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Background Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis. Design A systematic review and meta-analysis. Methods Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included. Results Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20–0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53–0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08–0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54–0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36–0.77; two out of 10 controlled cohort studies with neutral results). Conclusion CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation.

Aim.To study the association of V640L (rs6133) polymorphism in the P-selectin gene with acetylsalicylic acid (ASA) resistance in patients with coronary heart disease after coronary bypass surgery (CABG).Material and methods.The study included 104 patients aged 36-78 years (mean age 61.6±6.9 years) with stable angina pectoris: 61 (58.7%) patients had functional class II (according to Canadian Cardiovascular Society), 41 (39.4%) – class III and 2 (1.9%) – class IV. Atherosclerotic lesions of the coronary arteries were confirmed by coronary angiography. The antiplatelet therapy was stopped for at least 5 days before CABG. In the postoperative period, from the first day, all patients received 100 mg of ASA in enteric form, 61 patients received alone ASA therapy, 43 patients – combined antiplatelet therapy: ASA+clopidogrel (75 mg/day). The aggregation study was performed with an optical aggregometer, using 5 μM adenosinediphosphate (ADP) and 1 mM arachidonic acid inductors before CABG, on 1-3 day and on 8-10 day after surgical treatment. DNA samples were examined for the V640L (rs6133) polymorphism in the P-selectin gene by real-time polymerase chain reaction (PCR) using the allele-specific primers.Results. The frequency of the homozygous GG genotype of the rs6133 polymorphism was 84.6%; heterozygous GT genotype – 15.4%. The amplitude of aggregation with ADP before CABG, on 1-3 day and on 8-10 day after CABG for carriers of homozygotes of allele G vs carriers of the allele T were: 47.9±19.3%, 44.5±17.8%, 30.1±13.2% vs 47.9±17.1%, 46.3±16.5%, 39.6±22.0%, respectively (p=0.497, 0.441 and 0.687, respectively). The amplitude of aggregation with arachidonic acid before CABG, on 1-3 day and on 8-10 day after CABG for carriers of homozygotesof allele G vs carriers of the allele T, were: 47.9±23.2%, 24.5±21.7%, 12.3±16.3% vs 54.3±17.8%, 29.7±23.7%, 11±10.9%, respectively (p=0.416, 0.825 and 0.872, respectively). In the first 10 days of the postoperative period, 6 thrombotic events (5.7%) were observed in the study group: 2 strokes and 4 perioperative myocardial infarctions. Five events occurred in the group of patients with the GG genotype, 1 event in the group of patients with the GT genotype.Conclusion. V640L (rs6133) polymorphism in the P-selectin gene is not associated with ASA resistance in patients with coronary artery disease after CABG. The T allele of the rs6133 polymorphism is not associated with increased platelet aggregation activity after CABG and does not increase the risk of adverse events in the first 10 days after CABG.

The OBJECTIVEof the study was to assess the immediate results of the use of two internal thoracic arteries during coronary bypass surgery.MATERIAL AND METHODS. 200 patients with coronary artery disease underwent coronary artery bypass grafting in Samara cardiology dispensary from 2016 to 2018. Patients were divided into 2 groups. Group 1 (100 people) used both internal thoracic arteries (ITA) and the radial artery as conduits; group 2 (100 people) used the left ITA and the great saphenous vein as conduits. The duration of the operation, complications in the early postoperative period, and hospital mortality were evaluated.RESULTS. Groups (1 – 73 % of men, average age (59±12) years, average number of conduits – (3.1±0.4), 2 – 62 % of men, average age (67±7) years, average number of conduits – (3.3±0.6)) were significantly different only in age. The average duration of the operation in the group 1 was (174±25) min, in 2 – (165±18) min (p0.05). The number of complications in the early postoperative period did not have a statistically significant difference between the groups.CONCLUSION. Bilateral internal thoracic arteries coronary artery bypass grafting in CHD patients did not lead to a significant increase in the duration of the operation, an increase in mortality and infectious complications from the sternum, compared with single internal thoracic arteries grafting.

Objective The performance of coronary bypass grafting (CBG) induces a type of subclinical systemic inflammatory response syndrome. The present study was performed to examine the changes in pentraxin 3 (PTX3) and oxidative parameters during cross-clamping in patients undergoing CBG. We also examined factors affecting the development of postoperative atrial fibrillation (POAF). Method This study involved 40 patients who underwent elective on-pump CBG (33 men, 7 women; mean age, 60.8 ± 8.0 years). Blood specimens were drawn before anaesthesia and after aortic cross-clamping. POAF was detected by analysing the rhythm records of telemetry units for 96 hours postoperatively. Results The mean PTX3 concentration prior to surgery was 176.3 ± 148.4 pg/mL. After cross-clamping, it increased to 947.7 ± 377.2 pg/mL. The increase was statistically significant. Twelve patients had POAF. The leucocyte count and change in the oxidative stress index were significantly higher in patients without than with POAF. Although the increase in PTX3 was higher in patients without POAF, the difference was not statistically significant. Conclusion The PTX3 concentration significantly increases during CBG. A significant change in the oxidative stress index and a more intense increase in the PTX3 concentration were seen in patients without POAF.

Aim. To evaluate the range of risk factors associated with adverse cardiovascular events onset in hospital period of follow-up in patients with non-ST elevation acute coronary syndrome (NSTEACS) with multivessel disease (MD).Material and methods. To the study, under the framework of prospective, single-center registry, the NSTEACS and MD patients were included. Depending on the strategy of revascularization, three groups were selected: staged PCI, coronary bypass (CBG) and PCI as the first with CBG as the second stage. As adverse cardiovascular events, the following were taken: death, myocardial infarction, stroke or transient cerebral ishemia, clinically significant bleeding by BARC, repeat nonscheduled revascularization of target vessel. Results. Analysis revealed the groups of factors increasing the probability of adverse cardiovascular events. Those are: (1) clinical and demographic — older age, diabetes, postinfarction cardiosclerosis, multifocal atherosclerosis, chronic renal failure; (2) coronary and surgical — left main stem lesion, severe atherosclerosis by SYNTAX Score, high surgical risk by EuroScore II, revascularization strategy; (3) predominance of low or moderate risk by GRACE comparing with high risk.Conclusion. The results have confirmed high predictional significance of clinical and demography and coronary factors for development of adverse cardiovascular diseases. A significant finding of the study was the fact that in a hospital with surgery and endovascular treatment available 24/7, the intermediate and low GRACE risk in NSTEACS and MD is a factor of adverse cardiovascular events development due to revascularization delays if the risk is not high.

Recent guidelines it is permitted to continue aspirin before coronary bypass operation (CBG) (Class I, Level B). Nevertheless, absence of randomized multicenter studies makes it possible not to follow these in routine practice as the only. Practive of aspirin discontinuation before CBG is quite common due to anticipated risks of post-surgery complications. Aim . To evaluate the safety of CBG with continued aspirin. Material and methods. For the safety assessment of aspirin before CBG, we conducted prospective randomized study. Patients with stable coronary heart disease were included, who underwent CBG with continued aspirin (aspirin group), and another group included those who had aspirin discontinued (controls). Totally, 74 patients randomized. Treatment group included 37 patients, and 37 controls. Follow-up lasted for 5 minutes. As primary endpoint, the volume of operational blood loss was taken, during the next 24 hours post-surgery. As the second endpoint, the combination was taken as any cardiovascular adverse event: cardiac death, perioperational myocardial infarction, ischemic stroke. Results. There was noted, the comparability of intraoperational blood loss in comparison groups (p=0,166). Summary blood loss in 24 hours of postoperational blood loss showed statistical significance between groups (mean difference 100 mL, 95% CI 0-110 mL, p=0,027). This amount of blood loss is clinically non-significant. In aspirin group, there were 2 cases of perioperational myocardial infarction, by cardiac enzymes elevation, not statistically significant. Conclusion . Results of the study witness for the safety of CBG operations under continued aspirin as well as discontinued at least 5 days before surgery.

Introduction: The Department of Cardiovascular Surgery at the Sisli Hamidiye Etfal Training and Research Hospital was founded in 2014, and the first open heart surgery was performed on November 19, 2014. We aim to evaluate the results of the first 450 open heart surgeries retrospectively. Patients and Methods: Records of the first 450 consecutive open heart surgeries performed between November 2014 and October 2019 were retrospectively evaluated. All patients were treated with acetylsalicylic acid (100 mg/day) up to the preoperative day, and those who had acute coronary syndrome were continued to be treated with clopidogrel (75 mg/day). In all cases, the surgeries were performed through median sternotomy. The standard cardiopulmonary bypass technique was used in all patients who underwent coronary artery bypass grafting (CABG). Antegrade blood cardioplegia was given at 20-minute intervals to achieve a diastolic arrest of cardiac activity. In patients who underwent CABG, proximal anastomoses were performed under a side clamp, and sometimes, with single clamp technique depending on the patient characteristics. Results: The mean age of the patients was 58.7 years. The most common comorbidity seen in the patients was hypertension (62.9%). Other comorbid diseases observed in the patients were diabetes mellitus (43.6%), hyperlipidemia (28.0%), chronic obstructive pulmonary disease (24.9%), peripheral arterial disease (13.1%), and chronic renal dysfunction (4.7%). In-hospital death occurred in 33 of 450 patients with a mortality rate of 7.3%. Conclusion: Open heart surgeries can be performed with reasonable and successful mortality rates in our center., Giriş: Kasım 2014 tarihinde faaliyete geçen Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniğinde, 19 Kasım 2014 tarihinde ilk başarılı açık kalp ameliyatı yapılmıştır. Bu çalışmanın amacı, yapılan ilk 450 açık kalp ameliyatının sonuçlarını değerlendirmektir. Hastalar ve Yöntem: Kasım 2014-Aralık 2019 tarihleri arasında açık kalp ameliyatı yapılan toplam 450 hasta retrospektif olarak değerlendirildi. Stabil koroner arter hastalığı olan tüm hastalar operasyon gününe kadar 100 mg/gün asetilsalisilik asit ile tedavi edilirken, akut koroner sendromu olan olgularda 75 mg/gün klopidogrel tedavisi kesilmedi. Tüm olgularda operasyon medyan sternotomi ile yapıldı. Koroner arter baypas greftleme uygulanan tüm hastalarda standart kardiyopulmoner baypas tekniği kullanıldı. Diyastolik kardiyak arrest sağlamak için 20 dakikalık aralıklarla antegrad kan kardiyoplejisi verildi. CABG operasyonunda proksimal anastomoz yan klemp altında ve bazen hasta özelliklerine bağlı olarak tek klemp tekniği ile uygulandı. Bulgular: Hastaların yaş ortalaması 58.7 (19-87 yıl) yıl idi. Hipertansiyon (%62.9) en sık eşlik eden hastalık olup bunu diabetes mellitus (%43.6), hiperlipidemi (%28.0), kronik obstrüktif akciğer hastalığı (%24.9), periferik arter hastalığı (%13.1) ve kronik böbrek disfoksiyonu (%4.7) takip etmiştir. Hastane mortalitesi 450 hastada 33 (%7.3) olarak gerçekleşmiştir. Sonuç: Açık kalp operasyonları başarılı ve kabul edilebilir morbidite ve mortalite oranları ile merkezimizde devam etmektedir.

Background Postoperative atrial fibrillation is the most common arrhythmia seen after cardiac surgery. We aimed to determine the effect of obesity and metabolic syndrome on postoperative atrial fibrillation, whether they are independent risk factors, and their effect level. We also analyzed the effect of atrial fibrillation on postoperative complications. Methods In our clinic, 756 patients who underwent coronary artery bypass grafting between June 2010–September 2017 were evaluated retrospectively. Preoperatively, demographic characteristics, chronic diseases, body mass index, waist circumference measurements, and ejection fraction values of the cases were determined from file records. Perioperatively, cross-clamp and cardiopulmonary bypass times, intra-aortic balloon use, distal coronary bypass counts were determined. Postoperatively, complications, duration of intensive care unit and hospital stay, and mortality were evaluated. The patients were followed up with continuous 3-lead ECG monitorization on the postoperative first day and 12-lead ECG records once in a day on the remaining days. In the study, the first endpoint was the determination of atrial fibrillation and the second endpoint was the discharge time of the patient. Results The rate of postoperative atrial fibrillation was 21.3%. Atrial fibrillation was seen in 33% of metabolic syndrome cases and in 38.5% of obese cases. Atrial fibrillation was seen in 23, 24 and 17% of cases using statin, ACE inhibitor and beta blocker, respectively. It was seen in 21% of smokers and 20% of the COPD cases. In the study, metabolic syndrome, diabetes mellitus, hypertension, and obesity, between the ages of 56–78 with Metabolic syndrome, were found to affect the development of postoperative atrial fibrillation (2.46), (2.3), (1.6), and (1.65) times, respectively. In cases with postoperative atrial fibrillation, infection and stroke were 1.45 and 8.85 times more frequent, respectively. Patients with metabolic syndrome were found to have 31% longer hospital stay, and 17% higher infection rate. In obese patients, hospitalization was 23.5% longer. Conclusions Metabolic syndrome and obesity were found to be two independent risk factors for postoperative atrial fibrillation. If causes and mechanisms of postoperative atrial fibrillation are identified in planned cardiovascular interventions, we believe that cost of hospitalization and morbidity will be reduced.

BACKGROUND: The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. DESIGN: Structured review and meta-analysis. METHODS: Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. RESULTS: Out of n = 18,534 abstracts, 25 studies were identified for final evaluation (RCT: n = 1; pCCS: n = 7; rCCS: n = 17), including n = 219,702 patients (after ACS: n = 46,338; after CABG: n = 14,583; mixed populations: n = 158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; rCCS: HR 0.64, 95% CI 0.49-0.84; odds ratio 0.20, 95% CI 0.08-0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54-0.70) and in mixed CAD populations. CONCLUSIONS: CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.

Background A saccular aneurysm located at the bifurcation of the left main coronary artery (LMCA) is an extremely rare condition. A major cause of left main coronary aneurysm is atherosclerosis, and common complications include thrombosis, embolism, and rupture. Despite the serious nature of this condition, the ideal operative approach to LMCA aneurysm (LMCAA) has not been established. Furthermore, little is known about resection of the saccular aneurysm and closure using a small internal thoracic artery patch. Case presentation Here, we present the case of a 66-year-old woman who had significant stenosis in the left anterior descending artery and a saccular aneurysm at the bifurcation of the LMCAA, which was repaired using a small internal thoracic artery patch during coronary artery bypass grafting. Postoperative multislice computed tomography revealed the complete disappearance of the aneurysm and a successful repair with no luminal stenosis of the internal thoracic artery patch. In addition, the left internal thoracic artery graft was found to be patent. Conclusions Resection of the saccular LMCA aneurysm and closure using a small internal thoracic artery patch is safe and offer excellent results.

Background: The number of disorders caused by atherosclerosis of various arterial tree is constantly increasing worldwide. Multifocal atherosclerosis (MFA) remains to be an important problem limiting effectiveness of coronary bypass grafting. Aim: To compare one-year rates of unfavorable cardiovascular events in patients, who underwent coronary bypass grafting, depending on the degree of non-coronary stenoses (stenoses of extracranial arteries and lower limb arteries). Materials and methods: Two hundred and thirty two patients, that underwent coronary bypass graft surgery in 2006 due to clinical manifest coronary atherosclerosis, were included into the study. Oneyear outcome (10–12 months) was assessed with the following endpoints: coronary and non-coronary death, myocardial infarction, stroke, angina pectoris and severe chronic heart failure (III–IV functional classes). One-year combined outcome after coronary bypass grafting was considered unfavorable if these events were registered. Results: After initial assessment, patients were divided into 2 groups depending on the degree of coronary atherosclerosis; thereafter, each group was subdivided into subgroups depending on presence or absence of MFA. Compared to patients without MFA, those with hemodynamically significant stenosis (≥ 50%) of non-coronary arteries had higher rates of unfavorable one-year outcomes (р = 0.001). They had higher rates of stroke (20% (5) and 5.8% (12) of patients, respectively, р = 0.03) and of recurrent angina (р = 0.001). Patients with hemodynamically non-significant stenoses (≥ 30%) also had significantly higher rates of unfavorable events, compared to patients without stenoses: myocardial infarction, in 12 (11%) and 3 (2%), respectively (p = 0.006), stroke, in 14 (13%) and 3 (2%) (p = 0.001). Eighty four (79%) patients with MFA had clinical manifestations of angina pectoris, whereas among those without MFA, only 23 (18%) of patients (p = 0.0001). Severe chronic heart failure was significantly more frequent in the MFA group, than in patients with isolated coronary atherosclerosis (38 (36%) and 21 (17%) patients, respectively, p = 0.002). In the MFA group, 10 (9%) patients died, while in the group without MFA there was one death (0.8%) (p = 0.003). Conclusion: Taking into account non-coronary stenoses of ≥ 30%, compared to only hemodynamically significant stenoses of ≥ 50%, produces more significant differences in clinical and historical characteristics of patients.

Aim. To study interrelations of cardio-ankle vessel index (CAVI) with annual results of coronary bypass grafting (CBG) in patients with ischemic heart disease (CHD). Material and methods. On the first stage, we included 356 patients after CBG. All patients underwent CAVI assessment. In a year we analyzed the condition of 341 patient, and selected patients into groups: I (n=221) — CAVI >9,0 and II (n=120) group — CAVI

Aim. To assess the occurence of hemodynamically non-significant multifocal atherosclerosis (from 30% and more), renal dysfunction and their influence on the outcomes of in-hospital period of patients underwent coronary bypass surgery (CABG). Material and methods. The perioperational period of 720 patients analyzed, who were operated in 2011-2012 y. Before CABG all patients were assessed by colored duplex scanning of extracranial arteries and arteries of lower extremities to reveal the signs of multifocal atherosclerosis (MFA), also the creatinine concentration was measured in 1 day before and 7 days after CABG, and GFR was calculated by MDRD equation. The prevalence of worse outcomes was assessed after the operation (myocardial infarction, stroke, acute renal failure, remediastinotomy, death) during in-hospital period. Results. The prevalence of hemodynamically non-significant MFA (30% and more) in patients with CHD after CABG was 48%. Renal dysfunction (RD), by a decrease of GFR

Aim. To evaluate coronary bypass grafting under artificial circulation conditions on endothelial and erectile dysfunction in patients with ischemic heart disease (CHD). Material and methods. Totally 117 patients participated in the study, with stable CHD at the mean age 55,8±5,3 y. o., planned to CBG. In all patients we used questionnaire “International Index of Erectile dysfunction” (IIED), registration of nocturnal penile tumescenses (NPT), post compression tests on brachial and cavernous arteries. All patients were divided into two groups, those with and without erectile dysfunction (ED) (n=60, n=57, resp.). Results. By the results of the investigation in patients with ED after CBG there was significant worsening of erectile function. It was found, that the existence of ED before operation is an important prognostic factor for its progression after the operation. Others, with non-affected erectile function, after the operation had higher chances to save it. Even more, it was found that in patients without preoperational ED by 6 months after CBG there was tendency to improvement of EZVD comparing with baseline values, but in group with ED this tendency was not found. Also in patients without ED in all stages of study there was significantly better vasoregulating function of endothelium on brachial artery comparing to ED patients. The same tendency was found and on cavernous arteries. While analyzing the prevalence of cardiovascular events after CBG it was found that in ED group 4 patients (7%) cardiovascular events developed, but without ED — did not. Conclusion. So the presence of ED might be a significant marker of worse outcome in CHD patients, underwent CBG.

A carbon dioxide (CO(2)) embolism during endoscopic vein harvesting is a rare but potentially fatal complication. Early and accurate diagnosis is crucial for limiting the extent of the embolism and stabilizing the resulting cardiovascular compromise. We report a case of CO(2) embolization during endoscopic vein harvesting. Transesophageal echocardiography was instrumental in the diagnosis and management of this patient by further improving the decision making process, which resulted in the best outcome. Mid-esophageal bicaval view is the best view to determine whether a CO(2) embolism is coming from the upper or lower extremities.

Background Postoperative atrial fibrillation (AF) is a serious complication of coronary artery bypass grafting (CABG). There are scant data on the application of coronary computed tomography angiography (CCTA) for prediction of postoperative AF. Methods A total of 102 patients (77 male, mean age: 64 ± 10 years) with pre-procedural CCTA undergoing isolated CABG were enrolled. Clinical risk factors were collected. Qualitative and quantitative CCTA analysis of the atria, pulmonary veins (PV), and epicardial adipose tissue (EAT) along the left atrium (LA) was performed to determine the predictors for postoperative AF. The primary endpoint was defined as any in-hospital AF requiring treatment. Results Postoperative AF occurred in 24% of patients. Patients with AF had higher body mass index (29.7 ± 4.8 kg/m 2 vs 27.3 ± 3.9 kg/m 2 , p = 0.013), larger right atrial area (25.4 ± 5.3 cm 2 vs 22.3 ± 6.4 cm 2 , p = 0.035), LA systolic volume (114.7 ± 32.8 ml vs 96.8 ± 30.4 ml, p = 0.015), LA EAT volume (5.6 ± 3 ml vs 4 ± 2.5 ml, p = 0.009), and right superior PV ostium area (3.8 ± 1.3 cm 2 vs 3 ± 1 cm 2 , p = 0.021) compared to non-AF patients. By multivariable analysis, only LA EAT volume [odds ratio (OR): 1.21, 95% confidence interval (CI): 1.01–1.44, p = 0.036] and right superior PV ostium area (OR: 1.63, 95% CI: 1.06–2.50, p = 0.026) were independent predictors of AF. The optimal cut-offs for LA EAT volume and right superior PV ostium were >3.4 ml and >4.1 cm 2 , respectively (max. sensitivity: 83%, max. specificity: 86%). Conclusions Increased LA EAT and right superior PV ostial size are independently associated with AF after CABG. CCTA might be used as a noninvasive prediction tool for AF in patients undergoing CABG.

Background: This study aimed to test the beneficial effect of grape seed extract (GSE) (Vitis vinifera) and Vitamin C in oxidative stress and reperfusion injury induced by cardiopulmonary bypass (CPB) in coronary artery bypass surgery. Patients and Methods: In this randomized trial, 87 patients undergoing elective and isolated coronary bypass surgery included. The patients were randomly assigned into three groups (n = 29 each): (1) Control group with no treatment, (2) GSE group who received the extract 24 h before operation, 100 mg every 6 h, orally, (3) Vitamin C group who received 25 mg/kg Vitamin C through CPB during surgery. Blood samples were taken from coronary sinus at (T1) just before aortic cross clamp; (T2) just before starting controlled aortic root reperfusion; and (T3) 10 min after root reperfusion. Some clinical parameters and biochemical markers were compared among the groups. Results: There were significant differences in tracheal intubation times, sinus rhythm return, and left ventricular function between treatment groups compared with control (P < 0.05). Total antioxidant capacity was higher (P < 0.05) in both grape seed and Vitamin C groups at T2 and T3 times. In reperfusion period, malondialdehyde level was increased in control group; however, it was significantly lower for the grape seed group (P = 0.04). The differences in the mean levels of superoxide dismutase and glutathione peroxidase among the three groups were not significant (P > 0.05 in all cases). Conclusions: In our patients, GSE and Vitamin C had antioxidative effects and reduced deleterious effects of CPB during coronary artery bypass grafting surgery.

OBJECTIVE: The number of older patients being referred for aortic valve replacement with or without combined coronary bypass grafting (CABG) is increasing. The aim of this study was to evaluate operative risk factors, early and long-term results of isolated aortic valve and aortic valve replacement combined with CABG in octogenarians and nonagenarians. METHODS: In the last 10 years, 285 very elderly patients who underwent aortic valve replacement either alone or in combination with coronary artery bypass grafts were retrospectively studied. The population was divided into two groups; isolated aortic valve replacement was performed in 188 patients (group A) and 97 patients had aortic valve replacement combined with coronary surgery (group B). RESULTS: The overall hospital mortality was 5.3%, without statistical difference between groups. The incidence of low-output syndrome was higher in group B (P= 0.0001). The multivariate analysis for hospital mortality showed that urgency status, ejection fraction (EF)