Effects on Lung Function in Patients Undergoing Coronary Artery Surgery on versus off Cardiopulmonary Bypass: A Randomized Trial

2005 ◽  
Vol 1 (1) ◽  
pp. 35-39
Author(s):  
Gunaratnam Niranjann ◽  
George Asimakopoulos ◽  
Brendan Madden ◽  
Gillian Cockerill ◽  
Matthew Thompson ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Lung Function ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Coronary Artery Surgery ◽  
Significant Difference ◽  
Diffusion Studies ◽  
Group A ◽  
Group B

Background Coronary revascularization is associated with respiratory dysfunction and poor gas exchange postoperatively. Cardiopulmonary bypass (CPB) has been implicated as a possible explanation for this phenomenon. This study investigated respiratory function in patients undergoing coronary artery bypass grafting (CABG) on-CPB versus off-CPB to determine whether the off-CPB condition results in improved postoperative pulmonary function. Methods Forty patients were randomized into 1 of 2 groups: CABG on-CPB (group A) or off-CPB (group B). Pulmonary function tests, including spirometry and diffusion studies, were performed preoperatively and on postoperative day 5. Arterial blood gases on 100% oxygen were taken preoperatively (TP1), 15 minutes after sternal closure (TP2), and 3 hours postoperatively (TP3). Results The arterial partial pressure of oxygen (PaO2) on FiO2 1.0 decreased from 59.5 ± 11.5 kPa and 55.7 ± 12.2 kPaat TP1 to 39.5 ± 16 kPa and 39.7 ± 13 kPa at TP2 in groups A and B, respectively (P < 0.001), with no significant difference between groups. At TP3, the PaO2 partially recovered toward preoperative levels (P < 0.05). Spirometry revealed a significant reduction in FEV1 and FVC on the fifth postoperative day (P < 0.001), with no significant difference between groups. The corrected transfer factor for carbon monoxide reduced significantly in group A from 7.9 ± 2.5 mmolmin–1 · kPa–1 preoperatively to 5.1 ± 1.6 mmolmin–1 · kPa–1 postoperatively (P < 0.05). This reduction was not seen in group B. Conclusions Coronary artery surgery is associated with a marked reduction in lung function as measured by pulmonary function tests and PaO2. Diffusion studies revealed that on-CPB patients had significantly reduced diffusion capacities postoperatively compared with patients in the off-CPB group.

scholarly journals The Effect of Optimized Ultrafiltration on Perioperative Pulmonary Function During Cardiopulmonary Bypass in Infants Under 10 kg

2021 ◽  
Vol 9 ◽  
Author(s):  
Jianhong Niu ◽  
Guangdi Zhai ◽  
Aibin Zheng ◽  
Juanying Zhou ◽  
Shengqi Jiang ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Treatment Group ◽  
Lung Function ◽  
Pulmonary Function ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Combination Method ◽  
Control Group ◽  
Acid Base Balance ◽  
Significant Difference

Objective: This study aims to investigate the effect of optimized ultrafiltration on perioperative electrolytes, acid–base balance, and pulmonary function during cardiopulmonary bypass (CPB) in infants with low body weight (under 10 kg), using traditional balanced ultrafiltration and modified ultrafiltration.Methods: A total of 30 children who underwent surgical correction for congenital heart disease in Changzhou Children's Hospital between January 2018 and December 2019 were randomly divided into two groups. In the treatment group, ultrafiltration pre-treatment was carried out with blood-containing priming fluid prior to CPB. Balanced ultrafiltration was performed during the operation, and optimized and modified ultrafiltration were conducted before closing and extubation. In the control group, traditional balanced ultrafiltration was used during the operation, and a modified ultrafiltration combination was used before closing and extubation. Indexes such as blood gas analysis and electrolytes were measured perioperatively, and pulmonary function was observed.Results: No deaths were reported in either group. The ventilator-assisted breathing time was shorter in the treatment group than in the control group (P &lt; 0.05). The indexes of the treatment group were closer than those of the control group to the optimal physiological values. The concentrations of potassium ion (K+), lactate (Lac), and blood glucose (Glu) decreased, and there was significant difference between the two groups (P &lt; 0.05) at the end of CPB. Hemoglobin (Hb) and hematocrit (HCT) in the treatment group increased (P &lt; 0.01). Alveolar-arterial differences for oxygen (A-aDO2) and respiratory index (RI) increased significantly in both groups after operation. Children in the treatment group began to recover lung function earlier than children in the control group. Both A-aDO2 and RI were lower in the treatment group than in the control group at each time point after operation (P &lt; 0.05).Conclusion: Optimizing and modifying the traditional ultrafiltration combination method can effectively shorten the ultrafiltration time, reduce the adverse impacts of the ultrafiltration technique, and improve the lung function of infants after operation.

scholarly journals FVC, FEV1 and FEV1 / FVC % in Hypothyroid Female and their Relationships with Thyroid Hormones

1970 ◽  
Vol 6 (1) ◽  
pp. 45-51
Author(s):  
Pervin Akter ◽  
Shelina Begum ◽  
Taskina Ali ◽  
Noorzahan Begum
Keyword(s):  
Lung Function ◽  
Thyroid Hormones ◽  
Female Patients ◽  
Normal Ranges ◽  
Significant Difference ◽  
Microparticle Enzyme Immunoassay ◽  
Group A ◽  
Predicted Values ◽  
Group B ◽  
Serum Tsh

Background: Hypothyroidism is a common hormonal disorder affecting various organs including lungs. It may be associated with respiratory symptoms and can decrease lung function. Objective: To observe FVC, FEV1 and FEV1/ FVC % in hypothyroid female patients. Methods: This crosssectional study was carried out in the Department of Physiology, BSMMU, Dhaka, from 1st July 2008 to 30th June 2009 on 60 hypothyroid female patients of 30-50 years age (Group B). For comparison, 30 age and BMI matched apparently healthy subjects (Group A) were also studied. Based on receiving treatment, hypothyroid patients were divided into B1 (untreated patients on their 1st day of diagnosis) and B2 (patients treated for at least 12-18 months). They were selected from the Out Patient Department of Endocrinology wing of department of Medicine, BSMMU, Dhaka. Serum TSH and FT4 levels were measured by Microparticle Enzyme Immunoassay (MEIA) principle in AxSYM system. The FVC, FEV1, FEV1/FVC%, of all the subjects were measured by a digital MicroDL spirometer. Data were analyzed by One way ANOVA test, Independent sample t- test and Pearson’s correlation coefficient test. Results: The mean percentage of predicted values of all the lung function variables in healthy female subjects and treated hypothyroids were within normal ranges. However, all of them were lower in untreated hypothyroids in comparison to those of control and treated hypothyroids.FVC and FEV1 showed statistically significant (p<0.001) difference and FEV1/FVC% showed non significant difference . In addition, all the ventilatory variables had negative correlation with serum TSH level and positive correlation with serum FT4 level and these relationships were statistically significant in control (p<0.001) and treated hypothyroids (p<0.01). Conclusion: This study reveals that lung function may be lower in untreated hypothyrod patients and correlated with thyroid hormones. Treatment of hypothyroids may reverse this changes. Key words: FVC, FEV1 , FEV1/FVC%, Hypothyroidism    DOI: http://dx.doi.org/10.3329/jbsp.v6i1.8084 J Bangladesh Soc Physiol. 2011 June; 6(1): 45-51

Does Priming Implementation with Low-dose Albumin Reduce Postoperative Bleeding following Cardiopulmonary Bypass?

2003 ◽  
Vol 26 (3) ◽  
pp. 211-216 ◽  
Author(s):  
F. Onorati ◽  
G. Santarpino ◽  
A. Renzulli ◽  
M. De Feo ◽  
L.S. De Santo ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Low Dose ◽  
Postoperative Bleeding ◽  
Ringer Lactate ◽  
Versus Group ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Lactate Solution

This study aimed to assess whether low doses of albumin in the priming solution for cardiopulmonary bypass (CPB) reduce postoperative bleeding. Three-hundred and seventy-seven patients undergoing CPB were retrospectively assigned to group A (154 patients, CPB primed with 20 ml/kg Ringer Lactate solution + 0.75mg/kg albumin 20%) and group B (223 patients with 20 ml/kg Ringer Lactate). A significant difference was found in terms of reoperations for bleeding (group A 0/154 versus group B 9/223; P=0.033). The mean number of blood derivatives transfused per patient was higher in group B than in group A (p <0.001). Platelet count after CPB was higher in group A than in group B (175±52×103/μl versus 131±70×103/μl; P=0.045). The amount of postoperative bleeding was 525ml versus 680ml at 24hrs (p <0.001), 819ml versus 1102ml at 48hrs, (p <0.001), 963ml versus 1294ml at 72hrs, (p <0.045) (group A versus group B respectively). Crystalloid priming with low-dose albumin reduces postoperative bleeding.

Post Operative Complications Associated with Preoperative use of Clopidogrel in Patients Undergoning Coronary Artery Bypass Surgery

2021 ◽  
Vol 15 (10) ◽  
pp. 3154-3156
Author(s):  
Muhammad Shahid ◽  
Mujahid Ul Islam ◽  
Imtiaz Ahmad ◽  
Bahauddin Khan ◽  
Faizan Ahmad Ali ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Treatment Method ◽  
Significant Difference ◽  
Tube Output ◽  
Group A ◽  
Chest Tube Output ◽  
Group B

Background: Majority of the patients presenting for coronary artery bypass surgery are preoperatively on clopidogrel and aspirin i.e., Dual antiplatelets therapy (DAPT) because of high incidence of left main stem disease, acute coronary syndrome and diffuse coronary artery disease. Preceding coronary stenting and coming from far flung areas even from other countries with poor socioeconomic status contributes to continuation of DAPT till surgery. The main objective of the study was to evaluate hospital complications like chest tube output, re-explorations, blood, and blood product administration and in-hospital mortality in patients who continued DAPT till 48 hours prior to surgery versus those who continued DAPT until 48 to 120 hours before surgery. Methods: Preoperative history, perioperative and postoperative data of patients was gathered retrospectively from 1st July to 31st December 2019 in a tertiary care hospital of Peshawar. Total patients undergoing CABG Surgery were 223. From those 223 patients 192 patients were on DAPT. We than divided the 192 patients into two groups, Group A and Group B. 102 patients (Group A) received clopidogrel plus aspirin until 48 hours before surgery, and 89 patients (Group B) continued clopidogrel 48 to 120 hours prior to surgery. Chest tube output, need for exploration, in-hospital mortality, and blood or products transfusions among both groups were compared. Results: In terms of bleeding complications no significant difference between the both groups with similar chest drainage in the first 24 hours (602 ml and 609ml). In group A 33 patients received blood transfusion compared to 25 patients from group B. There was no significant difference in the amount of platelets given to group A (0.63 L) and to group B was (0.60 L). On the other hand, Group, A received 1.08 L fresh frozen plasma (FFPs) transfusion and group B 1.10 L respectively. Re-exploration was observed in Group A and B as (3 vs 2). Mortality was observed in 7 patients from group A and 2 from Group B. Conclusions: Usage of Dual antiplatelets therapy (DAPT) before surgery was an effective treatment method for postoperative complication of bleeding. It was suggested that with proper management with DAPT before surgery was planned is an effective and safe treatment method.. Keywords: Cardiopulmonary surgery, Coronary bypass grafting, hemoglobin, platelets, bleeding.

Effects on Lung Function in Patients Undergoing Coronary Artery Surgery on versus off Cardiopulmonary Bypass: A Randomized Trial

2005 ◽  
Vol 1 (1) ◽  
pp. 35-39
Author(s):  
Gunaratnam Niranjann ◽  
George Asimakopoulos ◽  
Brendan Madden ◽  
Gillian Cockerill ◽  
Matthew Thompson ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Lung Function ◽  
Randomized Trial ◽  
Coronary Artery Surgery

scholarly journals Atrial fibrillation after Coronary Artery Bypass Surgery with and without Cardiopulmonary Bypass

2018 ◽  
Vol 10 (2) ◽  
pp. 171-179
Author(s):  
Md Rezaul Karim ◽  
Tawfiq Ahmed ◽  
Shahriar Moinuddin ◽  
Tariq Ahmed Chowdhury ◽  
Moshfequre Rahman Khan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Off Pump ◽  
Coronary Artery Bypass Operation ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Background:Atrial fibrillation (AF) is the most common postoperative supraventricular arrhythmi. 20% to 40% of patients have AF after coronary artery bypass operation (CABG).Arrhythmia of all grades may occur due to cardiopulmonary bypass (CPB) and injuries inflicted during operativeprocedures. Thus it has been proposed that CABG surgery would be safer if CPB could be avoided.Methods:Total 60 patients who underwentCABG were selected for the study and divided in two groups. Group A: 30 patients with Off-pump CABG (OPCAB) and Group B: 30 patients with On-pump CABG. 12 lead ECG was done at morning on the day of surgery, after surgery & when any arrhythmia are noted for at least 7days. Morbidity of patients like arrhythmia and hospital mortality were recorded and compared during the first week after surgery.Results:Off-pump group (group- A) had less incidence of post-operative AF than on-pump group(group-B) (10% vs 40%). Postoperative blood requirement,total operative time, the period of mechanical ventilation,ICU stay and total postoperative hospital stayis significantly shorter in off-pump than in on-pump group of patients.Conclusion: This study clearly demonstrates that off pump CABG procedure is associated with less incidence of AF. Therefore OPCAB procedure for myocardial revascularization is clearly justified whenever feasible.Cardiovasc. j. 2018; 10(2): 171-179

scholarly journals Postoperative Tachyarrhythmias: On-Pump versus Off-Pump Coronary Artery Bypass Grafting

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Mohamed Shehata ◽  
Bassem AbdElhalim ◽  
Hany Hanna ◽  
Mervat Nabih
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Categorical Variables ◽  
Off Pump ◽  
Electrocardiographic Monitoring ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective. Tachyarrhythmias, after coronary artery bypass graft (CABG) surgery, develop in 11%–40% of patients. Surgery technique (on-pump or off-pump) might affect incidence of post-CABG tachyarrhythmias. Methods. The study included 60 patients undergoing CABG (≥2 grafts) with left ventricle ejection fraction (LV EF) >40%. Patients were divided into two groups equally: group A (on-pump) and group B (off-pump). Patients were subjected to electrocardiographic monitoring (7 days postoperatively), transthoracic echocardiography, with recording of surgical details and complications. Results. Data collected between December 2012 and May 2013 showed no significant difference between two groups regarding incidence of postoperative tachyarrhythmias with statistically significant higher incidence of supraventricular tachycardia in group B (P<0.05) and a trend towards higher incidence of atrial fibrillation in group A. Patients who developed postoperative tachyarrhythmias in group A showed higher prevalence of family history of coronary artery disease and higher incidence of postoperative chest infections (P<0.05), while those in group B showed higher mean LV EF (pre- and postoperatively) (P<0.05). Data were statistically described in terms of mean ± standard deviation. Comparison of numerical and categorical variables was done using Student’s t- and Chi-square tests, respectively. Conclusion. Adopting off-pump CABG technique is not associated with less incidence of post-operative tachyarrhythmias, as compared to on-pump technique.

Abstract 11785: The Association of Guideline Adherence of Coronary Revascularization and Clinical Outcomes for Patients With Stable and Complex Coronary Artery Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chenfei Rao ◽  
Zhe Zheng ◽  
Shengshou Hu ◽  
Heng Zhang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Research Network ◽  
Significant Difference ◽  
Group A ◽  
Artery Disease ◽  
Group B ◽  
Revascularization Procedures

Introduction: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) gained popularity in China, there are gaps in knowledge about the appropriateness of revascularization procedures and related outcomes of stable and complex coronary artery disease. Methods: Using the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) research network, this prospective study of 3-Vessel Disease (China PEACE-3VD) consecutively enrolled patients with 3-vessel and/or left-main disease diagnosed by elective coronary angiography in 24 large cardiovascular centers in China. We abstracted medical record data for patient characteristics and treatment strategies, the core lab calculated SYNTAX Scores for all patients. We classified the appropriateness of treatment for each patient using 2011 Guideline on Myocardial Revascularization published by European Society of Cardiology and European Association of Cardio-Thoracic Surgery. We compared the 1-year rates of major adverse cardiovascular and cerebral events (MACCE) between patients underwent revascularization with I/IIa and IIb/III indications. Results: We consecutively enrolled 3186 patients from participated hospitals. Among them, 20.4% (651) underwent medical therapy, 79.6% (2535) underwent revascularization procedures (PCI: 87.4%, 12.6% CABG) during the index hospitalization. For patients underwent revascularization procedures, 47.9% patients were suitable for both CABG and PCI (has I indication for CABG, and IIa indication for PCI, group A), 52.1% were only suitable for CABG (has I indication for CABG, and IIb/III for PCI, group B). In group A, 95% underwent PCI, 5% underwent CABG, the 1-year MACCE rates of CABG and PCI showed no significant difference (PCI: 4.6%, CABG: 7.7%, adjusted OR=1.21, p=0.81); In group B, 80.4% underwent PCI, 19.6% underwent CABG, the 1-year MACCE rates of CABG is significantly lower than PCI (PCI: 7.5%, CABG: 2.3%, adjusted OR=3.18, p=0.027). Conclusions: Using the Guideline on Myocardial Revascularization, we identified certain overuse of PCI for stable and complex coronary artery disease. The inappropriate use of PCI is associated with worse 1-year outcomes than CABG. (NCT01625312)

Use of autologous blood as part of the perfusate for cardiopulmonary bypass: a priming technique

Perfusion ◽  
2002 ◽  
Vol 17 (3) ◽  
pp. 211-216 ◽  
Author(s):  
G J Myers ◽  
J F Legare ◽  
J A Sullivan ◽  
R B Leadon ◽  
R Johnstone ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Serum Albumin ◽  
Autologous Blood ◽  
Colloid Osmotic Pressure ◽  
Significant Difference ◽  
Fluid Shifts ◽  
Group A ◽  
Intraoperative Period ◽  
Group B ◽  
Length Of Hospitalization

In an attempt to replace the oncotic and protein coating capabilities of serum albumin in the perfusate, we established a priming protocol that used autologous blood as part of the perfusate solution. Prior to March 1, 1999, our standard priming protocol was 1650 ml of crystalloid with 250 ml of 5% serum albumin and 5000 units of heparin. After removing albumin from our prime, our standard protocol was altered to include 40 ml of the patient’s autologous blood in 1800 ml of crystalloid and 10000 units of heparin. To determine the intraoperative effects of using albumin/crystalloid primes (Group A), autologous blood/crystalloid primes (Group B) and crystalloid primes (Group C), a total of 178 patients were sequentially evaluated. Intraoperative parameters evaluated were total protein (TP), colloid osmotic pressure (COP), platelets (Plts) and fluid requirements during cardiopulmonary bypass (CPB). During an overlapping 12-month period of time, 1092 consecutive cardiac surgical cases using CPB (584 albumin prime; 508 autologous blood prime) were evaluated for clinical outcomes in terms of mortality and length of hospitalization. In addition, over a period of 15 months, 1458 patients in both the autologous blood/crystalloid group and the crystalloid only group were evaluated for the incidence of high-pressure excursions (HPE) after going on bypass. Comparative reviews of TP, COP and Plts demonstrated no significant difference 10 min after the start of bypass between Groups A and B. However, in Group C, there was a statistically significant increase in the intraoperative fluid requirements during CPB, compared to both of the other groups. There was no significant difference in the incidence of HPE, with an occurrence of 1.04% in the crystalloid only group and 1.11% in the autologous blood/crystalloid group. Autologous blood perfusates were identical to albumin perfusates in their platelet protection and reduction of fluid shifts during the intraoperative period.

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