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Background: A novel, wireless, ultrasound biosensor that adheres to the neck and measures real-time Doppler of the carotid artery may be a useful functional hemodynamic monitor. A unique experimental set-up during elective coronary artery bypass surgery is described as a means to compare the wearable Doppler to trans-esophageal echocardiography (TEE). Methods: A total of two representative patients were studied at baseline and during Trendelenburg position. Carotid Doppler spectra from the wearable ultrasound and TEE were synchronously captured. Areas under the receiver operator curve (AUROC) were performed to assess the accuracy of changing common carotid artery velocity time integral (ccVTIΔ) at detecting a clinically significant change in stroke volume (SVΔ). Results: Synchronously measuring and comparing Doppler spectra from the wearable ultrasound and TEE is feasible during Trendelenburg positioning. In two representative cardiac surgical patients, the ccVTIΔ accurately detected a clinically significant SVΔ with AUROCs of 0.89, 0.91, and 0.95 when single-beat, 3-consecutive beat and 10-consecutive beat averages were assessed, respectively. Conclusion: In this proof-of-principle research communication, a wearable Doppler ultrasound system is successfully compared to TEE. Preliminary data suggests that the diagnostic accuracy of carotid Doppler ultrasonography at detecting clinically significant SVΔ is enhanced by averaging more cardiac cycles. [ABSTRACT FROM AUTHOR]

The narcissistic patient inevitably hears the analyst's initial interpretation that the patient is unconsciously self-critical as evidence that the analyst is critical of the patient. Just as he writes, in the footnote from i The Ego and the Id, I that the treatment depends on the analyst's being put in the place of the patient's ego ideal, he warns against breaking the rules of analysis. And another (pp. 660-661): I The subsequent development of a relatively punitive attitude among analysts, particularly towards narcissistic patients, is more difficult to understand, especially in those analysts whose focus was on the analysis of the ego. Long after finishing with my second training analyst, I found myself, in the treatment of a particular patient, doing something that my first training analyst had done in a way that had been hurtful to me. [Extracted from the article]

To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA). Patients with RA (n = 378) were retrospectively compared to patients without RA (n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes were studied with propensity score-matching adjustment for baseline features. The median follow-up was 9.7 years. Diagnosis of RA was associated with an increased risk of mortality after CABG compared to patients without RA (HR 1.50; CI 1.28–1.77; p <.0001). In addition, patients with RA were in higher risk of myocardial infarction during the follow-up period (HR 1.61; CI 1.28–2.04; p <.0001). Cumulative rate of repeated revascularization after CABG was 14.4% in RA patients and 12.0% in control patients (p =.060). Duration of RA before CABG (p =.011) and preoperative corticosteroid usage in RA (p =.041) were independently associated with higher mortality after CABG. There were no differences between the study groups in 30-d mortality or in the post-operative usage of cardiovascular medications. RA is independently associated with worse prognosis in coronary artery disease treated with CABG. Preoperative corticosteroid use and longer RA disease duration are additional risk factors for mortality. Patients with rheumatoid arthritis (RA) have impaired long-term outcomes after coronary artery bypass surgery (CABG). Glucocorticoid use before CABG and duration of RA are associated with higher mortality. Special attention should be paid in secondary prevention of cardiovascular disease in RA patients after CABG. [ABSTRACT FROM AUTHOR]

To study the long-term outcome differences between acute myocardial infarction (MI) and stable coronary artery disease (CAD) patients treated with coronary artery bypass grafting (CABG). We studied retrospectively patients with MI (n = 1882) or stable CAD (n = 13117) treated with isolated CABG between 2004 and 2014. Inverse propensity probability weight adjustment for baseline features was used. Median follow-up was 7.9 years. In-hospital mortality (8.6% vs. 1.6%; OR 5.94; p <.0001) and re-sternotomy (5.5% vs. 2.7%; OR 2.07; p <.0001) were more common in MI patients compared to stable CAD patients. Hospital surviving MI patients had higher all-cause mortality (28.2% vs. 22.2%; HR 1.37; p =.002) and MACE rate (34.4% vs. 27.4%; HR 1.22; CI 1.00–1.50; p =.049) at 10-year follow-up. Cardiovascular mortality (15.9% vs. 12.7%; HR 1.36; p =.017) and rate of new myocardial infarction (12.0% vs. 9.8%; HR 1.40; p =.034) were also higher in MI patients during follow-up. In follow-up of stabilized first-year survivors, the difference in all-cause (26.5% vs. 20.7%; HR 1.40; p =.003) and cardiovascular (14.2% vs. 11.4%; HR 1.37; p =.027) mortality continued to increase between MI and stable CAD patients. MI patients have poorer short- and long-term outcomes compared to stable CAD patients after CABG and risk difference continues to increase with time. Patients with myocardial infarction have poorer short- and long-term outcomes compared to stable coronary artery disease patients after coronary artery bypass grafting (CABG). Higher risk of death continues also in stabilized first-year myocardial infarct survivors. The importance of efficient secondary prevention and follow-up highlights in post-myocardial infarct population after CABG. [ABSTRACT FROM AUTHOR]

"As we learned about the connection between blood clots and COVID-19, we knew that aspirin used to prevent stroke and heart attack could be important for COVID-19 patients", said Dr. Jonathan Chow of the study team. Over-the-counter aspirin could protect the lungs of COVID-19 patients and minimize the need for mechanical ventilation, according to new research at the George Washington University. [Extracted from the article]

Background. Acute kidney injury (AKI) is one of the most common and serious complications for coronary disease (CAD) patients, suffering from coronary artery bypass surgery (CABG). AKI occurs in nearly 30% of cardiac surgery patients, including CABG patients, affecting renal function, prolonging hospitalization time, and increasing all-cause mortality. TGF-β1 and Smad3 are sensitive biomarkers in evaluating kidney function. Therefore, comparing the TGF-β1 and Smad3 levels between the AKI patients and non-AKI patients after CABG surgery might have an important significance for identifying the risk degree of AKI and applying effective preventive measures after CABG surgery. Objective. This study aims at comparing the TGF-β1 and Smad3 levels between the AKI patients and non-AKI patients after CABG surgery to identify the risk degree of AKI and apply effective preventive measures after CABG surgery in clinics. Materials and Methods. A total of 25 proper patients, diagnosed as coronary disease (CAD) and undergoing AKI after CABG, were selected as the AKI group. The 25 participants, who did not suffer from AKI after CABG, were recruited using the case-control matching method in SPSS 25.0 software as the non-AKI group. Also, corresponding surgical specimens (tissues) and samples of blood were collected from them. Histopathological analysis and immunofluorescent microscopy of lesion artery and kidney of patients, who have been treated with kidney transplants, were performed on surgical specimens to find the pathological and histological change difference between the two groups. RT-PCR and Western blot were conducted to quantify the levels of TGF-β1 and Smad3 expression in serum for the patients of AKI and non-AKI groups, respectively. Results. Serious renal fibrosis was noted in patients of the AKI group. In addition, by H&E staining of the lesion artery, severe histopathological changes including smooth muscles proliferation with endothelial cell infiltration, focal degeneration and disruptions, and less collagen accumulation were found in the lesion artery of patients from the AKI group. Higher levels of TGF-β1 and Smad3 were observed in serum of patients of the AKI group. Conclusion: The increased levels of TGF-β1 and Smad3 in serum might be risk factors for triggering AKI for CAD patients undergoing CABG. [ABSTRACT FROM AUTHOR]

Background: Graft patency is a fundamental predictor of long-term survival after coronary artery bypass surgery. Left and right internal thoracic artery (arterial) graft patency has been shown to be superior to that of saphenous vein grafts. More recently, the radial artery has been used as an a ortocoronary graft, but little is known about the midterm and long-term patency of this conduit. The ultimate goal of this operation is to achieve complete revascularization of the patient with conduits that will remain patent for the duration of the patient's lifetime. The excellent patency rates achieved with the pedicled left internal mammary artery are well described. Over the past decade, there has been considerable interest in whether the left internal mammary radial artery may provide results comparable to the arterial conduit. However, other studies have described that mild proximal stenosis of target vessels correlated with graft occlusion when an RA graft was used. Thus, we compared the short- and long-term results of patients who received an RA graft to the OM with those of patients who received an SVG. Methods: Following approval by the ethics and research committee of Kasr el Ainy faculty of Medicine Cairo University, and obtaining an informed consent, a prospective randomized clinical study was conducted on FIFTY who were operated upon with CABG. Requiring in addition to LIMA to LAD, revascularization of an obtuse marginal. These patients included 25 patients who received radial artery as the conduit. The selected patients for this study were evaluated postoperatively by MSCT angiography to comparative study between radial artery versus saphenous vein grafts patency after 5 years. Results: In our study according to graft patency by MSCT postoperative after 5 years of both groups showed statistically significant difference in group A which is p value 0.047 in group A 22 patients (88.0%) with radial to OM graft were patent while 3 patients (12.0%) with radial to OM were occluded. But in group B 16 patients (64.0%) with saphenous to OM graft were patent while 9 patients (36%) with saphenous to OM were occluded. Conclusion: In the long-term study, there was significant difference between total arterial revascularization and conventional CABG. Total arterial revascularization having low operative mortality and morbidity [ABSTRACT FROM AUTHOR]

Objectives: We sought to investigate stent healing and neointimal hyperplasia with ihtDEStiny drug-eluting stent (DES) by optical coherence tomography (OCT) examination conducted 9 months after implantation.Background: The currently used DES present certain features that have been linked separately to their better performance in terms of efficacy and safety.Methods: First-in-man, prospective and multicenter study including patients treated with ihtDEStiny stent undergoing OCT examination at 9 months follow up. The ihtDEStiny stent is a sirolimus eluting stent with an oval shape ultrathin struts (68 μm) and an abluminal coating of a fluoropolymer containing the antiplatelet agent triflusal. Primary endpoint was the percentage of obstruction of the in-stent volume by the neointima.Results: In 58 patients (63 lesions) in-stent late lumen loss was 0.11 ± 0.23 mm (95% CI 0.05-0.16) with only in 6% of stents being > 0.5 mm and in-segment binary stenosis was 1.6%. In OCT mean neointima volume obstruction was 10.5 ± 6.9% with a mean neointima thickness of 110.9 ± 89.8 μm. The proportion of uncovered struts was 2.5%, malapposed struts 1.1% and malapposed/uncovered struts 0.7% and no subclinical thrombi detected. Mean incomplete stent apposition area was 0.1 ± 0.1 mm2. At 12 months target lesion revascularization rate was 3% and no stent thrombosis was reported.Conclusions: In this study the ihtDEStiny stent has shown a very low degree of neointimal proliferation associated with a low rate of uncovered/malapposed struts and total absence of subclinical thrombi at 9 months follow up. [ABSTRACT FROM AUTHOR]

Background: Guide catheter extension is an integral part of percutaneous coronary intervention (PCI). First generation guide catheter extension devices are monorail, blunt ended tubular structures with limitations. The CrossLiner™ is a next generation guide extension "system" intended to allow safe, deep, coronary intubation.Methods: The CrossLiner was tested in a head-to-head study with the GuideLiner™ and GuideZilla™ in a porcine coronary model, with stenting. Data were collected from 8 coronary vessels from four animals, to evaluate the ability to deeply intubate the vessel with the guide extension.Results: The CrossLiner crossed distally and through a distal stented segment in 8/8 vessels, while the first-generation devices were stuck proximal to the stent (n=2/8) or at the stent edge (n=4/8), or passed partially into the deployed stent with difficulty (2/8) vessels (p < 0.0002 for deliverability). The average depth of guide extension delivery/ "intubation" was 12.9±3.6 cm for the CrossLiner and 5.6±1.1 cm for the first-generation guide extension (p < 0.001).Conclusions: The CrossLiner is a next generation guide extension system that may offer advantages over first generation devices. Further clinical evaluation will be required to assess the role of this new device in PCI. [ABSTRACT FROM AUTHOR]

To perform an untargeted data-driven analysis on the correlates and outcomes of coronary artery bypass grafting (CABG). FinnGen cohort study. The authors collected information on up to 1,327 disease traits before and after CABG from nationwide healthcare registers. A mixed population and patient sample of 127,911 individuals including 3,784 CABG patients. The authors assessed the association between (1) traits and incident CABG and (2) CABG and incident traits using multivariate-adjusted Cox models. Patients who underwent CABG and were in the fourth quartile of a risk score based on the top predictors of mortality had 12.2-fold increased risk of dying (95% confidence interval [CI], 10.3-14.5) compared with those in the first quartile. Cardiovascular disease (CVD) and CVD risk factors were most strongly associated with incident CABG. However, CABG was associated with death due to cardiac causes (hazard ratio [HR], 3.7; 95% CI, 3.5-4.0) or other causes (HR, 2.5; 95% CI, 2.4-2.7). CABG also was related to increased risk of several non-CVD traits, including anemia (HR, 3.4; 95% CI, 2.8-4.1), gastrointestinal disorders (HR, 2.2; 95% CI, 1.8-2.6), acute renal failure (HR, 4.2; 95% CI, 3.5-5.1), septicemia (HR, 3.6; 95% CI, 3.1-4.1), lung cancer (HR, 2.3; 95% CI, 1.9-2.8), Alzheimer's disease (HR, 2.5; 95% CI, 2.2-2.7), and chronic obstuctive pulmonary disease (HR, 2.5; 95% CI, 2.2-2.9). Known CVD risk factors associate most strongly with incident CABG. However, CABG is associated with increased risk of several, somewhat unexpected, non-CVD traits. More detailed study of these links is warranted to establish potential causality and pathogenesis. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to investigate whether vasoactiveinotropic score (VIS) is a predictor for early postoperative morbidity and mortality. Methods: This study was planned as a prospective cohort study, between Nov 20 2018 and May 15 2019, including a total of 290 patients aged 20 years or older who underwent elective on-pump coronary artery bypass grafting (CABG). Patients' demographic data, aortic cross-clamp and cardiopulmonary bypass times, European System for Cardiac Operative Risk Evaluation (EuroSCORE) score, cardiac ejection fraction (EF), VIS, intubation duration, and intensive care unit length of stay were recorded. Postoperative mortality and morbidity were recorded. Hourly doses of inotropes for VIS were recorded for each patient, and VIS was calculated. Results: Among the cases, 222 (77%) were male and 68 (23%) were female. The mean age of our patients was 62.5 years (37-86). Combined morbidity and mortality rates of our patients were 23.8%. An optimal cutoff point for VIS of 5.5 could predict combined morbidity and mortality with 90% sensitivity and 88% specificity. Low EF, prolonged operation time, high EuroSCORE, and high VIS are independent factors in the early postoperative period for the development of combined morbidity and mortality in patients who underwent elective CABG. Conclusion: VIS is the most critical and EuroSCORE is the second most important scoring systems. They independently predict combined morbidity and mortality in undergoing elective coronary artery bypass surgery. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) and also anemia are common in the elderly and have a negative impact on the clinical outcomes of patients. The coexistence of anemia and DM seems to be insufficiently recognized; therefore, the aim of our study is to analyze the incidence and clinical consequences of this coexistence, including mortality, in the population of people aged ≥60. A retrospective study was conducted on 981 primary care clinic patients aged ≥60 during 2013-2014. The prevalence of coexistence of DM and anemia (defined in accordance with WHO) and data on the incidence of comorbidities, hospitalization, medical procedures, and all-cause mortality were analyzed. In the study population, 25% had DM, while 5.4% had both DM and anemia. Peripheral artery disease (PAD) was found in 48 patients (4.89%) of the entire study population, more often in men (p < 0.001). Diabetic patients with anemia compared to nonanemic diabetics had more comorbidities (median 4 (4, 5) vs. 3 (2–4); p < 0.001)—PAD more often (p = 0.004), more hospitalization (median 2 (0–11) vs. 0 (0–11); p < 0.001), and more frequent medical procedures (e.g., percutaneous coronary intervention (p < 0.001), coronary artery bypass surgery (p = 0.027), arteriography (p < 0.001), and bypass surgery or endovascular treatments of lower limb ischemia (p < 0.001)). The cumulative survival of patients with both DM and anemia vs. nonanemic diabetics at 36 months was 86.4% vs. 99.3% (p < 0.001). A multivariate logistic regression model showed anemia to be a significant risk factor for death in diabetic patients (p = 0.013). Patients with both DM and anemia have more comorbidities than nonanemic diabetic patients; they are more often hospitalized, require medical procedures more frequently, and are at a higher risk of death. Effective treatment of anemia in patients with DM is advisable and may well improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Transit time flow measurement (TTFM) allows quality control in coronary artery bypass grafting but remains largely underused, probably because of limited information and the lack of standardization. We performed a systematic review of the evidence on TTFM and other methods for quality control in coronary artery bypass grafting following PRISMA standards and elaborated expert recommendations by using a structured process. A panel of 19 experts took part in the consensus process using a 3-step modified Delphi method that consisted of 2 rounds of electronic voting and a final face-to-face virtual meeting. Eighty percent agreement was required for acceptance of the statements. A 2-level scale (strong, moderate) was used to grade the statements based on the perceived likelihood of a clinical benefit. The existing evidence supports an association between TTFM readings and graft patency and postoperative clinical outcomes, although there is high methodological heterogeneity among the published series. The evidence is more robust for arterial, rather than venous, grafts and for grafts to the left anterior descending artery. Although TTFM use increases the duration and the cost of surgery, there are no data to quantify this effect. Based on the systematic review, 10 expert statements for TTFM use in clinical practice were formulated. Six were approved at the first round of voting, 3 at the second round, and 1 at the virtual meeting. In conclusion, although TTFM use may increase the costs and duration of the procedure and requires a learning curve, its cost/benefit ratio seems largely favorable, in view of the potential clinical consequences of graft dysfunction. These consensus statements will help to standardize the use of TTFM in clinical practice and provide guidance in clinical decision-making. [ABSTRACT FROM AUTHOR]

Objective. To study the protective effect of trimetazidine on myocardial cells in rats with myocardial infarction and explore its effect on ERK signaling pathway. Methods. 40 SD rats were randomly divided into the sham operation group, model group, low-dose group, and high-dose group (intra-abdominal injection of trimetazidine 5 mg/kg and 10 mg/kg, respectively), construction of rat myocardial infarction model by coronary artery left anterior descending artery ligation. 7 days after surgery, the survival rate and cardiac function of each group of rats were recorded. The myocardial infarct size was detected by TTC staining. The apoptosis level of rat cardiomyocytes was detected by TUNEL staining. The content of ROS in rat cardiomyocytes was detected by DCFH-DA. Western-blot was used to detection of Caspase-3, Bcl-2/Bax, and ERK signaling pathway-related proteins in myocardial tissue. Results. Compared with the model group, the survival rate of the rats in the low-dose group and the high-dose group was significantly increased (P < 0.01), the cardiac function was significantly improved (P < 0.01), the myocardial infarct size was significantly decreased (P < 0.01), the level of apoptosis was significantly decreased (P < 0.01), the content of ROS in cardiomyocytes was significantly decreased (P < 0.01), the protein expression of Caspase-3 and NF-κB in cardiomyocytes was significantly decreased (P < 0.01), and the expression of Bcl-2/Bax and p-ERK were significantly increased (P < 0.01). Conclusion. Trimetazidine can activate ERK signaling pathway in cardiomyocytes of rats with myocardial infarction, increase the expression of p-ERK, decrease the content of ROS in cardiomyocytes, decrease the expression of apoptotic proteins, reduce myocardial infarct size, improve cardiac function, and increase myocardial function. [ABSTRACT FROM AUTHOR]

Background: Heart surgery patients who develop acute and new-onset AF (postoperative atrial fibrillation, POAF) are among the most common postoperative complications, affecting around 35 percent of those who undergo the procedure. Objective: To assess the effectiveness of amiodarone in prophylaxis of AF post coronary artery bypass surgery (CABG). Patients and Methods: Our work represents a randomized clinical trial, which was carried out at National Heart Institute and Zagazig University from the period of August 2020 to June 2021. 68 patients, admitted for CABG and had high risk score according to POAF score, were included in our study. Results: Regarding mean left ventricular ejection fraction (LVEF), in group I was 47.52±5.85 while in group II it was 49.85±6.25. There was a statistically non-significant difference between the groups with a P value of 0.414. Mean Intensive Care Unit (ICU) period was 4.42±1.35 in group I, and group II was 2.73±0.95. The difference between the groups was statistically significantly shorter among group II (prophylaxis group) (P <0.01). Regarding development of POAF, in group I, the incidence of POAF was 85.3% while in group II, it was 38.2%. Difference among the two studied groups was statistically significantly lower in the group II (prophylaxis group). Conclusion: A prophylactic amiodarone strategy dramatically decreased incidence of POAF risk. All previous estimations of POAF risk reduction using prophylactic amiodarone were found to be accurate. Amiodarone was more effective in preventing postoperative atrial fibrillation with no serious side effects and it decreased postoperative ICU stay. [ABSTRACT FROM AUTHOR]

Summary: Delirium occurs commonly following major non‐cardiac and cardiac surgery and is associated with: postoperative mortality; postoperative neurocognitive dysfunction; increased length of hospital stay; and major postoperative complications and morbidity. The aim of this study was to investigate the effect of peri‐operative administration of dexmedetomidine on the incidence of postoperative delirium in non‐cardiac and cardiac surgical patients. In this randomised, double‐blind placebo‐controlled trial we included 63 patients aged ≥ 60 years undergoing major open abdominal surgery or coronary artery bypass graft surgery with cardiopulmonary bypass. The primary outcome was the incidence of postoperative delirium, as screened for with the Confusion Assessment Method. Delirium assessment was performed twice daily until postoperative day 5, at the time of discharge from hospital or until postoperative day 14. We found that dexmedetomidine was associated with a reduced incidence of postoperative delirium within the first 5 postoperative days, 43.8% vs. 17.9%, p = 0.038. Severity of delirium, screened with the Intensive Care Delirium Screening Checklist, was comparable in both groups, with a mean maximum score of 1.54 vs. 1.68, p = 0.767. No patients in the dexmedetomidine group died while five (15.6%) patients in the placebo group died, p = 0.029. For patients aged ≥ 60 years undergoing major cardiac or non‐cardiac surgery, we conclude that the peri‐operative administration of dexmedetomidine is associated with a lower incidence of postoperative delirium. [ABSTRACT FROM AUTHOR]

Background: del Nido cardioplegia has been adopted for use in adult cardiac surgery, despite a lack of robust randomised evidence supporting equivalence or superiority to conventional hyperkalaemic blood cardioplegia. We investigated the clinical surrogates of myocardial protection, and performed an extensive analysis of post‐operative high‐sensitivity Troponin T (hs‐TnT) values in a general adult cardiac surgery population receiving del Nido, in comparison to a historical hyperkalaemic blood cohort. Method: 171 consecutive patients of a single surgeon from between November 2018 and June 2020 received del Nido, and were compared to a historical cohort of 326 patients between January 2016 and November 2018 who received hyperkalaemic blood cardioplegia. Clinical markers of myocardial protection were compared, as were hs‐TnT values at 6, 12, 24, and 72‐h post‐operatively. Equivalence between groups was determined using the two one‐sided tests procedure. Results: There was no difference between the groups in the incidence of post‐operative low cardiac output state, inotropic support, or myocardial infarction. Del Nido patients had less defibrillation requirement, and more spontaneous resumption of normal sinus rhythm. High‐sensitivity Troponin T values were similar at all time‐points including in a coronary artery bypass graft subgroup, and in those patients with elevated pre‐operative hs‐TnT. Conclusion: In a broad cohort of adult cardiac surgery patients, including those undergoing coronary artery bypass surgery and those with recent myocardial infarction, del Nido provides equivalent myocardial protection and clinical outcomes when compared to hyperkalemic blood cardioplegia. Post‐operative high‐sensitivity Troponin T values were also equivalent between the groups. [ABSTRACT FROM AUTHOR]

Background Risk factors control and secondary prevention measures are often reported to be suboptimal in patients undergoing coronary artery bypass grafting (CABG) and may lead to worse clinical outcomes. We aimed to examine potentially modifiable risk factors in patients undergoing CABG and investigate their association with long-term coronary events. Methods Cardiovascular risk factors were recorded preoperatively in the setting of a cardiac catheterization laboratory and were analyzed in relation to long-term coronary events, defined as acute coronary syndrome (ACS) or revascularization after CABG. Results Study population included 1,125 patients undergoing CABG without previous revascularization. Modifiable risk factors included hypertension (71%), hyperlipidemia (67%), diabetes (42%), obesity (28%), and smoking (21%). Only 8% did not have any of the five risk factors. During the mean follow-up of 93 ± 52 months after CABG, 179 patients (16%) experienced a coronary event. Incidence rates were higher in patients with than without the presence of each of the modifiable risk factors, except obesity. Active smoking (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: (1.07–2.13); p = 0.020), presence of diabetes (HR: 1.61; 95% CI: 1.18–2.18; p = 0.002), and hyperlipidemia (HR: 2.13; 95% CI: 1.45–3.14; p < 0.001) were independent predictors of future coronary events after CABG; they also displayed a progressive stepwise increment in the risk of long-term coronary events when cumulatively present. Conclusions In patients undergoing CABG, diabetes, hyperlipidemia, and smoking, as documented preoperatively, were potentially modifiable risk factors that were independently and cumulatively associated with long-term risk of ACS or coronary revascularization, highlighting the importance of early identification and risk factors control for improving cardiovascular health after CABG. [ABSTRACT FROM AUTHOR]

Background In patients undergoing coronary artery bypass grafting (CABG), wide variability in transfusion rate (7.8% to 92.8%) raises the question of the amount of unnecessary transfusions. The aim of the study was (1) to identify CABG patients at low risk of bleeding to whom transfusion treatment should be avoided and (2) to calculate the amount of possible cost savings that would be achieved by avoiding transfusion in low bleeding risk patients. Methods This retrospective observational study enrolled patients undergoing isolated elective CABG from January 2010 to January 2018. Patients were divided with respect to the presence of excessive bleeding and transfusion costs were compared between the two groups. Predictors for postoperative excessive bleeding were defined and multivariable logistic regression analysis and risk modeling were performed. The use of a model to predict patients at low risk of bleeding allowed for the estimation of transfusion cost savings assuming the patients who were found to be at low risk of bleeding should not be transfused. Results A total of 1,426 patients were enrolled in the analysis. Of those, 28.3% had excessive postoperative bleeding. The multivariate logistic regression analysis model was developed to identify/predict patients without excessive bleeding (receiver operating characteristic curve analysis, area under the curve 72.3%, p < 0.001). When applied to the existing database, the use of the developed model identifying patients at low risk of bleeding may result in a 39.1% reduction of transfusions. Specifically, cost savings would be 48.2% for packed red blood cells, 38.9% for fresh frozen plasma, 10.9% for platelets concentrate, and 17.9% for fibrinogen concentrate. Conclusion The clinical and economic burdens associated with unnecessary transfusions are significant. Avoiding transfusion in CABG patients found to be at low risk of bleeding may result in significant reduction of transfusion rate and transfusion-associated costs. [ABSTRACT FROM AUTHOR]

Background: Nitric oxide (NO) is an important signalling molecule in the cardiovascular system with protective properties in ischaemia-reperfusion injury. Inorganic nitrate, an oxidation product of endogenous NO production and a constituent in our diet, can be recycled back to bioactive NO. We investigated if preoperative administration of inorganic nitrate could reduce troponin T release and other plasma markers of injury to the heart, liver, kidney, and brain in patients undergoing cardiac surgery.Methods: This single-centre, randomised, double-blind, placebo-controlled trial included 82 patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Oral sodium nitrate (700 mg×2) or placebo (NaCl) were administered before surgery. Biomarkers of ischaemia-reperfusion injury and plasma nitrate and nitrite were collected before and up to 72 h after surgery. Troponin T release was our predefined primary endpoint and biomarkers of renal, liver, and brain injury were secondary endpoints.Results: Plasma concentrations of nitrate and nitrite were elevated in nitrate-treated patients compared with placebo. The 72-h release of troponin T did not differ between groups. Other plasma biomarkers of organ injury were also similar between groups. Blood loss was not a predefined outcome parameter, but perioperative bleeding was 18% less in nitrate-treated patients compared with controls.Conclusion: Preoperative administration of inorganic nitrate did not influence troponin T release or other plasma biomarkers of organ injury in cardiac surgery.Clinical Trial Registration: NCT01348971. [ABSTRACT FROM AUTHOR]

Introduction : A search for strategies to address saphenous vein graft (SVG) failure – the main factor limiting the long-term success of coronary bypass grafting – has led to trialing of external stenting technologies. Areas covered : The manuscript covers historical development and current status of external scaffolding for the treatment of SVG intimal hyperplasia. Comprehensive literature review and personal communication with VGS leadership, the developer of the VEST device, served as the sources. Expert opinion : If the external scaffolding concept proves to be successful in mitigating the intimal hyperplasia inherent to arterialized saphenous vein conduits, it could have a dramatic impact on the recurrence of anginal symptoms, the need for repeat revascularization, and the incidence of myocardial infarction following CABG surgery. These laudable sequelae could ultimately convey significant public health repercussions by reducing healthcare resource use and improving the long-term survival and quality of life of CABG recipients. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing CABG often experience a varied series of discomfort symptoms post hospital dischargeinclude; shortness of breath, chest pain or angina pain, incisional pain, atrial fibrillation fatigue, leg swelling, sleep quality, loss of appetite, anxiety and depression. Specific educational program regarding symptoms management strategies (SMS) are used to improve patient outcome, therefore patients' compliance with this programis very essential to relief, manage it. Aim: to evaluate the effect of an educational program for patients post CABS on the compliance with (SMS). Design: a quasi-experimental design. Setting: conducted at outpatient clinics in Cardio Thoracic Academy at Ain Shams Hospital. Subject: a purposive sample of (150) patients post CABG were recruited. Tools: demographic, medical data, Cardiac Symptoms Survey (CSS) and compliance scale are used. Results: The subjects were complaint towards (SMS) pre-program (12.7%) changed to (83.3%) post program. As evidence, 53.3% of the subjects who had sever level of perception of symptoms pre, changed to 5.3% post. Moreover, (62.7%, 59.4% respectively) of the subjects who had sever level of frequency, severity of symptoms pre changed to (4 %, 2.7% respectively) post. In addition, (57.3% respectively) of the subjects who had sever level of interference with physical activity, enjoyment of life pre, changed to (4%,4% respectively) post. Conclusion: Educational program showed positive effect on the subjects experienced discomfort symptoms post CABG and their compliance towards the management strategies. [ABSTRACT FROM AUTHOR]