scholarly journals Evaluation of Nephroprotective Efficacy of Hypoxic Preconditioning in Patients Undergoing Coronary Artery Bypass Surgery

2016 ◽  
Vol 6 (4) ◽  
pp. 328-336 ◽  
Author(s):  
Zhaneta V. Vesnina ◽  
Yury B. Lishmanov ◽  
Ekaterina A. Alexandrova ◽  
Evgeniy A. Nesterov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Comparison Group ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Hypoxic Preconditioning ◽  
Lipocalin 2 ◽  
The Mean

Background: Nonpulsatile blood flow plays an important role in the pathogenesis of renal dysfunction in patients with extracorporeal circulation. In our opinion, hypoxic preconditioning (HP) can be used to protect kidneys from postsurgical dysfunction. The aim of this study was to evaluate nephroprotective efficacy of HP in myocardial revascularization with extracorporeal circulation. Methods: The randomized, controlled trial was performed in 63 patients undergoing coronary artery bypass grafting (CABG). Thirty-three patients were subjected to HP during CABG; 30 patients were included in the comparison group. All patients underwent dynamic renal scintigraphy with 99mТc-diethylenetriaminepentaacetic acid and were subjected to measuring the concentration of lipocalin in blood serum before and after CABG. Results: After CABG, the mean values of the total glomerular filtration rate (GFR) and GFR for each kidney significantly decreased only in patients of the comparison group. Significant increases in the concentration of serum neutrophil gelatinase-associated lipocalin occurred 5 h after surgery both in the group with HP (70.65 ± 46.71 to 127.58 ± 98.46 ng/ml) and in the comparison group (65.01 ± 38.64 to 171.65 ± 89.91 ng/ml). At the same time, the mean difference values between pre- and postoperative lipocalin levels were 56.94 ± 51.75 ng/ml in the study group and 106.64 ± 51.27 ng/ml in the comparison group; these differences were highly statistically significant (р = 0.004). Conclusion: The results of our study showed that (i) HP exerts nephroprotection in patients undergoing on-pump CABG, and (ii) determination of the lipocalin-2 level can be used for early diagnosis of acute kidney injury in cardiac surgery patients.

scholarly journals Conventional versus minimally invasive extracorporeal circulation in patients undergoing cardiac surgery: protocol for a randomised controlled trial (COMICS)

Perfusion ◽  
2020 ◽  
pp. 026765912094673
Author(s):  
Gianni D Angelini ◽  
Barnaby C Reeves ◽  
Jonathan Evans ◽  
Lucy A Culliford ◽  
Laura Collett ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Randomised Controlled

Introduction: Despite low mortality, cardiac surgery patients may experience serious life-threatening post-operative complications, often due to extracorporeal circulation and reperfusion. Miniaturised cardiopulmonary bypass (minimally invasive extracorporeal circulation) has been developed aiming to reduce the risk of post-operative complications arising with conventional extracorporeal circulation. Methods: The COMICS trial is a multi-centre, international, two-group parallel randomised controlled trial testing whether type II, III or IV minimally invasive extracorporeal circulation is effective and cost-effective compared to conventional extracorporeal circulation in patients undergoing elective or urgent coronary artery bypass grafting, aortic valve replacement or coronary artery bypass grafting + aortic valve replacement. Randomisation (1:1 ratio) is concealed and stratified by centre and surgical procedure. The primary outcome is a composite of 12 serious complications, objectively defined or adjudicated, 30 days after surgery. Secondary outcomes (at 30 days) include other serious adverse events (primary safety outcome), use of blood products, length of intensive care and hospital stay and generic health status (also at 90 days). Status of the trial: Two centres started recruiting on 08 May 2018; 10 are currently recruiting and 603 patients have been randomised (11 May 2020). The recruitment rate from 01 April 2019 to 31 March 2020 was 40-50 patients/month. About 80% have had coronary artery bypass grafting only. Adherence to allocation is good. Conclusions: The trial is feasible but criteria for progressing to a full trial were not met on time. The Trial Steering and Data Monitoring Committees have recommended that the trial should currently continue.

Impact of Gender on Outcome in Octogenarians after Coronary Artery Bypass Grafting

2016 ◽  
Vol 65 (04) ◽  
pp. 286-291 ◽  
Author(s):  
Bernd Panholzer ◽  
Katharina Huenges ◽  
Jill Jussli-Melchers ◽  
Felix Schoeneich ◽  
Christine Friedrich ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
The Mean ◽  
Surgery In Octogenarians ◽  
The Impact

Background Increasing life expectancy makes cardiac surgery in octogenarians not very uncommon. In this study, the impact of gender on outcome of octogenarians after coronary artery bypass grafting (CABG) was assessed. Materials and Methods We retrospectively studied 485 octogenarians (176 females: mean age 82.4 ± 2.2 years vs. 306 males: mean age 82.2 ± 2.4 years) who underwent isolated CABG using extracorporeal circulation between January 2005 and December 2012. Results No significant differences were noted between both gender groups with regard to preoperative risk factors. At baseline, the groups differed significantly with respect to mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) (women: 22.3 ± 17.4% vs. men: 17.5 ± 13.3%; p < 0.001). Likewise, EuroSCORE II differs significantly between women and men in our cohort (women: 16.7 ± 11.9% vs. men: 13.9 ± 10.7%; p = 0.008). Intraoperatively, the number of distal anastomoses (3.1 ± 0.9 vs. 3.2 ± 0.8), the mean extracorporeal circulation time (99 ± 31 vs. 102 ± 29 minutes), and the mean aortic cross-clamp time (63 ± 31 vs. 60 ± 19 minutes) were similar in both groups. Postoperatively, no significant differences in complications and major morbidity were observed between the groups. The 30-day mortality (women 8.0 vs. men 9.7%; p = 0.62) were without statistical significance between the groups. Conclusion Outcome of octogenarians after CABG resulted in acceptable mortality. Female gender was not associated with increased risks for morbidity and mortality after surgery. Satisfactory outcomes encourage the offering of surgery in octogenarians.

Multimodality Targeted Approach in Redo Off-Pump Coronary Artery Bypass Surgery

2003 ◽  
Vol 11 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Yugal K Mishra ◽  
Harpreet Wasir ◽  
Surendra N Khanna ◽  
Sameer Shrivastava ◽  
Yatin Mehta ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Myocardial Revascularization ◽  
Off Pump ◽  
Left Anterior Descending Artery ◽  
The Mean ◽  
Targeted Approach

Records of 86 patients who underwent off-pump redo coronary revascularization between December 1997 and December 2000, were analyzed. Approaches included median sternotomy (47), anterolateral thoracotomy for left anterior descending artery and diagonal targets (35), posterolateral thoracotomy for the obtuse marginal with proximal anastomosis on descending aorta (3), and a combined subxiphoid-anterior thoracotomy approach (1) for right gastroepiploic artery-to-left anterior descending artery anastomosis. The mean age was 61.82 years. There were 2 (2.3%) operative deaths. Complications included perioperative myocardial infarction in 4 patients and reexploration for bleeding in one. Blood transfusion was required in 12 patients. The mean length of hospital stay was 5 ± 2 days. A multimodality targeted approach for off-pump redo coronary artery bypass offers a less invasive but safer method of myocardial revascularization, with decreased complications, lower blood product requirement, and early hospital discharge.

Minimally invasive extracorporeal circulation is a cost-effective alternative to conventional extracorporeal circulation for coronary artery bypass grafting: propensity matched analysis

Perfusion ◽  
2020 ◽  
pp. 026765912092918
Author(s):  
Jason M Ali ◽  
Maksym Kovzel ◽  
Eve McPhilimey ◽  
Simon Colah ◽  
Ravi De Silva ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
The Mean

Introduction: Minimally invasive extracorporeal circulation has developed with the aim of reducing the impact of the adverse effects associated with conventional extracorporeal circulation. The aim of this study was to compare outcomes for patients undergoing coronary artery bypass grafting using minimally invasive extracorporeal circulation with those performed using conventional extracorporeal circulation. Methods: A retrospective analysis was performed of patients undergoing minimally invasive extracorporeal circulation coronary artery bypass grafting at a single centre. 2:1 propensity matching was performed to identify control patients undergoing conventional extracorporeal circulation coronary artery bypass grafting. Outcomes were compared using univariate analysis. Results: A total of 354 patients were included in the study, with 118 patients undergoing minimally invasive extracorporeal circulation coronary artery bypass grafting. Patients were well matched on baseline characteristics. The mean logistic EuroSCORE was 3.95 ± 4.20. Operative times (3.31 ± 1.52 vs. 3.56 ± 0.73, p = 0.03) were significantly shorter in minimally invasive extracorporeal circulation cases. Patients who underwent surgery with minimally invasive extracorporeal circulation had significantly less 12-hour blood loss (322.3 ± 13.2 mL vs. 380.8 ± 15.2 mL, p < 0.01). Correspondingly, a significantly lower proportion of patients were transfused (25.8% vs. 36%, p = 0.04), and the mean number of red blood cells transfused was lower (0.45 ± 0.95 vs. 0.97 ± 2.13, p = 0.01). Similarly, the number of coagulation products administered was lower (0.161 ± 0.05 vs. 0.40 ± 0.09, p = 0.05). There was a significantly lower incidence of acute kidney injury (11.0% vs. 19.9%, p = 0.03). Minimally invasive extracorporeal circulation was associated with a £679.50 cost saving per patient. Discussion: Minimally invasive extracorporeal circulation for coronary artery bypass grafting is associated with a reduced requirement for blood transfusion, reduced incidence of acute kidney injury and a significant cost saving. Minimally invasive extracorporeal circulation should be considered as an adjunct for all patients undergoing coronary artery bypass grafting.

scholarly journals Hemostatic Efficacy of a Flowable Collagen-Thrombin Matrix During Coronary Artery Bypass Grafting: A Double-Blind Randomized Controlled Trial

2021 ◽  
Author(s):  
Hyohyun Kim ◽  
Kang Ju Lee ◽  
Seung Hyun Lee ◽  
Dae yong Kang ◽  
Jun Hyuk Lee ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Surgical Revision ◽  
Hemostatic Agent ◽  
Double Blind ◽  
The Mean ◽  
Time Required

Abstract Background Flowable hemostatic agents are advantageous in that they can be applied to irregular wound surfaces and to areas that are difficult to approach directly. We sought to compare the effectiveness and safety of the flowable hemostatic sealants Collastat® (collagen hemostatic matrix, [CHM]) and Floseal® (gelatin hemostatic matrix, [GHM]) during off-pump coronary artery bypass (OPCAB). Methods In this prospective, randomized trial, 160 patients undergoing elective OPCAB surgery were enrolled between March 2018 and February 2020. After primary suture of the aortocoronary anastomosis, an area of hemorrhage was identified, and patients were double blind randomized to receive either CHM or GHM (n = 80, each). Study endpoints were the following: rate of successful intraoperative hemostasis and time required for hemostasis overall postoperative bleeding, rate of transfusion of blood products, rate of surgical revision for bleeding, postoperative morbidity, and intensive care unit stay. Results Of the total patients, 23% were female, and the mean age was 63 years (range: 42–81 years). Successful hemostasis within 5 min was achieved for 78 patients (97.5%) in the GHM group, compared to 80 patients (100%) in the CHM group (p = 0.497). Two patients receiving GHM required surgical revision to achieve hemostasis. There were no differences in the mean time required to obtain hemostasis (GHM vs. CHM, 1.49 ± 0.94 vs. 1.35 ± 0.60 min, p = 0.272), as confirmed by time-to-event analysis (p = 0.605). The two groups had similar amounts of mediastinal drainage for 24 h postoperatively (p = 0.298). The CHM group required less packed red blood cells, fresh frozen plasma, and platelets for transfusion than the GHM group (0.5 vs. 0.7 units per patient, p = 0.047; 17.5% vs. 25.0%, p = 0.034; 7.5% vs. 15.0%, p = 0.032; respectively). Conclusions CHM performed similarly to a commonly used hemostatic agent with regard to achieving effective and fast interoperative hemostasis during OPCAB. The topical flowable hemostatic agent, CHM, could be effectively used during cardiac surgery for intraoperative hemostasis of great vessels with high pressure. Trial registration : ClinicalTrials.gov, NCT 04310150

scholarly journals Does the use of the skeletonized internal thoracic artery result in less postoperative bleeding than the pedicled internal thoracic artery in coronary artery bypass surgery?

2020 ◽  
Vol 3 ◽  
Author(s):  
Guilherme Succi ◽  
Pedro Álvaro Barbosa Aguiar Neves ◽  
José Ernesto Succi ◽  
Maira Martins Ferrato dos Santos ◽  
Thathianne Pereira da Costa Neves
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Coronary Artery Bypass Surgery ◽  
Internal Thoracic Artery ◽  
Elective Surgery ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Myocardial Revascularization ◽  
Mammary Arteries

Objective: To compare the postoperative bleeding between the skeletonized grafts and pedicled internal thoracic artery (ITA) in coronary artery bypass. Material and Method: 132 elective patients submitted to the surgery of myocardial revascularization were retrospectively analyzed and the sample was equally distributed in groups according to the dissection performed on the ITA: G1, skeletonized and G2, pedicled. In both methods, the dissection was finished before the heparinization and the installation of extracorporeal circulation. The following clinical parameters were evaluated: extracorporeal circulation time, aortic clamping, drainage debit and administration of hemocomponents (erythrocytes and platelets).   Results: The average number of platelets concentrations and the drainage debit on the postoperative period were statistically higher for the pedicled dissection of the ITA compared to the skeletonized one. No statistically significant differences were observed regarding the use of one or two mammary arteries, as well as for the time of extracorporeal circulation and anoxia in the studied groups. Conclusion: The skeletonized preparation of the internal thoracic artery significantly reduced the blood loss after an elective surgery of myocardial revascularization.

scholarly journals Minimal Invasive Extra-corporeal Circulation on End Stage Coronary Artery Disease Patients Undergoing Myocardial Revascularization

2021 ◽  
Author(s):  
Ignazio Condello ◽  
Giuseppe Santarpino ◽  
Francesco Bartolomucci ◽  
Giovanni Valenti ◽  
Nicola Di Bari ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Minimal Invasive ◽  
Artery Disease ◽  
Lactate Levels ◽  
End Stage

Abstract Background: Patients with coronary artery disease (CAD) undergoing myocardial revascularization, with concomitant heart failure defined by left ventricular ejection fraction (LVEF) lower than 35%, constitute a population at risk of poor long-term prognosis and limited survival. The benefits of minimal invasive extracorporeal circulation (MiECC) on end stage coronary artery disease patients undergoing myocardial revascularization has not been described and evidenced by scientific studies. Materials and Methods: In this single-centre control study of 60 end stage coronary artery disease patients undergoing isolated coronary artery bypass grafting.The patients was divided in two contemporary groups: in group (MiECC), n= 30 coronary artery bypass grafting (CABG) was used MiECC, whereas, in group conventional extracorporeal circulation (cECC), n=30 CABG was used cECC.Results: Procedures of Group MiECC reported (mean values) of a DO2i of 305 mL/min/m2 in relation to O2ERi 21.5% vs a DO2i of 288 mL/min/m2 in relation to O2ERi 25.6% was found in group MiECC vs cECC (p=0.037). Lactate levels >3 mmol/L were reported in 7 group MiECC patients vs 20 group cECC patients (p=0.038), with blood glucose peak. Mean nadir Hb values during CPB were 9.7 g/dL in group MiECC vs 7.8 g/dL in group cECC (p = 0.044). CI during CPB was 2.4 L/min/m2 in both groups. Total red blood cell administration was 8 units in group MiECC vs 21 units in group cECC (p=0.022). A glycemic peak was recorded in 7 patients of group MiECC vs 20 patients of group cECC (p=0.037).Conclusion:The MiECC technique on end stage coronary artery disease was associated with a higher DO2i compared to cECC. MiECC patients showed a significant reduction in red blood cells units administration, in peak intraoperative lactate levels, which correlated with better postoperative renal outcome and shorter length of stay.

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