Background We aimed to investigate the predictive value of the prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after elective coronary artery bypass grafting (CABG). Methods A total of 336 consecutive patients with normal serum creatinine levels undergoing CABG were enrolled in this retrospective study. AKI was defined as meeting Acute Kidney Injury Network (AKIN) criteria based on the occurrence of creatinine changes within the first 48 h after CABG surgery. The patients were grouped according to whether they developed AKI or not into an AKI (−) and an AKI (+) group. Results AKI developed in 88 (26.2%) of all patients. The PNI was independently predictive of AKI (OR: 0.829, 95% CI: 0.783–0.877, p <  0.001). Moreover, C-reactive protein (CRP), a history of diabetes mellitus, and positive inotropric usage were independent risk factors for AKI in the multivariate logistic regression analysis. The area under the curve (AUC) of the multivariable model, including positive inotrope support, a history of diabetes mellitus, and CRP, was 0.693 (95% CI: 0.626–0.760, p <  0.001) in predicting AKIN. When the PNI was added to the multivariable model, the AUC was 0.819 (95% CI, 0.762–0.865, z = 3.777, difference p = 0.0002). Also, the addition of the PNI to the multivariable model was associated with a significant net reclassification improvement estimated at 88.2% ( p <  0.001) and an integrated discrimination improvement of 0.22 ( p <  0.001). Conclusions Our study demonstrated that decreasing the PNI could be associated with the development of AKI after coronary artery bypass surgery.

Cardiovascular disease is the most common cause of death in adult population in the world. The disease includes numerous problems, many of which are related to a process called atherosclerosis. Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of the arteries. This plaque narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke. There are many risk factors associated with cardio vascular disease (CVD). While some risk factors cannot be changed, such as family history, some of them can be modified with treatment such as abnormal blood lipid and sugar levels, obesity, smoking, and high blood pressure. Research makes it clear that abnormal blood lipid (fat) levels have a strong correlation with the risk of coronary artery disease, heart attack and coronary death. Cholesterol plays detrimental roles in the pathogenesis of atherosclerosis and CVD. In this chapter, we aim to summarize the relationship between blood cholesterol levels and CVD.

A mycotic aortic aneurysm (AA) is a rare and dangerous condition that is associated with substantial morbidity and mortality rates. It is defined as an aortic aneurysm with one or more of the following clinical signs: fever, elevated white blood cell count, positive blood or aneurysmal wall cultures, or purulent operative findings. Of all aortic aneurysms, 0.8% to 3.4% are mycotic.1 Those mycotic AAs that involve visceral arteries can result in disastrous sequelae, such as gangrene of the intestine. Here we present an account of the successful treatment of a mycotic thoracoabdominal aortic aneurysm (TAAA) that was accompanied by celiac artery occlusion. Case ReportIn May 2015, a 60-year-old woman presented with a 2-month history of back pain, which was associated with postprandial nausea and unintended weight loss. Before her admission, her gastric symptoms had led her to undergo esophagogastroduodenoscopy and colonoscopy, the results of which were specific for gastritis, hemorrhoids, and anal fissure. She had a history of hypertension and fibromyalgia and was taking nitrofurantoin for a recent urinary tract infection.Computed tomographic (CT) scans revealed a saccular aneurysm of the thoracoabdominal aorta, together with occlusion of the celiac artery and reconstitution via multiple small collateral arteries (Figs. 1 and 2). Her laboratory values were notable for leukocytosis (white blood cell count, 17 ×10 3 /mL) and a platelet count of 778,000/ mm 3 . Her blood and urine cultures on admission were negative. We chose to perform an open Crawford extent III TAAA repair, with reimplantation of the celiac axis using a prefabricated single-branched graft. Cerebrospinal fluid was drained preoperatively to protect the spinal cord. With the patient under endotracheal general anesthesia, a left thoracoabdominal incision was made through the 8th intercostal space. The left lung was collapsed with a double-lumen endotracheal tube. We divided the diaphragm and exposed the aneurysm (Fig. 3A). After administering heparin, we cross-clamped the mid-descending thoracic aorta. The aneurysm was opened, and the intraluminal thrombus was evacuated. We widely débrided the opened aortic wall, the appearance of which was consistent with infection. After soaking an 18-mm Dacron graft in rifampin (our standard choice of antibiotic when treating mycotic aneurysms), we anastomosed the graft to the affected segment of the aorta in an end-to-end fashion, with the distal anastomosis performed just proximal to the origins of the superior mesenteric artery. After endarterectomy, we sutured (also end-to-end) an 8-mm prefabricated side branch to the celiac artery (Fig. 3B).

A coronary artery aneurysm (CAA) is a focal dilation of a coronary artery to at least 1.5 times its normal diameter. These aneurysms are not common, having an incidence of up to 5% in the cardiac surgical population.1 They more characteristically affect the right coronary artery (RCA) than any single artery in the left coronary system. A giant CAA (>50 mm in diameter) associated with a coronary-cameral fistula (CCF) is particularly rare, for it is observed in only 0.02% of the cardiac surgical population.2,3 The usual sites for a coronary fistulous connection are the right ventricle, right atrium, and pulmonary artery; connection to the superior vena cava (SVC) is highly unusual. We describe the successful treatment of a large RCA aneurysm, which was associated with a CCF that drained into the SVC. Case ReportA 47-year-old man was referred to our service after a right-sided cardiac mass was found incidentally on computed tomography (CT) (Fig. 1) during the evaluation of kidney stones. He was asymptomatic and previously healthy. Coronary angiography showed a giant RCA aneurysm with a heavily tortuous branch that appeared to drain into the SVC (Figs. 2 and 3). The posterior descending artery and posterolateral branch were supplied through the aneurysm from the right coronary system. The left main coronary artery and its branches were normal.The patient underwent elective surgery via a median sternotomy, with the aid of general anesthesia. Operative findings confirmed that the aneurysm was confined to the middle portion of the RCA and had an extremely tortuous branch that drained into the SVC. We cannulated the ascending aorta and both venae cavae, then instituted standard cardiopulmonary bypass (CPB). After cross-clamping the ascending aorta, we stopped the heart by administering cold-blood cardioplegic solution. Myocardial protection was achieved by means of topical cooling and the intermittent antegrade and retrograde administration of cold-blood cardioplegic solution. We opened the aneurysmal sac and oversewed the main inlet and outlet branches of the aneurysm (Fig. 4). The aberrant branch vessel was ligated with pledgeted polypropylene sutures. We performed an aortotomy, evaluated the RCA orifice, and observed that it was of normal size. The main portion of the RCA was ligated proximally, via simple closure, to prevent hidden communication between the high-proximal segment of the RCA and other venous structures. Coronary artery bypass grafting (CABG) was then performed with a saphenous vein graft between the ascending aorta and the distal RCA. The remaining aneurysmal sac was closed with a 3-0 polypropylene running suture. The patient was easily weaned from CPB in sinus rhythm and without inotropic support. He had

Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were successfully repaired by means of a surgical bypass technique in which a Dacron graft was placed between the carotid and brachial arteries. We also discuss our strategy for determining the optimal surgical approach in these patients.