scholarly journals Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients

2020 ◽  
Vol 5 (3) ◽  
Keyword(s):  
Cardiac Surgery ◽  
Fibrinogen Level ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Plasma Fibrinogen ◽  
Surgical Patients ◽  
Plasma Fibrinogen Level ◽  
Off Pump ◽  
Group A ◽  
Group B

Background: Bleeding is a major concern after cardiac surgery and also a significant cause of morbidity and mortality. Postoperative mediastinal bleeding in patients undergoing cardiac surgery is still one of the most common complications. Objective: To find out Outcome of Plasma Fibrinogen Level and Postoperative Bleeding Following OPCAB Surgical Patients. Methods: This comparative cross-sectional study was carried out at the Department of Cardiac Surgery in BSMMU hospital from March, 2017 to August, 2019. The study population was 60, with 2 (two) groups having 30 patients in each. Patients from both the groups underwent OPCAB. Statistical analysis of different characteristics between the patients of both groups was done to draw a conclusion. Results: This study total sixty (60) patients who underwent off-pump coronary artery bypass graft surgery were evaluated in this study. Postoperative care at ICU was given to the patients of both groups as per standard hospital protocol. The findings of the study obtained from data analysis presented in the following pages. Among the study population mean age in group A was 55.43±8.53 years and in group B was 59.63±6.86 years. The difference in age between two groups was statistically significant (p<0.05). There was no statistical significance of gender between the two study groups (p>0.05). The mean BMI in group A was 24.13±2.49 kg/m² and that in group B was 24.62±3.71 kg/m². The findings were statistically not significant (p>0.05). Shows the comparison of postoperative variables between group A and B patients. Amount blood loss in 1st 12 hours immediate after surgery in group A and B were 185.67±35.20 ml and 219.67±57.32 ml respectively. Post-operative blood transfusion in group A and B were 2±0.53 units and 2.5±0.68 units respectively, which was statistically significant (p<0.05. There were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. The most valuable predictor for increased postoperative bleeding after OPCAB. Conclusion: In conclusion the efficacy were no postoperative thromboembolic events, cardiac ischemic incidents, re-exploration and mortality. Pearson co-efficient correlation test showed an inverse relationship between plasma fibrinogen level and postoperative bleeding following OPCAB. Fibrinogen concentration level was associated with increased postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting surgical patients.

The Effect of Combined Clopidogrel and Aspirin Therapy after Off-Pump Coronary Surgery

2009 ◽  
Vol 4 (5) ◽  
pp. 265-268 ◽  
Author(s):  
Emir Mujanovic ◽  
Midhat Nurkic ◽  
Jasmin Caluk ◽  
Ibrahim Terzic ◽  
Emir Kabil ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Median Sternotomy ◽  
Operation Time ◽  
Graft Patency ◽  
Off Pump ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. Methods Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. Results Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. Conclusions Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.

scholarly journals Preoperative plasma fibrinogen level and transfusion in cardiac surgery: a biphasic correlation

2020 ◽  
Vol 31 (5) ◽  
pp. 622-625
Author(s):  
Hélène Charbonneau ◽  
Marie Pasquie ◽  
Nicolas Mayeur
Keyword(s):  
Cardiac Surgery ◽  
Risk Factor ◽  
Retrospective Study ◽  
Fibrinogen Level ◽  
Postoperative Bleeding ◽  
Plasma Fibrinogen ◽  
Plasma Fibrinogen Level ◽  
Single Centre ◽  
Preoperative Status ◽  
Rbc Transfusion

Abstract Coagulopathic bleeding is a serious complication of cardiac surgery. A very low preoperative plasma fibrinogen level (PFL) has been previously described as a risk factor for red blood cell (RBC) transfusion in the perioperative setting. Nevertheless, contradictory results have been published concerning preoperative fibrinogen infusion to decrease RBC transfusion. These results highlight the need for a better description of the relation between preoperative PFL and RBC transfusion. In this single-centre retrospective study, we showed that both high and low PFLs are associated with an increase in RBC transfusion. A pro-inflammatory preoperative status could be involved in the association between high PFL and the increase in RBC transfusion. This non-linear relation between PFL and RBC transfusion could explain the difficulty of decreasing postoperative bleeding using only an algorithm aimed at increasing preoperative PFL.

scholarly journals Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

2018 ◽  
Vol 10 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Tawfiq Ahmed ◽  
Md Rezaul Karim ◽  
Jahangir Haider Khan ◽  
Shahriar Moinuddin
Keyword(s):  
Coronary Artery ◽  
Postoperative Period ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Neurocognitive Dysfunction ◽  
Off Pump ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Objective: The Neurological injury is an important complication after coronary artery bypass surgery (CABG). The incidence of neurocognitive impairment after cardiac surgery varies from 20% to 80%. In this study we tried to analyze this difference of neurologic dysfunction between On-pump CABG and Off-pump CABG (OPCAB).Methods:This is a case control study done in National Institute of Cardiovascular Disease (NICVD), Dhaka during the period of July 2012 to June 2014. Sixty Patients with Ischemic heart disease were the study population. Group- A includes 30 patients underwent on pump CABG, Group-B 30 patients underwent OPCAB. All the patients of both the groups were followed up to 2 month’s postoperatively to find out any neurological and neurocognitive dysfunctionby observing motor function, sensory function,Mini Mantel state (MMS) Examination, orientation, memory, attention and calculation, recall and language test.Results: Neurocognitive dysfunction in the early postoperative period is significantly different among the groups.Neurocognitive dysfunction was more in Group A in comparison to Group B, On 3rd and 8th POD the MINI Mental Scores were found to be significantly lower in On-pump group than those in Off-pump group (22.0 ± 5.28 vs. 25.67 ± 3.34, p = 0.002 and 25.93 ± 3.11 vs. 26.63 ± 2.50, p = 0.023 respectively).This neurocognitive dysfunction gradually improved by the end of two month postoperative period. Only 6.66% patient in Group-A was found neurocognitically dysfunctional and was referred to neurophysician for further treatment. In case of OPCAB Group, no patient suffered fromneuorocognitive dysfunction.Conclusion: This study has convincingly shown cardio-pulmonary bypass (CPB) has had detrimental effect on neurocognitive function in patients who underwent CABG.Cardiovasc. j. 2018; 10(2): 186-193

P1832Myocardial injury assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting. a pre-specified analysis of mass V trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A R Dallazen ◽  
W Hueb ◽  
P C Rezende ◽  
G A B Boros ◽  
F F Ribas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
T1 Mapping ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Native T1 ◽  
Before And After ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Abstract Background Myocardial structural damage may occur during coronary artery bypass grafting (CABG) surgery and is identified by the significant release of cardiac biomarkers. However, the evidence of these structural myocardial changes after CABG by current imaging methods remains unknown. To evaluate myocardial structure, we used the T1 mapping of cardiac magnetic resonance (CMR) before and after on-pump and off-pump CABG. Methods Patients with multivessel coronary artery disease and preserved ventricular function were included and underwent on or off-pump CABG. CMR and T1 mapping were performed using the MOLLI technique (modified Look-Locker inversion-recovery). Values of native T1 and extracellular volume fraction (ECV) were compared before and after on and off-pump procedures. Results Of 110 eligible patients, 34 were excluded due to the presence of new late enhancement or edema. Of 76 patients remained, 32 (42%) underwent on-pump (Group A) and 44 (58%) off-pump CABG (Group B). All baseline characteristics were similar between groups, besides the Syntax Score that was higher in Group A (25 × 21, p=0.002). For group A, native T1 before and after procedures was 1013 ms (998–1043) and 1004 ms (793–1048), p=0.19, and ECV was 26.4 (23.9–27.6) and 31.2 (27.6–33.9), p<0.001. For group B, native T1 before and after procedures was 1015 ms (970–1044) and 992 ms (867–1051), p=0.003, and ECV 27.5 (25.3–29.9) and 30.3 (26.5–34.3), p=0.02. The comparison of native T1 difference before and after procedures between groups A and B was not significant (Delta T1 −9.8 (−102 to 51.8) × −25.4 (−119 to 51,2), p=0.87. However, the difference of ECV between groups was statistically significant (ECV Delta 3.8 (2.2 to 7.1) × 1.3 (−1.1 to 4.9), p=0.039, respectively, for groups A and B. Figure 1 Conclusion In this sample, T1 mapping identified significant myocardial structural changes in both surgical revascularization procedures. Additionally, a marked myocardial injury generated by ECV changes were observed after on-pump CABG.

Effects of aspirin and desmopressin on platelet reactivity in patients undergoing cardiac surgery with extracorporeal circulation

2011 ◽  
Vol 105 (01) ◽  
pp. 113-121 ◽  
Author(s):  
Eliane Kmitta ◽  
Sami Kueri ◽  
Tomasz Zietak ◽  
Dietmar Trenk ◽  
Cornelius Keyl
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Extracorporeal Circulation ◽  
Platelet Reactivity ◽  
Therapy Group ◽  
Artery Bypass ◽  
Bleeding Tendency ◽  
Platelet Aggregometry ◽  
Group A ◽  
Group B

SummaryThe effect of desmopressin on platelet function in patients with continued antiplatelet therapy undergoing cardiac surgery is discussed controversially. We assessed platelet reactivity in 86 patients undergoing elective coronary artery bypass grafting (CABG) under extracorporeal circulation. Twenty-nine of these patients were without preoperative antiplatelet therapy (group A), while 57 were treated with acetylsalicylic acid (ASA) 100 mg qd up to the day of surgery. Out of this cohort, 24 patients received no desmopressin perioperatively (group B), whereas 33 patients were treated with desmopressin 0.4 μg/kg after administration of protamine due to increased bleeding tendency (group C). Multiple electrode platelet aggregometry with arachidonic acid as agonist showed a marked decrease of platelet reactivity in patients without antiplatelet therapy immediately after extracorporeal circulation compared to preoperative control (375 ± 227 vs. 749 ± 330 AU*min, p<0.001). Platelet reactivity recovered to preoperative controls in group A at 24 hours after protamine administration (662 ± 295 AU*min). Platelet reactivity in patients on ASA was not decreased further after extracorporeal circulation (group B: 197 ± 126 vs. 251 ± 203 AU*min, p=0.14; group C: 212 ± 100 vs. 245 ± 248 AU*min, p=0.43) and improved significantly within 24 hours. A statistically significant effect of desmopressin, however, could not be determined (group B: 392 ± 223 AU*min; group C: 439 ± 324 AU*min at 24 hours after protamine, p=0.63 for between-subjects contrast). Our data suggest that desmopressin does not affect platelet reactivity in patients on ASA undergoing CABG and is, therefore, not useful in this clinical setting.

Pentraxin 3 and other inflammatory biomarkers related to atrial fibrillation in cardiac surgery

Perfusion ◽  
2016 ◽  
Vol 32 (4) ◽  
pp. 269-278 ◽  
Author(s):  
Zdenka Holubcova ◽  
Pavel Kunes ◽  
Jiri Mandak ◽  
Dana Vlaskova ◽  
Martina Kolackova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Serum Levels ◽  
Inflammatory Biomarkers ◽  
Surgical Patients ◽  
Significant Difference ◽  
History Of ◽  
Group A ◽  
Group B ◽  
New Onset

Objectives: The aim was to evaluate the association between perioperative inflammatory biomarkers and atrial fibrillation (AF) in cardiac surgical patients. Methods: Forty-two patients undergoing cardiac surgery were divided into three groups according to the occurrence of AF: Group A (n = 22) – patients with no AF, Group B (n = 11) – patients with new onset AF postoperatively and Group C (n = 9) – patients with preoperative history of atrial fibrillation. The serum levels of PTX3, CRP, TLR2, IL-8, IL-18, sFas, MMP-7 and MMP-8 were measured at the following time points: before surgery, immediately and 6 h after surgery and on the 1st, 3rd and 7th postoperative days (POD). Results: Serum levels of PTX3 showed a significant difference between Groups A and C on the 3rd POD (p<0.05) and on the 7th POD (p<0.0001). IL-8 levels were different between Groups A and C immediately after surgery (p<0.05), 6 hours after surgery (p<0.05) and on the 3rd POD (p<0.05). There was a difference between Groups B and C on the 1st POD in IL-8 levels (p<0.05). The sFas levels differed between Groups A and C on the 3rd POD (p<0.01) and the 7th POD (p<0.05). There was also a difference on the 7th POD (p<0.05) between the Groups B and C. No significant differences between the groups was seen for other biomarkers. Conclusion: This study demonstrates significantly different dynamics of PTX3, IL-8 and sFas levels after cardiac surgery in relation to AF.

scholarly journals Correlation Between ROTEM FIBTEM Maximum Clot Firmness and Fibrinogen Levels in Pediatric Cardiac Surgery Patients

2018 ◽  
Vol 25 ◽  
pp. 107602961881638 ◽  
Author(s):  
Christopher F. Tirotta ◽  
Richard G. Lagueruela ◽  
Danielle Madril ◽  
Daria Salyakina ◽  
Weize Wang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Linear Regression ◽  
Linear Relationship ◽  
Fibrinogen Level ◽  
Linear Regression Analysis ◽  
Plasma Fibrinogen ◽  
Patient Specific ◽  
Plasma Fibrinogen Level ◽  
Positive Linear Relationship ◽  
Maximum Clot Firmness

This study evaluated whether rotational thromboelastometry (ROTEM; Tem International GmbH, Munich, Germany) FIBTEM maximum clot firmness (MCF) can be used to predict plasma fibrinogen level in pediatric patients undergoing cardiac surgery. Linear regression was conducted to predict plasma fibrinogen level using FIBTEM MCF (0.05 level of significance). Scatter plot with the regression line for the model fit was created. Fifty charts were retrospectively reviewed, and 87 independent measurements of FIBTEM MCF paired with plasma fibrinogen levels were identified for analysis. Linear regression analysis suggested a significant positive linear relationship ( P < .0001) between plasma fibrinogen levels and MCF. Both MCF intercept and slope were significantly correlated with fibrinogen level ( P < .0001). The estimated regression equation (predicted fibrinogen = 78.6 + 12.4 × MCF) indicates that a 1-mm increase in MCF raises plasma fibrinogen level by an average of 12.4 mg/dL. The statistically significant positive linear relationship observed between MCF and fibrinogen levels ( P < .001) suggests that MCF can be used as a surrogate for fibrinogen level. This relationship is of clinical relevance in the calculation of patient-specific dosing of fibrinogen supplementation in this setting.

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