Whenever possible, coronary bypass grafting should be delayed for at least 5 days in patients who received a high contrast dose, especially if they also have preoperative reduced renal function.

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Background Circulating endothelial progenitor cells (EPCs) are recruited from the blood system to sites of ischemia and endothelial damage, where they contribute to the repair and development of blood vessels. Since numerous eicosanoids including leukotrienes (LTs) and hydroxyeicosatetraenoic acids (HETEs) have been shown to exert potent pro-inflammatory activities, we examined their levels in chronic diabetic patients with severe cardiac ischemia in conjunction with the level and function of EPCs. Results Lipidomic analysis revealed a diabetes-specific increase (p<0.05) in inflammatory and angiogenic eicosanoids including the 5-lipoxygenase-derived LTB4 (4.11±1.17 vs 0.96±0.27 ng/ml), the lipoxygenase/CYP-derived 12-HETE (117.08±35.05 vs 24.34±10.03 ng/ml), 12-HETrE (17.56±4.43 vs 4.15±2.07 ng/ml), and the CYP-derived 20-HETE (0.32±0.04 vs 0.06±0.05 ng/ml) the level of which correlated with BMI (p=0.0027). In contrast, levels of the CYP-derived EETs were not significantly (p= 0.36) different between these two groups. EPC levels and their colony forming units were lower (p<0.05) with a reduced viability in diabetic patients compared with non-diabetics. EPC function (Colony-Forming Units (CFUs) and MTT assay) also negatively correlated with the circulating levels of HgA1C. Conclusion This study demonstrates a close association between elevated levels of highly pro-inflammatory eicosonoids, diabetes and EPC dysfunction in patients with cardiac ischemia, indicating that chronic inflammation impact negatively on EPC function and angiogenic capacity in diabetes.

Patients on dialysis have a high risk of perioperative mortality and poor long-term survival rates. Mortality is higher and survival is worse after combined CABG and valve-related procedures or multiple valve surgery than after isolated CABG and AVR.

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The similar reactivity and integrity of the radial artery in both techniques should encourage the less invasive endoscopic approach.

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