coronary artery bypass grafting

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Original Article

Parameter Predicting Postoperative Atrial Fibrillation in Coronary Artery Bypass Grafting Patients: Triglyceride-Cholesterol-Body Weight Index

Abstract

Background:

Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, particularly coronary artery bypass grafting (CABG). Despite advances in surgical techniques, POAF remains a significant cause of morbidity and mortality.

Objectives:

This study investigates the potential of the Triglyceride-Cholesterol-Body weight Index (TCBI) as a predictor of POAF, focusing on the impact of nutritional status on surgical outcomes.

Methods:

This retrospective study included 321 patients who underwent CABG surgery between January 2010 and January 2024. TCBI was calculated using preoperative blood samples and compared between those who developed POAF and those who did not. Statistical analyses, including Cox regression and ROC analysis, were performed to assess the predictive value of TCBI for POAF. P<0.05 was considered statistically significant.

Results:

Patients who developed POAF had significantly lower TCBI (1790.8 ± 689, 3413.3±1232, p<0.001, respectively) levels compared to those without POAF. Also, age (p<0.001), the frequency of hypertension (p=0.009), CRP (p=0.03), and WBC (p=0.02) values were also significantly higher in patients who developed POAF.TCBI was identified as an independent predictor of POAF (OR: 0.998, 95% CI: 0.997-0.999, p<0.001), with a cut-off value of 1932.4 predicting POAF with 75% sensitivity and 78% specificity.

Conclusion:

The TCBI is a reliable indicator for predicting POAF in CABG patients. Preoperative identification of patients with low TCBI could lead to targeted interventions, reducing postoperative complications and improving outcomes. Optimizing nutritional status before surgery may mitigate the risk of POAF.

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Editorial

Registries and Evidence-Based Medicine

Fernando Antibas Atik

Since the landmark achievement of Rene Favaloro in 1967, coronary artery bypass grafting (CABG) has developed great advances. Despite the widespread adoption of percutaneous coronary intervention with stenting, CABG remains an extremely important invasive treatment option in patients with coronary artery disease. Coronary artery bypass grafting has been extensively investigated in the literature through many randomized controlled trials and large-scale multicenter and unicenter observational registries, which have provided appropriateness of decision in a patient-centered approach, achieving the highest level of recommendation in many clinical scenarios.

In this issue of Arquivos Brasileiros de Cardiologia, a manuscript entitled “Age, Renal Failure and Transfusion are Risk Predictors of Prolonged Hospital Stay after Coronary Artery Bypass Grafting Surgery” addresses an important issue. The authors aimed to determine factors associated with prolonged postoperative hospital length of stay, defined as greater than 14 days. The authors studied 3703 patients submitted to CABG over 2 years, using the Sao Paulo State Registry REPPLICAR II. This data is out of date in about 5 years. They have found that 6.16% of patients had prolonged postoperative length of stay, being the preoperative and intraoperative determinants of the primary outcome, using multivariable logistic regression analysis, the presence of age greater than 60 years, preoperative kidney dysfunction, and intraoperative red blood cell transfusion.

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Artigo Original

Combined carotid endarterectomy and coronary artery bypass grafting: analysis of the results

Márcio Luís Lucas et al. Telmo Pedro Bonamigo Elton Luiz Schmidt Weber Fernando Antônio Lucchese

OBJECTIVE: To evaluate the results of combined surgery (carotid endarterectomy and coronary artery bypass grafting) in patients with concomitant carotid and coronary artery disease. METHODS: The authors reviewed 49 different reports describing several aspects of the combined surgery in 4788 patients to analyze early events in the perioperative period. RESULTS: Overall stroke, acute myocardial infarction (AMI), and mortality rates were 4.3%, 2.2%, and 4.2%, respectively. Most recent papers (1990 to 2000) show significant lower incidence of strokes compared to those published earlier (1972 to 1989) (4.1% x 10.2%; p < 0.05). In this same survey, the incidence of postoperative stroke was higher in the series with a small sample (n 100) (7.2% x 3.9%; p < 0.05), denoting the impact of surgeons' experience on postoperative results. CONCLUSION: In sum, we believe that combined carotid endarterectomy and coronary artery bypass grafting is a safe and effective procedure when performed by experienced and qualified surgeons.

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Artigo Original

Comparative study of the results of coronary artery bypass grafting and angioplasty for myocardial revascularization in patients with equivalent multivessel disease

Paulo Roberto Dutra da Silva et al. Whady Armindo Hueb Luiz Antônio Machado César Sérgio Almeida de Oliveira José Antônio Franchini Ramires

OBJECTIVE: To investigate the relative efficacy of different therapeutic strategies in patients with symptomatic multivessel coronary artery disease with preserved ventricular function. The primary objectives were defined as a combination of death of cardiac origin, acute myocardial infarction (AMI), and refractory angina that required revascularization, and the secondary objectives were defined as anginal state and exercise-induced ischemia. METHODS: Of the 20,769 patients assessed on cine coronary angiography at InCor, 210 were chosen for this study and were randomized either for coronary artery bypass grafting (CABG, n=105) or transluminal coronary angioplasty (TCA, n=105). RESULTS: A mean of 3.2±0.8 vessels received anastomoses and 2.1±0.8 were successfully dilated in the CABG and TCA groups, respectively. In a 5-year follow-up, the rates of events in the CABG and TCA groups were, respectively: mortality, 9.52% and 12.38%; acute myocardial infarction, 2.85% and 8.57% (P = 0.0668); and additional intervention, 2.85% and 24.76% (P < 0.001). The survival rate was 88.39% for CABG and 84.93% for TCA; the respective AMI-free percentages were 84.40% and 77.40%. In the CABG and TCA groups, 62% and 60% of the patients had no angina, respectively. The exercise tests were considered nonischemic in 62.5% and 62.1% of the patients in the CABG and TCA groups, respectively. CONCLUSION: In multivessel patients, compared with angioplasty, coronary artery bypass grafting was associated with a lower incidence of long-term events and a reduced need for new interventions (P=0.001).

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Artigo Original

Comparative analysis of the flows of left internal thoracic artery grafts dissected in the pedicled versus skeletonized manner for myocardial revascularization surgery

Gustavo Peressoni Castro

OBJECTIVE: To compare the free blood flow, caliber, and length of the left internal thoracic artery (LITA), dissected in the pedicled (P) and skeletonized (S) manners, during surgery before and after topical vasodilator (TV) application. METHODS: A randomized, blind, clinical trial was carried out with 50 patients undergoing elective myocardial revascularization to assess the use of the LITA in situ in its pedicled or skeletonized form. The 25 patients in the pedicled group (GP) had NYHA class II or III angina, ejection fraction (EF) of 50.8±9.2%, and 16 were of the male sex. The patients in the skeletonized group (SG) had NYHA class II angina, EF of 46.8±9.3%, and 19 were of the male sex. The measurements were performed before extracorporeal circulation and divided into 2 phases: phase 1 (before topical papaverine application) and phase 2 (15 min after topical application of papaverine, 2.5 mg/mL, at 37ºC). During the measurements, mean blood pressure, central venous pressure, and heart rate were monitored. RESULTS: The phase 1 and 2 results are as follows: 1) PG: blood flow, 46±16 and 77±28 mL/min; caliber, 1.4±0.1 and 1.7±0.1 mm, respectively; 2) SG: blood flow, 57±27 and 97±35 mL/min; and caliber, 1.4±0.1 and 1.8±0.2 mm, respectively. No significant differences were observed in length. CONCLUSION: The LITA in SG had a significant increase in blood flow and caliber after the use of TV compared with blood flow and caliber in PG (P=0.03 and P=0.01, respectively).

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Artigo Original

Endomyocardial biopsy foretells ventricular function recovery after coronary artery bypass grafting

Paulo L. Moreno et al. Orlando B. Wender Marinez Barra Lucia C. Pellanda … Luiz E. Rohde Nadine Clausell

OBJECTIVE: Patients with ischemic heart failure may benefit from coronary artery bypass grafting. The histopathological variables associated with improvement in ejection fraction 6 months after surgery were assessed. METHODS: This study comprised 24 patients indicated for coronary artery bypass grafting, ejection fraction < 35%, functional class II-IV heart failure, and mean age 59 ± 9 years. Endomyocardial biopsies were performed during and 6 months after surgery. Extension of the fibrosis, number of cells with myocytolysis, and hypertrophy of the muscle fiber were quantified by using a system of image analysis. Clinical and functional review was repeated within 6 months. RESULTS: A significant improvement in heart failure functional class was observed in 16 patients after 6 months of follow-up (from NYHA functional class 2.8±0.7 to 1.7±0.6; P <0.001), but the ejection fraction did not change (25±6 % vs. 26±10%). Hypertrophy of the muscle fiber was similar in the specimens biopsied in the pre- and postoperative periods (21±4 vs. 22± 4 µm), but the extension of fibrosis (8±8 vs. 21±15% area) and the number of cells with myocytolysis (9±11 vs. 21±15% cell) significantly increased. However, the composition of a histological score combining those 3 variables indicated a greater increase in the ventricular function of those with a lower degree of preoperative histopathological alterations. CONCLUSION: Patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting improved their ventricular function when the preoperative adverse histopathological alterations were of a lower degree.

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Parameter Predicting Postoperative Atrial Fibrillation in Coronary Artery Bypass Grafting Patients: Triglyceride-Cholesterol-Body Weight Index

Abstract

Background:

Objectives:

Methods:

Results:

Conclusion:

Registries and Evidence-Based Medicine

Combined carotid endarterectomy and coronary artery bypass grafting: analysis of the results

Comparative study of the results of coronary artery bypass grafting and angioplasty for myocardial revascularization in patients with equivalent multivessel disease

Comparative analysis of the flows of left internal thoracic artery grafts dissected in the pedicled versus skeletonized manner for myocardial revascularization surgery

Endomyocardial biopsy foretells ventricular function recovery after coronary artery bypass grafting

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