Implication of preoperative glycosylated hemoglobin level on short term outcomes in diabetic patients undergoing coronary artery bypass grafting

Background: Diabetes mellitus is one of the significant risk factors for adverse outcomes after coronary artery bypass surgery. The glycosylated haemoglobin i.e. HbA1c is a reliable diagnostic test to know the long-term glycemic status. The objective of the study is to investigate the implication of preoperative HbA1c level on short term outcomes after coronary artery bypass grafting (CABG).Method: Total 218 patients were studied, and the data were collected retrospectively. Patients are distributed into group 1 with HbA1c≤7 (good glycemic control) and group 2 with HbA1c>7 (poor glycemic control). The parameters studied for short term outcomes were revision due to bleeding, duration of mechanical ventilation, cerebrovascular accident (CVA), atrial fibrillation (AF), renal failure requiring dialysis, infective complications like sternal and leg wound infection, mediastinitis, pneumonia, urinary tract infection (UTI), sepsis; length of ICU stay and in-hospital mortality.Result: In comparison to group 1, patients of group 2 showed statistically significant more morbidity in view of short-term outcomes in this study.Conclusion: HbA1c>7 is associated with statistically significant adverse short-term outcomes after CABG.

Download Full-text

Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting

The Heart Surgery Forum ◽

10.1532/hsf.1341 ◽

2015 ◽

Vol 18 (6) ◽

pp. 255 ◽

Cited By ~ 7

Author(s):

Hüseyin Şaşkın ◽

Çagrı Düzyol ◽

Kazım Serhan Özcan ◽

Rezan Aksoy ◽

Mustafa Idiz

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Platelet To Lymphocyte Ratio ◽

Artery Bypass Grafting ◽

Lymphocyte Ratio ◽

Group 2 ◽

Group 1

Objective: To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation. Methods: We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142. Results: The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality. Conclusion: In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

Download Full-text

Evaluation of the Perioperative Period After Off-Pump Coronary Artery Bypass Grafting in Patients with the History of COVID-19

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/21.4409/g.c.038-80-85 ◽

2021 ◽

pp. 80-85

Author(s):

Artur V. Gabriyelyan ◽

Olexander V. Cheveliuk ◽

Svitlana V. Romanova ◽

Irina V. Kudlai ◽

Marchelina S. Gergi ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Perioperative Period ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

History Of ◽

Group 2 ◽

Group 1

Previous COVID-19 is known to have negative impact on postoperative course of coronary artery bypass grafting. According to a number of foreign sources, mortality after coronary artery bypass grafting is increased in patients with previous COVID-19, and the perioperative period is accompanied by complications such as myocardial infarction, acute renal failure, acute cerebrovascular accident, sternal infection. The aim. To evaluate the features of the perioperative period after coronary artery bypass grafting in patients with the history of COVID-19. Materials and methods. The research is based on the analysis of data from patients who were operated at the Department of Transplantation and Heart Surgery of Shalimov National Institute of Surgery and Transplantation for the last 2 years. The article presents a comparative analysis of the perioperative period after coronary artery bypass grafting on a beating heart in patients with and without the history of COVID-19. Both groups of patients were basically equivalent in demographics, incidence of comorbidities, NYHA functional class, ejection fraction, and the difference between them was insignificant. Severe course of previous COVID-19 was noted only in 2 (10%) patients, moderate in 6 (30%), mild in 12 (60%). The most common finding was 11% to 30% damage of the lung tissue which was observed in 10 (50%) patients. Residual effects of spiral computed tomography immediately before surgery were detected in 6 (30%) cases. Results and discussion. In the early postoperative period there were such complications as: acute myocardial infarc-tion, acute renal failure, acute cerebrovascular accident, sternal infection. In the early postoperative period, patients in both groups developed complications: 14 (70%) patients in group 1 vs. 7 (35%) patients in group 2. Acute renal failure (ARF) was verified by a 1.5–1.9-fold increase in creatinine levels compared to baseline, or ≥0.3 mg/dL (≥26.5 mmol/l), and was significantly more common in the group of patients after COVID-19 (6 [30%]) than in the group of patients with-out the history of COVID-19 (2 [10%]). The incidence of myocardial infarction confirmed by high levels of highly specific troponin T and changes in electrocardiography also prevailed in group 1 with 4 (20%) patients vs. 2 (10%) patients in group 2 (P <0.001). In patients with a history of COVID-19, the duration of ventilation and the need for additional oxygen-ation was higher compared to those who did not have COVID-19. We found that patients with the history of COVID-19 had more abundant exudates in the first 24 hours: 113 ± 36.4 ml in group 1 vs. 78 ± 26.8 ml in group 2 without COVID-19. The length of stay of the patients in the ICU differs in both groups: 78.4 ± 14.1 hours in group 1 and 52.8 ± 12.1 hours in group 2 (P <0.01), and is observed as a consequence of the above-mentioned complications accompanying early postoperative period. Conclusions. Analysis of the results of coronary artery bypass graft surgery in patients with a history of COVID-19 showed that the postoperative course in them is more severe compared with patients who did not have COVID-19. The patients with the history of COVID-19 who are candidates for coronary artery bypass grafting are more likely to devel-op acute myocardial infarction and acute renal failure manifested by increased creatinine in the postoperative period.

Download Full-text

Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes following Coronary Artery Bypass Grafting: A Randomized Clinical Trial

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1608686 ◽

2017 ◽

Vol 66 (06) ◽

pp. 442-451 ◽

Cited By ~ 1

Author(s):

Alireza Kamali ◽

Yazdan Ghandi ◽

Mehrzad Sharifi

Keyword(s):

Clinical Trial ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Postoperative Outcomes ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Group 2 ◽

Group 1

Background The topic of aspirin (acetylsalicylic acid, ASA) use in coronary artery disease patients planned for coronary artery bypass grafting during perioperative period is among the most disputed issues in cardiac surgery. We designed a study to weigh the risks and benefits of continued ASA ingestion until the time of surgery. Methods In this randomized double-blind clinical trial, 206 consecutive patients scheduled for isolated coronary artery bypass surgery (CABG) were randomly stratified into two groups. In group 1 (104 cases), patients were given 80 mg ASA per day until the day of surgery. In group 2 (102 patients), ASA (80 mg per day) was stopped 4 days before the operation. Patients in these two groups were similar in terms of preoperative patient and procedural characteristics. ASA was resumed 24 hours after the surgery in all patients. Results The rates of bleeding and reexploration within 24 hours of surgery were significantly higher in group 1 (824.3 vs. 492.1 mL, p < 0.001 and 5.7% vs. 0, p = 0.0138, respectively). The amount of intra- and postoperative packed red blood cell (PRBC) transfusion was considerably greater in group 1 (mean: 1.83 vs. 0.71 units, p < 0.001). The rate of hospital mortality was similar (1.9% in both the groups, p = 0.98). Patients in group 1 had significantly longer mean hospital stay than patients in group 2 (8 vs. 5.1 days, p < 0.001). Again the time interval between weaning from heart–lung machine and closing the sternum was strikingly longer in group 1 (mean: 32.1 vs. 14.5 minutes, p < 0.001). The incidence of adverse postoperative outcomes such as myocardial infarction, stroke, and renal failure was not statistically different between the two groups. Conclusion Sustained ASA use until the day of surgery in patients planned for elective isolated CABG can result in excessive bleeding, increased rate of reexploration, and need for more PRBC transfusion without any proven beneficial effect on reducing unfavorable postoperative outcomes. Hence, we recommend discontinuing ASA between 3 and 5 days before non-urgent CABG while keeping it on in nonelective circumstances.

Download Full-text

The Effects of Aortic Clamping Strategy on Myocardial Protection and Early Postoperative Outcomes During Coronary Artery Bypass Grafting Operations

The Heart Surgery Forum ◽

10.1532/hsf.3475 ◽

2021 ◽

Vol 24 (2) ◽

pp. E217-E222

Author(s):

Cüneyt Eris ◽

Burak Erdolu ◽

Mesut Engin ◽

Ahmet Kagan As ◽

Yasemin Ustundag

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Myocardial Protection ◽

Artery Bypass ◽

Postoperative Outcomes ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Group 2 ◽

Group 1

Background: The purpose of the present study was to compare the effects of two different clamping strategies for the construction of the proximal aortocoronary anastomoses on myocardial protection and postoperative outcomes during coronary artery bypass grafting (CABG) operations. Methods: In this retrospective study, we examined prospectively collected data of patients who underwent CABG for a 3-year period. Two hundred consecutive patients, who were diagnosed with triple vessel coronary artery disease (CAD), were selected and divided into two groups. In Group 1 (single clamp) (N = 100), venoaortic proximal anastomoses were performed using a single aortic cross-clamp, while in Group 2 (double clamp) (N = 100), proximal anastomoses were performed by using an aortic side clamp. Operative and postoperative outcomes of the patients were compared between the two groups. The serum levels of myocardial damage biomarkers, creatine phosphokinase-MB (CPK-MB), and high sensitive Troponin (hsTnI) results were measured preoperatively, intraoperatively, and postoperatively (6, 12, 24, and 48 hours). Results: Patient demographics and characteristics were similar between the two groups. In Group 1, cross-clamp duration time (65 min versus 49 min; P = .0001) was longer. However, perfusion time (91 min versus 85 min; P = .61) was similar between the two groups. In Group 2, postoperative CK-MB levels were significantly higher intraoperatively (P = .18), 6 hours (P = .22), 24 hours (P = .001), and 48 hours (P = .001) than in Group 1. HsTnI was only significantly higher in Group 2 versus Group 1 at 24 hours (P = .001) and 48 hours (P = .01) postoperatively. Time of intensive care unit stay, duration of extubation, and length of hospital stay were similar in both groups. Conclusion: The technique used for proximal anastomosis has a significant effect on perioperative results, especially on myocardial protection.

Download Full-text