Adherence to lifestyle changes after coronary artery bypass graft: Outcome of preoperative peer education

ObjectiveThis study was done to investigate the effect of preoperative peer education on patients' adherence to medication and lifestyle changes after Coronary Artery Bypass Graft (CABG).MethodsIn this randomized clinical trial, the peers of CABG patients conducted preoperative educational sessions at the ward in groups of 4–5 (n = 36) while the control group (n = 34) received routine education by a nurse. Adherence of both groups to medication and recommendations for lifestyle modification including physical activity, smoking, and diet was measured one and two months after discharge.ResultsA multivariate analysis of co-variance showed the significant effect of peer education on adherence (F = 32.586, p < 0.001; η² = 0.671). Univariate ANCOVA revealed a significant difference in adherence to diet between the two groups (F = 62.316, p = 0 0.0001; η² = 0.482). Based on the repeated measures ANOVA, peer education significantly improved the CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total adherence (F = 9.911, p = 0.002) compared to the control group.ConclusionPreoperative peer education had a significant effect on improving CABG patients' adherence to lifestyle changes after hospital discharge.Practice implicationPeer education can be used as an effective method to improve the CABG patients ' adherence to lifestyle changes.     

血嗜酸性粒细胞计数与冠状动脉旁路移植手术后肺炎风险（英文）

目的:研究血嗜酸性粒细胞计数与冠状动脉旁路移植手术患者术后肺炎风险的关系。方法:收集2008年~2017年在我院进行冠状动脉旁路移植手术的613例患者资料进行分析,比较不同血嗜酸性粒细胞计数患者术后肺炎发生率及住院死亡率,采用多因素回归分析明确患者术后肺炎的危险因素。结果:研究共纳入582例患者,其中220例患者血嗜酸性粒细胞比例2%(低血嗜酸性粒细胞组),362例患者血嗜酸性粒细胞比例≥2%(高血嗜酸性粒细胞组)。低血嗜酸性粒细胞组术后肺炎发生率(14.1%,31/220)明显高于高血嗜酸性粒细胞组(6.4%,23/362,P=0.002),而2组患者住院死亡率无明显差异。多因素回归分析结果显示低血嗜酸性粒细胞计数(OR=3.521,95%CI:1.213~10.223,P=0.021)、鼻胃管(OR=6.490,95%CI:2.757~15.280,P0.001)和机械通气时间≥24 h(OR=3.496,95%CI:1.156~10.178,P=0.035)为术后发生肺炎的独立危险因素。结论:低血嗜酸性粒细胞计数患者冠状动脉旁路移植手术后发生肺炎的风险升高。     

Impact of telephone counseling on the quality of life of patients discharged after coronary artery bypass grafts

BackgroundThis study aimed to assess the impact of telephone counseling on quality of life in patients with coronary artery bypass graft.MethodsA quasi-experimental study was conducted with 71 discharged patients after coronary artery bypass graft surgery at Ekbatan Edcuational hospital in Hamadan, Iran, in 2014. The patients were randomly allocated into intervention (n = 36) and control group (n = 35). The intervention group received education and counseling about therapeutic plan via telephone after discharge. Patients in the control group received only routines. All patients completed the quality of life questionnaire before and after the intervention period of five weeks.ResultsThere was no significant difference between intervention and control group about quality of life before intervention (p = 0.696). However, there was significant and positive deference between the two groups in favor of the telephone counseling after the intervention (P = 0.01) and control group (P = 0.04). Quality of life in the intervention group was significantly better compared to control group (P = 0.01).ConclusionsTelephone counseling could be a cost-effective patient counseling plan for therapeutic adherence after coronary artery bypass surgery in order to improve the patients’ quality of life.Practice implicationsTelephone counseling is feasible to implement and well accepted for patient counseling for many diseases.     

Short-term response of metabolic hormones to coronary artery bypass surgery

PurposeTo explore the response pattern of plasma adipokine and ghrelin levels to coronary artery bypass graft (CABG) surgery in patients with (on-pump) and without (off-pump) cardiopulmonary bypass (CPB).Material/methodsSixteen consecutive patients (age: 62 ± 10 years, male: 10) with obstructive coronary artery disease (CAD) who underwent elective CABG surgery with CPB and intraoperative GIK infusion were selected for on-pump group and 19 CAD patients (age: 63 ± 10 years, male: 16) were included in the off-pump group. Blood samples were taken before, during and after surgery. Intraoperative samples were withdrawn simultaneously for peripheral vein and sinus coronarius (SC). Plasma adipokine concentrations were measured by ELISA, those of ghrelin by RIA kits.ResultsIn response to surgical intervention there was an early, transient fall in plasma levels of adiponectin (p < 0.0001) and resistin (p = 0.002) followed by an increase to approach their initial values. Plasma ghrelin also increased (p = 0.045), this increase, however, was confined to the period of GIK supported CPB. Plasma insulin (p = 0.003) and resistin (p = 0.009) was significantly higher in the peripheral vein than in SC. The perioperative hormone profile of patients without CPB (off-pump) proved to be comparable to that of on-pump patients in spite of the insulin administration and greater oxidative and inflammatory stress.ConclusionsAdipose tissue-derived factors appear to mediate the metabolic and vascular changes that occur in patients with CABG surgery. Epicardial adipose tissue is unlikely to have major contribution to the development of CAD as adipokines are not elevated in SC independent of the mode of intervention.     

Impact of diabetes on mortality and complications after coronary artery by-pass graft operation in patients with left main coronary artery disease

PurposeLeft main disease (LMD) is a severe form of coronary artery disease (CAD). Fifty percent of patients with LMD treated conservatively die within 3–5 years of diagnosis. The aim of the study was to assess the influence of type 2 diabetes on early and late (2-year) prognosis and the risk of complications after coronary artery by-pass graft (CABG) surgery in patients with LMD.Material/methodsWe enrolled 257 patients diagnosed with LMD. 169 (67%) underwent CABG, 19 (8%) percutaneous coronary intervention (PCI) without left main stem protection. 30 (12%) patients had CABG previously. Patients treated with CABG were divided into two groups – with and without diabetes. There were 43 (25.4%) patients with diabetes and 126 (74.6%) without diabetes.ResultsWe observed more complications with wound healing (40.5% vs. 12.8%, p < 0.001) and sternal dehiscence (23.8% vs. 4.0%, p < 0.001) after CABG in patients with diabetes. There were no differences in 7-day, 30-day, 3-month and 1-year mortality. 2-Year mortality was also similar in both groups (11.6% vs. 11.1%, p = 0.928). Patients with diabetes were more frequently hospitalized due to other reasons than angina (39.5% vs. 20.6%, p = 0.014).ConclusionsPatients with diabetes and LMD had more often complications with wound healing and sternal dehiscence after CABG than patients without diabetes. Type 2 diabetes did not influence early and late mortality in patients with LMD treated with cardiac surgery, but the presence of diabetes was associated with more frequent hospitalizations.     

桡动脉解剖及获取技术在冠状动脉搭桥手术中的应用

目的：探讨冠状动脉搭桥术中桡动脉的获取技术方法及应用效果。方法：回顾性总结72例冠状动脉搭桥手术中取桡动脉的经验，介绍获取桡动脉的技术方法和体会。结果：在使用桡动脉获取技术的患者中，3例出现手术切口及手背皮肤术后短时间内麻木，其他患者无前臂感觉及活动障碍，无前臂缺血并发症。结论：当术前评价证实手部桡动脉供血区域有足够的侧枝循环时，桡动脉是最好的搭桥血管之一.     

冠状动脉旁路移植术后竞争血流对桥血管血流动力学的影响

目的 研究冠状动脉旁路移植术后,不同程度竞争血流对左侧胸廓内动脉管壁壁面切应力(wall shear stress, WSS)的影响。方法 基于阈值分割方法,通过采用SimVascular软件从CT图像提取并重建左侧胸廓内动脉(left internal mammary artery, LIMA) 左前降支（left anterior descending, LAD）吻合口模型。根据LAD的狭窄程度将竞争血流分为无竞争（100%狭窄）、轻度竞争（50%、75%狭窄）和高度竞争血流（0%、30%狭窄）3组。通过数值模拟方法观察上述情况下吻合口模型的血流动力学表现。结果 随着竞争血流的增加,LIMA桥血管管壁WSS逐渐降低,但是震荡程度逐渐增加。高度竞争血流组LIMA管壁平均WSS（0%狭窄：2.73 Pa,30%狭窄：2.85 Pa）明显低于轻度竞争血流组（50%狭窄：4.77 Pa,75%狭窄：6.01 Pa）和无竞争血流组(100%狭窄：8.64 Pa);而其震荡剪切指数(oscillatory shear index, OSI)（0%狭窄：0.206,30%狭窄：0.085）却明显高于轻度竞争血流组（50%狭窄：0.014,75%狭窄：0.013）和无竞争血流组(100%狭窄：0.006)。结论 当LAD狭窄程度小于50%时,大量的竞争血流会使LIMA管壁WSS明显降低,并且呈剧烈震荡的状态,这种不利的WSS表现会影响LIMA的远期通畅率,并造成手术远期疗效的下降。     

犬不停跳冠状动脉搭桥模型的构建

目的比较两种不同方法构建不停跳冠状动脉搭桥动物模型,探讨模型构建方法的可行性和优劣性。方法家犬20只随机分为头臂干组和降主动脉组,以小口径异种血管为桥血管。左侧第4肋间切口入胸,先行头臂干动脉或降主动脉端血管吻合,再行冠状动脉端血管吻合,术毕结扎左冠状动脉前降支近端。结果 2组犬均无术中死亡。头臂干组和降主动脉组主动脉端血管吻合用时分别为(33.9±4.8)min和(29.6±3.5)min(P0.05),冠状动脉端血管吻合用时分别为(28.5±3.0)min和(28.1±2.3)min(P0.05),2组术中出血量分别为(77.5±16.2)mL和(66.5±12.3)mL(P0.05)。降主动脉组术中侧壁钳夹降主动脉后股动脉血压明显降低,术后2只犬出现黑便。结论将小口径异种血管吻合在头臂干动脉或降主动脉均可成功构建犬不停跳冠状动脉搭桥模型;降主动脉组股动脉血压波动大,存在腹腔脏器缺血再灌注损伤;头臂干组血管吻合用时稍长,但术中股动脉血压波动小,模型构建相对更安全。     

Off-pump coronary artery bypass surgery in selected patients is superior to the conventional approach for patients with severely depressed left ventricular function

OBJECTIVES:

Patients with coronary artery disease and left ventricular dysfunction have high mortality when kept in clinical treatment. Coronary artery bypass grafting can improve survival and the quality of life. Recently, revascularization without cardiopulmonary bypass has been presented as a viable alternative. The aim of this study is to compare patients with left ventricular ejection fractions of less than 20% who underwent coronary artery bypass graft with or without cardiopulmonary bypass.

METHODS:

From January 2001 to December 2005, 217 nonrandomized, consecutive, and nonselected patients with an ejection fraction less than or equal to 20% underwent coronary artery bypass graft surgery with (112) or without (off-pump) (105) the use of cardiopulmonary bypass. We studied demographic, operative, and postoperative data.

RESULTS:

There were no demographic differences between groups. The outcome variables showed similar graft numbers in both groups. Mortality was 12.5% in the cardiopulmonary bypass group and 3.8% in the off-pump group. Postoperative complications were statistically different (cardiopulmonary bypass versus off-pump): total length of hospital stay (days)—11.3 vs. 7.2, length of ICU stay (days)—3.7 vs. 2.1, pulmonary complications—10.7% vs. 2.8%, intubation time (hours)—22 vs. 10, postoperative bleeding (mL)—654 vs. 440, acute renal failure—8.9% vs. 1.9% and left-ventricle ejection fraction before discharge—22% vs. 29%.

CONCLUSION:

Coronary artery bypass grafting without cardiopulmonary bypass in selected patients with severe left ventricular dysfunction is valid and safe and promotes less mortality and morbidity compared with conventional operations.     

Effect of a flow-streamlining implant at the distal anastomosis of a coronary artery bypass graft

Intimal thickening in the coronary artery bypass graft (CABG) distal anastomosis has been implicated as the major cause of restenosis and long-term graft failure. Several studies point to the interplay between nonuniform hemodynamics including disturbed flows and recirculation zones, wall shear stress, and long particle residence time as possible etiologies. The hemodynamic features of two anatomic models of saphenous-vein CABGs were studied and compared. One simulated an anastomosis with both diameter and compliance mismatch and a curvature at the connection, analogous to the geometry observed in a conventional cardiothoracic procedure. The other, simulated an anastomosis with a flow stabilizing anastomotic implant connector which improves current cardiothoracic procedures by eliminating the distal vein bulging and curvature. Physiologic flow conditions were imposed on both models and qualitative analysis of the flow was performed with dye injection and a digital camera. Quantitative analysis was performed with laser Doppler velocimetry. Results showed that the presence of the bulge at the veno-arterial junction, contributed to the formation of accentuated secondary structures (helices), which progress into the flow divider and significantly affect radial velocity components at the host vessel up to four diameters downstream of the junction. The model with the implant, achieved more hemodynamically efficient conditions on the host vessel with higher mean and maximum axial velocities and lower radial velocities than the conventional model. The presence of the sinus may also affect the magnitude and shape of the shear stress at locations where intimal thickening occurs. Thus, the presence of the implant creates a more streamlined environment with more primary and less secondary flow components which may then inhibit the development of intimal thickening, restenosis, and ultimate failure of the saphenous vein graft. © 2002 Biomedical Engineering Society. PAC2002: 8780Rb, 8719Rr, 8719Uv, 8763Lk, 8719Xx, 4262Be, 4780+v, 8710+e     

Assessment of the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients

Results:Of the 2220 patients, in hospital deaths occurred in 270 patients (mortality rate of 12.2%). The accuracy of mortality prediction in the logistic EuroSCORE and APACHE II model was 89.1%; in the local EuroSCORE (logistic) was 91.89%; and in the local EuroSCORE support vector machines (SVM) was 98.6%. The area under curve for ROC curve, was 0.724 (95% confidence interval [CI]: 0.57–0.88) for logistic EuroSCORE; 0.836 (95% CI: 0.731–0.942) for local EuroSCORE (logistic); 0.978 (95% CI: 0.937–1) for Local EuroSCORE (SVM); and 0.832 (95% CI: 0.723–0.941) for APACHE II model. The HL test showed good calibration for the local EuroSCORE (SVM), APACHE II model and local EuroSCORE (logistic) (P = 0.823, P = 0.748 and P = 0.06 respectively); but there was a significant difference between expected and observed mortality according to EuroSCORE model (P = 0.033).Conclusion:We detected logistic EuroSCORE risk model is not applicable on Iranian patients undergoing CABG surgery.     

冠状动脉旁路移植术后静脉桥再狭窄的基因治疗研究进展

冠状动脉旁路移植术是治疗缺血性心脏病安全、有效的方法.自体大隐静脉是术中最常用的移植血管材料.但是血栓形成、内膜增厚和粥样硬化导致的静脉桥再狭窄严重影响了其通畅率,而且至今尚无有效的治疗药物.分子生物学技术理论的发展为冠状动脉旁路移植术后静脉桥再狭窄的防治提供了新思路,基因治疗静脉桥再狭窄已成为目前研究的热点.本文主要从静脉桥再狭窄防治的目的基因、基因导入方式、基因载体等方面,对静脉桥再狭窄基因治疗的研究进展进行综述.     

“一站式”Hybrid手术治疗冠状动脉多支病变的初步体会

目的 探讨“一站式”Hybrid技术在冠状动脉旁路移植手术中的应用价值及临床近中期疗效.方法 回顾性分析2013年5月-2014年5月在安徽医科大学第一附属医院心脏血管外科一病区接受“一站式”Hybrid手术治疗的7例冠状动脉多支病变患者的资料并随访,手术由同一组医生完成.病例入选标准为:前降支病变较重不适合置入支架、非前降支适合置入支架的冠状动脉多支病变患者.其中男6例、女1例,年龄54 ～ 77岁,SYNTAX评分为27 ～ 36分.7例患者中左主干皆正常,左前降支近中段长段狭窄或多处狭窄大于85％5例,左前降支近中段闭塞性病变2例,回旋支及右冠状动脉均存在1～2处局限性狭窄,均有陈旧性心肌梗死,合并糖尿病3例.左室射血分数55％ ～65％,平均57.13％.结果 手术后无死亡;7例Hybrid患者术后即刻行冠状动脉造影及乳内动脉桥造影显示,吻合口及支架置入处通畅满意.随访1 ～12个月,所有患者心绞痛症状消失.手术后心电图检查无一例新增心肌梗死出现.结论 对于前降支不适合置入支架,非前降支适合置入支架的冠状动脉多支病变患者采用“一站式”Hybrid技术,有较好的临床疗效.个体化的微创手术方法才会使患者真正受益.     

Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

OBJECTIVE

The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.

INTRODUCTION

Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension.

METHODS

Thirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg⁻¹ (Group K) or propofol 0.5 mg.kg⁻¹ (Group P) during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices, stroke work index, and left and right ventricular stroke work indices were obtained before induction of anesthesia; one minute after induction; one, three, five, and ten minutes after intubation; one minute after skin incision; and at one minute after sternotomy.

RESULTS

There were significant changes in the measured and calculated hemodynamic variables when compared to their values before induction. One minute after induction, mean arterial pressure and the systemic vascular resistance index decreased significantly in group P (p<0.01).

CONCLUSION

There were no differences between groups in the consumption of sevoflurane or in the use of additional fentanyl. The combination of ketamine, midazolam, and fentanyl for the induction of anesthesia provided better hemodynamic stability during induction and until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.     

Metal allergy to stainless steel wire after coronary artery bypass grafting

 To our knowledge, this is the first reported case of a manganese metal allergy to stainless steel wire. A 51-year-old man suffered from a refractory pruritic erythematous wheal after the insertion of a stainless steel wire. The patch test showed strong reactions to manganese, one of the constituents of stainless steel wire. After the removal of all stainless steel wires, the symptoms were much improved, except for mild pruritus on his face. Received: March 28, 2002 / Accepted: October 16, 2002 Correspondence to:K. Takazawa     

“一站式” Hybrid手术治疗冠状动脉多支病变的初步体会

目的 探讨 “一站式”Hybrid技术在冠状动脉旁路移植手术中的应用价值及临床近中期疗效。方法 回顾性分析2013年5月—2014年5月在安徽医科大学第一附属医院心脏血管外科一病区接受“一站式” Hybrid手术治疗的7例冠状动脉多支病变患者的资料并随访,手术由同一组医生完成。病例入选标准为:前降支病变较重不适合置入支架、非前降支适合置入支架的冠状动脉多支病变患者。其中男6例、女1例,年龄54~77岁,SYNTAX评分为27~36分。7例患者中左主干皆正常,左前降支近中段长段狭窄或多处狭窄大于85% 5例,左前降支近中段闭塞性病变2例,回旋支及右冠状动脉均存在1~2处局限性狭窄,均有陈旧性心肌梗死,合并糖尿病3例。左室射血分数55%～65%,平均57.13%。结果 手术后无死亡;7例Hybrid患者术后即刻行冠状动脉造影及乳内动脉桥造影显示,吻合口及支架置入处通畅满意。随访1～12个月,所有患者心绞痛症状消失。手术后心电图检查无一例新增心肌梗死出现。结论 对于前降支不适合置入支架,非前降支适合置入支架的冠状动脉多支病变患者采用“一站式”Hybrid技术,有较好的临床疗效。个体化的微创手术方法才会使患者真正受益。     

Perceived control and change in physical functioning after coronary artery bypass grafting: A prospective study

We determined if perceived general and health-related control predicted change in physical functioning after coronary artery bypass grafting (CABG) in 1,038 patients. Control and physical functioning were assessed prior to hospital discharge and physical functioning also was assessed 6 weeks and 6 months later. The repeated measures outcome was modeled using a one-way analysis of covariance with interaction terms for General and Health-Related Control x Time. The sample was primarily composed of Caucasian (94%) men (73%) with a mean age of 65 ± 11 years. Increasing health-related control was an independent predictor of positive change in physical functioning with a stronger effect in women. There was a nearly significant association between increasing general control and positive physical functioning change. Lack of significant interactions with time indicate that higher control has a beneficial impact on physical functioning change at 6 weeks and 6 months. Assessing control may help clinicians predict post-CABG physical functioning and may shape intervention efforts. This study was supported by a grant from the Ethel F. Donaghue Women’s Health Investigator Program, New Haven, Connecticut, and a grant from the Quality Care Research Fund, Aetna Foundation, Hartford, Connecticut. As a doctoral student, Dr. Barry was supported by a National Institute on Aging training grant (T32AG000153). Dr. Barry currently is supported by a National Institute on Aging training grant (T32AG1934), Research Training in Geriatric Clinical Epidemiology.     

Cardiorespiratory simulation for the evaluation of recovery following coronary artery bypass surgery

The interpretation of a patient's status and recovery after coronary artery bypass surgery are difficult because of the complex interaction of many factors and because only relatively limited, non-specific measurements can be made. The objective of this study was to develop a simulation model of basic cardiorespiratory functions which would be useful as a clinical tool to obtain a refined characterization of a patient's cardiopulmonary interactions based on clinical measurements. The simulation was used to generate the same types of measurements obtained on patients. The basic approach was to adjust the simulation parameters so that the simulated measurements agreed with the patient's data. Thirty-five patients who had multiple coronary bypass surgery were simulated. The measurements agreed within clinical significance for a wide range of physiologic states. The resulting values of the simulation parameters provide functional indices of ventilation/perfusion disparity, diffusion gradients, venous-arterial pulmonary shunt, and respiratory dead space. The simulation model also offered a technique for estimating the efficacy of cardiorespiratory support maneuvers in changing blood gas and pH values in the critically ill post-coronary-bypass patient with an acute respiratory distress syndrome.     

Emotional support as a moderator of adjustment and compliance after coronary artery bypass surgery: A longitudinal study

The independent relationships of emotional support and marital status with posthospital adjustments following coronary artery bypass surgery (CABS) were examined longitudinally with an intake sample of 85 male patients. Follow-ups occurred at 1, 4, and 13 months after hospital release. Demographic characteristics (age, education) and cardiac status at the time of surgery (wall motion abnormalities) were controlled statistically. As anticipated, married patients were higher in emotional support throughout the follow-up period than were their unmarried counterparts, and both groups reported decreased support with time. Of more interest, higher support was significantly and independently predictive of better emotional status (lower anxiety, depression), perceived quality of life, and compliance with recommended behaviors (ambulating and not smoking). Support did not predict cardiac health (angina episodes, doctor visits for cardiac problems) during follow-up, however. There was no evidence that marital status, independent of emotional support, was related significantly to outcomes.This research was supported by a grant from the Maxicare Research and Education Foundation and by Academic Senate and biomedical research funds from the University of California, San Diego