Post Operative Complications Associated with Preoperative use of Clopidogrel in Patients Undergoning Coronary Artery Bypass Surgery

Background: Majority of the patients presenting for coronary artery bypass surgery are preoperatively on clopidogrel and aspirin i.e., Dual antiplatelets therapy (DAPT) because of high incidence of left main stem disease, acute coronary syndrome and diffuse coronary artery disease. Preceding coronary stenting and coming from far flung areas even from other countries with poor socioeconomic status contributes to continuation of DAPT till surgery. The main objective of the study was to evaluate hospital complications like chest tube output, re-explorations, blood, and blood product administration and in-hospital mortality in patients who continued DAPT till 48 hours prior to surgery versus those who continued DAPT until 48 to 120 hours before surgery. Methods: Preoperative history, perioperative and postoperative data of patients was gathered retrospectively from 1st July to 31st December 2019 in a tertiary care hospital of Peshawar. Total patients undergoing CABG Surgery were 223. From those 223 patients 192 patients were on DAPT. We than divided the 192 patients into two groups, Group A and Group B. 102 patients (Group A) received clopidogrel plus aspirin until 48 hours before surgery, and 89 patients (Group B) continued clopidogrel 48 to 120 hours prior to surgery. Chest tube output, need for exploration, in-hospital mortality, and blood or products transfusions among both groups were compared. Results: In terms of bleeding complications no significant difference between the both groups with similar chest drainage in the first 24 hours (602 ml and 609ml). In group A 33 patients received blood transfusion compared to 25 patients from group B. There was no significant difference in the amount of platelets given to group A (0.63 L) and to group B was (0.60 L). On the other hand, Group, A received 1.08 L fresh frozen plasma (FFPs) transfusion and group B 1.10 L respectively. Re-exploration was observed in Group A and B as (3 vs 2). Mortality was observed in 7 patients from group A and 2 from Group B. Conclusions: Usage of Dual antiplatelets therapy (DAPT) before surgery was an effective treatment method for postoperative complication of bleeding. It was suggested that with proper management with DAPT before surgery was planned is an effective and safe treatment method.. Keywords: Cardiopulmonary surgery, Coronary bypass grafting, hemoglobin, platelets, bleeding.

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Evaluation of Neurocognitive Dysfunction after Coronary Artery Bypass Surgery

Cardiovascular Journal ◽

10.3329/cardio.v10i2.36290 ◽

2018 ◽

Vol 10 (2) ◽

pp. 186-193 ◽

Cited By ~ 2

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

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Effects of Intravenous Triiodothyronine during Coronary Artery Bypass Surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000306 ◽

2002 ◽

Vol 10 (3) ◽

pp. 219-222 ◽

Cited By ~ 13

Author(s):

Mustafa Güden ◽

Belhhan Akpinar ◽

Ertan Sagğbaş ◽

İlhan Sanisoğlu ◽

Emine Cakali ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Double Blind Study ◽

Group A ◽

Group B

A prospective randomized and double-blind study was performed to evaluate whether perioperative triiodothyronine administration has any effect on cardiovascular performance after coronary artery bypass surgery. Sixty patients were assigned to 2 groups of 30 each. When crossclamping ended, group A received an intravenous bolus of triiodothyronine, followed by infusion for 6 hours. Group B received a placebo. Serum triiodothyronine levels and hemo-dynamic parameters were serially measured. Mean postoperative cardiac index was slightly, but not significantly, higher in group A, whereas systemic vascular resistance was significantly lower in group A. Compared with preoperative values, serum triiodothyronine levels dropped significantly in group B at the end of cardiopulmonary bypass and remained low 12 hours postoperatively, while levels rose significantly in group A. No significant differences were detected between the groups in the incidence of arrhythmia, the need for inotropic support, intensive care unit stay, mortality, and morbidity. Perioperative administration of triiodothyronine increased cardiac output slightly and decreased systemic vascular resistance, but it had no effect on operative outcome. Routine use after coronary surgery is thus not recommended.

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Conventional haemofiltration during routine coronary bypass surgery

Perfusion ◽

10.1177/026765919701200307 ◽

1997 ◽

Vol 12 (3) ◽

pp. 187-192 ◽

Cited By ~ 13

Author(s):

Ronald M Babka ◽

James Petress ◽

Richard Briggs ◽

Robert Helsel ◽

John Mack

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Coronary Bypass ◽

Postoperative Blood Loss ◽

Group A ◽

The Mean ◽

Group B

The use of conventional ultrafiltration during cardiopulmonary bypass (CPB) has been well recognized as an efficient modality of therapy to reverse the effects of deliberate haemodilution. Routine use of the haemofilter was prospectively studied on 60 patients undergoing coronary artery bypass surgery. Group A consisted of 30 patients on whom the ultrafiltrator was used and compared to group B who did not receive the ultrafiltration technique. The COBE 1200 ultrafiltration device was used. The results of the study demonstrated that, in group A, the mean total amount of ultrafiltrate collected during bypass was 2510 ± 804 ml per patient. The mean 24-h postoperative blood loss was 440 ± 192 ml in group A and 451 ± 136 ml in group B. The average bank blood transfused was 0.6 ± 1.3 units per patient in group A and 0.75 ± 1.5 units per patient in group B. Postoperative weight gain in group A averaged 3.5 ± 3.45 lb per patient, compared to 4.8 ± 3.7 lb per patient in group B. Postoperative length of stay averaged 6.4 ± 1.5 days per patient in group A and 6.4 ± 2.1 days per patient in group B. Overall patient charges averaged $33 706 ± 8348 per patient in group A and $33 041 ± 7674 per patient in group B. It was concluded that routine use of ultrafiltration during routine coronary artery bypass surgery with CPB offers no improvement in the quality of care nor does it decrease the patient’s overall charges.

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Early Outcome of Minimally Invasive Direct Coronary Artery Bypass Surgery- A hospital based study

Cardiovascular Journal ◽

10.3329/cardio.v13i2.52967 ◽

2021 ◽

Vol 13 (2) ◽

pp. 135-143

Author(s):

SM Quamrul Akhter ◽

AM Asif Rahim ◽

Quazi A Azad ◽

MF Maruf ◽

NA Kamrul Ahsan

Keyword(s):

Quality Of Life ◽

Cardiac Surgery ◽

Coronary Artery ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Post Operative Period ◽

Group A ◽

Group B

Background: coronary artery bypass surgery (CABG) is expensive, uses disposable appliances and patients require more perioperative intensive care, long stay in hospital and often have a lengthy recovery time. These complications, together with the growing trend towards less invasive techniques in other areas of surgery, have encouraged cardiac surgeons to see if minimally invasive cardiac surgery can become a reality with improved outcomes and costs. Methods: This is a prospective nonrandomized comparative clinical study done at the Department of Cardiac Surgery in National Institute of Cardiovascular Diseases (NICVD) Sher-E- Bangla Nagar, Dhaka from July 2006 to June 2008 among routine CABG patients. Purposive sampling was done with 26 patients in group A selected for MIDCAB and 24 patients in Group B selected for conventional CABG surgery. Patients were followed up for three months. Postoperative outcomes were assessed to evaluate the safety and efficacy of MIDCAB in relation to conventional CABG. Results: Mean age were 54.19 vs 53.87 in group A and Group B. 92.3% vs 87.5% were male respectively. Mean duration of operation, per operative blood loss transfusion and arrythmia were lower in MIDCAB group (p<0.05) number of grafts were also statistically significant (p< 0.001). Regarding post-operative outcome ventilation time in hours ICU stay post-operative hospital stay in days, postoperative MI and stroke rate were lower in favor of group A MIDCAB patients (p<0.001). Three months postoperatively six-meter walking distance is also statistically significant in favor of Group A MIDCAB (p<0.01) patients. However, pain score in early post-operative period was higher in group A significantly but it decreased significantly in late post-operative period which is also highly statistically different (p<0.001). However, mortality and quality of life at three months were similar in both groups. Conclusion: No difference in mortality rates detected between MIDCAB and CCABG group. But there was evidence that MIDCAB is associated with less perioperative and early postoperative morbidity and improved quality of life. The MIDCAB surgery is an effective procedure of complete revascularization in ischemic heart diseases like CCABG. The procedure is associated with shorter operating time, shorter ICU stay time, shorter hospital stays and better quality of life than for CCABG. Cardiovasc. j. 2021; 13(2): 135-143

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Thoracic Epidural Anesthesia for Coronary Bypass Surgery Affects Autonomic Neural Function and Arrhythmias

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/01.gim.0000198517.54063.74 ◽

2005 ◽

Vol 1 (2) ◽

pp. 83-87 ◽

Cited By ~ 5

Author(s):

Noriyoshi Yashiki ◽

Go Watanabe ◽

Shigeyuki Tomita ◽

Satoru Nishida ◽

Tamotsu Yasuda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

General Anesthesia ◽

Sympathetic Activity ◽

Bypass Surgery ◽

Artery Bypass ◽

Coronary Bypass ◽

Thoracic Epidural ◽

Group A ◽

Group B

Background In recent years, the invasiveness of coronary reconstruction has been markedly reduced. Awake off-pump coronary artery bypass (AOCAB), coronary bypass surgery with thoracic epidural anesthesia (TEA) without general anesthesia and cardiopulmonary bypass), has been reported in the literature. Because the details of this technique are still unclear, we evaluated its usefulness by examining the autonomic neural state and the incidence of arrhythmia. Methods Fifty-five patients who underwent elective coronary artery bypass grafting (CABG) between April and December 2003 were included in the study. Patients who underwent CABG under high TEA alone comprised group A, those who underwent CABG under general anesthesia combined with TEA comprised group B, and those who underwent CABG under general anesthesia alone comprised group C. Holter electrocardiography was performed before and after surgery, and perioperative electrocardiograms were recorded (before surgery and during surgery, postoperative days 0–3, and postoperative day 7). On obtained electrocardiograms, the autonomic neural state was evaluated by analysis of heart rate variability, and the incidence of atrial fibrillation. Results Concerning the autonomic neural state, sympathetic inhibition was observed during TEA in both groups A and B. After discontinuation of TEA, sympathetic activity recovered. Vagal activity was not inhibited in group A, but decreased during surgery and gradually recovered after surgery in group B. Evaluation of the balance between sympathetic and vagal activities showed that sympathetic activity became predominant rapidly on postoperative day 2 in group B but gradually after surgery in group A. The incidence of postoperative atrial fibrillation was the highest in group B. Conclusions In AOCAB, because there is no vagal inhibition, vagal dominance can be maintained after surgery. This may be associated with the lower incidence of postoperative atrial fibrillation in group A compared with group B. Further studies are necessary to evaluate the details of AOCAB.

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Comparison of Microplegia Solution and Del Nido Cardioplegia Solution in Coronary Artery Bypass Grafting Surgery: Which One is More Effective?

The Heart Surgery Forum ◽

10.1532/hsf.3955 ◽

2021 ◽

Vol 24 (5) ◽

pp. E842-E848

Author(s):

Yusuf Salim Urcun ◽

Arda Aybars Pala

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Ventricular Ejection Fraction ◽

Cardioplegia Solution ◽

Cross Clamp Time ◽

Extubation Time ◽

Significant Difference

Background: The aim of this study is to compare the efficacy of the microplegia solution and Del Nido cardioplegia solution in coronary artery bypass surgery with clinical, biochemical, and echocardiographic data. Methods: Three hundred patients, who underwent coronary artery bypass surgery between January 2017 and January 2020, by the same surgical team were included in the study. Preoperative, operative and postoperative data (cardiac biomarker levels, cross-clamp and CPB times, echocardiographic measurements, etc.) of the patients were compared. Results: In the study, cross-clamp time was significantly shorter in the DN cardioplegia group (55.60 ± 13.49 min/75.58 ± 12.43 min, P = 0.024). No significant difference was observed between the two groups in terms of intensive care stay, extubation time, hospital stay, and cardiopulmonary bypass time. In our study, it was shown that both the left and right ventricular ejection fraction was better protected in the Del Nido cardioplegia group (5.34±3.03 vs. 3.40±2.84, P = 0.017 and 3.82±1.19 vs. 2.28±1.87, P = 0.047, respectively), and the need for inotrope support was lower in this group (28% vs. 44%, P < 0.021). There was no significant difference between the groups, in terms of blood transfusion rates, IABP requirement. Conclusion: In light of short-term results, we can say that Del Nido cardioplegia provides better myocardial protection than microplegia. In addition, Del Nido cardioplegia can be given as a single dose for 90 minutes of cross-clamp time and therefore can be preferred to increase surgical comfort and reduce cross-clamp times.

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A Comparison of Patients Undergoing On- vs. Off-Pump Coronary Artery Bypass Surgery Managed with a Fast-Track Protocol

Journal of Clinical Medicine ◽

10.3390/jcm10194470 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4470

Author(s):

Henrike Grützner ◽

Anna Flo Forner ◽

Massimiliano Meineri ◽

Aniruddha Janai ◽

Jörg Ender ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Artery Bypass Surgery ◽

Fast Track ◽

Bypass Surgery ◽

Artery Bypass ◽

Post Anesthesia Care Unit ◽

Off Pump ◽

Significant Difference ◽

Pump Coronary Artery Bypass

The purpose of this study was to compare patients who underwent on- vs. off-pump coronary artery bypass surgery managed with a fast-track protocol. Between September 2012 and December 2018, n = 3505 coronary artery bypass surgeries were managed with a fast-track protocol in our specialized post-anesthesia care unit. Propensity score matching was applied and resulted in two equal groups of n = 926. There was no significant difference in ventilation time (on-pump 75 (55–120) min vs. off-pump 80 (55–120) min, p = 0.973). We found no statistically significant difference in primary fast-track failure in on-pump (8.2% (76)) vs. off-pump (6% (56)) groups (p = 0.702). The secondary fast-track failure rate was comparable (on-pump 12.9% (110) vs. off-pump 12.3% (107), p = 0.702). There were no significant differences between groups in regard to the post-anesthesia care unit, the intermediate care unit, and the hospital length of stay. Postoperative outcome and complications were also comparable, except for a statistically significant difference in PACU postoperative blood loss in on-pump (234 mL) vs. off-pump (323 mL, p < 0.0001) and red blood cell transfusion (11%) and (5%, p < 0.001), respectively. Our results suggest that on- and off-pump coronary artery bypass surgery in fast-track settings are comparable in terms of ventilation time, fast-track failure rate, and postoperative complications rate.

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Influence of Hypertension on Early outcome after Coronary Artery Bypass Surgery

University Heart Journal ◽

10.3329/uhj.v7i1.10203 ◽

2012 ◽

Vol 7 (1) ◽

pp. 13-15

Author(s):

Md Aslam Hossain ◽

Rezwanul Hoque ◽

Md Saifullah Khan ◽

Asit Baran Adhikary ◽

Mostafizur Rahman ◽

...

Keyword(s):

Coronary Artery ◽

Postoperative Complications ◽

Coronary Artery Bypass ◽

Bypass Surgery ◽

Artery Bypass ◽

Hypertensive Patients ◽

Early Outcome ◽

Hypertensive Group ◽

Group A ◽

Group B

Influence of hypertension on early outcome after coronary bypass surgery was studied during the period from January 2004 to December 2004, in the Department of cardiovascular surgery, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Sixty patients undergoing conventional coronary artery bypass grafting in cardioplegic arrested heart were divided equally into two groups, 30 patients with hypertension(Group A) and 30 patients without hypertension(Group B). Study showed that in hypertensive group, 60.00% developed postoperative complications, whereas it is 13.30% of non-hypertensive group. Twenty percent of group A and none of the Group-B patients developed sternal wound infection. Leg infections were 39% and 13.3% in Group A and Group B respectively. Two patients from the Group A developed stroke during postoperative period, but none of the Group B patient had the same problem. Duration of average postoperative ventilation was 2.35 times greater in hypertensive patients than non-hypertensive patients. Mean postoperative hospital stay for Group A and Group B patients being 13.20 and 10.90 days respectively. The study showed that hypertensive patients were at higher risk of developing postoperative complications compared to patients without hypertension. DOI: http://dx.doi.org/10.3329/uhj.v7i1.10203 UHJ 2011; 7(1): 13-15

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Postoperative Tachyarrhythmias: On-Pump versus Off-Pump Coronary Artery Bypass Grafting

ISRN Vascular Medicine ◽

10.1155/2014/659706 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7

Author(s):

Mohamed Shehata ◽

Bassem AbdElhalim ◽

Hany Hanna ◽

Mervat Nabih

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Categorical Variables ◽

Off Pump ◽

Electrocardiographic Monitoring ◽

Significant Difference ◽

Group A ◽

Group B

Objective. Tachyarrhythmias, after coronary artery bypass graft (CABG) surgery, develop in 11%–40% of patients. Surgery technique (on-pump or off-pump) might affect incidence of post-CABG tachyarrhythmias. Methods. The study included 60 patients undergoing CABG (≥2 grafts) with left ventricle ejection fraction (LV EF) >40%. Patients were divided into two groups equally: group A (on-pump) and group B (off-pump). Patients were subjected to electrocardiographic monitoring (7 days postoperatively), transthoracic echocardiography, with recording of surgical details and complications. Results. Data collected between December 2012 and May 2013 showed no significant difference between two groups regarding incidence of postoperative tachyarrhythmias with statistically significant higher incidence of supraventricular tachycardia in group B (P<0.05) and a trend towards higher incidence of atrial fibrillation in group A. Patients who developed postoperative tachyarrhythmias in group A showed higher prevalence of family history of coronary artery disease and higher incidence of postoperative chest infections (P<0.05), while those in group B showed higher mean LV EF (pre- and postoperatively) (P<0.05). Data were statistically described in terms of mean ± standard deviation. Comparison of numerical and categorical variables was done using Student’s t- and Chi-square tests, respectively. Conclusion. Adopting off-pump CABG technique is not associated with less incidence of post-operative tachyarrhythmias, as compared to on-pump technique.

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Abstract 11785: The Association of Guideline Adherence of Coronary Revascularization and Clinical Outcomes for Patients With Stable and Complex Coronary Artery Disease

Circulation ◽

10.1161/circ.132.suppl_3.11785 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Chenfei Rao ◽

Zhe Zheng ◽

Shengshou Hu ◽

Heng Zhang

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Artery Bypass ◽

Myocardial Revascularization ◽

Research Network ◽

Significant Difference ◽

Group A ◽

Artery Disease ◽

Group B ◽

Revascularization Procedures

Introduction: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) gained popularity in China, there are gaps in knowledge about the appropriateness of revascularization procedures and related outcomes of stable and complex coronary artery disease. Methods: Using the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) research network, this prospective study of 3-Vessel Disease (China PEACE-3VD) consecutively enrolled patients with 3-vessel and/or left-main disease diagnosed by elective coronary angiography in 24 large cardiovascular centers in China. We abstracted medical record data for patient characteristics and treatment strategies, the core lab calculated SYNTAX Scores for all patients. We classified the appropriateness of treatment for each patient using 2011 Guideline on Myocardial Revascularization published by European Society of Cardiology and European Association of Cardio-Thoracic Surgery. We compared the 1-year rates of major adverse cardiovascular and cerebral events (MACCE) between patients underwent revascularization with I/IIa and IIb/III indications. Results: We consecutively enrolled 3186 patients from participated hospitals. Among them, 20.4% (651) underwent medical therapy, 79.6% (2535) underwent revascularization procedures (PCI: 87.4%, 12.6% CABG) during the index hospitalization. For patients underwent revascularization procedures, 47.9% patients were suitable for both CABG and PCI (has I indication for CABG, and IIa indication for PCI, group A), 52.1% were only suitable for CABG (has I indication for CABG, and IIb/III for PCI, group B). In group A, 95% underwent PCI, 5% underwent CABG, the 1-year MACCE rates of CABG and PCI showed no significant difference (PCI: 4.6%, CABG: 7.7%, adjusted OR=1.21, p=0.81); In group B, 80.4% underwent PCI, 19.6% underwent CABG, the 1-year MACCE rates of CABG is significantly lower than PCI (PCI: 7.5%, CABG: 2.3%, adjusted OR=3.18, p=0.027). Conclusions: Using the Guideline on Myocardial Revascularization, we identified certain overuse of PCI for stable and complex coronary artery disease. The inappropriate use of PCI is associated with worse 1-year outcomes than CABG. (NCT01625312)

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