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BACKGROUND: Coronary Artery Bypass Grafting (CABG) is realised in patients with critical or advanced disease of coronary arteries. There are different pharmacotherapeutic approaches which are used as management, treatment and preventive therapy in cardiovascular disease or related comorbidities. Performing a successful surgery, pharmacotherapy, and increase of bypass patency rate remains a serious challenge. AIM: This study aims to analyse the patient characteristics undergoing CABG and evaluation of their drug utilisation rate and daily dosages in the perioperative period. MATERIAL AND METHODS: Data were collected from 102 patients in the period 2016-2017 and detailed therapeutic prescription and dosages, patient characteristics were analysed before the operation, after the operation and visit after operation in the Clinic of Cardiac surgery-University Clinical Center of Kosovo. RESULTS: Our findings had shown that patients provided to have normal biochemical parameters in the clinic before the operation, and were related to cardiovascular diseases and comorbidities and risk factors with mainly elective intervention. The, however, higher utilisation of cardiovascular drugs such as beta blockers, diuretics, anticoagulants, statins and lower calcium blockers, ACEi, ARBs, hydrochlorothiazide, amiodarone were founded. ARBs, beta blockers, statins, nitrates and nadroparin utilisation decreased after operation and visit after the operation, whereas amiodarone only in the visit after the operation. Diuretics are increased after the operation which decreases in the visit after the operation. Regarding the daily dosage, only metoprolol was increased in the visit after operation (P < 0.001) and visit after operation (P < 0.05) whereas losartan and furosemide were increased (P < 0.01) and (P < 0.05) respectively. CONCLUSION: The study showed that beta blockers, statins, aspirin, nitrates (before the operation), furosemide and spironolactone are the most utilised drugs. However, we found low utilisation rate for ACEi, ARBs, clopidogrel, nadroparin, warfarin, xanthines, amiodarone, calcium blockers. Daily dosages were different compared to before CABG only in metoprolol, losartan, and furosemide.

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The goal of this study was to test the effects of bioactive phenylpropanoid dibenzylbutyrolactone lignan arctigenin (ATG) in vascular tone. Human bypass graft vessel, from a saphenous vein (SV), were set up in organ bath system and contracted with potassium chloride (KCl, 40mM). Two concentration-response curves of noradrenaline (NE) (10nM-100µM) separated with an incubation period of 30min without (Control) or with ATG (3-100µM) were established. Inhibitors of nitric oxide, prostaglandins, K+ related channels or calcium influx were used to delineate the molecular mechanisms beyond ATG effects. To investigate anti-inflammatory actions, SV were treated with 10µM or 100µM ATG and incubated for 18h in the absence or presence of both interleukin-1beta (IL-1ß) and lipopolysaccharide (LPS) to mimic the physiological or inflamed tissue conditions. Proatherogenic and inflammatory mediators Interleukine-1 beta (IL-1ß), Monocyte Chemoattractant Proteine-1 (MCP-1), Tumor Necrosis Factor- α (TNF-α), Interleukine-6 (IL-6), Prostaglandin E2 (PGE2) and Interleukine-8 (IL-8) in the supernatant were measured. ATG significantly decreased vascular contractile response to NE. Moreover, it reduced contractions induced by KCl and cumulative addition of CaCl2. The mediators were significantly increased in inflammatory conditions compared to normal conditions, an effect which was inhibited by ATG (10 and 100µM). ATG reduces contractions in SV and decreases the production of proinflammatory-proatherogenic mediators, setting the stage for further evaluating the effect of ATG in cardiovascular diseases.

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We describe a 62 year old patient who presented with acute anterior ischemia and subsequently developed an iliopsoas hematoma. The patient was treated surgically due to rapid progression and femoral neuropathy, and the iliopsoas muscle rupture was diagnosed intraoperatively. The rupture was related to the external electrical defibrillation the patient had on admission. This was a rare case, and we hope the report would help to raise physicians' awareness regarding this complication and treatment.

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BACKGROUND: Although off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome. METHODS: Between January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded. RESULTS: OPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique. CONCLUSIONS: The patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.

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OBJECTIVE: The level of thyroid hormones is an important factor in determining the outcome of coronary artery bypass patients. Sodium nitroprusside (SNP) is a natural donor of nitric oxide which has been shown to interfere with thyroid hormone synthesis. Whether clinical use of sodium nitroprusside has any effect on thyroid function has not yet been investigated. The aim of this study was to investigate the effects of SNP administration on circulating levels of thyroid hormones. METHODS: One hundred and six consecutive patients who underwent coronary artery bypass grafting operation were prospectively randomized to receive continuous infusions of either SNP or saline limited to the rewarming time of cardiopulmonary bypass (CPB). Free triiodothyronine (T3), total T3, free thyroxine (T4), total T4 and thyroid-stimulating hormone (TSH) levels were analyzed. RESULTS: Free T3, TSH and albumin changes of SNP and control groups were statistically different from each other. In the SNP group, free T3 values stayed in the euthyroid range between CPB and post-CPB periods, the period when SNP was infused, whereas it continued to decline to hypothyroidic levels in the control group. In addition, in the SNP group, an elevation in TSH levels was observed during the CPB period. Postoperatively, an earlier restoration of free T3 and TSH levels was observed in the SNP group when compared to the control group. CONCLUSION: In this study, administration of SNP during cardiopulmonary bypass is shown to regulate free T3 and TSH levels positively.

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OBJECTIVE: We aimed to preserve sternal vascularity better by harvesting only midsegment of the right internal thoracic artery (RITA) than using conventional bilateral internal thoracic artery (BITA) harvesting method, and we evaluated the sternal vascularity with single photon emission computed tomography (SPECT). METHODS: In this prospective clinical randomized investigation, 135 patients undergoing coronary artery bypass surgery (CABG) were divided into three groups: Full-RITA group who had a full length of both ITA as a graft for CABG (n=45); mid-RITA group - a midsegment of RITA and left internal thoracic artery (LITA) (n=45); and non-RITA group who had only LITA (n=45). Before and after surgery, all patients underwent a bone scan with single photon emission computed tomography (SPECT) to evaluate the sternal vascular activity. Comparisons of variables were performed by Chi-square, ANOVA, Tukey HSD and paired t test as appropriate. The Bonferroni correction was applied for multiple comparisons. RESULTS: Postoperative early scans (6.9+/- 0.9 days) showed a reduction of blood flow in the both sides of the sternum compared with the preoperative scans (p<0.001). In full-RITA group, there was no significant difference between left and right hemi-sternum (0.56+/- 0.04 and 0.55+/- 0.02 respectively). However, in mid-RITA and non-RITA groups, right hemi-sternum showed significantly better vascularity than left hemi-sternum in the early postoperative period (p<0.001). Three patients (6.6%) with diabetes mellitus in full-RITA group had sternal infection; one of them was deep sternal infection with dehiscence. In mid-RITA group, there was only two patients who had superficial infection (4.4%) and in non-RITA group there was no infection (p=0.234). CONCLUSION: Mid-RITA harvesting technique can be preferred to preserve sternal vascularity better than conventional technique. By improving new techniques and methods, more acceptable sternal complications could be achieved than full-RITA technique.

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We describe a case of 68-year-old woman which was admitted to our hospital for mitral valve replacement (MVR), in whom acute compression of the vena cava inferior developed after repair of lacerated atrio-caval junction with hemostatic tissue sealant, biologic glue (BioGlue, Cryolife, inc, Kennesaw, Ga). Removal of the BioGlue relieved the unexpected problem.

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Essential thrombocythaemia (ET) is a rare chronic myeloproliferative disease characterised by persistent thrombocytosis. Cerebral, myocardial and peripheral thrombosis are frequently seen complications, but bleeding and venous thrombosis are more rare. Here, a case of essential thrombocythaemia complicated by cerebral and myocardial thrombosis is presented. The patient's platelet count was 680×10(9)/litre on admission. Electrocardiogram showed a slight ST elevation in leads V1 to V4. A coronary angiography was performed and it revealed a severe stenosis of the left anterior descending artery. The patient had a successful off-pump coronary artery bypass grafting surgery. After the operation the platelet count was 390×10(9)/litre. The patient received hydroxyurea and aspirin treatment preoperatively and continued postoperatively. ET is a rare myeloproliferative disease; its complications are also rare, but the occurrence of two life-threatening complications in the same patient is rarer still. Further investigations are needed to determine the risk stratification for patients with ET undergoing cardiac surgery.

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BACKGROUND: Atrial fibrillation (AF) often occurs after coronary artery bypass grafting and can result in increased morbidity and mortality. In the present pilot study, our aim was to investigate whether sodium nitroprusside (SNP), as a nitric oxide donor, can reduce the frequency of post-coronary artery bypass grafting AF. METHODS AND RESULTS: To investigate the effectiveness of SNP in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 100 consecutive patients in whom we performed elective and initial CABG operations. A control group of 50 patients were treated with placebo (dextrose 5% in water), whereas the SNP group (n=50 patients) was treated with SNP (0.5 microg x kg(-1) x min(-1)) during the rewarming period. High-sensitivity C-reactive protein levels were measured before surgery and 5 days postoperatively. All patients were monitored postoperatively with telemetry. Baseline characteristics were similar in both treatment groups. AF occurred in 12% of the SNP group and 27% of the control group. The occurrence of AF was significantly lower in the SNP group (P=0.005). The duration of AF in the SNP group was significantly shorter than that in the control group (5.33+/-1.86 and 7.55+/-1.94 hours, respectively; P=0.023). C-reactive protein levels were higher postoperatively in the control group than in the SNP group (P<0.05). Postoperative AF significantly prolonged postoperative hospital stay (P<0.05). CONCLUSIONS: The incidence of postoperative AF in the SNP group was reduced significantly. Further studies are needed to better delineate the anti-AF profile of SNP.

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The arterial pattern of the upper limb is one of the systems that shows a large number of variations in the adult human body. Most of these variations occur in either the radial or ulnar artery; brachial artery variations are less common. In this case report we describe the anomaly in the formation of the brachial artery system. Appreciation of variations in the upper extremity vasculature is essential to prevent injury, particularly in patients undergoing arteriography.

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Cardiac transplantation has emerged as the therapeutic procedure of choice for patients with end-stage heart disease but the availability of donor organs remains major limiting factor allowing only 1% of the candidates actually become transplant recipients. New therapeutic strategies are under intensive research for patients who do not meet patient selection criteria for transplantation or who suffer from donor organ shortage. Even though there are significant developments in the medical treatment of cardiac failure, the prognosis of this condition continues to be poor. The 20-40% of the candidates for cardiac transplantation die while they are included in the waiting list. Twenty percent mortality has been reported within the first year of transplantation with additional yearly mortality of 5% following the first year. Financial constraints, complications of immunosuppression and functional failure of the transplanted hearts are other limiting factors. This has brought up the necessity to search for alternative surgical treatment methods besides increasing the waiting periods of transplant candidates. The aim of this report is to summarize other currently available therapeutic alternatives for patients with end-stage cardiac disease.

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