Objective:Recent studies have demonstrated that preoperative statin therapy reduces the incidence of postoperative atrial fibrillation (AF). The objective of this study was to assess the efficacy of statin therapy started in the early postoperative period for the prevention from new-onset AF after isolated coronary artery bypass grafting (CABG).Methods:This prospective and randomized study consisted of 60 consecutive patients who underwent elective isolated CABG. Patients were divided into two groups to examine the influence of statins: those with postoperative statin therapy (statin group, n=30) and those without it (non-statin group, n=30). Patient data were collected and analyzed prospectively. In the statin group, each extubated patient was given 40 mg of atorvastatin per day, starting from an average of 6 hours after the operation.Results:The overall incidence of postoperative AF was 30%. Postoperative AF occurred in 5 patients (16.7%) in the statin group. This was significantly lower compared with 13 patients (43.3%) in the non-statin group (p=0.049). According to the multivariate analysis, postoperative atorvastatin reduced the risk of postoperative AF by 49% [odds ratio (OR) 0.512, 95% confidence interval (CI) 0.005 to 0.517, p=0.012]. Also, age was an independent predictor of postoperative AF (OR 1.299, 95% CI 1.115 to 1.514, p=0.001).Conclusion:Postoperative statin therapy seems to reduce new-onset AF after isolated CABG in our study.

In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

Introduction Elevated hemoglobin A1c levels in patients with diabetes mellitus have been known as a risk factor for acute kidney injury after coronary artery bypass grafting. However, the relationship between hemoglobin A1c levels in non-diabetics and acute kidney injury is under debate. We aimed to investigate the association of preoperative hemoglobin A1c levels with acute kidney injury in non-diabetic patients undergoing isolated coronary artery bypass grafting.Methods202 non-diabetic patients with normal renal function (serum creatinine <1.4 mg/dl) who underwent isolated coronary bypass were analyzed. Hemoglobin A1c level was measured at the baseline examination. Patients were separated into two groups according to preoperative Hemoglobin A1c level. Group 1 consisted of patients with preoperative HbA1c levels of < 5.6% and Group 2 consisted of patients with preoperative HbA1c levels of ≥ 5.6%. Acute kidney injury diagnosis was made by comparing baseline and postoperative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease Improving Global Outcomes (KDIGO) definition.ResultsAcute kidney injury occurred in 19 (10.5%) patients after surgery. The incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2. Elevated baseline hemoglobin A1c level was found to be associated with acute kidney injury (P=0.0001). None of the patients became hemodialysis dependent. The cut off value for acute kidney injury in our group of patients was 5.75%.ConclusionOur findings suggest that, in non-diabetics, elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Prospective randomized studies in larger groups are needed to confirm these results.

IntroductionAtrial fibrillation (AF) after coronary artery bypass grafting (CABG) operation is associated with increased risk of prolonged hospitalisation, health expenses and adverse clinical outcomes.AimTo investigate the relationship of atrial fibrillation after an isolated coronary artery bypass operation with levels of mean platelet volume and C-reactive protein.Material and methodsAmong 1240 patients who underwent operations for isolated coronary artery bypass grafting with cardiopulmonary bypass between January 2007 and May 2014, 1138 (91.8%) patients with preoperative normal sinusal rhythm were enrolled in the study. Patients were assigned to group 1 (n = 294) comprising patients who developed atrial fibrillation in the first 72 postoperative hours or group 2 (n = 844) comprising patients who remained in normal sinusal rhythm in the postoperative period.ResultsThe incidence of postoperative atrial fibrillation was 25.8%. The preoperative mean platelet volume (fl) and C-reactive protein (mg/dl) values in group 1 were 9.1 ±0.5 and 1.1 ±0.9 respectively, while these values were 8.3 ±0.6 and 0.5 ±0.3 respectively in group 2, which was statistically significant (p = 0.0001). Length of stay in the hospital (p = 0.0001) was higher in group 1. The values of mean platelet volume (fl) and mean C-reactive protein (mg/dl) were 9.9 ±0.9 and 30.9 ±3.4 respectively in group 1, while the values of mean platelet volume (fl) and mean C-reactive protein (mg/dl) were 8.8 ±0.6 and 24.9 ±4.8 respectively in group 2 (p = 0.0001 for mean platelet volume, p = 0.0001 for C-reactive protein). The difference between the groups was statistically significant in terms of postoperative neurologic events (p = 0.0001) and hospital mortality (p = 0.001). Increased C-reactive protein and mean platelet volume levels were found to be independent predictors of postoperative atrial fibrillation.ConclusionsIn our study, elevated preoperative mean platelet volume and C-reactive protein levels were associated with development of postoperative atrial fibrillation.

Background The aim of the present study was to investigate the role of inflammatory markers to predict amputation following embolectomy in acute arterial occlusion. Methods A total of 123 patients operated for arterial thromboembolectomy due to acute embolism were included in the study. The patients without an extremity amputation following thromboembolectomy were classified as Group 1 ( n = 91) and the rest were classified as Group 2 ( n = 32). These groups were compared in terms of clinical and demographic characteristics, C-reactive protein, complete blood count parameters, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red cell distribution width. Results The average age was 68.0 ± 11.7 years. The most common thromboembolism localization was femoral artery. When preoperative mean C-reactive protein ( p = 0.0001), mean platelet volume ( p = 0.0001), platelet-lymphocyte ratio ( p = 0.0001), neutrophil-lymphocyte ratio ( p = 0.0001) and red cell distribution width ( p = 0.0001) were compared, a statistically significant difference was observed between groups. In univariate and multivariate regression analysis, higher levels of preoperative C-reactive protein ( p = 0.009) and mean platelet volume ( p = 0.04) were detected as independent risk factors of early extremity amputation. Conclusion We observed that preoperative mean platelet volume and C-reactive protein were predictors of amputation after thromboembolectomy in acute arterial occlusion.

We describe a case of gunshot injury presenting with cardiac tamponade in which a dummy bullet advanced through the aorta and caused embolization in the right renal interlobar artery after passing above the sternoclavicular joint and penetrating into the aorta. Emergency surgery with cardiopulmonary bypass was performed to repair the cardiac tamponade and aortic injury. Postoperatively, a direct abdominal x ray revealed a bullet image, confirmed by an ultrasonography examination that demonstrated the presence of a metal object in the right renal pelvis. The bullet was considered to have reached the kidney via an arterial route and to cause embolization in the distal bed. The procedure was successful, and the patient was discharged on postoperative day 8. In gunshot injuries, if all entrance points are not paired with exit points, the possibility of an organ or extremity embolism caused by the presence of a bullet or shrapnel fragments in circulation should be borne in mind, although such occurrences are rare.

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