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Changes in the cardiac muscle electric activity as a result of Coronary Artery Bypass Graft operation

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Grajek M., Krzyminiewski R., Kalawski R., Kulczak M.
Polish Journal of Medical Physics And Engineering
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2008
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vol. 14
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issue 4
227-249
EN
Many bioelectric signals have a complex internal structure that can be a rich source of information on the tissue or cell processes. The structure of such signals can be analysed in detail by applying digital methods of signal processing. Therefore, of substantial use in diagnosis of the coronary arterial disease is the method of digital enhancement of increasing signal resolution ECG (NURSE-ECG), permitting detection of temporary changes in the electric potentials in the cardiac muscle in the process of depolarisation. Thanks to the application of NURSE-ECG it has become possible to detect relatively small changes in the electric activity of particular fragments of the cardiac muscle undetectable by the standard ECG method, caused by ischemia, the effect of a drug or infarct.The aim of this study was to identify and analyse changes in the electric activity of the cardiac muscle as a result of the Coronary Artery Bypass Graft (CABG) operation. In this study the method of NURSE-ECG has been applied in order to identify and analyse changes in the electric activity of the cardiac muscle as a result of the CABG operation. In the study performed in cooperation of the Institute of Physics Adam Mickiewicz University and the Strus Hospital, Cardiac Surgery Ward, 37 patients with advanced coronary arterial disease were asked to participate. The patients were examined prior to the operation, on the day after the operation and two months after the operation and a year after the operation. The ECG recordings were subjected to a numerical procedure of resolution enhancement by a NURSE-ECG program to reveal the tentative changes in the electric potential of the cardiac muscle on its depolarisation. Results of the study have shown that the NURSE ECG method can be applied to monitor changes in the electric activity of the cardiac muscle occurring as a result of CABG operation. One the second day after the operation in the majority of patients (70%) a rapid decrease of the total cardiac muscle activity was observed. The NURSE ECG seems to be a promising supplementary method in medical diagnosis. In particular it can be applied for qualification of patients for CABG operation and for verification of the operation effects.
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Influence of Carbohydrate Metabolism Disturbances on Early Postoperative Complications in Patients after Planned Coronary Artery By-pass Graft Surgery

88%
Greberski K., Bugajski P., Kalawski R., Guzik P., Wysocki H.
Polish Journal of Surgery
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2007
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vol. 79
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issue 7
496-502
EN
Improper glucose metabolism unfavorably influences the peri- and postoperative course, considering patients subjected to coronary artery bypass graft surgery. In case of such patients, one can observe an increased amount of perioperative complications.The aim the study was to determine the correlation between carbohydrate metabolism disturbances and mortality, as well as other postoperative complications in patients subjected to coronary artery bypass graft surgery.Material and methods. The study group comprised 117 patients under 80 years of age qualified for coronary artery bypass graft surgery using extracorporeal circulation and Off-Pump Coronary Artery Bypass (OPCAB). Patient observations were undertaken during hospitalization and six weeks after CABG. The examination was of prospective and observational character. The following end-points were considered:1. Cardiological complications:- death connected with cardiac diseases,- cardiogenic shock (low-output syndrome requiring the use of IABP),- pulmonary edema,- myocardial infarction.2. Other complications:- cerebral stroke,- renal insufficiency,- impaired postoperative wound healing following sternotomy or after saphenous veinConsidering statistical analysis, the following patient groups were distinguished: normal glucose metabolism (NGM), impaired glucose metabolism (IGM) or impaired fasting glucose (IFG), previously diagnosed or new diagnosis of diabetes mellitus (DM). The IGT and IFG groups were described as AGM-noDM (abnormal glucose metabolism- no diabetes mellitus).Results. The total number of postoperative complications, considering particular patient groups was as follows: in the NGM group, postoperative complications were noted in 3 (8.8%) patients (p<0.001) vs 9 (23.7%) in the AGM-noDM group (p<0.001) vs 21 (46.7%) in the DM group (p<0.001).The occurrence of particular complications was as follows: cardiogenic shock requiring intra-aortic balloon contrapulsation in 1 (2.9%) patient with NGM vs 1 (2.6%) with AGM-noDM vs 2 (4.4%) with DM. Acute renal insufficiency was observed in 1 (2.9%) patient with NGM vs 3 (7.9%) with AGM-noDM vs 6 (13.3%) with DM. Coronary by-pass graft impatency was noted in 0 patients with NGM vs 0 with AGM-noDM vs 3 (6.7%) patients with DM (p=0.085). Reoperation due to postoperative bleeding was required in 2 (5.9%) patients with NGM vs 4 (10.5%) with AGM-noDM vs 4 (8.9%) with DM. Postoperative cerebral stroke was observed in 0 patients with NGM vs 1 (2.6%) with AGM-noDM vs 2 (4.4%) with DM. Impaired sternotomy wound healing concerned 0 patients with NGM vs 2 (5.9%) with AGM-noDM vs 1 (2.2%) with DM. Impaired saphenous vein wound healing was observed in 0 patients with NGM vs 2 (5.3%) with AGM-noDM vs 23 (51.1%) with DM (p<0.001).Pulmonary edema was observed in 0 patients with NGM vs 1 (2.6%) with AGM-noDM vs 0 with DM. Death did not ocuured in cases of patients with NGM vs 1 (2.6%) with AGM-noDM vs 3 (6.7%) with DM.Conclusions. Postoperative complications occurred more frequently in patients with carbohydrate metabolism disturbances, especially diabetes mellitus, subjected to planned coronary artery bypass graft surgery.
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