scholarly journals Beneficial Effects of a Short Course of Physical Prehabilitation on Neurophysiological Functioning and Neurovascular Biomarkers in Patients Undergoing Coronary Artery Bypass Grafting

2021 ◽  
Vol 13 ◽  
Author(s):  
Olga A. Trubnikova ◽  
Irina V. Tarasova ◽  
Evgeniy G. Moskin ◽  
Darya S. Kupriyanova ◽  
Yuliya A. Argunova ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Neurovascular Unit ◽  
Postoperative Cognitive Dysfunction ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Short Course ◽  
Cabg Patients

This study aimed to evaluate the effects of a short course of physical prehabilitation on neurophysiological functioning and markers of the neurovascular unit in patients undergoing coronary artery bypass grafting (CABG). We performed a prospective randomized study involving 97 male CABG patients aged 45–70 years, 47 of whom underwent a 5–7-day preoperative course of aerobic physical training (PhT). Both groups of patients were comparable with respect to baseline clinical and anamnestic characteristics. An extended neuropsychological and electroencephalographic (EEG) study was performed before surgery and at 7–10 days after CABG. Markers of the neurovascular unit [S100β, neuron-specific enolase (NSE), and brain-derived neurotrophic factor (BDNF)] were examined as metabolic correlations of early postoperative cognitive dysfunction (POCD) at three time points: before surgery, within the first 24 h after surgery, and 7–10 days after CABG. POCD developed in 58% of patients who underwent preoperative PhT, and in 79.5% of patients who did not undergo training, 7–10 days after CABG. Patients without prehabilitation demonstrated a higher percentage of theta1 power increase in the relative change values as compared to the PhT patients (p = 0.015). The short preoperative course of PhT was associated with low plasma S100β concentration, but high BDNF levels in the postoperative period. Patients who underwent a short preoperative course of PhT had better cognitive and electrical cortical activity indicators. Markers of the neurovascular unit indicated lower perioperative brain injury after CABG in those who underwent training. A short course of PhT before CABG can decrease the brain’s susceptibility to ischemia and reduce the severity of cognitive impairments in cardiac surgery patients. Electrical brain activity indicators and neurovascular markers, such as S100β and BDNF, can be informative for the effectiveness of cardiac rehabilitation programs.

scholarly journals Impact of short-term physical prehabilitation on psychophysiological parameters in patients undergoing coronary artery bypass grafting

2020 ◽  
Vol 5 (4) ◽  
pp. 65-75
Author(s):  
О. A. Trubnikova ◽  
I. V. Tarasova ◽  
E. G. Mos’kin ◽  
D. S. Kupriyanova ◽  
I. D. Syrova ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Postoperative Cognitive Dysfunction ◽  
Cognitive Status ◽  
Study Endpoint ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Short Course

Aim. To study psychophysiological parameters in the patients undergoing coronary artery bypass grafting (CABG) who optionally underwent a short course of physical prehabilitation (PPR).Materials and Methods. We carried out a prospective randomised study which included 97 male patients (45 to 70 years) with coronary artery disease who underwent elected CABG; 47 of them additionally underwent a 5-7-day course of aerobic physical training before the surgery. Both patient groups were comparable with respect to the baseline clinicopathological features. Neuropsychological examination and electroencephalography was performed before the surgery and at 7th-10th day after CABG. Development of postoperative cognitive dysfunction (POCD) was considered as the study endpoint. Results. POCD developed in 58% patients with PPR and in 78.7% patients without PPR (p = 0.037); therefore, the risk of developing POCD in those who underwent PPR was lower (OR=0,39, р=0,045). Further, patients with PPR showed an increase in integral attention value relative to the preoperative state (p = 0.04) while those without PPR demonstrated a decrease in this cognitive parameter (p = 0.03). Integral attention value and general cognitive status remained higher in patients with PPR than in those without (p = 0.048 and p = 0.048, respectively) at 7th-10th day after CABG. The theta1 rhythm power increase was higher in patients without PPR at 7th-10th day after CABG (p = 0.01). Conclusion. The patients with a short preoperative course of PPR had better indicators of electrical cortical activity and higher integral cognitive value in the early postoperative period after CABG than those without training. Short course of PPR before CABG can increase the resistance of the brain to the intraoperative injury and may reduce the severity of the cognitive impairment after cardiac surgery. Indicators of brain electrical activity can be informative to evaluate the efficiency of cardiac rehabilitation

Redo coronary artery bypass grafting

2021 ◽  
pp. 369-374
Author(s):  
Faisal G. Bakaeen ◽  
Lars G. Svensson
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Scar Tissue ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Atherosclerotic Burden ◽  
Intraoperative Management ◽  
Cabg Patients

Patients who undergo redo coronary artery bypass grafting (CABG) are older, have more comorbidities, and a greater atherosclerotic burden than those who undergo primary CABG. In addition, redo CABG is technically more demanding than primary CABG. Sternal re-entry may be challenging because of the proximity of cardiovascular structures, including previous bypass grafts that could be at risk for injury. Furthermore, dissecting out the heart to institute cardiopulmonary bypass and exposing the coronary targets may be complicated by scar tissue and suboptimal dissection planes, with additional risk of injury to patent conduits or inadvertent manipulation of diseased conduits that can result in thromboembolic complications and ischaemia. Effective myocardial protection is especially important in redo CABG, and anatomical limitations must be overcome in patients with severe diffuse native disease or areas supplied by occluded grafts. Patent left internal thoracic arteries in redo CABG patients introduce an extra level of complexity in intraoperative management.

scholarly journals Prevalence and Risk Factors of Hypoxemia after Coronary Artery Bypass Grafting: The Time to Change Our Conceptions

2019 ◽  
Author(s):  
Fardin Yousefshahi ◽  
Elham Samadi ◽  
Omalbanin Paknejad ◽  
Ali Movafegh ◽  
Khosro Barkhordari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
The Mean ◽  
Cabg Patients

Background: Acute hypoxemia is the main characteristic of acute respiratory distress syndrome (ARDS), which is one of the most critical complications of coronary artery bypass grafting (CABG). Given the dearth of data on acute hypoxemia, we sought to determine its prevalence and risk factors among post-CABG patients. Methods: This cross-sectional study was conducted on on-pump CABG patients in Tehran Heart Center in 2 consecutive months in 2012. The effects of arterial blood gas variables, age, gender, the duration of the pump and cross-clamping, the ejection fraction, the creatinine level, and the body mass index on the prevalence of hypoxemia at the cutoff points of ARDS and acute lung injury were assessed. Results: Out of a total of 232 patients who remained in the study, 174 (75.0%) cases were male. The mean age was 60.60±9.42 years, and the mean body mass index was 27.15±3.93 kg/m2. None of the patients expired during the current admission. The ratio of partial pressure arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) 1 hour after admission to the intensive care unit (ICU), before extubation, and at 4 hours after extubation was less than 300 mmHg in 66.6%, 72.2%, and 86.6% of the patients and less than 200 mmHg in 20.8% 17.7%, and 30.2% of the patients, respectively. Among the different variables, only a heavier weight was associated with a PaO2/FiO2 ratio of less than 300 mmHg at 1 hour after ICU admission and at 4 hours after extubation (P=0.001). A rise in the cross-clamp time showed a significant association with the risk of a PaO2/FiO2 ratio of less than 200 mmHg at 4 hours after extubation (P=0.014). Conclusion: This study shows that hypoxemia following CABG is very common in the first 48 postoperative hours, although it is a benign and transient event. The high prevalence may affect the accuracy of the ARDS criteria and their positive or negative predictive value.   J Teh Univ Heart Ctr 2019;14(2):74-80   This paper should be cited as: Yousefshahi F, Samadi E, Paknejad O, Movafegh A, Barkhordari K, Bastan Hagh E, Dehestani B. Prevalence and Risk Factors of Hypoxemia after Coronary Artery Bypass Grafting: The Time to Change Our Conceptions. J Teh Univ Heart Ctr 2019;14(2):74-80.

scholarly journals A Novel Risk Stratification System for Predicting In-Hospital Mortality Following Coronary Artery Bypass Grafting Surgery with Impaired Left Ventricular Ejection Fraction

2020 ◽  
Vol 23 (5) ◽  
pp. E621-E626
Author(s):  
Hongyuan Lin ◽  
Jianfeng Hou ◽  
Hanwei Tang ◽  
Kai Chen ◽  
Shaoxian Guo ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Cabg Patients

Background: Coronary artery disease (CAD) is the most common cause of heart failure (HF), and impaired ejection fraction (EF<50%) is a crucial precursor to HF. Coronary artery bypass grafting (CABG) is an effective surgical solution to CAD-related HF. In light of the high risk of cardiac surgery, appropriate scores for groups of patients are of great importance. We aimed to establish a novel score to predict in-hospital mortality for impaired EF patients undergoing CABG. Methods: Clinical information of 1,976 consecutive CABG patients with EF<50% was collected from January 2012 to December 2017. A novel system was developed using the logistic regression model to predict in-hospital mortality among patients with EF<50% who were to undergo CABG. The scoring system was named PGLANCE, which is short for seven identified risk factors, including previous cardiac surgery, gender, load of surgery, aortic surgery, NYHA stage, creatinine, and EF. AUC statistic was used to test discrimination of the model, and the calibration of this model was assessed by the Hosmer-lemeshow (HL) statistic. We also evaluated the applicability of PGLANCE to predict in-hospital mortality by comparing the 95% CI of expected mortality to the observed one. Results were compared with the European Risk System in Cardiac Operations (EuroSCORE), EuroSCORE II, and Sino System for Coronary Operative Risk Evaluation (SinoSCORE). Results: By comparing with EuroSCORE, EuroSCORE II and SinoSCORE, PGLANCE was well calibrated (HL P = 0.311) and demonstrated powerful discrimination (AUC=0.846) in prediction of in-hospital mortality among impaired EF CABG patients. Furthermore, the 95% CI of mortality estimated by PGLANCE was closest to the observed value. Conclusion: PGLANCE is better with predicting in-hospital mortality than EuroSCORE, EuroSCORE II, and SinoSCORE for Chinese impaired EF CABG patients.

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