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

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

Sevoflurane Versus Propofol for Myocardial Protection in Patients Undergoing Coronary Artery Bypass Grafting Surgery: a Meta-analysis of Randomized Controlled Trials

Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting （CABG） surgery. Methods Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients＇ perioperative data, including patients＇ baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference （WMD） and 95% confidential interval （C/）. For dichotomous data, treatment effects were calculated as odds ratio （OR） and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity （Q test P〈0.05）. Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P〈0.05. Results Our search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups （all P〉0.05）. Patients randomized into sevoflurane group had higher post-bypass cardiac index （WMD=0.39, 95% CI： 0.18 to 0.60, P=0.0003）, lower troponin I level （WMD=-0.82, 95% CI：-0.87 to -0.85, P=0.0002）, lower incidence of myocardial ischemia （OR=0.37, 95% CI： 0.16 to 0.83, P=0.02）, shorter ICU and hospital stay length （WMD=-10.99, 95% CI： -12.97 to -9.01, P〈0.00001; WMD=-0.78, 95% CI： -1.00 to -0.56, P〈0.00001, respectively）. Conclusion This meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery.

Experience with Miniaturized Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Comparison of the NovoSCI Ready System to Off-Pump and Conventional Coronary Artery Bypass Grafting

The major source of morbidity following cardiopulmonary bypass (CPB) is the systemic inflammatory response (SIRS response) which leads to multiple derangements in different organ systems. To combat this, miniaturized cardiopulmonary bypass circuits (MCPBC) have been created to lessen the inflammatory response to CPB. Here we examine early outcomes following coronary artery bypass grafting (CABG) using a MCPBC system compared to conventional bypass techniques at a single institution. Methods: 60 consecutive patients undergoing elective CABG were prospectively enrolled. Nine patients underwent coronary artery bypass grafting (CABG) with conventional CPB (cCABG), 33 underwent off-pump CABG (OPCAB), and the remaining 18 patients underwent CABG with a MCPBC system. Demographics and outcomes were compared between groups and statistical analyses applied. Results: No significant difference was observed in mortality between groups, with only one death reported in total. Morbidity was also low, totaling only 6.7%, with none occurring in the MCPBC group. The MCPBC group required less PRBC and total blood product transfusion than the cCABG and OPCABG groups (p = 0.05), but changes in PLT and Hct over time were not different between groups. Conclusions: The MCPBC system was shown to be comparable to conventional bypass and OPCABG in terms of postoperative complications and mortality. Furthermore, the MCPBC system had the advantage of a decreased transfusion requirement. Based on our preliminary observations, this mini-cardiopulmonary bypass circuit provides a safe alternative to conventional bypass techniques.

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

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

Does Additional Coronary Artery Bypass Grafting Increase Hospital Mortality of Patients Requiring Valve Surgery?

Background: The aim of this study was to evaluate the impact of additional coronary revascularization on the early results in patients submitted to valve surgery. Patients and Methods: A retrospective review of the cardiac surgical database between January 2000 and December 2018 was performed. A total of 1667 patients were included and divided into two groups: Group A isolated valve surgery (IVS n = 1608) and Group B with valve surgery combined to coronary artery bypass grafting (VS + CABG n = 59). Demographic, operative data and postoperative outcomes were compared between groups. Results: Patients with combined procedure were older than patients who underwent isolated valvular surgery (64.9 ± 9.2 years vs 44.4 ± 13.1 years;p = 0.0001) and there was a higher proportion of diabetics (40.7% vs 6.6%;p = 0.0001). The 30 days mortality rate in the combined procedure group was 18.6% versus 6.2% in isolated valve surgery (p = 0.001). Also post-operative complications were more frequent than for patients who underwent IVS. Additionally we noted a high prevalence of coronary artery risk factors in patients with combined procedures. Conclusion: Surgical mortality and morbidity of coexisting coronary and heart valve disease were substantially higher than IVS. More efforts in medical management may reduce the incidence of adverse outcomes.

Impact of specialized nursing outpatient case management on postcoronary artery bypass grafting patients

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.

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.

Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh

Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk.

The importance of depression and alcohol use in coronary artery bypass graft surgery patients：risk factors for delirium and poorer quality of life

ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life （QOL） after co-ronary artery bypass （CABG） surgery.MethodsA total of 180 CABG patients （mean age of 63.5 ± 10.1 years, 82.2% males） completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.Results Delirium developed in 63 persons （35% of sample）. After adjustment for covariates, delirium was significantly associated with depression [odds ratio （OR）： 1.08; 95% confidence interval （CI）： 1.03-1.13,P = 0.003], anxiety （OR： 1.07; 95% CI： 1.02-1.13,P= 0.01） and stress （OR： 1.05; 95% CI： 1.00-1.09,P= 0.03）. Preoperative depression scores were associated with poorer QOL including bodily pain （β =-0.39,P = 0.013）, vitality （β=-0.32,P = 0.020）, social functioning （β=-0.51,P≤0.001）, emotional role function （β=-0.44,P = 0.003） and general health （β=-0.33,P = 0.038）. Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization.

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: 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.

The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery

Objectives:This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise(SDBRE)in reducing patients’pain levels during chest tube removal(CTR)post coronary artery bypass grafting(CABG)surgery.Methods:In 2019,fifty post-CABG patients were conveniently selected from a cardiac intensive care unit in Jordan’s major referral heart institute.The patients were randomly assigned to either an intervention group or a control group.A total of 25 patients were assigned into the experimental group who received slow deep breathing relaxation Exercise(SDBRE)alongside the conventional care before CTR.The remaining 25 patients constituted the control group(50%)that had CTR following conventional care.The Visual Analogue Scale(VAS)was used to measure the participants’pain levels during three phases:before CTR(Time 1),5-min post CTR(Time 2),and 15-min post CTR(Time 2)to compare the intervention effect between the two groups.Results:The data analysis findings for the control and intervention group of patients showed that there was a statistically significant decline in their pain level across time for both groups(H¼32.71,P<0.01;H=47.23,P<0.01)respectively.The intervention group had significantly lower pain levels than the control group at Time 2(3.50[1.20,5.30]vs.7.90[7.00,9.00],P<0.01)and Time 3(0.00[0.00,1.30]vs.3.60[2.40,4.10]P<0.01).Conclusions:Using SDBRE during CTR is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects.

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

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

Long-term survival and prognostic implications of Chinese type 2 diabetic patients with coronary artery disease after coronary artery bypass grafting

This study was conducted to determine the sur-vival rates of type 2 diabetic patients after coro-nary artery bypass grafting (CABG) surgery, and the prognostic factors related to all-cause mor-tality during a 7-year follow-up. The medical re-cords of 816 type 2 diabetic patients who un-derwent primary, isolated CABG surgery during 1997-2003 were studied. The Kaplan-Meier me- thod and Cox regression were used to estimate survival and the independence of prognostic factors associated with all-cause mortality. One hundred and five out of 816 patients expired during the 7-year period. The overall survival rate was 83.5% (95%CI: 78.7-88.3%). Associated prog- nostic factors varied by gender. For males, but not for females, smoking (RR=3.44, 95%CI: 1.01- 11.70), myocardial infarction (RR=4.77, 95% CI: 1.23-18.86), respiratory failure (RR=4.21, 95% CI: 1.48-7.99), cardiogenic shock (RR=12.58, 95% CI: 3.25-20.77), and congestive heart failure (RR= 3.77, 95%CI: 1.10-13.45) were significantly related to all-cause mortality. Older age at sur-gery (RR= 1.15, 95%CI: 1.04-1.27), emergent op-eration (RR= 21.29, 95%CI: 10.03-39.43), pul-monary ede-ma (RR=7.72, 95%CI: 1.89-15.59), and days of ICU stay (RR=1.05, 95%CI: 1.02-1.09) were significant- ly related to all-cause mortality in females only. In conclusion, several gen-der-related differences were noted pertaining to all-cause mortality and its relationship to smok- ing, myocardial infarction, respiratory failure, cardiogenic shock, congestive heart failure, older age at surgery, emergent operation, pul-monary edema, and days of ICU stay.

Clinical application of individualized total arterial coronary artery bypass grafting in coronary artery surgery

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.

Inotropic Requirement in Patients Undergoing Coronary Artery Bypass Grafting (CABG) in RSUP Dr. Hasan Sadikin Bandung in 2014-2016

Inotropic agents are indicated to treat ventricular dysfunction that frequently found post-CABG surgery. However, the use of inotropic isn’t free from disadvantageous side effects and is related to higher morbidity and mortality in post-CABG surgery patients. Several risk factors are known to affect higher need for inotropic agents’?post-CABG surgery. This study aims to discover the inotropic?requirement in patients undergoing CABG surgery based on age, sex, preoperative left ventricular ejection?fraction?(LVEF),?comorbidities,?cross clamping time (CCT), and cardiopulmonary bypass (CPB) duration in Hasan Sadikin General Hospital Bandung in 2014-2016. This study is a descriptive cross-sectional study done retrospectively through medical records. This study found the inotropic?requirement?post-CABG surgery was?130 patients (74.3%). The inotropic?requirement?based on age was?28 patients (80.0%) > 65 years old,?112 patients (75.7%) were?male, 18 patients (66.7%) were?female, 19 patients (100%) with ?LVEF, 41?patients (85.4%) with DM, 20 patients (90.9%) with CKD, 44?patients (93.6%) with >90 minute CCT, 37?patients (90.2%) with >120 minute duration CPB. In conclusion, there was a higher inotropic?requirement in?patients with age > 65 years?old,?preoperative LVEF??comorbidities,?CPB duration > 120 minutes and CCT > 90 minutes.

Coronary Artery Bypass Surgery for Patients with Severe Cerebrovascular Atherosclerosis: Importance of Preoperative Assessment and Perioperative Management

Objective: Cerebrovascular atherosclerosis is known to play a crucial role in perioperative stroke in coronary arterial bypass grafting (CABG). This study is to identify the degree of severity of cerebrovascular lesions for which patients can still undergo CABG with an acceptably low risk in current techniques. Methods: Cerebrovascular atherosclerosis was evaluated and graded for 200 consecutive patients prior to CABG. Grading was initially based on the level of stenosis in carotid, vertebral, and cerebral arteries: grade-0: normal or mild stenosis in cerebral arteries or stenosis <50% in other arteries;grade-1: moderate in cerebral arteries or 50% - 69% in others;grade-2: severe in cerebral arteries or 70% - 89% in others;grade-3: occlusion in cerebral arteries or 90% - 100% in others. The grading was finally adjusted to a risk of regional ischemia by considering symptoms, number of lesions, and brain perfusion in scintigram. Therefore, some patients were up-graded. Off-pump CABG was scheduled for all patients. The lowest systolic arterial pressure during surgery was differently controlled in each grade: grade-0: ≥70 mmHg;grade-1: ≥80 mmHg;grade-2: ≥80 mmHg with intra-aortic balloon pump (IABP);grade-3: ≥90 mmHg with IABP;grade-4: ≥90 mmHg with IABP and administration of thyamiral. Results: Grade-1 and -2 included 38 and 29 patients respectively. Grade-3 initially included 36 patients and 14 of them were up-graded to grade-4 (extremely high risk patients). Stroke was seen in one patient (0.5%), for whom mild speaking disturbance occurred on the fifth day from CABG. Conclusion: Patients with severe cerebrovascular atherosclerosis can undergo CABG with a low risk of stroke. Intraoperative management of blood pressure may be critical for stroke prevention in CABG.

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.

Combined Procedure for Coronary Artery Bypass Grafting and Pulmonary Hydatid Disease

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.

Fluid Overload after Coronary Artery Bypass Grafting Surgery Increases the Incidence of Post-Operative Complications

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.