BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,lim...BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,limiting its use in other regions.AIM To evaluate the performance of EuroSCORE II in patients undergoing coronary artery bypass graft(CABG)surgery at a hospital in Bogotá,Colombia.METHODS An observational,analytical study of a retrospective cohort was designed.All patients admitted to Hospital Universitario Mayor Méderi who underwent CABG between December 2015 and May 2020 were included.In-hospital mortality was the primary outcome evaluated.Furthermore,the performance of EuroSCORE II was assessed in this population.RESULTS A total of 1009 patients were included[median age 66 years IQR=59-72,78.2%men].The overall in-hospital mortality was 5.5%(n=56).The median mortality predicted using EuroSCORE II was 1.29(IQR=0.92-2.11).Non-ST-segment elevation myocardial infarction was the most common preoperative diagnosis(54.1%),followed by ST-segment elevation myocardial infarction(19.1%)and unstable angina(14.3%).Urgent surgery was performed in 87.3%of the patients(n=881).Mortality rates in each group were as follows:Low risk 6.0%(n=45,observed-to-expected(O/E)ratio,5.6),moderate risk 3.0%(n=5,O/E ratio 1.17),high risk 5.0%(n=4,O/E ratio 0.94),and very high risk 7.6%(n=2,O/E ratio 0.71).The overall O/E ratio was 4.2.The area under the curve of EuroSCORE II was 0.55[95%confidence interval:0.48-0.63]CONCLUSION EuroSCORE II exhibited poor performance in this population owing to its low discriminative ability.This finding may be explained by the fact that the population comprised older individuals with higher ventricular function impairment.Moreover,unlike the population in which this tool was originally developed,most patients were not electively admitted for the surgery.展开更多
Objectives: Coronary artery bypass grafting (CABG) is the preferred revascularisation option for diabetics with multivessel coronary artery disease, in current guideline recommendations. Not infrequently, coronary art...Objectives: Coronary artery bypass grafting (CABG) is the preferred revascularisation option for diabetics with multivessel coronary artery disease, in current guideline recommendations. Not infrequently, coronary artery disease causes minimal symptoms in diabetic patients, so they present late for surgery and this could have implications for clinical outcomes. We sought to examine differences in symptom severity between diabetics and non-diabetics at presentation for CABG, and the impact on in-hospital outcomes. Methods: We retrieved prospectively collected data for all patients who had CABG between January 2000 and December 2022. Perioperative variables were compared between diabetic and non-diabetics. The association between in-hospital major adverse cardiac and cerebrovascular events (MACCE) and perioperative variables was determined using multivariate analysis. Results: Of 10,834 patients, diabetics constituted 24.8% (n = 2687) with mean age 66.4 ± 8.7 years compared to non-diabetics 65.9 ± 9.4, p = 0.02. More diabetics (p Conclusions: Diabetics more often presented for non-elective CABG with advanced symptoms, impaired left ventricular function, prior myocardial infarction and coronary stenting. Advanced symptoms contributed to higher MACCE rates in diabetics. Diabetic patients should be referred early for surgery.展开更多
BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to ...BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.展开更多
Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of posto...Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.展开更多
Background: 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 acut...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.展开更多
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-...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.展开更多
Background:Coronary artery bypass grafting(CABG)is a coronary revascularization technique associated with diminished pulmonary function.During the first week after CABG,slow vital capacity(SVC)decreases by 30%–60%.Sc...Background:Coronary artery bypass grafting(CABG)is a coronary revascularization technique associated with diminished pulmonary function.During the first week after CABG,slow vital capacity(SVC)decreases by 30%–60%.Scalene muscles affect pulmonary function because they attach to the 1st and 2nd ribs.Shorter scalene muscles can decrease inhalation volume and chest expansion.Very few studies have assessed the effects of scalene stretching on SVC and chest expansion in patients post-CABG.Therefore,this study was aimed at determining the effects of scalene muscle stretching on SVC and chest expansion in such patients.Methods:A total of 74 patients post-CABG(phase 2)meeting the inclusion criteria were randomly allocated to two groups:an intervention group(n=30)performing scalene muscle stretching and a control group(n=30)performing active neck exercise.Pre&Post SVC and chest expansion were measured in all patients.A total of 14 patients wereexcluded.Statistical analysis was conducted in SPSS software(version 20.0).Results:SVC showed significant increase(P<0.05)in the intervention group compared with the control group.Chest expansion was statistically non-significant between groups(P>0.05).Conclusion and clinical implications:Scalene muscle stretching improves SVC in patients post-CABG(phase 2).Hence,scalene stretching should be included in programs for improving respiratory function.展开更多
Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstandi...Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsy- chological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.展开更多
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 ...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.展开更多
Objective To evaluate the outcome of off-pump coronary artery bypass grafting （OPCABG） using a bilateral internal mammary artery （BIMA） Y configuration graft to achieve total arterial myocardial revascularization....Objective To evaluate the outcome of off-pump coronary artery bypass grafting （OPCABG） using a bilateral internal mammary artery （BIMA） Y configuration graft to achieve total arterial myocardial revascularization. Methods From October 2002 to December 2008, 208 patients （196 males and 12 females） underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 ± 11.3 years, with an age range of 33-78 years. A total of 167 （80.2%） cases had triple-vessel disease. Left main stem disease was found in 33 （15.9%） cases, and double-vessel disease was found in 8 （3.9%） cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries （IMAs）, and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery （LIMA） in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intm-operatively with the HT311 transit time flowmeter. Results A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5± 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. Conclusions OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions.展开更多
Objective To identify the factors associated with the development of postoperative atrial fibrillation （POAF） after coronary artery bypass graft （CABG） in elderly patients with coronary artery disease （CAD）. Met...Objective To identify the factors associated with the development of postoperative atrial fibrillation （POAF） after coronary artery bypass graft （CABG） in elderly patients with coronary artery disease （CAD）. Methods A total of 81 patients with CAD who underwent CABG were enrolled in the study. Patients were divided into two groups： Group 1, without postoperative atrial fibrillation （59 patients, 74.6% men, mean age 65.8 ~ 4.0 years）; Group 2, with early new-onset atrial fibrillation after CABG （22 patients, 90.9% men, mean age 67.7 ＋ 5.4 years）. Interleukin （IL）-6, IL-8, IL-10, C-reactive protein （CRP）, fibrinogen, superoxide dismutase （SOD）, N-terminal pro-B-type natriuretic peptide （NT-proBNP）, and troponin I were studied. Results During the observation period, atrial fibrillation occurred in 27.2% cases, an average of 4.9 ±3.8 days after surgery. In group 2, the left atrium （LA） dimension was larger than in group 1 （43.9 ± 3.4 mm vs. 37.6 ±3.9 rnm, P 〈 0.001）. Patients with POAF had significantly higher IL-6 （72.7 ±60.8 pg/mL vs. 38.0 ± 34.6 pg/mL, P = 0.04）, IL-8 （11.9 ± 6.0 pg/mL vs. 7.7± 5.4 pg/mL, P = 0.01） and SOD （2462.0 ± 2029.3 units/g vs. 1515.0 ± 1292.9 units/g, P = 0.04） compared with group without POAF. The multivariate analysis showed that the odds ratio （OR） for POAF development in patients with left atrium more than 39 mm was 2.1 [95% confidence interval （CI）： 1.2-3.8, P = 0.0004], IL-6 levels more than 65.18 pg/mL-1.4 （95% Ch 1.1-2.7, P = 0.009）, IL-8 levels more than 9.67 pg/mL-1.2 （95% CI： 1.1-3.7, P ： 0.009）, SOD more than 2948 units/g-1.1 （95% Ch 1.01-2.9, P = 0.04）. Conclusions In our study, the independent predictors of postoperative atrial fibrillation after CABG in elderly patients were left atrium dimension and the increased postoperative concentration of IL-6, IL-8 and superoxide dismutase.展开更多
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 a...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.展开更多
Objectives:To describe the current state of exercise capacity as well as to identify its predictors in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) or coronary artery ...Objectives:To describe the current state of exercise capacity as well as to identify its predictors in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the mainland of China.Methods:A retrospective study design was employed.We evaluated 230 CAD patients following PCI or CABG in a cardiac rehabilitation center from January 2019 to October 2019.The patients were referred to undergo incremental cardiopulmonary exercise testing with a cycle ergometer.The Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale were used to evaluate patients' mental health.Statistical analysis was performed using the chi-square test,Fisher's exact test,t-test,Mann-Whitney U test,and binary logistic regression.Results:Among the 230 patients,223 patients demonstrated reduced exercise capacity.Resutlts of the logistic regression analysis showed that anxiety (OR =1.13,95% CI 1.01-1.32,P =0.029) was an independent risk factor for reduced exercise capacity in patients following the PCI or CABG.Conclusions:Exercise capacity of Chinese CAD patients after PCI or CABG was relatively poor.Alleviating symptoms of anxiety and making exercise prescriptions according to the results of the cardiopulmonary exercise test should be considered during the intervention to improve CAD patients' exercise capacity.展开更多
Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at a...Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between Januaa-y 2002 and December 201 I, a total of i01 consecutive patients at an age of S0 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ~ 2.27 years. Sixty-four （63.4%） were males and 37 （36.6%） were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit （ICU） stay, inotropic support, intra aortic balloon pulsation application, amount oferythrocyte transfusion and flesh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass （CPB） was found to be an inde- pendent predictor of mortality （OR： 1.18, 95% CI 1.01-1.38, P = 0.034）. The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.展开更多
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 ...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.展开更多
Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of ...Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of POD among patients who had coronary artery bypass grafting (CABG) in China.Methods: A prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients un-dergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, mini-mizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Out-comes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main results: Delirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48%(19/141) vs. 29.93%(41/137) for the Control Group (x2=11.112, P=0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (x2=12.743, P<0.001). Length of ICU stay was reduced significantly (Z= -6.026, P<0.001). Conclusion: The application of a nursing protocol targeting risk factors in this study seems to be asso-ciated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium.展开更多
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)surg...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.展开更多
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...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.展开更多
Objectives To investigate the procedure characteristics and long term follow-up ofpercutaneous coronary intervention （PCI） for sa phaneous vein graft （SVG） lesions in the elderly patients. Methods From December 20...Objectives To investigate the procedure characteristics and long term follow-up ofpercutaneous coronary intervention （PCI） for sa phaneous vein graft （SVG） lesions in the elderly patients. Methods From December 2005 to December 201 l, 84 graft lesions were treated percumneously. Seventeen were located at proximal anastomosis, 48 were located at SVG body, 19 were located at distal anastomosis. Pri mary endpoint was defined as major adverse cardiovascular events （MACE, composite of cardiac death, target vessel revascularization, acute myocardial infarction）. Results The graft age was 6.7 i 4.0 years. Most anastomosis lesions （80.0%） presented within one year post coro-nary artery bypass grafting （CABG）. Proximal anastomosis lesion had the lowest successful rate for PCI compared with graft body and distal anastomosis lesions （70.6% vs. 91.7%, 79.0%, P 〈 0.05）. The distal embolic protection device was used in 19.1% of patients, most frequently used in body graft PCI （29.2%, P 〈 0.01）. The diameter of the stent was smallest in distal anastomosis group （2.9 ±0.4 mm, P 〈 0.05）. The highest post dilatation pressure was required in the proximal anastomosis （17.8 ± 2.7 atm, P 〈 0.05）. The patients were followed up for 24.3 ±16.9 months. MACE occurred in 18.57% of patients. Incidence of MACE was highest among proximal anastomosis PCI （47.1% vs. body graft PCI 16.7%, distal anastomosis PCI 21.1%; P 〈 0.05）. Old myocardial infarction was the predictive factor for the poor clinical outcomes （P〈 0.04）. Conclusions PCI of SVG lesions is feasible with lower success rate. PCI of ostial graft anastomosis lesions had the lowest procedure success rate and highest MACE rate compared with graft body and distal anastomosis lesions. Old myocardial infarction was a predictive factor of poor outcomes.展开更多
BackgroundGeriatric patients with multivessel coronary artery disease （CAD） are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surge...BackgroundGeriatric patients with multivessel coronary artery disease （CAD） are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass （OPCAB） provides good quality graft on left anterior descending （LAD） without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy.MethodsWe retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included： 42 were treated with incomplete off-pump revascularization using left internal mammary artery （LIMA） on LAD; 41 were discharged in optimal medical therapy （OMT）, having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events （MACEs）.ResultsDuring follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those dis-charged in OMT （Log Rank ＆lt; 0.001）, and OMT group carries a propensity score-adjusted hazard ratio of 3.862 （P ＆lt; 0.001）. With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in OMT （Log Rank = 0.002）, and OMT group carries a propensity score-adjusted hazard ratio of 3.663 （P = 0.010）. There is no statistically significant difference concerning freedom from MACEs （Log Rank = 0.273）.ConclusionsFor high-risk patients with multivessel CAD, not eligible to on-pump complete revascularization surgery or percutaneous procedures, incomplete revascularization with OPCAB LIMA-on-LAD offers benefits in survival when compared to OMT alone.展开更多
文摘BACKGROUND The EuroSCORE II is a globally accepted tool for predicting mortality in patients undergoing cardiac surgery.However,the discriminative ability of this tool in non-European populations may be inadequate,limiting its use in other regions.AIM To evaluate the performance of EuroSCORE II in patients undergoing coronary artery bypass graft(CABG)surgery at a hospital in Bogotá,Colombia.METHODS An observational,analytical study of a retrospective cohort was designed.All patients admitted to Hospital Universitario Mayor Méderi who underwent CABG between December 2015 and May 2020 were included.In-hospital mortality was the primary outcome evaluated.Furthermore,the performance of EuroSCORE II was assessed in this population.RESULTS A total of 1009 patients were included[median age 66 years IQR=59-72,78.2%men].The overall in-hospital mortality was 5.5%(n=56).The median mortality predicted using EuroSCORE II was 1.29(IQR=0.92-2.11).Non-ST-segment elevation myocardial infarction was the most common preoperative diagnosis(54.1%),followed by ST-segment elevation myocardial infarction(19.1%)and unstable angina(14.3%).Urgent surgery was performed in 87.3%of the patients(n=881).Mortality rates in each group were as follows:Low risk 6.0%(n=45,observed-to-expected(O/E)ratio,5.6),moderate risk 3.0%(n=5,O/E ratio 1.17),high risk 5.0%(n=4,O/E ratio 0.94),and very high risk 7.6%(n=2,O/E ratio 0.71).The overall O/E ratio was 4.2.The area under the curve of EuroSCORE II was 0.55[95%confidence interval:0.48-0.63]CONCLUSION EuroSCORE II exhibited poor performance in this population owing to its low discriminative ability.This finding may be explained by the fact that the population comprised older individuals with higher ventricular function impairment.Moreover,unlike the population in which this tool was originally developed,most patients were not electively admitted for the surgery.
文摘Objectives: Coronary artery bypass grafting (CABG) is the preferred revascularisation option for diabetics with multivessel coronary artery disease, in current guideline recommendations. Not infrequently, coronary artery disease causes minimal symptoms in diabetic patients, so they present late for surgery and this could have implications for clinical outcomes. We sought to examine differences in symptom severity between diabetics and non-diabetics at presentation for CABG, and the impact on in-hospital outcomes. Methods: We retrieved prospectively collected data for all patients who had CABG between January 2000 and December 2022. Perioperative variables were compared between diabetic and non-diabetics. The association between in-hospital major adverse cardiac and cerebrovascular events (MACCE) and perioperative variables was determined using multivariate analysis. Results: Of 10,834 patients, diabetics constituted 24.8% (n = 2687) with mean age 66.4 ± 8.7 years compared to non-diabetics 65.9 ± 9.4, p = 0.02. More diabetics (p Conclusions: Diabetics more often presented for non-elective CABG with advanced symptoms, impaired left ventricular function, prior myocardial infarction and coronary stenting. Advanced symptoms contributed to higher MACCE rates in diabetics. Diabetic patients should be referred early for surgery.
文摘BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.
文摘Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.
文摘Background: 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.
文摘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.
文摘Background:Coronary artery bypass grafting(CABG)is a coronary revascularization technique associated with diminished pulmonary function.During the first week after CABG,slow vital capacity(SVC)decreases by 30%–60%.Scalene muscles affect pulmonary function because they attach to the 1st and 2nd ribs.Shorter scalene muscles can decrease inhalation volume and chest expansion.Very few studies have assessed the effects of scalene stretching on SVC and chest expansion in patients post-CABG.Therefore,this study was aimed at determining the effects of scalene muscle stretching on SVC and chest expansion in such patients.Methods:A total of 74 patients post-CABG(phase 2)meeting the inclusion criteria were randomly allocated to two groups:an intervention group(n=30)performing scalene muscle stretching and a control group(n=30)performing active neck exercise.Pre&Post SVC and chest expansion were measured in all patients.A total of 14 patients wereexcluded.Statistical analysis was conducted in SPSS software(version 20.0).Results:SVC showed significant increase(P<0.05)in the intervention group compared with the control group.Chest expansion was statistically non-significant between groups(P>0.05).Conclusion and clinical implications:Scalene muscle stretching improves SVC in patients post-CABG(phase 2).Hence,scalene stretching should be included in programs for improving respiratory function.
文摘Research to date indicates that the number of coronary artery bypass graft （CABG） surgery patients affected by depression （i.e., major, minor, dysthymia） approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsy- chological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.
文摘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.
文摘Objective To evaluate the outcome of off-pump coronary artery bypass grafting （OPCABG） using a bilateral internal mammary artery （BIMA） Y configuration graft to achieve total arterial myocardial revascularization. Methods From October 2002 to December 2008, 208 patients （196 males and 12 females） underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 ± 11.3 years, with an age range of 33-78 years. A total of 167 （80.2%） cases had triple-vessel disease. Left main stem disease was found in 33 （15.9%） cases, and double-vessel disease was found in 8 （3.9%） cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries （IMAs）, and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery （LIMA） in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intm-operatively with the HT311 transit time flowmeter. Results A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5± 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. Conclusions OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions.
文摘Objective To identify the factors associated with the development of postoperative atrial fibrillation （POAF） after coronary artery bypass graft （CABG） in elderly patients with coronary artery disease （CAD）. Methods A total of 81 patients with CAD who underwent CABG were enrolled in the study. Patients were divided into two groups： Group 1, without postoperative atrial fibrillation （59 patients, 74.6% men, mean age 65.8 ~ 4.0 years）; Group 2, with early new-onset atrial fibrillation after CABG （22 patients, 90.9% men, mean age 67.7 ＋ 5.4 years）. Interleukin （IL）-6, IL-8, IL-10, C-reactive protein （CRP）, fibrinogen, superoxide dismutase （SOD）, N-terminal pro-B-type natriuretic peptide （NT-proBNP）, and troponin I were studied. Results During the observation period, atrial fibrillation occurred in 27.2% cases, an average of 4.9 ±3.8 days after surgery. In group 2, the left atrium （LA） dimension was larger than in group 1 （43.9 ± 3.4 mm vs. 37.6 ±3.9 rnm, P 〈 0.001）. Patients with POAF had significantly higher IL-6 （72.7 ±60.8 pg/mL vs. 38.0 ± 34.6 pg/mL, P = 0.04）, IL-8 （11.9 ± 6.0 pg/mL vs. 7.7± 5.4 pg/mL, P = 0.01） and SOD （2462.0 ± 2029.3 units/g vs. 1515.0 ± 1292.9 units/g, P = 0.04） compared with group without POAF. The multivariate analysis showed that the odds ratio （OR） for POAF development in patients with left atrium more than 39 mm was 2.1 [95% confidence interval （CI）： 1.2-3.8, P = 0.0004], IL-6 levels more than 65.18 pg/mL-1.4 （95% Ch 1.1-2.7, P = 0.009）, IL-8 levels more than 9.67 pg/mL-1.2 （95% CI： 1.1-3.7, P ： 0.009）, SOD more than 2948 units/g-1.1 （95% Ch 1.01-2.9, P = 0.04）. Conclusions In our study, the independent predictors of postoperative atrial fibrillation after CABG in elderly patients were left atrium dimension and the increased postoperative concentration of IL-6, IL-8 and superoxide dismutase.
文摘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.
文摘Objectives:To describe the current state of exercise capacity as well as to identify its predictors in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in the mainland of China.Methods:A retrospective study design was employed.We evaluated 230 CAD patients following PCI or CABG in a cardiac rehabilitation center from January 2019 to October 2019.The patients were referred to undergo incremental cardiopulmonary exercise testing with a cycle ergometer.The Zung Self-Rating Anxiety Scale and the Zung Self-Rating Depression Scale were used to evaluate patients' mental health.Statistical analysis was performed using the chi-square test,Fisher's exact test,t-test,Mann-Whitney U test,and binary logistic regression.Results:Among the 230 patients,223 patients demonstrated reduced exercise capacity.Resutlts of the logistic regression analysis showed that anxiety (OR =1.13,95% CI 1.01-1.32,P =0.029) was an independent risk factor for reduced exercise capacity in patients following the PCI or CABG.Conclusions:Exercise capacity of Chinese CAD patients after PCI or CABG was relatively poor.Alleviating symptoms of anxiety and making exercise prescriptions according to the results of the cardiopulmonary exercise test should be considered during the intervention to improve CAD patients' exercise capacity.
文摘Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between Januaa-y 2002 and December 201 I, a total of i01 consecutive patients at an age of S0 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ~ 2.27 years. Sixty-four （63.4%） were males and 37 （36.6%） were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit （ICU） stay, inotropic support, intra aortic balloon pulsation application, amount oferythrocyte transfusion and flesh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass （CPB） was found to be an inde- pendent predictor of mortality （OR： 1.18, 95% CI 1.01-1.38, P = 0.034）. The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.
文摘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.
基金The study was funded by the Committee of Health and Family Planning of Shanghai,China(project number 201440100)
文摘Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of POD among patients who had coronary artery bypass grafting (CABG) in China.Methods: A prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients un-dergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, mini-mizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Out-comes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main results: Delirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48%(19/141) vs. 29.93%(41/137) for the Control Group (x2=11.112, P=0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (x2=12.743, P<0.001). Length of ICU stay was reduced significantly (Z= -6.026, P<0.001). Conclusion: The application of a nursing protocol targeting risk factors in this study seems to be asso-ciated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium.
文摘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.
基金supported by a grant from the National Natural Science Foundation of China(81170181)a Program for Development of Innovative Research Team in the First Affiliated Hospital of Nanjing Medical Universitya Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutes(PAPD)
文摘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.
文摘Objectives To investigate the procedure characteristics and long term follow-up ofpercutaneous coronary intervention （PCI） for sa phaneous vein graft （SVG） lesions in the elderly patients. Methods From December 2005 to December 201 l, 84 graft lesions were treated percumneously. Seventeen were located at proximal anastomosis, 48 were located at SVG body, 19 were located at distal anastomosis. Pri mary endpoint was defined as major adverse cardiovascular events （MACE, composite of cardiac death, target vessel revascularization, acute myocardial infarction）. Results The graft age was 6.7 i 4.0 years. Most anastomosis lesions （80.0%） presented within one year post coro-nary artery bypass grafting （CABG）. Proximal anastomosis lesion had the lowest successful rate for PCI compared with graft body and distal anastomosis lesions （70.6% vs. 91.7%, 79.0%, P 〈 0.05）. The distal embolic protection device was used in 19.1% of patients, most frequently used in body graft PCI （29.2%, P 〈 0.01）. The diameter of the stent was smallest in distal anastomosis group （2.9 ±0.4 mm, P 〈 0.05）. The highest post dilatation pressure was required in the proximal anastomosis （17.8 ± 2.7 atm, P 〈 0.05）. The patients were followed up for 24.3 ±16.9 months. MACE occurred in 18.57% of patients. Incidence of MACE was highest among proximal anastomosis PCI （47.1% vs. body graft PCI 16.7%, distal anastomosis PCI 21.1%; P 〈 0.05）. Old myocardial infarction was the predictive factor for the poor clinical outcomes （P〈 0.04）. Conclusions PCI of SVG lesions is feasible with lower success rate. PCI of ostial graft anastomosis lesions had the lowest procedure success rate and highest MACE rate compared with graft body and distal anastomosis lesions. Old myocardial infarction was a predictive factor of poor outcomes.
文摘BackgroundGeriatric patients with multivessel coronary artery disease （CAD） are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass （OPCAB） provides good quality graft on left anterior descending （LAD） without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy.MethodsWe retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included： 42 were treated with incomplete off-pump revascularization using left internal mammary artery （LIMA） on LAD; 41 were discharged in optimal medical therapy （OMT）, having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events （MACEs）.ResultsDuring follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those dis-charged in OMT （Log Rank ＆lt; 0.001）, and OMT group carries a propensity score-adjusted hazard ratio of 3.862 （P ＆lt; 0.001）. With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in OMT （Log Rank = 0.002）, and OMT group carries a propensity score-adjusted hazard ratio of 3.663 （P = 0.010）. There is no statistically significant difference concerning freedom from MACEs （Log Rank = 0.273）.ConclusionsFor high-risk patients with multivessel CAD, not eligible to on-pump complete revascularization surgery or percutaneous procedures, incomplete revascularization with OPCAB LIMA-on-LAD offers benefits in survival when compared to OMT alone.
