing the functional improvement of the epicardial conductance vessels following surgical revascularization.

In Japan, off-pump coronary artery bypass (OPCAB) is more common than on-pump coronary artery bypass. Superior early results of OPCAB have been reported; however, long-term results were still unclear. Purpose of this study is to evaluate the clinical outcomes of OPCAB in Japan using Japan Adult Cardiovascular Surgery Database. Between 2008 and 2010, 23,633 patients who underwent isolated coronary artery bypass were reported in database. We selected the cases from the hospital with mean annual coronary surgery volume of more than 50. Among the total of 7724 cases at 41 institutions, 2150 (31.2%) on-pump coronary artery bypass (ONCAB) and 5574 (68.8%) OPCAB cases were included. Propensity score (PS) matching was performed using PS developed from patient characteristics and preoperative factors resulting in 2007 cases matched pairs. Long-term follow-up data on patients’ mortality and stroke were collected. In-hospital mortality was significantly lower in OPCAB (ONCAB 1.1%, OPCAB 0.4% p = 0.01). Stroke was low in OPCAB group (ONCAB 1.7%, OPCAB 0.8%, p = 0.01). There was no statistically significant difference between OPCAB and ONCAB regarding 7-year overall survival (86.1% vs 88.1% respectively), composite outcomes (72.0% vs 73.9% respectively), or cardiac deaths (97.3% vs 97.1% respectively). Subgroup analysis (more than 75 years old) showed a worse trend in OPCAB group. Only in OPCAB group, incomplete revascularization significantly influenced 7-year survival. OPCAB is associated with early prognostic benefits; however, it might be less favorable outcomes in the long term when patients are older or with incomplete revascularization.

Fei Gao,1,* Lingtong Shan,2,* Chong Wang,3,* Xiaoqi Meng,4 Jiapeng Chen,5 Lixiang Han,6 Yangyang Zhang,3 Zhi Li6 1Cardiovascular Department, Huaiyin Hospital of Huai’an City, Huai’an, Jiangsu, People’s Republic of China; 2Department of Thoracic Surgery, Sheyang County People’s Hospital, Yancheng, Jiangsu, People’s Republic of China; 3Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 4The Second Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 5Xinglin College, Nantong University, Nantong, Jiangsu, People’s Republic of China; 6Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhi LiDepartment of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of ChinaTel +86 13770606815Email zhili_cths@163.comYangyang ZhangDepartment of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Shanghai, 200120, People’s Republic of ChinaTel +86 13818132320Email zhangyangyang_wy@vip.sina.comObjective: To evaluate the powers of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score in predicting in-hospital and medium-term mortality of patients undergoing coronary artery bypass grafting (CABG).Methods: Totally 1628 Chinese patients were included between January 2000 and January 2018. Their perioperative clinical data were collected and the patients were closely followed up. According to the length of follow-up time, the total cohort was divided into 1-year, 2-year, 3-year, 4-year and 5-year groups. The in-hospital and medium-term risk prediction of EuroSCORE II and STS score were comparatively assessed by calibration, discrimination, decision curve analysis (DCA), net reclassification index (NRI), integrated discrimination improvement (IDI) and Bland-Altman analysis.Results: About 36 (2.21%) patients died during hospitalization. Both EuroSCORE II and STS score performed extremely well in predicting in-hospital mortality (area under curve = 0.900 and 0.879, respectively). However, calibration and discrimination analyses showed gradual decrease when these two risk evaluation systems were used to predict mortality during the follow-up period. At the same time, the predictive ability of EuroSCORE II was better than STS score. DCA curves showed that the performances of the two evaluation systems were roughly equal between the threshold probability of 0% to 20%. The percentage of correct reclassification of EuroSCORE II was 21.64% higher than that of STS score in predicting 2-year postoperative mortality. The IDI index showed that the predictive capabilities of these two systems were roughly equivalent. Bland-Altman analysis showed no significant difference between the values of the two systems.Conclusion: EuroSCORE II and STS score have excellent predictive powers in predicting in-hospital mortality of patients undergoing CABG. In particular, EuroSCORE II is superior in calibration and discrimination. The prediction efficiency of the two risk evaluation systems is still acceptable for two-year postoperative mortality, but decreases year by year.Keywords: EuroSCORE II, STS score, coronary artery bypass grafting, in-hospital mortality, medium-term prognosis

Background The long-term outcomes for patients after coronary artery bypass grafting (CABG) have been received more and more concern. The existing prediction models are mostly focused on in-hospital operative mortality after CABG, but there is still little research on long-term mortality prediction model for patients after CABG. Objective To develop and validate a novel nomogram for predicting 3-year mortality in critically ill patients after CABG. Methods Data for developing novel predictive model were extracted from Medical Information Mart for Intensive cart III (MIMIC-III), of which 2929 critically ill patients who underwent CABG at the first admission were enrolled. Results A novel prognostic nomogram for 3-year mortality was constructed with the seven independent prognostic factors, including age, congestive heart failure, white blood cell, creatinine, SpO2, anion gap, and continuous renal replacement treatment derived from the multivariable logistic regression. The nomogram indicated accurate discrimination in primary (AUC: 0.81) and validation cohort (AUC: 0.802), which were better than traditional severity scores. And good consistency between the predictive and observed outcome was showed by the calibration curve for 3-year mortality. The decision curve analysis also showed higher clinical net benefit than traditional severity scores. Conclusion The novel nomogram had well performance to predict 3-year mortality in critically ill patients after CABG. The prediction model provided valuable information for treatment strategy and postdischarge management, which may be helpful in improving the long-term prognosis in critically ill patients after CABG.

OBJECTIVES Sequential radial artery (RA) grafting has the potential to enhance arterial revascularization compared to single grafting. Sequential RA grafting was performed predominantly with a single side-to-side anastomosis. The study aimed to assess if sequential RA grafting improved long-term graft patency compared to single RA grafting. In addition, the anastomotic patencies of side-to-side and end-to-side anastomoses in sequential RA grafting were assessed. METHODS Two hundred nineteen patients underwent isolated coronary artery bypass grafting with skeletonized RA conduits between 2005 and 2016. Of these, 208 patients underwent radiological graft assessment; thus, 125 and 83 patients underwent single and sequential RA grafting, respectively. The graft and anastomotic patency rates were estimated using the Kaplan–Meier method. RESULTS The median follow-up period was 9.1 years, and the radiological assessment lasted 5.1 years. The overall RA graft patency rates at 1, 5 and 10 years were 99.4%, 92.7% and 88.1%, respectively. The RA graft patency rate for sequential grafting was similar to that for single grafting (88.7% vs 87.4% at 10 years; P = 0.88). In the stratified analysis of anastomotic patency, the patency rate of side-to-side anastomoses of sequential RA grafting was significantly better than that of end-to-side anastomoses (100% vs 88.7% at 10 years; P = 0.01). CONCLUSIONS The long-term RA graft patencies of sequential and single grafting were equally high. The anastomotic patency of side-to-side anastomoses of sequential RA grafting was remarkably high. Considering these findings, the RA can be effectively used for multiple arterial coronary revascularizations.

Aim. To assess the hemodynamic status by transpulmonary thermodilution (TPTD) in patients with ischemic heart disease (IHD) with different comorbidities before and after coronary artery bypass grafting (CABG).Materials and methods. 66 patients with IHD (40 men and 26 women) aged 53 to 77 years who were admitted for planned CABG were examined. The patients were divided into three groups according to the comorbidity: cardiovascular, respiratory, and metabolic. The first comorbidity was represented by a combination of IHD and multifocal atherosclerosis, the second – by IHD and chronic obstructive pulmonary disease (COPD), and the third – by IHD and metabolic syndrome (MS). All patients underwent CABG with the use of cardiopulmonary bypass. Hemodynamic parameters were recorded by the TPTD method using the Pulsion Picco Plus module (Germany) at 3 stages: after the start of mechanical ventilation (stage I), after the completion of cardiopulmonary bypass (stage II), and 24 hours after CABG (stage III).Results. The patients with IHD with different comorbidities differed in characteristic signs of hemodynamic changes. In IHD with comorbid COPD, after withdrawal from the cardiopulmonary bypass and 24 hours after CABG, the highest index of systemic vascular resistance, the minimum values of the global ejection fraction, and a decrease in the global end-diastolic volume and pulmonary blood volume less noticeable compared with other groups of patients were noted. With comorbid respiratory and metabolic disorders, the maximum values for the indices of extravascular lung water and pulmonary vascular permeability were recorded. In the patients with a comorbid cardiovascular disease, hemodynamic and volume status violations in the dynamic follow-up were less pronounced.Conclusion. The use of the TPTD method in patients with IHD before and after CABG makes it possible to specify the functional state of the circulatory system in different comorbidities, which increases the effectiveness of risk stratification and the accuracy of predicting possible complications.

The study of long-term results of coronary artery bypass grafting (CABG) in patients with different sexes has been a relevant problem of cardiology and heart surgery over the past thirty years. Female sex is an independent risk factors for worse outcomes in the long-term follow-up period after CABG according to many studies. However, there are publications suggesting that the results in women are better than in men in the long-term period after CABG. This literature review is devoted to studies of long-term complications and survival in patients after CABG depending on their gender. The evidence for gender differences after CABG is currently based on male-dominated studies. Most authors show that women have a higher degree of comorbidity. Another risk factor is age. Women undergo surgery at an older age. Besides, long-term survival is affected by the completeness of revascularization and multiarterial bypass grafting. Current diagnostic and treatment algorithms shift towards the assessment of coronary artery disease in men, which potentially may result in incorrect diagnosis or interpretation of existing disease and incorrect choice of treatment tactics in female patients. Despite large pool of accumulated data, this question remains open and requires new trials and continuing studies focusing on the impact of gender factor on the long-term survival.

The article presents a clinical case of a staged hybrid treatment for an aortic arch aneurysm in patient who previously underwent coronary artery bypass grafting and exoplasty of the ascending aorta. Possible alternative treatment options for this pathology are reviewed, and the features of surgical and endovascular treatment are also described.

Background: Vein graft occlusion is deemed a major challenge in coronary artery bypass grafting. Previous studies implied that the no-touch technique for vein graft harvesting could reduce occlusion rate compared with the conventional approach; however, evidence on the clinical benefit and generalizability of the no-touch technique is scare. Methods: From April 2017 to June 2019, we randomly assigned 2655 patients undergoing coronary artery bypass grafting at 7 hospitals in a 1:1 ratio to receive no-touch technique or conventional approach for vein harvesting. The primary outcome was vein graft occlusion on computed tomography angiography at 3 months and the secondary outcomes included 12-month vein graft occlusion, recurrence of angina, and major adverse cardiac and cerebrovascular events. The generalized estimate equation model was used to account for the cluster effect of grafts from the same patient. Results: During the follow-up, 2533 (96.0%) participants received computed tomography angiography at 3 months after coronary artery bypass grafting and 2434 (92.2%) received it at 12 months. The no-touch group had significantly lower rates of vein graft occlusion than the conventional group both at 3 months (2.8% versus 4.8%; odds ratio, 0.57 [95% CI, 0.41–0.80]; P P P P Conclusions: Compared with the conventional vein harvesting approach in coronary artery bypass grafting, the no-touch technique significantly reduced the risk of vein graft occlusion and improved patient prognosis. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03126409.

Актуальность. Проблема ишемического повреждения миокарда при проведении кардиохирургических операций еще далека от окончательного решения. Так, в зависимости от методики кардиопротекции частота интраоперационного инфаркта миокарда встречается от 2 до 7,2 % случаев, острая сердечная недостаточность — от 2,7 до 51,2 %, острые нарушения сердечного ритма — от 20 до 63,6 %. Цель. Изучение сравнительной эффективности кардиопротекторного действия искусственной электрической фибрилляции сердца и раствора Бретшнайдера при выполнении операций аортокоронарного шунтирования в условиях искусственного кровообращения. Материалы и методы. В исследовании приняли участие 118 пациентов с ишемической болезнью сердца, которым на базе ГУ «Институт сердца МЗ Украины» (г. Киев), в условиях искусственного кровообращения, были выполнены операции аортокоронарного шунтирования. У 58 пациентов (1-я группа) нами использовалась искусственная электрическая фибрилляция сердца. У 60 пациентов (2-я группа) применялась фармакохолодовая кардиоплегия с использованием раствора Бретшнайдера. Результаты. Сравнительный анализ эффективности локальной кардио- протекции показал наличие достоверной статистической разницы в показателях среднего артериального давления между двумя исследуемыми группами в постперфузионном периоде (р = 0,003572). Причем показатели среднего артериального давления в 1-й группе были на 22,1 ± 1,2 % выше по сравнению с аналогичными показателями, которые зарегистрированы во 2-й группе. Ударный индекс в 1-й группе составил 48,9 ± 1,34 мл/м2, что было на 21,3 ± 1,21 % больше по сравнению с показателями, полученными в аналогичный период во 2-й группе (р < 0,05). Фракция выброса, которая в постперфузионном периоде была ниже во 2-й группе по сравнению с аналогичными показателями в первой группе на 19,0 ± 1,14 % (р < 0,05), в дальнейшем, к концу операции, восстанавливалась до 49,2 ± 1,35 % и не имела достоверных статистических различий с 1-й группой (p = 0,4235). Количество аритмий в 1-й группе составило 17,2 %, что на 7,2 % больше, чем во 2-й группе. Определение сравнительной активности тропонина I на всех этапах наблюдения не выявило статистически достоверной межгрупповой разницы. Выводы. Локальная кардиопротекция с использованием искусственной электрической фибрилляции сердца, по сравнению с фармакохолодовой кардиоплегической защитой миокарда раствором Бретшнайдера, может провоцировать большую аритмогенную активность, но более устойчиво поддерживает сократительную способность миокарда и обеспечивает надежный уровень кардиопротекции.

BACKGROUND: Significant bleeding following cardiac surgery is a recognised complication, associated with a requirement for re-exploration and blood transfusion, both associated with increased morbidity and early mortality. The aim of this study was to examine the impact of the volume of early postoperative bleeding on long-term survival for patients undergoing coronary artery bypass grafting (CABG). METHODS: A retrospective analysis was performed of patients undergoing first-time isolated CABG at a single centre between January 2003 and April 2013, conditional from 30-day survival. RESULTS: Six thousand two hundred and sixty-five patients were analysed, with a mean Logistic EuroSCORE of 4.9%. The mean age was 67.8 years. Median follow-up was 11.5 years. The overall 10- and 15-year survival was 70.6% and 51.9% respectively. Following surgery, 4.6% (n=291) required return to theatre for re-exploration, and 43.6% (n=2,733) received at least one red cell transfusion. In multivariable analysis, the strongest correlates of mortality were age, smoking history, BMI, COPD, renal impairment, preoperative left ventricular function and preoperative haemoglobin (Hb) level. Twelve-hour blood loss was an additional predictor of inferior long-term survival. Five-year survival was 89.6% for patients with 1,000 mL. Re-exploration and receiving blood transfusion were not associated with reduced long-term survival. CONCLUSIONS: Significant 12-hour blood loss is associated with inferior long-term survival following CABG. This observation supports efforts aimed at improving intra-operative haemostasis and aggressive management of patients with early signs of bleeding.

Актуальность. Прямая реваскуляризация миокарда является наиболее эффективным, а иногда единственным методом лечения больных ишемической болезнью легких (ИБС). На сегодняшний день существуют основные технологии коронарного шунтирования (КШ) — в условиях искусственного кровообращения с кардиоплегией и выполнения операции на работающем сердце. КШ на работающем сердце имеет определенные преимущества, но нередко во время операции возникают ситуации, требующие экстренного перехода на искусственное кровообращение (ИК). Экстренный переход на ИК значительно влияет на непосредственные результаты оперативного вмешательства, поэтому оптимальным является дооперационное определение пациентов, у которых существует высокий риск необходимости конверсии. Целью исследования была оптимизация определения показаний к применению вспомогательного ИК путем определения предикторов интраоперационных осложнений и конверсии на ИК при КШ на работающем сердце у больных ИБС. Материалы и методы. Выполнен ретроспективный анализ историй болезней 4068 пациентов, которые были прооперированы в отделении хирургического лечения ИБС в Национальном институте сердечно-сосудистой хирургии им. Н.Н. Амосова. Все пациенты перенесли изолированное аортокоронарное и/или мамарно-коронарное шунтирование, в том числе 82 (2,0 %) пациента с экстренной конверсией на ИК при КШ и 110 (2,7 %) пациентов, которым КШ выполнялось в условиях запланированного вспомогательного ИК без применения кардиоплегии. Результаты. Установлено, что у больных, которым применено ИК при КШ на работающем сердце, наблюдается достоверное увеличение летальности в течение 30 дней и частоты послеоперационных осложнений (сердечная, дыхательная, почечная недостаточность и инфекционные осложнения), особенно в случаях экстренного перехода. По результатам анализа исходных клинико-анамнестических данных (сопутствующая патология, особенности основной и сопутствующей кардиальной патологии, срочность операции и особенности поражения коронарных артерий) были обнаружены предикторы интраоперационных осложнений, в том числе требующих экстренного перехода на ИК, и предложена комплексная система оценки риска интраоперационных осложнений. Выводы. Применение предложенного метода прогнозирования позволяет определить пациентов, которым целесообразно выполнять КШ в условиях вспомогательного ИК.

An Intra-operative Transesophageal Echocardiographic Study to Compare The Effect of Sevourane and Isourane on Left Ventricular Dysfunction In Patients With Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting Using Cardiopulmonary Bypass Context : Diastolic dysfunction has been increasingly recognized as an important cause of congestive heart failure (CHF) and resultant morbidity. About 50% patients with CHF have 'diastolic heart failure' in spite of a normal systolic function with preserved ejection fraction. The widely used volatile anesthetic agents, Isourane and Sevourane, are considered important components of balanced anesthesia technique. However their effects on left ventricular (LV) systolic and diastolic function have not been precisely dened. This study was designed to quantify and compare their effects on left ventricular function by TEE before start of CPB. Aims : To compare the effects of Isourane and Sevourane on echocardiographic LVsystolic and diastolic parameters. Settings and design : After obtaining institutional ethics committee clearance and informed consent from 60 patients operated within my study period was included . Data were collected after induction and just before going on bypass. Materials and Methods : After inducing the patients with institutional protocol one group was given isourane(Group I) and another group was given sevourane(Group S), both at 1MAC. TEE parameters measuring LVsystolic and diastolic functions were done. Statistical analysis : Data were analysed by Epi Info (TM) 7.2.2.2. Result and conclusion :Isourane was better than sevourane in comparism of systolic and diastolic dysfunction.

Coronary artery bypass grafting (CABG) can compromise pulmonary function and range of motion (ROM) of the shoulder and knee joints due to median sternotomy and saphenectomy, the Pilates method being a strategy for reducing loss.To evaluate the effect of applying the Pilates method on pulmonary function and ROM in patients undergoing CABG.ology: This is a clinical trial. Patients were evaluated preoperatively at discharge from the hospital for shoulder flexion and abduction and knee flexion-extension. In addition, vital capacity(VC), maximum inspiratory pressure(MIP), expiratory pressure(MEP) and peak expiratory flow(PEF) were evaluated. Upon discharge from the Intensive Care Unit (ICU), they were divided into a control group(CG) that received conventional assistance and Pilates(PG) was increased with Pilates method techniques.40 patients were analyzed, 25 were men(61%), with a mean age of 66 ± 7 years. At the end, the left shoulder abduction in the CG was 105±9vs115 ± 8 in the PG(p = 0.03), the right shoulder abduction in the CG 104 ± 11vs116 ± 10 in the PG(p 0.001) and right knee flexion in the CG 78 ± 13vs92 ± 9 in the PG(0.002). In relation to MIP, the CG had a loss of 32 ± 8 while the PG 18 ± 10cmH2O(p 0.001), the worsening MEP was 31 ± 9(CG)vs29 ± 11cmH2O(PG)(p = 0.53), the VC in the CG reduced 8±9vs6±8 in the PG(p = 0.23) and the PEF reduced 107 ± 5 in the GCvs83 ± 88 in the PG(p = 0.09).It is concluded that the Pilates method decreased the loss of ROM and maximum inspiratory pressure in patients undergoing coronary artery bypass grafting.

Актуальность. Проведение кардиохирургических операций с искусственным кровообращением у пациентов пожилого и старческого возраста связано со значительным риском развития послеоперационных ­осложнений. Пациенты старше 65 лет имеют повышенный риск заболеваемости и смертности вследствие коморбидных состояний, таких как сахарный диабет, заболевания периферических сосудов и дисфункция почек. Цель: провести анализ основных предоперационных факторов риска у пациентов пожилого и старческого возраста и определить их влияние на развитие осложнений в послеоперационном периоде. Материалы и методы. По данным предоперационного сбора анамнеза и обследования установлено, что из 214 пациентов, вовлеченных в исследование, коморбидные заболевания выявлялись у 102 человек (первая группа). Артериальная гипертензия наблюдалась у 73 (34,1 %) человек, цереброваскулярные заболевания — у 18 (8,4 %), сахарный диабет выявлялся у 27 (12,6 %), хронические обструктивные заболевания легких — у 9 (4,2 %), хронические заболевания почек — у 8 (3,7 %) человек. У 112 (52,4 %) пациентов не выявлено признаков сопутствующих заболеваний. Все пациенты оперировались в условиях общей анестезии на основе севофлурана (1,5–2 минимальных альвеолярных концентрации). Искусственное кровообращение проводилось на аппарате System 1 (Terumo, США) с использованием одноразовых мембранных оксигенаторов Affinity (Medtronic, США) в условиях умеренной гипотермии (32 °С). Для oценки гeмoдинaмичних пoкaзателей нами использовался мeтoд эхокaрдиoгрaфии. Результаты. Уровень тропонина у полиморбидных пациентов оказывался на 35,9 % (р = 0,012) достоверно выше по сравнению с пациентами без коморбидной патологии. Следует также отметить наличие статистически достоверного коэффициента корреляции между послеоперационным уровнем тропонина и коморбидностью пациентов (r = 0,315). Между коморбидностью пациентов и потребностью в более длительной послеоперационной инотропной поддержке обнаружена статистически достоверная корреляционная связь (r = 0,411). У пациентов с сопутствующими заболеваниями был на 33,1 % (р = 0,001) выше среднего уровень креатинина для мужчин и на 33,3 % (р = 0,001) — для женщин по сравнению с пациентами без коморбидной патологии. Коэффициенты корреляции между уровнем креатинина и коморбидностью пациентов составляли 0,452 и 0,486 для мужчин и женщин соответственно. Продолжительность пребывания на искусственной вентиляции легких в послеоперационном периоде у пациентов с коморбидными заболеваниями оказывалась на 42,9 % (р = 0,002) достоверно больше, чем у пациентов без коморбидной патологии. При этом наблюдалась существенная корреляционная связь с коморбидностью пациентов (r = 0,306). Выводы. Согласно полученным результатам, у пациентов с коморбидной патологией наблюдались более тяжелые метаболические нарушения, чем у пациентов без сопутствующей патологии. Кроме того, у пациентов с сопутствующими заболеваниями оказывался достоверно выше риск развития послеоперационных осложнений, таких как повышенный послеоперационный уровень тропонина, потребность в инотропах > 48 ч, острое повреждение почек и большая продолжительность искусственной вентиляции легких.

Sotos syndrome, characterized by cerebral gigantism with neurologic disorders, is an overgrowth syndrome caused by mutations of the NSD1 gene, with an estimated prevalence of 1:10,000-1:50,000. We herein describe the first case of Sotos syndrome complicated by acute coronary syndrome, for which emergency coronary artery bypass grafting was performed. (Level of Difficulty: Intermediate.), Central Illustration

Актуальность. Хирургическая реваскуляризация миокарда является эффективным способом лечения больных с ишемической болезнью сердца. Обязательным этапом проведения экстракорпорального кровообращения является индуцированная остановка сердца и связанный с этим период общей ишемии. Поэтому при выполнении операций аортокоронарного шунтирования в условиях искусственного кровообращения развивается острая сердечная недостаточность, выраженная в той или иной степени. Несмотря на постоянное совершенствование методов искусственного кровообращения, анестезии и кардиопротекции, частота интраоперационного инфаркта миокарда составляет от 2 до 7,2 % случаев, острой сердечной недостаточности — от 2,7 до 51,2 %, острых нарушений сердечного ритма — от 20 до 63,6 %. Цель исследования: улучшить результаты лечения кардиохирургических больных с сердечной недостаточностью, перенесших оперативное вмешательство — шунтирование коронарных артерий с применением экстракорпорального кровообращения, путем усовершенствования протокола периоперационного ведения пациентов. Материалы и методы. На базе Государственного научного учреждения «Научно-практический центр профилактической и клинической медицины» Государственного управления делами было прооперировано 100 кардиохирургических больных ишемической болезнью сердца, которым было выполнено аортокоронарное шунтирование с использованием искусственного кровообращения. От всех больных было получено информированное согласие на участие в исследовании. Пациенты были разделены на две группы. Пациентам группы 1 (40 больных) в послеоперационном периоде коррекцию гемодинамических расстройств выполняли по стандартным действующим протоколам. В группе 2 (60 больных) был применен дифференцированный подход к коррекции гемодинамических расстройств. В подгруппе 1 (20 больных) в послеоперационном периоде коррекцию гемодинамических расстройств выполняли с помощью добутамина и достигли стабилизации. В подгруппе 2 (11 больных, у которых была диагностирована в предоперационном периоде гипофосфатемия) для коррекции гемодинамических расстройств кроме добутамина использовали препарат фруктозо-1,6-дифосфат по схеме: 5 г препарата вводили непосредственно перед началом перфузии и 5 г — на 30-й минуте искусственного крово­обращения. Препарат, эндогенный высокоэнергетический промежуточный метаболит гликолитического пути, непосредственно усиливает образование высокоэнергетического фосфата (аденозинтрифосфата). В подгруппе 3 (6 больных) в послеоперационном периоде кроме добутамина для коррекции гемодинамических расстройств применили препарат тиворель (1 мл 42 мг аргинина гидро­хлорида и 20 мг левокарнитина). В подгруппе 4 (23 больных) в послеоперационном периоде не было гемодинамических расстройств, коррекцию не выполняли. Результаты. Был разработан периоперационный анестезиологический менеджмент у кардиохирургических больных с сердечной недостаточностью, перенесших аортокоронарное шунтирование с использованием искусственного кровообращения. Для мониторинга функции сердечно-сосудистой системы использовали электрокардиографию, эхокардиографию, фазаграфию, определяли вариабельность сердечного ритма по Р.М. Баевскому. Фазаграфия — это инновационный метод обработки электрокардиограмм, разработанный НАН Украины. Суть метода — исследование симмет­рии/асимметрии зубца Т электрокардиограммы как маркера ишемических изменений миокарда. Определение симметричности волны Т в фазовом пространстве является эффективным диагностическим критерием наличия ишемии (показатель βТ) на электрокардиограмме. Результаты исследований свидетельствуют о возможности использования метода фазаграфии, в частности анализа симметрии зубца Т как маркера ишемических изменений в миокарде, у кардиохирургических больных, перенесших аортокоронарное шунтирование с использованием искусственного кровообращения. Установлено, что в группе 2 для стабилизации гемодинамики, кислородного статуса, микроциркуляции были использованы меньшие дозы симпатомиметиков, были меньше продолжительность их применения, частота гемодинамически значимой фибрилляции предсердий, доза введенного амиодарона, продолжительность искусственной вентиляции легких по сравнению с группой 1. Выводы. Полученные данные свидетельствуют, что разработанный алгоритм периоперационного ведения кардиохирургических больных с сердечной недостаточностью дает возможность значительно ускорить реабилитацию кардиохирургических больных, повысить комфорт пациента и сократить срок пребывания в больнице до 6–7 суток.

Objectives: The aim of this study was to determine the frequency of operative mortality in patients who had low serum albumin on admission and were undergoing coronary artery bypass grafting (CABG) after nutritional support at a tertiary care cardiac center in Karachi, Pakistan. Methodology: A retrospective study was conducted at an adult cardiac surgery department of the largest tertiary care cardiac center in Karachi, Pakistan. Patients who had undergone isolated CABG during January to December 2019 admitted with low serum albumin (less than 3.5mg/dl) and received nutritional treatment before surgery were included in the study. Patients were monitored for a month to measure the 30 day mortality. Results: There were 82.4% male patients and the mean age was 55.49±8.52 years. Preoperative mean serum haemoglobin, serum creatinine, and serum albumin levels were 12.225±1.19 mg/dl, 1.05±0.21 mg/dl, and 2.825±0.39 mg/dl respectively. Postoperative mortality was recorded in 1.7% of the total patients. Conclusion: In patients with low serum albumin levels and had undergone isolated CABG after nutritional pre-treatment, mortality was mainly associated with peri-operative myocardial infarction. While, the incidence of delayed wound healing and atrial fibrillation were found to be high in these patients.

Background: The aim of this study is to compare the efficacy of the microplegia solution and Del Nido cardioplegia solution in coronary artery bypass surgery with clinical, biochemical, and echocardiographic data. Methods: Three hundred patients, who underwent coronary artery bypass surgery between January 2017 and January 2020, by the same surgical team were included in the study. Preoperative, operative and postoperative data (cardiac biomarker levels, cross-clamp and CPB times, echocardiographic measurements, etc.) of the patients were compared. Results: In the study, cross-clamp time was significantly shorter in the DN cardioplegia group (55.60 ± 13.49 min/75.58 ± 12.43 min, P = 0.024). No significant difference was observed between the two groups in terms of intensive care stay, extubation time, hospital stay, and cardiopulmonary bypass time. In our study, it was shown that both the left and right ventricular ejection fraction was better protected in the Del Nido cardioplegia group (5.34±3.03 vs. 3.40±2.84, P = 0.017 and 3.82±1.19 vs. 2.28±1.87, P = 0.047, respectively), and the need for inotrope support was lower in this group (28% vs. 44%, P < 0.021). There was no significant difference between the groups, in terms of blood transfusion rates, IABP requirement. Conclusion: In light of short-term results, we can say that Del Nido cardioplegia provides better myocardial protection than microplegia. In addition, Del Nido cardioplegia can be given as a single dose for 90 minutes of cross-clamp time and therefore can be preferred to increase surgical comfort and reduce cross-clamp times.

Aim. Evaluation of nanostructural and micromechanical characteristics of erythrocytes and their relationship with the parameters of oxygen transport in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) under artificial circulation (AC).Materials and methods. The study involved 30 men with IHD aged 53 to 67 years with a median of 63 years, who underwent planned CABG with AC at the clinic of the Far Eastern Federal University. Blood sampling from patients was carried out before the AC and one day after it from a venous catheter located in the right atrium. Erythrocytes were scanned using a Bioscope Catalyst atomic force microscope (AFM) (Bruker, USA) in combination with an Axiovert 200 inverted microscope (Zeiss, Germany). The micromechanical properties of cell membranes were investigated with the PFQNM-LC-A-CAL cantilevers. The following were recorded: the diameter of erythrocytes, the height of their side, area, volume, membrane rigidity, strength of its adhesion, Young's modulus, elastic deformation. To assess oxygen transport, the oxygen delivery index (DO2I), consumption (VO2I), and extraction ratio (O2ER) were calculated.Results. In one day after CABG, a decrease in DO2I, VO2I, and O2ER was recorded by 14%, 33%, and 16%, respectively, which indicated a limitation in the gas transport function of the blood. Analysis of the AFM characteristics of erythrocytes showed an increase in their area by 35%, in diameter by 6%, in volume by 19%, and the height of the side by 5 times. At the same time, multidirectional changes in the micromechanical properties of erythrocyte membranes were noted: Young's modulus and stiffness decreased by 3.2 and 2 times, respectively; the adhesion force increased by 2.7 times, and the elastic deformation – by 2.2 times. Correlation analysis showed the presence of reliable relationships between indicators of oxygen transport and biomechanical parameters of erythrocyte membranes.Conclusion. A comprehensive analysis of the nanostructural parameters of erythrocytes and oxygen transport expands the understanding of the pathophysiological mechanisms of postperfusion disorders in patients with coronary artery disease after CABG under conditions of cardiopulmonary bypass.

Double valve replacement is now-a-days a common procedure to treat diseased cardiac valves and the primary aim of prophylactic aortic replacement during concomitant valve replacement is to prevent dreadful complication like dissection, aortic rupture and even death. Although aortic surgeries are complex and have high morbidity and mortality rates, additional double valve procedure with coronary surgery can make it even worse. But for these patients, surgery remains the one and only treatment option for symptom relieve and prolongation of life. We herein present a case of severe aortic stenosis (AS) with severe aortic regurgitation (AR) with severe mitral regurgitation (MR) with coronary artery disease (CAD) and aortic aneurysm treated successfully by us at Square Hospitals; and to our best knowledge and according to the published articles, this is probably the first time, this type of combined cardiac procedure has been accomplished along with aortic surgery, in our country. We recommend that surgeons should perform bypass grafting along with aortic replacement and valve replacement surgery when indicated, without worrying that adding such a procedure will escalate post-operative adverse effect. Cardiovasc j 2021; 14(1): 82-87

Background Incisional negative pressure wound therapy has been described as an effective method to prevent wound infections after open heart surgery in several publications. However, most studies have examined relatively small patient groups, only a few were randomized, and some have manufacturer-sponsorship. Most of the studies have utilized Prevena; there are only a few reports describing the PICO incisional negative pressure wound therapy system. Methods We conducted a prospective cohort study involving a propensity score-matched analysis to evaluate the effect of PICO incisional negative pressure wound therapy after coronary artery bypass grafting. A total of 180 high-risk patients with obesity or diabetes were included in the study group. The control group included 772 high-risk patients operated before the initiation of the study protocol. Results The rates of deep sternal wound infections in the PICO group and in the control group were 3.9 and 3.1%, respectively. The rates of superficial wound infections needing operative treatment were 3.1 and 0.8%, respectively. After propensity score matching with two groups of 174 patients, the incidence of both deep and superficial infections remained slightly elevated in the PICO group. None of the infections were due to technical difficulties or early interruption of the treatment. Conclusion It seems that incisional negative pressure wound therapy with PICO is not effective in preventing wound infections after coronary artery bypass grafting. The main difference in this study compared with previous reports is the relatively low incidence of infections in our control group.

Background: We aimed to investigate the neutrophil-lymphocyte ratio (NLR) as a predictor of mortality in patients, who had undergone on-pump and off-pump coronary artery bypass grafting (CABG). Methods: This retrospective study comprised of 457 patients, who underwent CABG (323 on-pump and 134 off-pump) between January 2014 and October 2019. Preoperative, postoperative (PO) 1st hour, PO 1st day, and PO 5th day neutrophil-lymphocyte ratios were calculated. The patients were compared, according to demographic, laboratory, and clinical data. A receiver operating characteristics curve was applied to estimate a cut-off value of NLR for mortality. Results: The on-pump group was older (P = 0.001), had a lower Euroscore II (P = 0.036), had a higher graft number (P < 0.001), intensive care unit stay (P = 0.001), and all PO NLRs, except preoperative NLR. There were 14 (3.06%) patients with mortality. Overall (N = 457), PO 1st hour (P = 0.001), PO 1st day (P < 0.001), and PO 5th day (P = 0.016) NLRs were considerably higher in patients with mortality. While none of the NLRs revealed a significant difference in the off-pump group, PO 1st hour (P = 0.004) PO 1st day (P < 0.001), and PO 5th day (P = 0.007) NLRs were higher in patients with mortality in the on-pump group. The increase in odds ratio of PO NLR was higher in patients with mortality in the overall group of PO 1st day and in the on-pump group of PO 1st hour and PO 1st day. The best combination of sensitivity and specificity was reached at a cut-off value of 6.4 for PO 1st hour NLR and 31.8 for PO 1st day NLR. Conclusions: As in indicator of inflammatory state, NLR readily can be used as a predictor of mortality. Regardless of the CABG technique used, postoperative 1st hour and postoperative 1st day NLR >6.4 and 31.8, respectively, are highly related to mortality.

OBJECTIVES Previous reports have found females are a higher risk of morbidity and mortality following isolated coronary artery bypass grafting (CABG). Here, we describe the differences in outcomes following isolated CABG between males and females. METHODS Following a systematic literature search, studies reporting sex-related outcomes following isolated CABG were pooled in a meta-analysis performed using the generic inverse variance method. The primary outcome was operative mortality. Secondary outcomes included rates of stroke, repeat revascularization, myocardial infarction, major adverse cardiac events, and late mortality. Subgroup analyses were performed for studies published before and after the year 2000 and for the type of risk adjustment. RESULTS Eighty-four studies were included with a total of 903 346 patients. Females were at higher risk for operative mortality (odds ratio: 1.77, 95% confidence interval [CI]: 1.64–1.92, P 0.001) but not repeat revascularization (IRR: 0.99, 95% CI: 0.76–1.29, P = 0.95). The use of the off-pump technique or multiple arterial grafts was not associated with the primary outcome. CONCLUSIONS Females undergoing CABG are at higher risk for operative and late mortality as well as postoperative events including major adverse cardiac events, myocardial infarction and stroke. PROSPERO registration CRD42020187556

Aim. To identify the factors influencing the development of postoperative atrial fibrillation (POAF).Methods. The study included 100 patients with indications for cardiac surgery, aged 53 to 82 years (mean age 67.2±17 years). The group included patients who had no history of AF before surgery. Cardiac surgery in the group was presented in 63 patients by coronary artery bypass grafting, and in 37 – by intervention on the heart valves. All respondents were divided into 2 groups: the first included 39 people (39%) who had AF paroxysms lasting more than 30 seconds in the early postoperative period, with a peak at 1–2 days, in 13 (33.3%) cases of AF relapsed. The second group of patients was represented by 61 patients (61%) without cardiac arrhythmias after surgery.Results. The dependence of the development of POAF on age, the concentration of C-reactive protein in the peripheral blood taken on the day of cardiac surgery, the longitudinal size of the left atrium before surgery was revealed.Conclusion. It was found out that a number of factors such as age, preoperative left atrium size, C-reactive protein level in the first days after surgery suggest the development of POAF. The use of the predictors obtained can make it possible to develop an effective strategy for the prevention of POAF.

Introduction: In Malaysia, MIDCABG started in 3 centers developing the technique. As the technique is gaining traction in the country, this study aims to compare the quality of life following MIDCABG compared with conventional CABG in one of the centers actively developing this technique. Methods: A retrospective cohort study was performed involving 30 post CABG patients which consists of 15 MIDCABG and 15 conventional CABG from January 2015 to May 2018. 15 from 21 post-MIDCABG patients were included and selected, based on EuroSCORE II less than 5. Modified Post-Operative Quality of Recovery Scale was used to assess and compare the quality of life following respective approaches. Data were analyzed using SPSS version software and comparison using mean rank with p 0.05. Conclusion: There is no significant difference in quality of recovery following MIDCABG compared to conventional CABG. Modified PostOPQRS system can be a useful assessment tool to evaluate the impact of an intervention in relation of quality of life.

Background/Aim: Acute kidney injury may occur due to renal ischemia and hypoxia during coronary artery bypass surgery. Monitoring of renal regional tissue oxygenation might be useful to determine renal hypoxia. We aimed to investigate whether renal oxygen saturation values differ between diabetic and non-diabetic patients and evaluate the relationship between intra-operative renal oxygen saturation values and postoperative renal function.Methods: Forty consecutive patients aged 18-65 years, who underwent elective coronary artery bypass grafting, were included in this prospective case-control study. Body mass index ≥30 kg/m2 and the presence of renal damage were considered the exclusion criteria. Group I consisted of diabetic patients (n = 20), and Group II consisted of non-diabetic patients (n = 20). Near Infrared Spectroscopy (NIRS) recorded renal saturation values just before the intubation as the basal value and every 10 minutes after intubation in all patients. Creatinine clearances and glomerular filtration rates were calculated along with blood urea nitrogen and creatinine values on the postoperative 1st and 3rd days of all patients. Results: The two groups were similar in terms of gender, age, body mass index, duration of surgery, cross-clamp time, and total cardiopulmonary bypass duration (P>0.05). While there was no difference between baseline values, significant differences were found between preoperative BUN and creatinine and POD 3 BUN and creatinine values in Group 1 (P=0.003 and P=0.046, respectively) and Group 2 (P=0.018 and P=0.030, respectively). There was no significant difference between two groups in renal oxygen saturation values considering both basal and post-intubation measurements (P>0.05 for all). However, an earlier decrease in renal oxygen saturation values was seen in diabetic patients (P0.05 for all).Conclusion: Although coronary artery graft bypass surgery does not lead to a significant difference in renal saturation values, as determined by Near Infrared Spectroscopy, in diabetic patients compared to non-diabetic patients, NIRS may be helpful and beneficial to show renal ischemia in these patients.

Purpose: The principal of this analysis was to understand global feature of the number and type of grafts and number of diseased vessels of those undergoing coronary artery bypass grafting (CABG) and their short-term clinical results. Methods and Results: This report presents annual report on the collective data of CABG in the year 2018 (1 January–31 December). Data were collected based on the series of questionnaire which has been performed by The Japanese Association for Coronary Artery Surgery (JACAS), capturing the corresponding data from the Japan Adult Cardiovascular Surgery Database (JCVSD). We also analyzed descriptive clinical results of those undergoing surgeries for acute myocardial infarction and ischemic mitral regurgitation. Conclusion: This is the first article summarizing the results from annually performed questionnaires by JACAS based on JCVSD, on the trend of CABG procedures and clinical results in Japan as a scientific manuscript.

Introduction Due to its deleterious effects, early identification of patients at risk of postoperative AF (POAF) is of critical importance. Preexisting proarrhythmic atrial remodeling could contribute to this increased risk. Therefore, we aimed to evaluate the presence of preexisting proarrhythmic atrial remodeling and its impact on POAF occurrence in patients undergoing coronary artery bypass grafting (CABG). Methods Data regarding atrial structural (atrial size and histology), electrical (P-wave and atrial action potential parameters, mRNA expression of several AF-related genes), and autonomic (heart rate variability parameters) proarrhythmic remodeling were compared between patients with (AF; n=11) and without (no-AF; n=19) POAF. Impact of POAF on postoperative outcomes was also evaluated. Results No significant difference was observed in atrial electrical parameters between the two groups (all p>0.05). However, compared with no-AF, AF patients had more important subepicardial adipose infiltration (p=0.02) and higher markers of parasympathetic and sympathetic modulation (both p=0.03). Patients with POAF had longer hospital stay and more often presented postoperative renal dysfunction (both p=0.04). Conclusion These findings suggest that preexisting atrial structural (i.e., increased atrial subepicardial adiposity) and autonomic (i.e., sympatho-vagal coactivation) alterations could favor the occurrence of POAF. At its turn, POAF was associated with altered postoperative outcomes in CABG patients.

Background Severe carotid artery stenosis (sCAS) is frequently discovered at the time of evaluation for coronary arterial revascularization. However, there has been controversy regarding the optimal management of sCAS. This study evaluated the potential effects of untreated sCAS at time of coronary artery bypass grafting (CABG) in contemporary practice. Methods This was a retrospective study from a multihospital healthcare system including patients undergoing isolated CABG between 2011 and 2018. Patients were stratified by the presence of sCAS (≥80% stenosis) in at least 1 carotid artery. Perioperative and 5-year stroke were compared, and multivariable analysis was used to identify risk-adjusted predictors of stroke and mortality. Results A total of 5475 patients were included, 459 (8.4%) with sCAS and 5016 (91.6%) without sCAS. Patients with sCAS experienced more frequent perioperative stroke (4.4% vs 1.2%; P Conclusions This contemporary analysis of CABG procedures reveals that concurrent sCAS continues to confer a significant stroke risk, especially in those with history of previous stroke. Although whether sCAS lesions are responsible for most strokes is unclear, they likely serve as a surrogate for other stroke risk factors.

Background Flowable hemostatic agents are advantageous in that they can be applied to irregular wound surfaces and to areas that are difficult to approach directly. We sought to compare the effectiveness and safety of the flowable hemostatic sealants Collastat® (collagen hemostatic matrix, [CHM]) and Floseal® (gelatin hemostatic matrix, [GHM]) during off-pump coronary artery bypass (OPCAB). Methods In this prospective, randomized trial, 160 patients undergoing elective OPCAB surgery were enrolled between March 2018 and February 2020. After primary suture of the aortocoronary anastomosis, an area of hemorrhage was identified, and patients were double blind randomized to receive either CHM or GHM (n = 80, each). Study endpoints were the following: rate of successful intraoperative hemostasis and time required for hemostasis overall postoperative bleeding, rate of transfusion of blood products, rate of surgical revision for bleeding, postoperative morbidity, and intensive care unit stay. Results Of the total patients, 23% were female, and the mean age was 63 years (range: 42–81 years). Successful hemostasis within 5 min was achieved for 78 patients (97.5%) in the GHM group, compared to 80 patients (100%) in the CHM group (p = 0.497). Two patients receiving GHM required surgical revision to achieve hemostasis. There were no differences in the mean time required to obtain hemostasis (GHM vs. CHM, 1.49 ± 0.94 vs. 1.35 ± 0.60 min, p = 0.272), as confirmed by time-to-event analysis (p = 0.605). The two groups had similar amounts of mediastinal drainage for 24 h postoperatively (p = 0.298). The CHM group required less packed red blood cells, fresh frozen plasma, and platelets for transfusion than the GHM group (0.5 vs. 0.7 units per patient, p = 0.047; 17.5% vs. 25.0%, p = 0.034; 7.5% vs. 15.0%, p = 0.032; respectively). Conclusions CHM performed similarly to a commonly used hemostatic agent with regard to achieving effective and fast interoperative hemostasis during OPCAB. The topical flowable hemostatic agent, CHM, could be effectively used during cardiac surgery for intraoperative hemostasis of great vessels with high pressure. Trial registration : ClinicalTrials.gov, NCT 04310150

Higher serum resistin levels were reported to be associated with increased mortality risk. We aimed to assess the predictive value of resistin levels in perivascular adipose tissue (PVAT) around the left main coronary artery (LMCA) for mid-term survival of patients with advanced coronary artery disease (CAD). This was a prospective study including patients referred for elective coronary artery grafting in 2016 and 2017, performed using a standard approach. A sample of PVAT was harvested and resistin levels were measured using an enzyme-linked immunosorbent assay. Patients were followed from the day of the procedure until March 2021. In each patient, the SYNTAX score and EuroSCORE II were calculated. The study included 108 patients aged 68.1 ±7.9 years, including 83 men (76.9 %). The duration of follow-up was 731 (range, 275-1020) for nonsurvivors and 1418 median (range, 1174-1559) for survivors (p

Background Recent randomized controlled trials have sparked debate about the optimal treatment of patients suffering from left main coronary artery disease. The present study analyzes outcomes of left main stenting versus coronary bypass grafting (CABG) in a nationwide registry in patients with chronic coronary syndrome (CCS). Methods All cases suffering from CCS and left main coronary artery disease treated either with CABG or stent, were identified within the database of the German bureau of statistics. Logistic or linear regression models were used with 20 baseline patient characteristics as potential confounders to compare both regimens. Results In 2018, 1318 cases with left main stenosis were treated with CABG and 8,920 with stent. Patients assigned for stenting were older (72.58 ± 9.87 vs. 68.63 ± 9.40, p p p = 0.748; aOR stroke: 0.59 [0.27; 1.32], p = 0.199). Stent implantation was associated with a reduced risk of relevant bleeding (aOR 0.38 [0.24; 0.61], p p = 0.002), and postoperative delirium (aOR 0.16 [0.11; 0.22], p p p Conclusion Left main stenting is a safe and effective treatment option for CCS-patients suffering from left main coronary artery disease at reasonable economic cost. Graphic abstract

Chronic total occlusions (CTO) are found commonly in patients with prior coronary artery bypass grafting (CABG). We sought to determine the effect of CABG on collateral robustness in patients with a CTO. Patients with a CTO diagnosed on coronary angiography between July 2010 and December 2019 were included in this study. Patients were classified as either CTO supplied by a functional graft, CTO supplied by collaterals from a non-grafted donor vessel (non-grafted) or a CTO supplied by collaterals from a grafted donor vessel (grafted). The degree of collateral robustness was determined by the Rentrop classification and collateral connection (CC) grade. Demographic, angiographic and clinical outcomes were recorded. A total of 2088 CTO lesions were identified, of which 878 (42.0%) were supplied by a functional graft, 994 (47.6%) CTOs were supplied by a non-grafted donor vessel and 216 (10.3%) CTOs were supplied by a grafted donor vessel. CTOs supplied by a grafted donor vessel had lower rates of robust collaterals (37.0% vs 83.0%, p

Purpose of review Less invasive multivessel coronary artery bypass grafting techniques have seen a progressive evolution over the last two decades. In their current state, they are easily reproduced and applicable to most patients requiring multivessel revascularization. The purpose of this review is to highlight their importance among a spectrum of evolving therapies and the accruing evidence in their favour. Recent findings The first large dual center experience with minimally invasive coronary artery bypass grafting (MICS CABG) demonstrated the feasibility of performing multivessel surgical revascularization without the need for sternotomy or cardiopulmonary bypass. Subsequent angiographic studies to assess graft patency showed excellent early results. Studies comparing MICS CABG to conventional CABG demonstrate faster recovery while reducing hospitalization and cost. Summary Multivessel less invasive coronary artery bypass grafting is basically limited to two procedures, MICS CABG and robotically assisted totally endoscopic CABG (TECAB). MICS CABG has evolved as a procedure that preserves the safety and efficacy of conventional CABG while avoiding the associated morbidity. It is reproducible, versatile and holds promise as the procedure of choice for multivessel coronary revascularization in the future. TECAB is likely the pinnacle of minimally invasive coronary surgery, the growth of which is hindered by widespread acceptance and industry involvement.

Background Frailty syndrome and cardiovascular diseases are closely related because of the shared physiological pathway of chronic, low-intensity inflammation. Frailty syndrome may be an adverse factor in the prognosis of patients with cardiovascular disease (CVD). Objectives To assess the influence of frailty syndrome on patient prognosis after coronary artery bypass grafting (CABG). Material and methods The study was conducted at the Clinic of Cardiac Surgery in Katowice and involved 180 patients (56 women, 31.11%) over 60 years of age who qualified for CABG surgery. The Tilburg Frailty Indicator (TFI) was used to assess frailty syndrome and the The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was used to assess quality of life. Statistical analysis was performed using R software. Results Frailty syndrome was diagnosed in 42 patients (23.3%), including 24 men and 18 women. More than 1/3 of patients had complications during or after surgery, including 34.6% of patients without frailty syndrome and 28.6% of patients with frailty features. All of the complications occurred in 57 (31.6%) patients. Early complications accounted for 89.5% of all events - 93.3% of which occurred in patients without frailty syndrome and 75.00% in patients with frailty features (p = 0.289). Conclusions More than 1/3 of patients experienced complications during or after the CABG procedure. Early postoperative complications accounted for almost all of the adverse events in patients with frailty. However, frailty syndrome was a poor predictor of rehospitalization.

OBJECTIVES Robotic off-pump totally endoscopic coronary artery bypass (TECAB) is the least invasive form of surgical coronary revascularization. It has proved to be highly effective and safe. Its benefits are well-established and include fewer complications, shorter hospital stay and quicker return to normal activities. TECAB has undergone 2 decades of technological advancement to include multivessel grafting, a beating-heart approach and successful completion in multiple patient groups in experienced hands. The aim of this report was to examine outcomes of robotic off-pump TECAB at our institution over 7 years. METHODS Data from 544 patients undergoing TECAB between July 2013 and August 2020 were retrospectively examined. The C-Port Flex-A distal anastomotic device was used for the majority of grafts (70%). Yearly follow-up was conducted. Angiographic early patency data were reviewed for patients undergoing hybrid revascularization. RESULTS The mean age was 66 years, with 1.7% mean STS risk. Fifty-six percentage had multivessel TECAB. There was 1 conversion to sternotomy, and 46% extubation in the Operating Room (OR). Mortality was 0.9%. Early graft patency was 97%. At mid-term follow-up at 38 months, cardiac mortality was 2.7% and freedom from major adverse cardiac events was 92.5%. CONCLUSIONS We conclude that robotic beating-heart TECAB in the current era is safe and effective with excellent outcomes and comparable early angiographic patency to standard coronary artery bypass grafting surgery when performed frequently by an experienced team. This procedure was completed in our hands both with and without an anastomotic device. Longer-term studies are warranted.