scholarly journals Early Outcomes of Custodiol versus Blood Cardioplegia in Coronary Artery Bypass Graft Surgery at Ain Shams University Hospitals

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G S Sayed ◽  
I A Ismail ◽  
R M R Khorshid ◽  
A H Mohamed
Keyword(s):  
Coronary Artery ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The Other ◽  
P Value ◽  
Artery Bypass Graft ◽  
University Hospitals ◽  
Blood Cardioplegia ◽  
Significant Difference

Abstract Background Inadequate myocardial protection in long ischemic periods followed by reperfusion is an issue of concern in cardiac surgery. Cardioplegic solutions improve the tolerance to ischemia and reperfusion by preserving myocardial energy reserves, preventing osmotic and electrolyte imbalances and buffering acidosis. The aim of the study was to compare early outcomes of Histidine–tryptophan–ketoglutarate (HTK) solution versus blood cardioplegia in coronary artery bypass graft surgery at Ain Shams University Hospitals. Methodology This was a retrospective study conducted on patients who underwent isolated elective CABG at the department of cardiothoracic surgery at Ain Shams University Hospitals from the 1stof January, 2017 to the 1st of August, 2018. Results the analysis between these two groups divided as the following: first group who received Histidine–tryptophan–ketoglutarate (HTK) and the second who received conventional blood cardioplegia , There was no statistically significant difference between the two groups of myocardial protection in terms of morbidity and mortality with a p-value >0.05. With a stastically significant increase in Total bypass time with a p value <0.05 and a highly significant difference in terms of post operative Ventilation time and ICU stay which was higher in HTK group with a p-value of < 0.01 between the two groups. Conclusion Conventional blood cardioplegia showed superiority in terms of metabolic recovery based on the incidence of spontaneous defibrillation, ventilation time and ICU stay on the other hand Histidine–tryptophan–ketoglutarate (HTK) cardioplegia is a much more easily administered cardiolplegia technique without the need of preparation or repeated administration. Both Solutions showed efficacy in different areas that could be owed to the small sample size we used which cannot asses the ultimum superiority of one solution over the other .

scholarly journals Comparison of Sevoflurane and Isoflurane for Myocardial Protection During Coronary Artery Bypass Surgery in a Tertiary Care Center in Nepal

2019 ◽  
Vol 41 (2) ◽  
pp. 45-49
Author(s):  
Priska Bastola ◽  
Bishwas Pradhan ◽  
Madindra Basnet
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Secondary Outcome ◽  
Artery Bypass Graft ◽  
Time Intervals ◽  
Significant Difference

Introduction: Myocardial protection during Coronary Artery Bypass Graft (CABG) has always been an area of concern so we aimed to evaluate the level of release of Creatine Phosphokinase (CPK-MB) and Troponin I (cTnI) at various time intervals in the first 24 hours after on pump CABG in patients receiving either Sevoflurane or Isoflurane. Furthermore clinically relevant patient outcomes were also evaluated in patients undergoing on pump coronaryartery bypass grafting. Methods: This was a prospective randomized trial in patients undergoing on pump coronary artery bypass graft surgery, which was conducted from January 2016 till June 2017. A total of 105 patients were enrolled out of which there were 53 in Isoflurane and 52 in Sevoflurane group who received the respective volatile anesthetic agents throughout the surgery except during bypass at 1-1.5 MAC. The primary outcome was comparison of the CPK MB and cTnI levels at 0 hr, 6 hr, 12 hr and 24 hr after surgery from baseline, whereas the secondary outcomes were duration of intensive care unit stay, usage of vasopressors and inotropes, renal dysfunction, stroke. Results: No significant difference in CPK MB and cTnI levels at all time intervals in both the groups, the other secondary outcome parameters were comparable. Conclusion: The study found no difference in the cardiac markers between the two anesthetics. Based on the data, Sevofluraneand Isoflurane might be used equivalently in patients undergoing coronary artery bypass graft surgery with extracorporeal circulation without any difference in their myocardial protection function.

scholarly journals Influence of arm position during infraclavicular subclavian vein catheterization in coronary artery bypass graft surgery

2018 ◽  
Vol 10 (4) ◽  
pp. 192-196 ◽  
Author(s):  
Masoud Tarbiat ◽  
Maryam Davoudi ◽  
Sayed Ahmadreza Salimbahrami
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Success Rate ◽  
Subclavian Vein ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Neutral Group ◽  
Significant Difference ◽  
Vein Catheterization

Introduction: Percutaneous subclavian vein catheterization via infraclavicular approach is one of the most widely used cannulation techniques for inserting catheters into a central vein. The aim of this study was to evaluate influence of arm position during infraclavicular subclavian vein catheterization with landmark-based technique in coronary artery bypass graft (CABG) surgery. Methods: Between September 2017 and June 2018, this prospective randomized clinical trial was performed in 320 patients. The patients were randomly assigned to the Neutral group (the arms kept by the side) or Abduction group (the arm was abducted to 90°). The success and complication rates were compared in the two groups. The data were analyzed using SPSS software. Results: In the first attempt of subclavian vein cannulation, the success rate had no significant difference between the two groups (P = 0.185). In the second attempt of catheterization, the success rate in Abduction group (40.5%) was lower than Neutral group (81.2%). The overall success rate in two attempts were (84.4%) in the Abduction group and (96.2%) in the Neutral group. There was a significant difference between two groups in the second and overall success rates (P = 0.0001). In 34 (10.6%) patients, subclavian artery puncture occurred, 30 (18.8%) in the Abduction group and 4 (2.5%) in the Neutral group. There was a significant difference between two groups (P = 0.0001). Pneumothorax was occurred in 15 (9.4%) in the Abduction group and 3 (1.9%) in the Neutral group. There was also a significant difference between two groups (P = 0.004). The differences in other complications on two groups were statistically insignificant. Conclusion: Compared with Abduction group, the Neutral group resulted in higher success rate and fewer subclavian artery puncture and pneumothorax. The incidences of other complications were similar on both groups.

scholarly journals Comparison of urinary KIM-1 and NGAL and plasma creatinine in patients undergoing coronary artery bypass graft surgery

2020 ◽  
Vol 10 (1) ◽  
pp. e04-e04
Author(s):  
Maryam Saeedi Ghaheh ◽  
Saeed Mardani ◽  
Afsaneh Malekpour ◽  
Farzaneh Kadkhodaei Elyaderani ◽  
Fatemeh Salehi Choliche ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Serum Creatinine ◽  
Coronary Artery Bypass Graft ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Kidney Injury ◽  
High Ability ◽  
Urinary Ngal ◽  
Artery Bypass Graft ◽  
Significant Difference

Introduction: Serum creatinine level is currently being used as an indicator to detect acute kidney injury (AKI) after cardiac surgery, which is delayed and unreliable. Objectives: This study was conducted to determine the AKI in patients undergoing coronary artery bypass graft (CABG) surgery by measurement of urinary creatinine and plasma kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL). Patients and Methods: In this cross-sectional study, 96 patients undergoing CABG were divided based on their serum creatinine level of the fourth day after procedure into two groups of AKI (an increase of creatinine more than 0.3 mg/dl or more than 150 % of its baseline level) and non-AKI. In both groups urinary KIM-1 and urinary NGAL were measured on the first day of surgery (first 24 h). Results: No significant difference was observed in baseline creatinine between the two groups (P>0.05). However postoperative serum creatinine, creatinine changes, urinary NGAL and KIM1 showed significant difference between the groups (P<0.05). Serum creatinine was positively correlated with KIM-1 (r = 0.666, P<0.001) and NGAL (r = 0.660, P<0.001). KIM-1 and NGAL had high ability to detect AKI [area under the ROC (receiver operating characteristic) curve of 0.929 and 0.838, respectively]. The NGAL at cut-off point of 97.4 had 86% sensitivity and 80% specificity and KIM-1 at cut-off point of 14.8 had 84% sensitivity and 89% specificity. Conclusion: KIM-1 and NGAL had high ability to detect AKI. However, KIM-1 had higher detection ability than that of NGAL.

scholarly journals Blood Glucose Profile Post Coronary Artery Bypass Graft in Rsup H. Adam Malik Medan

2018 ◽  
Vol 5 (1) ◽  
pp. 3470-3472
Author(s):  
Farhan Syarif ◽  
Marshal . ◽  
Doddy Prabisma Pohan
Keyword(s):  
Blood Glucose ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Glucose Level ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Significant Difference

Cardiopulmonary bypass (CPB) is widely used for systemic and oxygenated systemic settings during open heart surgery. (Simon L, 2004) To date there is yet to be found a definitive biochemical marker that can be considered prognostic in patients who subside. using a CPB machine. Hyperglycemia is defined as a glucose level above the normal physiological range. Normal blood glucose level is 70-120 mg and levels > 120 mg/dL is a diagnostic level for diabetes. During CPB and coronary artery bypass off-pump (OPCAB), most patients tend to have elevated blood glucose levels despite no previous diabetes medical history. This study uses a descriptive study design study with a retrospective approach. The study was conducted in the Division of Cardiac and Cardiac Surgery of the Department of Surgery of the Faculty of Medicine USU/ RSUP H. Adam Malik Medan. The study was conducted after the proposal was approved. The population in this study were patients who performed Coronary Artery ByPass Graft surgery using Cardiopulmonary Bypass (CBP) at RSUP H. Adam Malik Medan in 2016 (01 January - 31 December 2016). The study involved patients who performed Coronary Artery ByPass Graft surgery using a CPB machine in RS. Haji Adam Malik Medan. The number of research subjects was 41 people. . Based on sex it is seen that more men (84.3%) than women. The mean of postoperative KGD H + 3 was the highest KGD that was 218,28 + 23,5 mg / dL. The use of Humulin R is most commonly used in insulin therapy with patients with postoperative CPB hyperglycemia. Based on the ANOVA test there was a significant difference in the value of KGD in H + 1 post CPB operation compared to H + 2 post CPB operation (p = 0.013, p <0.05).

scholarly journals Evaluation Of Pulmonary Functions Of Off-Pump Coronary Artery Bypass Graft Patients

KYAMC Journal ◽  
2017 ◽  
Vol 4 (1) ◽  
pp. 341-347
Author(s):  
Md Masumul Gani Chowdhury ◽  
Md Zakaria ◽  
NAK Ahsan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Gas Exchange ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pulmonary Functions ◽  
Significant Difference ◽  
Pump Cabg

Background: Cardiopulmonary bypass has been implicated in causing poor pulmonary gas exchange postoperatively in patients undergoing coronary artery bypass graft (CABG). This nonrandomized prospective study was conducted to determine whether patients undergoing off-pump CABG and thereby avoiding cardiopulmonary bypass will have improved pulmonary functions postoperatively.Method: Sixty patients undergoing elective CABG in the National Institute of Cardiovascular Diseases (NICVD), Dhaka between July 2005 and June 2006 were consecutively selected in the study. Sample was divided into two groups: Group A- off-pump CABG and Group-B on-pump CABG. The test statistics used to analyze the data were descriptive statistics as Chi-square (×2) and Student's t-test.Results: Preoperative arterial blood gas (ABG) analysis showed no significant difference. ABG immediately at ICU on FiO2 1 revealed significantly better gas exchange in off-pump group (PaO2: 296.5±32.4 torr vs 234.8±10.7 torr, p<0.001; D(A-a)O2: 378.5±27.3 torr vs 439.2±10.3 torr, p<0.001; PaCO2: 38.5±3.8 torr vs 40.1±1.8 torr, p=0.045). ABG on 3rd postoperative day revealed no significant difference between the two groups. Ventilation time in off-pump group was significantly less than in on-pump group (10.5±2.8 hours vs 14.8±3.7 hours, p<0.001). For ICU stay, there was no significant difference. Postoperative spirometry at 3 month and pulmonary complications within 3 months were not different between groups.Conclusion: off-pump CABG group yielded better gas exchange and earlier extubation than on-pump CABG group.KYAMC Journal Vol. 4, No.-1, July 2013, Page 341-347

Remote ischemic preconditioning effects on inflammatory markers and myocardial protection in coronary artery bypass graft surgery

Perfusion ◽  
2020 ◽  
pp. 026765912097929
Author(s):  
Farhad Gorjipour ◽  
Tahereh Saeedzadeh ◽  
Yaser Toloueitabar ◽  
Naser Kachoueian ◽  
Sepideh Bahlouli Ghashghaei ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Serum Level ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Ischemic Preconditioning ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Remote Ischemic Preconditioning ◽  
Artery Bypass Graft

Background: Induction of short episodes of ischemia to remote organs, namely upper or lower limbs, literally known as remote ischemic preconditioning (RIPC) has been suggested as a preconditioning approach to ameliorate ischemia/reperfusion injury (IRI). RIPC has been demonstrated to effectively protect various vital organs, including heart, against the next ischemic events in preclinical studies. However, human studies are required to approve its clinical applicability. Present study was performed to evaluate the effect of RIPC on the myocardial protection and inflammatory response markers in patients undergoing coronary artery bypass graft surgery Methods: In this randomized clinical trial, 43 coronary artery bypass graft (CABG) patients from Imam Hossein educational hospital were allocated in two groups, RIPC (21 patients) and control (22 patients). Serum level of interleukin (IL)-4, IL-8, and IL-10, interferon (IFN)-γ and Cardiac Troponin-I (cTnI) were measured in (1) after induction of anesthesia (before incision of skin), (2) after separation from CPB and (3) 24 hours after ICU arrival. Results: increase pack cell transfusions were observed in control group in ICU. Serum level of IL-10 at 24 hours after ICU admission was significantly higher in the RIPC group. Significantly lower amounts of IL-8 at post-CPB time were observed in the RIPC group in comparison with control. Conclusion: RIPC regulates the circulatory inflammatory cytokines, IL-8 decrement and IL-10 elevation, which could be translated into protection against IRI. However, further studies with larger sample sizes with careful consideration of parameters such as use of propofol as an anesthetic in the patients should be conducted to consolidate the findings from the current study.

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