Frequency of deep infection of the sternal wound in diabetic patients utilizing skeletonized versus pedicled harvesting technique of internal thoracic artery after CABG surgery.

Objectives: After coronary artery bypass graft (CABG) surgery, infection of the sternum is a serious issue as it would adversely affect the mortality of patient. Left internal thoracic artery (LITA) has significant benefits but after its utilization occurrence of sternal infection is documented especially in diabetic patients due to impairment in blood flow of sternum. Our objective was to document the frequency of deep infection of the sternal wound in patients with diabetes utilizing skeletonized versus pedicled harvesting technique of the left ITA after CABG Surgery in our population. Study Design: An observational study was retrospectively done. Setting: National Institute of Cardiovascular Diseases, Karachi. Period: January 2013 to October 2015. Material and Methods: The sample size of the study was determined to be a total of two hundred and twenty patients who had primary, isolated and elective CABG surgery. One hundred and ten patients were included in whom skeletonized left ITA was utilized and in one hundred and ten patients pedicled left ITA was utilized. We used the statistical Chi square test and p < 0.05 was considered significant. Results: Deep infection of the sternal wound occurred in 3.64% of the patients with diabetes in whom the pedicled left ITA was utilized and did not occur in any of the diabetic patients in whom the skeletonized left ITA was utilized. Post CABG surgery frequency of deep infection of the sternal wound was greater in those patients in whom the LITA was harvested utilizing the pedicled technique (p<0.05). Conclusion: There is decreased frequency of deep infection of the sternal wound in patients with diabetes utilizing the skeletonized harvesting technique of the left ITA after CABG Surgery.

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The effect of intraoperative glycemic control on surgical site infections among diabetic patients undergoing coronary artery bypass graft (CABG) surgery

Heliyon ◽

10.1016/j.heliyon.2021.e08529 ◽

2021 ◽

pp. e08529

Author(s):

Issa M. Hweidi ◽

Ala M. Zytoon ◽

Audai A. Hayajneh ◽

Salwa M. Al-Obeisat ◽

Aysam I. Hweidi

Keyword(s):

Coronary Artery ◽

Glycemic Control ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Surgical Site Infections ◽

Diabetic Patients ◽

Artery Bypass Graft ◽

Cabg Surgery

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Abstract 2314: Insulin is the Protective Component of Glucose-Insulin-Potassium Solutions during Coronary Artery Bypass Graft Surgery in Patients with Diabetes

Circulation ◽

10.1161/circ.118.suppl_18.s_705 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Harold L Lazar ◽

Marie McDonnell ◽

Stuart Chipkin ◽

Yusheng Bao ◽

Carmel Fitzgerald ◽

...

Keyword(s):

Glycemic Control ◽

Artery Bypass ◽

Bypass Graft ◽

Heart Association ◽

Diabetic Patients ◽

Protective Effects ◽

Term Survival ◽

Perioperative Morbidity ◽

Patients With Diabetes ◽

Cabg Patients

Maintaining glycemic control(120 –180mg/dl)with GIK solutions in patients with diabetes undergoing CABG decreases perioperative morbidity and enhances long-term survival. The mechanism by which GIK exerts its protective effects is unknown. This study was undertaken to determine whether it is substrate enhancement with glucose, glycemic control with insulin, or the combination of glucose + insulin + potassium which contributes to improved outcomes with GIK in CABG patients with diabetes. One hundred-twenty diabetic patients undergoing isolated CABG surgery were prospectively randomized to achieve glycemic control(120 –180mg/dl)using an INSULIN infusion(100units/100mlNS),LOW GIK(500mlD5W + 80units insulin + 40mEqKCL), and HIGH GIK(D20W + 200units insulin + 80mEqKCL) beginning on anesthetic induction and continuing for 18 hours after surgery. Variables assessed included Major Adverse Events(MAE=death, MI, CVA, atrial fibrillation, infection, ventilation > 24 hours, inotropic usage > 24hours,lenght of stay > 7days), serum glucose, the amount of insulin infused, and serum free fatty acids(ffa).Values are mean+/− standard deviation. HIGH GIK delivered more insulin and resulted in significantly lower levels of glucose and ffa. However, it had no effect on the incidence of MAEs compared to INSULIN infusions without glucose and potassium. Insulin, rather than substrate enhancement with glucose and potassium, is the key element in GIK used in CABG patients with diabetes. Augmenting insulin delivery results in lower levels of glucose and ffa, but has no effect on clinical outcomes as long as gylcemic control(120 –180mg/dl) is achieved. This research has received full or partial funding support from the American Heart Association, AHA National Center. RESULTS

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Association Between Smoking and Foot Ulcer among Patients with Diabetes Mellitus, Wad Medani, Sudan

Sudan Journal of Medical Sciences ◽

10.18502/sjms.v16i4.9943 ◽

2021 ◽

Author(s):

Abeer AbdElrahman Elnour Eltilib

Keyword(s):

Diabetes Mellitus ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Primary Data ◽

Diabetic Patients ◽

Chi Square ◽

Patients With Diabetes ◽

Negative Effect ◽

Chi Square Test ◽

The Relationship

Background: This study aimed to assess the relationship between smoking and diabetic foot ulcer (DFU) among adult diabetic patients presenting to Aldarga Diabetic Center, Wad Medani, Sudan in 2020. Methods: This comprehensive study is based on primary data obtained via a longitudinal cross-section random sample of 400 patients with diabetes mellitus who presented to Aldarga Diabetic Health Center in Wad Medani Town, Gezira State, Sudan between September and December 2020. Data were collected using a structured questionnaire. The core questions included two main dimensions: sociodemographic variables and smoking. Data were analyzed using the SPSS software, v.20, using descriptive and inferential statistics, namely, frequency tables and graphs, showing the Chi-square test of the relationship between the dependent and the independent variables. Results: Of the 400 participants, 96 were clearly diagnosed with foot ulcer giving a proportion of 33% in the sample. There was a statistically significant relationship between smoking and DFU. A Chi-square test was done to measure the relationship between smoking and foot ulcer, which was significant at P = 0.043. Conclusion: Extensive awareness programs to control the negative effect of smoking in accelerating DFU and amputation are necessary.

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Management of the Asymptomatic Diabetic Patient with Evidence of Ischaemia

European Cardiology Review ◽

10.15420/ecr.2010.6.1.62 ◽

2010 ◽

Vol 6 (1) ◽

pp. 62

Author(s):

Dimitrios Bliagos ◽

Ajay J Kirtane ◽

Jeffrey W Moses ◽

◽

...

Keyword(s):

Coronary Artery ◽

Medical Therapy ◽

Artery Bypass ◽

Coronary Intervention ◽

Diabetic Patients ◽

Ageing Population ◽

Patients With Diabetes ◽

Risk Patients ◽

Asymptomatic Diabetic Patient ◽

Artery Disease

In the US, a total of 23.6 million people have diabetes, representing 7.8% of the population, and the prevalence of diabetes is on the rise due to an increasingly sedentary lifestyle, increasing obesity and an ageing population. Coronary artery disease is the leading cause of death in patients with diabetes, despite a reduction in cardiovascular events over the last 50 years, due in part to better medical therapy. Asymptomatic diabetic patients with evidence of ischaemia on stress testing have higher cardiac mortality; increasing amounts of ischaemia are associated with higher mortality rates. Revascularisation of high-risk patients, or those with significant ischaemia, has the potential to improve outcomes in this patient population. The choice of which revascularisation strategy to choose – either percutaneous coronary intervention (PCI) or coronary artery bypass grafting – should be carefully individualised, and must always be implemented against the background of optimal medical therapy.

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Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1584688 ◽

2016 ◽

Vol 65 (04) ◽

pp. 265-271

Author(s):

Andrea Perrotti ◽

Enrica Dorigo ◽

Camille Durst ◽

Djamel Kaili ◽

Sidney Chocron ◽

...

Keyword(s):

Coronary Artery ◽

Internal Thoracic Artery ◽

Artery Bypass ◽

Univariate Analysis ◽

Bypass Graft ◽

Myocardial Revascularization ◽

Wound Complication ◽

Safe Procedure ◽

Off Pump

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

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Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

Case Reports in Ophthalmology ◽

10.1159/000468143 ◽

2017 ◽

Vol 8 (1) ◽

pp. 200-207

Author(s):

Sarah Farukhi Ahmed ◽

Audrey Xi Tai ◽

Mason Schmutz ◽

John Combs ◽

Sameh Mosaed

Keyword(s):

Risk Factors ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Vision Loss ◽

Artery Bypass ◽

Venous Pressure ◽

Bypass Graft ◽

Ischemic Optic Neuropathy ◽

Cabg Surgery ◽

Ocular Hypotony

Importance: The purpose of this case report is to evaluate risk factors associated with post-coronary artery bypass graft (CABG) ocular hypotony compared to post-CABG ischemic optic neuropathy. Observations: The patient described here is a single case at the University of California, Irvine Medical Center, from July 2016. This case demonstrates the rare incidence of acute post-CABG ocular hypotony and vision loss in a patient with prior history of optic atrophy. Both vision loss and hypotony resolved completely to baseline without intervention within 3 days postoperatively. Conclusions and Relevance: Severe anemia and large fluctuations in central venous pressure and blood pressure can occur in any patient undergoing CABG surgery. These hemodynamic shifts can cause transient ischemia to pressure controlling systems such as the ciliary body and reduce episcleral venous pressure. Other risk factors for acute hypotony in the setting of CABG surgery also include the use of hypertonic agents, cardiopulmonary bypass, and intravenous anesthesia.

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