Patients undergoing cardiac surgery with preoperative prealbumin levels of ≤ 20 mg/dL have an increased risk for postoperative infections and the need for longer mechanical ventilation. If feasible, nutrition optimization of such patients may be considered prior to cardiac surgery.

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Background: Novel oral anticoagulants (NOAC) have been shown to have comparable risk profiles compared with warfarin. However, data on the use of NOACs in cardiac surgery patients is limited. The aim of this study is to compare postoperative effusion rates in patients who were anticoagulated with NOACs vs warfarin after coronary artery bypass grafting (CABG). Methods: A retrospective review of 2017 patients undergoing isolated CABG from 2014 to 2017 was performed. Of those patients, 246 patients (12.2%) were placed on either a NOAC or warfarin postoperatively. The combined rates of postoperative pericardial and pleural effusions requiring invasive intervention during the index hospitalization and up to 3 months postoperatively were compared between patients who were placed on NOACs vs warfarin. Results: Of the 246 patients placed on oral anticoagulation after isolated CABG, 64 (26.0%) were placed on NOACs, and 182 (74.0%) received warfarin. There were no significant differences in preoperative coagulation profile and use of anticoagulation and antiplatelets preoperatively between the groups. Of the patients anticoagulated with NOACs postoperatively, 17 patients (26.6%) required invasive interventions for effusions compared with 24 patients (13.2%) in the cohort anticoagulated with warfarin (P < 0.014). Of the patients who required interventions for effusions, those on NOACs were more likely to require delayed interventions compared with those on warfarin. Conclusions: Patients receiving NOACs after CABG are at increased risk of developing effusions requiring invasive interventions compared to patients receiving warfarin. This increased risk should be taken into consideration when choosing the appropriate anticoagulation strategy for postoperative patients with CABG.

IntroductionThere is substantial variability in the preoperative use of intraaortic balloon pumps (IABPs) in patients undergoing coronary artery bypass grafting post myocardial infarction. The objective of this study is to determine the effect of preoperative IABPs on postsurgical outcomes in this subset of patients.MethodsFrom 2007 to 2012, 877 patients underwent isolated coronary artery bypass post myocardial infarction. Four hundred and six patients were propensity-score matched based on the likelihood of receiving a preoperative balloon pump. Total blood transfusion requirements, composite in-hospital morbidity and/or mortality end point, total hours in the intensive care unit, and length of hospital stay were compared between the two groups.ResultsNo significant differences in demographics, preoperative risk factors, intraoperative variables or length of hospital stay were found between patients with and without balloon pumps after propensity score matching. Compared to patients without balloon pumps, a higher percentage of patients with preoperative IABPs required transfusions. Patients with preoperative balloon pumps were more likely to have the composite end point of in-hospital morbidity (24.1% versus 12.8%, P <0.004), and increased hours in the intensive care unit (median hours: 69.0 versus 46.0, P <0.013) as compared to patients without balloon pumps.ConclusionsThe use of preoperative IABPs in patients undergoing isolated coronary artery bypass grafting after myocardial infarction is associated with increased transfusion requirements, increased in-hospital morbidity and longer postoperative intensive care unit stay as compared to patients without IABPs.