Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting

2015 ◽  
Vol 18 (6) ◽  
pp. 255 ◽  
Author(s):  
Hüseyin Şaşkın ◽  
Çagrı Düzyol ◽  
Kazım Serhan Özcan ◽  
Rezan Aksoy ◽  
Mustafa Idiz
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Platelet To Lymphocyte Ratio ◽  
Artery Bypass Grafting ◽  
Lymphocyte Ratio ◽  
Group 2 ◽  
Group 1

<strong>Objective:</strong> To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation.<br /><strong>Methods:</strong> We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142.<br /><strong>Results:</strong> The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality.<br /><strong>Conclusion:</strong> In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

scholarly journals Evaluation of the Perioperative Period After Off-Pump Coronary Artery Bypass Grafting in Patients with the History of COVID-19

2021 ◽  
pp. 80-85
Author(s):  
Artur V. Gabriyelyan ◽  
Olexander V. Cheveliuk ◽  
Svitlana V. Romanova ◽  
Irina V. Kudlai ◽  
Marchelina S. Gergi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Perioperative Period ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
History Of ◽  
Group 2 ◽  
Group 1

Previous COVID-19 is known to have negative impact on postoperative course of coronary artery bypass grafting. According to a number of foreign sources, mortality after coronary artery bypass grafting is increased in patients with previous COVID-19, and the perioperative period is accompanied by complications such as myocardial infarction, acute renal failure, acute cerebrovascular accident, sternal infection. The aim. To evaluate the features of the perioperative period after coronary artery bypass grafting in patients with the history of COVID-19. Materials and methods. The research is based on the analysis of data from patients who were operated at the Department of Transplantation and Heart Surgery of Shalimov National Institute of Surgery and Transplantation for the last 2 years. The article presents a comparative analysis of the perioperative period after coronary artery bypass grafting on a beating heart in patients with and without the history of COVID-19. Both groups of patients were basically equivalent in demographics, incidence of comorbidities, NYHA functional class, ejection fraction, and the difference between them was insignificant. Severe course of previous COVID-19 was noted only in 2 (10%) patients, moderate in 6 (30%), mild in 12 (60%). The most common finding was 11% to 30% damage of the lung tissue which was observed in 10 (50%) patients. Residual effects of spiral computed tomography immediately before surgery were detected in 6 (30%) cases. Results and discussion. In the early postoperative period there were such complications as: acute myocardial infarc-tion, acute renal failure, acute cerebrovascular accident, sternal infection. In the early postoperative period, patients in both groups developed complications: 14 (70%) patients in group 1 vs. 7 (35%) patients in group 2. Acute renal failure (ARF) was verified by a 1.5–1.9-fold increase in creatinine levels compared to baseline, or ≥0.3 mg/dL (≥26.5 mmol/l), and was significantly more common in the group of patients after COVID-19 (6 [30%]) than in the group of patients with-out the history of COVID-19 (2 [10%]). The incidence of myocardial infarction confirmed by high levels of highly specific troponin T and changes in electrocardiography also prevailed in group 1 with 4 (20%) patients vs. 2 (10%) patients in group 2 (P <0.001). In patients with a history of COVID-19, the duration of ventilation and the need for additional oxygen-ation was higher compared to those who did not have COVID-19. We found that patients with the history of COVID-19 had more abundant exudates in the first 24 hours: 113 ± 36.4 ml in group 1 vs. 78 ± 26.8 ml in group 2 without COVID-19. The length of stay of the patients in the ICU differs in both groups: 78.4 ± 14.1 hours in group 1 and 52.8 ± 12.1 hours in group 2 (P <0.01), and is observed as a consequence of the above-mentioned complications accompanying early postoperative period. Conclusions. Analysis of the results of coronary artery bypass graft surgery in patients with a history of COVID-19 showed that the postoperative course in them is more severe compared with patients who did not have COVID-19. The patients with the history of COVID-19 who are candidates for coronary artery bypass grafting are more likely to devel-op acute myocardial infarction and acute renal failure manifested by increased creatinine in the postoperative period.

Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes following Coronary Artery Bypass Grafting: A Randomized Clinical Trial

2017 ◽  
Vol 66 (06) ◽  
pp. 442-451 ◽  
Author(s):  
Alireza Kamali ◽  
Yazdan Ghandi ◽  
Mehrzad Sharifi
Keyword(s):  
Clinical Trial ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Postoperative Outcomes ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Group 2 ◽  
Group 1

Background The topic of aspirin (acetylsalicylic acid, ASA) use in coronary artery disease patients planned for coronary artery bypass grafting during perioperative period is among the most disputed issues in cardiac surgery. We designed a study to weigh the risks and benefits of continued ASA ingestion until the time of surgery. Methods In this randomized double-blind clinical trial, 206 consecutive patients scheduled for isolated coronary artery bypass surgery (CABG) were randomly stratified into two groups. In group 1 (104 cases), patients were given 80 mg ASA per day until the day of surgery. In group 2 (102 patients), ASA (80 mg per day) was stopped 4 days before the operation. Patients in these two groups were similar in terms of preoperative patient and procedural characteristics. ASA was resumed 24 hours after the surgery in all patients. Results The rates of bleeding and reexploration within 24 hours of surgery were significantly higher in group 1 (824.3 vs. 492.1 mL, p < 0.001 and 5.7% vs. 0, p = 0.0138, respectively). The amount of intra- and postoperative packed red blood cell (PRBC) transfusion was considerably greater in group 1 (mean: 1.83 vs. 0.71 units, p < 0.001). The rate of hospital mortality was similar (1.9% in both the groups, p = 0.98). Patients in group 1 had significantly longer mean hospital stay than patients in group 2 (8 vs. 5.1 days, p < 0.001). Again the time interval between weaning from heart–lung machine and closing the sternum was strikingly longer in group 1 (mean: 32.1 vs. 14.5 minutes, p < 0.001). The incidence of adverse postoperative outcomes such as myocardial infarction, stroke, and renal failure was not statistically different between the two groups. Conclusion Sustained ASA use until the day of surgery in patients planned for elective isolated CABG can result in excessive bleeding, increased rate of reexploration, and need for more PRBC transfusion without any proven beneficial effect on reducing unfavorable postoperative outcomes. Hence, we recommend discontinuing ASA between 3 and 5 days before non-urgent CABG while keeping it on in nonelective circumstances.

scholarly journals The Effects of Aortic Clamping Strategy on Myocardial Protection and Early Postoperative Outcomes During Coronary Artery Bypass Grafting Operations

2021 ◽  
Vol 24 (2) ◽  
pp. E217-E222
Author(s):  
Cüneyt Eris ◽  
Burak Erdolu ◽  
Mesut Engin ◽  
Ahmet Kagan As ◽  
Yasemin Ustundag
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Postoperative Outcomes ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Group 2 ◽  
Group 1

Background: The purpose of the present study was to compare the effects of two different clamping strategies for the construction of the proximal aortocoronary anastomoses on myocardial protection and postoperative outcomes during coronary artery bypass grafting (CABG) operations. Methods: In this retrospective study, we examined prospectively collected data of patients who underwent CABG for a 3-year period. Two hundred consecutive patients, who were diagnosed with triple vessel coronary artery disease (CAD), were selected and divided into two groups. In Group 1 (single clamp) (N = 100), venoaortic proximal anastomoses were performed using a single aortic cross-clamp, while in Group 2 (double clamp) (N = 100), proximal anastomoses were performed by using an aortic side clamp. Operative and postoperative outcomes of the patients were compared between the two groups. The serum levels of myocardial damage biomarkers, creatine phosphokinase-MB (CPK-MB), and high sensitive Troponin (hsTnI) results were measured preoperatively, intraoperatively, and postoperatively (6, 12, 24, and 48 hours). Results: Patient demographics and characteristics were similar between the two groups. In Group 1, cross-clamp duration time (65 min versus 49 min; P = .0001) was longer. However, perfusion time (91 min versus 85 min; P = .61) was similar between the two groups. In Group 2, postoperative CK-MB levels were significantly higher intraoperatively (P = .18), 6 hours (P = .22), 24 hours (P = .001), and 48 hours (P = .001) than in Group 1. HsTnI was only significantly higher in Group 2 versus Group 1 at 24 hours (P = .001) and 48 hours (P = .01) postoperatively. Time of intensive care unit stay, duration of extubation, and length of hospital stay were similar in both groups. Conclusion: The technique used for proximal anastomosis has a significant effect on perioperative results, especially on myocardial protection.

scholarly journals Implication of preoperative glycosylated hemoglobin level on short term outcomes in diabetic patients undergoing coronary artery bypass grafting

2020 ◽  
Vol 7 (11) ◽  
pp. 3590
Author(s):  
Debmalya Saha ◽  
Rakesh Sharma ◽  
Lakshmi Sinha ◽  
Ahmed Ali ◽  
Sunita Chaudhary ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Glycemic Control ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Short Term ◽  
Artery Bypass Grafting ◽  
Group 2 ◽  
Group 1

Background: Diabetes mellitus is one of the significant risk factors for adverse outcomes after coronary artery bypass surgery. The glycosylated haemoglobin i.e. HbA1c is a reliable diagnostic test to know the long-term glycemic status. The objective of the study is to investigate the implication of preoperative HbA1c level on short term outcomes after coronary artery bypass grafting (CABG).Method: Total 218 patients were studied, and the data were collected retrospectively. Patients are distributed into group 1 with HbA1c≤7 (good glycemic control) and group 2 with HbA1c>7 (poor glycemic control). The parameters studied for short term outcomes were revision due to bleeding, duration of mechanical ventilation, cerebrovascular accident (CVA), atrial fibrillation (AF), renal failure requiring dialysis, infective complications like sternal and leg wound infection, mediastinitis, pneumonia, urinary tract infection (UTI), sepsis; length of ICU stay and in-hospital mortality.Result: In comparison to group 1, patients of group 2 showed statistically significant more morbidity in view of short-term outcomes in this study.Conclusion: HbA1c>7 is associated with statistically significant adverse short-term outcomes after CABG.

scholarly journals Features and hospital outcomes of coronary artery bypass grafting in patients with calcification of target coronary arteries

2020 ◽  
Vol 25 (8) ◽  
pp. 3687
Author(s):  
R. S. Akchurin ◽  
A. A. Shiryaev ◽  
V. P. Vasiliev ◽  
D. M. Galyautdinov ◽  
E. E. Vlasova ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Early Results ◽  
Group 2 ◽  
Group 1

Aim. To compare strategy and early results of coronary artery bypass grafting (CABG) in patients with and without calcification of target coronary arteries (TCA).Material and methods. The prospective study analyzed the data of patients (n=462) who underwent elective isolated CABG in 2017-2018 using cardiopulmonary bypass and microsurgery. Two groups were distinguished: group 1 — patients with TCA calcification (n=108), group 2 — patients without TCA calcification (n=354). In cases where the distal coronary artery lesion did not allow standard bypass grafting, additional complex anastomoses were provided. A comparison of intraoperative parameters and early results of CABG was carried out.Results. In groups 1 and 2, the revascularization index did not differ significantly and was 4,5 and 4,3, respectively. The frequency of complex surgical interventions in group 1 was higher: for example, ‘Y’ grafts were used in groups 1 and 2, respectively, in 32% (35/108) and 12% (44/354), p<0,05; sequential anastomoses in 14% (15/108) and 7% (26/354), p<0,05; prolonged patch-angioplasty — in 21% (23/108) and 5% (16/354), p<0,05; anastomoses with arteries <1,5 mm in diameter — in 33% (36/108) and 4% (14/354), p<0,05; coronary endarterectomy in 17% (18/108) and 5% (16/354), p<0,05, respectively. The duration of cardiopulmonary bypass was longer in group 1. At the same time, the hospital clinical results did not differ significantly: mortality was not registered; the frequency of perioperative myocardial infarction was 1,8% (group 1) and 1,1% (group 2); the need for inotropes, frequency of arrhythmia, length of stay in the intensive care unit and hospital were similar; there were no cases of in-hospital angina recurrence.Conclusion. CABG in patients with calcification of TCA is associated with surgical challenges and need for complex adjunct techniques. Nevertheless, complete surgical revascularization is real in these cases, and the hospital results are comparable to those in patients without calcification.

Analysis of Pre-and Post-operative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Acute Kidney Injury After Coronary Artery Bypass Grafting Surgery

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Lonasis Cabuslay ◽  
Lopa AT ◽  
Wibawa SY ◽  
Rauf DE
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Kidney Injury ◽  
High Morbidity ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Lymphocyte Ratio

Acute Kidney Injury (AKI) remains a common complication of post-operative Coronary Artery Bypass Grafting (CABG)related to high morbidity and mortality. Systemic inflammation has been known as a part of the pathogenesis of acute kidneyinjury. This study aimed to analyze the Neutrophil Lymphocyte (N/L) ratio and Platelet Lymphocyte (P/L) ratio in post-operativeAKI. This research was a retrospective study involving 76 patients who underwent CABG surgery in Dr. Wahidin SudirohusodoCentral Hospital, Makassar, between January 2015 and May 2019. The diagnosis of AKI was based on Kidney Disease ImprovingGlobal Outcomes (KDIGO) 2012 criteria. The N/L ratio and P/L ratio were calculated respectively as a neutrophil count ratio tolymphocyte count and platelet count to lymphocyte count. Twenty-five (32.9%) patients developed AKI in the first 48 hours ofthe post-operative period. There was no difference in pre-operative N/L ratio and the P/L ratio between AKI and non-AKIgroups (p > 0.05). Both ratios increased after surgery and were significantly different between the two groups with higher meanratio in non-AKI (16.93±9.16 vs. 21.86±11.13, p=0.040 and 239,24±184,36 vs. 314,49±143,73, p=0.011). Both pre-operativeand post-operative N/L ratio and P/L ratio could not distinguish AKI after CABG.

scholarly journals Retrospective Evaluation of the Pre- and Postoperative Neutrophil-Lymphocyte Ratio as a Predictor of Mortality in Patients Who Underwent Coronary Artery Bypass Grafting

2021 ◽  
Vol 24 (5) ◽  
pp. E814-E820
Author(s):  
Aykut ŞAHIN ◽  
Emrah Sisli
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference

Background: We aimed to investigate the neutrophil-lymphocyte ratio (NLR) as a predictor of mortality in patients, who had undergone on-pump and off-pump coronary artery bypass grafting (CABG). Methods: This retrospective study comprised of 457 patients, who underwent CABG (323 on-pump and 134 off-pump) between January 2014 and October 2019. Preoperative, postoperative (PO) 1st hour, PO 1st day, and PO 5th day neutrophil-lymphocyte ratios were calculated. The patients were compared, according to demographic, laboratory, and clinical data. A receiver operating characteristics curve was applied to estimate a cut-off value of NLR for mortality. Results: The on-pump group was older (P = 0.001), had a lower Euroscore II (P = 0.036), had a higher graft number (P < 0.001), intensive care unit stay (P = 0.001), and all PO NLRs, except preoperative NLR. There were 14 (3.06%) patients with mortality. Overall (N = 457), PO 1st hour (P = 0.001), PO 1st day (P < 0.001), and PO 5th day (P = 0.016) NLRs were considerably higher in patients with mortality. While none of the NLRs revealed a significant difference in the off-pump group, PO 1st hour (P = 0.004) PO 1st day (P < 0.001), and PO 5th day (P = 0.007) NLRs were higher in patients with mortality in the on-pump group. The increase in odds ratio of PO NLR was higher in patients with mortality in the overall group of PO 1st day and in the on-pump group of PO 1st hour and PO 1st day. The best combination of sensitivity and specificity was reached at a cut-off value of 6.4 for PO 1st hour NLR and 31.8 for PO 1st day NLR. Conclusions: As in indicator of inflammatory state, NLR readily can be used as a predictor of mortality. Regardless of the CABG technique used, postoperative 1st hour and postoperative 1st day NLR >6.4 and 31.8, respectively, are highly related to mortality.

Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting

2007 ◽  
Vol 154 (5) ◽  
pp. 995-1002 ◽  
Author(s):  
Patrick H. Gibson ◽  
Bernard L. Croal ◽  
Brian H. Cuthbertson ◽  
Gary R. Small ◽  
Adaeze I. Ifezulike ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

L-Carnitine Supplementation Reduces Short-Term Neutrophil-Lymphocyte Ratio in Patients Undergoing Coronary Artery Bypass Grafting

2015 ◽  
Vol 100 (7-8) ◽  
pp. 1160-1168 ◽  
Author(s):  
Mustafa Aldemir ◽  
Mehmet Bilgehan Pektaş ◽  
Ali İhsan Parlar ◽  
Önder Akcı ◽  
Sadık Volkan Emren ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Neutrophil To Lymphocyte Ratio ◽  
Bypass Grafting ◽  
Carnitine Supplementation ◽  
Artery Bypass Grafting ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

This study aims to investigate whether preoperative L-carnitine supplementation affects the neutrophil-to-lymphocyte ratio (NLR) in patients undergoing coronary artery bypass grafting surgery. The neutrophil-to-lymphocyte ratio is an inflammatory marker that has proven usefulness for predicting postoperative complications in coronary artery bypass surgery. A lot of studies concerning the role of L-carnitine in the immune system have been performed, contradictory results have been reported on its effects on absolute numbers of WBC subtypes. This randomized, double-blinded, placebo-controlled study was conducted among patients scheduled for coronary artery bypass grafting surgery between June 2012 and December 2013 in our cardiovascular surgery clinic. A total of 60 consecutive patients were randomized and divided into 2 groups. The first group received 2 g of L-carnitine in 1000 mL of 0.9% saline solution infused over 24 hours for each of the 3 preoperative days (L-carnitine group, n = 30), or only 1000 mL of 0.9% saline solution for the same time period (placebo group, n = 30). The basal values of leukocyte, neutrophil, lymphocyte counts, and neutrophil to lymphocyte ratio were similar in the 2 groups. After L-carnitine supplementation (just before surgery), leukocyte and neutrophil counts of the L-carnitine group were significantly lower than those of the placebo group (7.7 ± 1.5 versus 9.7 ± 2.6, P &lt; 0.001 and 4.6 ± 1.3 versus 6.5 ± 2.2, P &lt; 0.001). On postoperative day 1, lymphocyte counts were significantly higher in the L-carnitine group (1.1 ± 0.6 versus 0.8 ± 0.9, P &lt; 0.001). Moreover, the increase in NLR was significantly lower in the L-carnitine group at postoperative day 1 (20.7 ± 13.8 versus 10.8 ± 4.1, P &lt; 0.001). Preoperative L-carnitine supplementation may reduce neutrophil-lymphocyte ratio during the early postoperative period of coronary artery bypass grafting surgery.

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