BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to ...BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.展开更多
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 posto...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.展开更多
BACKGROUND One of the major perioperative complications for coronary artery bypass graft(CABG)is stroke.The risk of perioperative stroke after CABG is approximately 2%.Carotid stenosis(CS)is considered an independent ...BACKGROUND One of the major perioperative complications for coronary artery bypass graft(CABG)is stroke.The risk of perioperative stroke after CABG is approximately 2%.Carotid stenosis(CS)is considered an independent predictor of perioperative stroke risk in CABG patients.The optimal management of such patients has been a source of controversy.One of the possible surgical options is synchronous carotid endarterectomy(CEA)and CABG.Here,we have presented 4 cases of successful synchronous CEA and CABG.Our center’s experience with 4 cases of significant carotid artery stenosis,which were successfully managed with combined CEA and CABG,are detailed.The first case was a female who presented for CABG after a ST-elevation myocardial infarction.She had right internal carotid artery(ICA)occlusion and 90%left ICA stenosis.The second case was a male who was electively admitted for CABG.It was discovered that he had left ICA occlusion and 90%right ICA stenosis.The third case was a male with a history of stroke,two months prior to admission.He presented with non-ST-elevation myocardial infarction.Preoperatively,it was discovered that he had>90%right ICA stenosis.The final case was a male who was electively admitted for CABG.It was discovered that he had bilateral>90%ICA stenosis.We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG.CONCLUSION Our case series demonstrated that synchronous CEA and CABG was safe.A multicenter study with additional patients is needed.It is necessary for clinicians to screen for CS in high-risk patients with features.展开更多
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 ...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.展开更多
BACKGROUND Most patients with cardiovascular disorders suffer from coronary artery diseases,which can be treated successfully using coronary artery bypass grafting(CABG).One of the unpleasant events following CABG is ...BACKGROUND Most patients with cardiovascular disorders suffer from coronary artery diseases,which can be treated successfully using coronary artery bypass grafting(CABG).One of the unpleasant events following CABG is postoperative vision loss(POVL).Vulnerability of retinal vessels to hemodynamic changes,an expectable event following CABG,may contribute to the development of POVL,which might be associated with the changes in the choroidal and retinal structures.AIM To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer(NFL)thickness,and progression of diabetic and hypertensive retinopathy after CABG.METHODS In this prospective,cross-sectional study,49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery.RESULTS Among the study participants,56%were male with a mean age of 62.84 years±10.49 years(range 33–80 years).Diabetes mellitus was observed in eight participants(32%).None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy,central retinal artery occlusion,and cortical blindness.The mean value of the preoperative best corrected visual acuity was 0.11±0.10 logMAR(range,0–0.4),which worsened to 0.15±0.08 logMAR(range,0–0.4)after CABG(P=0.031).No significant difference was observed between the preand postsurgical choroidal(P=0.853)and macular(P=0.507)thickness,NFL thickness in the subfoveal(P>0.999)and peripapillary areas(P=0.659),as well as the severity of diabetic and hypertensive retinopathy.CONCLUSION CABG may reduce visual acuity without affecting ocular structures.Postoperative vision reduction might be attributable to molecular or cellular variations,changes in visual pathway function,or central nervous system.展开更多
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 preven...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 0<sup>th</sup>, 1<sup>st</sup>, 2<sup>nd</sup>, and 3<sup>rd</sup> 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.展开更多
Background: Risk stratification of long-term outcomes for patients undergoing Coronary artery bypass grafting has enormous potential clinical importance. Aim: To develop risk stratification models for predicting long-...Background: Risk stratification of long-term outcomes for patients undergoing Coronary artery bypass grafting has enormous potential clinical importance. Aim: To develop risk stratification models for predicting long-term outcomes following coronary artery bypass graft (CABG) surgery. Methods: We retrospectively revised the electronic medical records of 2330 patients who underwent adult Cardiac surgery between August 2016 and December 2022 at Madinah Cardiac Center, Saudi Arabia. Three hundred patients fulfilled the eligibility criteria of CABG operations with a complete follow-up period of at least 24 months, and data reporting. The collected data included patient demographics, comorbidities, laboratory data, pharmacotherapy, echocardiographic parameters, procedural details, postoperative data, in-hospital outcomes, and follow-up data. Our follow-up was depending on the clinical status (NYHA class), chest pain recurrence, medication dependence and echo follow-up. A univariate analysis was performed between each patient risk factor and the long-term outcome to determine the preoperative, operative, and postoperative factors significantly associated with each long-term outcome. Then a multivariable logistic regression analysis was performed with a stepwise, forward selection procedure. Significant (p < 0.05) risk factors were identified and were used as candidate variables in the development of a multivariable risk prediction model. Results: The incidence of all-cause mortality during hospital admission or follow-up period was 2.3%. Other long-term outcomes included all-cause recurrent hospitalization (9.8%), recurrent chest pain (2.4%), and the need for revascularization by using a stent in 5 (3.0%) patients. Thirteen (4.4%) patients suffered heart failure and they were on the maximum anti-failure medications. The model for predicting all-cause mortality included the preoperative EF ≤ 35% (AOR: 30.757, p = 0.061), the bypass time (AOR: 1.029, p = 0.003), and the duration of ventilation following the operation (AOR: 1.237, p = 0.021). The model for risk stratification of recurrent hospitalization comprised the preoperative EF ≤ 35% (AOR: 6.198, p p = 0.023), low postoperative cardiac output (AOR: 3.622, p = 0.007), and the development of postoperative atrial fibrillation (AOR: 2.787, p = 0.038). Low postoperative cardiac output was the only predictor that significantly contributed to recurrent chest pain (AOR: 11.66, p = 0.004). Finally, the model consisted of low postoperative cardiac output (AOR: 5.976, p < 0.001) and postoperative ventricular fibrillation (AOR: 4.216, p = 0.019) was significantly associated with an increased likelihood of the future need for revascularization using a stent. Conclusions: A risk prediction model was developed in a Saudi cohort for predicting all-cause mortality risk during both hospital admission and the follow-up period of at least 24 months after isolated CABG surgery. A set of models were also developed for predicting long-term risks of all-cause recurrent hospitalization, recurrent chest pain, heart failure, and the need for revascularization by using stents.展开更多
Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of ...Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of POD among patients who had coronary artery bypass grafting (CABG) in China.Methods: A prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients un-dergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, mini-mizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Out-comes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main results: Delirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48%(19/141) vs. 29.93%(41/137) for the Control Group (x2=11.112, P=0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (x2=12.743, P<0.001). Length of ICU stay was reduced significantly (Z= -6.026, P<0.001). Conclusion: The application of a nursing protocol targeting risk factors in this study seems to be asso-ciated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium.展开更多
A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left low...A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left lower lobectomy were performed through median sternotomy. This approach avoids complications due to staged operations and cardiopulmonary bypass (CPB). This report shows that simultaneous off pump CABG and pulmonary operations can be performed safely in patients with coronary artery disease (CAD) associated with lung cancer.展开更多
This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standar...This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standard bridging technique (SBT, n=72) in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups (P〉0.05). There were no statistical differences in total operation time (226±28 min vs. 224±30 min, P〉0.05), number of damaged vessels (0.12±0.05 vs. 0.16±0.06, P〉0.05) and short medium-term outcomes including revascularization rate (1.25% vs. 2.78%, P〉0.05), vessel dysfunction rate (11.25% vs. 11.11%, P〉0.05) and mortality (0.00% vs. 0.00%, P〉0.05). Use of EVH was associated with significant reduction of total harvesting time (41±6 min vs. 63±11 min, P〈0.05), incision length (4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05) and postoperative lower extremity complications (P〈0.05). EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.展开更多
Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF...Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312 (33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥ 70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm), a history of AF, prolonged p-wave duration (≥ 120 ms) and increased number of grafts (≥13). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of 13-blockers, hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.展开更多
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 ...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.展开更多
Objective: To evaluate the clinical effect and quality of life (QOL) in coronary artery bypass grafting (CABG) patients treated according to syndrome differentiation of TCM. Methods: Eighty-two CABG patients were allo...Objective: To evaluate the clinical effect and quality of life (QOL) in coronary artery bypass grafting (CABG) patients treated according to syndrome differentiation of TCM. Methods: Eighty-two CABG patients were allocated in the control group (n = 39) treated with conventional method of western medicine, and the TCM-treated group (n展开更多
BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound inf...BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery(CABG),in which the left internal mammary artery(LIMA)is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used.This study determined whether these favorable clinical results could be realized at the authors’institute.AIM To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery.METHODS CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019.LIMA was used in 35 patients,radial artery(RA)was used in 35 patients,and right gastroepiploic artery(RGEA)was used in 9 patients.Perioperative complications were observed,short-term graft patency rate was followed-up,and quality of life was assessed.RESULTS All patients underwent off-pump coronary artery bypass and the surgeries were successful.All of them were discharged without any complications or deaths.During the follow-up,it was found that patients’angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II.A total of 90 vessels were grafted with no occlusion for internal mammary artery,three occlusions for RA,and one occlusion for RGEA.CONCLUSION The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.展开更多
Porcelain aorta(PA)is an asymptomatic atherosclerotic disease,characterized by circumferential calcification throughout the whole perimeter of the aorta.It is seen in 2%to 9.3%of patients undergoing elective coronary ...Porcelain aorta(PA)is an asymptomatic atherosclerotic disease,characterized by circumferential calcification throughout the whole perimeter of the aorta.It is seen in 2%to 9.3%of patients undergoing elective coronary artery bypass grafting(CABG)and makes manipulation of the ascending aorta impossible.It has been clearly shown that most emboli seen and detected during the CABG procedure occur during aortic cross-clamping and aortic side-clamping.Manipulation of porcelain or a severely atherosclerotic aorta increases the risk of perioperative stroke.The incidence of stroke after CABG is between 0.48%and 2.9%,and the risk is correlated with the extent and severity of the atherosclerotic disease.A conventional CABG procedure involves successive steps that include cannulation of the ascending aorta,application of a cross-clamp to the aorta,and partial clamping of the aorta to create the proximal anastomosis.Therefore in procedures that involve cannulation,clamping,or proximal anastomosis,and where aortic manipulation is inevitable,preassessment of the atherosclerotic aortic plaques is crucial.Although many surgeons still rely on intraoperative manual aortic palpation,this approach has very low sensitivity and underestimates the severity of the atherosclerotic illness.Imaging methods including preoperative computed tomography or intraoperative epiaortic ultrasonography enable modification of the surgical technique according to the severity of atherosclerosis.Various surgical techniques have been described to reduce the risk of atheroembolism that may lead to cerebrovascular events in patients with severely atherosclerotic ascending aorta.Anaortic or“no-touch”techniques that do not utilize aortic manipulation may significantly decrease the development of neurological complications by avoiding aortic maneuvers known to cause emboli.In cases where severe atherosclerotic disease or other factors preclude safe use of the ascending aorta,modifications in the surgical techniques,such as switching to different cannulation sites including the axillary/subclavian,femoral and innominate arteries,or using hypothermic ventricular fibrillation and in-situ pedicled arterial grafts,or performing proximal anastomoses at alternative anatomical locations will enable CABG operations to be performed safely with low morbidity and mortality rates in patients with porcelain aortas.展开更多
Transesophapeal echocardiography (TEE) can be used as a diagnostic tool during cardiac surgery to direct the surgical procedure and diagnose unanticipated problems. TEE has also been one of the most important means ...Transesophapeal echocardiography (TEE) can be used as a diagnostic tool during cardiac surgery to direct the surgical procedure and diagnose unanticipated problems. TEE has also been one of the most important means of monitoring myocardial ischemia dur- ing coronary artery bypas grafting procedures. The cardiac anesthesiologist can apply intraoperative TEE in evaluating coronary artery anatomy and aorta atherosclerosis, assessing diastolic left ventricular function and preload,measuring intracardiac pressure and cardiac output,detecting ischaemic mitral regurgitation,intracardiac air and pericardial effusion.展开更多
In this study we reported one case of combined procedure for coronary artery bypass grafting and excision of right pulmonary hydatid cyst. Concerns of possible hydatid systemic dissemination as a result of direct vasc...In this study we reported one case of combined procedure for coronary artery bypass grafting and excision of right pulmonary hydatid cyst. Concerns of possible hydatid systemic dissemination as a result of direct vascular breaches are raised. We suggest that avoidance of cardiopulmonary bypass (CPB) if that possible is beneficial for the treatment. If not possible then the excision and clearance of the hydatid cyst should be done in the first place before going on bypass.展开更多
This study is a prospective trial comparing the incidence of post-operative complications to fluid status in patients undergoing coronary artery bypass grafting (CABG) surgery. One hundred and nine subjects undergoing...This study is a prospective trial comparing the incidence of post-operative complications to fluid status in patients undergoing coronary artery bypass grafting (CABG) surgery. One hundred and nine subjects undergoing CABG surgery at the Jewish general hospital were recruited over a 5 months period in the year 2006. All of the patients underwent CABG surgery “on pump”. Post operative fluid overload was measured by weight gain. Using logistic regression with complications (major vs. minor only/none) as an outcome and fluid overload as a covariate, the risk of major complications significantly increases for fluid overload ≥5 kg compared to 1 - 5 kg (p < 0.001), while the risk for ≤1 kg is not significantly different from 1 - 5 kg. Also, the risk of major complications significantly (p = 0.012) increases for days with fluid overload ≥5 days in comparison to ≤1 day.展开更多
BACKGROUND Although early abdominal complications after coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB)are rare,the associated mortality remains high.AIM To develop a risk score for the predictio...BACKGROUND Although early abdominal complications after coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB)are rare,the associated mortality remains high.AIM To develop a risk score for the prediction of early abdominal complications after CABG with CPB.METHODS This retrospective study was performed in the Federal State Budgetary Establishment“Federal Center of Cardiovascular Surgery”of the Ministry of Health of Russia(the city of Chelyabinsk)and included data of 6586 patients who underwent CABG with CPB during 2011-2017.The risk factors taken for evaluation were compared between patients with early abdominal complications(n=73)and without them(n=6513).We identified the most important risk factors and their influence on the development of early abdominal complications after CABG with CPB.RESULTS Gender and the presence of postinfarction cardiosclerosis,chronic kidney disease,or diabetes in the anamnesis did not affect the occurrence of abdominal complications.The leading risk factors of the early abdominal complications after CABG with CPB were multifocal atherosclerosis,extracorporeal membrane oxygenation,intra-aortic balloon pump,atrial fibrillation,perioperative myocardial infarction,and the need for resternotomy in the postoperative period.The average value of the predicted probability was 0.087±0.015 in patients with early abdominal complications after CABG with CPB and 0.0094±0.0003 in patients without these complications.The percentage of correct classification turned out to be 98.9%.After calculating a score for each of the leading risk factors,we counted a total score for each particular patient.The highest risk was noted in patients with a total score of 7 or more.CONCLUSION The developed score predicts the risk of early abdominal complications after CABG with CPB and makes it possible to stratify patients by risk groups.展开更多
New surgical techniques for coronary artery bypass graft (CABG) have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgica...New surgical techniques for coronary artery bypass graft (CABG) have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expense can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.展开更多
文摘BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.
文摘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.
文摘BACKGROUND One of the major perioperative complications for coronary artery bypass graft(CABG)is stroke.The risk of perioperative stroke after CABG is approximately 2%.Carotid stenosis(CS)is considered an independent predictor of perioperative stroke risk in CABG patients.The optimal management of such patients has been a source of controversy.One of the possible surgical options is synchronous carotid endarterectomy(CEA)and CABG.Here,we have presented 4 cases of successful synchronous CEA and CABG.Our center’s experience with 4 cases of significant carotid artery stenosis,which were successfully managed with combined CEA and CABG,are detailed.The first case was a female who presented for CABG after a ST-elevation myocardial infarction.She had right internal carotid artery(ICA)occlusion and 90%left ICA stenosis.The second case was a male who was electively admitted for CABG.It was discovered that he had left ICA occlusion and 90%right ICA stenosis.The third case was a male with a history of stroke,two months prior to admission.He presented with non-ST-elevation myocardial infarction.Preoperatively,it was discovered that he had>90%right ICA stenosis.The final case was a male who was electively admitted for CABG.It was discovered that he had bilateral>90%ICA stenosis.We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG.CONCLUSION Our case series demonstrated that synchronous CEA and CABG was safe.A multicenter study with additional patients is needed.It is necessary for clinicians to screen for CS in high-risk patients with features.
基金The present study is extracted from an M.A.thesis conducted in Nasibeh School of Nursing and Midwifery at Mazandaran University of Medical Sciences with proposal No.of IR.MAZUMS.REC.1399.803supported by Mazandaran University of Medical Sciences(grant number 8524).
文摘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.
文摘BACKGROUND Most patients with cardiovascular disorders suffer from coronary artery diseases,which can be treated successfully using coronary artery bypass grafting(CABG).One of the unpleasant events following CABG is postoperative vision loss(POVL).Vulnerability of retinal vessels to hemodynamic changes,an expectable event following CABG,may contribute to the development of POVL,which might be associated with the changes in the choroidal and retinal structures.AIM To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer(NFL)thickness,and progression of diabetic and hypertensive retinopathy after CABG.METHODS In this prospective,cross-sectional study,49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery.RESULTS Among the study participants,56%were male with a mean age of 62.84 years±10.49 years(range 33–80 years).Diabetes mellitus was observed in eight participants(32%).None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy,central retinal artery occlusion,and cortical blindness.The mean value of the preoperative best corrected visual acuity was 0.11±0.10 logMAR(range,0–0.4),which worsened to 0.15±0.08 logMAR(range,0–0.4)after CABG(P=0.031).No significant difference was observed between the preand postsurgical choroidal(P=0.853)and macular(P=0.507)thickness,NFL thickness in the subfoveal(P>0.999)and peripapillary areas(P=0.659),as well as the severity of diabetic and hypertensive retinopathy.CONCLUSION CABG may reduce visual acuity without affecting ocular structures.Postoperative vision reduction might be attributable to molecular or cellular variations,changes in visual pathway function,or central nervous system.
文摘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 0<sup>th</sup>, 1<sup>st</sup>, 2<sup>nd</sup>, and 3<sup>rd</sup> 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.
文摘Background: Risk stratification of long-term outcomes for patients undergoing Coronary artery bypass grafting has enormous potential clinical importance. Aim: To develop risk stratification models for predicting long-term outcomes following coronary artery bypass graft (CABG) surgery. Methods: We retrospectively revised the electronic medical records of 2330 patients who underwent adult Cardiac surgery between August 2016 and December 2022 at Madinah Cardiac Center, Saudi Arabia. Three hundred patients fulfilled the eligibility criteria of CABG operations with a complete follow-up period of at least 24 months, and data reporting. The collected data included patient demographics, comorbidities, laboratory data, pharmacotherapy, echocardiographic parameters, procedural details, postoperative data, in-hospital outcomes, and follow-up data. Our follow-up was depending on the clinical status (NYHA class), chest pain recurrence, medication dependence and echo follow-up. A univariate analysis was performed between each patient risk factor and the long-term outcome to determine the preoperative, operative, and postoperative factors significantly associated with each long-term outcome. Then a multivariable logistic regression analysis was performed with a stepwise, forward selection procedure. Significant (p < 0.05) risk factors were identified and were used as candidate variables in the development of a multivariable risk prediction model. Results: The incidence of all-cause mortality during hospital admission or follow-up period was 2.3%. Other long-term outcomes included all-cause recurrent hospitalization (9.8%), recurrent chest pain (2.4%), and the need for revascularization by using a stent in 5 (3.0%) patients. Thirteen (4.4%) patients suffered heart failure and they were on the maximum anti-failure medications. The model for predicting all-cause mortality included the preoperative EF ≤ 35% (AOR: 30.757, p = 0.061), the bypass time (AOR: 1.029, p = 0.003), and the duration of ventilation following the operation (AOR: 1.237, p = 0.021). The model for risk stratification of recurrent hospitalization comprised the preoperative EF ≤ 35% (AOR: 6.198, p p = 0.023), low postoperative cardiac output (AOR: 3.622, p = 0.007), and the development of postoperative atrial fibrillation (AOR: 2.787, p = 0.038). Low postoperative cardiac output was the only predictor that significantly contributed to recurrent chest pain (AOR: 11.66, p = 0.004). Finally, the model consisted of low postoperative cardiac output (AOR: 5.976, p < 0.001) and postoperative ventricular fibrillation (AOR: 4.216, p = 0.019) was significantly associated with an increased likelihood of the future need for revascularization using a stent. Conclusions: A risk prediction model was developed in a Saudi cohort for predicting all-cause mortality risk during both hospital admission and the follow-up period of at least 24 months after isolated CABG surgery. A set of models were also developed for predicting long-term risks of all-cause recurrent hospitalization, recurrent chest pain, heart failure, and the need for revascularization by using stents.
基金The study was funded by the Committee of Health and Family Planning of Shanghai,China(project number 201440100)
文摘Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of POD among patients who had coronary artery bypass grafting (CABG) in China.Methods: A prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients un-dergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, mini-mizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Out-comes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main results: Delirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48%(19/141) vs. 29.93%(41/137) for the Control Group (x2=11.112, P=0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (x2=12.743, P<0.001). Length of ICU stay was reduced significantly (Z= -6.026, P<0.001). Conclusion: The application of a nursing protocol targeting risk factors in this study seems to be asso-ciated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium.
文摘A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left lower lobectomy were performed through median sternotomy. This approach avoids complications due to staged operations and cardiopulmonary bypass (CPB). This report shows that simultaneous off pump CABG and pulmonary operations can be performed safely in patients with coronary artery disease (CAD) associated with lung cancer.
文摘This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standard bridging technique (SBT, n=72) in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups (P〉0.05). There were no statistical differences in total operation time (226±28 min vs. 224±30 min, P〉0.05), number of damaged vessels (0.12±0.05 vs. 0.16±0.06, P〉0.05) and short medium-term outcomes including revascularization rate (1.25% vs. 2.78%, P〉0.05), vessel dysfunction rate (11.25% vs. 11.11%, P〉0.05) and mortality (0.00% vs. 0.00%, P〉0.05). Use of EVH was associated with significant reduction of total harvesting time (41±6 min vs. 63±11 min, P〈0.05), incision length (4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05) and postoperative lower extremity complications (P〈0.05). EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.
基金This study was supported by 135 foundation of Jiangsu province
文摘Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312 (33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥ 70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm), a history of AF, prolonged p-wave duration (≥ 120 ms) and increased number of grafts (≥13). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of 13-blockers, hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.
基金supported by National Natural S cience Foundation of China(81570373)。
文摘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.
文摘Objective: To evaluate the clinical effect and quality of life (QOL) in coronary artery bypass grafting (CABG) patients treated according to syndrome differentiation of TCM. Methods: Eighty-two CABG patients were allocated in the control group (n = 39) treated with conventional method of western medicine, and the TCM-treated group (n
文摘BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery(CABG),in which the left internal mammary artery(LIMA)is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used.This study determined whether these favorable clinical results could be realized at the authors’institute.AIM To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery.METHODS CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019.LIMA was used in 35 patients,radial artery(RA)was used in 35 patients,and right gastroepiploic artery(RGEA)was used in 9 patients.Perioperative complications were observed,short-term graft patency rate was followed-up,and quality of life was assessed.RESULTS All patients underwent off-pump coronary artery bypass and the surgeries were successful.All of them were discharged without any complications or deaths.During the follow-up,it was found that patients’angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II.A total of 90 vessels were grafted with no occlusion for internal mammary artery,three occlusions for RA,and one occlusion for RGEA.CONCLUSION The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.
文摘Porcelain aorta(PA)is an asymptomatic atherosclerotic disease,characterized by circumferential calcification throughout the whole perimeter of the aorta.It is seen in 2%to 9.3%of patients undergoing elective coronary artery bypass grafting(CABG)and makes manipulation of the ascending aorta impossible.It has been clearly shown that most emboli seen and detected during the CABG procedure occur during aortic cross-clamping and aortic side-clamping.Manipulation of porcelain or a severely atherosclerotic aorta increases the risk of perioperative stroke.The incidence of stroke after CABG is between 0.48%and 2.9%,and the risk is correlated with the extent and severity of the atherosclerotic disease.A conventional CABG procedure involves successive steps that include cannulation of the ascending aorta,application of a cross-clamp to the aorta,and partial clamping of the aorta to create the proximal anastomosis.Therefore in procedures that involve cannulation,clamping,or proximal anastomosis,and where aortic manipulation is inevitable,preassessment of the atherosclerotic aortic plaques is crucial.Although many surgeons still rely on intraoperative manual aortic palpation,this approach has very low sensitivity and underestimates the severity of the atherosclerotic illness.Imaging methods including preoperative computed tomography or intraoperative epiaortic ultrasonography enable modification of the surgical technique according to the severity of atherosclerosis.Various surgical techniques have been described to reduce the risk of atheroembolism that may lead to cerebrovascular events in patients with severely atherosclerotic ascending aorta.Anaortic or“no-touch”techniques that do not utilize aortic manipulation may significantly decrease the development of neurological complications by avoiding aortic maneuvers known to cause emboli.In cases where severe atherosclerotic disease or other factors preclude safe use of the ascending aorta,modifications in the surgical techniques,such as switching to different cannulation sites including the axillary/subclavian,femoral and innominate arteries,or using hypothermic ventricular fibrillation and in-situ pedicled arterial grafts,or performing proximal anastomoses at alternative anatomical locations will enable CABG operations to be performed safely with low morbidity and mortality rates in patients with porcelain aortas.
文摘Transesophapeal echocardiography (TEE) can be used as a diagnostic tool during cardiac surgery to direct the surgical procedure and diagnose unanticipated problems. TEE has also been one of the most important means of monitoring myocardial ischemia dur- ing coronary artery bypas grafting procedures. The cardiac anesthesiologist can apply intraoperative TEE in evaluating coronary artery anatomy and aorta atherosclerosis, assessing diastolic left ventricular function and preload,measuring intracardiac pressure and cardiac output,detecting ischaemic mitral regurgitation,intracardiac air and pericardial effusion.
文摘In this study we reported one case of combined procedure for coronary artery bypass grafting and excision of right pulmonary hydatid cyst. Concerns of possible hydatid systemic dissemination as a result of direct vascular breaches are raised. We suggest that avoidance of cardiopulmonary bypass (CPB) if that possible is beneficial for the treatment. If not possible then the excision and clearance of the hydatid cyst should be done in the first place before going on bypass.
文摘This study is a prospective trial comparing the incidence of post-operative complications to fluid status in patients undergoing coronary artery bypass grafting (CABG) surgery. One hundred and nine subjects undergoing CABG surgery at the Jewish general hospital were recruited over a 5 months period in the year 2006. All of the patients underwent CABG surgery “on pump”. Post operative fluid overload was measured by weight gain. Using logistic regression with complications (major vs. minor only/none) as an outcome and fluid overload as a covariate, the risk of major complications significantly increases for fluid overload ≥5 kg compared to 1 - 5 kg (p < 0.001), while the risk for ≤1 kg is not significantly different from 1 - 5 kg. Also, the risk of major complications significantly (p = 0.012) increases for days with fluid overload ≥5 days in comparison to ≤1 day.
文摘BACKGROUND Although early abdominal complications after coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB)are rare,the associated mortality remains high.AIM To develop a risk score for the prediction of early abdominal complications after CABG with CPB.METHODS This retrospective study was performed in the Federal State Budgetary Establishment“Federal Center of Cardiovascular Surgery”of the Ministry of Health of Russia(the city of Chelyabinsk)and included data of 6586 patients who underwent CABG with CPB during 2011-2017.The risk factors taken for evaluation were compared between patients with early abdominal complications(n=73)and without them(n=6513).We identified the most important risk factors and their influence on the development of early abdominal complications after CABG with CPB.RESULTS Gender and the presence of postinfarction cardiosclerosis,chronic kidney disease,or diabetes in the anamnesis did not affect the occurrence of abdominal complications.The leading risk factors of the early abdominal complications after CABG with CPB were multifocal atherosclerosis,extracorporeal membrane oxygenation,intra-aortic balloon pump,atrial fibrillation,perioperative myocardial infarction,and the need for resternotomy in the postoperative period.The average value of the predicted probability was 0.087±0.015 in patients with early abdominal complications after CABG with CPB and 0.0094±0.0003 in patients without these complications.The percentage of correct classification turned out to be 98.9%.After calculating a score for each of the leading risk factors,we counted a total score for each particular patient.The highest risk was noted in patients with a total score of 7 or more.CONCLUSION The developed score predicts the risk of early abdominal complications after CABG with CPB and makes it possible to stratify patients by risk groups.
文摘New surgical techniques for coronary artery bypass graft (CABG) have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expense can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.