scholarly journals Coronary Artery Bypass Graft Surgery in Patients on Ticagrelor Therapy Is Not Associated with Adverse Perioperative Outcomes

2021 ◽  
Author(s):  
Sammer Diab ◽  
Mattan Arazi ◽  
Leonid Leonid Sternik ◽  
Ehud Raanani Ehud Raanani ◽  
Erez Kachel ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Acetylsalicylic Acid ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Bleeding Complications ◽  
Perioperative Outcomes ◽  
Chest Drainage ◽  
Group A

Abstract Background Management of patients treated with ticagrelor is challenging, as stopping Ticagrelor prior to coronary bypass graft surgery (CABG) may increase the risk of acute stent thrombosis. The aim of the study was to compare bleeding complications in patients treated with ticagrelor combined with acetylsalicylic acid (ASA) until one day before surgery versus ASA alone. Methods Bleeding complications, defined as the composite of red blood cells transfusion ≥ 1000ml, chest drainage ≥ 2000ml, and bleeding requiring surgical re-exploration, were compared in 161 patients, 101 on preoperative acetylsalicylic acid (ASA) alone (group A) and 65 on ticagrelor + ASA (group B). Results There were no differences in bleeding complications between the two groups (26% vs. 27% in group A and B, respectively), with similar chest drainage in the first 24 hours (569 ± 393ml and 649 ± 427ml, respectively). Conclusions Continuing ticagrelor until coronary artery bypass surgery was not associated with increased bleeding complications, suggesting that with appropriate perioperative management, continuing ticagrelor until surgery may be safe.

scholarly journals Coronary artery bypass graft surgery in patients on ticagrelor therapy is not associated with adverse perioperative outcomes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sammer Diab ◽  
Mattan Arazi ◽  
Leonid Sternik ◽  
Ehud Raanani ◽  
Erez Kachel ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Acetylsalicylic Acid ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Red Blood Cell Transfusion ◽  
Bleeding Complications ◽  
Perioperative Outcomes ◽  
Chest Drainage ◽  
Group A

Abstract Background Management of patients treated with Ticagrelor is challenging, as stopping Ticagrelor prior to coronary bypass graft surgery (CABG) may increase the risk of acute stent thrombosis. The aim of the study was to compare bleeding complications in patients treated with ticagrelor combined with acetylsalicylic acid (ASA) versus ASA alone until 1 day before surgery. Methods Bleeding complications, defined as the composite of red blood cell transfusion ≥1000 ml, chest drainage ≥2000 ml, and bleeding requiring surgical re-exploration, were compared in 161 patients, with 101 on preoperative acetylsalicylic acid (ASA) alone (group A) and 65 on ticagrelor + ASA (group B). Results There were no differences in bleeding complications between the two groups (26% vs. 27% in group A and B, respectively), with similar chest drainage in the first 24 h (569 ± 393 ml and 649 ± 427 ml, respectively). Conclusions Continuing ticagrelor until coronary artery bypass surgery was not associated with increased bleeding complications, suggesting that continued management with ticagrelor until surgery may be safe.

scholarly journals Predictors of Atrial Fibrillation following Coronary Artery Bypass Grafting

2011 ◽  
Vol 5 ◽  
pp. CMC.S7170 ◽  
Author(s):  
Feridoun Sabzi ◽  
Abdol Hamid Zokaei ◽  
Abdol Rasoul Moloudi
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
Bypass Graft ◽  
Multivariate Logistic Regression Analysis ◽  
Categorical Variables ◽  
Group A ◽  
Group B

Background Atrial fibrillation (AF) is a frequent and serious complication of coronary artery bypass graft (CABG) surgery. Methods: We undertook a retrospective review of the records of patients undergoing CABG at Imam Ali Hospital between February 1, 2003 and February 1, 2006. The patients were divided in two groups, ie, Group A (AF) and Group B (no AF). The association between the occurrence of AF following CABG and other variables was compared with respect to continuous or categorical variables by t-test and χ2-test. Results Multivariate logistic regression analysis of potentially predictive factors in univariate analysis showed that opium use, type of operation, and crossclamp time were predictors of AF following CABG. Conclusion This study identifies some new predictors of postoperative AF, control of which could lead to a lower incidence of AF and reduced morbidity, mortality, and resource utilization for patients undergoing cardiac surgery.

scholarly journals Bisoprolol Versus Corticosteroid and Bisoprolol Combination for Prevention of Atrial Fibrillation After On-Pump Coronary Artery Bypass Graft Surgery

2019 ◽  
Vol 13 (1) ◽  
pp. 18-24
Author(s):  
Ramy Mahrose ◽  
Ahmed M. Elsayed ◽  
Mohamed S. Elshorbagy
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Group A ◽  
Pump Coronary Artery Bypass ◽  
Group B

Background:The most common cardiac arrhythmia that happens after on-pump Coronary Artery Bypass Graft (CABG) surgery is Atrial Fibrillation (AF). It is combined with several postoperative complications such as increased incidence of stroke, increased hospital stay and increased costs.Objectives:The aim of this study was to look for safe, effective, reliable and well tolerated tools for the prevention of atrial fibrillation after on pump coronary artery bypass surgery.Patients and Methods:The study enclosed 176 patients (the age ranges from 40 to 79 years) and scheduled for elective on-pump CABG operations without concomitant procedures. The patients were selected randomly into two equal groups. Group (A) in which bisoprolol was used to prevent atrial fibrillation after surgery. Group (B) in which bisoprolol and hydrocortisone were used for prevention of atrial fibrillation after surgery. For each patient, the following data were collected: gender, preoperative diseases, cardiopulmonary bypass time, intraoperative cross clamp time, Left internal mammary Artery usage, incidence of postoperative atrial fibrillation, death, myocardial infarction chest infection and C-reactive protein amount in plasma.Results:There was a statistically significant decrease in the occurrence of atrial fibrillation in group (B) when compared to corresponding values in group (A). Also, group (B) showed a statistically significant decrease in length of hospital stay in comparison to group (A). C-reactive protein concentrations on the 1stand 2ndpostoperative days were lower significantly in group (B) than in group (A). There were no statistically significant differences between both groups regarding gender, preoperative diseases, cardiorespiratory bypass time, intraoperative cross clamp time, Left internal mammary artery usage, death, myocardial infarction and chest infection.Conclusion:This study demonstrated that using bisoprolol and hydrocortisone combination showed greater benefit than the use of bisoprolol only for prevention of postoperative AF after on-pump coronary artery bypass graft surgery.

scholarly journals Peroperative epicardial ultrasonography of distal coronary artery bypass graft anastomoses using a stabilizing device. A feasibility study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jan Jesper Andreasen ◽  
Dorte Nøhr ◽  
Alex Skovsbo Jørgensen ◽  
Poul Erik Haahr
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Learning Curve ◽  
Coronary Artery Bypass ◽  
Feasibility Study ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Artery Bypass Graft ◽  
Pump Cabg

Abstract Background Widespread use of intraoperative epicardial ultrasonography (ECUS) for quality assessment of coronary artery bypass graft anastomoses during coronary artery bypass grafting (CABG) has not occurred - presumably due to technological and practical challenges including the need to maintain stable and optimal acoustic contact between the ultrasound probe and the target without the risk of distorting the anastomosis. We investigated the feasibility of using a stabilizing device during ultrasound imaging of distal coronary bypass graft anastomoses in patients undergoing on-pump CABG. Imaging was performed in both the longitudinal and transverse planes. Methods Single-centre, observational prospective feasibility study among 51 patients undergoing elective, isolated on-pump CABG. Ultrasonography of peripheral coronary bypass anastomoses was performed using a stabilizing device upon which the ultrasound transducer was connected. Transit-time flow measurement (TTFM) was also performed. Descriptive statistical tests were used. Results Longitudinal and transverse images from the heel, middle and toe were obtained from 134 of 155 coronary anastomoses (86.5%). After the learning curve (15 patients), all six projections were obtained from 100 of 108 anastomoses scanned (93%). Failure to obtain images were typical due to a sequential curved graft with anastomoses that could not be contained in the straight cavity of the stabilizing device, echo artefacts from a Titanium clip located in the roof of the anastomoses, and challenges in interpreting the images during the learning curve. No complications were associated with the ECUS procedure. The combined ECUS and TTFM resulted in immediate revision of five peripheral anastomoses. Conclusions Peroperative use of a stabilizing device during ultrasonography of coronary artery bypass anastomoses in on-pump surgery facilitates imaging and provides surgeons with non-deformed longitudinal and transverse images of all parts of the anastomoses in all coronary territories. Peroperative ECUS in addition to flow measurements has the potential to increase the likelihood of detecting technical errors in constructed anastomoses. Trial registration The study was registered on September 29, 2016, ClinicalTrials.gov ID: NCT02919124.

Antegrade-Retrograde Cardioplegia for Myocardial Protection during Coronary Artery Bypass Graft Surgery

1998 ◽  
Vol 6 (3) ◽  
pp. 188-194
Author(s):  
Tarek A Abdel Aziz ◽  
Najib Al Khaja ◽  
Mohamed A Ali ◽  
Ali S Maklad ◽  
Mohamed F Bassiouny ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Damage ◽  
Artery Bypass Graft ◽  
Retrograde Cardioplegia ◽  
Group A ◽  
Group B

This prospective randomized clinical study was designed to assess and compare the use of combined antegrade-retrograde cardioplegia versus antegrade cardioplegia in providing adequate myocardial preservation during coronary artery bypass graft surgery. Fifty patients undergoing elective coronary artery bypass grafting were randomly divided into 2 groups according to the route of cardioplegic delivery: group A (25 patients) received antegrade cold crystalloid cardioplegia; group B (25 patients) received combined antegrade-retrograde cold crystalloid cardioplegia. The groups were compared by clinical and electrocardiographic criteria and biochemical markers of ischemic myocardial damage. There was a highly significant statistical difference between the groups in terms of spontaneous recovery of sinus rhythm (40% of patients in group A versus 96% in group B). The use of direct current shock to restore sinus rhythm was higher in group A (60%) compared with group B (4%). Low cardiac output occurred in 20% of patients in group A and in 16% of patients in group B but this difference was not statistically significant. No bundle-branch block was found in group B whereas the incidence was 8% in group A. Significantly higher levels of biochemical markers of myocardial damage were obtained in group A at 10 minutes, 4 hours, and 12 hours after declamping. These results indicate that combined antegrade-retrograde cardioplegia is superior to antegrade cardioplegia for myocardial protection during coronary artery bypass graft surgery.

scholarly journals Assessment of Platelet Reactivity and Inflammatory Markers in Coronary Artery Bypass Graft Patients Treated with Acetylsalicylic Acid with Flavonoid Supplementation

Molecules ◽  
2021 ◽  
Vol 26 (24) ◽  
pp. 7486
Author(s):  
Aldona Siennicka ◽  
Magdalena Kłysz ◽  
Monika Adamska ◽  
Kornel Chełstowski ◽  
Andrzej Biskupski ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Acetylsalicylic Acid ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Inflammatory Markers ◽  
Platelet Reactivity ◽  
Artery Bypass ◽  
Late Phase ◽  
Bypass Graft ◽  
Aggregation Effect

The recommended pharmacological therapy for patients with coronary artery disease (CAD) treated by coronary artery bypass grafting (CABG) is acetylsalicylic acid (ASA). To improve the antiplatelet effect, supplementation with flavonoids is also recommended. The aim of this study was to estimate anti-aggregation properties of diosmin, in combination with ASA, pre- and postoperatively and assess the relationship of this therapy with inflammatory processes in CAD patients undergoing CABG. The study patients (n = 26) took diosmin (1000 mg/day); the control patients (n = 27) took a placebo. The therapeutic period for taking diosmin was from at least 30 days before to 30 days after CABG. All patients also took 75 mg/day ASA. Platelet aggregation and IL-6, CRP, and fibrinogen concentrations were determined before and 30 days after surgery. Results showed that diosmin did not enhance the anti-aggregation effect of ASA at any assessment time. However, there was a stronger anti-aggregation effect 30 days after surgery that was diosmin independent and was associated with acute-phase markers in the postoperative period. Increased levels of inflammatory markers in the late phase of the postoperative period may provide an unfavorable prognostic factor in long-term follow-up, which should prompt the use of stronger antiplatelet therapy in patients after CABG.

scholarly journals Comparative Evaluation of ‘Will Bleed, Papworth, Track and Trust’ Bleeding Risk Scores in Diabetic Isolated Coronary Bypass Graft Surgery Patients and Laying the Foundations for Optimum Risk Score for Bleeding After Coronary Bypass Graft Surgery

2021 ◽  
Author(s):  
engin akgül ◽  
Abdulkerim Ozhan
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Risk Score ◽  
Blood Product ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Scoring Systems ◽  
Diabetic Patients ◽  
Coronary Bypass Graft

Background: One of the most undesired complications after open heart operations is bleeding. In our study, we set ourselves two different goals: examining ‘Papworth, Will-Bleed, Track and Trust’ bleeding scoring systems to determine the most predictive one among diabetic patients undergoing isolated coronary bypass surgery, and determining the variables that should be included in the new scoring systems to be established for this patient group. Methods: The files of 297 diabetic patients who underwent isolated coronary artery bypass operation between 2017-2019 were retrospectively reviewed. Patients who underwent emergency surgery with a beating heart, those with reoperated open hart surgery, those with ticagrelor use, and those who died within the first 24 postoperative hours were excluded from the study. Drainage from the thorax and mediastinal tubes and blood product transfusions to the patients within the first 24 hours were noted and analyzed according to scoring systems. Results: Scoring systems are evaluated based on ‘European Multicenter Study on Coronary Artery Bypass Grafting Bleeding Severity (E-CABG)’. In this study including diabetic patients only, Papworth was better predictive of E-CABG bleeding Grade 2-3. We found that Will-Bleed, Track, Trust, the other scoring systems we examined had discriminatory value in terms of E-CABG bleeding Grade 2-3 in our study group. Among the parameters in the scoring systems, we concluded that gender, preoperative hemoglobin (or hematocrit) value, preoperative platelet count, use of antiplatelets until less than five days prior to the operation, and preoperative creatinine (or eGFR) values should be included in the scoring system we aim to establish in the future, called the “Optimum Risk Score for Bleeding (ORS).” Conclusion: Considering the possible risks of bleeding and blood product transfusion, scoring systems that will provide accurate results for patient blood management will be lifesaving and increase the cost-effectiveness of the treatment.

Thoracoscopic Transmyocardial Laser Revascularization: Is Prior Coronary Artery Bypass Grafting a Contraindication?

2007 ◽  
Vol 2 (3) ◽  
pp. 112-115 ◽  
Author(s):  
Gary S. Allen ◽  
Jason Budde
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Airway Injury ◽  
Transmyocardial Laser Revascularization ◽  
Port Access ◽  
Group A ◽  
Group B

Objective Recently, thoracoscopic techniques have been used to perform transmyocardial laser revascularization (TMR) in patients who are not suitable candidates for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions. Whether or not prior CABG contraindicates a port access–only approach to TMR is unclear. This study compares patients with and without prior CABG who have undergone thoracoscopic TMR. Methods Between May 2003 and October 2005, 23 consecutive patients (6 without prior CABG, group A; and 17 with prior CABG, group B) underwent thoracoscopic TMR, using a holmium:yttriumaluminum-garnet (Ho:YAG) laser system. Either 3 or 4 port incisions (each ≤2 cm in length) were used, depending on the patient's anatomy. Procedural success was defined as the ability to create all intended channels without conversion to thoracotomy. Results Patient demographics were not significantly different between group A and group B (mean age, 65.8 ± 4.3 years versus 67.4 ± 2.4 years, Canadian Cardiovascular Society angina class 3.7 ± 0.2 versus 3.9 ± 0.1, and Parsonnet score 12.0 ± 3.2 versus 20.5 ± 2.4). Fourteen (82.4%) group B patients had a prior left internal mammary artery to left anterior descending artery graft, of which 12 (85.7%) were patent. One patient in group A had an airway injury at intubation that led to an extended hospital stay of 30 days. One patient in group A (16.7%) and one patient in group B (5.9%) required a blood transfusion (P = NS). Adhesion lysis time in group B ranged from 0 to 68 minutes (mean, 27 ± 5.6 minutes). Neither group had a conversion to thoracotomy or any deaths through a mean combined follow-up of 12 months. Conclusions A port access approach is safe and reproducible for patients who are candidates for sole therapy TMR. Prior CABG, including patent grafts, is not a contraindication to thoracoscopic TMR.

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