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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

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.

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.

Background Coronary artery bypass grafting (CABG) and surgical aortic valve replacement (AVR) are the 2 most common cardiac surgery procedures in North America. We derived and externally validated clinical models to estimate the likelihood of death within 30 days of CABG, AVR or combined CABG + AVR. Methods We obtained data from the CorHealth Ontario Cardiac Registry and several linked population health administrative databases from Ontario, Canada. We derived multiple logistic regression models from all adult patients who underwent CABG, AVR or combined CABG + AVR from April 2017 to March 2019, and validated them in 2 temporally distinct cohorts (April 2015 to March 2017 and April 2019 to March 2020). Results The derivation cohorts included 13 435 patients who underwent CABG (30-d mortality 1.73%), 1970 patients who underwent AVR (30-d mortality 1.68%) and 1510 patients who underwent combined CABG + AVR (30-d mortality 3.05%). The final models for predicting 30-day mortality included 15 variables for patients undergoing CABG, 5 variables for patients undergoing AVR and 5 variables for patients undergoing combined CABG + AVR. Model discrimination was excellent for the CABG (c-statistic 0.888, optimism-corrected 0.866) AVR (c-statistic 0.850, optimism-corrected 0.762) and CABG + AVR (c-statistic 0.844, optimism-corrected 0.776) models, with similar results in the validation cohorts. Interpretation Our models, leveraging readily available, multidimensional data sources, computed accurate risk-adjusted 30-day mortality rates for CABG, AVR and combined CABG + AVR, with discrimination comparable to more complex American and European models. The ability to accurately predict perioperative mortality rates for these procedures will be valuable for quality improvement initiatives across institutions.

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.

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.

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.

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

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.

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

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.

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.

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.

The treatment of coronary artery disease has substantially changed over the past two decades. However, it is unknown whether and how much these changes have contributed to the improvement of long-term outcomes after coronary revascularization. We assessed trends in the demographics, practice patterns and long-term outcomes in 24,951 patients who underwent their first percutaneous coronary intervention (PCI) (n = 20,106), or isolated coronary artery bypass grafting (CABG) (n = 4,845) using the data in a series of the CREDO-Kyoto PCI/CABG Registries (Cohort-1 [2000 to 2002]: n = 7,435, Cohort-2 [2005 to 2007]: n = 8,435, and Cohort-3 [2011 to 2013]: n = 9,081). From Cohort-1 to Cohort-3, the patients got progressively older across subsequent cohorts (67.0 ± 10.0, 68.4 ± 9.9, and 69.8 ± 10.2 years, ptrend

Coronary artery fistula (CAF) is one of the most common coronary artery anomalies. The most common fistulas originate from the right coronary artery and drain into the right heart structures. Due to the variety of coronary fistulas, the surgical treatment strategy is individualized for each case. We report two cases of giant aneurysmal CAF originating from the left circumflex artery. One case required coronary artery bypass grafting, while the other did not.

В данной статье представлены особенности липидного спектра у пациентов с острым коронарным синдромом в отдаленном периоде после операции коронарного шунтирования (КШ), в сравнении групп с Инфарктом миокарда (ИМ) и Нестабильной стенокардии (НС), а также результаты приверженности к гиполипидемической терапии с особенностями достижения целевых уровней липидного спектра. Полученные результаты представляют, что по липидному спектру группы идентичны между собой и отличаются от нормы, пациенты с низкой приверженности к гиполипидемической терапии и не достигают целевых уровень по холестерин липопротеинов низкой плотности (ХС-ЛПНП) рекомендованным Европейского кардиологического общества (ESC, ЕОК) от 2019г. This article presents the features of the lipid spectrum in patients with acute coronary syndrome in the long-term period after coronary artery bypass grafting (CABG) surgery, in comparison with the groups with myocardial infarction and Unstable angina pectoris, as well as the results of adherence to lipid-lowering therapy with particularities of achieving target levels of the lipid spectrum. The results obtained represent that in terms of the lipid spectrum the groups are identical and differ from the norm, patients with low adherence to lipid-lowering therapy and do not reach the target levels for low-density lipoprotein cholesterol (LDL-C) recommended by the European Society of Cardiology (ESC) from 2019.

BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery (CABG), in which the left internal mammary artery (LIMA) is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used. This study determined whether these favorable clinical results could be realized at the authors’ institute. AIM To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery. METHODS CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019. LIMA was used in 35 patients, radial artery (RA) was used in 35 patients, and right gastroepiploic artery (RGEA) was used in 9 patients. Perioperative complications were observed, short-term graft patency rate was followed-up, and quality of life was assessed. RESULTS All patients underwent off-pump coronary artery bypass and the surgeries were successful. All of them were discharged without any complications or deaths. During the follow-up, it was found that patients’ angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II. A total of 90 vessels were grafted with no occlusion for internal mammary artery, three occlusions for RA, and one occlusion for RGEA. CONCLUSION The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.

Coronary artery bypass grafting (CABG) often causes physiological changes in patients. Although functional changes, such as lung function and exercise capacity changes, are observed in patients, there are no detailed studies examining this. The aim was to compare preoperative and postoperative pulmonary function and exercise capacity in patients undergoing on-pump CABG with a multidimensional index (BODE index). Demographic and surgical characteristics of patients were recorded. Pulmonary function test, six-minute walk test (6MWT), and modified Medical Research Council (mMRC) dyspnea score were assessed and BODE index were calculated in preoperative and at six months postoperatively. A total of 75 patients were included with a mean ± standard deviation age of 59.8±10.0 years. The male to female ratio was 57/18. There was a statistically significant decrease in the forced expiratory flow at 25-75% (FEF25-75%) value after CABG. Other pulmonary function test values were also lower in the postoperative period compared to the preoperative period, but these changes were not significant. The mean distance achieved in the 6MWT (p=0.02) and the mMRC dyspnea score (p=0.001) were significantly better postoperatively. The BODE index, which combines these parameters, had increased in the postoperative period. Age (OR 1.09; 95% CI: 1.008-1.181) and postoperative FEF25-75% (OR -0.96; 95% CI: 0.938-0.988) were the independent predictors of BODE score ≥3 in multivariate analysis. Despite the decrease in pulmonary function in patients undergoing CABG, there was an improvement in exercise capacity and dyspnea score.

This article provides an analysis of the results of surgical treatment of patients with various forms of coronary artery disease, the study of the quality and reliability of myocardial revascularization, assessment of patency and functional viability of coronary grafts in the early postoperative period using echocardiography and myocardial perfusion scintigraphy. The retrospective material of our study is based on the results of surgical treatment of 130 patients with coronary artery disease who were operated on in the IHD department over the past year. All patients underwent examination according to a standard protocol: electrocardiography, 24-hour Holter monitoring, selective coronary ventriculography and shuntography, echocardiography, perfusion scintigraphy before and after surgery, drug stress test to assess myocardial perfusion and contractility and its differentiation (ischemia, scarring) with hypoperfusion.

Aim. To develop a method of intermittent normobaric hypoxic low-intensity treadmill training for cardiac rehabilitation of patients inthe early postoperative stage after coronary artery bypass grafting. To assess the risks cardiovascular system (CVS) complications inusing the method. Material and methods. The study involved 44 patients (10 women aged 50 to 73 years and 34 men aged 40 to 71 years) with coronaryheart disease who underwent coronary artery bypass grafting. For cardiac rehabilitation, hypoxic gas mixtures were used, supplied tothe patient for breathing through an oxygen mask in combination with low-intensity training on the ReaTerra treadmill. To assess therisks of CVS complications when applying the method, we used the APKO-8-RIC oscillometric analyzer for cardiac output and bloodpressure parameters. The Robinson indices, endurance coefficient, Kerdo vegetative index, CVS adaptive potential index were calculated.Upon completion of the cardiac rehabilitation program, the subjects completed the SF – 36 Health Status Survey. Results. Studies have shown that the use of the cardiac rehabilitation method restored the level of blood pressure and heart rate,increased the Kerdo index of autonomic balance/ The Robinson index characterized the optimal work of the CVS, the endurance coefficientcharacterized the CVS endurance as satisfactory. The adaptive potential of the CVS corresponded to the physiological values ofthe norm, the activity of the heart was assessed as economical and effective, which testified to the satisfactory adaptation of patientsto the training process with the applied method. According to the questionnaire, physical and psychological components of health inpatients after a training course were qualitatively higher than before training. Conclusion. The method of intermittent normobaric hypoxytherapy in combination with low-intensity treadmill training in patients atthe early postoperative stage after coronary bypass grafting has shown high effectiveness in CVS diseases, contributing to the activationof adaptive, hemodynamic sanogenetic mechanisms, providing stimulation of rehabilitation potential in individuals of differentage groups and does not increase the risk of CVS complications.

Aim. To evaluate the effectiveness of the color pulse reflexology (CPR) methods and autogenous training (AT) in rehabilitation programs for patients after myocardial infarction (MI) and coronary artery bypass grafting (CABG). Material and methods. The study included 157 male patients with coronary artery disease aged 53.7 + 4.3 years who had undergone myocardial infarction and CABG surgery for 1 to 2 months. The patients were prescribed a standard program of sanatorium-resort treatment using natural factors and necessary medicines. The first – the control group of patients (CG, 63 people) was added to the AT treatment program, and the second – the main group (MG, 52 people) – the CPR method – 10 sessions of each method. The apparatus «Amulet 201» was used to correct the psycho-emotional state of patients with signals of the green and yellow ranges of the optical spectrum through a visual analyzer. Results. In the first group of patients, people with anxiety-depressive and asthenic syndromes experienced “restructuring” of the personal values scale: significantly reduced irritability, mental and physical fatigue, which contributed to the elimination of astenization, the restoration of nervous and physical potential, the behavioral functions and sleep normalization after a course of the treatment. In the second group of patients with cardiophobic and anxiety-sensing syndromes, there was improvement in well-being, sleep, decreased fatigue and phobic experiences, internal tension and anxiety, intensity and frequency of pain in the heart after the treatment. The majority of patients who took CPR and were re-admitted to sanatorium-resort treatment within 12 months after MI showed a significant improvement in their general condition and quality of life. Conclusion. When identifying asthenic, anxiety-depressive and agrypnia syndromes with an average daily non-dipper curve in cardiac surgery patients, the use of AT and CPR against the background of complex sanatorium-resort treatment in most cases gave a good and stable therapeutic effect, helped to correct the psychological and hemodynamic profiles, restore efficiency and improve the quality of life.

Ишемическая болезнь сердца (ИБС) является ведущей причиной смертности во всем мире. Реваскуляризация миокарда на протяжении почти 50 лет остается одним из основных методов лечения ишемической болезни сердца (ИБС). Несмотря на своевременную реваскуляризацию миокарда путем операции КШ как и в экстренном и в плановом порядке, число новых коронарных событии у этих же лиц встречается значительно часто во всем мире и в том числе, и в Казахстане. В данной работе в виде литературного обзора описаны особенности новых коронарных событии, с акцентом на инфаркт миокарда, и типичные факторы риска ИБС у пациентов с ранее выполненной операцией КШ в отделанном периоде. Далее эти вопросы дают сосредоточенного внимания для разработки и совершенствования профилактических стратегий, направленных на снижение воздействия конкретных факторов риска сердечно-сосудистых заболеваний, таких как диета, образ жизни, контроль веса, приверженность лечения и т.п. Coronary artery disease (CHD) is the leading cause of death worldwide. For almost 50 years, myocardial revascularization has remained one of the main methods of treating coronary heart disease (CHD). Despite the timely revascularization of the myocardium by CABG surgery, as well as in an emergency and in a planned manner, the number of new coronary events in the same persons occurs significantly throughout the world, including in Kazakhstan. In this paper, a literary review describes the features of new coronary events, with an emphasis on myocardial infarction, and typical risk factors for CHD in patients with a previously performed CABG operation in the remote period. These issues further provide focused attention for the development and improvement of preventive strategies aimed at reducing exposure to specific cardiovascular risk factors such as diet, lifestyle, weight management, adherence to treatment, etc.

Коронарное шунтирование (КШ) занимает ведущее место в лечении ишемической болезни сердца (ИБС). Однако имеется целый ряд нерешенных вопросов, таких как профилактика осложнений, снижение смертности, сокращение сроков реабилитации и т.д. Фибрилляция предсердий после коронарного шунтирования является одними из наиболее распространенных осложнений, которые могут способствовать повышенному риску осложнений, увеличению продолжительности пребывания в стационаре и стоимости лечения, а также смертности. Проблемы, связанные с возникновением ФП в раннем послеоперационном периоде кардиохирургической операции, побуждают сегодня многих исследователей к поиску предикторов ее развития и способов своевременной и эффективной профилактики осложнения. В этой статье представлена наиболее часто встречаемые предикторы фибрилляции предсердий после коронарного шунтирования. Идентификация предикторов послеоперационных фибрилляции предсердий в дальнейшем времени позволяет снизить риски ожидаемых осложнений и смертности. Coronary artery bypass grafting (CABG) occupies a leading place in the treatment of coronary artery disease (IHD). However, there are a number of unresolved issues, such as prevention of complications, reduction of mortality, reduction of rehabilitation time, etc.Atrial fibrillation after coronary artery bypass grafting is one of the most common complications that can contribute to an increased risk of complications, length of hospital stay and cost of treatment, and mortality. The problems associated with the occurrence of AF in the early postoperative period of cardiac surgery prompt many researchers today to search for predictors of its development and ways of timely and effective prevention of complications. This article presents the most common predictors of atrial fibrillation after coronary artery bypass grafting. Identification of predictors of postoperative atrial fibrillation in the future can reduce the risks of expected complications and mortality.

Patients recovering from coronary artery bypass grafting (CABG) are particularly vulnerable to impaired functional capacity, as well as quality of recovery because in addition to the direct effect of heart disease on cardiac performance, the surgical procedure and preoperative factors also contribute to loss of function. Early moderate intensity walking protocols can be effective in improving the health status of these patients. Still, there is hardly any evidence about the effect of early moderate intensity walking after CABG in the patients having high risk preoperative status for pulmonary complications. Therefore, this study has been designed to compare the effects of early moderate intensity walking on walking distance and quality of recovery, in two different groups of patients, with varying preoperative status. The study was set up as a 2-group, non-randomised comparative experimental design. 30 subjects, 27 males and 3 females, with a mean age of 55.2±6.7 years were included in the study. All the patients were mobilised early as per the early moderate intensity walking protocol. A six minute walk distance (6MWD) and a quality of recovery questionnaire were taken as outcome measures. Both groups showed significant improvement in 6MWD, but no statistical significant difference was found between the groups in improvement of 6MWD. Quality of recovery was also similar between the groups. Results indicate that the early moderate intensity walking can be implemented even on high risk patients with no adverse clinical sequelae. Thus, the early moderate intensity walking can be prescribed safely even to high risk patients.

Coronary revascularization has matured as a field since coronary artery bypass grafting (CABG) was first developed over 50 years ago, with diagnostic and treatment methods having advanced dramatically. CABG remains the standard of care for obstructive coronary artery disease, particularly for patients with multivessel disease or diabetes. It is now recognized that not all CABG is created equal-operative strategy, including conduit choice for bypass grafts and target coronary selection, affects survival. A multidisciplinary approach including surgeons with a special interest in CABG is recommended to optimize treatment selection and outcomes.

Platelet functions are thought to contribute to clinical outcomes after heart surgery. This study was conducted to assess the pivotal roles of vascular endothelial growth factor-A (VEGF-A) and microRNA-126 (miR-126) during coronary artery bypass grafting (CABG). Whole blood was collected for platelet isolation from 67 patients who underwent CABG surgery between July 2013 and March 2014. VEGF-A and miR-126 levels in serum, plasma, and platelets were measured at various time points and compared with clinical characteristics. The platelet count was decreased at 3 days after CABG. This dynamic change in platelet count was larger after conventional coronary artery bypass (CCAB) than off-pump coronary artery bypass (OPCAB). VEGF-A in the same number of platelets (IP-VEGF-A) was increased at 3 days after CABG, followed by an increase of VEGF-A in serum (S-VEGF-A) at 7 days after surgery. The miR-126-3p level in serum (S-miR-126-3p) increased rapidly after CABG and then decreased below preoperative levels. The IP-VEGF-A level on day 7 after CABG in patients with peripheral artery disease (PAD), who suffered from endothelial dysfunction, was higher compared with patients without PAD. Conversely, S-miR-126-3p on day 7 after surgery was lower in patients with PAD than in patients without PAD. Low levels of S-miR-126-3p due to endothelial dysfunction may lead to high IP-VEGF-A, which is closely related to complications after CABG.

Aim of the studySeveral psychosocial characteristics are well known to be importantly related to coronary heart disease (CHD). However, psychological aspects of surgical treatment of CHD and its implications for rehabilitation perspectives and cognitive changes of cardiac patients remain poorly understood. The article presents the results of studying the dynamics of emotional state of patients after coronary artery bypass grafting (CABG), measured before the surgery and at different stages of the rehabilitation process, and on a comparative analysis of trait and state anxiety and alexithymia of patients with CHD with different cognitive dynamics.Subject or material and methods118 patients with CHD, undergoing CABG were examined (average age 59,86 ± 7,31 years). The study was conducted using the clinical and psychological method and a specially developed complex of pato- and neuropsychological methods for assessing various spheres of cognitive functioning and emotional state of the patients.ResultsIt was shown that patients with cognitive impairment are characterized by great anxiety in the field of social contacts and an understanding of the social sphere as the main source of anxiety stress and uncertainty in itself. Patients complaining about the state of the cognitive sphere generally have a greater degree of personal anxiety, a feeling of emotional discomfort, dissatisfaction with life situations, and increased anxiety in the field of social contacts.DiscussionMost differences in the emotional state of patients with different cognitive dynamics were found even before surgery.ConclusionsTherefore, it seems reasonable to introduce additional short-term psychotherapeutic interventions aimed at stabilizing the emotional state of patients preparing for CABG surgery.

In 2017, the European Society of Cardiology outlined the importance of the problem of diagnosing myocardial ischemia-reperfusion injury following coronary artery bypass grafting. Myocardial injury can be accompanied by a critical decline in the cardiac index and an increase in cardiac troponin I plasma levels. The prognostic value troponin I elevation after coronary artery bypass grafting is poorly understood. Objective: to determine the prognostic value of troponin I plasma levels in relation to a fall in the cardiac index after coronary artery bypass grafting (CABG). Task: To determine the probability the cardiac index falling below 2.2 for troponin I levels in the first hours, and on days 1, 2, 3, 4 after CABG. Materials and methods. The single-center, non-randomized prospective study, running from 2016 to 2019, included 336 patients admitted for elective surgical treatment of coronary artery disease. The CABG patients were divided into three observation groups: off-pump (n = 175), on-pump (n = 128), and pump-assisted (n = 33). Troponin I levels were measured in the first hours, and on days 1, 2, 3, 4 after surgery using the Pathfast Compact immunoassay analyzer. Cardiac index was measured by invasive method. Results. In patients with a cardiac index higher than 2.2, troponin I level did not exceed 0.5 ng/mL in the off-pump group, 6 ng/mL in the on-pump group, and 3.5 ng/mL in the pump-assisted group. Patients with cardiac index lower than 2.2 have comparable troponin I levels in all groups - 21 ng/mL. Troponin I thresholds on day 1 after surgery, which, when exceeded, was associated with the likelihood of the cardiac index falling below 2.2, was 3.78 ng/mL in the off-pump group, 9.67 ng/mL in the on-pump group and 17.06 ng/mL in the pump-assisted group. Conclusion. After off-pump CABG, clinically significant myocardial injury should be expected at lower troponin I levels (3.78 ng/mL) than after on-pump CABG (9.67 ng/mL) and pump-assisted CABG (14.7 ng/mL).

The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach.There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI.Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access.The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG.The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG.

The aim.To evaluate the clinical outcomes and features of the state of the platelet-plasma and vascular hemostasis in patients (pts) with unstable angina and coronary artery bypass grafting (CABG) on-pump and off-pump for the correction of antithrombotic therapy and reduce the number of postoperative cardiovascular events.Material and methods.The study included 146 pts with unstable angina (UA) with a surgical treatment strategy. CG amounted to 106 pts with CABG and a standard approach to drug maintenance. MG comprised 40 pts with CABG and a personalized approach to antithrombotic therapy.Results.In CABG off-pump in pts with UA, an increased in platelet aggregation and activation of platelet hemostasis occurs on the 2nd day of the postoperative period, in CABG on-pump on the 5-7th day. Activation of plasma hemostasis had laboratory manifestations on the 5-7th day of the postoperative period, and is most pronounced in CABG on-pump, compared with CABG off-pump. After 1 month of control, 38,7% pts with UA and CABG were characterized by the presence of high residual platelet reactivity against the background of standard antiplatelet treatment, of which 23,6% retained activation of plasma hemostasis, which is manifested in excess of the normal level of D-dimers, as well as an increased in peak thrombin concentration and endogenous thrombin potential. Patients with UA and CABG who underwent correction of antithrombotic therapy differed from patients with a standard approach to treatment with a significantly lower number of repeated cardiovascular events over 2 years of follow-up (5% versus 22.6%).