2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

The Journal of thoracic and cardiovascular surgery (Impact Factor: 3.41). 01/2012; 143(1):4-34. DOI: 10.1016/j.jtcvs.2011.10.015
Source: PubMed
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine if changing from multidose cefuroxime-based to flucloxacillin (or teicoplanin) and gentamicin-based antibiotic prophylaxis for cardiac surgery was as effective at preventing infections without increasing postoperative renal impairment. Outcomes in consecutive patients from two 18-month periods with the different antibiotic regimes. Group 1 (1725 patients)-cefuroxime 1.5 g at induction and postoperatively. Group 2 (1695 patients)-flucloxacillin (or teicoplanin) and gentamicin at induction, valve procedures received further dose on weaning bypass. Primary end-points: new/worsening renal impairment, surgical site infection (SSI), Clostridium difficile infection (CDI). Multivariate logistic regression and interrupted time series segmented regression analysis were used. Demographics were similar (age, EuroSCORE, gender, preoperative renal impairment). There were fewer wound infections in group 2: SSI 3.2% (group 1) versus 2.7% (group2) (p = NS); sternal infections 2.7% versus 2.0% (p = NS). New or worsening renal impairment was less frequent with gentamicin (4.3% group 1 vs. 3.4% group 2, p = NS). Mean postoperative stay 9.4 days (group 1) versus 8.7 days (group 2) (p = 0.05). Logistic regression identified: diabetes, EuroSCORE associated with increased risk of renal and infective complications; female gender, pre-existing renal impairment associated with increased risk of acute renal impairment; bypass time associated with increased risk of wound infection. There were nine CDIs in group 1 compared with one in group 2 (p = 0.02). The change from multidose cephalosporin prophylaxis to short-course flucloxacillin (or teicoplanin) and gentamicin was not associated with an increase in renal complications, and resulted in significantly fewer CDIs, with no significant change in the incidence of wound infections.
    Journal of Cardiac Surgery 07/2013; · 1.35 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A minimal extracorporeal circulation (MECC) circuit integrates the advances in cardiopulmonary bypass (CPB) technology into a single circuit and is associated with improved short-term outcome. The aim of this study was to prospectively evaluate MECC compared with conventional CPB in facilitating fast-track recovery after elective coronary revascularization procedures. Prospective randomized study. All patients scheduled for elective coronary artery surgery were evaluated, excluding those considered particularly high risk for fast-track failure. The fast-track protocol included careful preoperative patient selection, a fast-track anesthetic technique based on minimal administration of fentanyl, surgery at normothermia, early postoperative extubation in the cardiac recovery unit, and admission to the cardiothoracic ward within the first 24 hours postoperatively. One hundred twenty patients were assigned randomly into 2 groups (60 in each group). Group A included patients who were operated on using the MECC circuit, whereas patients in Group B underwent surgery on conventional CPB. Incidence of fast-track recovery was significantly higher in patients undergoing MECC (25% v 6.7%, p = 0.006). MECC also was recognized as a strong independent predictor of early recovery, with an odds ratio of 3.8 (p = 0.011). Duration of mechanical ventilation and cardiac recovery unit stay were significantly lower in patients undergoing MECC together with the need for blood transfusion, duration of inotropic support, need for an intra-aortic balloon pump, and development of postoperative atrial fibrillation and renal failure. MECC promotes successful early recovery after elective coronary revascularization procedures, even in a nondedicated cardiac intensive care unit setting.
    Journal of cardiothoracic and vascular anesthesia 06/2013; · 1.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Conventional coronary artery bypass grafting (C-CABG) and off-pump CABG (OPCAB) surgery may produce different patients’ outcomes, including the extent of cardiac autonomic (CA) imbalance. The beneficial effects of an exercise-based inpatient programme on heart rate variability (HRV) for C-CABG patients have already been demonstrated by our group. However, there are no studies about the impact of a cardiac rehabilitation (CR) on HRV behaviour after OPCAB. The aim of this study is to compare the influence of both operative techniques on HRV pattern following CR in the postoperative (PO) period. Methods Cardiac autonomic function was evaluated by HRV indices pre- and post-CR in patients undergoing C-CABG (n = 15) and OPCAB (n = 13). All patients participated in a short-term (approximately 5 days) supervised CR programme of early mobilization, consisting of progressive exercises, from active-assistive movements at PO day 1 to climbing flights of stairs at PO day 5. ResultsBoth groups demonstrated a reduction in HRV following surgery. The CR programme promoted improvements in HRV indices at discharge for both groups. The OPCAB group presented with higher HRV values at discharge, compared to the C-CABG group, indicating a better recovery of CA function. Conclusion Our data suggest that patients submitted to OPCAB and an inpatient CR programme present with greater improvement in CA function compared to C-CABG.
    Clinical Physiology and Functional Imaging 12/2013; · 1.33 Impact Factor

Full-text (2 Sources)

Available from
May 29, 2014