The Neutrophil to Lymphocyte Ratio and Serum Albumin as Predictors of Acute Kidney Injury After Coronary Artery Bypass Grafting

Postoperative acute kidney injury (AKI) is a highly prevalent and serious complication after cardiac surgery. The aim of this study is to identify the predictors of AKI and the cut-off values after isolated off-pump coronary artery bypass grafting (OPCAB). A total of 329 adult patients, who underwent isolated OPCAB between December 2008 and February 2021, were retrospectively analyzed. The patients were divided into three groups: non-AKI, early AKI and late AKI groups. The early AKI group or the late AKI group were defined as ‘having AKI that occurred before or after 48 hours postoperatively’, respectively. Multivariate logistic regression analysis was performed to identify the predictors of AKI. Receiver operating characteristic (ROC) curve analysis was used to evaluate the cutoff value, the sensitivity, and the specificity of the predictors. On the multivariate analysis, the emergency surgery, the preoperative serum albumin, and the postoperative day 1 neutrophil to lymphocyte ratio (NL ratio) were identified as the independent predictors of AKI. However, neither albumin nor the NL ratio predicted late AKI. The present study showed the preoperative albumin and the postoperative day 1 NL ratio were the robust and independent predictors of postoperative early AKI in isolated OPCAB.

Microcirculatory Response to Blood vs. Crystalloid Cardioplegia During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB.Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T0) to discontinuation of CPB (T5).Results: In the both crystalloid [crystalloid cardioplegia group (CCG)] and blood cardioplegia [blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T0 to T5 (%Δ)T0−T5 in all the functional microcirculatory parameters [%ΔTVDT0−T5(CCG): −10.86 ± 2.323 vs. %ΔTVDT0−T5(BCG): 0.0804 ± 1.107, p < 0.001; %ΔPVDT0−T5(CCG): −12.91 ± 2.884 vs. %ΔPVDT0−T5(BCG): 1.528 ± 1.144, p < 0.001; %ΔPPVT0−T5(CCG): −2.345 ± 1.049 vs. %ΔPPVT0−T5(BCG): 1.482 ± 0.576, p < 0.01].Conclusion: Blood cardioplegia ameliorates CPB-induced microcirculatory alterations better than crystalloid cardioplegia in patients undergoing CABG, which may reflect attenuation of the systemic inflammatory response. Future investigations are needed to identify the underlying mechanisms of the beneficial effects of blood cardioplegia on microcirculation.

Causes affecting the working capacity of patients undergoing coronary bypass surgery (systematic review)

A review of the available domestic and foreign literary sources is presented concerning factors affecting the working capacity of persons after coronary artery bypass grafting. It was found that in Russia, after surgical treatment of coronary heart disease, there is an increase in the number of disabled people compared to foreign data. In recent years, there has been an increase in patients undergoing coronary bypass surgery. However, this did not reduce the increasing number of disabled people after coronary artery bypass grafting, which does not correspond to the initial expectations about the cost-effectiveness of this type of surgery. According to Russian researchers, the proportion of persons with disabilities referred for surgical myocardial revascularization was 39.0-42.5%. Subsequently, this indicator increased to 64.0%. In other countries, the dynamics are different. Among patients under 60 years of age who underwent surgical treatment of coronary artery disease, more than half returned to work. In general, labour activity was restored by 67.5%, and the number of disabled persons decreased from 56.0 to 42.0%. Social and medical factors were assessed to establish the causes of disability after coronary artery bypass grafting. World experience testifies to the critical role of state social support in preserving the labour status of patients, which ultimately justifies the economic costs of surgical treatment. To assess the degree of disability after coronary artery bypass grafting, social status before surgical treatment of coronary heart disease, and the severity of comorbid pathology. To increase the economic efficiency of coronary bypass surgery, it is necessary to organize an affordable and effective rehabilitation program, uniform criteria for referring patients to medical and social expertise.

Outcome of patients with normal and decreased heart rate variability coronary artery bypass grafting surgey

Introduction and objectives: Previous studies have shown that after coronary artery bypass grafting (CABG), heart rate variability (HRV) becomes decreased. The aim of this study was to evaluate the role of decreased heart rate variability in coronary artery bypass grafting patients. Methods: The study involved 119 consecutive patients who underwent the first CABG operation with sinus rhythm. All subjects underwent assessed with 24-hour Holter recordings 2 days preoperative and 7 days postoperative at Hanoi Heart Hospital from 6/2016 to 8/2018. Major adverse cardiovascular events was defined as cardiac death, recurrent myocardial infarction, stroke, decompensated heart failure and re-hospitalization. The patients were followed up for 6 months. Main results: The incidence of major adverse cardiovascular events was 10.8% followed to 6 months. The incidence of pre and postoperative low HRV varies from 28.6% (preop) to 51.8% (postop 7 days). In which, decreased HRV preoperative predictors of major adverse cardiac events in patients undergoing coronary artery bypass graft surgery: followed up for 3 months: (OR:3,40; 95%CI: 0,97 – 12,11; p>0,05), followed up for 6 months (OR:3,41; 95%CI: 1,05 – 11,05; p<0,05). Conclusions: Preoperative with low HRV was pedict a risk factor for major adverse cardiovascular events.

Changes in heart rate variability pre and postoperative coronary artery bypass grafting

Introduction and objectives: Previous studies have shown that after coronary artery bypass grafting (CABG), heart rate variability (HRV) becomes decreased. The loss of the peripheral autonomic sympathetic and parasympathetic control in Sinoatrial Node in the form of an autonomic cardioneuropathy syndrome is the predictor of the pre and postoperative complications after CABG. The aim of this study was to establish the temporal pattern of change in the decrease of HRV observed after CABG. Methods: The study involved 119 consecutive patients who underwent the first CABG operation with sinus rhythm. All subjects underwent assessed with 24-hour Holter recordings 2 days preoperative and 7 days, 3 months, 6 months postoperative at Hanoi Heart Hospital from 6/2016 to 8/2018. Main results: All indicators of heart rate variability decreased to the lowest level after surgery 7 days, recovers to the preoperative values within three to six months of the procedure. The incidence of pre and postoperative low HRV varies from 28.6% (preop) to 51.8% (postop 7 days), 19.6% (postop 3 months) and 12.7% (postop 6 months). Conclusions: This study have showed that CABG surgery generally leads to significant reduction in HRV. HRV gradually recovers to the preoperative values within three to six months of the procedure.