Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidi...Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidity and mortality. However, sternal wound complication (SWC) remains challenging following the procedure. The technique of left internal mammary artery (LIMA) harvesting has been shown to impact the incidence of SWC. This study aimed to compare the incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB. The patients were divided into two groups of 30 each based on the technique of LIMA harvesting used, i.e., skeletonized (group A) or pedicled (group B). The postoperative ICU care was given to each patient as per the protocol. The statistical analysis was conducted using the SPSS version 26.0 for Windows software. Results: The results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was not statistically significant between the two groups (p = 0.35). The mean age, gender distribution, and comorbidities such as hypertension, diabetes, dyslipidemia, and anemia were also not statistically significant between the two groups. The number of smokers was statistically significant between the two groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of operation, duration of mechanical ventilation, duration of chest drains, duration of the central venous line, and amount of postoperative mediastinal bleeding were also not statistically significant between the two groups. The distribution of wound complications, duration of ICU stays, and hospital stay between the two groups was also not statistically significant. Conclusion: In conclusion, this study found that the incidence of SWC was less in skeletonized LIMA harvesting than in pedicled LIMA harvesting after OPCAB. However, this finding was not statistically significant. Further studies with larger sample sizes may be needed to confirm these results and determine the appropriate technique of LIMA harvesting to decrease the incidence of SWC after OPCAB.展开更多
<strong>Background</strong><b><span style="font-size:12px;font-family:Verdana;">:</span></b><span style="font-size:10.0pt;font-family:;" "=""&g...<strong>Background</strong><b><span style="font-size:12px;font-family:Verdana;">:</span></b><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;"> Coronary artery bypass grafting (CABG) is an important modality of treatment for ischemic heart disease. Both off-pump and on-pump CABG have direct effect on the level cardiac biomarkers in the perioperative period. The use of cardiopulmonary bypass (CPB) and aortic cross-clamping may cause additive myocardial damage leading to further elevation of blood markers. The present study is aimed at measuring and comparing the cardiac biomarker levels in immediate post-operative period after on-pump CABG (ONCAB) and off-pump CABG (OPCAB). </span><b><span style="font-family:Verdana;font-size:12px;">Methods</span></b></span><b><span style="font-size:12px;font-family:Verdana;">:</span></b><span style="font-size:12px;font-family:Verdana;"> All the patients who underwent CABG from January 2015 to June 2016 on elective or emergency basis at Nilratan Sircar Medical College & Hospital have been included in the study. Total 106 patients were operated for CABG of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB.</span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;">For the comparison of data the blood markers Troponin-T (Trop-T) and Creatine Kinase-MB (CK-MB) are measured during anesthesia before surgery, </span><span style="font-family:Verdana;font-size:12px;">post-operatively after 1</span></span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:12px;font-family:Verdana;">hour, post-operatively after 4</span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:12px;font-family:Verdana;">hours and post-operatively</span><span style="font-size:12px;font-family:Verdana;"> after 20</span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;">hours. All recorded data are analyzed using standard statistical methods. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b><span style="font-size:12px;font-family:Verdana;">:</span></b><b><i><span style="font-size:10.0pt;font-family:;" "=""> </span></i></b><span style="font-size:12px;font-family:Verdana;">We found the markers are elevated immediately after surgery and gradually come down within 24 hours after surgery</span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:12px;font-family:Verdana;">in both OPCAB and ONCAB groups. The elevation is more after ONCAB than OPCAB group in immediate post-operative period but the difference is not significant after 20 hours of surgery.</span><span style="font-size:10.0pt;font-family:;" "=""> </span><b><span style="font-size:12px;font-family:Verdana;">Conclusion</span></b><b><span style="font-size:12px;font-family:Verdana;">:</span></b><span style="font-size:12px;font-family:Verdana;"> Elevated levels of cardiac biomarkers in the immediate post-operative period indicate myocardial damage during surgery, especially after ONCAB in comparison to OPCAB. This may attribute to the better hemodynamic stability in the immediate post-operative period after OPCAB than ONCAB assuming comparable and adequate revascularization in patients of both groups. The avoidance of CPB and cross-clamp may explain better myocardial functioning immediately after </span><span style="font-family:Verdana;">OPCAB. But after 20 hours, the level of cardiac markers is comparable in both groups indicating little difference in post-operative recovery and long-term prognosis.</span>展开更多
Introduction: Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We ...Introduction: Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We report a single surgeon, single center experience of the first 37 consecutive patients undergoing off-pump surgery. Patients were selected for OPCAB (study group) individually and matched retrospectively to a control group of 113 patients performed over an identical time frame. Data were retrieved from a hospital data base (TOMCAT). Results: Mean Logistic European System of Cardiac Operative Risk Stratification (EuroSCORE) was slightly higher in the off-pump group (3.8% versus 2.9%). One patient died during the study and this was in the off-pump CAB group (OPCAB-30 day mortality 2.7%). Operating time was slightly shorter in the off-pump group (3 hours 28 minutes versus 3 hours 49 minutes, p = 0.15). After exclusion of outliers, total hospital stay was significantly shorter for off-pump cases (mean 6.8 days versus 8.37 days), while Intensive Care Unit (ICU) stay (1.2 versus 1.4 days) and ventilation time were only slightly shorter (9.35 hours versus 10.6 hours) for off-pump cases. Chest tube drainage was significantly lower in the off-pump group (484 ml versus 744 ml, p = 0.04) with correspondingly slightly lower transfusion requirements and significantly increased discharge haemoglobin concentrations in OPCAB. There was one cerebrovascular accident (CVA) in the off-pump group and none in the on-pump group. Conclusion: In this study we show short term outcomes for introduction of off-pump into surgical technique. Length of ICU stay, ventilation times, chest tube drainage, transfusion re0 quirements and pre-discharge haemoglobin concentration all appeared superior in the off pump group. The off-pump technique was safely introduced into the surgeon`s service with relatively little mortality. Experience of surgeon was considered advantageous for fast adaption of the technique. However, numbers were too small to make strong inferences. With practice more patients should benefit from the technique.展开更多
Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lact...Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lactate and mixed venous oxygen saturation were measured in 4 groups of patients—number of grafts, presence or absence of left main coronary artery disease, ejection fraction and serum creatinine. Blood samples were taken before induction, after grafting, on intensive care unit admission, 24 hours and 48 hours after surgery. The measured blood lactate and mixed venous oxygen saturation are compared to assess the outcomes in terms of duration of ventilation and intensive care unit stay. Results: The blood lactate and mixed venous oxygen saturation values increased post operatively but no statistically significant difference in three groups— number of grafts, left main coronary artery disease and ejection fraction. In serum creatinine group, the blood lactate value was found to be statistically significant after grafting in patients with creatinine <1.5 mg/dl, however, there was a significant disparity in numbers. Conclusion: Mixed venous oxygen saturation is a better predictor of morbidity than blood lactate in terms of intensive care unit stay in patients undergoing off pump coronary artery bypass grafting.展开更多
Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative...Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative cardiovascular functioning is an important determinant for outcome of surgery. In On-Pump CABG (ONCAB), the cardiopulmonary bypass has a negative effect on myocardium. Off-Pump CABG (OPCAB) avoids the effect of CPB but complete revascularization with difficult positioning of heart is technically demanding. This study is aimed to compare the cardiovascular functioning in the immediate post-operative period after OPCAB and ONCAB. Methods: Total 106 patients were operated for CABG from January 2015 to June 2016, of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison, hemodynamic parameters were measured during anesthesia before surgery, postoperatively after 1 and 4 hours (h) in the ICU, and in the morning after surgery, approximately after 20 h. Results: The time-dependent rise of hemodynamic parameters like Cardiac Output (CO), Cardiac Index (CI), Stroke volume (SV) and Left Ventricular Stroke Work Index (LVSWI) in the immediate post-operative hours (1 h and 4 h) are more predominant in OPCAB group than ONCAB group although the difference is eliminated mostly at 20 h. The better peripheral vasodilation after OPCAB causes immediate fall of Systemic Vascular Resistance Index (SVRI) after OPCAB. Conclusion: Better cardiovascular functioning immediately after OPCAB than ONCAB may be important for better hemodynamic stability. The difference is however eliminated after 24 hours indicating little significance in long term outcome.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
文摘Background: Off-pump coronary artery bypass grafting (OPCAB) is a surgical procedure that has gained popularity due to its potential benefits over traditional coronary artery bypass grafting, including reduced morbidity and mortality. However, sternal wound complication (SWC) remains challenging following the procedure. The technique of left internal mammary artery (LIMA) harvesting has been shown to impact the incidence of SWC. This study aimed to compare the incidence of SWC between two techniques of LIMA harvesting, i.e., skeletonized and pedicled. Methods: The study was conducted at the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, and included 60 patients who underwent OPCAB. The patients were divided into two groups of 30 each based on the technique of LIMA harvesting used, i.e., skeletonized (group A) or pedicled (group B). The postoperative ICU care was given to each patient as per the protocol. The statistical analysis was conducted using the SPSS version 26.0 for Windows software. Results: The results showed that 5 (8.33%) patients developed SWC, with 1 (1.67%) patient in group A and 4 (6.66%) patients in group B. However, the occurrence of SWC was not statistically significant between the two groups (p = 0.35). The mean age, gender distribution, and comorbidities such as hypertension, diabetes, dyslipidemia, and anemia were also not statistically significant between the two groups. The number of smokers was statistically significant between the two groups (p = 0.03), and the occurrence of SWC was found to be higher in smoker patients in group B (p = 0.04). Preoperative and postoperative parameters such as duration of operation, duration of mechanical ventilation, duration of chest drains, duration of the central venous line, and amount of postoperative mediastinal bleeding were also not statistically significant between the two groups. The distribution of wound complications, duration of ICU stays, and hospital stay between the two groups was also not statistically significant. Conclusion: In conclusion, this study found that the incidence of SWC was less in skeletonized LIMA harvesting than in pedicled LIMA harvesting after OPCAB. However, this finding was not statistically significant. Further studies with larger sample sizes may be needed to confirm these results and determine the appropriate technique of LIMA harvesting to decrease the incidence of SWC after OPCAB.
文摘<strong>Background</strong><b><span style="font-size:12px;font-family:Verdana;">:</span></b><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;"> Coronary artery bypass grafting (CABG) is an important modality of treatment for ischemic heart disease. Both off-pump and on-pump CABG have direct effect on the level cardiac biomarkers in the perioperative period. The use of cardiopulmonary bypass (CPB) and aortic cross-clamping may cause additive myocardial damage leading to further elevation of blood markers. The present study is aimed at measuring and comparing the cardiac biomarker levels in immediate post-operative period after on-pump CABG (ONCAB) and off-pump CABG (OPCAB). </span><b><span style="font-family:Verdana;font-size:12px;">Methods</span></b></span><b><span style="font-size:12px;font-family:Verdana;">:</span></b><span style="font-size:12px;font-family:Verdana;"> All the patients who underwent CABG from January 2015 to June 2016 on elective or emergency basis at Nilratan Sircar Medical College & Hospital have been included in the study. Total 106 patients were operated for CABG of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB.</span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;">For the comparison of data the blood markers Troponin-T (Trop-T) and Creatine Kinase-MB (CK-MB) are measured during anesthesia before surgery, </span><span style="font-family:Verdana;font-size:12px;">post-operatively after 1</span></span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:12px;font-family:Verdana;">hour, post-operatively after 4</span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:12px;font-family:Verdana;">hours and post-operatively</span><span style="font-size:12px;font-family:Verdana;"> after 20</span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;">hours. All recorded data are analyzed using standard statistical methods. </span><b><span style="font-family:Verdana;font-size:12px;">Results</span></b></span><b><span style="font-size:12px;font-family:Verdana;">:</span></b><b><i><span style="font-size:10.0pt;font-family:;" "=""> </span></i></b><span style="font-size:12px;font-family:Verdana;">We found the markers are elevated immediately after surgery and gradually come down within 24 hours after surgery</span><span style="font-size:10.0pt;font-family:;" "=""> </span><span style="font-size:12px;font-family:Verdana;">in both OPCAB and ONCAB groups. The elevation is more after ONCAB than OPCAB group in immediate post-operative period but the difference is not significant after 20 hours of surgery.</span><span style="font-size:10.0pt;font-family:;" "=""> </span><b><span style="font-size:12px;font-family:Verdana;">Conclusion</span></b><b><span style="font-size:12px;font-family:Verdana;">:</span></b><span style="font-size:12px;font-family:Verdana;"> Elevated levels of cardiac biomarkers in the immediate post-operative period indicate myocardial damage during surgery, especially after ONCAB in comparison to OPCAB. This may attribute to the better hemodynamic stability in the immediate post-operative period after OPCAB than ONCAB assuming comparable and adequate revascularization in patients of both groups. The avoidance of CPB and cross-clamp may explain better myocardial functioning immediately after </span><span style="font-family:Verdana;">OPCAB. But after 20 hours, the level of cardiac markers is comparable in both groups indicating little difference in post-operative recovery and long-term prognosis.</span>
文摘Introduction: Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We report a single surgeon, single center experience of the first 37 consecutive patients undergoing off-pump surgery. Patients were selected for OPCAB (study group) individually and matched retrospectively to a control group of 113 patients performed over an identical time frame. Data were retrieved from a hospital data base (TOMCAT). Results: Mean Logistic European System of Cardiac Operative Risk Stratification (EuroSCORE) was slightly higher in the off-pump group (3.8% versus 2.9%). One patient died during the study and this was in the off-pump CAB group (OPCAB-30 day mortality 2.7%). Operating time was slightly shorter in the off-pump group (3 hours 28 minutes versus 3 hours 49 minutes, p = 0.15). After exclusion of outliers, total hospital stay was significantly shorter for off-pump cases (mean 6.8 days versus 8.37 days), while Intensive Care Unit (ICU) stay (1.2 versus 1.4 days) and ventilation time were only slightly shorter (9.35 hours versus 10.6 hours) for off-pump cases. Chest tube drainage was significantly lower in the off-pump group (484 ml versus 744 ml, p = 0.04) with correspondingly slightly lower transfusion requirements and significantly increased discharge haemoglobin concentrations in OPCAB. There was one cerebrovascular accident (CVA) in the off-pump group and none in the on-pump group. Conclusion: In this study we show short term outcomes for introduction of off-pump into surgical technique. Length of ICU stay, ventilation times, chest tube drainage, transfusion re0 quirements and pre-discharge haemoglobin concentration all appeared superior in the off pump group. The off-pump technique was safely introduced into the surgeon`s service with relatively little mortality. Experience of surgeon was considered advantageous for fast adaption of the technique. However, numbers were too small to make strong inferences. With practice more patients should benefit from the technique.
文摘Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lactate and mixed venous oxygen saturation were measured in 4 groups of patients—number of grafts, presence or absence of left main coronary artery disease, ejection fraction and serum creatinine. Blood samples were taken before induction, after grafting, on intensive care unit admission, 24 hours and 48 hours after surgery. The measured blood lactate and mixed venous oxygen saturation are compared to assess the outcomes in terms of duration of ventilation and intensive care unit stay. Results: The blood lactate and mixed venous oxygen saturation values increased post operatively but no statistically significant difference in three groups— number of grafts, left main coronary artery disease and ejection fraction. In serum creatinine group, the blood lactate value was found to be statistically significant after grafting in patients with creatinine <1.5 mg/dl, however, there was a significant disparity in numbers. Conclusion: Mixed venous oxygen saturation is a better predictor of morbidity than blood lactate in terms of intensive care unit stay in patients undergoing off pump coronary artery bypass grafting.
文摘Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative cardiovascular functioning is an important determinant for outcome of surgery. In On-Pump CABG (ONCAB), the cardiopulmonary bypass has a negative effect on myocardium. Off-Pump CABG (OPCAB) avoids the effect of CPB but complete revascularization with difficult positioning of heart is technically demanding. This study is aimed to compare the cardiovascular functioning in the immediate post-operative period after OPCAB and ONCAB. Methods: Total 106 patients were operated for CABG from January 2015 to June 2016, of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison, hemodynamic parameters were measured during anesthesia before surgery, postoperatively after 1 and 4 hours (h) in the ICU, and in the morning after surgery, approximately after 20 h. Results: The time-dependent rise of hemodynamic parameters like Cardiac Output (CO), Cardiac Index (CI), Stroke volume (SV) and Left Ventricular Stroke Work Index (LVSWI) in the immediate post-operative hours (1 h and 4 h) are more predominant in OPCAB group than ONCAB group although the difference is eliminated mostly at 20 h. The better peripheral vasodilation after OPCAB causes immediate fall of Systemic Vascular Resistance Index (SVRI) after OPCAB. Conclusion: Better cardiovascular functioning immediately after OPCAB than ONCAB may be important for better hemodynamic stability. The difference is however eliminated after 24 hours indicating little significance in long term outcome.
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.