Transient liver dysfunction increases surgical site infections after coronary surgery

2018 ◽  
Vol 26 (6) ◽  
pp. 439-445 ◽  
Author(s):  
Rakan I Nazer ◽  
Khalid A Alburikan ◽  
Anhar Ullah ◽  
Ali M Albarrati ◽  
Mazen Hassanain
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Liver Dysfunction ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Surgical Site Infections ◽  
Perioperative Period ◽  
Coronary Bypass Surgery ◽  
Cardiac Procedures

Background Surgical site infections can have a significant impact on cardiac surgical outcome. The liver plays an important role in infection prevention. This study aimed to retrospectively determine whether transient postoperative liver dysfunction after coronary bypass surgery increased surgical site infections. Methods A modified version of the Schindl scoring scale for liver dysfunction was adapted to objectively quantify transient liver dysfunction in the first 7 days after on-pump coronary artery bypass grafting. A retrospective analysis of clinical outcomes at 30 months postoperatively was performed on data of 575 patients who underwent coronary artery bypass between 2014 and 2016. The patients were categorized into a liver dysfunction group (Schindl score ≥ 4) and a non-liver dysfunction group (Schindl score < 4). Results The liver dysfunction group (47.3%) had significantly more patients who were obese, current smokers, and had diabetes, renal impairment, and peripheral vascular disease. Surgical site infections occurred predominantly in the liver dysfunction group (12.1% vs. 0.3%, p < 0.001). The independent predictors of surgical site infection were liver dysfunction, body mass index > 30 kg m−2, and coronary bypass surgery combined with other cardiac procedures. Conclusions Surgical wound infections can be precipitated by multiple factors before, during, and after coronary bypass surgery. Transient liver dysfunction in the perioperative period is associated with an increased rate of surgical infections even after adjusting for known risk factors. Considering this factor as well as other known risks may help to identify and stratify patients with a potentially higher risk of surgical site infections.

scholarly journals Causes affecting the working capacity of patients undergoing coronary bypass surgery (systematic review)

2021 ◽  
Vol 65 (6) ◽  
pp. 581-586
Author(s):  
Maria A. Kuzmichkina ◽  
Viktoria N. Serebryakova
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

A review of the available domestic and foreign literary sources is presented concerning factors affecting the working capacity of persons after coronary artery bypass grafting. It was found that in Russia, after surgical treatment of coronary heart disease, there is an increase in the number of disabled people compared to foreign data. In recent years, there has been an increase in patients undergoing coronary bypass surgery. However, this did not reduce the increasing number of disabled people after coronary artery bypass grafting, which does not correspond to the initial expectations about the cost-effectiveness of this type of surgery. According to Russian researchers, the proportion of persons with disabilities referred for surgical myocardial revascularization was 39.0-42.5%. Subsequently, this indicator increased to 64.0%. In other countries, the dynamics are different. Among patients under 60 years of age who underwent surgical treatment of coronary artery disease, more than half returned to work. In general, labour activity was restored by 67.5%, and the number of disabled persons decreased from 56.0 to 42.0%. Social and medical factors were assessed to establish the causes of disability after coronary artery bypass grafting. World experience testifies to the critical role of state social support in preserving the labour status of patients, which ultimately justifies the economic costs of surgical treatment. To assess the degree of disability after coronary artery bypass grafting, social status before surgical treatment of coronary heart disease, and the severity of comorbid pathology. To increase the economic efficiency of coronary bypass surgery, it is necessary to organize an affordable and effective rehabilitation program, uniform criteria for referring patients to medical and social expertise.

A Case Report on Concomitant Coronary Artery Bypass Operation and Renal Transplantation

2014 ◽  
Vol 17 (3) ◽  
pp. 180
Author(s):  
Yucel Ozen ◽  
Sabit Sarikaya ◽  
O. Atlas ◽  
D. Cekmecelioglu ◽  
Kann Kirali ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Renal Transplantation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Asymptomatic Patients ◽  
Artery Disease

Renal transplantation is successfully implemented in patients undergoing coronary bypass surgery. We performed concomitant coronary bypass surgery and renal transplantation in a patient found to have a left main coronary artery lesion after coronary angiography, which was performed in our clinic during preoperative evaluation of renal transplantation. We suggest the application of coronary-artery bypass grafting (CABG) or stent implantation 2 months after renal transplantation in asymptomatic patients with coronary artery disease. But, if severe coronary artery disease is detected in symptomatic patients, we suggest the concurrent application CABG and renal transplantation.

scholarly journals Return to work after coronary artery bypass surgery

Medicina ◽  
2008 ◽  
Vol 44 (11) ◽  
pp. 841 ◽  
Author(s):  
Donatas Vasiliauskas ◽  
Rasa Raugalienė ◽  
Vytautas Grižas ◽  
Jolanta Marcinkevičienė ◽  
Lina Jasiukevičienė ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Return To Work ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Group I

The aim of this study was to assess the possible reasons for not returning to work after coronary artery bypass surgery. A total of 134 patients (aged 65 years and younger) who underwent coronary bypass surgery in 2003 were examined. The analysis was performed in three groups of the patients: Group I, patients who were employed before surgery and returned to work after it (n=51); Group II, patients who were employed before surgery but did not return to work after surgery (n=55); and Group III, patients who were unemployed before and remained unemployed after surgery due to health problems (n=28). Number of injured coronary arteries, the extent of operation, postoperative complications, risk factors for ischemic heart disease, clinical status of patients (angina pain and heart failure), physical tolerance, and return to work within one year after coronary bypass surgery were analyzed. It was found that 48.1% of patients who were employed before surgery returned to work after myocardial revascularization. About 30% of patients experienced recurrent symptoms of angina after 12 months. Logistic regression analysis revealed that return to work was significantly influenced by female gender, physical pattern of work, age, and severity of heart failure.

The Comparison between Minimally Invasive Coronary Bypass Grafting Surgery and Conventional Bypass Grafting Surgery in Proximal LAD Lesion

2015 ◽  
Vol 18 (2) ◽  
pp. 042 ◽  
Author(s):  
Mehmet Ezelsoy ◽  
Baris Caynak ◽  
Muhammed Bayram ◽  
Kerem Oral ◽  
Zehra Bayramoglu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Robotic Group ◽  
Bypass Group

<strong>Background</strong>: Minimally invasive bypass grafting surgery has entered the clincal routine in several centers around the world, with an increasing popularity in the last decade. In our study, we aimed to make a comparison between minimally invasive coronary artery bypass grafting surgery and conventional bypass grafting surgery in isolated proximal left anterior descending artery (LAD) lesions. <br /><strong>Methods</strong>: Between January 2004 and December 2011, patients with proximal LAD lesions, who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery, were included in the study. In Group 1, coronary bypass with cardiopulmonary bypass and complete sternotomy were applied to 35 patients and in Group 2, robotically assisted minimally invasive bypass surgery was applied to 35 patients. The demographic, preoperative, perioperative, and postoperative data were collected retrospectively.<br /><strong>Results</strong>: The mean follow-up time of the conventional bypass group was 5.7 ± 1.7 years, whereas this ratio was 7.3 ±1.3 in the robotic group. There was no postoperative transient ischemic attack (TIA), wound infection, mortality, or need for intra-aortic balloon pump (IABP) in any of the patients. In the conventional bypass group, blood transfusion and ventilation time were significantly higher (P &lt; .05) than in the robotic group. The intensive care unit (ICU) stay and hospital stay were remarkably shorter in the robotic group <br />(P &lt; .01). The postoperative pneumonia rate was significantly higher (20%) in the conventional bypass group <br />(P &lt; .01). Postoperative day 1 pain score was higher in the robotic group (P &lt; .05), however, postoperative day 3 pain score in the conventional bypass group was higher (P &lt; .05). Graft patency rate was 88.6% in the conventional bypass group whereas this ratio was 91.4% in the robotic bypass group, which was not clinically significant (P &gt; .05).<br /><strong>Conclusion</strong>: In isolated proximal LAD stenosis, robotic assisted minimally invasive coronary artery bypass grafting surgery requires less blood products, is associated with shorter ICU and hospital stay, and lesser pain in the early postoperative period in contrast to conventional surgery. The result of our studies, which showed similarities to the past studies, lead us to recognize the importance of minimally invasive interventions and the need to perform them more frequently in the future.

Cost of surgical site infections following coronary artery bypass surgery

2001 ◽  
Vol 71 (11) ◽  
pp. 662-664 ◽  
Author(s):  
Adam W. J. Jenney ◽  
Glenys A. Harrington ◽  
Philip L. Russo ◽  
Denis W. Spelman
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Surgical Site Infections

scholarly journals Early Patency Evaluation of New Distal Anastomotic Device in Internal Mammary Artery Grafts Using Computed Tomography Angiography

2010 ◽  
Vol 5 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Husam H. Balkhy ◽  
L. Samuel Wann ◽  
Susan Arnsdorf
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Internal Mammary

Introduction Traditional coronary artery bypass grafting is performed using a hand sewn technique. The C-Port xA and Flex A anastomotic stapling devices (Cardica Inc., Redwood City, CA) were cleared by the Food and Drug Administration for use in distal coronary anastomoses in November 2006 and April 2007, respectively. They provide the ability to create a compliant, consistently reproducible, and automated anastomosis. Multidetector computed tomography (CT) has been shown to be effective in evaluating coronary artery bypass graft patency. Methods The first 24 patients to undergo internal mammary artery (IMA) anastomosis using the automated device in our practice were included in the study. Twenty-five IMA grafts (24 left IMA and 1 right IMA) were created using the C-Port xA or Flex A anastomotic device as part of multivessel off-pump coronary revascularization by sternotomy. Graft patency was evaluated at 30 days in the first 10 grafts and at 90 days in the next 15 grafts using multidetector (64 slice) CT. Results There were no device failures. There were no perioperative strokes, myocardial infarctions, or deaths. All 10 IMA grafts evaluated at 30 days were patent using multidetector CT. One of the 15 IMA grafts studied at 90 days was occluded using multidetector computed tomography. Conclusions The C-Port xA and Flex A distal anastomotic devices provided a safe and effective means to create a left IMA-left anterior descending artery anastomoses in coronary bypass surgery with excellent short to midterm patency in this early experience. Long-term follow-up is warranted. These findings will have important implications for future sternal sparing coronary bypass surgery.

scholarly journals The Pathways to Increase the Efficacy of Drug Therapy in Patients with Ischemic Heart Disease after Coronary Artery Bypass Grafting

Kardiologiia ◽  
2019 ◽  
Vol 59 (6) ◽  
pp. 12-17
Author(s):  
O. L. Barbarash ◽  
V. V. Kashtalap ◽  
M. V. Zykov ◽  
O. N. Hryachkova ◽  
I. A. Shibanova
Keyword(s):  
Heart Disease ◽  
Drug Therapy ◽  
Coronary Artery ◽  
Ischemic Heart Disease ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Ischemic Heart

Purpose: to assess drug therapy and achievement of target parameters of treatment in patients with ischemic heart disease (IHD) during 3–5 years of follow-up aſter coronary bypass surgery.Materials and methods. From the initial sample of the coronary bypass surgery registry (n=680) we selected for this study 111 men (mean age 61 [55; 65] years) hospitalized in 2011 with clinical picture of IHD for coronary artery bypass graſting (CABG).Results. Mean duration of follow-up was 4.2 years. Mortality was 11.7 % (n=13), 11 deaths were cardiovascular, 2 – from unknown causes. End points defined as repeat hospitalizations and IHD progression were registered in 18 of 98 patients (18.4 %). Only in 25 % of patients during 3–5 years of observation aſter CABG there were no clinical signs of angina. Five patients (5.1 %) developed new type 2 diabetes. Drug therapy: 80 patients (81.6 %) received acetylsalicylic acid, 60 (61.2 %) – angiotensin converting enzyme inhibitors, 80 (81.6 %) – β-adrenoblockers. Eighty-one men (82.6 %) received statins, but only 20 of 98 re-examined patients (20.4 %) took high doses. Target levels of low density lipoprotein cholesterolConclusion. Data of clinical practice illustrate insufficient quality of basic and antianginal therapy in patients with IHD aſter CABG. Indicators of control of angina, heart rate, achievement of target levels of parameters of lipid metabolism remain unsatisfactory.

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