399 A Re-Audit of Secondary Prevention Medications Following Coronary Artery Bypass Grafting: Are We Still Compliant with The Updated Guidelines?

Introduction In the years following myocardial revascularisation with bypass grafts, patients remain at risk for subsequent ischemia as a result of native coronary artery disease progression or development of graft occlusion. Therefore, secondary measures, primarily medical therapy, play an indispensable role in post-operative care. An audit conducted in 2014 identified reduced compliance to prescription of secondary prevention medications. This audit aims to re- evaluate the level of compliance to updated guidelines. Method A retrospective case-note review of 100 patients, who underwent CABG (Coronary Artery Bypass-Grafts), was conducted primarily focusing on prescription of secondary prevention drugs at discharge, indications, and contraindications. Results 99% patients were discharged on anti-platelet agents. However, 12%, discharged on dual anti-platelet agents, did not have any indications for them. 97 % patients were discharged on beta-blocker. Of the 3 defaulters, one had contraindication to beta blockade. 96% patients were discharged on one or more lipid lowering agents and 74% were discharged on ACEi/ARBs. Of the 26% patients discharged without RAAS (Renin Angiotensin Aldosterone System) inhibitor, 9% had no clear indication for it whereas for 7%, it was contraindicated at discharge. Conclusions A generalised improvement in compliance rate is noted for secondary prevention medications prescription according to updated guidelines from the previous audit.

Off-pump coronary artery grafting in patients with reduced ejection fraction

The outcome of coronary artery bypass surgery depends on complete revascularization. In our paper, we attempt to demonstrate that Off-pump coronary artery bypass (OPCAB) is applicable to coronary heart disease patients with low LVEF. Low LVEF does not affect cardiac revascularization. Low LVEF is an independent risk factor for the outcome of CABG patients, but it does not mean that the OPCAB procedure leads to poor outcomes. In our hospital, we used on-pump CABG or conventional bypass surgery for coronary heart disease patients with low LVEF before 2010.With the accumulation of cases, OPCAB is now used in more than 95% of coronary artery bypass grafts in our center. Our data suggest that OPCAB is safe and reliable for patients with low LVEF.

The current diagnosis and treatment of high-risk patients with chronic primary and secondary mitral valve regurgitation

Mitral valve regurgitation (MR) is due primarily to either primary degeneration of the mitral valve with Barlow's or fibroelastic disease or is secondary to ischemic or nonischemic cardiomyopathies. Echocardiography is essential to assess MR etiology and severity, the remodeling of cardiac chambers and to characterize longitudinal chamber changes to determine optimal therapies. Surgery is recommended for severe primary MR if persistent symptoms are present or if left ventricle dysfunction is present with an EF <60% or a left ventricle end-systolic diameter ≥40 mm. For secondary MR, therapy of heart failure with vasodilators and diuretics improves forward cardiac output. Coronary artery bypass grafts (CABG) or percutaneous coronary intervention (PCI) should be considered for severe MR due to ischemia. This review summarizes the pathophysiology, the characteristics, the management and the different interventions for high risk patients with chronic primary and secondary MR.

Indications to coronary artery bypass graft angiography in the early postoperative period

Aim. To determine indications to emergency coronary artery bypass angiography.Methods. 7,616 medical records of patients with coronary artery disease who underwent isolated CABG in the period from 2012 to 2019 at the Federal Center for Cardiovascular Surgery were reviewed. Of them, 103 (1.35%) patients underwent emergency coronary artery bypass graft angiography in the early postoperative period to verify signs of myocardial damage. Patients were assigned to two groups based on angiographic findings and selected treatment strategy. Out of 75 patients, 57 patients from Group 1 had no severe angiographic signs of occlusive changes of the grafts and native arteries. But 18 patients reported failed graft and required conservative management. Group 2 (n = 28) included patients who had failed coronary artery bypass grafts according to angiography findings. 20 patients underwent endovascular treatment, and 8 patients underwent repeated surgery. The control group included 30 patients (0.39%) without any signs of ischemic myocardial damage. Intraoperative flow was assessed as well as postoperative electrocardiographic and echocardiographic records. Biochemical markers of myocardial damage were measured.Results. Blood flow velocity was less than 20 ml/min, and the pulsatility index exceeded 3.0 according to the intraoperative flow assessment of coronary artery bypass grafts with impaired blood flow according to angiography findings. There was no relationship found between ischemic changes according to ECG, ECHO-CG, and angiographic findings. Significant differences were found in troponin I levels between Group 1 (patients with coronary artery graft dysfunction) and the control group (Group 3) at all time intervals (1, 6, 12, 24 and 48 hours).Conclusion. The predictors of failed coronary artery bypass grafts in the early postoperative period allowed identifying indications to emergency angiography.