P1839Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C A K Nakashima ◽  
L A O Dallan ◽  
L A F Lisboa ◽  
L A Hajjar ◽  
A M Soeiro ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Artery Bypass Graft ◽  
Platelet Aggregability

Abstract Background Dual antiplatelet therapy is recommended for patients (pts) with acute coronary syndromes (ACS). However, 10–15% of pts have indication of coronary artery bypass graft (CABG) for the index event and current guidelines recommend stopping clopidogrel at least 5 days prior to CABG. This waiting time could increase hospital length of stay, thus having negative impacts on costs and clinical complications. Purpose To evaluate if release to CABG based on platelet aggregability by Multiplate AnalyzerTM would be non-inferior in comparison with common practice (5 days) in terms of 24-hours post-CABG bleeding. Methods The PLAT-CABG (NCT 02516267) is a randomized, open label, non-inferiority trial (boundary 25%) testing a strategy of platelet aggregability-guided release to CABG versus standard-of-care on the primary endpoint of chest tube drainage in the first 24 hours post CABG. A total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and with indication for CABG, were assigned to clopidogrel discontinued 5 days prior to CABG (control group) vs. daily measurements of platelet aggregability to ADP using Multiplate AnalyzerTM (intervention group) with CABG occurring after recovering from platelet inhibition (pre-defined as a threshold of 46 AU). Results The main results are depicted in the table Main results of PLAT-CABG study Variables Control Group (n=95) Intervention Group (n=95) P-value for superiority P-value for non-inferiority Chest tube drainage (mL), Median (25th–75th) 350 (250–500) 350 (250–500) 0.680 0.001 Time symptom to CABG (hours), Median (25th–75th) 191 (150–281) 166 (119–225) <0.001 NA Time surgery indication to CABG (hours), Median (25th–75th) 136 (112–161) 112 (66–142) <0.001 NA CABG = coronary artery bypass graft. Conclusion Platelet-aggregability guided release to CABG is non-inferior to standard of care in ACS patients awaiting CABG in terms of peri-operative bleeding and significantly shortens the time to CABG. Acknowledgement/Funding Roche Diagnostica Brazil

Increased Risk of Sternal Complications in Patients with Plasma Cell Dyscrasias (PCDs) Undergoing Coronary Artery Bypass Graft (CABG)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5319-5319
Author(s):  
Malini M Patel ◽  
Shams B Bufalino ◽  
Anai N Kothari ◽  
Paul C Kuo ◽  
Sucha Nand
Keyword(s):  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Increased Risk

Abstract Introduction: Skeletal events, including fractures, form an important part of the clinical spectrum of PCDs. Skeletal surveys, even though less sensitive than MRI, remain the usual method of screening for lytic lesions and fractures in these patients but may miss subtle abnormalities. Patients undergoing a CABG normally require a midline sternal incision, which may increase the risk of a skeletal event. Patients with PCDs also have an increased risk of infection, thrombosis, and renal failure. To our knowledge, there is no published data about complications of cardiothoracic surgery in these patients. We hypothesized that patients with PCDs will have a higher risk of complications when compared to those without such history. Methods: Data on patients who underwent non-urgent coronary artery bypass graft (CABG) surgery from 2007 to 2011 was obtained by querying the Healthcare Cost and Utilization State Inpatient Databases for Florida and California. Information was available only for the inpatient stay plus a 30-day follow-up period. Diagnoses of multiple myeloma and monoclonal gammopathy of unknown significance (MGUS) were identified using ICD-9-CM codes. Mixed-effects logistic models were used to measure the association between PCDs and postoperative sternal complications controlling for demographics and comorbidity. Secondary outcomes of study in bivariate analysis included postoperative complications and 30-day readmission rates. Results: A total of 54,422 patients who underwent non-urgent CABG were identified. Of those patients, 500 were known to have a PCD. Ninety two percent of those patients (462 out of 500) had a diagnosis of MGUS. Median age was 66.6 years for the control group and 65.4 years in the PCDs group, and the male to female ratio was equal in both cohorts. In the PCD group, there was a statistically significant higher incidence of anemia, obesity, and renal failure prior to surgical intervention. Sternal infections occurred in 519 (1%) of the patients in the control group versus 18 (3.6%) of the patients in PCDs group (p<0.001). The 30-day all cause readmission rate was similar between the two groups but the 30-day sternal complication rate was significantly higher in the PCDs group (6.8% vs 3.7%; p<0.001). The odds ratio of sternal infection was 3.84 (CI 2.38-6.20) and the odds ratio of sternal dehiscence was 3.87 (CI 1.98-7.57) in the PCDs group when compared to the control group, both of which are statistically significant. Similarly, the odds ratio of sternal complications at 30-days was 1.92 (CI 1.35-2.73) in the PCDs group when compared to the control group. There were no statistically significant differences in the rates of postoperative myocardial infarctions, strokes, urinary tract infections, acute kidney injury, pneumonias, deep venous thrombosis, and gastrointestinal complications between the two cohorts. Conclusions: Our data shows that patients with PCDs have a lower hemoglobin level, renal insufficiency, and are obese at the time of coronary bypass surgery. It is important to note that the majority of the subjects in our study population had MGUS, a condition usually associated with little morbidity. Nonetheless, our cohort of patients with PCDs had a significantly increased risk of sternal wound infection and dehiscence. The treating physicians should be aware of these risks and patients should be informed. Prospective studies will be necessary to confirm and extend these findings. Disclosures No relevant conflicts of interest to declare.

Intravenous glycoprotein IIbIIIa inhibitor bridging for urgent coronary artery bypass graft after acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.R.C Ferreira ◽  
L.M Baracioli ◽  
T Dalcoquio ◽  
C.A.K Nakashima ◽  
C.D Soffiatti ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Red Blood Cells ◽  
Coronary Artery Bypass ◽  
Blood Cells ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Coronary Syndrome

Abstract Background Previous studies have shown the safety of intravenous glycoprotein (GP) IIbIIIa inhibitors used as a bridging after ADP receptor blocker withdrawal in patients with stable coronary artery disease and previous percutaneous coronary interventions (PCI) undergoing cardiac or non-cardiac surgeries. However, there are few data analyzing GP IIbIIIa inhibitor bridging among patients with acute coronary syndromes (ACS) scheduled for coronary artery bypass graft (CABG) during the same hospitalization. Purpose To evaluate the safety of tirofiban bridging after clopidogrel withdraw in post-ACS patients schedule for CABG during the same hospitalization. Methods Fifty-six patients who underwent CABG after tirofiban bridging post-ACS (bridge group - BG) were compared to 56 sex and age-matched controls also submitted to same-hospitalization CABG post-ACS without bridging (control group - CG). All patients received aspirin plus clopidogrel for ACS; clopidogrel was withdrawn 5 to 7 days before CABG and aspirin was maintained during the whole perioperative period. The primary endpoint was chest tube output in the first 24h after CABG (CTO24h). We hypothesized that BG would be non-inferior to CG, with a non-inferiority margin of 25% in excess of CTO24h in the BG compared to the CG, based on prior literature data. Other exploratory analyses were: blood transfusions, number of red blood cells/patient and re-thoracotomy 24h after surgery. A multivariable linear regression model was developed considering CTO24h as dependent variable and adjusted for other eight co-variates, described in the figure. Results From the 112 patients included (75% men; mean age 60.2±9.3 years), in comparison with CG, BG had higher proportion of STEMI (80.0% vs. 28.6%, p&lt;0.01), fibrinolytic utilization (25% vs. 7.1%, p&lt;0.05), PCI in the acute phase (92.9% vs. 0%, p&lt;0.01) and LMCA stenosis (30.4% vs. 7.1% p&lt;0.01). Tirofiban was utilized by clinician discretion due to PCI in the same hospitalization previously to CABG (n=52), previous PCI up to 3 months before index event (n=3) or severe LMCA stenosis (n=1). BG patients received tirofiban for a mean of 4.3±2.1 days and it was withdrawn at a mean of 6.6±4.3 hours before CABG. After adjustments, BG was non-inferior to CG regarding CTO24h (figure) There were no significant differences between BG and CG regarding need for blood transfusion (26.8% vs. 26.8%, p&gt;0.99), mean number of red blood cells/patient (0.3±0.8 vs 0.5±1.2, p=0.35) or re-thoracotomy due to bleeding (5.4% vs 0%, p=0.24). Conclusion Among ACS patients submitted to urgent CABG after clopidogrel withdrawal, tirofiban bridging, compared to no bridging, was not associated with higher risk of bleeding in the first 24 hours after surgery. Our study suggests that tirofiban may be a safe therapy to patients with high risk of thrombotic complication (such as stent thrombosis or re-infarction) after clopidogrel withdraw. Figure 1 Funding Acknowledgement Type of funding source: None

The effects of ocean sounds on sleep after coronary artery bypass graft surgery

1992 ◽  
Vol 1 (1) ◽  
pp. 91-97 ◽  
Author(s):  
JW Williamson
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
White Noise ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Falling Asleep ◽  
Cabg Patients

OBJECTIVE: To investigate the influence of ocean sounds (white noise) on the night sleep pattern of postoperative coronary artery bypass graft (CABG) patients after transfer from an intensive care unit. DESIGN: A before and after trial with an experimental and a control group was used in this intervention study. SETTING: A large public hospital with primary, secondary, and tertiary care facilities. PATIENTS: A consecutive sample of 60 first-time CABG patients was systematically assigned to the experimental or the control group. INTERVENTION: For the experimental group, the sounds were played on the Marsona Sound Conditioner (Marpac Corporation, Wilmington, NC) for three consecutive nights posttransfer from the ICU. No control of environment, except for the elimination of white noise, was done for the control group. MAIN OUTCOME MEASURES: The Richards-Campbell Sleep Questionnaire, a visual analog scale, provided self-reported sleep scores on six variables. Analysis of covariance was used to test the difference between the posttest scores of the groups, with the pretest used as the covariate. RESULTS: There were significant differences in sleep depth, awakening, return to sleep, quality of sleep, and total sleep scores; the group receiving ocean sounds reported higher scores, indicating better sleep. There was no difference in the falling asleep scores. CONCLUSION: The use of ocean sounds is a viable intervention to foster optimal sleep patterns in postoperative CABG patients after transfer from the ICU.

scholarly journals Comparison of Two Different Methods of obtaining Strain by Perioperative Transesophageal Echocardiography in Patients undergoing Coronary Artery Bypass Graft Surgery: A Prospective Observational Study

2016 ◽  
Vol 4 (2) ◽  
pp. 37-44
Author(s):  
Banashree Mandal ◽  
Ravi Raj ◽  
Alok Kumar ◽  
Imran Bhat
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Transesophageal Echocardiography ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Tissue Doppler ◽  
Myocardial Deformation ◽  
P Value ◽  
Artery Bypass Graft

ABSTRACT Introduction Tissue deformation imaging enables the objective assessment of regional myocardial deformation assessed by ultrasound-based strain and strain rate. There are two ways to compute myocardial deformation (strain) using echocardiography: One-dimensional tissue Doppler (DTI)-derived strain and two-dimensional (2D) strain derived from B-mode images (speckle tracking, 2D-ST). This study compares the myocardial deformation parameter (i.e., strain) by these two techniques in the perioperative period using transesophageal echocardiography (TEE) in patients undergoing surgery for coronary artery bypass graft (CABG). Materials and methods We performed preoperative global longitudinal strain (GLS) of left ventricle (LV) using 2D-ST and DTI, three-dimensional (3D) left ventricular ejection fraction (LVEF) and 2D LVEF in a consecutive series of 50 adult patients scheduled for on-pump CABG. Result There was no difference between 2D and 3D LVEF (p < 0.0001), GLS using 2D-ST and DTI (p-value = 0.0005). The 3D LVEF correlated well with GLS using 2D-ST (r = 0.54, p < 0.0001) and less with tissue Doppler-derived GLS (r = 0.35, p-value = 0.0131). Conclusion The LV GLS calculated using 2D-ST correlates well with LV GLS derived from DTI using TEE. The LV GLS also correlated well with the 3D LVEF. How to cite this article Kumar A, Mandal B, Raj R, Bhat I. Comparison of Two Different Methods of obtaining Strain by Perioperative Transesophageal Echocardiography in Patients undergoing Coronary Artery Bypass Graft Surgery: A Prospective Observational Study. J Perioper Echocardiogr 2016;4(2):37-44.

scholarly journals Modifying Stressors Using Betty Neuman System Modeling in Coronary Artery Bypass Graft: a Randomized Clinical Trial

2020 ◽  
Vol 9 (1) ◽  
pp. 13-19
Author(s):  
Elham Akhlaghi ◽  
Sima Babaei ◽  
Shahla Abolhassani
Keyword(s):  
Clinical Trial ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Randomized Clinical Trial ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Personal Factors

Introduction: Coronary artery disease (CAD) is one of the major causes of mortality all over the world. In this relation, coronary artery bypass grafting (CABG) is one of the most important treatments for CAD patients. However, it leads to a lot of stress in the patient. The aim of this study was to use the Neuman model to moderate the stressors in patients undergoing coronary artery bypass graft. Methods: This study was a randomized clinical trial of two groups performed on patients admitted to the coronary artery bypass graft; and the study completed with 64 patients. The intervention was performed by the researcher according to the format of the Neuman Model, which included the investigation of the stressors, and the determination of the goals and strategies for the actions. Intrapersonal, interpersonal, and extra personal factors were evaluated using a Revised Cardiac Surgery Stressor Scale (RCSSS). The intervention program was designed by the researcher based on prevention levels using scientific resources. The collected data were analyzed in SPSS ver. 13 using descriptive and inferential statistics. Results: Before the intervention, the mean score of the stressors was not significantly different between the two groups. But immediately after the intervention and before discharging the intervention group, it was significantly less than the control group. Conclusion: Using a Neuman-based program as an effective and low-cost intervention can moderate the stressors and reduce the stress of patients awaiting coronary artery bypass graft. This theory can be a good guide to offering the roles needed to provide health services in the community.

Effects of Phospholipid-Coated Extracorporeal Circuits on Clinical Outcome Parameters and Systemic Inflammatory Response in Coronary Artery Bypass Graft Patients

2005 ◽  
Vol 6 (1) ◽  
pp. 47 ◽  
Author(s):  
Christina Schulz ◽  
Anita Pritisanac ◽  
Albert Sch�tz ◽  
Erich Kilger ◽  
Helmut Platzer ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Clinical Outcome ◽  
Inflammatory Response ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Systemic Inflammatory Response ◽  
Control Group ◽  
Artery Bypass Graft

<P>Introduction: The use of extracorporeal circulation (ECC) during coronary artery bypass graft (CABG) surgery is associated with a systemic inflammatory response due to the contact of blood with artificial surfaces. The clinical relevance of ECC-related systemic inflammation varies with the patient, and such inflammation may be accompanied by intermittent organ dysfunction and an increased catecholamine requirement. We investigated the effects of a new phospholipid coating system of ECC on systemic inflammatory response and clinical outcome following CABG. </P><P>Methods: Patients scheduled for CABG surgery were prospectively divided randomly into 2 patient groups: patients using noncoated ECC materials and patients using phospholipid-coated ECC materials. Clinical data measured perioperatively included hemodynamics, aortic clamp time, duration of bypass, time to extubation, catecholamine requirement, length of intensive care unit (ICU) stay, postoperative blood loss, and amount of blood transfused. In addition, blood samples were collected before cannulation and at 2, 24, and 48 hours postoperative. Cytokines (tumor necrosis factor 3 [TNF-3] and interleukin 10 [IL-10]) and P-selectin were measured with an enzyme-linked immunosorbent assay. Plasma nitrate/nitrite levels (NOx) were determined by the Griess reaction. </P><P>Results: A significant increase of TNF-3 level was noted in the uncoated control group only. In the uncoated group, IL-10 levels significantly increased at 2 hours postoperative, whereas levels remained unchanged in the phospholipid coating group. P-selectin increased 2 hours postoperative in the uncoated group, and no significant changes were noted in the phospholipid coating group. At 24 hours postoperative, total plasma NOx production significantly increased in the phospholipid coating group but remained constant in the control group. No significant differences with respect to postoperative parameters (time to extubation, ICU stay, amount of bleeding, blood transfused, and catecholamine requirement) were observed. </P><P>Conclusions: Phospholipid coating significantly reduces the systemic increase in proinflammatory and anti-inflammatory cytokines and P-selectin. Despite the comparable clinical outcomes in this study, the observed significant reduction in systemic inflammatory parameter values suggests an improved biocompatibility of ECC materials when they are coated with phospholipids.</P>

The effect of melatonin on interleukins 22 and 13 in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass: A Clinical Trial

2020 ◽  
Author(s):  
Reza Jouybar ◽  
Mansour Jannati ◽  
Saeed Khademi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The Body ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Significant Difference

Abstract Objective: Coronary artery bypass graft surgery with cardiopulmonary bypass (CABG) is one treatment for patients with coronary artery disease. After CABG, a series of inflammatory processes occur which affect other organs of the body and even cause severe organ damage and subsequently a worse prognosis. The purpose of this study was to evaluate the effect of pre-surgically administered melatonin on interleukins 22 and 13 in patients undergoing CABG.Results: In this study, 22 patients were evaluated, 10 patients (45.5%) in the Melatonin group, and 12 patients (54.5%) in the control group. The mean level of IL-22 at all time-points in T2, T3, and T4 was significantly lower in the Melatonin group (P <0.05). There was also a significant increase in IL-22 in both groups at T4 compared to T1. There was no significant difference between the two groups in IL-13 at any time, but the Melatonin group at T2 had a significant decrease in IL-13 compared to T1. This study showed that preoperative melatonin administration could prevent the increase of IL-22 but not IL-13.

Impact of closed versus open venous reservoirs on patient outcomes in isolated coronary artery bypass graft surgery

Perfusion ◽  
2000 ◽  
Vol 15 (5) ◽  
pp. 467-472 ◽  
Author(s):  
Chris Brown Mahoney ◽  
James E Donnelly
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Circuit ◽  
Closed Circuit ◽  
P Value ◽  
Artery Bypass Graft ◽  
Circuit Group

Data were collected retrospectively on 1681 consecutive isolated coronary artery bypass graft patients at Millard Fillmore Hospital (Buffalo, New York, USA) undergoing coronary artery bypass. No patients were excluded. There were 616 patients in the open circuit group and 1065 in the closed circuit group. Patients in the closed circuit group exhibited a trend towards a higher incidence of most pre-existing comorbidities, with acute myocardial infarction, pre-existing cerebrovascular disease and the incidence of extensively calcified aortas all being significantly higher. Significantly different postbypass outcomes favored the closed circuit group, with levels of sepsis of 1% for open and 0% for closed and respiratory failure of 4% for open and 1% for closed. The length of stay approached significance with a p-value of 0.057 (open 9.85 days and closed 7.53). Use of an open circuit was a significant, independent predictor for increased use of units of packed red blood cells and total units of blood products. This study provides evidence that closed venous reservoirs can favorably impact surgical outcomes and reduce resulting healthcare costs.

scholarly journals The Effect of N-acetyl Cysteine on Liver Function after On-pump Coronary Artery Bypass Graft Surgery: A Double-Blind Randomized Clinical Trial

2021 ◽  
Author(s):  
fatemeh javaherforooshzadeh ◽  
pegah abbasi hormozi ◽  
Reza Akhondzadeh ◽  
Alireza olapour ◽  
Syed jalal Hashemi
Keyword(s):  
Coronary Artery ◽  
Liver Function ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
P Value ◽  
Artery Bypass Graft ◽  
Acetyl Cysteine ◽  
Pump Coronary Artery Bypass

Abstract Purpose: Somebody's organ dysfunctions such as heart, lung, kidney, and liver dysfunction are associated with the cardiopulmonary bypass in open-heart surgery.This study aimed effect of the N-acetyl cysteine injection on liver function after on-pump Coronary Artery Bypass Graft SurgeryMethod: In this clinical trial conducted in Golestan Hospital, Ahvaz, Iran, 60 candidates for coronary artery bypass graft surgery were selected based on the inclusion criteria. The candidates were then randomly divided into two intervention and control groups (30 people each).Intervention: Patients received 3 (2 intraoperative and 1 postoperative) doses of IV N-acetyl cysteine (100 mg/kg) (n=30) or placebo (n=30) over 24 hour. The main outcomes were serum Alkaline Phosphatase, Aspartate Aminotransferase, Alanine Aminotransferase, Bilirubin, PTT, and INR at 4 and 48 hours after surgery. Statistical analysis: The dates were analyzed using SPSS 22. Descriptive statistics were reported as mean ± standard deviation for continuous variables and as frequency and percentage for categorical variables. An unpaired t-test was used to compare the parameters with a normal distribution. Statistical significance level was defined at p-value < 0.05.Results: there were significant differences in terms of, ALT, AST, ALP and Bilirubin levels 4(p-value < 0.001) and 48h after surgery (p-value = 0.002).Conclusion: Based on the findings, intravenous administration of N-acetyl cysteine in patients with CABG significantly may be preserved liver function. Trial registry: Registered under No. Trial registration number IRCT20190506043492N2, date of registration :2020.05.23 .Retrospectively registered

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