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.

Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.

Response characteristics of PWR primary circuit under SBLOCAs considering steam bypass discharging

Small-break superposed station blackout(SBO)accidents are the basic design accidents of nuclear power plants.Under the condition of a small break in the cold leg,SBO further increases the severity of the accident,and the steam bypass discharg-ing system(GCT)in the second circuit can play an important role in guaranteeing core safety.To explore the influence of the GCT on the thermal-hydraulic characteristics of the primary circuit,RELAP5 software was used to establish a numerical model based on a typical pressurized water reactor nuclear power plant.Five different small breaks in the cold-leg super-posed SBO were selected,and the impact of the GCT operation on the transient response characteristics of the primary and secondary circuit systems was analyzed.The results show that the GCT plays an indispensable role in core heat removal during an accident;otherwise,core safety cannot be guaranteed.The GCT was used in conjunction with the primary safety injection system during the placement process.When the break diameter was greater than a certain critical value,the core cooling rate could not be guaranteed to be less than 100 K/h;however,the core remained in a safe state.

Effects of sevoflurane on left ventricular function by speckletracking echocardiography in coronary bypass patients: A randomized trial

The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.

Results of the First 10 Cases of Coronary Bypass Surgery in Senegal

This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.

Abnormal ACT in a Patient with Prekallikrein Deficiency Undergoing Cardiopulmonary Bypass

Prekallikrein deficiency is a disorder that often remains undiagnosed. Prekallikrein activates factor XII, which initiates the intrinsic coagulation pathway. Prekallikrein deficiency results in prolonged Partial Thromboplastin Time and Activated Clotting Time in absence of anticoagulants or active bleeding. This case report describes the anesthesia management of a patient with Prekallikrein deficiency who underwent cardiac surgery with Cardiopulmonary Bypass for correction of a congenital cardiac malformation. We highlight the importance of understanding the different tests available for the diagnosis of coagulation factors deficiency during administration of heparin in the setting of cardiovascular procedures under general anesthesia.

Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III obesity.It aids in significant weight loss and improves obesity-related medical conditions.Despite its effectiveness,postoperative care still has challenges.Clinical evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after RYGB.Therefore,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB candidates.AIM To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing RYGB.METHODS Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of RYGB.The resultant risk scores were derived from the coefficients of statistically significant variables.The performance of the model was evaluated using receiver operating curves through 5-fold cross-validation.RESULTS Of the 26 initial variables,six predictors were identified.These included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(P<0.001),length of stay(Coef 0.08,P<0.001),prior deep venous thrombosis(Coef 1.61,P<0.001),hemoglobin A1c>7%(Coef 1.19,P<0.001),venous stasis history(Coef 1.43,P<0.001),and preoperative anticoagulation use(Coef 1.24,P<0.001).These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk post-RYGB.The risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of 0.91.Without training,the same model performed satisfactorily in patients with laparoscopic sleeve gastrectomy with an AUC of 0.63(95%CI:0.62-0.64)and endoscopic sleeve gastroplasty with an AUC of 0.76(95%CI:0.75-0.78).CONCLUSION This simple risk model uses only six variables to assist clinicians in the preoperative risk stratification of RYGB patients,offering insights into factors that heighten the risk of VTE events.

Analysis of long-term outcome of modified gastric bypass for type 2 diabetes mellitus in Chinese patients

BACKGROUND Bariatric and metabolic surgery have been routinely performed following the rapid increase in obesity and metabolic diseases worldwide.Of all evolving procedures,Roux-en-Y gastric bypass(RYGB)is considered the gold standard for surgical treatment of patients with type 2 diabetes mellitus(T2DM)and obesity.RYGB was introduced in China nearly 20 years ago,but the number of RYGB surgeries only accounts for 3.1%of the total number of weight loss and metabolic surgeries in China,it’s effect on Chinese people still needs further study.AIM To investigate the effect and safety of a modified gastric bypass performed in Chinese patients with T2DM.METHODS Patients with obesity and T2DM who underwent modified gastric bypass,with>5-year follow-up data,were analyzed.RESULTS All 37 patients underwent uneventful laparoscopic surgery,no patient was switched to laparotomy during the surgery,and no severe complications were reported.Average weight and body mass index of the patients reduced from 84.6±17.3(60.0–140.0)kg and 30.9±5.0(24.7–46.2)kg/m2 to 67.1±12.2(24.7–46.2)kg and 24.6±3.9(17.7–36.5)kg/m2,respectively,and fasting plasma glucose and glycated hemoglobin decreased from 7.4±3.4 mmol/L and 8.2%±1.7%preoperatively to 6.5±1.3 mmol/L and 6.5%±0.9%5-years postoperatively,respectively.Only 29.7%(11/37)of the patients used hypoglycemic drugs 5-years postoperatively,and the complete remission rate of T2DM was 29.7%(11/37).Triglyceride level reduced significantly but high-density lipoprotein increased significantly(both P<0.05)compared with those during the preoperative period.Liver and renal function improved significantly postoperatively,and binary logistic regression analysis revealed that the patients’preoperative history of T2DM and fasting C-peptide were significant prognostic factors influencing complete T2DM remission after RYGB(P=0.006 and 0.012,respectively).CONCLUSION The modified gastric bypass is a safe and feasible procedure for Chinese patients with obesity and T2DM,exhibiting satisfactory amelioration of weight problems,hyperglycemia,and combination disease.

Duodenal-jejunal bypass improves hypothalamic oxidative stress and inflammation in diabetic rats via glucagon-like peptide 1-mediated Nrf2/HO-1 signaling

BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal jejunal bypass(DJB)surgery significantly improves brain glucose metabolism in T2DM rats,the role and the metabolism of DJB in improving brain oxidative stress and inflammation condition in T2DM rats remain unclear.AIM To investigate the role and metabolism of DJB in improving hypothalamic oxidative stress and inflammation condition in T2DM rats.METHODS A T2DM rat model was induced via a high-glucose and high-fat diet,combined with a low-dose streptozotocin injection.T2DM rats were divided into DJB operation and Sham operation groups.DJB surgical intervention was carried out on T2DM rats.The differential expression of hypothalamic proteins was analyzed using quantitative proteomics analysis.Proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of T2DM rats were analyzed by flow cytometry,quantitative real-time PCR,Western blotting,and immunofluorescence.RESULTS Quantitative proteomics analysis showed significant differences in proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of rats with T2DM-DJB after DJB surgery,compared to the T2DM-Sham groups of rats.Oxidative stress-related proteins(glucagon-like peptide 1 receptor,Nrf2,and HO-1)were significantly increased(P<0.05)in the hypothalamus of rats with T2DM after DJB surgery.DJB surgery significantly reduced(P<0.05)hypothalamic inflammation in T2DM rats by inhibiting the activation of NF-κB and decreasing the expression of interleukin(IL)-1βand IL-6.DJB surgery significantly reduced(P<0.05)the expression of factors related to neuronal injury(glial fibrillary acidic protein and Caspase-3)in the hypothalamus of T2DM rats and upregulated(P<0.05)the expression of neuroprotective factors(C-fos,Ki67,Bcl-2,and BDNF),thereby reducing hypothalamic injury in T2DM rats.CONCLUSION DJB surgery improve oxidative stress and inflammation in the hypothalamus of T2DM rats and reduce neuronal cell injury by activating the glucagon-like peptide 1 receptor-mediated Nrf2/HO-1 signaling pathway.

Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting： which is better in patients with chronic obstructive pulmonary disease？

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

Clopidogrel improves aspirin response after off-pump coronary artery bypass surgery

We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass （OPCAB） surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group （30 patients） received mono-antiplatelet treatment （MAPT） with aspirin 100 mg daily and the other group received dual anfiplatelet treatment （DAPT） with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachi- donic acid （PLAA） and adenosine diphosphate （ADP） （PLADP） were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given （62.1% vs, 32.1%, 34.5% vs. 10.7%, respectively, both P 〈 0.05）. There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.

Off-pump coronary artery bypass grafting: Misperceptions and misconceptions

Coronary artery bypass grafting(CABG) continues to be one of the most commonly performed cardiac surgical procedures worldwide. Conventional CABG performed on cardiopulmonary bypass termed on-pump CABG is regarded as the gold standard. However, on-pump CABG results in several physiologic derangements including but not limited to thrombocytopenia, activation of complement factors, immune suppression, and inflammatory responses leading to organ dysfunction.Furthermore, manipulating an atherosclerotic ascending aorta during cannulation and cross-clamping can predispose to embolization and stroke risk. Recognition of these detrimental effects of on-pump CABG resulted in resurgence of off-pump CABG nearly two decades ago.Off-pump CABG since its resurgence has been a subject of intensive scrutiny and speculation. Despite numerous retrospective nonrandomized studies, prospective randomized trials, and meta-analyses validating the safety and efficacy of off-pump CABG, opponents of the technique have persistently demanded abandonment of off-pump CABG. Several misconceptions and misperceptions are used as an excuse for such demands. This review article examines published scientific evidence to evaluate these misperceptions and misconceptions about off-pump CABG.

Off-pump versus on-pump coronary artery bypass surgery for the treatment of left main with triple coronary artery disease

Objective：To obtain early results of off-pump coronarE~ artery bypass grafting（OPCAB） in patients with significant left main coronary artery（LMCA） and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery（CCAB）. Methods：Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demo- graphic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results： The number of distal anastomo- sis and grafts varied from 3 to 6. The average number per patient was similar in the two groups （OPCAB group：3.76 ± 0.98, CCAB group：3.81 ± 1.02）. Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance （P 〉 0.05）. The frequency of atrial fibrillation （AF）, IABP usage, mediastinitis, re-operation for bleeding （or tamponade） were similar in the two groups （P 〉 0.05）. Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group（P 〈 0.05）.Conclusion： Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.

Off-pump coronary artery bypass grafting versus optimal medical therapy alone：effectiveness of incomplete revascularization in high risk patients

有 multivessel 的 BackgroundGeriatric 病人冠的动脉疾病(CAD ) 是一个挑战性的组对待；这些盒子关于在这些病人上并且经常承担主要外科的实际利益在心队以内得到讨论导致放纵外科的选择。经皮的过程代表一种重要选择，但是冠的解剖可能是相反的。离开泵冠的动脉绕过(OPCAB ) 提供好质量没有暴露病人到的左前面的下降上的接枝(男孩) 心肺绕过，并且可能是在有多重 comorbidities 的病人的理想的选择，不是对合格经皮或在泵上过程。这研究的目的是没有经皮的选择在高风险的病人在中间的后续期间比较幸存，也与 OPCAB 对待或在回顾地从 2008 年 6 月评估到 2013 年 6 月的医药 therapy.MethodsWe 排出，有 multivessel CAD 的 83 个高风险的病人被包括：42 在男孩上用左内部乳房的动脉(LIMA ) 与不完全的离开泵 revascularization 被对待；41 在最佳的医药治疗(OMT ) 被解除，拒绝了外科。后续在 2015 年 3 月结束了，与一电话的会见。主要端点是从所有原因死亡的幸存；第二等的端点从非致命的主要不利心脏的事件(权标) 是从心脏相关的死亡和自由的幸存 .ResultsDuring 列在后面在上面，在 OPCAB 组的 11 死亡和在 OMT 组的 27 死亡发生了。死亡分别地由于在 6 和 15 个病人的心脏的因素。权标在 OMT 组在 OPCAB 组并且在 4 个病人在 6 个病人被观察。关于从所有原因死亡的幸存，经历了多于那些熬过的 OPCAB 的病人在 OMT 排出(木头等级 &#x0003c；0.001 ) ，并且 OMT 组带倾向 3.862 的调整分数的危险比率(P &#x0003c；0.001 ) 。关于从心脏相关的事件的幸存，经历了多于那些熬过的 OPCAB 的病人在 OMT 排出(木头等级 = 0.002 ) ，并且 OMT 组带倾向 3.663 的调整分数的危险比率(P = 0.010 ) 。有关从权标的自由没有统计上重要的差别(木头等级 = 0.273 ).ConclusionsFor 有 multivessel CAD 的高风险的病人，不是对在泵上合格完全的 revascularization 外科或经皮的过程，有 OPCAB LIMA-on-LAD 提议的不完全的 revascularization 在幸存受益什么时候与 OMT 相比独自一个。

Redo Coronary Artery Bypass Grafting: On-Pump and Off-Pump Coronary Artery Bypass Grafting Revascularization Techniques

Objective To analyze the short-term outcomes of redo coronary artery bypass grafting(CABG) using on-pump and off-pump CABG techniques. Methods From January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique(redo-ONCAB group) and 40 underwent off-pump CABG technique(redo-OPCAB group). Furthermore, transmyocardial laser revascularization was performed in high-risk patients who were not suitable to conventional grafting. Clinical data of the two groups were recorded and analyzed including operation time, coronary grafts, incomplete revascularization, postoperative ventilation, perioperative stroke, and low output syndrome, etc. Results There were no significantly differences in age, gender distribution, incidences of hypertension, stroke, and other clinical characteristics between redo-OPCAB group and redo-ONCAB group(all P>0.05), except for incidences of renal dysfunction and pulmonary disease(all P<0.05). The number of grafting vessels in the redo-ONCAB and redo-OPCAB groups was 2.1 ± 0.74 and 1.4 ±0.52 respectively. There was significant difference between the two groups(P=0.0243). Compared with the redo-ONCAB group, there was shorter operation time(P=0.0045), postoperative ventilation(P=0.0211) and intensive care unit stay(P=0.0400), as well as fewer use of platelet(P=0.0338) and blood transfusion(P=0.0034) in the redo-OPCAB group. The incidence of incomplete revascularization(P=0.0253) and the use of transmyocardial laser revascularization(P=0.0052) were higher in the redo-OPCAB group than those in the redo-ONCAB group(all P<0.05). However, no significant differences were showed for the incidence of the use of intra aortic balloon pump and continuous renal replacement therapy, perioperative stroke, low output syndrome, and in-hospital mortality between the two groups(all P>0.05). Conclusion Redo CABG is the safety and efficacy surgical procedure, and redo-OPCAB technique with better outcomes is commended especially in high-risk patients.

Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft

ObjectiveTo 评估离开泵的结果冠的动脉用一根双边的内部乳房的动脉(BIMA ) 绕过 grafting (OPCABG ) 完成全部的动脉的心肌的 revascularization.MethodsFrom 2002 年 10 月到 2008 年12月的 Y 配置接枝， 208 个病人( 196 男性和 12 女性)用 BIMA Y 配置接枝经历了 OPCABG 。病人的平均年龄是 56.5 &#x000b1；11.3 年，与 33-78 年的一个年龄范围。167 的一个总数(80.2%) 盒子有三倍容器的疾病。左主要的茎疾病在 33 被发现(15.9%) 盒子，和双容器疾病在 8 被发现(3.9%) 盒子。semi-skeletonization 技术被用来收获二根内部乳房的动脉(IMA ) ，然后免费恰好内部的乳房的动脉在 situ 是到左内部乳房的动脉(LIMA ) 的连接 end-to-side 完成 Y 配置接枝。离开泵和顺序的吻合方法被用来执行冠的动脉在所有病人绕过外科。接枝明显与 HT311 运输时间 flowmeter.ResultsA 总数 intra-operatively 被估计 728 远侧吻合在 208 个病人被执行，与是的一般水准 3.5 &#x000b1；1.3 每人。没有人死了或在用 BIMA Y 接枝的 operation.ConclusionsOPCABG 安全、有效完成全部的动脉的 revascularization 以后，在 30 天以内经历了周期性的咽峡炎。这个方法在上升主动脉和另外的切口上避免外科的操作。

Incidence of Atrial Fibrillation after Off-pump versus On-pump Coronary Artery Bypass Grafting:A Meta-analysis of Randomized Clinical Trials and Propensity Score Matching Trials

The association between atrial fibrillation（AF） after coronary artery bypass grafting（CABG） and the surgical techniques selected has been extensively reported. However, no consistent results were obtained. In the present study, a meta-analysis was conducted by searching the electronic databases Pub Med, Embase, Web of Science, and Cochrane to identify the association of post-CABG AF with on-pump（conventional CABG, c CABG） or off-pump CABG（OPCABG）. Outcomes from randomized clinical trials（RCTs） and propensity score matching（PSM） trials were pooled by using the fixed-effect or the random-effect modeling method, and verified by the quality-effect modeling method. There were 35 studies with 36 independent reports that met the inclusion criteria and were eventually included in our meta-analysis. The total odds ratio（OR） of the incidence of post-CABG AF between OPCABG and c CABG was 0.80（95% CI 0.71–0.91）. The 25 randomized clinical trials（RCTs） had an OR of 0.69（95% CI 0.56–0.86）, while the OR of the 11 PSM trials was 0.88（95% CI 0.77–1.00）. Twenty-six studies involving the patients at a mean age no more than 65 years showed an OR of 0.76（95% CI 0.64–0.90）, whereas 10 studies with patients greater than 65 years old showed an OR of 0.90（95% CI 0.78–1.05）. The results of this meta-analysis suggest that OPCAB surgery may reduce the incidence of post-CABG AF when compared to c CABG and that younger patients may benefit more from OPCAB and have a lower incidence of post-CABG AF.

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass —A Vettath Modification

Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.

Severe bleeding following off-pump coronary artery bypass grafting:predictive factors and risk model

BACKGROUND Severe bleeding following cardiac surgery remains a troublesome complication,but to date,there is a lack of comprehensive predictive models for the risk of severe bleeding following off-pump coronary artery bypass grafting(OPCABG).This study aims to analyze relevant indicators of severe bleeding after isolated OPCABG and establish a corresponding risk assessment model.METHODS The clinical data of 584 patients who underwent OPCABG from January 2018 to April 2020 were retrospectively analyzed.We gathered the preoperative baseline data and postoperative data immediately after intensive care unit admission and used multifactor logistic regression to screen the potential predictors of severe bleeding,upon which we established a predictive model.Using the consistency index and calibration curve,decision curve,and clinical impact curve analysis,we evaluated the performance of the model.RESULTS This study is the first to establish a risk assessment and prediction model for severe bleeding following isolated OPCABG.Eight independent risk factors were identified:male sex,aspirin/clopidogrel withdrawal time,platelet count,fibrinogen level,C-reactive protein,serum creatinine,and total bilirubin.Among the 483 patients in the training group,138 patients(28.6%)had severe bleeding;among the 101 patients in the verification group,25 patients(24.8%)had severe bleeding.Receiver operating characteristic(ROC)curve analysis for the internal training group revealed a convincing performance with a concordance index(C-index)of 0.859,while the area under the ROC curve for the external validation data was 0.807.Decision curve analysis showed that the model was useful for both groups.CONCLUSIONS Although there are some limitations,the model can effectively predict the probability of severe bleeding following isolated OPCABG and is therefore worthy of further exploration and verification.

Anesthesia with ciprofol in cardiac surgery with cardiopulmonary bypass:A case report

BACKGROUND Ciprofol is a novel agent for intravenous general anesthesia.In February 2022,it was approved by the National Medical Products Administration for general anesthesia induction and maintenance.It has the advantages of fast onset,fast elimination,stable circulation,and few adverse reactions.However,the efficacy and safety of ciprofol in cardiac surgery with cardiopulmonary bypass have not been reported.Here we describe a case where ciprofol was successfully used for anesthesia in cardiac surgery with cardiopulmonary bypass.CASE SUMMARY A 72-year-old man(height 176 cm;weight 70 kg)was diagnosed with coronary atherosclerotic cardiomyopathy requiring coronary artery bypass grafting and left ventricular aneurysmectomy.Ciprofol was administered for induction(0.4 mg/kg)and maintenance(0.6-1.0 mg/kg/h)of general anesthesia.During the entire operation,the bispectral index,hemodynamics,and blood oxygen saturation were maintained at normal levels.The patient recovered well after surgery,with no serious adverse events related to ciprofol.CONCLUSION Ciprofol is safe and effective for anesthesia in cardiac surgery with cardiopulmonary bypass.