The effects of melatonin on the oxidative stress and duration of atrial fibrillation after coronary artery bypass graft surgery: A Randomized Controlled Trial

2020 ◽  
Vol 20 ◽  
Author(s):  
Saghar Barati ◽  
Alireza Jahangirifard ◽  
Zargham Hossein Ahmadi ◽  
Maria Tavakoli-Ardakani ◽  
Farzaneh Dastan
Keyword(s):  
Oxidative Stress ◽  
Atrial Fibrillation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
P Value ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Significant Difference ◽  
Hs Crp

Background: Atrial Fibrillation (AF) is a common complication following Coronary artery bypass graft (CABG) Surgery, which may be due to oxidative stress, necrosis and inflammation during CABG and can lead to increases the length of hospital stay and the risk of morbidity and mortality. Melatonin is a hormone with anti-oxidant and anti-inflammatory properties in the cardiovascular system. This study assessed the efficacy of sublingual consumption of melatonin in reducing necrosis and inflammation, in patients undergoing CABG with respect to C-reactive protein (hs-CRP), Creatine KinaseMuscle-Brain subunits (CK-MB) and cardiac Troponin T (cTnT) levels. Methods: One hundred and two patients were enrolled and twenty-six patients were excluded during the study process and finally seventy-six patients undergoing CABG surgery randomly assigned to melatonin group (n = 38, 12 mg sublingual melatonin the evening before and 1 hour before surgery, or the control group which did not receive Melatonin, n = 38). Three patients in the melatonin group and three patients in the control group were excluded from the study because of discontinued intervention and lost to follow up. The samples were collected before and 24 hours after surgery. hs-CRP, CKMB, and cTnT levels were measured in all patients with the Elisa method. Results: There was no significant difference in influencing variables among the groups at the baseline. The incidence of AF following CABG surgery was not statistically significant between the two groups, (p value = 0.71). However, the duration of AF (p value = 0.01), the levels of hs-CRP (p value = 0.001) and CK-MB (p value = 0.004) measured, 24 hours after surgery were significantly lower in the melatonin group. cTnT levels measured 24 hours post-CABG did not show any significant difference in both groups (p value = 0.52). Conclusion: Our findings suggest that the administration of melatonin may help modulate oxidative stress, based on the reduction of the levels of hs-CRP, CK-MB, and the duration of AF following CABG surgery.

Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Seyed Tayeb Moradian ◽  
Fatemah Beitollahi ◽  
Mohammad Saeid Ghiasi ◽  
Amir vahedian-azimi
Keyword(s):  
Clinical Trial ◽  
Pulse Oximetry ◽  
Fast Track ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Non Invasive

Abstract Background Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery. Methods In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35); the intervention group and the control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilator setting changes, and alarms were compared between the groups. Results The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, P > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, P < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were lower in the intervention group (P < 0.05). However, the differences in the length of stay in ICU between the two groups were not significant (P = 0.219). Conclusion According to our results, the use of non-invasive monitors, including capnography and pulse oximetry, is emphasized in order to utilize FTE after CABG surgery. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Nevertheless, further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings. Trial registration: IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192

scholarly journals Lipid Peroxidation Product and Glutathione Levels in Patients with Coronary Heart Disease Before and After Surgery

2015 ◽  
Vol 4 (2) ◽  
pp. 78-82
Author(s):  
Rahman Khansha ◽  
Behnoosh Miladpour ◽  
Zohreh Mostafavi-Pour ◽  
Fatemeh Zal
Keyword(s):  
Oxidative Stress ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Lipid Peroxidation Product ◽  
Cabg Surgery ◽  
Significant Difference ◽  
Before And After

Background: It has been reported that ischemia-reperfusion is associated with augmentation of oxidative stress and its specific and sensitive markers. Oxidative stress may cause atrial fibrillation (AF) which is a common consequence after cardiac surgery. Dietary supplementation with antioxidants might lower the incidence of AF following coronary artery bypass graft (CABG) surgery. Materials and Methods: Fifty patients with coronary heart disease (CHD) referred to Namazi and Faghihi Hospitals in Shiraz, undergone elective CABG, were enrolled in this study. For evaluation of oxidative stress, whole blood was taken before and 24 hours after surgery and malondialdehyde (MDA) as an oxidative marker and glutathione (GSH) as an antioxidant marker were measured. Results: Results showed a significant difference between the mean concentration of GSH before and after CABG surgery (P <0.05); however, the difference in plasma MDA levels before and after CABG was insignificant. Conclusion: CABG surgery results in oxidative stress and reduces GSH 24h after surgery and administration of antioxidants may attenuate post-operative oxidative stress. [GMJ.2015;4(2):78-82]

scholarly journals Role of Magnesium Sulphate for Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Open Heart Bypass (CABG) Surgery

2012 ◽  
Vol 8 (1) ◽  
pp. 12-14
Author(s):  
Ashia Ali ◽  
Md Kamrul Hassan ◽  
Mostofa Nuruzzaman ◽  
Sumsu Zzaman ◽  
Mostafizur Rahman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Single Dose ◽  
Magnesium Sulphate ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Cabg Surgery ◽  
Cardiac Anaesthesia ◽  
Pace Maker

To assess the role of magnesium sulphate infusion after coronary artery bypass graft (CABG) surgery in  preventing atrial arrhythmias that may occur following CABG operation. Cardiac anaesthesia wing of   Bangabandhu Sheik Mujib Medical University, Dhaka from 2007 to 2009. Design: Prospective randomized  non blined. All patients under going primary CABG surgery and having sinus rhythm before surgery were alternatively randomized into the study or control group. Patient with history of Atrial Fibrillation (AF), Left   Atrial (LA) dysfunction, renal-impairment and implanted pace maker were excluded from the study. The patients in the study group received 10 mmol of magnesium (2.47gm) in 10 ml saline intravenously over 10 min after termination of Cardio Pulmonary Bypass (CPB). The end point was development 0f AF for 10 min   or if an episode of AF had to be treated because of symptoms. A total of 60 patients were included in the study 30 in each group. The incident of AF was 14% in patients who received single dose of magnesium. The  patients without magnesium had an AF incidence of 20% (p=0.353) not significant. Single dose magnesium infusion does not prevent AF statistically, but the haemodynamic parameters in patients receiving magnesium were more stable during the whole period of observation. DOI: http://dx.doi.org/10.3329/uhj.v8i1.11661 University Heart Journal Vol. 8, No. 1, January 2012

scholarly journals Increased risk of atrial fibrillation among patients undergoing coronary artery bypass graft surgery while receiving nitrates and antiplatelet agents

2018 ◽  
Vol 46 (8) ◽  
pp. 3183-3194 ◽  
Author(s):  
Jimmy T. Efird ◽  
Charulata Jindal ◽  
Andy C. Kiser ◽  
Shahab A. Akhter ◽  
Patricia B. Crane ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Antiplatelet Agents ◽  
Guanosine Monophosphate ◽  
Artery Bypass Graft ◽  
Cabg Surgery

Background Postoperative atrial fibrillation (POAF) is a frequent complication of coronary artery bypass graft (CABG) surgery. This arrhythmia occurs more frequently among patients who receive perioperative inotropic therapy (PINOT). Administration of nitrates with antiplatelet agents reduces the conversion rate of cyclic guanosine monophosphate to guanosine monophosphate. This process is associated with increased concentrations of free radicals, catecholamines, and blood plasma volume. We hypothesized that patients undergoing CABG surgery who receive PINOT may be more susceptible to POAF when nitrates are administered with antiplatelet agents. Methods Clinical records were examined from a prospectively maintained cohort of 4,124 patients undergoing primary isolated CABG surgery to identify POAF-associated factors. Results POAF risk was increased among patients receiving PINOT, and the greatest effect was observed when nitrates were administered with antiplatelet therapy. Adjustment for comorbidities did not substantively change the study results. Conclusions Administration of nitrates with certain antiplatelet agents was associated with an increased POAF risk among patients undergoing CABG surgery. Additional studies are needed to determine whether preventive strategies such as administration of antioxidants will reduce this risk.

scholarly journals On-Pump Beating Heart versus Off-Pump Coronary Artery Bypass Graft Surgery: Short-Term Follow-up Outcomes of a Single Center

2021 ◽  
Vol 7 (1) ◽  
pp. 3-8
Author(s):  
Ekin İlkeli ◽  
Ali Cemal Düzgün
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Beating Heart ◽  
Artery Bypass Graft ◽  
Single Center ◽  
Cabg Surgery ◽  
Off Pump ◽  
Pump Cabg

Abstract Background and Aim: Novel surgical approaches are gaining attention in an attempt to overcome possible adverse events following coronary artery bypass graft (CABG) surgery. This single-center study aimed to evaluate and compare the early postoperative outcomes of on-pump beating-heart (OPBH-CABG) versus off-pump CABG surgery in similar risk groups with a total number of 1–2 grafts. Methods: The records of a total of 229 patients who underwent non-emergency, primary, isolated, either OPBH-CABG (n = 32) or off-pump CABG (n = 197) surgery were retrospectively evaluated. Reported outcome measures included baseline data, the number of coronary artery grafts, prophylactic intra-aortic balloon pump, time of extubation from mechanical ventilation, duration of stay in the coronary ICU and hospital, as well as early postoperative complications, in-hospital and early postoperative mortality. Results: The groups were identical with regards to age and BMI. The patients in the off-pump group received a higher number of grafts (1.84 ± 0.36 vs. 1.18 ± 0.39, p <0.0001). The OPBH-CABG group had a higher Euroscore II score (2.514 ± 1.68 vs. 1.706 ± 1.93, p = 0.021). The time to extubation after the surgery, postoperative length of ICU stay, and total length of hospital stay were similar between the groups (p = 0.2228; p = 0.098; p = 0.717, respectively). The incidence of arrythmia and atrial fibrillation was higher in the on-pump group (12.5% vs. 2.53%, p <0.05). One patient in the on-pump, and four patients in the off-pump groups deceased due to postoperative complications. Conclusions: OPBH-CABG surgery is comparable to off-pump CABG in terms of early postoperative outcomes. In patients who underwent OPBH-CABG, the risk of arrythmia and atrial fibrillation should be of concern and solved with optimal strategies.

C-reactive protein after coronary artery bypass graft surgery and its relationship with postoperative atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1182-1188 ◽  
Author(s):  
Oliver Juul Olesen ◽  
Naja Emborg Vinding ◽  
Lauge Østergaard ◽  
Jawad H Butt ◽  
Gunnar H Gislason ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
C Reactive Protein ◽  
Cabg Surgery ◽  
Reactive Protein

Abstract Aims Postoperative atrial fibrillation (POAF), a common complication following coronary artery bypass graft (CABG) surgery, is associated with increased morbidity and mortality. Inflammation may be an important factor for the pathogenesis of POAF, and increased preoperative levels of C-reactive protein (CRP) are associated with the development of POAF. However, the relationship between postoperative CRP and POAF is less well established. Methods and results Patients undergoing first-time isolated CABG surgery (1 January 2000–31 December 2016) were identified using the Eastern Danish Heart Surgery Database and nationwide administrative registries. Patients with no history of atrial fibrillation and with available CRP measurements from postoperative day (POD) 4 were included. The study population was divided into quartiles based on CRP. The association between CRP levels and the odds of developing POAF was investigated using multivariable logistic regression analysis. We included 6711 patients. The CRP intervals on POD 4 for the CRP groups (lowest to highest) were ≤90, &gt;90 to ≤127, &gt;127 to ≤175, and &gt;175 mg/L, respectively. Patients in the highest CRP group were older and more often men compared with patients in the lowest CRP group [median age 67 years (P25–P75: 61–73) and 84.7% men vs. median age 64 years (P25–P75: 56–70) and 77.9% men]. In the lowest and highest CRP groups, 25% and 35% developed POAF, respectively. In adjusted analysis, the highest CRP group, compared with the lowest CRP group, was associated with greater odds of developing POAF (odds ratio 1.31; 95% confidence interval 1.12–1.54). Conclusion Increased postoperative CRP levels after CABG surgery was associated with the development of POAF.

scholarly journals Early Outcomes of Custodiol versus Blood Cardioplegia in Coronary Artery Bypass Graft Surgery at Ain Shams University Hospitals

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G S Sayed ◽  
I A Ismail ◽  
R M R Khorshid ◽  
A H Mohamed
Keyword(s):  
Coronary Artery ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The Other ◽  
P Value ◽  
Artery Bypass Graft ◽  
University Hospitals ◽  
Blood Cardioplegia ◽  
Significant Difference

Abstract Background Inadequate myocardial protection in long ischemic periods followed by reperfusion is an issue of concern in cardiac surgery. Cardioplegic solutions improve the tolerance to ischemia and reperfusion by preserving myocardial energy reserves, preventing osmotic and electrolyte imbalances and buffering acidosis. The aim of the study was to compare early outcomes of Histidine–tryptophan–ketoglutarate (HTK) solution versus blood cardioplegia in coronary artery bypass graft surgery at Ain Shams University Hospitals. Methodology This was a retrospective study conducted on patients who underwent isolated elective CABG at the department of cardiothoracic surgery at Ain Shams University Hospitals from the 1stof January, 2017 to the 1st of August, 2018. Results the analysis between these two groups divided as the following: first group who received Histidine–tryptophan–ketoglutarate (HTK) and the second who received conventional blood cardioplegia , There was no statistically significant difference between the two groups of myocardial protection in terms of morbidity and mortality with a p-value &gt;0.05. With a stastically significant increase in Total bypass time with a p value &lt;0.05 and a highly significant difference in terms of post operative Ventilation time and ICU stay which was higher in HTK group with a p-value of &lt; 0.01 between the two groups. Conclusion Conventional blood cardioplegia showed superiority in terms of metabolic recovery based on the incidence of spontaneous defibrillation, ventilation time and ICU stay on the other hand Histidine–tryptophan–ketoglutarate (HTK) cardioplegia is a much more easily administered cardiolplegia technique without the need of preparation or repeated administration. Both Solutions showed efficacy in different areas that could be owed to the small sample size we used which cannot asses the ultimum superiority of one solution over the other .

P1839Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C A K Nakashima ◽  
L A O Dallan ◽  
L A F Lisboa ◽  
L A Hajjar ◽  
A M Soeiro ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Artery Bypass Graft ◽  
Platelet Aggregability

Abstract Background Dual antiplatelet therapy is recommended for patients (pts) with acute coronary syndromes (ACS). However, 10–15% of pts have indication of coronary artery bypass graft (CABG) for the index event and current guidelines recommend stopping clopidogrel at least 5 days prior to CABG. This waiting time could increase hospital length of stay, thus having negative impacts on costs and clinical complications. Purpose To evaluate if release to CABG based on platelet aggregability by Multiplate AnalyzerTM would be non-inferior in comparison with common practice (5 days) in terms of 24-hours post-CABG bleeding. Methods The PLAT-CABG (NCT 02516267) is a randomized, open label, non-inferiority trial (boundary 25%) testing a strategy of platelet aggregability-guided release to CABG versus standard-of-care on the primary endpoint of chest tube drainage in the first 24 hours post CABG. A total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and with indication for CABG, were assigned to clopidogrel discontinued 5 days prior to CABG (control group) vs. daily measurements of platelet aggregability to ADP using Multiplate AnalyzerTM (intervention group) with CABG occurring after recovering from platelet inhibition (pre-defined as a threshold of 46 AU). Results The main results are depicted in the table Main results of PLAT-CABG study Variables Control Group (n=95) Intervention Group (n=95) P-value for superiority P-value for non-inferiority Chest tube drainage (mL), Median (25th–75th) 350 (250–500) 350 (250–500) 0.680 0.001 Time symptom to CABG (hours), Median (25th–75th) 191 (150–281) 166 (119–225) <0.001 NA Time surgery indication to CABG (hours), Median (25th–75th) 136 (112–161) 112 (66–142) <0.001 NA CABG = coronary artery bypass graft. Conclusion Platelet-aggregability guided release to CABG is non-inferior to standard of care in ACS patients awaiting CABG in terms of peri-operative bleeding and significantly shortens the time to CABG. Acknowledgement/Funding Roche Diagnostica Brazil

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