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This literature review focuses on the choice of treatment strategies in patients with aortic stenosis. The main surgical techniques for this condition are presented. The rationale for the efficiency of transcatheter aortic valve implantation is provided. The results of studies comparing the outcomes of surgical and endovascular correction of aortic stenosis are analyzed. Particular attention is paid to the treatment choices in patients with aortic stenosis and a history of coronary artery bypass grafting. Conclusions on the perspectives of transcatheter aortic valve implantation in this cohort of patients are reached.

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 Equipment entrapment during percutaneous coronary intervention (PCI) may lead to acute ischemia necessitating emergency surgery. CASE PRESENTATION This is the first case report where emergency surgery had to be performed on beating heart, for removal of retained PCI equipment, due to an incidental finding of severely atheromatous aorta precluding cross-clamp. Ultrasound-guided aortic cannulation and off-pump strategy made the complex reconstruction of left anterior descending artery possible. CONCLUSIONS PCI equipment entrapment and subsequent myocardial ischemia, with or without hemodynamic compromise, necessitates emergency surgery and should involve an early discussion with a cardiothoracic team. Each case poses different challenges and requires surgical planning to devise an individualized management strategy. Intraoperative finding of atheromatous aorta may be managed with pump-assisted beating heart surgery and clampless technique to achieve satisfactory results.

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.

Background:Although coronary artery bypass grafting is not frequently performed in children, Kawasaki disease is one of the most common indications for coronary artery bypass grafting in children. Here, we reviewed the long-term clinical outcomes including graft patency after coronary artery bypass grafting.Methods:Between March 2004 and March 2013, six patients with Kawasaki disease underwent coronary artery bypass grafting. All patients were male. Their median age was 13.0 years (interquartile range, 7.8–17.8 years) at the timing of coronary artery bypass grafting, and the median age at the onset of Kawasaki disease was 3.3 years (interquartile range, 1.0–7.0 years). Four patients presented with multiple lesions including aneurysms.Results:The median follow-up duration was 12.1 years (interquartile range, 9.5–13.1 years), and there were no operative complications or overall mortality. One patient had pre-operative symptoms such as exertional chest pain and dyspnoea on exertion, whereas one patient had ventricular tachyarrhythmia. There was an improvement in subjective symptoms after surgery in two patients. The left internal thoracic artery, right internal thoracic artery, and saphenous vein were used in five (83.3%), one (16.7%), and two (33.3%) cases, respectively. In all six patients, post-operative single-photon emission CT findings showed improved perfusion compared with pre-operative single-photon emission CT. All grafts were patent as confirmed by coronary angiography or CT angiography.Conclusions:Coronary artery bypass grafting could be a good surgical option in children with coronary lesions caused by Kawasaki disease in terms of graft patency and myocardial perfusion.

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.

Introduction: Throughout the world, cardiovascular disease is a leading cause of not only morbidity but also mortality too. Myocardial infarction is the primary reason for admission in cardiac rehabilitation unit, patients of Coronary artery bypass Graft (CABG) surgery along with other cardiac condition like valve surgery, post PTCA (Percutaneous Transluminal Coronary Angioplasty) are also being referred for cardiac rehabilitation. Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG) surgery, is a surgical procedure for partially obstructed coronary artery (the "target vessel"). The purpose is to restore normal blood ow to the partially obstructed coronary artery. Our study is an attempt to understand the age, gender and risk factors pattern in patients attending for cardiac rehabilitation after Coronary Artery Bypass Grafting (CABG) Surgery. Material And Methods: This Retrospective Cohort Study was conducted in the Department of Physical Medicine and Rehabilitation of Institute of Post Graduate Medical Education and Research (IPGME & R) and SSKM Hospitals, Kolkata after getting Institutional ethical committee clearance and informed consent. Relevant data regarding medical, personal history and demographics collected from the patients attended for cardiac rehabilitation (CR) after coronary artery bypass grafting (CABG) surgery between January, 2014 to June, 2015 (18 months) were being used for analysis. Results: Data were summarised by routine descriptive statistics. Maximum number of patients are in the age group of 51-60 years. Most of study population are male (90%). Study showed show 42.5 % are smoker, 37.5 % diabetic, 27.5 % are obese, 82.5 % are dyslipidaemic, 57.5 % are hypertensive. Conclusion: Our study shows most of our patient is male of 5th decade. Minimum age is 46-year, maximum age is 71 years with the mean age 55.4 years. most of study population are male (90%). Among the study population, 42.5 % are smoker, 37.5 % diabetic, 27.5 % are obese, 82.5 % are dyslipidaemic, 57.5 % are hypertensive. Hence male sex is an important risk factor for coronary artery disease. Early and aggressive attention to these risk factors e.g., smoking, diabetes, obesity, dyslipidaemia, hypertension could drastically reduce the need for coronary procedures such as angioplasty, stent, and bypass surgeries.

Coronary artery bypass grafting (CABG) was introduced in the 1960s as the first procedure for direct coronary artery revascularization and rapidly became one of the most common surgical procedures worldwide, with an overall total of more than 20 million operations performed. CABG continues to be the most common cardiac surgical procedure performed and has been one of the most carefully studied therapies. Best CABG techniques, optimal bypass conduits, and appropriate patient selection have been rigorously tested in landmark clinical trials, some of which have resolved controversy and most of which have stoked further debate and trials. The evolution of CABG cannot be properly portrayed without presenting it in the context of the parallel development of percutaneous coronary intervention. In this Historical Perspective, we a provide a broad overview of the history of coronary revascularization with a focus on the foundations, evolution, best evidence, and future directions of CABG.

Although not formalized into current risk assessment models, frailty has been associated with negative postoperative outcomes in many specialties. Using administrative coding, we evaluated the impact of frailty on in-hospital death, complications, and resource use in a nationally representative cohort of patients undergoing isolated coronary artery bypass grafting (CABG).Patients aged 18 years and older who underwent isolated CABG across the United States were identified using the 2005 to 2016 National Inpatient Sample. Frailty was defined using a derivative of the validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Mortality, length of stay, inflation-adjusted costs, and postoperative complications were evaluated using multilevel multivariable regression.Of an estimated 2,137,618 patients undergoing isolated CABG, 85,879 (4.0%) were considered frail. The proportion of frail patients increased over the study period (nonparametric test for trend P = .002), while annual mortality rates declined (nonparametric test for trend P.001). Frail patients were older (68.9 ± 10.7 years vs 65.0 ± 10.6 years, P.001), and more commonly female (32.8% vs 26.2%, P.001). After adjustment, frailty was associated with increased odds of in-hospital death (adjusted odds ratio [AOR], 2.49; 95% confidence interval [CI], 2.30-2.70; P.001), major complications (AOR, 2.55; 95% CI, 2.39-2.71; P.001), increased length of stay (AOR, 1.40; 95% CI, 1.09-2.11; P.001), and costs (AOR, 1.03; 95% CI, 1.02-1.07; P.001).Frailty, as identified by administrative coding, serves as a strong independent predictor of death and complications after CABG. Incorporation of frailty into risk models may aid in counseling patients about operative risk and benchmarking outcomes.

Introduction: Cardiovascular disease is leading cause of mortality and morbidity throughout the world. Despite optimum medical and surgical management, a large number of patients became unable to maintain normal activity of daily living due to inadequate rehabilitation. Rehabilitation cannot be regarded as an isolated form or stage of therapy. Coronary artery bypass surgery, also known as coronary artery bypass graft surgery, is a surgical procedure to bypass the obstructed coronary artery (the "target vessel"). India has a large number of patients of coronary artery disease who needs CABG operation. Over few decades post-operative rehabilitation of CABG patients is done though there is no separate national level guidelines for Indian population even in post myocardial infarction patients like western countries though socio economic prole, health infrastructure and need are different from rest of the world. So, our study is a humble attempt to examine the efcacy of rehabilitation programme followed in western world. Material and methods: In this Open labelled parallel group prospective randomised trial, conducted in the Department of Physical Medicine and Rehabilitation in collaboration with the cardio-thoracic and vascular surgery (CTVS) unit of the Institute of Cardio-Vascular Sciences, at the Institute of Post Graduate Medical Education and Research (IPGMER) and SSKM Hospitals, Kolkata between January, 2014 to June, 2015 (18 months). Patients who undergone CABG operation in CTVS Department SSKM Hospital, Kolkata were included. Total 80 patients, 40 in each group were recruited. Patients were randomised to cardiopulmonary rehabilitation group (n=40); named as cases and usual care group (n=40); named as control. Institutional ethical committee clearance was taken. Informed consent was taken from each patient before including them in this study. Every patient was explained about the programme. Parameters used:1. Forced vital capacity (FVC), 2. Metabolic Equivalent (MET), 3. Functional assessment (6MWT). Patient will be assessed at the end of 1 week,6 week and 3month of operation. FVC and 6MWT were performed in each visit where MET assessment was done in 6 week and 3 months. Results: Data will be summarised by routine descriptive statistics. Numerical variables will be compared between groups by Student's Unpaired 't' test if normally distributed or by Mann-Whitney's 'U' test if otherwise. Variation over time would be assessed through repeated measures Analysis of Variance (ANOVA) or by Friedman's ANOVA if otherwise. Chi-Square test or Fisher's Exact test would be employed for inter-group comparison of categorical variance. Analysis will be two-tailed and p

Burr entrapment is a rare but serious complication during rotational atherectomy (RA). The Japanese have termed this the Kokeshi phenomenon named after a wooden doll found in northern Japan consisted of a simple trunk but a large head akin to the Rotablator (Mechery et al., 2016; Kaneda et al., 2000). The reason underlying this complication is the lack of diamond dust on the back end of the burr (Lin et al., 2013). The burr is olive-shaped and has diamond coating at its distal surface for antegrade ablation. The proximal part is smooth without diamonds, which prevents backward ablation of tissues when retracted (Lin et al., 2013; Dahdouh et al., 2013). Rota entrapment usually needs surgical management with coronary artery bypass grafting (CABG) surgery. To date, only few cases of successful non-traumatic retrieval using nonsurgical bailout techniques have been published (Grise et al., 2002). We report a case of burr entrapment within the left anterior descending (LAD) artery which was successfully retrieved by combination of multiple maneuvers and the patient underwent routine PCI following the retrieval.

Background: In this study, we investigated the impact of concomitant coronary artery bypass grafting (CABG) on operative and midterm mortality in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair. Methods: From January 2012 to December 2014, among 489 patients (mean age: 47.6 ± 10.4 years, 77.1% male) with ATAAD who received surgical repair at our institute, 21 patients (4.3%) underwent concomitant CABG. Isolated aortic repair was performed in the remaining 468 cases (95.7%). Coronary dissection was indicated in 15 patients (Neri classification type B in 2, type C in 13), concomitant coronary artery disease in five and coronary artery compression in one. The follow-up time was 97.3% at 44.1 ± 13.9 months. Results: A total of 44 patients (9%) died from surgery, and operative mortality in the concomitant CABG group was significantly higher than that in the isolated aortic repair group (47.6%, 10/21 vs. 7.3%, 34/468; P

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.

The aim of the study is to analyze the peculiarities of the timing of discontinuation of antiplatelet and anticoagulant therapy before coronary artery bypass grafting. The study is based on a retrospective analysis of 194 patients who were discharged after coronary artery bypass surgery from M. Amosov National Institute of Cardiovascular Surgery, National Academy of Sciences of Ukraine for the period of 2009 - 2019. The average age of the patients was 64.2±8.9 years. All the patients underwent standard laboratory tests, coronary angiography and coronary artery bypass grafting. The analysis of the regimen of antiplatelet and anticoagulant therapy showed that 44 (22.6%) patients discontinued this medication 1 day before surgery. 86 (44.3%) patients were recommended to discontinue the medication within 2-5 days before coronary artery bypass grafting, 40 (20.6%) patients discontinued antithrombotic drugs 6-10 days before the operation. 11 (5.6%) patients did not received anticoagulants and antiplatelet agents before the operation. The majority of patients (67.01%) terminated antiplatelet therapy 1-5 days before the operation; intraoperative blood loss in average was 334.7±89.7ml. A correlation analysis between the regimen of antiplatelet / anticoagulant therapy and intraoperative blood loss revealed a negative relationship (r = -, 0.85). The patients who were on triple therapy before coronary artery bypass grafting underwent hemotransfusion in 75% of cases; among the patients who received dual antiplatelet therapy, blood transfusion was performed in 26.04% of cases, and patients who were on monotherapy with acetylsalicylic acid, blood products were transfused in 22,8% of cases. Conclusions: earlier withdrawal of antiplatelet agents before coronary bypass grafting is associated with fewer blood transfusions - when antithrombotic therapy was terminated 1 day before coronary artery bypass grafting, the frequency of blood transfusions was 36.3%, and among the patients who did not receive antiplatelet therapy before surgery, blood transfusion was performed in 18.1% of cases.

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.

Ibutilideis less frequently used drug for atrial fibrillation (AF) in postoperative coronary artery bypass grafting (CABG) patients as compare to amiodarone. We therefore investigated the comparative efficacy of ibutilde and amiodarone for cardioversion in atrial fibrillation after CABG.To compare the efficacy of ibutilide and amiodarone for cardioversion of AF in post CABG patients. Narayana Multispeciality Hospital, Jaipur. Single center, randomized, double blind, comparative prospective study.Total 80 post CABG patients who developed AF were divided into two groups (Group A) Ibutilde and (Group B) Amiodarone respectively. The cardioversion time and cardioversion rate were measured. Unpaired t-test, Paired t-test, Chi square test / Fisher exact test. P value The cardioversion rate at 4hrs in group A was 42.5% and in group B was 50% (p value > 0.001). At 24 hrs cardioversion rate in group A was 95% and in group B was 87.5% (p value > 0.001). The mean time of conversion to sinus rhythm in group A was 382.85 minutes and in group B was 492.30 minutes. (p value= 0.235)Ibutilide was as effective as amiodarone for restoration of sinus rhythm in postoperative coronary bypass grafting patients who developed atrial fibrillation in their postoperative intensive care unit stay. Ibutilide may be superior to amiodarone in terms of hemodynamics and systemic side effects.

The objective was to improve the surgical treatment tactics in patients with non-small cell lung cancer (NSCLC) and coronary heart disease (CHD), requiring myocardial revascularization.Methods and materials. Two groups consisting of 24 patients operated on for NSCLC were examined. In one group, operations for NSCLC were performed in the second stage after coronary artery bypass grafting (CABG). Survival rates in both groups and factors influencing them were evaluated.Results. The number of postoperative complications in both groups was comparable: 20.8 % in patients with CABG and 16.6 % in the group operated only for NSCLC. Indicators of relapse-free and overall survival did not differ significantly from each other (p=0.90 and p=0.95). Only the stage of the disease (p=0.009) and the implementation of complex cancer treatment in case of its necessity (p=0.035) had a reliably impact on the long-term results of the operation. The first stage of myocardial revascularization surgery did not affect the results of treatment (p=0.94), as well as the age of patients, the volume of performed surgery, the morphological picture of the tumor.Conclusion. The staging approach to the treatment of patients with NSCLC and critical forms of CHD requiring myocardial revascularization is reliable, convenient and does not affect the long-term results of treatment.

Background Use of multiple arterial grafts (MAGs) provides superior patency and long-term survival benefit compared with venous grafts during coronary artery bypass grafting (CABG). However, MAGs are used infrequently for CABG. We hypothesized that specific measures introduced at our institution would lead to an increase in the use of MAGs. Study Design Use of MAGs before and after introduction of bundled measures was compared. Measures included increased education in arterial graft harvesting, inclusion as a quality metric, and hiring of surgeon champions. Patients younger than 70 years who underwent first time, isolated CABG using at least 1 arterial graft were included. Number and type of grafts used were compared between time periods using chi-square test. Secondary outcomes included postoperative complications. Complications were compared between time periods, as well as between MAG and non-MAG recipients before and after propensity score matching using Fisher exact test and univariate logistic regression. Multivariable logistic regression was used to determine patient characteristics associated with MAG use. Results There were 2,169 patients included from 2012 to 2019. MAG use increased significantly after introduction of measures (21.1% to 41.9%; p Conclusions A programmatic emphasis on the use of MAGs for CABG is an effective method to increase its use.

Introduction: The objective of this study is to compare the effects of conventional monopolar electrosurgery (CMES) and low-thermal plasma kinetic cautery (PKC) on complications such as bleeding, abnormal wound healing, pain, and drainage in patients who underwent on-pump coronary artery bypass grafting (CABG). Methods: This retrospective clinical study included 258 patients undergoing CABG; the patients were randomized to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients’ clinical data were examined retrospectively for biochemical variables, postoperative drainage, post-surgery erythrocyte suspension transfusion count, surgical site pain examined with visual analogue scale (VAS), and wound healing. Two-sided P-value > 0.05 was considered as statistically significant. Results: The median post-surgery erythrocyte suspension transfusion number was significantly lower with PKC compared to CMES (0 [0-1] vs. 1 [1-4], respectively, P

Background The role of simulation-based training in coronary artery bypass grafting remains undefined. Barriers to simulator use include clinical and personal obligations, insufficient materials, and lack of mentorship. The purpose of this study was to implement a longitudinal, residency-wide coronary anastomosis simulation curriculum. Methods A prospective observational study was conducted from 2018 to 2019 at a single academic center. All residents of the Thoracic Surgery training program participated. Each participant was provided a low-fidelity coronary anastomosis simulator, high-quality instruments, and faculty mentor. Formal assessments were held quarterly, and residents were encouraged to practice alone and with their mentor. Baseline and follow-up metrics were compared with simple descriptive statistics. Results Seventeen residents and 12 faculty participated in the study. Residents demonstrated increased use of the simulator, with 21% participating in independent practice at baseline and 82% in the fourth quarter (P = .02). The median score on the Thoracic Surgery Directors Association Vessel Anastomosis Assessment improved from 42 out of 65 at baseline to 54 out of 65 in the fourth quarter (P = .04), and mean anastomosis time was reduced by 5 minutes 6 seconds (P = .02). Over 12 months, junior residents demonstrated a mean reduction in anastomosis time of 6 minutes 36 seconds, and senior residents decreased anastomosis time by 3 minutes 6 seconds (P = .02). Conclusions Providing residents with a low-fidelity coronary anastomosis trainer with high-quality instruments and a faculty mentor improved rates of independent practice, Thoracic Surgery Directors Association assessment scores, and anastomosis time. Our next step is validating the coronary simulator curriculum by measuring improvement of resident performance in the operating room.

The efficacy of coronary artery bypass grafting for pregnancy-related spontaneous coronary artery dissection (SCAD) is controversial, as graft occlusion due to SCAD lesion healing has been reported. Only 24 grafts in 14 cases of coronary artery bypass grafting for SCAD have been reported: 8 of the 9 arterial grafts were occluded, but 9 of the 15 vein grafts were patent. We encountered a case of coronary artery bypass grafting with left internal thoracic artery to the left antero-descending branch due to pregnancy-related SCAD. The patient’s graft revealed good patency immediately postoperatively but string signs 7 months later due to healing of SCAD lesions.

Background Roadway injuries are a leading cause of lower extremity vascular trauma. Treating these injuries involves controlling life-threatening hemorrhage and restoring distal perfusion. Materials and Methods We describe a unique presentation of chronic iliac artery occlusion in the setting of blunt trauma requiring extra-anatomic bypass for maximal limb salvage. Results A 50-year-old male presented after a pedestrian versus auto accident. He had mangled bilateral lower extremities and was taken emergently for lower extremity amputations. He was found to have chronic left common iliac occlusion and a femoral-femoral bypass was performed to assist with healing his left below-the-knee amputation Discussion Lack of adequate perfusion can cause poor outcomes in limb salvage. This case demonstrated that lower extremity trauma can be complicated by chronic vascular disease. Reperfusion and adequate wound healing can be accomplished by using bypass grafting after more traditional reperfusion techniques fail.

Paraplegia is an unpredictable neurologic complication after coronary artery bypass grafting (CABG) surgery. It is rare but fatal, and the mechanism still is unclear. We aimed to make a summary of the possible causes of paraplegia after CABG. Pubmed database was searched from January 1, 1978 to December 31, 2019, and 14 studies were finally included. Paraplegia after CABG is a multifactorial consequence, but spinal cord ischemia is the key pathological factor to postoperative paraplegia.

INTRODUCTION The Nuss procedure is the most common procedure used to treat patients with pectus excavatum. The effect of the Nuss bars on the long-term internal mammary artery flow (IMA) is not well studied. This could have an impact on patients requiring a coronary artery bypass grafting surgery after the Nuss procedure. We performed a systematic review to study the impact of the Nuss bars on the IMA long term flow. METHODS A Medline search from January 1990 to August 2020 was performed using [Nuss OR thoracoscopic pectus OR minimally invasive pectus] AND [Internal mammary OR Internal thoracic OR IMA OR ITA]. English language papers only were included. This trial was registered with PROSPERO under registration number CRD42021234010. RESULTS A total of 48 papers were identified using the reported search, of which three represented the best evidence to answer the clinical question. One study looked at the IMA flow via computed tomography (CT)-angiography on the 10th postoperative day after the Nuss procedure and found 15 out of 34 patients (44%) to have abnormal IMA blood flow but with no clinical consequences. Two studies looked at the IMA flow after removal of the Nuss-bar. The first study utilized CT-angiography on the 5th postoperative day after Nuss-bar removal and found four out of the six patients studied (67%) to have abnormal flow. The last study was composed of 19 patients and looked at IMA flow during the presence of the Nuss-bars and after its removal utilizing Doppler-angiography. It found 11 out of 19 patients (58%) to have abnormal blood flow with the bars in place. After removal of the bars, only two patients (10%) were found to have unilateral IMA obstructed flow. CONCLUSION In patients undergoing the Nuss procedure for management of pectus excavatum, the internal mammary artery flow is compromised in 44%-58% of patients with the bar in situ. When these patients are assessed 10 days following removal of the bar, some reversal of compromised IMA flow is evident. However, in up to 67% of patients, abnormal IMA flow remains. Further studies are required to determine whether this abnormal flow is permanent, which will require examining patients at longer follow-up intervals. Patients undergoing coronary artery bypass grafting who have a history of a Nuss procedure should receive preoperative IMA imaging.

Background: Surgeon’s preference is an important factor in clinical strategy for off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass graft (CABG) surgery. This study analyzed surgeons’ understanding of and propensity for both techniques. Methods: A survey was performed by self-reported questionnaire. Two sections were included: Q1 questionnaire investigated each surgeon’s opinion on the indications of OPCAB and ONCAB; and Q2 questionnaire investigated each surgeon’s choice of OPCAB or ONCAB in different clinical situations. Results: The questionnaires were sent to 169 surgeons. In Q1, 71.2% of surgeons indicated that the degree of overlap between the indications of OPCAB and ONCAB is >70%; 55.1% believed that OPCAB had a wider scope of indications than ONCAB, and 35.3% believed that ONCAB had a wider scope of indications than OPCAB. In Q2, >70% of surgeons who responded chose OPCAB for patients with the following characteristics: high risk of stroke, renal dysfunction, pulmonary dysfunction, malignancy, clotting and coagulation disorders, or age ≥80 years. More than 57.5% of surgeons chose ONCAB for patients with poor target vessels or ventricular enlargement and dysfunction. For novice surgeons, 87.5% of surgeons chose ONCAB. Conclusion: Most surgeons surveyed agreed that OPCAB and ONCAB are suitable for most patients; however, surgeons’ preference for ONCAB or OPCAB varied. Surgeons are more willing to choose ONCAB in the presence of complicated heart conditions and OPCAB in the presence of serious concomitant diseases.

Purpose Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) still accounts for 80% of all CABG conduits (Park et al., 2020) [1]. In India, both the individual and sequential saphenous grafting techniques are used arbitrarily, and there has not been a study that compares the mid-term patency of these two. This is specially relevant in view of smaller coronaries in Indians than the Caucasian counterparts. This study aims to compare the patency for on pump CABG’s. Methods In the present study, 323 patients underwent either sequential (group A, N = 151 grafts, each graft having two anastomoses each) or individual (group B, N = 344 grafts) saphenous vein CABG, between February 2014 and June 2017. The SVG anastomoses were created on obtuse marginal (OM1/OM2) and posterior descending artery (PDA). The graft patency of the vein grafts as well as the left internal mammary artery were assessed by serial coronary angiograms. Results Results were evaluated at 6 months, 1, 2 and 3 years post operatively. Group A showed a higher graft patency at 3 years at 80.8%, and group B, 67.1% (P = 0.002). Also, anastomoses on sequential conduits had overall better patency rates at three years (77.2% vs 67.2%, P = 0.005). The groups showed similar results at one year post operatively. Conclusions Sequential bypass grafts were associated with superior mid-term patency compared with individual grafts. These findings suggest the more favourable results of sequential bypass grafting to be attributed to the enhanced flow haemodynamics.

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.

Purpose of review This review aims to compare outcomes of males and females undergoing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), off-pump CABG (OPCAB), minimally invasive direct CABG (MIDCAB), and robotic total endoscopic CABG (TECAB). Recent findings Females demonstrated increased rates of morbidity and mortality post PCI and CABG. In studies that performed risk adjustments, these differences were reduced. Although inferior outcomes were observed for females in some measures, generally outcomes between males and females were comparable post OPCAB, MIDCAB, and TECAB. Summary Previous literature has demonstrated that females undergoing coronary revascularization experience inferior postoperative outcomes when compared to their male counterparts. The discrepancies between males and females narrow, but do not disappear when preoperative risks are accounted for and when considering minimally invasive approaches such as MIDCAB, OPCAB, and TECAB. Minimally invasive cardiac surgery has demonstrated numerous benefits with reduced morbidity, mortality, and shorter recovery times. In patients with increased comorbidities, minimally invasive approaches confer a greater advantage. As females often fall within this category, it is paramount that the diagnosis and referral process be optimized to account for preoperative differences to provide the most beneficial approach if the disparity between the sexes is to be addressed.

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.

Objective: To explore the experiences of post-coronary artery bypass grafting patients in Pakistan. Method: The qualitative, descriptive, phenomenological study was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from May 2018 to April 2019, and comprised patients having undergone coronary artery bypass grafting. Data was collected through semi-structured interviews that included probing questions. Codes, categories and themes were framed through extensive thematic analysis. Results: Of the 14 patients, 11(78.6%) were males with a mean age of 51 years, and 3(21.4%) were females with a mean age of 63 years. Four main themes were generated; challenges, perceptions about coronary artery bypass grafting, coping with the challenges, and perceptions about nurses and doctors. The subjects were of the view that they were affected with certain types of physical, psychological and financial challenges. These encounters affected the patients post-procedure in almost every aspect of their lives and made it difficult for them to carry out activities on a daily basis. Further, coping strategies varied on from individual to individual. Conclusion: Patients after coronary artery bypass grafting were found to encounter issues related to physical, psychological and social spheres. Care for such patients must be planned in a way to avoid such challenges. Continuous...

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.

A clinical case of surgical treatment of a patient with atherosclerotic combined lesions of the coronary and carotid areas is presented. A staged surgery was performed. The first stage was carotid endarterectomy sequentially on both sides. The second stage is three-vessel coronary artery bypass grafting. The patient was examined 2 years after the operation. There are no data on restenosis of the reconstruction zone of the carotid system. The return of angina pectoris is not noted.

Background The updated Australian System for Cardiac Operative Risk Evaluation (AusSCORE II) and the Society of Thoracic Surgeons (STS) Score are well-established tools in cardiac surgery for estimating operative mortality risk. No validation analysis of both risk models has been undertaken for a contemporary New Zealand population undergoing isolated coronary bypass surgery. We therefore aimed to assess the efficacy of these models in predicting mortality for New Zealand patients receiving isolated coronary artery bypass grafting (CABG). Material and Methods A prospective database was maintained of patients undergoing isolated CABG at a major tertiary referral centre in New Zealand between September 2014 and September 2017. This database collected the patients’ demographic, clinical, biochemical, operative and mortality data. The primary outcome measure was the correlation between the predicted AusSCORE II and STS Score mortality risks and the observed 30-day mortality events for all patients in the database using discrimination and calibration statistics. Discrimination and calibration were assessed using receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow test respectively. Results A total of 933 patients underwent isolated CABG during the 3-year study period. There were seven deaths in the study cohort occurring within 30 days of surgery. Discrimination analysis demonstrated the area under the ROC curve (AUC) of the AusSCORE II and STS Score as 88.2% (95% CI: 85.9–90.2, p Calibration analysis revealed Hosmer-Lemeshow test p-values for the AusSCORE II and STS Score as 0.696 and 0.294 respectively. Discussion ROC curve analysis produced very high and statistically significant AUC values for the AusSCORE II and STS Score. Hosmer-Lemeshow test analysis revealed that both risk scoring tools are well calibrated for our study cohort. Therefore, the AusSCORE II and STS Score are both strongly predictive of 30-day mortality for isolated coronary artery bypass grafting surgery in our New Zealand patient population. Both risk models have performed with excellent discrimination and calibration. There is, however, a need to consider the performance of these risk stratification models in other cardiac surgical procedures outside isolated coronary bypass surgery where appropriate.

Coronary artery bypass grafting (CABG) is rarely performed in infants because of its technical difficulty and unclear long-term results. A 90-day-old male infant weighing 3.5 kg who underwent an arterial switch operation (ASO) for transposition of the great arteries developed left coronary artery insufficiency despite augmentation and reimplantation of the left coronary button. On-pump beating heart CABG was performed using an internal mammary artery graft to revascularize the left anterior descending artery. Postoperative computed tomography angiography revealed that the graft was patent. At 7 months postoperatively, the patient weighed 8.5 kg, and echocardiography revealed good ventricular function. CABG can be an alternative treatment for post-ASO coronary complications in early infancy.