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Early Aerobic Exercise after Coronary Artery Bypass Surgery: A Systematic Review
Abstracts
that M. hominis infections had a high mortality rate with predisposing factors being that of poor cardiorespiratory function and aspiration. One should suspect M. hominis when gram staining reveals no bacteria but large amounts of neutrophils.
Reference [1] Mattila PS, et al. Life-threatening Mycoplasma hominis mediastinitis. Clin Infect Dis 1999;29(6):1529–37.
http://dx.doi.org/10.1016/j.hlc.2017.03.036 Rotem Targeted Fibrinogen Transfusion During Emergency Repair of a Type A Dissecting Aneurysm Qaasim Dollie, Dr ∗ , Sylvio Provenzano, Dr, Tony Ghent, Mr, James Winearls, Dr, Andrie Stroebel, Dr Gold Coast University Hospital, Brisbane, QLD, Australia In this abstract, we present a case where rotational thromboelastometry (ROTEM) was used to identify specific clotting deficiencies allowing judicious product usage. A 77-yearold male presented with Type A dissection from the aortic root extending into all the major arch vessels and descending aorta to superior mesenteric artery. There was associated aortic valve incompetence. Bentall’s procedure was thus performed with significant bypass (342 min) and cross clamp time (125 min) and deep hypothermic arrest (17 min). Coming off bypass bleeding was ∼500 mL/min via cardiotomy. Surgical exploration along with traditional methods of packing found no obvious surgically correctable cause to the bleed. The earliest biochemical marker indicative of the coagulopathy on ROTEM was that of a significant decrease in A5 of Fibtem and Extem. Both measured clot firmness 5 minutes after the initiation of clotting and formation of thrombin, influenced by fibrinogen and platelet interaction. With this information, a novel but calculated dose of 10 g of fibrinogen concentrate was given. The results were evident minutes after administration in that the surgical field was dry without a single further stitch and the patient was able to come off bypass safely. From ED to theatre a total 4 units of packed red blood cells, 3 units of platelets, 1000IU of prothrombinex and 10 g of fibrinogen was given. A further 3 units of packed cells were given over the course of his stay. Using ROTEM we were able to identify specific areas of coagulopathy early on and target our therapy with a novel dose of fibrinogen, ultimately minimising blood product usage and their known adverse effects. http://dx.doi.org/10.1016/j.hlc.2017.03.037
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Early Aerobic Exercise after Coronary Artery Bypass Surgery: A Systematic Review Mathew Doyle, Dr ∗ , Praveen Indraratna, Dr, Marc Brown, Mr University of Wollongong, Sydney, NSW, Australia Introduction: Aerobic exercise (AE) reduces morbidity and mortality for patients following coronary artery bypass graft (CABG) surgery. AE is commonly commenced at least 4 weeks following CABG during outpatient cardiac rehabilitation. AE in the early postoperative period may improve aerobic and functional capacity of patients at hospital discharge. The aim of the present study was to assess the outcomes of early AE following CABG. Methods: A systematic review of the literature was conducted for studies published on outcomes of patients undergoing early (commencing within 2 weeks of CABG) aerobic or functional exercise training. Predefined inclusion criteria included studies reporting on early (<4 weeks) outcomes. Results: Seven studies were identified according to selection criteria. A total of 473 patients received early AE interventions. Functional capacity when measured by 6-minute walk test (6MWT) was higher in early AE groups (mean = 404.6m) compared with control groups (mean = 378m). Mean ventilatory anaerobic threshold following early AE was 12.15 ml/kg/min and mean peak oxygen uptake was 18.2 ml/kg/min. Early postoperative outcomes included atrial fibrillation (22.9%), deep sternal wound infection (0%) and mortality (0%). Discussion: This study is the only review of early exercise following CABG identified from the current literature. Our results indicate that early AE can be safely performed in selected patients following uncomplicated CABG, with improvements in functional and aerobic capacity in the early postoperative period. Future studies should focus on patient cohorts at higher risk of acute functional or aerobic deconditioning such as the elderly, obese and those with functional limitations from comorbidities. http://dx.doi.org/10.1016/j.hlc.2017.03.038 Surgical Aortic Valve Replacement in the Elderly Mathew Doyle, Dr ∗ , Stewart Moss, Dr, Claudia Villanueva, Dr, Sheen Peeceeyen, Dr, Con Manganas, Dr St George Public Hospital, Sydney, NSW, Australia Background: Percutaneous aortic valve implantation is increasingly available to elderly patients with aortic stenosis, with potential to reduce hospital length of stay and associated morbidity. We aim to evaluate early clinical outcomes of octogenarians undergoing surgical aortic valve replacement (SAVR) via median sternotomy to determine perioperative
that M. hominis infections had a high mortality rate with predisposing factors being that of poor cardiorespiratory function and aspiration. One should suspect M. hominis when gram staining reveals no bacteria but large amounts of neutrophils.
Reference [1] Mattila PS, et al. Life-threatening Mycoplasma hominis mediastinitis. Clin Infect Dis 1999;29(6):1529–37.
http://dx.doi.org/10.1016/j.hlc.2017.03.036 Rotem Targeted Fibrinogen Transfusion During Emergency Repair of a Type A Dissecting Aneurysm Qaasim Dollie, Dr ∗ , Sylvio Provenzano, Dr, Tony Ghent, Mr, James Winearls, Dr, Andrie Stroebel, Dr Gold Coast University Hospital, Brisbane, QLD, Australia In this abstract, we present a case where rotational thromboelastometry (ROTEM) was used to identify specific clotting deficiencies allowing judicious product usage. A 77-yearold male presented with Type A dissection from the aortic root extending into all the major arch vessels and descending aorta to superior mesenteric artery. There was associated aortic valve incompetence. Bentall’s procedure was thus performed with significant bypass (342 min) and cross clamp time (125 min) and deep hypothermic arrest (17 min). Coming off bypass bleeding was ∼500 mL/min via cardiotomy. Surgical exploration along with traditional methods of packing found no obvious surgically correctable cause to the bleed. The earliest biochemical marker indicative of the coagulopathy on ROTEM was that of a significant decrease in A5 of Fibtem and Extem. Both measured clot firmness 5 minutes after the initiation of clotting and formation of thrombin, influenced by fibrinogen and platelet interaction. With this information, a novel but calculated dose of 10 g of fibrinogen concentrate was given. The results were evident minutes after administration in that the surgical field was dry without a single further stitch and the patient was able to come off bypass safely. From ED to theatre a total 4 units of packed red blood cells, 3 units of platelets, 1000IU of prothrombinex and 10 g of fibrinogen was given. A further 3 units of packed cells were given over the course of his stay. Using ROTEM we were able to identify specific areas of coagulopathy early on and target our therapy with a novel dose of fibrinogen, ultimately minimising blood product usage and their known adverse effects. http://dx.doi.org/10.1016/j.hlc.2017.03.037
S365
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Early Aerobic Exercise after Coronary Artery Bypass Surgery: A Systematic Review Mathew Doyle, Dr ∗ , Praveen Indraratna, Dr, Marc Brown, Mr University of Wollongong, Sydney, NSW, Australia Introduction: Aerobic exercise (AE) reduces morbidity and mortality for patients following coronary artery bypass graft (CABG) surgery. AE is commonly commenced at least 4 weeks following CABG during outpatient cardiac rehabilitation. AE in the early postoperative period may improve aerobic and functional capacity of patients at hospital discharge. The aim of the present study was to assess the outcomes of early AE following CABG. Methods: A systematic review of the literature was conducted for studies published on outcomes of patients undergoing early (commencing within 2 weeks of CABG) aerobic or functional exercise training. Predefined inclusion criteria included studies reporting on early (<4 weeks) outcomes. Results: Seven studies were identified according to selection criteria. A total of 473 patients received early AE interventions. Functional capacity when measured by 6-minute walk test (6MWT) was higher in early AE groups (mean = 404.6m) compared with control groups (mean = 378m). Mean ventilatory anaerobic threshold following early AE was 12.15 ml/kg/min and mean peak oxygen uptake was 18.2 ml/kg/min. Early postoperative outcomes included atrial fibrillation (22.9%), deep sternal wound infection (0%) and mortality (0%). Discussion: This study is the only review of early exercise following CABG identified from the current literature. Our results indicate that early AE can be safely performed in selected patients following uncomplicated CABG, with improvements in functional and aerobic capacity in the early postoperative period. Future studies should focus on patient cohorts at higher risk of acute functional or aerobic deconditioning such as the elderly, obese and those with functional limitations from comorbidities. http://dx.doi.org/10.1016/j.hlc.2017.03.038 Surgical Aortic Valve Replacement in the Elderly Mathew Doyle, Dr ∗ , Stewart Moss, Dr, Claudia Villanueva, Dr, Sheen Peeceeyen, Dr, Con Manganas, Dr St George Public Hospital, Sydney, NSW, Australia Background: Percutaneous aortic valve implantation is increasingly available to elderly patients with aortic stenosis, with potential to reduce hospital length of stay and associated morbidity. We aim to evaluate early clinical outcomes of octogenarians undergoing surgical aortic valve replacement (SAVR) via median sternotomy to determine perioperative