CABG in obese patient: is the degree of obesity the key factor?

Abstract

agree that these changes, along with the numerous neurohumoral vasoactive substances that are released during CPB can have a marked effect on vasomotor tone and vascular permeability after cardiac surgery. These vascular changes can markedly affect the recover of patients after cardiac surgery. Our review of vasomotor dysfunction after cardiac surgery was not intended to be an exhaustive review of the etiology of all pathologic changes that occur during cardiac surgery, but rather briefly review the changes that occur in the regulation of vascular tone only. The pathologic processes leading to altered vascular tone and permeabilty are still relatively poorly understood. While some of the processes listed by Dr Sameh do undoubedly account for some of the vascular alterations observed, there is little definitive proof of this for all cases. It was hoped by many that off bypass (OPCAB) coronary revascularization might lessen the vasomotor changes that occur after cardiac surgery, but this in many cases this has not been observed. Because of a lack of definitive information regarding the cause of vascular changes after cardiac surgery, further investigation will be necessary to fully elucidate the answer. We appreciate your comments.We read with interest the paper by Lindhout and coauthors from Nijemegen, addressing the important issue of the early mortality and morbidity after CABG in obese patients [1]. As the authors correctly stated in their paper, the prevalence of obesity has taken on epidemics form and this is deeply affecting the characteristics of the patients referred for CABG. We congratulate the colleague from The Netherlands for the excellent results they report in these subset of patients, but we would be briefly report our experience and add few comments. We do think, in fact, that the conclusions of their study, although based on correct statistical analysis, do not reflect the true and complete situation. We are undertaking a similar study in our centre (in south Wales) and the breakdown of our population gives a complete different figures. Indeed in our division out of 3275 patients undergoing CABG over the past 7 years, 937 (28.6%) were obese (BMIO30) compared to 18.2% to the population of the study from Nijemegen. Furthermore the mean BMI of our total population was 28.4G4.2 with a median of 28 and a maximum value of 52 (compared to 27.1G3.6; 26.9 and 46.2, respectively, of the study population). It is also remarkable that, in our population, although the number of patient with 'extreme' obesity (BMIO40) [2] was relatively low (0.6% of the total-2.2% of the obese patients), the percentage of patients with 'moderate' obesity (BMIO35!40) was significantly higher (220 patients-5.8% of the total-22% of the obese patients). These findings are similar to those of a recent study from the group of Minneapolis [3]. Probably due to these differences in the patient population, our preliminary results are quite different with a significant increased incidence of prolonged ITU/HDU stay and Ventilation time in ...

The Influence of Obesity on Perioperative Course in High-Risk Patients with Coronary Artery Disease in Cardiac Surgery

“…Автори запропонували концепцію, що як недостатню вагу, так і морбідне ожиріння слід враховувати перед операцією [6][7][8]. У роботах Pasquale Totaro зі співавторами [9,10] наголошено, що населення з різних географічних регіонів може характеризуватися надзвичайно різним середнім значенням ІМТ та проста класифікація ожиріння на основі ІМТ більше ніж 30 кг/м 2 могла, безумовно, вводити в оману при прогнозуванні післяопераційних ускладнень [9]. У популяції пацієнтів автори виявили, що граничний ІМТ = 35 кг/м 2 суттєво корелював з поганим результатом коронарного шунтування (КШ).…”