Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh

Background: Serum albumin, a vital plasma protein, helps maintain intravascular colloidal osmotic pressure, cardiac output, and renal function. Low preoperative serum albumin is linked to poor outcomes, including acute kidney injury (AKI), after off-pump coronary artery bypass (OPCAB) surgery. This study aimed to assess the relationship between preoperative serum albumin levels and early postoperative renal injury. Methods: This prospective comparative cross-sectional study was conducted from August 2019 to February 2021 at the National Heart Foundation Hospital & Research Institute, Bangladesh. It included 160 adult patients with normal preoperative renal function undergoing OPCAB. Patients were divided into two groups: Group A (serum albumin ≥ 4.0 gm/dl) and Group B (serum albumin Results: Preoperative serum albumin was significantly different between groups (Group A: 4.21 ± 0.05 gm/dl, Group B: 3.69 ± 0.04 gm/dl, p = 0.028). Group B had a higher incidence of hypertension (71.25% vs. 51.25%, p st and 3rd postoperative days were higher in Group B (p th day. Postoperative AKI occurred in 18.75% of Group A and 36.25% of Group B. Multivariate regression indicated that low preoperative serum albumin is an independent risk factor for postoperative AKI (p = 0.012, OR = 1.815, CI: 0.675 - 1.162). Conclusion: Preoperative serum albumin level is a valuable predictor of postoperative renal function. Ensuring high normal serum albumin levels before surgery can help minimize the risk of postoperative AKI.

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.

Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.

The study of using infrared thermal image to assist surgery of coronary artery bypass

Digital infrared thermography is suitable for monitoring the planar two-dimensional temperature distribution of curved surfaces of objects by sensing their infrared radiation. Cardiac infrared thermography also has a thermal coronary angiography alias. This study proposes a digital image processing methodology for locating blood clot blockage. This methodology contains four consequent processes. The two-dimensional gray scale infrared thermograph pixels are first binarized and classified as background or coronary arteries using multi-thresh adaptive segmentation.The coronary artery contours are extracted from segmented raw pixels using continuous pepper-like pixel removal,erosion,subtraction,recursive neighborhood visiting,contour point-list construction and short edge deletion.In the third process one coronary artery branch is selected by physicians for calculating the longest curved central axis using morphological thinning and neighborhood analysis. In the last process the nearest left and right distances from each pixel along the directional central axis to its corresponding boundary contour are added as the coronary artery variable diameter at the current pixel's position. A variable diameter versus straighten length diagram along this axial curved path is plotted to provide useful physiological information to the physician. An obstruction rate equation is then defined to calculate the possible vascular blockage positions with the local minimal rates. Finally,preoperative cases are tested to prove the predictive positions are correct in comparison to individual patient myocardial perfusion imaging.

Coronary artery bypass graft surgery in a patient with ureterosigmoidostomy

A 75-year-old male patient had stable angina pectoris After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ureterosigmoidostomy because of bladder cancer After that, his micturition was via the rectum. We did not experience that before. As is known, monitoring of urine output is very important after cardiac surgery The patient was consulted with an urologist for how to monitor urine output in him. Transrectal catheterization was recommended for our follow-up, but before the catheterization bowel cleansing is necessary. Four-vessel on-pump coronary artery bypass graft surgery was performed without any problem. Peroperative urine volume and arterial blood gas results were normal. Urine output is a sensitive variable reflecting the patient's effective blood volume and tissue perfusion. Urinary catheterization is a standard for all cardiac surgeries and it allows the patients' urine to drain freely from the bladder for collection. Monitoring of urine output in patients with ureterosigmoidostomy is impossible by standard urinary catheterization method. In this casewe performed transrectal catheterization for Urine flow follow-up. Urine flow follow-up is essential after the open-heart surgery and it can be measured in different ways, as in our case.

The effect of endoscopic vein harvesting in coronary artery bypass surgery:association between vein harvesting techniques and quality of conduits,wound complications,and cardiovascular events

Objective The study aimed to compare quality of saphenous vein(SV)grafts,wound complications,and clinical outcomes between endoscopic vein harvesting(EVH)technique and open vein harvesting(OVH)technique of coronary artery bypass graft(CABG)surgery.Methods One hundred patients with multi-vessel coronary disease underwent elective CABG using SV grafts were prospectively recruited and randomized into two groups.

The Effects of Etomidate and Propofol Induction on Hemodynamic and Endocrine Response in Patients Undergoing Coronary Artery Bypass Graft Surgery on Cardiopulmonary Bypass

Aim: To compare the effects of propofol and etomidate induction on hemodynamic parameters and serum cortisol levels in patients with normal left ventricular function undergoing elective coronary artery bypass graft surgery on cardiopulmonary bypass. Material and Method: After approval from the Institute Ethics committee hundred American Society of Anesthesiologists (ASA) grade II or III patients undergoing scheduled coronary artery bypass surgery on cardiopulmonary bypass were enrolled in the study. Patients were allocated randomly to receive either propofol or etomidate for anesthesia induction. Anesthesia was maintained in both groups with sevoflurane, vecuronium bromide for muscle relaxation (0.1 mg/kg, boluses) and fentanyl up to a total dose of 20 mcg/kg. Result: The baseline serum cortisol values were within normal limits in both the groups. The serum cortisol levels in the propofol group increased more than two fold, whereas the values in the etomidate group decreased by close to fifty percent on weaning from cardiopulmonary bypass (CPB). There was no significant difference in serum cortisol levels in the two groups at twenty-four hours after induction, although the values were close to double the baseline levels. Hemodynamically, etomidate group was more stable than propofol group following induction of anesthesia (P < 0.05). Conclusion: The surge in serum cortisol levels on the initiation of CPB seen after the use of propofol is prevented by the use of etomidate. Serum cortisol levels in both groups are well above the baseline at twenty-four hours without any untoward effects. Etomidate provides more stable hemodynamic parameters when used for induction of anesthesia as compared to propofol.

Comparison of Coronary Artery Bypass Surgery Results in Patients under 40 and over 80

Purpose: Coronary artery disease incidence under 40 years age is increasing parallel with atherosclerotic disease at the present day while it’s seen frequently over 40. We compared the preoperative risk factors and early postoperative results of patients under 40 years age with those over 80 years age executed coronary artery bypass surgery in our clinic in this retrospective study. Patients and method: 128 patients (106 patients under 40 years age (Group 1) and 22 patients aged over 80 (Group 2)) executed coronary artery bypass surgery between January 2004 and June 2012 in our clinic are included in this study. Result: Mean age was 45.2 ± 17.2. Smoking, diabetes mellitus and high low density lipoprotein levels were the predisposing risk factors in Group 1 while hypertension and chronic obstructive pulmonary disease are predominated in the other. All patients are taken to surgical procedure under elective conditions. Aortic cross clamp duration were 37.02 ± 16.2 and 38.9 ± 13.5 minutes respectively;total cardiopulmonary bypass interval was 67.1 ± 26.3 minutes. Utilization of left internal mammarian artery was significantly higher (p = 0.01) in group 1 when compared in terms of graft management. Necessity of positive inotropic support (p = 0.033) and intraaortic balloon pump demand (p = 0.315) are found higher in Group 2. Atrial fibrillation, neurologic complications, delirium, wound infection, and postoperative revision demand are found significantly low (p = 0.136) in Group 1. There was no mortality in both groups. Discussion: Postoperative complications are seen more often in the elder group, while there was no significant difference in terms of mortality in both groups. Coronary revascularisation is safely practical in both young and elder patients with well early postoperative results and acceptable hospital mortality.

The effect of head and facial massage on sleep condition after coronary artery bypass graft surgery

Background:Sleep disorders after heart surgery lead to increased heart rate,myocardial oxygen demand,and cause dysrhythmia that worsens heart ischemia.The purpose of this study was to determine the effect of head and facial massage on sleep conditions following coronary artery bypass graft surgery.Materials and methods:A randomized controlled trial was performed on 72 patients.They were randomly divided into interventional(n=36)and control groups(n=36).On the third to fifth day after the operation,head and the facial massage were done for 15 min in the intervention group.The patients in the control group received only routine care.Richard Campbell’s Sleep Questionnaire was completed for four consecutive days for each group.Data were analyzed in SPSS V26.Results:Mean scores for sleep conditions before the intervention no statistically significant difference seen between the two groups(P>0.05).After the intervention,there was a statistically significant difference between mean scores for sleep conditions of the interventional and control groups(P<0.001).Also with general estimated equation test compared mean scores for sleep conditions between two groups.That revealed sleep condition total score in the intervention group was more than the control group and the trend of changes over time was statistically significant(P<0.001).Conclusion:Head and facial massage is an effective nursing intervention in improving the sleep condition of patients after coronary artery bypass graft.Due to the fact that head and face massage is an easy method and brings patient satisfaction,it is recommended to use this method as a suitable supplement for drug therapy and postoperative interventions in these patients.

The Effects of Clamp and Shunt Usage on Vascular Endothelium in Coronary Artery Bypass Grafting Surgery

In this review we aimed to present the effects of clamp and shunt usage on vascular endothelium in coronary artery surgery under the light of current literature data. Each surgical team or even each surgeon uses different methods in order to create bloodless surgical site during beating heart surgical procedures. Every method has its own advantages and disadvantages. There is no formed consensus regarding this issue. Surgeons still want to operate on bloodless surgical fields. But, they have concerns about continuity of blood flow and vascular endothelial injury during off-pump coronary surgery. In order to achieve a consensus statement about this issue, multicentric larger studies are needed.

Levosimendan usage in patients with left ventricle dysfunction in coronary artery bypass graft surgery

Introduction: In this study we explicated early results of patients (the patients in whom levosimendan was used) who underwent coronary artery bypass graft surgery with ejection fraction 35% or less. We compared this group with the patients in whom levo-simendan was not used. Material and Methods: 97 patients who have 35% ejection fraction or less taken to isolated coronary artery bypass surgery between January 2009 and December 2011 in our clinic are chosen for this study retrospectively. We compared the patients in whom levosimendan was used with the patients in whom levosimendan was not used. Levo- simendan (Simdax, Abbott) has been used according to surgeon’s decision in patients. Results: The mean age of group 1 was 62.3 ± 7.6, and the mean age of group 2 was 59.3 ± 10.5 (p > 0.05). It was detected that the average ejection fraction was less in group 1 (p 0.05). It was found that need for blood transfusion were less in group 1 than group 2 (p 0.05). Conclusion: We consider levosimendan reduces need for blood transfusion in coronary artery bypass graft surgery. This results may change with increasing number of patients so we consider that multicenter larger study is needed.

Using Magnesium Sulfate to Prevent Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery: A Single Centre Experience in Bangladesh

Background: Atrial fibrillation commonly occurs following cardiac surgery, particularly after coronary artery bypass grafting. Magnesium, known for its stabilizing effect on cell membranes, has shown promise in preventing postoperative atrial fibrillation. This study aimed to assess the impact of intravenous magnesium infusion in preventing atrial fibrillation after off-pump coronary artery bypass grafting, where maintaining stable cell membranes is crucial in averting this complication. Methods: A cross-sectional study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, from March 2020 to February 2022. Sixty-six patients who underwent off-pump coronary artery bypass grafting were enrolled and divided into two groups. Group A (n = 33) received intravenous magnesium sulfate (10 mmol/2.47gm) for three days after surgery, while Group B (n = 33) did not receive magnesium sulfate. Postoperative atrial fibrillation occurrence in the Intensive Care Unit (ICU) within three days after surgery was evaluated using convenient sampling. Statistical analysis was performed with SPSS version 26.0, utilizing independent Student’s t-test for continuous data and Chi-square and Fisher’s exact test for categorical data. A p-value of ≤0.05 was considered statistically significant. Results: No significant differences in age or gender were observed between the two groups. Group B exhibited significantly lower magnesium levels than Group A on the 0th, 1st, 2nd, and 3rd days post-surgery. Additionally, Group B experienced a higher incidence of postoperative atrial fibrillation, longer ICU stays, and two mortalities. The study did not detect any adverse effects associated with magnesium infusion. Conclusion: It has been demonstrated that administering magnesium intravenously after off-pump coronary artery bypass grafting can lower the chances of developing atrial fibrillation. This demonstrates the potential advantages of using magnesium as a preventative measure for postoperative atrial fibrillation in such cases.

Effect of Health Education Program on Self-Efficacy and Functional Capacity of Patients with Coronary Artery Bypass Surgery in Khartoum State-Sudan, 2015-2019

Coronary heart disease is among the most prevalent and costly of all global health problems. Coronary artery bypass grafting (CABG) has been increasingly used since the 1960s. Coronary heart disease is a leading cause of death worldwide, including Sudan. Self-efficacy and functional capacity is a critical factor for quality of life in patients who has undergone CABG as well as for their caregivers from their families. Aim of the Study: To explore the effects of an educational program on self-efficacy and functional capacity of patients after CABG. 1) There will be no significant difference between the intervention group and control group concerning knowledge regarding Self-efficacy and functional capacity post CABG surgery. 2) The application of our educational program for the patients will enhance the patients with CABG surgery and improve knowledge about Self-efficacy and functional capacity post CABG surgery. 3) There are some socio demographic factors that affect the response to the educational program. Methods: This was a quasi-experimental, interventional and hospital-based study, including pre-test, a post-test and follow-up test, with a control group, conducted during the period from September 2014 to June 2019. Patients were recruited consecutively to the cases and control group using convenience sampling. The sample consisted of 76 patients;41 as cases and 35 as control group. The sample included those who had undergone CABG in Khartoum State. Relevant data were collected using a checklist to monitor the effect of a health education program on self-efficacy and functional capacity of the patients. Result: The results showed marked improvement in patients’ self-efficacy and functional capacity between pretest and posttest for the study group;p-value = (0.001) in the health status of cases in comparison to the control group. The indices were observed to be higher for patients who received a nursing educational program throughout the study period;p-value = (0.002).

Risk Factors for Mortality of Patients Waiting for Elective Coronary Artery Bypass Graft Surgery

Background: Insufficient capacity for cardiac surgery results in extensive waiting time for patients requiring coronary artery bypass grafting (CABG). Previous studies have reported a consequence of an increased risk of mortality while waiting for CABG. Identification of risk factors for mortality is important in patients waiting for CABG. Objectives: To assess mortality rates and identify risk factors for mortality of patients waiting for CABG. Methods: This retrospective cohort study was done on patients waiting for elective CABG in dr. Kariadi General Hospital from January 2018 to December 2020. Identification of risk factors associated with mortality was done on patients who were waiting for CABG using logistic regression methods. Results: There were 162 patients fulfilling the criteria, with a mean waiting time for surgery of 9.8 months. While waiting for CABG surgery, 32 (19.7%) patients died of any cause. Independent risk factors for death while waiting for CABG included left ventricular ejection fraction ≤ 45% (OR 4.75;95% CI 1.76 - 12.78;p = 0.002), left main disease (OR 4.12;95% CI 1.50 - 11.27;p = 0.006), serum creatinine ≥ 1.5 mg/dl (OR 3.71;95% CI 1.41 - 9.74;p = 0.008), and a number of coronary artery disease risk factors ≥ 3 (OR 3.34;95% CI 1.24 - 8.99;p = 0.017). Conclusions: Long waiting time for CABG is associated with a high mortality rate which is influenced by left ventricular ejection fraction ≤ 45%, left main disease, serum creatinine ≥ 1.5 mg/dl, and a number of coronary arteries disease risk factors ≥ 3.

Awake off-pump coronary artery bypass surgery in 25 patients

Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Resuits The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotomy. There was no mortality. Mean length of stay in the intensive care unit was 16 .2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia

Is coronary artery bypass surgery riskier in female?

Introduction: In this study we examined the early results of coronary artery bypass surgery in our female patients and compared them with those of our male patients. Material and Methods: One thousand and ninety four patients who underwent coronary artery bypass surgery between January 2009 and December 2011 inour clinic were included into this study. Three hundred and thirteen female patients (group 1) were compared to 781 male patients (group 2). Results: The mean age of group 1 was 61.4 ± 9.6, and the mean age of group 2 was 58.1 ± 9.6 (p < 0.001). The ratio of diabetes mellitus and hypertension in group 1 was higher than that of group 2 (p < 0.001). There were no significant difference between two groups when compared regarding the need for inotropics after weaning from cardiopulmonary bypass, cross clamp and total cardiopulmonary bypass periods (p > 0.05). It was found that the amount of drainage was higher in group 1 than group 2 (p < 0.001). There was no significant difference between two groups when compared in terms of mortality, re-operation (because of bleeding), postoperative atrial fibrillation, need for intraaortic balloon pump, usage of levosimendan, cerebrovascular accident, chronic renal failure, discharging intervals and period in intensive care unit. It was found that sternal wound infection was higher in group 1 than group 2 (p < 0.05). Conclusion: We consider that female gender does not put an additional risk to increase mortality and morbidity in coronary artery bypass surgery.

Predictive risk factors for prolonged stay in intensive care unit in patients undergoing coronary artery bypass grafting surgery

Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses

Predictive value of SinoSCORE on in-hospital mortality and postoperative complications after coronary artery bypass surgery

Objective To evaluate the performance of the Sino System for Coronary Operative Risk Evaluation (SinoSCORE) on in hospital mortality and postoperative complications in patients undergoing coronary artery bypass grafting (CABG) in a single heart center. Methods From January 2007 to December 2008,clinical information of 201 consecutive patients undergoing isolated CABG in our hospital was collected. The SinoSCORE was used to

Predictive risk factors associated with prolonged stay in the intensive care unit for patients undergoing coronary artery bypass grafting surgery

Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital

The prediction of early mortality in off-pump coronary artery bypass surgery:SinoSCORE versus EuroSCORE

Objective To compare the validation of the Sino System for Coronary Operative Risk Evaluation (SinoSCORE) with the European system for cardiac operative risk evaluation (EuroSCORE) in patients undergoing off-pump coronary artery bypass (OPCAB) surgery in China. Methods Data of patients who underwent OPCAB between 2004 and 2005 in