Journal of

Background and Aim: Stroke is an important cause of morbidity and mortality in patients undergoing coronary artery bypass (CABG) surgery. There are various mechanisms that can cause prioperative strokes in patients undergoing CABG other than Carotid Artery disease. The goal of this study is to evaluate whether the presence of stenosis internal carotid artery (ICA) influences prioperative stroke and mortality rates in patients subjected to Coronary Artery Bypass Grafting. 

Materials and Methods: After institutional ethical committee review and approval, a retrospective review was undertaken of 1978 bypass procedures with saphenous vein graft performed over a period of four years is conducted. All those who had valve replacement or non-CABG procedure were excluded from this study. Carotid duplex ultrasonography scans were performed as part of preoperative evaluation of these patients. Ultrasound imaging measurement and velocity criteria were taken in to consideration in the estimation of degree of the carotid arteries. The stenosis of ICA was classified as non significant stenosis when there was<60% narrowing of the arterial lumen, and significant stenosis when there was 60%-99% narrowing of the arterial lumen.

Results: prioperative stroke rates were 0.8 %, 46.8% and 90%for groups A, B, and C, respectively. Group A results varied significantly from group's B (P=0.0001) and C (P=0.0001). Statistically significant difference was noted between groups B and C (p=0.0001    ). Prioperative mortality rates for groups A, B, and C, were 1.0 %, 16.7 % and 70 % respectively. The mortality rate for group A was lower than for groups B (P=0.0001) and C (P=0.0001).

Conclusion: The presence of an ICA occlusion increases the morbidity and mortality in patients undergoing CABG.

Background and Aim: Discontinuing aspirin use in patients before coronary artery bypass grafting (CABG) has focused on bleeding risks. The aim of this study was to determind the effect of aspirin use on overall mortality with this procedure.

Materials and Methods: In a retrospective review was under taken of 2,252 consecutive isolated coronary artery bypass grafting (CABG) procedures performed between July 1995 and May 3003 in Tehran, Shriati hospital. Patients who had isolated CABG operations and received aspirin were analyzed and compared to nonusers undergoing similar bypass procedures during the same period. Aspirin use was defined by identification of ingestion within 7 days before the operation.

Results: CABG patients using preoperative aspirin were less likely to experience in hospital hemorrhage compared to nonusers (P=0.0001). Significant difference was seen for transfusion of blood products, and need for reexploration for hemorrhage between patients who did and did not receive aspirin (P=0.0001).
Mortality in multivariate (odds ratio [OR] =0.12, 95%confidence interval [0.05, 0.28] analysis was less to patients using aspirin compared to nonusers (p=0.0001).

Conclusions : Preoperative aspirin use appears to be associated with a decreased risk of mortality in CABG patients with significant increase in hemorrhage, blood product requirements, or related morbidities.

Background and Aim: Females were reported to have significantly lower hematocrit (Hct), which might be the cause of increased need for blood transfusion. The goal of this study is to determine risk factors affecting blood transfusion in patients undergoing coronary artery bypass graft procedure related to gender

Materials and Methods: A cross sectional review of 500 (306 males and 194 females) ASA physical status I or Il patients undergoing bypass procedures with saphenous vein graft performed over a one year period were included in this study. The conducting of anesthesia was standardized. For each patient, we recorded the gender, age, body weight, height, body surface area (BSA), and duration of surgery. Hematocrit levels prior to surgery and the end of surgery were recorded. Packed red blood cell (PRBC) administration and use of fresh frozen plasma (FFP) and platelets were noted. Differences between the data for female and male patients were evaluated using Student's t-test, Chi-square test and using regression analysis.

Results: Approximately 57.2 % (111) female and only 39.9% (121) male patients received PRBCs. On average, females received 1. 6 units of PRBCs intraoperatively and 2. 6 units of PRBCs during the entire hospital stay, while the males received 1.1 units and 1.8 units for similar periods (P=0.0001). When females and males were compared within the same subgroups for age, body surface area (BSA), duration of surgery, and preoperative Hct, etc. ...had a significant correlation with age, postoperative Hct and BSA in females but had a significant correlation with preoperative Hct, preoperative PRBC and duration of surgery in males (P<0.05). Multiple logistic regression analysis showed that the probability of a patient receiving or not receiving PRBC transfusion is significantly influenced by preoperative Hct, postoperative Hct, duration of surgery, preoperative PRBC mass, and gender.

Discussion and Conclusion: Gender is an independent essential determinant of blood transfusion in CABG patients, and may interact with BSA, preoperative Hct, duration of surgery and other factors in determining the probability of transfusion.