Effects of pulmonary perfusion during cardiopulmonary bypass on lung functions after cardiac operation

Background Pulmonary artery perfusion during cardiopulmonary bypass (CPB) is a known but rarely used technique in adult cardiac surgery. In this study, we aimed to investigate biochemical and histopathological effects of pulmonary artery perfusion during CPB on lung functions. Methods Between May 2014 and August 2014, all patients (n = 24) who gave informed consent for participating this study with inclusion criteria were included. Patients undergoing isolated coronary artery bypass grafting were sequentially randomized to conventional CPB (control group, n = 12) and conventional CPB with selective pulmonary artery perfusion (study group, n = 12). Lung functions were monitored using PF ratio, alveolar-arterial oxygen gradient, and lactate levels. A small sample tissue from the left lung was excised for histopathologic examination. Immunocytochemistry analysis was performed using anti-rabbit polyclonal vascular endothelial growth factor (VEGF), rabbit polyclonal inducible nitric oxide synthase (i-NOS), and BCL-2 antibodies. Results Postoperative course of the patients were uneventful without any clinical outcome differences in terms of cardiopulmonary complications, ventilation time and hospital stay. Pulmonary perfusion group had significantly better oxygenation values after extubation and at postoperative 24-hour. Electron microscopy examinations revealed better preservation of the alveolar wall integrity with pulmonary perfusion. The intensity of VEGF, i-NOS, and BCL-2 antibody expressions in bronchial epithelial cells were more prominent in the pulmonary perfusion group. Conclusions Pulmonary artery perfusion during aortic cross-clamping provides better oxygenation and preservation of the wall alveolar integrity after coronary artery bypass grafting surgery. This technique can be used as a protective strategy to minimize CPB-induced lung injury in adult cardiac surgery

The Preventive Effects of Posterior Pericardiotomy with Intrapericardial Tube on the Development of Pericardial Effusion, Atrial Fibrillation, and Acute Kidney Injury after Coronary Artery Surgery: A Prospective, Randomized, Controlled Trial

Background Pericardial effusion (PE), atrial fibrillation (AF), and acute kidney injury (AKI) are commonly found after coronary artery surgery. These adverse events may also be interwoven in the postoperative period. In this prospective study, we investigated whether posterior pericardiotomy (PP) with intrapericardial tube positioned along the right atrium (pericardial space intervention) is effective in the prevention of these adverse events

The Fate of Patent Stents in Patients Undergoing Coronary Artery Bypass Grafting

Objectives: Bypassing a patently stented coronary artery has a risk of flow competition, and leaving it ungrafted has a high risk of stent restenosis. This study determines the fate of patently stented coronary arteries bypassed and left ungrafted. Materials and Methods: Patients undergoing isolated coronary artery bypass grafting (CABG) with previous percutaneous coronary intervention (PCI) were retrospectively scanned between January 1, 2015, and January 1, 2020. Patients undergoing surgery with a patently stented coronary artery were identified. Postoperative coronary angiography was performed in 52 of these patients. Results: There were 24 patients whose patently stented coronary artery was bypassed and 28 whose patently stented coronary artery was not bypassed. The median follow-up time was 49 months in the non-bypass group and 53.5 months in the bypass group. Twenty (71.4%) patently stented coronary arteries remained open in the non-bypass group, and 23 (95.8%) vessels were open in the bypass group (p=0.02). The estimated open rate of vessels was 56% in the non-bypass group and 95% in the bypass group at five years (log-rank p=0.01). Major adverse cardiac events were developed in 12 (42.8%) patients in the non-bypass group and 6 (25%) patients in the bypass group. Conclusion: Patients with an open stented vessel that was not bypassed during CABG have a risk of in-stent restenosis and major adverse cardiac events during the mid-and long-term periods. It may not be safe to leave patently stented coronary arteries ungrafted, particularly those with bare metal stents