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>

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.

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