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Coronary bypass operation is one of the greatest achievements of medical science in the 20th century. Alexis Carrel in 1910 and Arthur Vineberg in 1945 tried to perform surgical revascularization of the diseased coronary arteries. In the beginning of the 1950s many surgeons attempted experimentally to anastomose internal thoracic artery to the coronary arteries. Success was achieved simultaneously and independently by Vladimir Demikhov in Russia and Gordon Murray in Canada. Then the real success come of mammary-coronary bypass with tantalum ring by Robert H Goetz and with suture technique by Vasilii I Kolesov. Then autogenous great saphenous vein used by Rene G Favaloro and others and made the procedure popular worldwide. Which contribution is greater, when medicine depends on evolution and big accomplishment reached by means of the contribution of many. There comes the interesting question who should be given the credit of introducing this major surgical procedure, and along comes the ethical issue whether any single individual should be ascertained the fatherhood of CABG or any historic event at all!. [ABSTRACT FROM AUTHOR]

Background: Ablation of the vein of Marshall (VOM) by dehydrated ethanol (DE) is an important method for completely blocking the mitral isthmus (MI). Before DE ablation of the VOM, Marshall angiography should be performed so that the contrast medium is inevitably exposed to DE. Method: We present a case of DE ablation of the VOM. When iodixanol was exposed to DE, some floccule embolized the lumen of the over‐the‐wire (OTW) balloon dilatation catheter and led to the impossibility of DE ablation. Then, we performed in vitro experiments: iodixanol, not iomeprol, produced many stable white floccules when it encountered DE. Conclusion: Iodixanol is not an appropriate contrast for DE ablation of the VOM. However, if there is no other alternative contrast, the following methods might be used to address the problem: ⑴ diluted iodixanol (iodixanol:normal saline 1:1) could be used for VOM ablation; or ⑵ the lumen of the OTW could be flushed by NS after VOM angiography, and then DE injection could be performed. [ABSTRACT FROM AUTHOR]

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Introduction: Studies have shown that age, serum creatinine levels, and left ventricular ejection fraction (LVEF) combined in ACEF score have predictive value for clinical outcomes in patients undergoing elective coronary artery bypass surgery and promising value for those undergoing percutaneous coronary interventions (PCI)1-3. The aim of this study was to investigate the prediction value of ACEF score for a novel major adverse cardiovascular events (MACE) and cardiovascular (CV) death in patients with acute coronary syndrome (ACS). Patients and Methods: We included patients hospitalized at Dubrava University Hospital with ACS from January 2017 to January 2024. Data involving baseline demographic characteristics, laboratory results on admission, comorbidities, ACS type and MACE were collected. The ACEF score was calculated using the formula: age (years)/LVEF (%) +1(if baseline serum creatinine was>176 µmol/L). MACE was defined as a composite of novel ACS and need for elective or urgent percutaneous or surgical revascularization. Follow-up data were collected by clinical visits or telephone interviews. Results: This registry-based study included 1414 ACS patients with median age of 64 years (IQR 56- 72), 70% male. Total of 817 (58%) patients had ST elevation myocardial infarction (STEMI). Median follow up was 16 months (IQR 4-36). Median serum creatinine levels were 81 µmol/L (IQR 69-96) and LVEF 55% (IQR 45-60). ACEF score ranged from 0.436 to 5.533 with median of 1.181 (IQR 1.00-1.454). Patients were devided into tertiles based on ACEF score (low ≤1,000 (n376); 1,000> mid ≤1,454 (n686), high ≥1,454(n352)). ACEF score correlated significantly both with CV death (HR 31.17, 95%CI 15.58 -74.12, p<0.05) and with MACE (HR 21.28, 11.24-98.04, p<0.001), with AICcWt severity 0. Conclusion: Our data suggest that ACEF score has significant correlation with MACE and CV death in ACS patients, but more patients with diverse ACEF score must be included to confirm its real prediction value. [ABSTRACT FROM AUTHOR]

Patients undergoing coronary artery bypass grafting (CABG) are at increased risk of perioperative stroke. Carotid atherosclerosis has been identified as an independent risk factor for stroke during and in the early postoperative period of cardiac surgery. However, the pathogenesis of peri-CABG stroke is multifactorial and frequently involves other noncarotid causes, such as cardiac emboli and aortic atheroma. Therefore, routine population-wide screening of carotid stenosis is not recommended, but target screening of patients at high risk of carotid-related perioperative stroke can have benefits. Carotid duplex sonography is recommended as an initial screening tool. Elimination of carotid stenosis before cardiac surgery is indicated in patients in whom carotid atherosclerosis is suspected to be the primary contributor to perioperative stroke. In patients with advanced carotid atherosclerosis, an individualized revascularization approach, including simultaneous or staged procedures, is advocated. The prevailing consensus is that synchronous surgery is safer than staged procedures. Carotid artery stenting represents a less invasive alternative, but its role in high-risk patients requires further investigation. In conclusion, the risk of perioperative stroke in patients undergoing CABG involves different factors, and carotid artery stenosis is involved in its pathogenesis only in some patients. Therefore, individualized approaches and careful consideration of patient risk factors are essential in determining the need for carotid screening and revascularization before CABG. [ABSTRACT FROM AUTHOR]

Minimally invasive extracorporeal circulation has been shown to be non-inferior or even superior to conventional cardiopulmonary bypass circuits in isolated coronary artery bypass grafting, but there is little evidence whether the addition of a heparin-coated circuit can further reduce the inflammatory response and amount of bleeding in these patients.A single-center randomized control trial enrolled 49 adult patients scheduled to undergo isolated coronary artery bypass grafting with minimally invasive extracorporeal circulation (MiECC) between January 2015 and December 2018. Patients were randomized 1:1 to either the heparin-coated circuit group, or the uncoated (control) circuit group. The primary outcome was chest tube output 18 h after weaning from MiECC, and secondary outcomes included inflammatory (TNF-α, IL-6, IL-8, IL-10) and complement (C3a, C4d, C5a, sC5b-9) biomarkers, platelet count and function (D2D, TAT, SDC1, PF4), number of transfused blood products, and 30-day survival.Patients were randomized to undergo myocardial revascularization using heparin-coated circuits (n = 25), and to the uncoated MiECC circuit (n = 24), with comparable baseline demographics. No significant difference was observed in chest tube output and for all secondary outcomes. IL-6 and IL-8 were increased from baseline at 18 h after weaning (effect size 0.29 and 0.05, respectively) and sC5b-9 was lower (effect size 0.11) in the heparin-coated than in the uncoated MiECC, although not significantly different.Compared with an uncoated MiECC circuit, heparin-coated MiECC circuit was not associated with a reduction in postoperative bleeding, transfusion, inflammation, complement activation, and platelet biomarkers, following isolated coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

Non-anemic patients showed no difference in the incidence of heart failure comparing PCI to CABG revascularization. CABG patients who were anemic at discharge were shown to have a higher mortality rate during follow-up compared to anemic PCI patients. This paper's analysis of the Gulf Left Main Registry also found a higher incidence of heart failure in anemic-at-discharge PCI patients at follow up compared to CABG patients with anemia at discharge. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis. [Extracted from the article]

Coronary artery aneurysms (CAAs) after drug-eluting stents are rare. They can be found during routine angiograms when asymptomatic or present with acute coronary syndromes. We report a case of multiple CAAs who presented 8 years after the initial stenting. Left anterior descending artery was the culprit vessel and managed with restenting. [ABSTRACT FROM AUTHOR]

Background: Saphenous vein graft (SVG) is the most common conduit for coronary artery bypass graft (CABG) surgery. SVG harvesting has two techniques: open and endoscopic. At present, endoscopic vein harvesting (EVH) has become prevalent due to reduced complications and increased patient satisfaction. Objective: To introduce and establish basic knowledge about the risk of surgical site infections after coronary artery bypass surgery through the use of endoscopic saphenous vein harvesting. Conclusion: SSI following CABG continues to be a major cause of morbidity. This serious complication often occurs after discharge and is associated with open SVG harvesting, larger body mass, and blood transfusions. The endoscopic procedure seems to lessen wound-related complications, increase patient satisfaction, and decrease postoperative pain, length of hospital stay, and use of wound-management resources. [ABSTRACT FROM AUTHOR]

The risk of mortality and morbidity is high in patients with advanced age and additional systemic diseases who will undergo coronary artery bypass surgery. For this reason, the chosen anesthesia method and surgical approach gain importance. With the “Fast track cardiac anesthesia” (FTKA) protocol, the length of stay in hospitals and intensive care units is shortened, thus reducing the risk of mortality and morbidity in elderly and comorbid patients. In recent years, the use of Minimal Extracorporeal Circulatory Systems (MECC) has become widespread by modifying conventional extracorporeal circulatory systems in open heart surgery. With MECC, the systemic inflammatory response seen in the conventional system is reduced. In this article, we present the combination of FTCA protocol and MECC use, which we successfully applied in an 81-year-old patient with comorbidities. Our patient underwent triple coronary artery bypass surgery and was discharged on the 6th post-operative day with full recovery. We believe that the risks can be reduced and successful results are obtained with the anesthesia method (FTKA) and surgical approach (MECC) chosen in patients with advanced age and additional systemic diseases who will undergo coronary artery bypass surgery. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the change of left ventricular twist after coronary artery bypass grafting by using three-dimensional speckle tracking technology combined with left-chamber acoustic contrast, and to explore its clinical application value in evaluating the therapeutic effect. Methods: (1) Selected 30 patients who underwent elective coronary artery bypass grafting in the Department of Cardiac Surgery of our hospital, including 19 males and 11 females, with left ventricular ejection fraction ≥ 50%. The history of acute and old myocardial infarction and other organic heart diseases were excluded. In addition, 30 people with normal results of coronary angiography or coronary CT imaging were selected as the control group, and the results of blood biochemical and electrocardiographic examinations were normal. At the same time, other organic diseases were excluded. (2) Echocardiography was performed 1-3 days before bypass surgery, early (7-15) days after surgery, and 3 months after surgery, and contrast-enhanced echocardiography of the left heart chamber was performed at the same time. Turn on the 4D mode, obtain left ventricular twist parameters, and perform comparative analysis before and after surgery. Results: Left-chamber angiography can improve the accuracy of automatic tracing of the equipment. The overall twisting amplitude of the left ventricle in the preoperative case group was significantly reduced, and the difference was significant compared with the normal control group (P<0.05). The twisting angle of the left ventricle in the early postoperative period was slightly higher than that before the operation, and only the increase in the middle segment was significantly different from that before the operation (P<0.05). Three months after the operation, the left ventricular torsion gradually increased, which was close to that of the normal control group, and there was a significant difference compared with the early postoperative period (P<0.05). Conclusion: Three-dimensional speckle tracking imaging combined with left angiography can accurately detect the changes of left ventricular twist before and after coronary artery bypass surgery. Left ventricular twist can sensitively reflect the changes of postoperative left ventricular systolic function. [ABSTRACT FROM AUTHOR]

The CHA2DS2-VASc score is a reliable tool used to estimate the risk of ischemic stroke (IS) in patients with atrial fibrillation (AF). Few tools exist for the prediction of new-onset AF (NOAF) after myocardial infarction (MI) and its relation to IS. We studied the usefulness of CHA2DS2-VASc in predicting NOAF and IS in a long-term follow-up after MI. Consecutive MI patients without baseline AF (n = 70,922; mean age: 68.2 years), discharged from 20 hospitals in Finland during 2005–2018, were retrospectively studied using national registries. The outcomes of interest after discharge were NOAF- and IS-assessed with competing risk analyses at one and ten years. The median follow-up was 4.2 years. The median baseline CHA2DS2-VASc score was 3 (IQR 2–5). The likelihood of both NOAF and NOAF-related IS increased stepwise with this score at one and ten years (all p < 0.0001). The one-year-adjusted subdistribution hazard ratio (sHR) was 4.03 (CI 3.68–4.42) for NOAF in patients with CHA2DS2-VASc scores ≥6 points. The cumulative incidence of IS was 15.2% in patients with NOAF vs. 6.2% in patients without AF at 10 years after MI (adj. sHR 2.12; CI 1.98–2.28; p < 0.0001). Coronary artery bypass surgery was associated with a higher NOAF incidence compared to percutaneous coronary intervention (adj. sHR 1.87; CI 1.65–2.13; p < 0.0001 one year after MI). The CHA2DS2-VASc score is a simple tool used to estimate the long-term risk of NOAF and IS after MI in patients without baseline AF. Coronary bypass surgery is associated with an increased NOAF incidence after MI. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) is the most common complication after surgery for atherosclerotic cardiovascular disease (ASCVD) and leads to extended hospital stays and increased mortality. Myeloperoxidase (MPO) in postoperative pericardial drainage fluid is associated with an increased risk of POAF; however, the correlations between MPO in intraoperative pericardial fluid and POAF remain largely unknown. The aim of the study was to evaluate whether MPO is associated with POAF. Methods: A total of 97 patients with no history of atrial arrhythmia who had undergone coronary artery bypass surgery (CABG) were identified. We prospectively measured the levels of MPO in intraoperative pericardial fluid and blood using the human magnetic Luminex assay. Then, the occurrence of atrial fibrillation was continuously observed by postoperative ECG and telemetry strips until discharge. Results: Our data showed that POAF occurred in 24 of 97 patients (24.74%). MPO levels in blood were higher in the POAF group than the SR group (p = 0.064). Patients with POAF had significantly higher intraoperative pericardial fluid MPO levels than patients who remained in SR (p = 0.021). There was no significant correlation between pericardial fluid MPO levels and blood MPO levels (r = −0.47, p = 0.770). In a multivariable logistic regression model, pericardial fluid MPO levels were significantly associated with a higher risk of POAF (odds ratio = 1.016, 95% confidence interval, 1.001–1.031; p = 0.031). Conclusions: Higher intraoperative pericardial fluid MPO levels are linked with POAF in patients undergoing CABG. This finding provides insight into a possible mechanism of MPO in pericardial fluid increase susceptibility to developing POAF in patients undergoing CABG. [ABSTRACT FROM AUTHOR]

Objectives: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) predicts in‐hospital mortality for patients undergoing cardiac surgery. Many variables associated with increased surgical mortality persist postoperatively. The aim of this study was to investigate the predictive value of the logistic EuroSCORE to long‐term survival after coronary artery bypass surgery. Methods: Data were collected retrospectively for all patients undergoing coronary artery bypass graft (CABG) at a single center between January 1, 2009 and December 31, 2009. Data submitted to NICOR were used for EuroSCORE and in‐hospital outcomes; longer‐term, all‐cause mortality from NHS digital Personal Demographic Service. Low (<3), intermediate (3–6), and high‐risk (>6) logistic EuroSCORE groups were identified and analyzed using the appropriate statistical methodology, with p values less than.05 being taken as significant. Results: Six hundred and sixty‐three patients underwent isolated CABG procedures during the study. The 1‐, 3‐, 5‐, and 10‐year survival rates were 97.6%, 94.3%, 89.3%, and 73.5%, respectively. Comparing survival outcomes between low‐, intermediate‐, and high‐risk groups showed that the logistic EuroSCORE was able to predict long‐term outcomes (p <.05). In addition, poor left ventricular ejection fraction, serum creatinine above 200 ml, chronic pulmonary disease, extracardiac arteriopathy, and pulmonary hypertension were identified as independent predictors of long‐term mortality. Conclusions: Our study demonstrates the logistic EuroSCORE predicted long‐term outcomes following CABG surgery. This finding can inform patients of the long‐term risks of CABG surgery and guide MDT decision‐making. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive direct coronary artery bypass has enabled coronary artery bypass graft to compete with the appeal of less invasive percutaneous coronary procedures. Favorable results of coronary artery bypass surgery performed without the use of cardiopulmonary bypass and without touching the aorta (anOPCAB) have enabled the development and use of minimally invasive methods. Methods: Between 2016 and 2021, 112 patients underwent multivessel coronary bypass surgery performed using a minimally invasive method through a small thoracotomy in the left chest with off‐pump, anaortic, and all‐arterial grafts (Minimally Invasive Off‐Pump Anaortic Coronary Artery Bypass [MACAB]). Patient data were collected and retrospectively analyzed. Eight series from the literature using the multivessel mini‐OPCAB and MACAB technique were also evaluated. Results: Collectively, from the literature, 2729 patients underwent an average of 2.4 bypasses with an early mortality rate of 0.7% and a stroke rate of 0.16%. In our MACAB case series, 112 patients underwent an average of 2.9 bypasses with a mortality rate of 1.8% and a stroke rate of 0%. Conclusion: MACAB can be performed safely by experienced surgeons and reduces neurological injury and surgical trauma and may be a good alternative for multivessel stenting. Simulation systems are essential for its dissemination, and teams dedicated to coronary surgery—with subspecialty expertise—are necessary to achieve good outcomes. [ABSTRACT FROM AUTHOR]

Background: Poor preoperative health‐related quality of life (HRQoL) has been associated with reduced short‐term survival after coronary artery bypass graft (CABG) surgery; however, its impact on long‐term mortality is unknown. This study's objective was to determine if baseline HRQoL status predicts 5‐year post‐CABG mortality. Methods: This prespecified, randomized on/off bypass follow‐up study (ROOBY‐FS) subanalysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans RAND Short Form‐36 (VR‐36), between 5‐year post‐CABG survivors and nonsurvivors. Standardized subscores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey subcomponents independently predicted 5‐year mortality (p ≤.05). Results: Of the 2203 ROOBY‐FS enrollees, 2104 (95.5%) completed baseline surveys. Significant differences between 5‐year post‐CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non‐White race/ethnicity, lower education status, and off‐pump CABG. Adjusting for these factors, baseline VR‐36 physical component summary score (p =.01), VR‐36 mental component summary score (p <.001), and SAQ physical limitation score (p =.003) were all associated with 5‐year all‐cause mortality. Conclusions: Pre‐CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient‐provider shared decision‐making and enhancing pre‐CABG informed consent. [ABSTRACT FROM AUTHOR]

Background: Coronary artery bypass grafting (CABG) in the setting of an acute coronary syndrome is a high‐risk procedure, and the best strategy for myocardial revascularisation remains debated. This study compares the 30‐day mortality benefit of on‐pump CABG (ONCAB), off‐pump CABG (OPCAB), and on‐pump beating heart CABG (OnBHCAB) strategies. Methods: A systematic search of three electronic databases was conducted for studies comparing ONCAB with OPCAB or OnBHCAB in patients with acute coronary syndrome (ACS). The primary outcome, 30‐day mortality, was compared using a Bayesian hierarchical network meta‐analysis (NMA). A random effects consistency model was applied, and direct and indirect comparisons were made to determine the relative effectiveness of each strategy on postoperative outcomes. Results: One randomised controlled trial and eighteen observational studies fulfilling the inclusion criteria were identified. A total of 4320, 5559, and 1962 patients underwent ONCAB, OPCAB, and OnBHCAB respectively. NMA showed that OPCAB had the highest probability of ranking as the most effective treatment in terms of 30‐day mortality (odds ratio [OR], 0.50; 95% credible interval [CrI], 0.23−1.00), followed by OnBHCAB (OR, 0.62; 95% CrI, 0.20−1.57), however the 95% CrI crossed or included unity. A subgroup NMA of nine studies assessing only acute myocardial infarction (AMI) patients demonstrated a 72% reduction in likelihood of 30‐day mortality after OPCAB (CrI, 0.07−0.83). No significant increase in rate of stroke, renal dysfunction or length of intensive care unit stay was found for either strategy. Conclusions: Although no single best surgical revascularisation approach in ACS patients was identified, the significant mortality benefit with OPCAB seen with AMI suggests high acuity patients may benefit most from avoiding further myocardial injury associated with cardiopulmonary bypass and cardioplegic arrest. [ABSTRACT FROM AUTHOR]

Background: Surgical management of coexisting cardiac disease and extra‐cranial carotid artery disease is a controversial area of debate. Thus, in this challenging scenario, risk stratification may play a key role in surgical decision making. Aim: To report the results of single‐stage coronary/valve surgery (CVS) and carotid endarterectomy (CEA), and to identify predictive factors associated with 30‐day mortality. Methods: This was a multicenter, retrospective study of prospectively maintained data from three academic tertiary referral hospitals. For this study, only patients treated with single‐stage CVS, meaning coronary artery bypass surgery or valve surgery, and CEA between March 1, 2000 and March 30, 2020, were included. Primary outcome measure of interest was 30‐day mortality. Secondary outcomes were neurologic events rate, and a composite endpoint of postoperative stroke/death rate. Results: During the study period, there were 386 patients who underwent the following procedures: CEA with isolated coronary artery bypass graft in 243 (63%) cases, with isolated valve surgery in 40 (10.4%), and combination of coronary artery bypass grafting and valve surgery in 103 (26.7%). Postoperative neurologic event rate was 2.6% (n = 10) which includes 5 (1.3%) transient ischemic attacks and 5 (1.3%) strokes (major n = 3, minor n = 2). The 30‐day mortality rate was 3.9% (n = 15). Predictors of 30‐day mortality included preoperative left heart insufficiency (odds ratio [OR]: 5.44, 95% confidence interval [CI]: 1.63–18.17, p =.006), and postoperative stroke (OR: 197.11, 95% CI: 18.28–2124.93, p <.001). No predictor for postoperative stroke and for composite endpoint was identified. Conclusions: Considering that postoperative stroke rate and mortality was acceptably low, single‐stage approach is an effective option in such selected high‐risk patients. [ABSTRACT FROM AUTHOR]

Background: Purpose of the present study is an evaluation of postoperative incidence for delirium after coronary artery bypass surgery (CABG). Study addressed whether application of Histidine‐Tryptophan‐Ketoglutarate (HTK) solution (Bretschneider) or blood cardioplegia (Calafiore) is associated with increased of postoperative delirium cases. Materials and Methods: In a retrospective, single center evaluation a total number of 273 patients were enrolled in the study from January 2017 to October 2021. There were 124 patients assigned to the Calafiore group blood cardioplegic solution (BCC) and 149 patients were included in the Bretschneider group (HTK). The primary endpoint was the postoperative delirium rate in its frequency of occurrence. Definition of the dilirium status was performed using the Confusion Assessment Method in the Intensive Care Unit (CAM‐ICU) score during the first three postoperative days. Secondary endpoints were the time intervals of intensive care duration of stay, mechanical ventilation, total extracorporeal circulation, ischemia and reperfusion. Serum levels of the electrolytes Sodium, Potassium, ionized Calcium, and Chloride were monitored. Results: Although no significant difference in delirium status between the groups were noticed, on third postoperative day, delirium rate dependent on cardioplegia solution used (HTK 12.0%; BCC 3.0%; p =.024) and duration of intensive care stay differed (HTK 4.5 vs. BCC 3.0 days; p =.001). Although Ischemic time (HTK 73.0 vs. BCC 83.0 min; p <.001) and reperfusion time (HTK 35.0 vs. Calafiore 24.0 min; p <.001) were extended in the BCC group less cases of delirium were diagnosed. Serum sodium levels after HTK cardioplegic infusion were decreased (HTK 129.68 vs. BCC 138.96 mmol/l; p <.001). The significant difference persists up to the hundredth extracorporeal circulation circuit min (p =.005). Conclusion: The present data suggest an impact of the cardioplegic solution used upon postoperative delirium rates. Optimization of cardiac arrest protocols is needed. Present data encourage further prospective studies regarding the impact of cardioplegic solutions on electrolyte imbalance for postoperative delirium rates in CABG surgery. [ABSTRACT FROM AUTHOR]

Since the Bracey study, transfusion thresholds have been evaluated in six additional trials in patients undergoing coronary artery bypass surgery. These trials compare a higher hemoglobin level to a lower transfusion threshold, often referred to as liberal transfusion and restrictive transfusion, respectively. In October 1999, Art Bracey and colleagues published one of the earliest transfusion trigger trials in the journal B TRANSFUSION b .[5] The trial enrolled 428 patients undergoing elective primary coronary artery bypass surgery at the Texas Heart Institute, which was one of the leading cardiac surgery centers. [Extracted from the article]

Background: Elderly patients undergoing cardiac operation often suffer various metabolic comorbidities, such as diabetes mellitus (DM) and obesity. The metabolic disorders in these individuals are widely considered to be possible predisposing factors for unfavourable prognosis. This retrospective study was aimed to determine the association of metabolic diseases with the mortality of elderly patients after coronary artery bypass grafting (CABG) and to identify the protective or risk factors related to their short- and long-term survival.Methods: Totally 684 patients aged 75 years or above undergoing isolated CABG were evaluated retrospectively. There were two groups depending on the body mass index (BMI): an overweight and obesity group (n = 354) and a normal weight and lean group (n = 330). Propensity score matching (PSM) was performed to adjust baseline clinical characteristics, which reduced confounding bias. The short-term postoperative mortality was tested via logistic regression. Kaplan-Meier and Cox regression analyses were done to compute the overall survival in each group and to identify relevant variables associated with all-cause mortality, respectively.Results: The prevalence rates of metabolic comorbidities in the total cohort were: diabetes mellitus (32.5%), overweight or obesity (51.8%) and hypertension (72.8%). The 30-day postoperative mortality was 5.1% and the long-term mortality was 15.25% at a median 46.2-month follow-up (1.0-178.6 months). The 30-day postoperative mortality was relevant to DM, diseased coronary arteries, New York Heart Association class, intra-aortic balloon pump and emergency surgery. The long-term mortality was negatively associated with overweight and obesity. Univariate and multivariate logistic regression recognized DM as an adverse factor related with 30-day postoperative mortality whether before or after PSM. The long-term mortality was not significantly relevant with DM (HR = 0.753, 95% CI 0.402-1.411). Overweight or obesity was not the risk factor of 30-day postoperative mortality (OR = 1.284, 95% CI 0.426-3.868), but was the protective factor of long-term survival (HR = 0.512, 95% CI 0.279-0.939).Conclusions: The "obesity paradox" exists regarding the prognosis of individuals aged ≥ 75, which was presented as lower long-term mortality no matter from all cause or cardio-cerebrovascular cause in patients with BMI ≥ 24. Trial registration ChiCTR2200061869 (05/07/2022). [ABSTRACT FROM AUTHOR]

Background: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease.Methods: This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization.Results: During a median follow-up of 11.8 years (interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88-1.56]; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53]; P=0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27]; P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG.Conclusions: In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up.Registration: URL: https://www.Clinicaltrials: gov; Unique identifiers: NCT05125367 and NCT00997828. [ABSTRACT FROM AUTHOR]

Approximately 95% of patients of any age undergoing contemporary, coronary bypass surgery will receive at least 1 saphenous vein graft (SVG). It is recognized that SVG will develop progressive and accelerated atherosclerosis, resulting in a stenosis, and in occlusion that occurs in 50% by 10 years postoperatively. For arterial conduits, there is little evidence of progressive failure as for SVG. Could avoidance of SVG (total arterial revascularization [TAR]) lead to a different late (>5 year) survival? A literature review of 23 studies (N = 100,314 matched patients) at a mean 8.8 years postoperative found reduced all-cause mortality for TAR (HR: 0.77; 95% CI: 0.71-0.84; P < 0.001). An expanded analysis with a new unpublished data set (N = 63,288 matched patients) was combined with the literature review (N = 127,565). It found reduced all-cause mortality for TAR (HR: 0.78; 95% CI: 0.72-0.85; P < 0.001). Additional Bayesian analysis found a very high probability of a TAR-associated reduction all-cause mortality. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES HTK-Solution (Custodiol) is a well-established cardioplegic and organ preservation solution. We currently developed a novel HTK-based solution, Custodiol-N, which includes iron chelators to reduce oxidative injury, as well as l -arginine, to improve endothelial function. In this first-in-human study, Custodiol-N was compared to Custodiol in patients undergoing elective coronary artery bypass surgery. The aim of this comparison was to evaluate the safety and ability of Custodiol-N to protect cardiac tissue. METHODS The study was designed as a prospective randomized double-blind non-inferiority trial. Primary end point was area under the curve (AUC) of creatine kinase muscle-brain (CK-MB) within the first 24 h after surgery. Secondary end points included peak CK-MB and troponin-T and AUC of troponin-T release, cardiac index, cumulative catecholamine dose, intensive care unit stay and mortality. All values in the abstract are given as mean ± SD, P  < 0.05 was considered statistically significant. RESULTS Early termination of the trial was performed per protocol as the primary non-inferiority end-point was reached after inclusion of 101 patients. CK-MB AUC (878 ± 549 vs 779 ± 439 h U/l, non-inferiority P  < 0.001, Custodiol vs Custodiol-N) and troponin-T AUC (12990 ± 8347 vs 13498 ± 6513 h pg/ml, noninferiority P  < 0.001, Custodiol vs Custodiol-N) were similar in both groups. Although the trial was designed for non-inferiority, peak CK-MB (52 ± 40 vs 42 ± 28 U/l, superiority P  < 0.03, Custodiol vs Custodiol-N) was significantly lower in the Custodiol-N group. CONCLUSIONS This study shows that Custodiol-N is safe and provides similar cardiac protection as the established HTK-Custodiol solution. Significantly reduced peak CK-MB levels in the Custodiol-N group in the full analysis set may implicate a beneficial effect on ischaemia/reperfusion injury in the setting of coronary bypass surgery. [ABSTRACT FROM AUTHOR]

Introduction: Anomalous aortic origin of coronary artery (AAOCA) is the second leading cause of sudden cardiac death in children and young adults. Intramural-interarterial course is the most frequent anatomic variation and coronary unroofing is widest adopted for surgical management. Symptoms recurrence is described regardless of the technique used. This study aims to describe how an anatomic patient-centered approach aimed to restore a normal coronary artery take-off is associated with symptoms resolution.Methods: From 2008 to 2021, 25 patients were operated on for an AAOCA at a median age of 20 years. Nineteen patients had a right AAOCA and six had left AAOCA. Intramural course was present in 18 patients. Seventy-six percent were symptomatic. No episodes of aborted sudden cardiac death before surgery was described in the population. Surgical technique used were coronary unroofing in 18 patients, coronary neo-ostioplasty in 3, coronary Reimplantation in 3, and main pulmonary artery re-location in 1.Results: No hospital mortality or reoperation was observed in our experience as well as major complications related to surgery. Mean hospital length of stay was 8.5 days. None of patients reported symptoms recurrence at follow-up. Young athletes returned to play competitive sport. Postoperative computed tomography scan evaluation showed a general improvement of the take-off angle.Conclusions: AAOCA requires a patient anatomic-based surgical management. There is not a single surgical technique that can fits all anatomic subtype of AAOCA. Surgical techniques may be selected on the base of the preoperative images and intraoperative findings. In our experience, this policy is associated with no symptoms recurrence. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the levels of YKL-40 during and after coronary artery bypass grafting surgery (CABG) and to establish possible connections between YKL-40 and markers of oxidative stress, inflammation, and myocardial injury. Patients undergoing elective CABG utilizing cardiopulmonary bypass (CPB) were recruited into the study. Blood samples were collected at the onset of anesthesia, during surgery and post-operatively. Levels of YKL-40, 8-isoprostane, interleukin-8 (IL-8), monocyte chemotactic protein-1 (MCP-1) and troponin T (TnT) were measured by immunoassay. YKL-40 levels increased significantly 24 h after CPB. Positive correlation was seen between post-operative TnT and YKL-40 levels (r = 0.457, p = 0.016) and, interestingly, baseline YKL-40 predicted post-operative TnT increase (r = 0.374, p = 0.050). There was also a clear association between YKL-40 and the chemotactic factors MCP-1 (r = 0.440, p = 0.028) and IL-8 (r = 0.484, p = 0.011) linking YKL-40 to cardiac inflammation and fibrosis following CABG. The present results show, for the first time, that YKL-40 is associated with myocardial injury and leukocyte-activating factors following coronary artery bypass surgery. YKL-40 may be a factor and/or biomarker of myocardial inflammation and injury and subsequent fibrosis following heart surgery. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative atrial fibrillation (poAF) is a common complication of coronary artery bypass grafting, and its reasons are still the subject of research. The aim of this study was to evaluate whether QT interval is related to new onset of poAF occurrence. Methods: This study included 167 patients undergoing elective isolated off-pump coronary artery bypass grafting (OPCAB) surgery. Patients were divided into two groups as poAF (+) and poAF (-), according to the development of poAF, and the results of the measurements were compared between the groups. Results: PoAF was detected in 37 (22.1%) of 167 patients who underwent OPCAB surgery. When QT interval measurements were compared, preoperative and postoperative QT and corrected QT interval (QTc) values were significantly longer in the group with atrial fibrillation. Mean values of preoperative QT were 407.5±27.1 in the poAF (-) group vs. 438.5±48.5 in the poAF (+) group (P<0.001). Mean values of preoperative QTc were 419.1±14.5 in the poAF (-) group vs. 448.5±26.6 in the poAF (+) group (P<0.001). Mean values of postoperative QT were 416.3±48.3 in the poAF (-) group vs. 439.2±45.8 in the poAF (+) group (P=0.005). And mean values of postoperative QTc were 419.8±12.5 in the poAF (-) group vs. 452.0±23.3 in the poAF (+) group (P<0.001). Conclusion: QT interval measurement may be a new parameter in predicting poAF development after OPCAB surgery. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance (IR) is a significant risk factor for cardiometabolic diseases and a defining feature of type 2 diabetes mellitus (T2DM). This study aimed to examine the potential value of triglyceride-glucose (TyG) index as a predictor of prognosis in coronary heart disease (CHD) patients with T2DM after coronary artery bypass grafting (CABG) surgery and to facilitate the identification of those at high risk of major adverse cardiovascular events (MACEs) for closer monitoring or possible early intervention. Methods: This study enrolled 386 T2DM patients who underwent CABG surgery at Nanjing Drum Tower Hospital. Patients were separated into two groups according to the median preoperative TyG Index. The Kaplan-Meier plot was used to compare the rate of MACEs-free survival in T2DM patients after CABG. The independent risk factors for the occurrence of MACEs were investigated using multivariate analysis. Nomogram was used to depict the predictive model. Results: Significantly more MACEs occurred in individuals with higher medians of the TyG index (65 (33.7%) vs. 39 (20.2%), p=0.003). TyG index [hazard ratio (HR) 12.926], LVEF [hazard ratio (HR) 0.916], and NYHA functional class III/IV [hazard ratio (HR) 4.331] were identified as independent predictors of MACEs incidence in post-CABG T2DM patients by multivariate analysis. The area under the curve (AUC) for predicting MACEs using the TyG index was 0.89 at five years. Combining the TyG index, LVEF, and NYHA functional class III/IV to build a novel risk assessment model for postoperative MACEs, the AUC climbed to 0.93 at five years. With AUCs, the nomogram comprised of the TyG index, LVEF, and NYHA functional class III/IV demonstrated strong specificity in the training and test sets. Conclusions: The incidence of MACEs is high among post-CABG T2DM patients with a high TyG index. TyG index improves the diagnostic accuracy of MACEs, especially at long-term follow-up. A high TyG index may serve as an early warning signal for individuals to undertake lifestyle adjustments that can reduce the progression or incidence of MACEs. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular diseases, especially coronary artery diseases, are among the most common diseases in the world. Different methods are used to treat patients with coronary artery disease, and coronary artery bypass surgery (CABG) is considered the most common treatment method in advanced coronary artery disease. Cardiopulmonary bypass (CPB) is one of the most common approaches, but it has complications, the most important of which is acute kidney failure. Therefore, the aim of this study is to investigate the effect of CPB on glomerular filtration rate after open heart surgery. Material and Methods: This analytical cross-sectional study was conducted on patients who underwent open heart surgery using CPB. The data collection form includes demographic information (i.e., age, gender, weight, height, body surface area), underlying disease (i.e., diabetes, hypertension, cerebrovascular accident, hyperlipidemia, left ventricular failure), addiction history and laboratory information (urea, creatinine, Hemoglobin and fasting blood sugar) before surgery and up to three days after surgery (Urea and creatinine daily for the patient up to three days after surgery). Also, other data included the duration of use of pump, cross clamp, duration of anesthesia, duration of surgery, duration of mechanical ventilation, duration of hospitalization in the ward and ICU, the amount of blood products and Lasix (furosemide), usage in the operating room and ICU. All data were collected after reviewing the patients' medical records. Also, possible complications such as pulmonary complications, acute kidney failure, cardiac arrhythmia, reoperation due to bleeding, deep infection of the operation site, need for mechanical ventilation were extracted from the medical records. SPSS version 26 software was used for data analysis. Results: In this study, 200 patients were studied, 62.5% of whom were men. The average age was 59.31 ± 10.21 years. The most common underlying diseases were hypertension (55.5%), diabetes (39.5%) and hyperlipidemia (13.5%). The average GFR of the patients after the operation was increased compared to before the operation. The amount of GFR was higher on the first (P=0.001), second (P=0.01) and third (P=0.002) days after surgery in the group receiving less than one hour of CPB compared to the group receiving more than one hour of CPB. Twenty-one patients had acute kidney injury, all of which belonged to the group receiving more than one hour of cardiopulmonary pump. Postoperative creatinine and urea were higher in patients with CPB for more than one hour than in patients with CPB for less than one hour. Patients who had a CPB duration of more than one hour needed to consume more blood products both in the operating room and in the ICU compared to patients with CPB of less than one hour. Conclusion: The present study revealed that the use of CPB in all patients did not cause a decrease in mean GFR compared to before surgery, but longer use of CPB (more than one hour) was associated with higher levels of creatinine and urea after surgery. Overall, the findings of this study showed that long-term use of CPB may be linked to more kidney complications and bleeding. [ABSTRACT FROM AUTHOR]

Background: Left ventricular longitudinal strain is an emerging marker of ventricular systolic function. However, the prognostic value of apical four-chamber longitudinal strain after heart valve surgery in real-world clinical practice is uncertain. The authors investigated whether left ventricular apical four-chamber longitudinal strain measured in real-world practice is helpful for predicting postoperative outcomes in patients undergoing heart valve surgery. Methods: This observational cohort study was conducted in patients who underwent heart valve surgery between January 2014 and December 2018 at a tertiary hospital in South Korea. The exposure of interest was preoperative left ventricular apical four-chamber longitudinal strain. The primary outcome was postoperative all-cause mortality. Results: Among 1,773 study patients (median age, 63 years; female, 45.9%), 132 (7.4%) died during a median follow-up of 27.2 months. Preoperative left ventricular apical four-chamber longitudinal strain was significantly associated with all-cause mortality (adjusted hazard ratio, 0.94 per 1% increment in absolute value; 95% CI [0.90, 0.99], P = 0.022), whereas left ventricular ejection fraction (LVEF) was not significantly associated with all-cause mortality (adjusted hazard ratio: 1.01, 95% CI [0.99, 1.03], P = 0.222). Moreover, combining left ventricular apical four-chamber longitudinal strain to the LVEF and conventional prognostic factors enhance the prognostic model for all-cause mortality (P = 0.022). Conclusions: In patients undergoing heart valve surgery without coronary artery disease, left ventricular apical four-chamber longitudinal strain measured in real-world clinical practice was independently associated with postoperative survival. Left ventricular longitudinal strain measurement may be helpful for outcome prediction after valve surgery. [ABSTRACT FROM AUTHOR]

Introduction: Expression of haematopoietic stem and progenitor cells occurs as a result of an inflammatory reaction caused by a damaged organ. Patients undergoing coronary artery bypass surgery (CABG) using cardiopulmonary bypass (CPB) are exposed to an inflammatory reaction, which may be a trigger in the mobilization of regenerative cells. Aim: To assess the impact of CPB on stem and progenitor cells mobilization in patients scheduled for CABG. Material and methods: Twenty patients with stable coronary disease, who were scheduled for CABG, were included in the study. Peripheral blood samples were collected perioperatively: 2 h before surgery, before CPB, at CPB weaning, 24 h postoperatively, and on the 6th postoperative day. Analyses of immune-labelled cells were carried out on an ImageStream (IS) system. Results: The following cell populations were identified during cardiac surgery: haematopoietic stem cells (HSC), mesenchymal cells (MSC), endothelial progenitors (EPC), and very small embryonic-like cells (VSEL). The profile of cell mobilization coincides with the perioperative inflammatory response. Mobilization of stem and progenitor cells induced by CPB did not occur in any of the isolated cell lines (p > 0.05). The expression profile of stem and progenitor cells was related with the inflammatory reaction associated with traumatic stress in all cell lines. Type 2 diabetes is a disease that is hampering the trend of MSC mobilization. Conclusions: Mobilization of haematopoietic stem and progenitor cells was not related with CPB. The inflammatory reaction was associated with perioperative trauma. Cell release was inhibited in patients with diabetes. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES We assessed adherence to statins, beta-blockers and renin–angiotensin system (RAS) inhibitors after coronary artery bypass graft surgery and factors associated with non-adherence. METHODS This nationwide retrospective cohort study included all individuals undergoing coronary artery bypass surgery from 22 May 2007 to 20 December 2018, at Landspitali—the National University Hospital (n  = 1536). Data on dispensed prescriptions were retrieved from the National Prescription Medicine Registry. Adherence was estimated by the proportion of days covered up to 2 years after hospital discharge, with cut-offs for strict adherence and non-adherence at over 80% and under 50%, respectively. Multivariable logistic regression was used to assess variables associated with non-adherence. RESULTS Criteria for strict adherence were met by 39.2%, 36.9% and 30.1% of patients for statins, beta-blockers and RAS inhibitors, respectively. Non-adherence criteria were met for 14.4%, 25.9% and 43.6% of patients for statins, beta-blockers and RAS inhibitors, respectively. High Hospital Frailty Risk Score Class (statins: odds ratio (OR) 2.29, confidence interval (CI) 1.02–4.86; RAS inhibitors: OR 2.06, CI 1.04–4.04), concomitant aortic valve replacement (statins: OR 1.64, CI 1.11–2.38; RAS inhibitors: OR 1.78, CI 1.26–2.52) and a new prescription for a medication class following surgery (statins: OR 2.87, CI 2.06–4.01; beta-blockers: OR 1.70, CI 1.32–2.18; RAS inhibitors: OR 6.95, CI 5.27–9.25) were associated with non-adherence. CONCLUSIONS Non-adherence to medical therapy after coronary artery bypass surgery is common. Patients with a higher burden of frailty and patients naive to the medical treatment of coronary artery disease should be a target group for efforts to increase medication adherence. [ABSTRACT FROM AUTHOR]

Background: Obesity has been correlated with certain sociodemographic and health variables of patients with coronary artery diseases (CADs). There are seven traditional obesity parameters, which have been used to measure obesity (body mass index [BMI], waist-to-height ratio [WHtR], waist-hip ratio [WHR], body adiposity index [BAI], body shape index [BSI], waist circumference [WC], and hip circumference [HC]). This study aimed to describe the differences in the number of stented coronary arteries based on the aforementioned seven traditional obesity parameters among patients with CADs undergoing cardiac catheterization. Method: A descriptive cross-sectional study was conducted among 220 hospitalized patients with CADs undergoing a cardiac catheterization. Data were analyzed using frequencies, percentages, bar graphs presentation, and receiver operating characteristics. Results: Receiver operating characteristic curve indicated that the best cut off point of WC is 95 cm in predicting number of stented coronary arteries with a sensitivity of 76% and a specificity of 68%. BMI had a high sensitivity with the number of stented coronary arteries. The sensitivity values of parameters ranged from 0.45 to 0.92 and the specificity values ranged from 0.25 to 0.68. All traditional obesity parameters except the BSI had a good ability to be highly associated with the number of stented coronary arteries. Conclusions: Healthcare providers, including nurses, should pay a high attention to these obesity parameters while caring of patients with CAD undergoing cardiac catheterization. [ABSTRACT FROM AUTHOR]

The highly contagious and rapidly spreading coronavirus 2 (SARS-CoV 2) has been associated with the development of severe acute respiratory syndrome, a potentially fatal disease. A patient who underwent coronary artery bypass surgery for an acute myocardial infarction developed acute respiratory failure due to coronavirus 2 (SARS-CoV-2) pneumonia in the early postoperative period. The patient was placed on mechanical ventilation (MV) and V-V (veno-venous) ECMO (Extracorporeal Membrane Oxygenation) support. Here we discuss the application of decortication in the patient due to the development of pneumothorax and prolonged air leak empyema in the follow-up, and the subsequent development of pleural thickening. [ABSTRACT FROM AUTHOR]

Background Controversy exists about left ventricular systolic function recovery after coronary artery bypass grafting in patients with ischemic cardiomyopathy. The aim of this study is to evaluate the temporal evolvement of left ventricular systolic function after coronary artery bypass surgery in patients with ischemic cardiomyopathy. Patients and Methods A total of 50 patients with coronary artery disease and left ventricular ejection fraction (LVEF) ≤35% underwent isolated coronary artery bypass grafting in a single center in the period 2017 to 2019. We performed a retrospective analysis of the echocardiographic and clinical follow-up data at 3 months and 1 year postoperatively. Results Median LVEF preoperatively was 25% (20–33%), mean patient age was 66 ± 8.2 years, 33 (66%) patients were operated off-pump, and 22 (44%) procedures were non-elective. There was no in-hospital myocardial infarction, stroke, and repeat revascularization. Three (6%) patients underwent re-exploration for bleeding or tamponade. In-hospital mortality was 8% and 1-year mortality was 12%. At 1 year postoperatively, there was no repeat revascularization, no myocardial infarction, 1 (2.6%) patient had a transient ischemic attack, and 10 (20%) patients required an implantable defibrillator. There was a statistically significant median ejection fraction increase at 3 months (15% [5–22%], p < 0.0001) and 1 year (23% [13–25%], p < 0.0001) postoperatively, with an absolute increase ≥10% in 32 (74.4%) and 30 (78.9%) patients at 3 months and 1 year, respectively. Conclusion Patients with ischemic cardiomyopathy undergoing coronary artery bypass surgery show continuous recovery of left ventricular systolic function in the first postoperative year. [ABSTRACT FROM AUTHOR]

Background Revascularization strategies might be limited in patients with lack of sufficient bypass graft material and increased risk of wound healing disturbances. In this regard, we present first results of patients treated with left internal mammary artery (LIMA) as T-graft with itself due to left-sided double-vessel disease, elevated risk of wound healing infection, and lack of graft material. Methods Eighteen patients were retrospectively analyzed in this study. All patients received LIMA grafting, and additional T-graft with itself during off-pump coronary artery bypass surgery. The investigation was focused on intraoperative and postoperative outcomes. Results LIMA-LIMA T-graft was performed in a total of 18 patients. Mean Fowler score accounted for 18.2 ± 2.9. Severe vein varicosis was present in 9 patients, and 38.9% of patients had lacking venous graft material due to prior vein stripping. A total of 2.5 ± 0.5 distal anastomoses were performed. Mean flow of LIMA—left anterior descending anastomosis was 41.72 ± 12.11 mL/min with a mean pulsatility index (PI) of 1.01 ± 0.21. Mean flow of subsequent T-graft accounted for 26.31 ± 4.22 mL/min with a mean PI of 1.59 ± 0.47. Median hospital stay was 7(6.75;8) days. No incidence of postoperative wound healing disorders was observed and all patients were discharged off hospital. Conclusions LIMA as T-graft with itself to treat left-sided double-vessel disease is feasible and safe in patients with missing bypass graft material and increased risk of deep sternal wound infection. Further prospective studies are necessary to confirm our results. [ABSTRACT FROM AUTHOR]

Background and Objectives: The hemoadsorption device CytoSorb® (CytoSorbents Inc., Princeton, NJ, USA) has been shown to efficiently remove ticagrelor from whole blood in vitro. A promising clinical experience was made with the integration of the hemoadsorption cartridge on the cardiopulmonary bypass (CPB) circuit during cardiac surgery to reduce adverse events. Materials and Methods: In this report, we describe a novel approach using a new apheresis platform, PUR-01 (Nikkisio Co., Ltd., Tokyo, Japan), which was used as the extracorporeal circuit where CytoSorb® could be installed for the removal of ticagrelor during off-pump coronary artery bypass (OPCAB) procedures. Results: In a 74-year-old male (index case) with coronary artery disease and dual antiplatelet therapy, hemoadsorption was initiated with a skin incision for OPCAB surgery and was continued for 221 min to eliminate ticagrelor. The blood volume that had circulated through the CytoSorb® was 39.04 L in total. Thus far, this treatment strategy has been used in four cases with CHD and DAPT who needed OPCAB surgery. The intraoperative and postoperative courses were uneventful in all patients. No device-related adverse events occurred. Conclusions: The combination of the PUR-01 apheresis pump and hemoadsorption with the CytoSorb® column during OPCAB procedures appears to be safe and effective in eliminating antiplatelet drugs. [ABSTRACT FROM AUTHOR]

Background: Octogenarians constitute the fastest-growing segment within contemporary cardiac surgery, yet precise risk assessment in this age group remains challenging. Aims: This study aimed to evaluate EuroSCORE II reliability in octogenarians undergoing isolated coronary surgery and to create an adjustment formula if necessary. Patients and Methods: All octogenarians who had isolated coronary surgery in Poland from January 2012 to December 2023, recorded in the Polish National Registry of Cardiac Surgical Procedures (KROK registry), were retrospectively assessed. EuroSCORE II's reliability was measured using the ROC curve area and observed-to-predicted mortality ratio, differentiating on-pump and off-pump cases. A nomogram was developed to enhance predictive accuracy. Results: Among 5771 octogenarians, 2729 (47.3%) underwent on-pump and 3042 (52.7%) underwent off-pump surgery. EuroSCORE II demonstrated reliability in off-pump patients (AUC:0.72, O/E ratio:0.98) but underestimated mortality for on-pump cases (AUC:0.73, O/E ratio:1.62). The lowest predicted mortality group (0.50-1.82%) showed the greatest discrepancies. Calibration was improved by adding a coefficient and creating a nomogram. Conclusions: EuroSCORE II was dependable in predicting outcomes for Polish octogenarians undergoing isolated coronary surgery. Observed mortality following on-pump surgeries was higher than expected, which was corrected by adding a coefficient to the initial EuroSCORE II calculation.

The article discusses research which investigated the efficacy of adjunctive intravenous methylprednisolone in improving outcomes for patients with acute ischemic stroke due to proximal large-vessel occlusion (LVO), referencing a study by Y. Shan et al published in the "Journal of American Medical Association."

The article discusses the clinical implications of using ivabradine, a selective I f channel inhibitor, in patients undergoing off-pump coronary artery bypass surgery. The study conducted by Virmani and colleagues found that ivabradine can effectively reduce the need for intraoperative beta-blockers, which can be potentially harmful. However, there are limitations to using ivabradine in cardiac surgery, such as its comparably extended pharmacologic half-life and the potential risk of bradycardia. Additionally, the authors note that the beneficial effects of ivabradine on mortality and morbidity may not be as significant in patients with preserved ejection fraction. Further research is needed to determine the optimal use of ivabradine in different patient populations. [Extracted from the article]

The article discusses a research study on the impact of pectointercostal fascial block (PIFB) on the stress response in open heart surgeries. The author acknowledges the study's methodology but raises some points for consideration. They question the use of certain biomarkers and suggest that serial measurements of cortisol would be a better marker for stress response. The author also notes the inclusion of various types of open heart surgeries in the study, suggesting that focusing on a specific type would have been better. Overall, the author encourages careful interpretation of the study's conclusion. [Extracted from the article]

Background: Several of the most extensively used risk prediction tools for coronary artery bypass grafting outcomes include female sex as an independent risk factor for postoperative outcomes. It is not clear whether this putative increased surgical risk impacts long-term survival. This study aimed to assess sex differences in 10-year all-cause mortality. Methods: Retrospective analysis of 5340 consecutive patients undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. The primary endpoint was all-cause mortality at ten years. We employed an overlap weighting algorithm to minimize confounding. Its target population highlights patients with the most overlap in their observed characteristics, and its corresponding estimand is the average treatment effect in the overlap population. Results: We identified that 5340 patients underwent isolated CABG: 1104 (20.7%) were female, and 4236 (79.3%) were male. Sixteen patients were lost to follow-up (0.3%). The median follow-up time was 12.79 (IQR, 9.52–16.66) years: 12.68 (IQR, 9.48–16.54) years for the male patient group and 13.13 (IQR, 9.75–16.98) years for the female patient group. The primary endpoint of all-cause mortality at ten years occurred in 1106 patients (26.1%) in the male patient group, compared with 315 (28.5%) in the female patient group. The unweighted survival analysis for both groups reveals the worst long-term prognosis for the female cohort (hazard ratio, 1.22; 95% CI, 1.10 to 1.35; p < 0.001), while in the overlap weighted survival analysis, such long-term difference in prognosis disappears (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; p = 0.693). Conclusion: In this longitudinal, population-level analysis of patients undergoing primary, isolated CABG, we demonstrated that the female sex is not associated with increased long-term all-cause mortality compared to their male counterparts. Thus, sex should not influence the undertaking of an adequate revascularization strategy. [ABSTRACT FROM AUTHOR]

Coronary artery spasm after coronary artery bypass grafting is a rare but life-threatening condition. Herein, we report the case of a 77-year-old man who received off-pump coronary artery bypass grafting. An hour after surgery, there was a sudden hemodynamic compromise due to coronary artery spasm, prompting emergent coronary angiography with extracorporeal membrane oxygenation support. Because the angiography results showed diffuse severe spasm of the entire native coronary artery, the patient was treated with an intracoronary injection of vasodilators. The patient recovered in 7 days with mechanical support, catecholamines, and vasodilators, and he was discharged on postoperative day 30. Although coronary artery spasm after off-pump coronary artery bypass surgery is a rare condition, it must be suspected when sudden circulatory collapse occurs. [ABSTRACT FROM AUTHOR]

Our study examines the association between the favorability of percutaneous coronary intervention (PCI) and/or coronary artery bypass surgery (CABG) and the presence of conflicts of interest (COIs) among authors. We used the "Citing Articles" tool on the New England Journal of Medicine website to identify editorials on the use of PCI/CABG for stable ischemic heart disease. Authors were rated as "supportive," "neutral," or "critical" of these interventions based on the content of their editorials. COIs for each author were identified using past publications found on Scopus, PubMed, or a general internet search. A total of 606 articles were identified, and data were extracted from 56 of them. Among the 149 authors, 64 (43.0%) had a COI. Of these 64 authors, 19 (29.7%) disclosed their COI, while 45 (70.3%) did not. Overall, among authors with a COI, there was no association between disclosed and undisclosed COIs and the authors' view of PCI/CABG [χ2 (2, N = 64) = 1.63, p =.44]. If an author was associated with Medtronic, Abbott, or Boston Scientific, they were more likely to favor PCI/CABG if they had an undisclosed COI relative to authors who disclosed COIs [χ2 (1, N = 31) = 5.04, p =.025]. Authors publishing in a cardiology journal were more likely to view PCI/CABG favorably relative to those publishing in a general medicine journal [χ2 (2, N = 62) = 7.17, p =.028]. Editors should adopt policies to counteract the unbalancing effects that COIs have on medical opinions and evidence. • Editorials are used to highlight discussion in pertinent fields of research. • Relevant conflicts of interest can sway the opinion of such editorials. • Journals could adopt policies to counteract the unbalancing effects that conflicts of interest have. [ABSTRACT FROM AUTHOR]

We retrospectively evaluated the association between preoperative mild thyroid dysfunction (subclinical hypothyroidism [SCH] or low triiodothyronine [T3] syndrome) and outcomes in patients who underwent off-pump coronary surgery (OPCAB). Further, 800 patients (2015–2020) were divided into euthyroid, low T3, and SCH groups. The primary outcome assessed the association with composite endpoints (myocardial infarction, prolonged mechanical ventilation [>24 h], acute kidney injury, and 30-day/in-hospital mortality). The secondary outcome assessed the association with long-term mortality and 10% and 8% of the patients exhibited low T3 and SCH, respectively. Incidences of composite endpoints were significantly higher in the low T3 and SCH groups versus the euthyroid group (50.6%, 45.2%, 17.4%, respectively, p < 0.001). Multivariable regression analysis revealed chronic kidney disease, anemia, EuroSCORE, low T3, and SCH as independent risk factors of composite endpoints. The long-term mortality rate (median follow-up, 30 months) was higher in the low T3 and SCH groups than in the euthyroid group (9.6%, 11.3%, 2.4%, respectively, p < 0.001). In the absence of overt thyroid dysfunction, low T3 and SCH were associated with increased risk of adverse outcomes after OPCAB. Moreover, the adverse influences of low T3 and SCH seem to extend to long-term mortality, implying that routine thyroid function tests may enhance accurate risk stratification. [ABSTRACT FROM AUTHOR]

The role of inflammatory cytokines is well researched in acute coronary syndrome (ACS) and rheumatoid arthritis (RA), but not in the presence of both conditions. This study aimed to compare TNF-α expression, serum TNF-α, IL-6, and hs-CRP in ACS patients with RA (n = 46) with ACS patients without RA (n = 49) and healthy controls (n = 50). TNF-α expression was assessed from coronary artery samples, taken during coronary artery bypass surgery. Serum levels TNF-α, IL-6, and hs-CRP were measured 24 and 48 h after cardiac surgery. Stronger TNF-α expression was observed in the ACS patients with RA versus the ACS patients without RA, p = 0.001. Serum TNF-α, IL-6, and hs-CRP at the 24th h were significantly elevated in both patient groups and distinguished them from the healthy controls with accuracy ranging from 80 to 99%. At the 48th h, serum TNF-α and IL-6 in the ACS group without RA decreased to those of the healthy controls but remained high in the group with RA. ACS cases with RA could be correctly identified from the levels of IL-6 (AUC = 0.885, 95% CI 0.791 to 0.938) and TNF-α (AUC = 0.852, 95%CI 0.720 to 0.922). Our results suggest that the presence of RA in ACS cases is likely to provoke stronger TNF-α expression on atherosclerotic plaques, aggravate the pro-inflammatory response, and sustain it even after the cardiac stress is lowered. In ACS cases with RA, long-term monitoring and control of TNF-α and IL-6 levels can be a useful preventive strategy. [ABSTRACT FROM AUTHOR]