text:
Coronary Artery Bypass Grafting
... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...
Coronary Artery Bypass Surgery
... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...
Objective and Design The soluble urokinase plasminogen activator receptor (suPAR) has been recently recognized as a potential biological marker of various disease states, but the impact of a major surgical intervention on the suPAR level has not yet been established. The aim of our study was to investigate if the induction of a systemic inflammatory reaction in response to cardiopulmonary bypass would be accompanied by an increase in the plasma suPAR level. Methods and Subjects Patients undergoing coronary artery bypass grafting under cardiopulmonary bypass (CPB) were added. Based on the baseline suPAR level, patients were divided into group 1 (suPAR within normal range) or group 2 (suPAR above range). Blood was collected before the induction of anesthesia and 6 and 24 hours after surgery. Plasma suPAR, IL-6, IL-8, TNF-?, troponin I, NT-proBNP, and NGAL were quantified to assess the impact of surgical trauma on these markers. Results The baseline suPAR level was within the normal range in 31 patients (3.3 ng/mL), and elevated in 29 (5.1 ng/mL) (p<0.001). Baseline mediators of systemic inflammatory reaction concentrations (IL-6, TNF-?, and IL-8) and organ injury indices (troponin I, NT-proBNP, and NGAL) were low and increased after surgery in all patients (p<0.05). The surgery did not cause significant changes in the suPAR level either at 6 or 24 hours after, however the difference between groups observed at baseline remained substantial during the postoperative period. Conclusions There was no change in the suPAR level observed in patients subjected to elective cardiac coronary artery bypass surgery and CPB, despite activation of a systemic inflammatory reaction. PMID:24911522
Gozdzik, Waldemar; Adamik, Barbara; Gozdzik, Anna; Rachwalik, Maciej; Kustrzycki, Wojciech; K�bler, Andrzej
Who Needs Coronary Artery Bypass Grafting?
... from the NHLBI on Twitter. Who Needs Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... Artery Bypass Grafting, visit www.clinicaltrials.gov . Coronary Artery Bypass Grafting in the News November 18, 2014 ...
What Is Coronary Artery Bypass Grafting (CABG)?
... Medical Illustrations: Jill Rhead, MA What is Coronary Artery Bypass Grafting (CABG)? What Can Happen When Blockages ... Condition be Like After CABG? WHAT IS CORONARY ARTERY BYPASS GRAFTING (CABG)? Coronary artery bypass grafting or " ...
Relative effectiveness of moderate versus more aggressive lipid lowering, and of low dose anticoagulation versus placebo, in delaying saphenous vein coronary bypass graft atherosclerosis and preventing occlusion of saphenous grafts of patients with saphenous vein coronary bypass ...
Types of Coronary Artery Bypass Grafting
... shocks are used to restart the heart. Off-Pump Coronary Artery Bypass Grafting This type of CABG ... heart-lung bypass machine isn't used. Off-pump CABG sometimes is called beating heart bypass grafting. ...
... procedures performed each year in the United States. Arteries can become clogged over time by the buildup ... bypass" around a section of clogged or diseased artery. The surgery involves using a section of blood ...
What to Expect during Coronary Artery Bypass Grafting
... NHLBI on Twitter. What To Expect During Coronary Artery Bypass Grafting Coronary artery bypass grafting (CABG) requires ... surgery to newer, less-invasive methods. Traditional Coronary Artery Bypass Grafting This type of surgery usually lasts ...
Fibrin Adhesive: Clinical Application in Coronary Artery Bypass Graft Surgery
Fibrin adhesive was used 72 times in a group of 67 patients undergoing elective coronary artery bypass graft surgery. The indications were prophylactic sealing of potential sources of bleeding, topical hemostasis (control of bleeding sites dangerous or difficult to suture), and fixation of the graft in the optimal position. The method of glue application under varying circumstances is described and the results are reported. This experience suggests that in some cases the glue expedites the operation and makes it safer. We conclude that the fibrin sealing represents a valid aid in coronary artery bypass graft surgery. PMID:15227018
Fundar�, Pino; Velardi, Antonio R.; Santoli, Carmine
Neuropsychological disorders after coronary bypass surgery.
OBJECTIVES: A prospective assessment of neuropsychological impairment in the early postoperative stage after coronary bypass surgery. METHODS: Seventy patients undergoing elective coronary bypass surgery (CABG) were investigated preoperatively, two to three and five to nine days postoperatively with a comprehensive neuropsychological assessment including orientation, word fluency, naming, arithmetic, memory, and visuoconstructive tasks. RESULTS: Patients exhibited significant early postoperative impairment affecting all tasks but naming. Except for the orientation measurement, most patients recovered by the fifth to ninth postoperative day. Only six patients had delirium according to DSM III-R criteria on the second or third postoperative day. Cluster analysis of neuropsychological data obtained on the second to third postoperative day identified 10 patients who were cognitively compromised. As a group, these patients had required a greater number of defibrillations and exhibited lower cardiac indices postoperatively. Preoperatively, patients at risk for postoperative dysfunction were characterised by lower verbal memory, word fluency, and clock orientation scores. CONCLUSIONS: Simple preoperative neuropsychological assessment may be helpful and clinically applicable in identifying patients at risk for postoperative cognitive dysfunction and may contribute to improve postoperative management aiming at the prevention of delirium or other transient neuropsychological disorders. Images PMID:9219757
Walzer, T; Herrmann, M; Wallesch, C W
What Are the Risks of Coronary Artery Bypass Grafting?
... on Twitter. What Are the Risks of Coronary Artery Bypass Grafting? As with any type of surgery, ... Artery Bypass Grafting, visit www.clinicaltrials.gov . Coronary Artery Bypass Grafting in the News November 18, 2014 ...
Economics of coronary artery bypass grafting
To decide whether the number of operations for coronary artery bypass grafting should be increased, maintained at the present levels, or decreased we need to know how cost effective they are relative to other claimants on the resources of the National Health Service. For this purpose effectiveness is taken to be the effect on life expectancy adjusted for the quality
Alan Williams
Although early tracheal extubation in cardiac anesthesia is safe and cost beneficial, questions still remain regarding how early after cardiac surgery patients should be trache- ally extubated (TE). Our objective was to determine the effects on resource use if patients scheduled for coronary artery bypass grafting have TE in the operating room (OR). We studied 100 consecutive patients undergoing elective
KENNETH J. TUMAN; Felix R. Montes; Sandra I. Sanchez; Juan C. Giraldo; Jose D. Rincon; Ismael E. Rincon; Maria V. Vanegas; Hernan Charris
Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. In this study we examined the effect of surgery on atrial elec- trophysiology as measured by P-wave characteristics and to determine the potential predictive value of P-wave characteristics on the incidences of postopera- tive AF in patients undergoing CABG surgery. Patients undergoing elective CABG surgery were
Joby Chandy; Toshiko Nakai; Randall J. Lee; Wayne H. Bellows; Samir Dzankic; Jacqueline M. Leung
Coronary stent management in elective genitourinary surgery.
What's known on the subject? and What does the study add? Withdrawal of dual antiplatelet therapy before the recommended, 12 months for drug-eluting stents and 1 month for bare-metal stents increases the rate of major adverse coronary events and mortality. However, in those undergoing surgery the risk of bleeding is increased substantially for those on antiplatelet agents. Successful management in patients with coronary stents who must undergo elective or non-elective urological surgery should be a multidisciplinary decision. This article reviews the literature and recommends a protocol for clinical management of patients undergoing urological procedures after coronary stent placement. To review the literature on coronary stents and genitourinary surgery and provide a protocol for perioperative. The keywords, 'elective surgery', 'aspirin', 'clopidogrel', 'guidelines for percutaneous coronary intervention', and 'antiplatelet therapy after coronary stent placement' were used to search PubMed for any relevant articles relating to coronary stents. Recommendations were made based on the whether the procedures patients were exposed to placed them at low-, moderate- or high-bleeding risk based on the extent of the procedure. All elective procedures should be delayed for 1 month after bare-metal stent placement and 1 year after drug-eluting stent placement. In patients classified as low risk (endoscopy and laser prostatectomy), aspirin should be continued throughout the perioperative period and dual antiplatelet therapy should continue 24-48 h postoperatively, if there is no concern for active bleeding. In those classified as moderate risk (scrotal procedures, transurethral resection of bladder tumours, transurethral resection of the prostate, urinary sphincter placement) dual antiplatelet therapy should be discontinued 5-7 days before the procedure and continued within 7 days after procedure, if there is no concern for active bleeding, in consultation with cardiology. In high-risk procedures (cystectomy, nephrectomy, prostatectomy, penile prosthesis placement) dual antiplatelet therapy should be discontinued 10 days before the procedure and continued postoperatively within 7-10 days of the procedure, when there is no longer a concern for active bleeding with the assistance of a cardiologist. Coronary artery disease is becoming more prominent in our society, increasing the use of coronary stents and antiplatelet agents. With the proposed protocol, it is safe to proceed with surgical intervention in those that have adequate stent endothelialisation. PMID:22192977
Gupta, Angela D; Streiff, Michael; Resar, Jon; Schoenberg, Mark
Coronary Artery Bypass Graft Surgery (Beyond the Basics)
... article will be updated as needed on our web site ( www.uptodate.com/patients ). Related topics for ... 360:961. GRAPHICS Plaque formation Graphic 78702 Version 3.0 Coronary artery bypass graft surgery During coronary artery ...
Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass
Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution. PMID:20592988
Ogus, Temucin Noyan; Erdim, Filiz; Selimoglu, Ozer; Tekiner, Fatih; Ugurlucan, Murat
BACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS We randomly assigned 1800 patients with three-vessel or left
Patrick W. Serruys; Marie-Claude Morice; A. Pieter Kappetein; Antonio Colombo; David R. Holmes; Michael J. Mack; E. Stahle; Ted E. Feldman; Marcel van den Brand; Eric J. Bass; Nic Van Dyck; K. Leadly; Keith D. Dawkins; Friedrich W. Mohr
Objective: Cardiopulmonary bypass and global cardiac arrest enable safe coronary artery bypass grafting but have adverse effects. In off-pump coronary bypass grafting, invasiveness is reduced, but anastomosis suturing is jeopardized by cardiac motion. Therefore the key to successful off-pump coronary bypass grafting is effective local cardiac wall stabilization. Methods: We prospectively assessed the safety and efficacy of the Octopus tissue
Erik W. L. Jansen; Cornelius Borst; Jaap R. Lahpor; Paul F. Gr�ndeman; Frank D. Eefting; Arno Nierich; Etienne O. Robles de Medina; Johan J. Bred�e
Coronary bypass using bilateral internal mammary arteries in an achondroplast.
Coronary bypass grafting for ischemic heart disease in achondroplastic dwarfs is very rare. Shortage of veins and inadequate vein quality may cause difficulties during surgery. Only 2 cases of coronary bypass surgery in an achondroplastic dwarf, in which the left internal mammary artery and vein grafts were used, have been reported. We describe the case of a 55-year-old male achondroplastic dwarf who had triple-vessel coronary disease and underwent successful coronary bypass surgery using one saphenous vein graft and bilateral internal mammary artery grafts. The anatomic and surgical challenges in achondroplasia are highlighted. PMID:24887865
Alassal, Mohamed Abdulwahab; Youssef, Mostafa; Koudieh, Mohammed
Cerebral dysfunction after coronary artery bypass surgery.
Cerebral dysfunction after cardiac surgery remains a devastating complication and is growing in importance with our aging populations. Neurological complications following cardiac surgery can be classified broadly as stroke, encephalopathy (including delirium), or postoperative cognitive dysfunction (POCD). These etiologies are caused primary by cerebral emboli, hypoperfusion, or inflammation that has largely been attributed to the use of cardiopulmonary bypass. Preventative operative strategies, such as off-pump coronary artery bypass grafting (CABG), can potentially reduce the incidence of postoperative neurological complications by avoiding manipulation of the ascending aorta. Although off-pump CABG is associated with reduced risk of stroke, there are no convincing differences in POCD between off-pump and on-pump CABG. Recently, the focus of postoperative neurological research has shifted from managing cardiopulmonary bypass to patient-related factors. Identifying changes in brains of aged individuals undergoing cardiac surgery may improve strategies for preventing cerebral dysfunction. Advanced age is associated with more undiagnosed cerebrovascular disease and is a major risk factor for stroke and POCD following cardiac surgery. Preoperative cerebrovascular evaluation and adaptation of surgical strategies will provide preventative approaches for cerebral dysfunction after CABG. This review focuses on recent findings of the relationship between perioperative stress and underlying fragility of the brain in cardiac surgical patients. PMID:23982856
Goto, Tomoko; Maekawa, Kengo
Acute complications of elective coronary angioplasty: a review of 500 consecutive procedures.
In 500 consecutive procedures of elective coronary angioplasty attempted at a centre with a primary success of 86%, one or more major acute complications occurred in 34 cases (6.8%). Twenty four patients (4.8%) sustained an acute myocardial infarction (in six this was despite emergency coronary artery bypass surgery) and two patients (0.4%) had emergency coronary bypass without myocardial infarction. Ventricular fibrillation was a complication without sequelae in five (1.0%) patients; one (0.2%) patient died because of refractory ventricular fibrillation and ensuing electromechanical dissociation. "Benign" coronary artery rupture occurred in one (0.2%) patient, and one (0.2%) patient had elective coronary surgery to retrieve the tip of a fractured guide wire after an otherwise successful angioplasty. Despite a low mortality, coronary angioplasty is associated with major complications in about one of 14 procedures; the complication is usually acute myocardial infarction caused by occlusion of the vessel. Images Fig 1 Fig 2 PMID:2963656
Steffenino, G; Meier, B; Finci, L; Velebit, V; von Segesser, L; Faidutti, B; Rutishauser, W
[Concomitant surgery--coronary artery bypass and pulmonary lobectomy].
Coronary artery disease amenable to percutaneous interventions or coronary artery bypass grafting, and resectable lung cancer are major causes of morbidity and mortality. We present our experience in the treatment of 3 patients (men aged 64 and 66 and a woman of 77) who each had significant coronary artery disease and a resectable lung tumor. They underwent combined coronary artery bypass grafting and pulmonary lobectomy. We conclude from our experience and review of the literature that concomitant surgery in such cases is safe and effective, decreases suffering, and decreases the cost of 2 separate invasive procedures. PMID:10883246
Korach, A; Izhar, U; Rudis, E; Elami, A
Robotically assisted totally endoscopic coronary artery bypass surgery
Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the �best of both worlds� from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations. PMID:24251021
Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi
Surgical results of video-assisted minimally invasive direct coronary artery bypass
Background. A video-assisted minimally invasive direct coronary artery bypass procedure is defined as a combination of video thoracoscopic internal mammary artery harvest and direct coronary bypass grafting through a minithoracotomy without cardiopulmonary bypass. We reviewed our experience with this procedure and examined its efficacy.Methods. Since November 1995, 110 patients have undergone a minimally invasive direct coronary artery bypass procedure in
Kagami Miyaji; Randall K Wolf; John B Flege Jr
Coronary artery bypass grafting and concomitant excision of chest wall chondrosarcoma
Coexistence of coronary artery disease and cancer with both requiring surgical treatment at the same time is rare. A 52 year male undergoing elective coronary artery bypass grafting was incidentally discovered to have a large soft tissue mass of variable consistency with cartilaginous elements arising from the right costal margin and adjoining ribs by a broad attachment and protruding into right pleural cavity. Frozen section suggested it to be either a chondrosarcoma or a teratoma. A wide excision of the mass with the adjoining muscle and periosteum along with quadruple coronary artery bypass grafting was done. This report is unusual on account of a) being the first reported case in world literature of concomitant excision of chondrosarcoma and coronary artery bypass grafting and b) the conservative management of the incidentally discovered chondrosarcoma by wide excision rather than chest wall resection with no local recurrence to date. Pathology of chondrosarcoma, in particular, and various management strategies when coronary artery disease and cancer coexist, in general, is discussed. PMID:19226473
Kaul, Pankaj; Duthie, David JR; Ganti, Somsekhar; Ramnath, Radhika
Successful management of refractory lethal coronary spasm after off-pump coronary bypass grafting.
Coronary artery spasm after coronary artery bypass grafting is a rare cause of acute myocardial infarction. A 68-year-old man who successfully tolerated off-pump coronary artery bypass grafting had a life-threatening spasm at 16 hours postoperatively. Emergent coronary angiography was performed and demonstrated whole vessel spasm of the bilateral coronary arteries and completely patent grafts. Several transcatheter intracoronary injections of vasodilators failed to relieve the spasm completely. After observation in ICU for 4 days with intra-aortic balloon pumping and a high dose of catecholamine, cardiac function was re-established and the patient recovered. PMID:22190422
Hosoba, Soh; Suzuki, Tomoaki; Takashima, Noriyuki; Kinoshita, Takeshi; Kuryanagi, Satoshi; Nota, Hiromitsu; Asai, Tohru
Refractory vascular spasm associated with coronary bypass grafting.
Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management. PMID:25346903
Kim, Young Sam; Yoon, Yong Han; Kim, Jeoung Taek; Shinn, Helen Ki; Woo, Seong Ill; Baek, Wan Ki
Conduits for Coronary Bypass: Internal Thoracic Artery
This second report in the series on coronary artery bypass presents the authors experience and personal views on the internal thoracic artery (ITA) which date to 1966. There has been a very gradual evolution in the acceptance of this conduit which was initially compared with the saphenous vein and viewed as an improbable alternative to it. As is common with concepts and techniques which are 'outside the box' there was skepticism and criticism of this new conduit which was more difficult and time consuming to harvest for the surgeon who had to do it all. It was viewed as small, fragile, spastic and its flow capacity was questioned. Only a few surgeons employed it because of these issues and some of them would frequently graft it to the diagonal artery as it was thought not to supply adequate flow for the left anterior descending unless it was small. After a decade, angiographic data revealed superior patency to vein grafts. Even this evidence and survival benefit reported a few years later did not convince many surgeons that their concerns about limitations justified its use. Thus widespread adaption of the ITA as the conduit of choice for the anterior descending required another decade and bilateral use is only now expanding to more than 5% of patients in the US and somewhat faster in other countries. PMID:23275918
Early neurological complications of coronary artery bypass surgery.
A prospective study of 312 patients undergoing elective coronary artery bypass surgery was undertaken to determine the incidence, severity, and functional impact of postoperative neurological complications. Detailed evaluation of the patients showed that neurological complications after surgery were common, occurring in 191 of the 312 patients (61%). Although such a high proportion of the total developed detectable changes, serious neurological morbidity was rare. Neurological disorders resulted in death in only one patient (0.3%) and severe disability in only four (1.3%). Forty eight patients were mildly disabled during the early postoperative period, and the remaining 138 with neurological signs had no serious functional disability. The postoperative neurological disorders detected included one death from cerebral hypoxic damage. Prolonged depression of conscious level was observed in 10 patients (3%) and definite stroke in 15 (5%); 78 (25%) developed ophthalmological abnormalities and 123 (39%) primitive reflexes; postoperative psychosis was observed in four (1%); and 37 (12%) developed disorders of the peripheral nervous system. The incidence of serious neurological problems such as fatal cerebral damage, stroke, and brachial plexopathy is in accordance with experience elsewhere. Lesser abnormalities, whose detection required detailed neurological examination, were much commoner than expected from previous reports. Images p1387-a PMID:2998539
Shaw, P J; Bates, D; Cartlidge, N E; Heaviside, D; Julian, D G; Shaw, D A
The effects on blood flows of coronary artery by-pass grafts during intra-aortic balloon pumping.
The internal thoracic artery (ITA), as well as aorto-coronary by-pass grafts, has been used for widely coronary artery by-pass grafting. Intra-aortic balloon pumping (IABP) is the first choice for left ventricular support when low output syndrome occurs during coronary artery by-pass surgery. However, the effect of diastolic augmentation by IABP may vary to the type of grafts. Graft flow with and without IABP support were measured in six patients undergoing elective coronary artery bypass surgery requiring IABP at Kanazawa National Hospital. The patients ranged in age from 59 to 67 years, with a mean age of 63 years, and included one woman and five men. In all cases, the left ITA was dissected from the thoracic wall as pedicle, and anastomosed in situ to the left anterior descending artery. Saphenous vein grafts (SVGs) were used for aortocoronary by-pass to the obtuse marginal branches, the first diagonal branches, the left circumflex branches, and/or the right coronary artery. Blood flow in 6 ITAs, 11 SVGs to the left coronary artery systems, and three SVGs to the right coronary artery was measured by ultrasound transit-time flowmeter simultaneously with the electrocardiogram. Blood flows in ITA grafts and SVGs were measured during IABP assist and unassisting under hemodynamically stable conditions after discontinuing cardiopulmonary by-pass. The systolic and diastolic flows of each graft were measured using the peak of the R wave and the end of T wave on the electrocardiogram as the references for systole. Systolic flow during IABP were similar to unassisted flow in both ITA and SVGs.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7775565
Tedoriya, T; Akemoto, K; Imai, T; Ueyama, T; Kawasuji, M; Watanabe, Y
Predictors of low cardiac output syndrome after coronary artery bypass
The purpose of this study was to identify patients at risk for the development of low cardiac output syndrome after coronary artery bypass. Low cardiac output syndrome was defined as the need for postoperative intraaortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit to maintain the systolic blood pressure greater than 90 mm
Vivek Rao; Joan Ivanov; Richard D. Weisel; John S. Ikonomidis; George T. Christakis; Tirone E. David
Relationshi?p between atrial fibrillation and coronary bypass surgery
Objective: Atrial fibrillation (AF) is the most common arrhythmia seen after coronary artery surgery. The purpose this study was to determine incidence of AF that develops after coronary surgery and the factors affecting its development. Methods: Four hundred and forty eight patients who had coronary bypass surgery between February 2007 and September 2011 in the Cardiovascular Surgery Clinic were included in the study. Patients with history of chronic renal failure, redo coronary bypass surgery, valvular disease, thyroid disease, ventricular aneurysm and treatment with beta-blockers were excluded from the study of EF. Results: Two hundred and ninety nine patients were male and 149 were female and their age varied between 38 and 85 and their mean age was 61�5. Surgery was performed on beating heart on 178 patients and the others were operated with cardiopulmonary bypass (CPB). Advanced age, male sex and history of hypertension was more in AF developed patient group. There was no difference between AF developed group and the other group in terms of diameter of left atrium, ejection fraction (EF), CPB time and cross clamp time. Conclusion: Advanced age, male sex, hypertension and prolonged P-wave duration are the factors that are associated with AF after coronary surgery. Avoidance of CPB does not decrease AF development. PMID:24948993
Ozcan, Sedat
Management of early postoperative coronary artery bypass graft failure
Perioperative graft failure following coronary artery bypass grafting (CABG) may result in acute myocardial ischaemia. Whether acute percutaneous coronary intervention, emergency reoperation or conservative intensive care treatment should be used is currently unknown. Between 2003 and 2009, 39 of the 5598 patients who underwent isolated CABG surgery underwent early postoperative coronary angiography for suspected myocardial ischaemia. Following angiography, two groups were identified: patients who underwent immediately reintervention (group 1); and those treated conservatively (group 2). Primary study endpoints were mortality and postoperative myocardial infarct size. Postoperative coronary angiography revealed early perioperative bypass graft failure in 32 of 39 patients. Acute percutaneous coronary intervention was performed in 15 patients, redo-CABG in 4 patients and conservative treatment in 13 patients. The number of failing bypass grafts were significantly higher in group 1 compared with group 2 (P�=�0.0251). A trend toward lower post-procedural peak cardiac troponin T and creatinine phosphokinase serum levels in group 1 was observed (163.0 vs. 206.0 and 4.35 vs. 5.53, respectively) (P�=�0.0662 and 0.1648). Early reintervention may limit the extent of myocardial cellular damage compared with conservative medical strategy in patients with myocardial ischaemia due to early graft failure. PMID:22223760
Laflamme, Maxime; DeMey, Nathalie; Bouchard, Denis; Carrier, Michel; Demers, Philippe; Pellerin, Michel; Couture, Pierre; Perrault, Louis P.
Coronary artery bypass surgery, performed with or without cardiopulmonary bypass, is frequently followed by postoperative cognitive decline. Near-infrared spectroscopy is commonly used to assess cerebral tissue oxygenation, especially during cardiac surgery. Recent studies have suggested an association between cerebral desaturation and postoperative cognitive dysfunction. We therefore studied cerebral oxygen desaturation, defined as area under the cerebral oxygenation curve < 40% of > 10 min.%, with respect to cognitive performance at 4 days (early) and 3 months (late) postoperatively, compared with baseline, using a computerised cognitive test battery. We included 60 patients, of mean (SD) age 62.8 (9.4) years, scheduled for elective coronary artery bypass grafting, who were randomly allocated to surgery with or without cardiopulmonary bypass. Cerebral desaturation occurred in only three patients and there was no difference in cerebral oxygenation between the two groups at any time. Among patients who received cardiopulmonary bypass, 18 (62%) had early cognitive decline, compared with 16 (53%) in the group without cardiopulmonary bypass (p = 0.50). Three months after surgery, 11 patients (39%) in the cardiopulmonary bypass group displayed cognitive dysfunction, compared with four (14%) in the non-cardiopulmonary bypass group (p = 0.03). The use of cardiopulmonary bypass was identified as an independent risk factor for the development of late cognitive dysfunction (OR 6.4 (95% CI 1.2-33.0) p = 0.027. In conclusion, although cerebral oxygen desaturation was rare in our population, postoperative cognitive decline was common in both groups, suggesting that factors other than hypoxic neuronal injury are responsible. PMID:24750013
Kok, W F; van Harten, A E; Koene, B M J A; Mariani, M A; Koerts, J; Tucha, O; Absalom, A R; Scheeren, T W L
BACKGROUND: Coronary artery bypass grafting (CABG) is associated with high morbidity in patients with chronic obstructive pulmonary disease (COPD). We examine the effect of preoperative systemic corticosteroids on morbidity in this setting. METHODS: Ninety candidates for elective CABG participated in a prospective, open randomized trial, including 30 patients with COPD who received a single injection of a long-acting corticosteroid, 30
Daniele Starobin; Mordechai Rehuven Kramer; Moshe Garty; David Shitirt
Is body size the cause for poor outcomes of coronary artery bypass operations in women?
Although small body size and coronary artery diameter are recognized as major contributors to the increased risk of coronary artery bypass grafting in women, few studies have established the independent influence of body size and gender on outcome. We studied 7025 consecutive patients (5694 men, 1331 women) undergoing isolated coronary artery bypass grafting between 1990 and 1994. Women were older,
George T. Christakis; Richard D. Weisel; Karen J. Buth; Stephen E. Fremes; Vivek Rao; Kostas P. Panagiotopoulos; Joan Ivanov; Bernard S. Goldman; Tirone E. David
Neuropsychologic impairment in patients undergoing cardiopulmonary bypass may be associated with cerebral blood flow changes arising from different management protocols for carbon dioxide tension during bypass. Seventy patients having coronary artery bypass grafting were randomized to either pH-stat or alpha-stat acid-base management during cardiopulmonary bypass with a membrane oxygenator. In each patient, cerebral blood flow (xenon 133 clearance), middle cerebral
R. L. Patel; M. R. Turtle; D. J. Chambers; D. N. James; S. Newman; G. E. Venn
Clinical and Economic Impact of Diabetes Following Coronary Artery Bypass
Background.Diabetes has been shown to have a negative impact on mortality following coronary artery bypass graft (CABG) surgery. This analysis examines the impact of diabetes on additional clinical and economic outcomes.Material and methods.Between May and October of 1996, 312 consecutive patients undergoing isolated primary CABG were followed through hospital discharge. A total of 114 diabetics (37%) and 198 nondiabetics (63%)
Robert D. Stewart; Stephen J. Lahey; Sidney Levitsky; Carlos S�nchez; Christian T. Campos
Objective: The need to avoid the risks associated with cardiopulmonary bypass has led to the interest in coronary operations without cardiopulmonary bypass. Patients and methods: From April 1994 to September 1995, 44 patients (mean age 63.3 � 10.0 years, range 43 to 83 years) were selected for video-assisted coronary artery bypass grafting without cardiopulmonary bypass through a small anterior thoracotomy.
Federico Benetti; Massimo A. Mariani; Guido Sani; Piet W. Boonstra; Jan G. Grandjean; Pierpaolo Giomarelli; Michele Toscano
Background Coronary artery bypass grafting (CABG) with cardioplegic cardiac arrest and cardiopulmonary bypass (CPB) is associated with myocardial injury. The aim of this study was to investigate whether a modified mechanical post-conditioning (MMPOC) technique has a myocardial protective effect by enhancing early metabolic recovery of the heart following revascularization. Methods A prospective, randomized trial was conducted at a single-center university hospital performing adult cardiac surgery. Seventy-nine adult patients undergoing first-time elective isolated multivessel coronary artery bypass grafting were prospectively randomized to MMPOC or control group. Anesthetic, cardiopulmonary bypass, myocardial protection, and surgical techniques were standardized. The post reperfusion cardiac indices, inotrope use and biochemical-electrocardiographic evidence of myocardial injury were recorded. The incidence of postoperative complications was recorded prospectively. Results Operative characteristics, including CPB and aortic cross-clamp time, were similar between the two groups (p>0.05). The MMPOC group had lower troponin I and other cardiac biomarkers level post CPB and postoperatively, with greater improvement in cardiac indices (p<0.001). MMPOC shortened post surgery hospitalization from 9.1?�?2.1 to 7.5?�?1.6?days (p<0.001). Conclusions MMPOC technique promotes early metabolic recovery of the heart during elective CABG, leading to better myocardial protection and functional recovery. PMID:22877317
OBJECTIVESWe sought to evaluate immediate and late outcomes after stenting for left main coronary artery (LMCA) stenosis.BACKGROUNDConventional percutaneous transluminal coronary angioplasty (PTCA), for which coronary artery bypass grafting (CABG) has been the gold standard therapy for years, has yielded poor results in unprotected LMCA lesions. The development of coronary stents, together with their dramatic patency improvement provided by new antiplatelet
Marc Silvestri; Paul Barragan; Jo�l Sainsous; Gilles Bayet; Jean-Baptiste Simeoni; Pierre-Olivier Roquebert; Gilles Macaluso; Jean-Louis Bouvier; Bertrand Comet
Coronary artery bypass graft surgery in a patient with ureterosigmoidostomy.
A 75-year-old male patient had stable angina pectoris. After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ureterosigmoidostomy because of bladder cancer. After that, his micturition was via the rectum. We did not experience that before. As is known, monitoring of urine output is very important after cardiac surgery. The patient was consulted with an urologist for how to monitor urine output in him. Transrectal catheterization was recommended for our follow-up, but before the catheterization bowel cleansing is necessary. Four-vessel on-pump coronary artery bypass graft surgery was performed without any problem. Peroperative urine volume and arterial blood gas results were normal. Urine output is a sensitive variable reflecting the patient's effective blood volume and tissue perfusion. Urinary catheterization is a standard for all cardiac surgeries, and it allows the patients' urine to drain freely from the bladder for collection. Monitoring of urine output in patients with ureterosigmoidostomy is impossible by standard urinary catheterization method. In this case we performed transrectal catheterization for Urine flow follow-up. Urine flow follow-up is essential after the open-heart surgery and it can be measured in different ways, as in our case. PMID:25232552
Haberal, Ismail; Ozsoy, Deniz; Sipahi, Ege; Mert, Murat
Objective: Diabetes mellitus is a risk factor for death after coronary artery bypass grafting. Its relative risk may be related to the level of perioperative hyperglycemia. We hypothesized that strict glucose control with a continuous insulin infusion in the perioperative period would reduce hospital mortality. Methods: All patients with diabetes undergoing coronary artery bypass grafting (n = 3554) were treated
Anthony P. Furnary; Guangqiang Gao; Gary L. Grunkemeier; YingXing Wu; Kathryn J. Zerr; Stephen O. Bookin; H. Storm Floten; Albert Starr
Objective: Our objective was to identify risk factors for deep sternal site infection after coronary artery bypass grafting at a community hospital. Methods: We compared the prevalence of deep sternal site infection among patients having coronary artery bypass grafting during the study (January 1995�March 1998) and pre-study (January 1992�December 1994) periods. We compared any patient having a deep sternal site
William E. Trick; William E. Scheckler; Jerome I. Tokars; Kevin C. Jones; Mel L. Reppen; Ellen M. Smith; William R. Jarvis
Objective: The aim of this study was to assess the long-term results of use of the radial artery as a conduit for coronary artery bypass grafting. Methods: After revival of the technique in 1989, the radial artery was used as a conduit in 910 patients undergoing coronary artery bypass grafting. A complete follow-up was obtained for the first 102 consecutive
Christophe Acar; Amhad Ramsheyi; Jean-Yves Pagny; Victor Jebara; Pascal Barrier; Jean-No�l Fabiani; Alain Deloche; Jean-L�on Guermonprez; Alain Carpentier
Current status of arterial grafts for coronary artery bypass grafting
For over a decade there has been accumulating evidence that the use of more than a single arterial graft during coronary artery bypass grafting can improve clinical outcomes. However the vast majority of patients in most developed countries still only receive a single arterial conduit even in the presence of multivessel coronary artery disease. This review summarizes the current evidence for the use of a second internal mammary artery and/or radial artery graft. While in comparison to vein grafts the superior patency of internal mammary artery grafts is well established, there now exists strong and consistent evidence of the superior patency of radial arteries over the longer term. Likewise, there is a rapidly growing body of evidence that the superior patency of both these arteries in comparison to vein grafts translates into improved clinical outcomes. PMID:23977618
Objective. This study assessed the feasibility of coronary artery bypass grafting on the beating heart without interruption of native coronary blood flow using a novel anastomosis site restraining device.Background. Recently, an end-to-side bypass technique was described that does not require interruption of flow in the recipient artery.Methods. By means of a suction device (�Octopus�), in 31 pigs the epicardium was
Cornelius Borst; Erik W. L. Jansen; Cornelis A. F. Tulleken; Paul F. Grundeman; Hendricus J. Mansvelt Beck; Jeroen W. F. van Dongen; Kees C. Hodde; Jaap J. Bred�e
Hydrogel-electrospun mesh composites for coronary artery bypass grafts.
The aim of the present study was to investigate the potential of hydrogel-electrospun mesh hybrid scaffolds as coronary artery bypass grafts. The circumferential mechanical properties of blood vessels modulate a broad range of phenomena, including vessel stress and mass transport, which, in turn, have a critical impact on cardiovascular function. Thus, coronary artery bypass grafts should mimic key features of the nonlinear stress-strain behavior characteristic of coronary arteries. In native arteries, this J-shaped circumferential stress-strain curve arises primarily from initial load transfer to low stiffness elastic fibers followed by progressive recruitment and tensing of higher stiffness arterial collagen fibers. This nonlinear mechanical response is difficult to achieve with a single-component scaffold while simultaneously meeting the suture retention strength and tensile strength requirements of an implantable graft. For instance, although electrospun scaffolds have a number of advantages for arterial tissue engineering, including relatively high tensile strengths, tubular mesh constructs formed by conventional electrospinning methods do not generally display biphasic stress-strain curves. In the present work, we demonstrate that a multicomponent scaffold comprised of polyurethane electrospun mesh layers (intended to mimic the role of arterial collagen fibers) bonded together by a fibrin hydrogel matrix (designed to mimic the role of arterial elastic fibers) results in a composite construct which retains the high tensile strength and suture retention strength of electrospun mesh but which displays a J-shaped mechanical response similar to that of native coronary artery. Moreover, we show that these hybrid constructs support cell infiltration and extracellular matrix accumulation following 12-day exposure to continuous cyclic distension. PMID:21083438
McMahon, Rebecca E; Qu, Xin; Jimenez-Vergara, Andrea Carolina; Bashur, Chris A; Guelcher, Scott A; Goldstein, Aaron S; Hahn, Mariah S
A review of 1,582 consecutive Octopus off-pump coronary bypass patients
Background. Off-pump coronary bypass may provide a safer form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in the increasingly complex patients being referred for operation. This study reviews the entire experience of the Medtronic Octopus System (Medtronic, Minneapolis, MN) for beating heart bypass from 7 surgeons. Demographics, operative procedures, early outcomes, and trends in usage
James C Hart; Ted H Spooner; John Pym; Thomas F Flavin; James R Edgerton; Michael J Mack; Erik W. L Jansen
Outcome and Graft Patency in Coronary Artery Bypass Grafting with Coronary Endarterectomy
Background Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. Methods This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After follow-up at 9.66�3.65 months post-surgery, 28 patients from the CE+ group underwent angiography to evaluate the patency of grafts and native coronary vessels. Results Patients in the CE+ group had a more prevalent history of diabetes (48% vs. 36%) and number of diseased vessels (2.88�0.39 vs. 2.70�0.85). The overall hospital mortality was 1.8%, and no significant difference was observed between the two groups. In the 28 patients who underwent reangiography, 113 vessels were bypassed and 29 endarterectomies were performed, mostly on the left anterior descending artery (12 endarterectomies) and the right coronary artery (8 endarterectomies). In the endarterectomized vessels, a 66% patency rate was found in both the grafts and the native vessels. The native coronary vessels were more likely to be patent when the left internal mammary artery was used as a conduit than when a saphenous vein bypass graft was used. Conclusion The lack of a significant difference in postoperative complications in patients who underwent CABG with or without CE may indicate that CE does not expose patients to a higher risk of complications. Since most of the endarterectomized vessels were shown to be patent during the follow-up period, we propose that endarterectomy is a viable option for patients with severely diseased vessels.
Nemati, Mohammad Hassan; Astaneh, Behrooz; Khosropanah, Shahdad
Early and Midterm Outcome of Redo Coronary Artery Bypass Grafting: On-Pump versus Off-Pump Bypass
Background Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality as compared to the first-time operation. Further, the application of the off-pump technique to redo CABG is limited due to technical difficulties. The aim of this retrospective study was to analyze early and midterm results after redo CABG and compare the outcome of redo on-pump and off-pump CABG. Methods From June 1996 to October 2011, elective redo CABG was performed in 32 patients. Mean age was 64.8 years (on pump 64.3 years vs. off pump 65.5 years; p=0.658), and 21 patients were male. Among these patients, 14 (43.8%) underwent on-pump CABG, and 18 (56.2%) underwent off-pump CABG. Results Internal thoracic artery was used in 22 patients (68.8%), and total arterial revascularization was achieved in 17 patients (53.1%). The average number of distal anastomoses was 2.13, and the rate of incomplete revascularization was 43.8%. The rate of total arterial revascularization was higher in the off-pump group (14.3% vs. 83.3%, p<0.001), and the use of saphenous vein graft was more in the on-pump group (78.6% vs. 16.7%, p<0.001). Overall hospital mortality was 3.1% (n=1) and was comparable in both groups (on pump 7.1% vs. off pump 0%; p=0.249). Postoperative complications occurred in 9 patients (64.2%), and the rate of complications was high in the on-pump group without statistical significance (64.2% vs. 33.3%, p=0.082). The mean follow-up duration was 5.4 years, and overall survival at 10 years was 86.0%�10.5%. There was no significant difference in the 10-year survival rate between the two groups (79.6% vs. 100%, p=0.225). Conclusion Redo CABG can be safely performed with acceptable mortality. Redo off-pump coronary artery bypass is feasible with low mortality and morbidity, comparable target vessel bypass grafting, and long-term survival. The off-pump technique might be considered a safe option for redo CABG in high-risk patients. PMID:25207219
Shin, Yu Rim; Lee, Sak; Joo, Hyun Chel; Youn, Young-Nam; Kim, Jong Gun; Yoo, Kyung-Jong
Objectives: We sought to examine the effect of sociodemographic characteristics and perioperative clinical factors 1 year after coronary bypass operations on low health-related quality of life. We also sought to assess the usefulness of an additional single question on overall health for identifying patients with low health-related quality of life. Methods: This report is part of the Israeli coronary artery
Elisheva Simchen; Noya Galai; Dalit Braun; Yana Zitser-Gurevich; Eti Shabtai; Irit Naveh
Background. Beating heart coronary artery bypass graft surgery of the left anterior descending, diagonal, and right coronary artery can be performed safely with the Octopus Stabilization System. However, tilting of the heart, which is necessary to reach the obtuse marginal and distal right coronary arteries, causes hemodynamic instability. This study was performed to investigate the possible role of the Enabler
Gijs G Geskes; Andr� L Dekker; Frederik H van der Veen; Audrey A Cramers; Jos G Maessen; David Shoshani; Kees B Prenger
Background Atelectasis is a major cause of hypoxemia after coronary artery bypass grafting (CABG) and is commonly ascribed to general anesthesia, high inspiratory oxygen concentration and cardiopulmonary bypass (CPB). The objective of this study was to evaluate the role of heart-induced pulmonary compression after CABG with CPB. Methods Seventeen patients without pre-operative cardiac failure who were scheduled for coronary artery bypass graft underwent pre- and postoperative thoracic computed tomography. The cardiac mass, the pressure exerted on the lungs by the right and left heart and the fraction of collapsed lower lobe segments below and outside of the heart limits were evaluated on a computed tomography section 1 cm above the diaphragmatic cupola. Results In the postoperative period, cardiac mass increased by 32% (117�31 g versus 155�35 g, p<0.001), leading to an increase in the pressure that was exerted on the lungs by the right (2.2�0.6 g.cm?2 versus 3.2�1.2 g.cm?2, p<0.05) and left heart (2.4�0.7 g.cm?2 versus 4.2�1.8 g.cm?2, p<0.001). The proportion of collapsed lung segments beneath the heart markedly increased [from 6.7% to 32.9% on the right side (p<0.001) and from 6.2% to 29% on the left side (p<0.001)], whereas the proportion of collapsed lung segments outside of the heart limits slightly increased [from 0.7% to 10.8% on the right side (p<0.001) and from 1.5% to 12.6% on the left side (p<0.001)]. Conclusion The pressure that is exerted by the heart on the lungs increased postoperatively and contributed to the collapse of subjacent pulmonary segments. PMID:24244331
Neves, Fl�vio H.; Carmona, Maria J.; Auler, Jos� O. C.; Rodrigues, Roseny R.; Rouby, Jean Jacques; Malbouisson, Luiz M. S.
Severe hypocalcaemia following coronary artery bypass grafting due to hypoparathyroidism.
A 55 years old man was extubated on first postoperative day following coronary artery bypass grafting at 7:30 am. The same day at 5 pm, he became drowsy but arousable only on painful stimuli with severe generalized hypertonia and bilateral upgoing plantars. He was reventilated and a provisional diagnosis of cerebrovascular accident was made. CT scan of brain was normal except for bilateral basal ganglia calcification. On further investigations, he was found to be severely hypocalcaemic due to hypoparathyroidism. All symptoms resolved on the treatment of his hypocalcaemia. There was no history of neck surgery in this patient and the case additionally highlights important interaction between parathyroid hormone (PTH) in calcium metabolism. PMID:23823956
Riaz, Rehan; Khan, Shafqat Ali; Akhtar, Raja Parvez
Intraoperative imaging techniques to assess coronary artery bypass graft patency.
Graft patency verification is increasingly recognized as an important component of coronary artery bypass grafting. Intuitively, eliminating intraoperative graft failure should reduce cardiac mortality and morbidity in the short term and improve clinical outcome in the long term. Although conventional angiography remains the gold standard technique for assessing graft patency, it is rarely available in the operating room and consequently several other less invasive approaches have been advocated. This article reviews the two currently most commonly used modalities for graft patency assessment, intraoperative fluorescence imaging and transit-time flowmetry, and discusses their value and limitations. Both techniques can reliably detect otherwise unsuspected occluded grafts and this is crucial for internal thoracic arteries because of their prognostic significance. Although neither technology can consistently identify more minor, non-occlusive abnormalities, the intraoperative fluorescence imaging technique seems to be more sensitive and less susceptible to "false positive" images. PMID:17532450
Balacumaraswami, Lognathen; Taggart, David P
Bilateral axillary and suprascapular neuropathy after coronary artery bypass surgery.
Neuropathies after coronary artery bypass (CABG) and cardiac surgery are usually transient and have been described fairly frequently. Our patient presented with an acute onset of a surprisingly symmetrical bilateral axillary and suprascapular neuropathy during the immediate CABG period (which to our knowledge has not been reported on before). The patient, aged 64 years, suffered from diabetes mellitus type 2 and hypertension, and underwent a triple CABG. Electroneuronographic and electromyographic examination confirmed the presence of the bilateral axillary and suprascapular neuropathy, which showed only minimal improvement 15 months later. The surmise is that the neuropathy developed as a result of compression or overstretching of the involved nerves during the surgical procedure, associated with suboptimal positioning of the arms. The 'hands-up position', with careful sternal retraction (Cooley retractor), may appear to prevent the posterior displacement of the shoulders and plexus injuries. The diabetes mellitus may have acted as an aggravating factor. PMID:17117233
Hassan, I; Jacobs, A G; Baig, M E; Van der Meyden, C H
On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients
Background There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG) with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG) in coronary high-risk patients in comparison with the conventional methods. Methods In a prospective research study, 3000 off-pump CABG patients were considered during June 2003 to December 2011. Among these, 157 patients with one or more of the following risk factors were included for OPBCABG; severe left main stenosis, early post-acute myocardial infarction with ongoing chest pain, unstable angina, intractable ventricular arrhythmia, post complicated coronary intervention and severe left ventricular dysfunction. These patients were compared with 157 similar patients undergone CCABG with aortic cross clamp before 2003. Results Preoperative patient characteristics revealed no significant differences between the two groups. The patients� mean age and number of grafts were 57 years and 3 per patient respectively. Hospital mortality was 3.2% and 9% in OPBCABG and CCABG groups, respectively (P<0.001). Preoperative myocardial infarction, requirement of inotropic agents and intraaortic balloon pump, renal dysfunction and prolonged ventilation time were significantly higher in CCABG group. Conclusion Our results suggest that OPBCABG is effective in coronary high-risk patients and significantly reduces mortality and the incidence of perioperative MI and other major complications. PMID:25650152
Afrasiabirad, Abbas; Safaie, Naser; Montazergaem, Hosein
Background While hemodynamic monitoring is often performed following coronary artery bypass grafting (CABG), the relationship between postoperative central venous pressure (CVP) measurement and clinical outcomes is unknown. Methods Detailed clinical data were analyzed from 2,390 randomly selected patients undergoing high risk CABG or CABG/valve at 55 hospitals participating in the Society of Thoracic Surgeons' National Cardiac Surgery Database from 2004 to 2005. Eligible patients underwent elective/urgent isolated CABG with an ejection fraction < 40%, or elective/urgent CABG at age ?65 years with diabetes or a glomerular filtration rate 60 mL/min per 1.73 m2. Correlation between post-operative CVP and in-hospital / 30-day mortality and renal failure was assessed as a continuous variable, both unadjusted and after adjusting for important clinical factors using logistic regression modeling. Results Mean age was 72 years, 54% of patients had diabetes mellitus, 49% were urgent procedures, and mean cardiopulmonary bypass time was 105 minutes. Patients� CVP 6 hours post-operation was strongly associated with in-hospital and 30 day mortality: odds ratio (OR) 1.5 (95% confidence interval [CI] 1.23, 1.87) for every 5 mmHg increase in CVP, p<0.0001. This association remained significant after risk-adjustment for cardiac index: adjusted OR 1.44 (95% CI 1.10, 1.89), p<0.01. A model adjusting for cardiac index also revealed increased incidence of mortality or renal failure: adjusted OR 1.5 (95% CI 1.28, 1.86) for every 5 mmHg increase in CVP, p<0.0001. Conclusion Patients� central venous pressure at 6 hours following CABG surgery was highly predictive of operative mortality or renal failure, independent of cardiac index and other important clinical variables. Future studies will need to assess whether post-operative CVP can be used to guide intervention and improve outcomes. PMID:25035048
Williams, Judson B.; Peterson, Eric D.; Wojdyla, Daniel; Ferguson, T. Bruce; Smith, Peter K.; Milano, Carmelo A.; Lopes, Renato D.
Total i.v. anaesthesia with propofol and alfentanil for coronary artery bypass grafting.
The haemodynamic effects of total i.v. anaesthesia with a combination of propofol and alfentanil infusions were studied in eight patients with good left ventricular function undergoing coronary artery bypass surgery. Haemodynamic indices were measured before anaesthesia and at specified intervals before cardiopulmonary bypass. The technique resulted in haemodynamic changes comparable to those reported with opioid-based anaesthesia for coronary artery surgery, and has potential advantages. PMID:2064887
Manara, A R; Monk, C R; Bolsin, S N; Prys-Roberts, C
Recently the availability of transit time flow measurement (TTFM) is reported especially in off-pump coronary artery bypass grafting (CABG). But little is known about TTFM findings in on-pump CABG. We examined the correlation between the TTFM flow pattern and the angiography findings in on-pump CABG. The subjects consisted of 52 patients who underwent on-pump CABG and angiography early after operation. In these patients, 55 internal thoracic artery (ITA), 17 gastroepiploic artery (GEA), 13 saphenous vein graft (SVG) and 41 radial artery (RA) were tested with TTFM during cardiopulmonary bypass (CPB). TTFM demonstrated a diastolic filling pattern in 53 ITA, 16 GEA, 13 SVG and 36 RA. The angiography revealed that all these grafts were perfectly patent with the exception of a GEA with a flow competition pattern. TTFM revealed an abnormal flow pattern in 2 ITA (these 2 grafts were revised during CPB and the angiography demonstrated their perfect patency), 1 GEA (to and fro pattern), 0 SVG and 5 RA (the abnormal pattern was due to graft spasm in 3 of 5, and the angiography revealed their perfect patency, however, the angiography detected stenosis in the remaining 2 grafts). The present study found that the TTFM flow pattern during CPB correlated well with the angiography findings. TTFM during CPB was useful to detect graft failure, and grafts were revised safely during CPB. PMID:16004331
Hagiwara, H; Shirakawa, M; Nakayama, T; Asai, T; Nakayama, M; Ito, T; Yano, Y
Generally, patients with prior coronary artery bypass graft (CABG) are often under-represented in acute coronary syndrome (ACS) clinical trials. Nevertheless, there is growing global attention concerning their short- and long-term prognosis. Some reports suggest prior CABG as an independent risk factor for increased mortality, while others report an equal or a more favorable prognosis despite their adverse baseline clinical characteristics. The reasons for this 'risk-mortality paradox' need to be further evaluated. More recent reports showed a significant reduction in in-hospital morbidity and mortality over a 20-year period of follow up that may be attributed to the improvement in surgical CABG techniques and increased use of evidence-based therapies over the past two decades. In the current review we discuss the available literature regarding outcomes of prior CABG patients who are presenting with ACS. PMID:24754442
Al-Aqeedi, Rafid Fayadh; Al Suwaidi, Jassim
Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease
BACKGROUND: The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease. METHODS: A total of 1205 patients were randomly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and
P. W Serruys; F Unger; F Sousa; J. E. Sousa; A. Jatene; J. J. R. M. Bonnier; J. P. A. M. Schonberger; N. Buller; R. Bonser; Brand van den M. J. B. M
Objective: In cases of aortic valve replacement, the downstream flow profile and turbulence in the ascending aorta differ according to the prosthetic aortic valve implanted. The objective of this work is to study the influence of prosthetic valve type on the flow in the bypass grafts implanted to the ascending aorta in cases of concomitant aortic valve replacement and coronary
Wael Hassanein; Alexander Albert; Ines Florath; Yasser Y. Hegazy; Ulrich Rosendahl; Stefan Bauer; Juergen Ennker
Objective: In cases of aortic valve replacement, the downstream flow profile and turbulence in the ascending aorta differ according to the prosthetic aortic valve implanted. The objective of this work is to study the influence of prosthetic valve type on the flow in the bypass grafts implanted to the ascending aorta in cases of concomitant aortic valve replacement and coronary
Wael Hassanein; Alexander Albert; Ines Florath; Yasser Y. Hegazy; Ulrich Rosendahl; Stefan Bauer; Juergen Ennker
Background. Concomitant coronary artery disease with aortic valve disease is an established risk factor for diminished late survival. This study evaluated the results of bioprosthetic (BAVR) or mechanical aortic valve replacement (MAVR) performed with coronary artery bypass grafting (CABG).Methods. From January 1984 through July 1997, combined AVR + CABG was performed in 750 consecutive patients; 469 received BAVR and 281
Cary W. Akins; Alan D. Hilgenberg; Gus J. Vlahakes; Thomas E. MacGillivray; David F. Torchiana; Joren C. Madsen
The Sexual Adjustment of Coronary Bypass Surgery Patients: A 4-Year Follow-Up.
ERIC Educational Resources Information Center
Measured the sexual adjustment of 14 individuals before coronary bypass surgery and both four months and four years afterwards. Results showed that sexual adjustment worsened with the onset of symptomatic coronary artery disease and did not improve at either follow-up interval. (LLL)
Thurer, Shari; Thurer, Robert L.
Off-pump coronary bypass grafting: how to use the octopus tissue stabilizer
Off-pump coronary artery bypass grafting requires immobilization of the coronary artery. A suction device (Octopus Tissue Stabilizer), attached to the epicardium and connected rigidly to the operating table rail, was used through limited and full surgical access for single-vessel and multivessel arterial revascularization, respectively. An outline for its application, as used by us to construct 122 anastomoses in 70 patients,
Erik W. L Jansen; JaapR Lahpor; Cornelius Borst; PaulF Gr�ndeman; JohanJ Bred�e
Objective: Coronary artery bypass grafting (CABG) in patients with endstage coronary disease (CAD) significantly improves symptoms and prolongs life expectancy. Left ventricular function is also improved in some patients, but not in others. Factors which influence functional recovery of hibernating myocardium after revascularization are at present under investigation. Methods: From 3\\/2000 to 8\\/2002, we analyzed 41 patients with an ejection
Harald Hausmann; Rudolf Meyer; Henryk Siniawski; Reinhard Pregla; Matthias Gutberlet; Holger Amthauer; Roland Felix; Roland Hetzer
Objective: Coronary artery bypass grafting (CABG) in patients with endstage coronary disease (CAD) significantly improves symptoms and prolongs life expectancy. Left ventricular function is also improved in some patients, but not in others. Factors which influence functional recovery of hibernating myocardium after revascularization are at present under investigation. Methods: From 3\\/2000 to 8\\/2002, we analyzed 41 patients with an ejection
Harald Hausmann; Rudolf Meyer; Henryk Siniawski; Reinhard Pregla; Matthias Gutberlet; Holger Amthauer; Roland Felix; Roland Hetzer
The effects of coronary artery bypass graft (CAB) and coronary collaterals (CC) on myocardial blood flow (MBF) were studied in 24 patients undergoing 29 CAB's. MBF after CAB was compared to preexisting MBF by intraoperatively injecting 133xenon via distal CAB with proximal CAB first occluded then open. Pressure gradients across bypassed obstructions were measured. The results were correlated with preoperative coronary arteriograms to determine the effects of CC on MBF and postobstructive perfusion pressures. Mean MBF was increased by CAB from 32�6 (se) ml/min per 100 g (CAB occluded) to 118�13 ml/min per 100 g (CAB open). The 133Xe clearance curves with CAB open were resolved into slow (19�2 ml/min per 100 g) and rapid (133�12 ml/min per 100 g) phases, suggesting that MBF remained heterogeneous after CAB. Vessels with less than 80% stenosis by angiography had pressure gradients less than 20 mm Hg across obstructions, high postobstructive perfusion pressures (75�7 mm Hg), and normal MBF (87�6 ml/min per 100 g) even with CAB occluded. Vessels with greater than 80% stenosis or total occlusion by angiography had significant pressure gradients with marked reduction of postobstructive MBF. No significant difference in postobstructive MBF was found when vessels with CC (21�4 ml/min per 100 g) were compared to those without CC (17�4 ml/min per 100 g) (P > 0.4). These studies demonstrate that (a) mean MBF increased 268% after CAB, (b) heterogeneous MBF persisted after CAB, (c) CC were not associated with significant increases in MBF, and (d) vessels with less than 80% stenosis had less than 20 mm Hg gradient with minimal effect on resting MBF. Images PMID:5056655
Smith, Sidney C.; Gorlin, Richard; Herman, Michael V.; Taylor, Warren J.; Collins, John J.
Implications of Hemodialysis in Patients Undergoing Coronary Artery Bypass Grafting
Background Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population. Methods Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model. Results Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2). Conclusion Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations. PMID:25309935
Efird, Jimmy T.; O�Neal, Wesley T.; Gouge, Catherine A.; Kindell, Linda C.; Kennedy, Whitney L.; Bolin, Paul; O�Neal, Jason B.; Anderson, Curtis A.; Rodriguez, Evelio; Ferguson, T. Bruce; Chitwood, W. Randolph; Kypson, Alan P.
[Mesenteric traction syndrome during coronary artery bypass graft surgery].
Mesenteric traction syndrome (MTS) consists of decreased systemic vascular resistance, increased cardiac output, facial flushing and palmar erythema. Local production of PGI2 is thought to be the cause. We experienced a rare case of MTS that occurred during coronary artery bypass graft surgery (CABG). A 64-year-old man was scheduled for CABG for the treatment of angina pectoris. Hemodynamic variables were stable until 50 minutes after surgical incision. Blood pressure fell down suddenly from 110/50 to 70/40 mmHg, accompanied by obvious facial flushing and palmar erythema, when the surgeons were preparing the right gastroepiploic artery. Hemodynamic changes and cutaneous hyperemia returned to the baseline level in about 40 minutes. After this episode, the operation was performed uneventfully. The time sequence between the onset of the surgical procedure and the hemodynamic and cutaneous findings strongly suggest the release of PGI2 and MTS. In patients undergoing CABG with the gastroepiploic artery graft, pretreatment with NSAID might avoid sudden circulatory changes of MTS. PMID:9071111
Koyama, K; Kaneko, I; Mori, K
Preventing Deep Wound Infection after Coronary Artery Bypass Grafting
The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include prolonged perfusion time, the use of one or more internal mammary arteries as grafts, blood transfusion, and mechanical circulatory assistance. The chief postoperative risk factor is reoperation, usually for bleeding. Unresolved issues include the optimal approach to Staphylococcus aureus nasal colonization and the choice of a prophylactic antibiotic regimen. We recommend that cardiac surgery programs supplement their audit processes and ongoing vigilance for infections with periodic, multidisciplinary reviews of best-practice standards for preoperative, intraoperative, and postoperative patient care. PMID:23678210
Bryan, Charles S.; Yarbrough, William M.
Prevalence of Delirium in Opium Users after Coronary Artery Bypass Graft Surgery
Background: Postoperative cognitive dysfunction, especially delirium commonly occurs after cardiac surgery. Clinical evidences suggest an increase in delirium in opium abusers after Coronary Artery Bypass Graft (CABG) surgery. In this study, the prevalence of delirium in addict (opium user) and nonaddict patients after CABG were compared. Methods: In a cross-sectional study after obtaining institutional approval and informed consent, 325 patients candidate for elective CABG were included in the study. All patients with history of opium abuse met the criteria for opioid dependence using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition definitions. Delirium after CABG was assessed in addict (opium user) and nonaddict patients up to a maximum of 5 days after surgery with the Intensive Care Delirium Screening Checklist. Results: A total of 325 patients were evaluated (208 without and 117 with a history of opium abuse). Postoperative delirium occurred within 72 h after surgery in 44.31% of all patients. There was a significant difference in the prevalence of postoperative delirium between the opium users (80.7%) and nonaddict patients (25%) in the intensive care unit (P < 0.001). Opium addiction was a risk factor for postoperative delirium after CABG Surgery. Conclusions: Delirium after CABG surgery is more prevalent in opium users compared with nonaddict patients. Therefore, opium abuse is a possible risk factor for postoperative delirium in cardiac surgical patients. PMID:25105003
Eizadi-Mood, Nastaran; Aghadavoudi, Omid; Najarzadegan, Mohammad Reza; Fard, Masoud Mozhdehi
We present a case of a 13-year old girl experiencing recurring angina pectoris due to an occlusion of the left main coronary artery after arterial switch operation in infancy. To avoid a repeat sternotomy and the use of cardiopulmonary bypass, the patient underwent uncomplicated operative myocardial revascularization in the minimally invasive direct coronary artery bypass (MIDCAB) technique. PMID:23985412
Jussli-Melchers, Jill; Haneya, Assad; Hoffmann, Grischa; Cremer, Jochen
Coronary Arteries Bypass Grafting Surgery in Elderly Patients
Background: The incidence of coronary artery bypass grafting surgery (CABG) in elderly patients has been increasing. There are contradictory reports on the early outcome of elderly coronary artery patients as compared with their young counterparts. We designed this retrospective study to address this issue. Methods: We retrospectively analyzed the results of 1489 on�pump CABG cases performed at our hospital during a 4.5-year period. Perioperative data such as demographic, medical, clinical, operative, and postoperative variables were collected and compared between patients 70 years old or younger (Group A, n = 1164) and patients above 70 years of age (Group B, n = 325). Statistical analysis was performed using the t-test for the continuous and the X2 tests for the categorical variables. Significant variables according to the univariate analysis (X2 and t-test) were further analyzed using multivariate logistic regression analysis. Results: The variables of weight (P value < 0.001), preoperative PO2 (P value = 0.005), ejection fraction > 30% (P value = 0.001), body surface area (P value = 0.003), and hypercholesterolemia (P value = 0.007) were higher in Group A, whereas preoperative myocardial infarction (P value < 0.001), postoperative low cardiac output syndrome (P value = 0.019), emergent surgery (P value = 0.003), inotropic drug use (P value < 0.001), preoperative heparin use (P value < 0.001), re-exploration for bleeding (P value = 0.015), hospital stay (P value < 0.001), low ejection fraction (? 30%) (P value = 0.001), preoperative creatinine > 1.5 mg/dl (P value < 0.001), chronic obstructive pulmonary disease (P value < 0.001), intra-aortic balloon pump use (P value < 0.001), infection (P value < 0.001), pulmonary complications (P value < 0.001), atrial fibrillation (P value < 0.001), postoperative renal complications (P value < 0.001), and death (P value = 0.012) were more frequent in Group B. Conclusion: CABG in the elderly patients had certain surgical risks such as chronic obstructive pulmonary disease, preoperative myocardial infarction, emergent surgery, and death. Also, postoperative complications such as pulmonary complications, inotropic drug use, intra-aortic balloon pump use, and infection were more frequent in the elderly than in the younger patients. PMID:23967029
Sabzi, Feridoun; Kazerani, Hashem; Jalali, Arash; Samadi, Mojgan; Ghasemi, Fahime
Chest tubes are one cause of pain after cardiac surgery. In a prospective, randomized study, we investigated the effects of the position of chest tubes on acute postoperative pain and pulmonary morbidities in patients who underwent coronary artery bypass grafting. From June through December 2010, 40 patients who underwent elective coronary artery bypass grafting were enrolled in the study. We investigated 2 randomized groups of patients: Group 1 (n-20) had a left chest tube inserted through the midline inferior to the xiphoid process (subxiphoid approach), and Group 2 (n-20) had a left chest tube inserted through the 6th intercostal space along the anterior axillary line (intercostal approach). We compared the results with respect to postoperative pain, the need for analgesic agents, chest-tube drainage, pulmonary morbidities, and duration of hospitalization. The intensity of postoperative pain was similar between the groups. The cumulative doses of analgesic agents, incidence of pulmonary morbidities, and duration of hospitalization were also similar. Pleural effusion and atelectasis were each diagnosed in 3 patients in Group 1 (15%) and 1 patient in Group 2 (5%) (both P=0.68). Two of the patients in Group 1 required drainage of the pleural effusion. In our study, we found that the subxiphoid and intercostal approaches for chest-tube placement yielded similar clinical outcomes. PMID:22949766
Guden, Mustafa; Korkmaz, Askin Ali; Onan, Burak; Onan, Ismihan Selen; Tarakci, Sevim Indelen; Fidan, Fatma
Aspirin and Postoperative Bleeding After Coronary Artery Bypass Grafting
Objective To evaluate the relationship between aspirin ingestion and postoperative bleeding complications, and to test the hypothesis that there is a subset of patients who are aspirin hyperresponders with a proclivity toward platelet dysfunction. Summary Background Data Despite numerous retrospective and prospective analyses, it is still controversial as to whether aspirin ingestion before coronary artery bypass grafting (CABG) is associated with significant postoperative bleeding. Methods Between January 1995 and December 1999, the records of 2,606 consecutive patients undergoing CABG were reviewed to identify patients with a history of aspirin ingestion up until the time of surgery. Aspirin ingestion was correlated with postoperative blood transfusion using multivariate analysis. In a subset of preoperative aspirin users (n = 40), bleeding times were measured before and after aspirin use. Flow cytometry was performed in another cohort of patients with known heart disease (n = 30) to determine the effect of aspirin on platelet surface receptors. Results During the 5-year study period, 63% of the CABG patients were identified as aspirin users. Among these, 23.1% required blood transfusions compared with 19% for the nonusers. Non-red blood cell transfusions were more common in aspirin users, as was reexploration for bleeding. Stratification of these results according to the frequency of aspirin use showed that aspirin is an independent multivariate predictor of postoperative blood transfusion only in high-risk patients. In the prospective studies, aspirin treatment resulted in a significant increase in the template bleeding time, an increase in platelet PAR-1 thrombin receptor activity, and a decrease in the binding of platelets to monocytes. Conclusions The findings support the hypothesis that aspirin is associated with a greater likelihood of postoperative bleeding. A platelet function testing algorithm that combines preoperative risk factor assessment, template bleeding times, and flow cytometry may allow the identification of aspirin hyperresponders who are at increased risk for bleeding. PMID:12035038
Ferraris, Victor A.; Ferraris, Suellen P.; Joseph, Oji; Wehner, Paulette; Mentzer, Robert M.
Cigarette smoking in British men and selection for coronary artery bypass surgery.
OBJECTIVE: To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. DESIGN: A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. SUBJECTS AND SETTING: 7735 men drawn from one general practice in each of 24 British towns. MAIN OUTCOME MEASURE: Coronary artery bypass graft surgery. RESULTS: Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). CONCLUSION: Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery. PMID:8697156
Morris, R. W.; McCallum, A. K.; Walker, M.; Whincup, P. H.; Ebrahim, S.; Shaper, A. G.
Objective: We sought to determine risk factors for deep and superficial chest wound infections after coronary artery bypass graft surgery to develop predictive models. Methods: We retrospectively analyzed data collected on 1980 consecutive patients undergoing coronary artery bypass surgery at our institution between January 1, 1996, and June 30, 1999, by using the Society of Thoracic Surgery database. Independent risk
Margaret A. Olsen; Patricia Lock-Buckley; Diane Hopkins; Louis B. Polish; Thoralf M. Sundt; Victoria J. Fraser
BACKGROUND: Diffuse microvascular bleeding remains a common problem after cardiac procedures. Systemic use of antifibrinolytic reduces the postoperative blood loss. The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting (CABG). METHODS: Thirty eight patients scheduled for primary isolated coronary artery bypass grafting were included
Hosam Fawzy; Elsayed Elmistekawy; Daniel Bonneau; David Latter; Lee Errett
Background: Right Ventricular (RV) dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. Patients and Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI) on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson�s correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF). P value < 0.05 was considered as statistically significant. Results: This study was conducted on 30 patients (mean age = 60.00 � 8.44 years; 24 [80%] males). In the pre-procedural echocardiography, 15 patients (50%) had normal RV function, 14 patients (46.7%) had grade-1 RV dysfunction, and only 1 patient (3.3%) had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV) function. Conclusions: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia.
Nikdoust, Farahnaz; Tabatabaei, Seyed Abdolhosein; Shafiee, Akbar; Mostafavi, Atoosa; Mohamadi, Maryam; Mohammadi, Sareh
Does Clopidogrel Increase Blood Loss Following Coronary Artery Bypass Surgery?
BackgroundClopidogrel (Plavix) is a potent inhibitor of platelet aggregation used concomitantly with percutaneous coronary interventions and in patients with acute coronary syndromes. Its favorable effects on preventing thrombus formation may have deleterious effects on hemostasis in patients undergoing coronary surgery.
Michael W. A. Chu; Steve R. Wilson; Richard J. Novick; Larry W. Stitt; MacKenzie A. Quantz
Purpose Coronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs). Materials and Methods The study population was comprised of 199 consecutive patients admitted with unprotected LMCAD. All of the patients were assigned to PCI (88 patients) or CABG (111 patients). The primary clinical end point indicated death, stroke of acute coronary syndrome (ACS). Results Patients assigned to PCI were at higher operative risk than patients scheduled for CABG (6.49�4.09 vs. 4.81�2.67, p=0.0032). Comparison of the group that received DESs with the CABG group did not reveal any differences in major adverse cardio-cerebral events (MACCE) occurrence (21% vs. 16%, p=NS). Patients in the CABG and PCI groups died with similar frequency (11% vs. 16%, p=NS). The mortality rate in the CABG group was higher than among those treated with DES (11% vs. 3%, p=0.049). The rate of ACS was higher in the PCI group than in the CABG group (13% vs. 4%, p=0.016). Conclusion Despite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI. PMID:22187233
Morawiec, Beata; Fudal, Marcin; Milejski, Wojciech; Jache?, Wojciech; Nowalany-Kozielska, Ewa
The treatment of malignant ventricular tachycardia by aorto-coronary saphenous vein bypass graft
A 61-year-old man with a previous cardiac infarction had at least fifteen attacks of ventricular tachycardia which finally did not respond to either drug or electrical therapy. Angiography showed a blocked right coronary artery and a non-contractile portion of postero-inferior left ventricular wall.An aorto to right coronary saphenous vein bypass graft was inserted, and although attacks of tachycardia occurred following
H. Ikram; R. M. Jeffery; R. A. Parkins; A. R. Makey; E. R. J. Emery; D. L. Stone
Cardiac troponin I as an early marker of myocardial damage after coronary bypass surgery
Study objective: To evaluate the performance of cardiac specific markers, cardiac troponin I (cTnI) and CK-MB by mass assay (CK-MB mass), for the early diagnosis of myocardial ischemia and\\/or infarction after coronary bypass surgery. Methods: Prospective clinical, electrocardiograpic and biologic follow-up of 117 patients undergoing isolated coronary surgery with the use of intermittent anterograde normothermic blood cardioplegia. Blood samples for
Luc Jacquet; Philippe Noirhomme; Gebrin El Khoury; Martin Goenen; Marianne Philippe; Jacques Col; Robert Dion
Prognostic impact of body mass index in patients undergoing coronary artery bypass surgery
BackgroundObesity has numerous adverse effects on general, and especially, cardiovascular health. Plasma adiponectin, an adipokine, is inversely related to adipose tissue mass, and also the prognosis of heart failure and coronary artery disease (CAD). Coronary artery bypass grafting (CABG) surgery is usually the treatment of choice for patients with complex CAD.ObjectiveTo investigate the impact of body mass index (BMI) and
Shih-Hsien Sung; Tao-Cheng Wu; Cheng-Hsiung Huang; Shing-Jong Lin; Jaw-Wen Chen
Early graft occlusion after coronary artery bypass grafting may have deleterious consequences. We routinely use transit-time flowmetry after termination of cardiopulmonary bypass, and we report five cases of early graft failure detected by the flowmeter. Electrocardiographic (ECG) changes were seen in only one of these five cases, and none of the patients had low cardiac output or other signs of graft failure at the end of the operation. The cause of graft failure was tagging in one case, rotation of internal mammary artery grafts in two and kinking of vein grafts in two cases. All errors were corrected, and control flowmetry showed normal flow rates after correction. Flowmetry takes less than 10 min, even with multiple bypass grafts. Based on our results, we advocate routine quality control with flowmetry after termination of cardiopulmonary bypass, since ECG changes are insufficient as checks of flow in bypass grafts. PMID:10399803
Jakobsen, H L; Kjaergard, H K
Temporary Diabetes Insipidus in 2 Men after On-Pump Coronary Artery Bypass Grafting
Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used. PMID:23466483
Uyar, Ihsan Sami; Sahin, Veysel; Akpinar, Besir; Yurtman, Volkan; Abacilar, Feyzi; Okur, Faik Fevzi; Ates, Mehmet
Temporary diabetes insipidus in 2 men after on-pump coronary artery bypass grafting.
Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used. PMID:23466483
Uyar, Ihsan Sami; Sahin, Veysel; Akpinar, Besir; Yurtman, Volkan; Abacilar, Feyzi; Okur, Faik Fevzi; Ates, Mehmet
Background: In some opinions, opium consumption has traditionally been considered to be a means to lower blood lipids and to put off heart diseases. In this study, the relationship between opium consumption and risk factors of coronary artery diseases, hemodynamic factors and cardiac related functions before and after surgery was evaluated. Materials and Methods: In a cross-sectional study 325 patient's candidate for elective coronary artery bypass grafting were enrolled in a period of 6 months. Opium addicted patients were recognized based on taking history from the patients by an anaesthesiologist. Serum lipid profile was determined at the beginning of the study. Frequency and distribution of coronary artery diseases were assessed according to the pre-operative coronary angiography. Results: From 325 patients, 117 patients were opium abusers and 208 patients were not. Mean duration of opium abuse was 12.6 � 7.7 years. Mean total serum cholesterol levels were not significantly different in abusers and non-users patients (185 � 47 vs. 190 � 49, P > 0.05). Mean level of low-density lipoprotein cholesterol was significantly higher in addicted group (121 � 27 vs. 81 � 22, P < 0.05). Mean triglyceride level was also higher in addicted patients (203 � 114 vs. 162 � 98, P < 0.05). The prevalence of diabetes and glucose levels was considerably lower in opium addicted cases. Mean body mass index was also lower in addicted patients significantly (25.3 � 3.7 vs. 27.5 � 4.1, P < 0.05). Conclusion: There may be a relationship between opium abuse and aggravating lipid profile and hypercholesterolemia and coronary artery disease.
Aghadavoudi, Omid; Eizadi-Mood, Nastaran; Najarzadegan, Mohammad Reza
Arterial end-to-side grafting in coronary artery bypass grafting: the Tector procedure
Background. The current treatment of choice in patients with three-vessel coronary disease is coronary artery bypass grafting. The use of the left internal mammary artery in bypass grafting has shown superior long-term outcomes compared with venous grafting. In our study we assess the safety and feasibility of all-arterial coronary artery bypass graft surgery using the procedure as described by Tector et al. in 2001. Methods. Between June 2001 and February 2007, we studied 133 patients eligible for non-emergency surgical revascularisation. Primary endpoints were death or re-infarction within a 30-day period. Secondary endpoints were the need for emergency coronary surgery, angioplasty and mediastinitis. Long-term follow-up had a mean duration of 33 months postoperatively. Results. All 133 patients were successfully revascularised, 98% with the off-pump technique. In 93% of the patients (n=124) full arterial grafting was achieved using both internal mammary arteries. Thirty-day mortality was 1.5% (n=2), ten re-thoracotomies were performed, one myocardial infarction and one case of mediastinitis were reported. In the next four years six additional patients died. Most of these deaths were due to non-cardiovascular causes. Two patients required angioplasty because of distal bypass graft failure and one for new native coronary artery disease. Conclusion. All-arterial bypass grafting using both internal mammary arteries with the technique as described by Tector is safe and feasible without excess deep sternal wound infections. Late major adverse cardiac events are rare and due to distal graft dysfunction, which can be treated by percutaneous coronary intervention. (Neth Heart J 2010;18:7-11.) PMID:20111637
de Mulder, M.; Broers, C.J.M.; Jansen, E.K.; de Swart, H.B.R.M.; Peels, H.O.J.; Lieuw-a-Fa, M.L.M.; Umans, V.A.W.M.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass (OPCAB) grafting should be considered as an alternative to the conventional on-pump surgery (ONCAB) in patients presenting with acute coronary syndrome (ACS) requiring emergency revascularization. Eighty-two papers were identified by a systematic search, of which nine were judged to best answer the clinical question. Of these, one was a randomized controlled trial and the remaining eight were retrospective observational studies. The author, journal, date, patient group, country of publication, relevant outcomes, results and study weaknesses were tabulated. In total, these nine studies included 3001 patients (n = 817 OPCAB, 2184 ONCAB) undergoing emergency revascularization in the setting of ACS. The timing between the onset of ACS and operative intervention ranged from 6 to 72 h. All cases were categorized as urgent/emergent according to the National confidential enquiry into patient outcome and death classification of intervention. Six studies included patients with preoperative cardiogenic shock; however the majority of patients were haemodynamically stable at the time of surgery. Three out of nine studies showed an improvement in 30-day mortality with OPCAB although the remaining six reveal no significant mortality benefit. No difference in long-term mortality was observed between the two techniques. OPCAB was associated with significantly fewer grafts per patient (six studies) and less complete revascularization (two studies). We conclude that whilst OPCAB may have a beneficial effect on 30-day mortality in haemodynamically stable patients undergoing emergency revascularization, there is a lack of high-quality data with clearly defined patient demographics. Future studies must ensure adequate preoperative matching between OPCAB and ONCAB groups and clearly categorize haemodynamic status, disease pattern and time to surgery in order to determine the patients in whom OPCAB may confer the greatest benefit. PMID:23184562
Moscarelli, Marco; Harling, Leanne; Ashrafian, Hutan; Athanasiou, Thanos
Risk factors for leg harvest surgical site infections after coronary artery bypass graft surgery
ObjectiveHarvest site infections are more common than chest surgical infections after coronary artery bypass surgery, yet few studies detail risk factors for these infections. We sought to determine independent risk factors for leg surgical site infections using our institutional Society of Thoracic Surgeons database.
Margaret A Olsen; Thoralf M Sundt; Jennifer S Lawton; Ralph J Damiano; Diane Hopkins-Broyles; Patricia Lock-Buckley; Victoria J Fraser
Risk factors for stroke in patients undergoing coronary artery bypass grafting
Objective: To determine predictors of stroke in patients undergoing first-time coronary bypass grafting, we prospectively collected data on 1631 consecutive patients. Methods: Patients with a history of stroke and\\/or central nervous system symptoms (n = 134) and\\/or carotid bruits (n = 95) underwent carotid Doppler evaluation. Stenosis greater than 70% was considered significant. Patients with symptomatic disease or asymptomatic bilateral
Lynda L. Mickleborough; Paul M. Walker; Yasushi Takagi; Masanori Ohashi; Joan Ivanov; Miguel Tamariz
Values obtained for cardiac output (CO) were compared using thermodilution (TD) with those obtained using bioimpedance (Bi) as measured using the Bomed NCCOM3 (Revision 6) in 28 consecutive patients in the first 24h after coronary artery bypass surgery (CABS). In 46 paired measurements made in the first 12 h after CABS Bi values for CO were significantly lower than TD
A. N. Thomas; J. Ryan; B. R. H. Doran; B. J. Pollard
Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments
Objective: The development of endoscopic coronary artery bypass grafting has been limited because of poor visualization and increased technical difficulties in carrying out operations through ports. We investigated whether the use of robotic assisted instruments could minimize these difficulties. Methods: After a period of technical development and training on cadavers (n = 8) with the Intuitive Surgical system (Intuitive Surgical,
Didier Loulmet; Alain Carpentier; Nicola d'Attellis; Alain Berrebi; Cyril Cardon; Olivier Ponzio; Bertrand Aup�cle; John Y. M. Relland
Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes
ERIC Educational Resources Information Center
Purpose: To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery. Methods: Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We�
Dao, Tam K.; Chu, Danny; Springer, Justin; Hiatt, Emily; Nguyen, Quang
Simulation of Blood Flow Coronary Artery with Consecutive Stenosis and Coronary-Coronary Bypass
Introduction In this research the behavior of coronary arteries has been studied with symmetric and asymmetric consecutive stenosis, and grafted vessels. Methods The incompressible Navier-Stokes and energy equations were discretized with second-order upwind method. Assumptions such as Newtonian fluid, wall rigidity and steady-flow were used. Results All the calculations showed the same results with Newtonians and non- Newtonian fluids. It was found that the possibility of stenosis be reduced by increasing the graft angle. However, there exists further stenosis possibility. Among the three graft angles 20, 30 ? and 40, the 30 ? was found to be the reliable ones. Conclusion Based on these findings, it can be deduced that there would be a high risk of further atherosclerosis when the first stenose has the maximum percentage. PMID:23678413
Razavi, Seyed Esmail; Zanbouri, Ramin; Arjmandi-Tash, Omid
Closed-chest totally endoscopic coronary artery bypass grafting (TECAB) is feasible using robotic technology. During the early phases, TECAB was restricted to single bypass grafts to the left anterior descending artery system. Because most patients referred for coronary artery bypass surgery have multivessel disease, development of endoscopic multiple bypass grafting is mandatory. Experimental work on multivessel TECAB was carried out in the early 2000s, and first clinical cases were already performed. With further technological development of operating robots, double, triple, and quadruple TECAB has become feasible both on the arrested heart and on the beating heart. To date, 161 cases of multivessel TECAB using the da Vinci telemanipulation systems are published in the literature. The main advances enabling multivessel TECAB were the availability of a robotic endostabilizer for beating heart procedures and increased surgeon skills using remote access heart-lung machine perfusion and endo-cardioplegia. Both internal mammary arteries can be harvested and both radial artery and vein graft can be used in multivessel TECAB. Y-grafting and sequential grafting are feasible. Multivessel endoscopic surgical revascularization can be combined with percutaneous coronary interventions in advanced hybrid coronary revascularization. Time requirements for multivessel TECAB are significant, and conversion rates to larger thoracic incisions are higher than those observed for single-vessel TECAB. Clinical short- and long-term outcomes, however, seem to meet the standards of open coronary bypass surgery through sternotomy. The main advantages of multivessel TECAB are a completely preserved sternum, use of double internal mammary artery even in risk groups, and a remarkably short recovery time. PMID:22576029
Bonatti, Johannes; Lee, Jeffrey D; Bonaros, Nikolaos; Schachner, Thomas; Lehr, Eric J
Can Plasma Fibrinogen Levels Predict Bleeding After Coronary Artery Bypass Grafting?
Background: Fibrinogen is the main biomarker for bleeding. To prevent excessive postoperative bleeding, it would be useful to identify high-risk patients before coronary artery bypass grafting (CABG). Objectives: In order to predicating bleeding after CABG, we sought to determine whether preoperative fibrinogen concentration was associated with the amount of bleeding following CABG. Patients and Methods: A total of 144 patients (mean age = 61.50 � 9.42 years; 65.7% men), undergoing elective and isolated CABG, were included in this case-series study. The same anesthesia technique and medicines were selected for all the patients. In the ICU, the patients were assessed in terms of bleeding at 12 and 24 hours post-operation, amount of contingent blood products received, and relevant tests. Statistical tests were subsequently conducted to analyze the correlation between preoperative fibrinogen concentration and the amount of post-CABG bleeding. Results: The mean � standard deviation of bleeding at 12 and 24 hours post-operation was 285.37 � 280.27 and 499.31 � 355.57 mL, respectively. The results showed that postoperative bleeding was associated with different factors whereas pre-anesthesia fibrinogen was not correlated with bleeding at 12 (P = 0.856) and 24 hours (P = 0.936) post-operation. There were correlations between the extra-corporal circulation time and bleeding at 12 hours post-operation (? = 0.231, P = 0.007) and bleeding at 24 hours post-operation (? = 0.218, P = 0.013). Conclusions: Preoperative assessment of plasma fibrinogen levels failed to predict post-CABG bleeding. PMID:25478546
Jalali, Alireza; Ghiasi, Mohammadsaeid; Aghaei, Aghdas; Khaleghparast, Shiva; Ghanbari, Behrooz; Bakhshandeh, Hooman
Background Atherosclerotic disease in coronary artery bypass grafting (CABG) patients is a potential contributor to complications in the perioperative periods. This study was undertaken to better define how the frequency of aortic atheromatous disease among patients coming for CABG has evolved over the last decade. Methods Data from elective patients coming for CABG who underwent transesophageal echocardiography (TEE) examinations following induction of anesthesia were obtained for the years 2002 and 2009. Aortas were graded according to the method of Kronzon, with the following interpretations: normal = grade I, intimal thickening = 2, atheroma of less than 5 mm = 3, atheroma of > 5 mm = 4, and any mobile atheroma = 5. The data of 124 patients who underwent comprehensive exam of the aorta by one cardiac anesthesiologist were gathered and assigned into two groups based on the year TEE was done. Student�s t-test was used for statistical analysis. A P value < 0.05 was considered significant. The data were presented as mean � SD. Results There was significant difference between group 2002 (2.05 � 1.28) and group 2009 (2.59 � 1.11) in atheroma grade (P = 0.013). Conclusions Patients coming for CABG in group 2009 exhibited significantly higher grades of aortic atheroma on TEE, compared to group 2002. Understanding the risk of atheroma in the elderly CABG population may help in altering surgical approaches to lessen the risk of catastrophic stroke. Potential options needing further study include the off-pump approach and modification of cross-clamp site and technique as well as other modalities. PMID:25379067
Denny, John T.; Pantin, Enrique; Chiricolo, Antonio; Tse, James; Denny, Julia E.; Mungekar, Sagar S.; Chyu, Darrick; Solina, Alann
Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed. PMID:6968314
Harris, P L; Woollard, K; Bartoli, A; Makey, A R
Heparin-bonded circuits improve clinical outcomes in emergency coronary artery bypass grafting.
Compared to patients undergoing elective or urgent coronary artery bypass grafting (CABG), those undergoing emergency CABG (EM-CABG) have a higher morbidity and mortality. The use of heparin-bonded circuits (HBC) has been shown to improve clinical outcomes in nonemergent CABG patients. It is not known, however, whether the improved hemostasis and attenuation of the inflammatory response to cardiopulmonary bypass, conferred by HBC, can overcome the high incidence of comorbid risk factors in (EM-CABG) patients and improve their outcomes. A retrospective analysis of 206 consecutive patients undergoing EM-CABG over 4 years (1993-1997) at one institution was performed. Eighty-one patients were treated with conventional non-heparin-bonded circuits (NHBC) with full anticoagulation protocol (FAP, activated clotting time [ACT] > 480 sec); 125 patients were treated with HBC and a lower anticoagulation protocol (LAP, ACT > 280 seconds). Outcomes and results were collected prospectively and are presented as mean +/- SD. Preoperative risk profiles were similar in both treatment groups. Postoperatively, compared with the NHBC group, patients treated with HBC/LAP required fewer homologous donor units (4.1 +/- 10.7 vs 8.2 +/- 13.6 units, p = 0.005), were less likely to require inotropic support (18.6% vs 38.3%, p = 0.005), and had a lower incidence of perioperative myocardial infarction (MI, 3.2% vs 12.3%, p = 0.04) and pulmonary complications (4.0% vs 12.3%, p = 0.04). The use of HBC/LAP resulted in a decreased incidence of postoperative complications (12.8% vs 28.4%, p = 0.01, odds ratio 0.37 with 95% confidence interval [CI] 0.18-0.76). This resulted in a shorter duration of ventilatory support (30.5 +/- 54.0 vs 72.8 +/- 16.7 hours, p = 0.009), ICU stay (38.2 +/- 36.5 vs 91.5 +/- 68.7 hours, p = 0.009), hospital stay (8.0 +/- 7.1 vs 11.0 +/- 8.9 days, p = 0.008), and therefore cost. In conclusion, the use of HBC/LAP in EM-CABG resulted in a reduction of homologous transfusion and postoperative complications associated with decreased hospital stays and cost. PMID:9690498
Aldea, G S; Lilly, K; Gaudiani, J M; O'Gara, P; Stein, D; Bao, Y; Treanor, P; Osman, A; Shapira, O M; Lazar, H L; Shemin, R J
Cardiopulmonary bypass has been reported to have many effects on the immune system. The aim of this study was to investigate\\u000a the efficiency and usefulness of off-pump coronary artery bypass (OPCAB) surgery on patients who had coronary artery disease\\u000a besides malign neoplasia. We applied OPCAB operations to 217 patients between March 2001 and April 2004, ten of whom had malign
?brahim �zs�yler; Levent Yilik; ?ahin Bozok; Bilgin Emrecan; Mert Kestell?; Nagihan Karahan; Ali G�rb�z
ObjectivesWe evaluated the effect of African American (AA) and Hispanic American (HA) ethnicity on mortality and complications following coronary artery bypass graft (CABG) surgery in the Veterans Health Administration (VHA).
John S Rumsfeld; Mary E Plomondon; Eric D Peterson; Michael G Shlipak; Charles Maynard; Gary K Grunwald; Frederick L Grover; A. Laurie W Shroyer
[Iliac aneurysm rupture during preconditioning with levosimendan for coronary artery bypass graft].
We present the case of a 77 year-old patient scheduled for coronary artery bypass. During the infusion of levosimendan as preconditioning for surgery, a rupture of right common iliac artery occurred. Surgery was delayed and an urgent aorto-bifemoral bypass was performed. We believe that the rupture of the artery was triggered by an increase in transmural pressure due to the inotropic effects of levosimendan in a dilated diseased vessel. To our knowledge, there are no cases of aneurysm rupture as a complication during levosimendan infusion, but the coincidence of events in time strongly suggests some kind of causal relationship. PMID:23664061
Rom�n Fern�ndez, A; L�pez �lvarez, A; Corujeira Rivera, M C; Vilanova V�zquez, V; Carregal Ra��, A; Pereira Loureiro, M �
Background Stents are now used in the majority of percutaneous coronary revascularization procedures. It is not clear whether the higher initial cost of stenting is later repaid by reducing costly complications and repeat revascularization procedures, especially for patients with multivessel disease. Methods To project the long-term costs of using coronary stents, angioplasty, or bypass surgery to treat patients with multivessel
Cynthia A. Yock; Derek B. Boothroyd; Douglas K. Owens; Carla Winston; Mark A. Hlatky
Post angioplasty coronary artery bypass grafting in patient with myasthenia gravis.
A 62 years old patient developed myasthenia gravis 2 years after his percutaneous coronary intervention. He was advised thymectomy for myasthenia gravis. During his cardiological evaluation, he was incidentally diagnosed to have 3 vessel disease. Hence, a simultaneous surgical intervention was performed consisting of thymectomy and CABG via standard cardiopulmonary bypass through median sternotomy. Previous medical history of diabetes and corticosteroid therapy made the patient immunocompromised. Therefore, a careful overall therapeutic strategy was devised to prevent mediastinitis. After his thymectomy and coronary artery bypass grafting, he was extubated within 6 hours. Plasmapheresis was done one day before the surgery and on first postoperative day. His medications for myasthenia gravis (pyridostigmine and prednisolone) were not stopped before and after the surgery. Patient was discharged on 6th postoperative day without any complications. On his follow-up 6 weeks postoperatively, his condition was unremarkable. PMID:25518756
Hasan Zaidi, Syed Danish; Khan, Muhammad Shahzeb; Bawany, Faizan Imran; Dar, Mudassir Iqbal; Khan, Abdul Bari
Digital tools to facilitate intraoperative coronary artery bypass graft patency assessment.
Intraoperative graft failure is an important cause of cardiac mortality and morbidity. Hence, verification of graft patency should be one of the most important aspects of coronary artery bypass grafting. Although several techniques have been advocated to assess intraoperative graft patency, there is no unanimously accepted method. Intraoperative fluorescence imaging is a novel technique based on the fluorescence of indocyanine green dye, which provides real-time visual images of graft flow in the operating room. Transit-time flowmetry is based on the ultrasound principle and provides mean graft flow and derived values such as pulsatility index. This article describes the usefulness and limitations of various techniques in general and summarizes the current knowledge with the use of these two techniques in the setting of intraoperative coronary artery bypass graft patency assessment. PMID:15619196
Balacumaraswami, Lognathen; Taggart, David P
Risk-Adjusted Survival after Coronary Artery Bypass Grafting: Implications for Quality Improvement
Mortality represents an important outcome measure following coronary artery bypass grafting. Shorter survival times may reflect poor surgical quality and an increased number of costly postoperative complications. Quality control efforts aimed at increasing survival times may be misleading if not properly adjusted for case-mix severity. This paper demonstrates how to construct and cross-validate efficiency-outcome plots for a specified time (e.g., 6-month and 1-year survival) after coronary artery bypass grafting, accounting for baseline cardiovascular risk factors. The application of this approach to regional centers allows for the localization of risk stratification rather than applying overly broad and non-specific models to their patient populations. PMID:25050654
Efird, Jimmy T.; O�Neal, Wesley T.; Davies, Stephen W.; O�Neal, Jason B.; Kindell, Linda C.; Anderson, Curtis A.; Chitwood, W. Randolph; Ferguson, T. Bruce; Kypson, Alan P.
Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery
We conducted a study to compare the effectiveness of patientcontrolled analgesia (PCA) technique to conventional analgesic\\u000a therapy (CAT) after coronary artery bypass graft (CABG). The PCA group received hydromorphone 0.1 mg � hr?1 basal infusion and bolus doses of 0.2 mg Q 5 min (maximum 1.2 mg � hr?1) while the CAT group received morphine 2.5 mg iv Q 30
Norman R. Searle; Micheline Roy; Georges Bergeron; Jean Perrault; Jeanne Roof; Corrie Heermans; Micheline Courtemanche; Christine Derners; Raymond Cartier
Background. Supraventricular tachyarrhythmia (SVT) commonly occurs shortly after coronary artery bypass grafting (CABG), but ventricular arrhythmias are less documented.Methods. On the 1st postoperative day, 206 consecutive eligible patients were prospectively randomized to a sotalol group (80 mg b.i.d.; n = 103) or a control group without ?-blockade or antiarrhythmic drugs (n = 103).Results. The SVT incidence (predominantly atrial fibrillation) accounted
Patrick Evrard; Manuel Gonzalez; Jacques Jamart; Brigitte Malhomme; Dominique Blommaert; Philippe Eucher; Etienne Install�
Concomitant coronary bypass and below knee amputation in a diabetic patient.
A 57-year-old man presented with unstable angina and uncontrolled diabetes with diabetic foot. It was decided to perform right below knee amputation with coronary revascularization in a single stage. Right below knee amputation was carried out first. The left anterior descending artery, ramus intermedius, and second obtuse marginal branch of the circumflex were bypassed on a beating heart, using saphenous vein grafts. The patient was discharged on the 7th postoperative day after a course of antibiotics. PMID:24887827
Khanna, Surendra Nath; Paul, Mathews; Sharma, Krishnan K; Karlekar, Anil
Early complications and long-term survival in severely obese coronary bypass patients.
Our objective was to describe the short-term morbidity of coronary artery bypass operations and the effect of surgery plus aggressive cardiac rehabilitation on the long-term prognosis of severely obese patients with coronary artery disease. We investigated an inception cohort of 28 consecutive severely obese patients with three-vessel coronary disease followed on average for 51 months. The patients' age, preoperative and postoperative weight, risk factors, and cholesterol were measured. We performed coronary artery bypass surgery, then began aggressive cardiac rehabilitation programs. We recorded intraoperative data, perioperative deaths, complications, readmissions, and lengths of stay. Also, New York Heart classifications and use of anti-anginal or cholesterol-lowering medications were noted. All patients were followed up. Despite high morbidity, long-term function and survival of severely obese CABG patients compares favorably with that of average patients. However, aggressive behavior modification fails to alter their postoperative weight or risk profile, placing them at risk for both second CABG procedures and continued obesity-related disease occurrences. PMID:7486423
Rohs, T; Polanski, P; Just, S C; Gordon, W; Just-Viera, J O
Off-pump coronary artery bypass grafting using skeletonized in situ arterial grafts
Skeletonization is an advanced technique of graft harvesting for coronary artery bypass grafting (CABG), and while it requires meticulous attention, it has many advantages. For example, skeletonization of internal thoracic artery (ITA) can minimize sternal ischemia and lower the risk of mediastinitis, and is longer and larger than pedicled ITA. In this article we describe the surgical techniques demonstrated in our video, which details our techniques of skeletonization of arterial grafts and off-pump coronary artery bypass (OPCAB) exclusively using these in situ grafts. Our method of right gastroepiploic artery (GEA) skeletonization has only three technical steps. The first step is to pass thin vessel loops under the GEA. The second step is to unroof the tissue surrounding the GEA. The last step is to seal and sever all the branches. Skeletonization of the GEA not only prevents vasospasm but also leads to GEA dilatation, and facilitates inspection and makes sequential anastomosis easier. Bilateral use of the skeletonized ITA and use of the skeletonized GEA can cover most coronary artery target sites without any manipulation of the ascending aorta. In our consecutive series of over 1,000 patients, the stroke rate was 0.5%. Our method helps to make the technique simple and secure in this technically demanding operation, and we believe that OPCAB with these grafts provides the best possible coronary revascularization. PMID:23977635
Suzuki, Tomoaki; Nota, Hiromitsu; Kuroyanagi, Satoshi; Kinoshita, Takeshi; Takashima, Noriyuki; Hayakawa, Masato; Naito, Shiho
OBJECTIVE�To investigate the value of coronary pressure derived fractional flow reserve (FFR) measurements in supporting decisions about medical or surgical treatment in patients with angiographically equivocal left main coronary artery stenosis.?DESIGN�A two centre prospective single cohort follow up study.?INTERVENTIONS�FFR of the left main coronary artery was determined in 54�consecutive patients with angiographically equivocal left main coronary artery disease. If FFR was ?�0.75, medical treatment was chosen; if FFR was <�0.75, surgical treatment was chosen.?MAIN OUTCOME MEASURES�Freedom from death, myocardial infarction, or any coronary revascularisation procedure.?RESULTS�In 24�patients (44%), FFR was ?�0.75 and medical treatment was chosen (medical group). In the remaining 30�patients (56%), FFR was <�0.75 and bypass surgery was performed (surgical group). Mean (SD) follow up was 29�(15) months (range 12-65 months). Survival among patients at three years of follow up was 100% in the medical group and 97% in the surgical group. Event-free survival was 76% in the medical group and 83% in the surgical group.?CONCLUSIONS�FFR supports decision making in equivocal left main coronary artery disease. If FFR is below 0.75,�the decision for bypass surgery is supported. If FFR is above 0.75,�a conservative approach is justified.???Keywords: coronary artery disease; left main coronary artery; fractional flow reserve; coronary artery bypass PMID:11602550
Bech, G; Droste, H; Pijls, N; De Bruyne, B; Bonnier, J; Michels, H; Peels, K; Koolen, J
Patient-Specific Multiscale Modeling of Blood Flow for Coronary Artery Bypass Graft Surgery
We present a computational framework for multiscale modeling and simulation of blood flow in coronary artery bypass graft (CABG) patients. Using this framework, only CT and non-invasive clinical measurements are required without the need to assume pressure and/or flow waveforms in the coronaries and we can capture global circulatory dynamics. We demonstrate this methodology in a case study of a patient with multiple CABGs. A patient-specific model of the blood vessels is constructed from CT image data to include the aorta, aortic branch vessels (brachiocephalic artery and carotids), the coronary arteries and multiple bypass grafts. The rest of the circulatory system is modeled using a lumped parameter network (LPN) 0 dimensional (0D) system comprised of resistances, capacitors (compliance), inductors (inertance), elastance and diodes (valves) that are tuned to match patient-specific clinical data. A finite element solver is used to compute blood flow and pressure in the 3D (3 dimensional) model, and this solver is implicitly coupled to the 0D LPN code at all inlets and outlets. By systematically parameterizing the graft geometry, we evaluate the influence of graft shape on the local hemodynamics, and global circulatory dynamics. Virtual manipulation of graft geometry is automated using Bezier splines and control points along the pathlines. Using this framework, we quantify wall shear stress, wall shear stress gradients and oscillatory shear index for different surgical geometries. We also compare pressures, flow rates and ventricular pressure�volume loops pre- and post-bypass graft surgery. We observe that PV loops do not change significantly after CABG but that both coronary perfusion and local hemodynamic parameters near the anastomosis region change substantially. Implications for future patient-specific optimization of CABG are discussed. PMID:22539149
Sankaran, Sethuraman; Moghadam, Mahdi Esmaily; Kahn, Andrew M.; Tseng, Elaine E.; Guccione, Julius M.; Marsden, Alison L.
The efficacy of percutaneous transluminal angioplasty in improving recurrent anginal symptoms and myocardial perfusion after coronary artery bypass graft surgery was assessed prospectively in 55 patients, of whom 50 had an initial angiographic and clinical success. Although 80% of those successfully dilated were initially free of angina at 23 +/- 11 months of follow-up, one half of these patients had recurrent angina. Although only 48% of the patient cohort had complete relief of angina, 94% had less angina than before dilatation and 86% were able to decrease antianginal medications. Fifteen patients with persistent or recurrent angina had from one to five repeat dilatations. After angioplasty, lung thallium uptake, the extent of abnormal scan segments, and the magnitude of redistribution in dilated lesions were significantly reduced (n = 24 patients). Redistribution defects were seen in 38% of patients on postangioplasty scans. All were associated with subsequent angina. Of various clinical, angiographic, exercise, and thallium-201 scan variables, only the presence of delayed redistribution was an independent predictor of recurrent angina. Restenosis was the most common underlying cause for this exercise-induced perfusion defect. Thus percutaneous coronary angioplasty performed as primary therapy for recurrent angina after bypass surgery is moderately successful in long-term follow-up for the amelioration of symptoms and enhancement of regional myocardial perfusion.
Reed, D.C.; Beller, G.A.; Nygaard, T.W.; Tedesco, C.; Watson, D.D.; Burwell, L.R.
The Randomized Endo-vein Graft Prospective (REGROUP) trial (ClinicalTrials.gov NCT01850082) is a randomized, intent-to-treat, 2-arm, parallel-design, multicenter study funded by the Cooperative Studies Program (CSP No. 588) of the US Department of Veterans Affairs. Cardiac surgeons at 16 Veterans Affairs (VA) medical centers with technical expertise in performing both endoscopic vein harvesting (EVH) and open vein harvesting (OVH) were recruited as the REGROUP surgeon participants. Subjects requiring elective or urgent coronary artery bypass grafting using cardiopulmonary bypass with use of ?1 saphenous vein graft will be screened for enrollment using pre-established inclusion/exclusion criteria. Enrolled subjects (planned N = 1150) will be randomized to 1 of the 2 arms (EVH or OVH) after an experienced vein harvester has been assigned. The primary outcomes measure is the rate of major adverse cardiac events (MACE), including death, myocardial infarction, or revascularization. Subject assessments will be performed at multiple times, including at baseline, intraoperatively, postoperatively, and at discharge (or 30 days after surgery, if still hospitalized). Assessment of leg-wound complications will be completed at 6 weeks after surgery. Telephone follow-ups will occur at 3-month intervals after surgery until the participating sites are decommissioned after the trial's completion (approximately 4.5 years after the full study startup). To assess long-term outcomes, centralized follow-up of MACE for 2 additional years will be centrally performed using VA and non-VA clinical and administrative databases. The primary MACE outcome will be compared between the 2 arms, EVH and OVH, at the end of the trial duration. PMID:24633760
Zenati, Marco A; Gaziano, J Michael; Collins, Joseph F; Biswas, Kousick; Gabany, Jennifer M; Quin, Jacquelyn A; Bitondo, Jerene M; Bakaeen, Faisal G; Kelly, Rosemary F; Shroyer, A Laurie; Bhatt, Deepak L
Background Elevated baseline C-reactive protein (CRP) levels are associated with increased risk for developing cardiovascular disease. Several CRP gene variants have been associated with altered baseline CRP levels in ambulatory populations. However, the influence of CRP gene variants on CRP levels during inflammatory states, such as surgery, is largely unexplored. We describe the association between candidate CRP gene variants and postoperative plasma CRP levels in patients undergoing primary, elective coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). Methods Using a multicenter candidate gene association study design, we examined the association between seventeen candidate CRP single nucleotide polymorphisms (SNPs) and inferred haplotypes, and altered postoperative CRP levels in 604 patients undergoing CABG surgery with CPB. Perioperative CRP levels were measured immediately prior to surgery, post-CPB and on postoperative days (POD) 1�4. Results CRP levels were significantly elevated at all postoperative time points when compared with preoperative levels (P < 0.0001). After adjusting for clinical covariates, the minor allele of the synonymous coding SNP, rs1800947 was associated with lower peak postoperative CRP levels (P = 2.4 � 10-4) and lower CRP levels across all postoperative time points (P = 4.8 � 10-5). rs1800947 remained highly significant after Bonferroni adjustment for multiple comparisons. Conclusion We identified a CRP gene SNP associated with lower postoperative CRP levels in patients undergoing CABG surgery with CPB. Further investigation is needed to clarify the significance of this association between CRP gene variants and the acute-phase rise in postoperative CRP levels with regard to the risk of adverse postoperative outcomes. PMID:19426506
Perry, Tj�rvi E; Muehlschlegel, Jochen D; Liu, Kuang-Yu; Fox, Amanda A; Collard, Charles D; Body, Simon C; Shernan, Stanton K
Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review
In this paper, coronary arterial bypass grafting hemodynamics and anastomosis designs are reviewed. The paper specifically addresses the biomechanical factors for enhancement of the patency of coronary artery bypass grafts (CABGs). Stenosis of distal anastomosis, caused by thrombosis and intimal hyperplasia (IH), is the major cause of failure of CABGs. Strong correlations have been established between the hemodynamics and vessel wall biomechanical factors and the initiation and development of IH and thrombus formation. Accordingly, several investigations have been conducted and numerous anastomotic geometries and devices have been designed to better regulate the blood flow fields and distribution of hemodynamic parameters and biomechanical factors at the distal anastomosis, in order to enhance the patency of CABGs. Enhancement of longevity and patency rate of CABGs can eliminate the need for re-operation and can significantly lower morbidity, and thereby reduces medical costs for patients suffering from coronary stenosis. This invited review focuses on various endeavors made thus far to design a patency-enhancing optimized anastomotic configuration for the distal junction of CABGs. PMID:24330653
BACKGROUND/OBJECTIVE: The development of acute renal injury (ARI) is an important indicator of clinical outcomes after cardiac surgery. Neutrophil gelatinase-associated lipocalin (NGAL) has been certified as a predictive biomarker of hypoxic ARI. The present study aimed to determine the predictive role of NGAL in coronary bypass graft (CABG) surgery. METHOD: A total of 72 consecutive patients undergoing elective CABG were enrolled in the study. NGAL levels were determined preoperatively and postoperatively after 6 h, 24 h and 72 h for all participants. The participants were then divided into two groups according to their preoperative creatinine levels (group I, creatinine 111.38 ?mol/L to 361.55 ?mol/L; group II, creatinine <111.38 ?mol/L). RESULTS: There was no statistically significant difference between the groups according to their NGAL values (P>0.05), except at 6 h (P=0.045). Three patients required continuous hemodialysis. Comparison of the NGAL levels of these three patients with those of the other participants did not reveal any correlation with serum creatinine levels. In contrast, the NGAL levels were significantly lower in the continuous hemodialysis patients (1.9�1 ng/mL) compared with those of the other participants (22.6�12.8 ng/mL; P=0.001). CONCLUSION: NGAL is one of the most frequently used biomarkers for ARI after cardiac operations, especially in younger patients. The participants in the present study were coronary artery disease patients and were, therefore, older than patients in previous reports. These results support the view that NGAL is not a relevant predictive factor for ARI in patients with CABG, including older patients. PMID:23940432
Demirtas, Sinan; Caliskan, Ahmet; Karahan, Oguz; Yavuz, Celal; Guclu, Orkut; Cayir, Mustafa Cagdas; Toktas, Faruk; Tiryakioglu, Osman
Cerebral hemodynamics during coronary artery bypass graft surgery: the effect of carotid stenosis.
Carotid stenosis is a frequent coexisting condition in patients undergoing coronary artery bypass graft (CABG) surgery. The impact of carotid stenosis on cerebral perfusion is not fully understood. The purpose of this study was to determine the impact of carotid stenosis on cerebral blood flow velocity in patients undergoing CABG. Seventy-three patients undergoing CABG were prospectively recruited and underwent preoperative Duplex carotid ultrasound to evaluate the degree of carotid stenosis. Intraoperatively, transcranial Doppler ultrasound was used to record the mean flow velocity (MFV) within the bilateral middle cerebral arteries. In addition, during the period of cardiopulmonary bypass, regulators of cerebral hemodynamics such as hematocrit, partial pressure of carbon dioxide and temperature were recorded. The ipsilateral middle cerebral artery mean flow velocity was compared in arteries with and without carotid stenosis using a repeated measures analysis. Seventy-three patients underwent intraoperative monitoring during CABG and 30% (n=22) had carotid stenosis. Overall, MFV rose throughout the duration of CABG including when the patient was on cardiopulmonary bypass. However, there was no significant MFV difference between those arteries with and without stenosis (F=1.2, p=.21). Further analysis during cardiopulmonary bypass, demonstrated that hemodilution and partial pressure of carbon dioxide may play a role in cerebral autoregulation during CABG. Carotid stenosis did not impact mean cerebral blood flow velocity during CABG. The cerebrovascular regulatory process appears to be largely intact during CABG. PMID:19540657
Rudolph, James L; Sorond, Farzaneh A; Pochay, Val E; Haime, Miguel; Treanor, Patrick; Crittenden, Michael D; Babikian, Viken L
[Ultrasonic doppler flowmetry in intraoperative diagnosis of coronary bypass grafts incompetence].
According to the findings of many authors, occlusion of bypass grafts may develop as early as during surgery in 4-12% of patients. At discharge from hospital this index may reach 5-20%, increasing to 30% within the first year. Incompetence of bypass grafts is in many cases a consequence of errors in surgical technique and may therefore be decreased by means of improving the control over quality of coronary bypass grafting. Using the method of ultrasound Doppler flowmetry in the conditions of artificial circulation and clamped artery, we assessed a total of 64 composite bypass grafts. Blood flow was assessed by such parameters as the pulsatility index (PI), mean volumetric blood flow velocity (Qmean), and percentage of diastolic volumetric filling (DF). The obtained results were statistically processed. The mean values of blood flow parameters were obtained, followed by determining dependence between peripheral resistance (PI) prior to removal of the clamp from the aorta and peripheral resistance (PI) measured after termination of extracorporeal circulation. PMID:24722020
Bazylev, V V; Rosse?kin, E V; Mikuliak, A I; Karpun'kin, O A
Changing profile of elderly patients undergoing coronary bypass surgery
Objective Are elderly patients now undergoing CABG at higher risk than several years ago? Methods 1536 patients, aged between 70 and 77 years, who underwent CABG between January 1987 and December 2001, were analysed. Group A 1987-1989 (n=177); group B 1990-1992 (n=243); group C 1993-1995 (n=362); group D 1996-1998 (n=418); and group E 1999-2001 (n=336). The Euroscore evaluated operative risk. Results There was an increase in the percentage of the study population from 12.5 to 24.1% (p=0.000). Mean age increased from 72.1�1.8 to 73.2�1.9 years (p=0.047). The percentage of patients with neurological (p=0.002), renal (p=0.013) and lung disease (p=0.04), a previous PTCA (p=0.000), left main stenosis (p=0.003), impaired ventricular function (p=0.000) and reoperations (p=0.01) increased. Emergency/urgent operations (p=0.001) decreased. Hospital mortality decreased from 7.3 to 5.7% (p=0.34). Only neurological problems increased significantly (p=0.03). The calculated operative risk by Euroscore remained stable (p=0.28). To eliminate the influence of the urgent/emergency situation, the Euroscore was recalculated, supposing that all patients were elective. At that moment a significant increase in the operative risk was seen (p=0.02). Conclusion Over the last few years there has not only been an increase in the number of older patients undergoing CABG, but even in this older population there is an increasing number of high-risk patients.
Cloin, E.C.W.; Noyez, L.
Many patients undergo elective coronary angiography without pre-procedural stress testing which may be suitable if performed in patients with more angina pectoris or more frequently identified obstructive coronary artery disease (CAD). Patients in the NCDR CathPCI Registry� undergoing elective coronary angiography between July 2009 and April 2013 were assessed for differences in angina (Canadian Cardiovascular Society [CCS] class) and severity of obstructive CAD in those with and without pre-procedural stress testing, stratified by prior CAD history. Given the large sample size, differences were considered clinically meaningful if the standardized difference (SD) was >10%. Of 790,601 patients without prior CAD history, 36.9% did not undergo prior stress testing. Compared to patients with prior stress testing, patients without prior stress testing were more frequently angina free (CCS class 0; 28.2% with stress test vs. 38.5% without, SD=14.8%) and had similar rates of obstructive CAD (40.1% with stress test vs. 35.7% without, SD=9.0). Among 449,579 patients with prior CAD history, 44.2% did not undergo prior stress testing. Patients without prior stress testing reported more angina (CCS Class III/IV angina: 17.8% vs. 13.4%; SD=11.3%) but were not more likely to have obstructive CAD (78.7% vs. 81.1%; SD=5.8%) than patients with prior stress testing. In conclusion, approximately 40% of patients undergoing elective coronary angiography did not have pre-procedural risk stratification with stress testing. For these patients, the clinical decision to proceed directly to invasive evaluation was not driven primarily by severe angina and did not result in higher detection rates for obstructive CAD. PMID:24890987
Abdallah, Mouin S.; Spertus, John A.; Nallamothu, Brahmajee K.; Kennedy, Kevin F.; Arnold, Suzanne V.; Chan, Paul S.
Many patients undergo elective coronary angiography without preprocedural stress testing that may be suitable if performed in patients with more angina pectoris or more frequently identified obstructive coronary artery disease (CAD). Patients in the National Cardiovascular Data Registry CathPCI Registry undergoing elective coronary angiography from July 2009 to April 2013 were assessed for differences in angina (Canadian Cardiovascular Society [CCS] class) and severity of obstructive CAD in those with and without preprocedural stress testing, stratified by CAD history. Given the large sample size, differences were considered clinically meaningful if the standardized difference (SD) was >10%. Of 790,601 patients without CAD history, 36.9% did not undergo preprocedural stress testing. Compared with patients with preprocedural stress testing, patients without preprocedural stress testing were more frequently angina free (CCS class 0; 28.2% with stress test vs 38.5% without, SD�= 14.8%) and had similar rates of obstructive CAD (40.1% with stress test vs 35.7% without, SD�= 9.0). Of 449,579 patients with CAD history, 44.2% did not undergo preprocedural stress testing. Patients without preprocedural stress testing reported more angina (CCS class III/IV angina: 17.8% vs 13.4%; SD�= 11.3%) but were not more likely to have obstructive CAD (78.7% vs 81.1%; SD�= 5.8%) than patients with preprocedural stress testing. In conclusion, approximately 40% of patients undergoing elective coronary angiography did not have preprocedural risk stratification with stress testing. For these patients, the clinical decision to proceed directly to invasive evaluation was not driven primarily by severe angina and did not result in higher detection rates for obstructive CAD. PMID:24890987
Abdallah, Mouin S; Spertus, John A; Nallamothu, Brahmajee K; Kennedy, Kevin F; Arnold, Suzanne V; Chan, Paul S
We report a case of sudden death in Takayasu arteritis after coronary artery bypass. A 22-year-old girl visited our hospital in June 2009 because of paroxysmal chest tightness and shortness of breath for 2 years. She was diagnosed as Takayasu arteritis, the limited stenosis of upper aorta ventralis, low perfusion pressure changes of double renal artery and double lower limbs artery, left ventricular mural thrombus and patent foramen ovale. The coronary artery bypass grafting was conducted. However, the symptoms were recurrent 2 months later. PMID:24482725
Zhang, Hongming; Liu, Danan; Li, Xiaoyan; Tan, Hong; Jin, Qun; Liu, Xunwei
Pregnancy after myocardial infarction and coronary artery bypass grafting � is it safe?
Pregnancy after myocardial infarction (MI) and coronary artery bypass grafting (CABG), although still rare, is slowly becoming a challenge in everyday clinical practice. In recent decades MI has been observed to occur more frequently in young women. Concurrently an increasing number of women decide to become pregnant at more advanced age. Although pregnancy after MI and CABG may be possible and safe, a multidisciplinary approach involving careful evaluation by the cardiac and obstetric team in each individual is mandatory. Two cases of pregnant women with a history of MI treated with CABG are presented and their management is discussed. PMID:24799925
Janion-Sadowska, Agnieszka; Sadowski, Marcin; Kurzawski, Jacek; Polewczyk, Anna; Janion, Marianna
Technical issues in the use of the radial artery as a coronary artery bypass conduit.
The clinical and angiographic benefits related to the use of the radial artery (RA) as a bypass conduit have extensively been proven. However, due to its morpho-functional features and its anatomic position, successful use of the RA requires careful consideration of several technical issues. We herein summarize the current evidence on all the technical aspects related to the RA use in coronary surgery such as the preoperative evaluation of ulnar compensation, the different means of intraoperative vasodilatation, and the various harvesting techniques. PMID:25443025
Gaudino, Mario; Crea, Filippo; Cammertoni, Federico; Mazza, Andrea; Toesca, Amelia; Massetti, Massimo
We aimed to evaluate image quality, radiation dose and diagnostic accuracy of coronary CT angiography (CCTA) with a prospectively\\u000a gated transverse-axial scan (PGT) compared with a retrospectively gated helical scan (RGH), using a 64-slice scanner in patients\\u000a who underwent coronary artery bypass graft (CABG). Of the 131 consecutive patients that underwent CABG using 64-slice multidetector\\u000a row computed tomography during 2008,
Jae Hwan Lee; Eun Ju Chun; Sang Il Choi; Mani Vembar; Cheong Lim; Kay-Hyun Park; Dong-Ju Choi
We have performed 12 cases of robotically assisted coronary artery bypass grafting (CABG) to accomplish less invasive revascularization. In this report, we describe a new method of robotically assisted internal thoracic artery (ITA) harvesting via subxiphoid approach, using the da Vinci surgical system. A 22-year-old man with three-vessel coronary artery disease due to Kawasaki disease was referred to our institution
Munehisa Takata; Go Watanabe; Teruaki Ushijima; Norihiko Ishikawa
One of the serious complications followingcoronary artery bypass surgery is postoperative acute myocardial infarction commonly due to graft thrombosis, kinking, or spasm. Two recommended approaches for management of this event includeRescue percutaneous coronary intervention (PCI) and urgent open heart surgery. In the present case series, we described and compared early and long-term results of rescue PCI and reoperation in patients with three-vessel coronary artery disease undergoing CABG postoperatively and suffered acute myocardial infarction. PMID:25567467
Sadeghi, Mohsen Mirmohammad; Hashemi, Mohammad; Rabbani, Majid; Gharipour, Mojgan; Nilfroush, Peyman; Majidi, Elham; Farahamand, Niloufar; Sadeghi, Poya Mirmohammad
Cardiopulmonary bypass has been reported to have many effects on the immune system. The aim of this study was to investigate the efficiency and usefulness of off-pump coronary artery bypass (OPCAB) surgery on patients who had coronary artery disease besides malign neoplasia. We applied OPCAB operations to 217 patients between March 2001 and April 2004, ten of whom had malign neoplasia. These patients were diagnosed to have coronary artery disease on their routine examination for their oncologic operation. The malignancies were stomach cancer (2 patients), colon-rectum carcinoma (3 patients), breast carcinoma (2 patients), surrenal carcinoma (1 patient), larynx carcinoma (1 patient), and meningioma (1 patient). The patients were operated on for their neoplasia by the related clinics at a mean of 42 days after the OPCAB surgery. The patients were discharged with surgical success and without any cardiac complications. Coronary artery bypass surgery before a noncardiac major operation may effectively decrease the long-term mortality due to myocardial ischemia. Severe coronary artery disease should be surgically treated in those patients who are scheduled to undergo an operation for malign neoplasia. Extracorporeal circulation impairs the immune system and negatively affects the defense of host against malignancy. Therefore, patients with severe coronary artery disease who are candidates for oncologic operation should be treated with OPCAB. PMID:17143712
Ozs�yler, Ibrahim; Yilik, Levent; Bozok, Sahin; Emrecan, Bilgin; Kestelli, Mert; Karahan, Nagihan; G�rb�z, Ali
[Off-pump coronary artery bypass grafting using donut and SPY].
Off-pump coronary artery bypass grafting (OPCAB) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on operators' capability due to technical difficulties. In this article, detail operative procedures are introduced to perform OPCAB in 100% for isolated coronary patients. Selecting better stabilizer may be a key of success. Donut Heart Stabilizer can make a still and stable operative field to anastomose less than 1 mm coronary artery. It is very useful to achieve complete revascularization for all stenosed coronary branches. OPCAB with 9 arterial grafts could be done using Donut. SPY Intra-operative Imaging System is also important to get 100% patency rate of the grafts. Using SPY, we can avoid graft trouble during operation in operation room (OR). SPY image is the best key information for operators to decide revision of the failed grafting. Donut 2 Heart Stabilizer has been improved to make more wide and stable operative field. Donut and SPY is the best combination for OPCAB. PMID:12910938
Takahashi, M; Ishikawa, T; Higashidani, K; Katoh, H
Objectives To assess the results of transit time flowmetry (TTF) on a consecutive group of coronary artery bypass grafting (CABG) patients at Queen Alia Heart Institute. Methods Intraoperative flow measurements of a consecutive group of 436 CABG patients. The flow pattern for each coronary artery system was assessed including mean flows, pulsatility index (PI) and the need for revision. Results A total of 1394 grafts in 436 patients were assessed (3.2 grafts per patient), wherein 100 grafts showed inadequate flowmetry results (7.2%); most of which were in the circumflex and right coronary artery systems with a percentage of 9.4% and the least in the LAD system with a percentage of 4.4%. The mean flow of grafts to the LAD system was 33.4�5.3 mL/min with a PI of 2.4�0.4; while the mean for grafts to the circumflex artery system was 35.1�7.2 mL/min with a PI of 3.5�0.7. The mean for the right coronary artery was 38.4�5.9 mL/min with a PI of 2.6�0.6. Revisions occurred in five patients (1.1%). Suboptimal grafts to the LAD system exhibited a flow of 14.1�7.4 mL/min with a PI of 6.9�1.7. While for the circumflex system a flow of 5.5�3.6 mL/min was reported with a PI of 10.4�7.8; and for the right coronary system a flow of 7.2�5.3 mL/min with a PI of 9.1�5.7 was reported. Conclusion Grafts to the LAD system showed the best flowmetry results compared to grafts to the circumflex and right coronary systems. A proportion of poor grafts were revised. PMID:23226818
Harahsheh, Basel
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. PMID:20423499
We present a patient who developed recurrent angina after coronary artery bypass grafting (CABG). Myocardial single-photon emission computed tomography (SPECT) demonstrated deterioration in the myocardial perfusion, and coronary angiography revealed an overgrown side branch of the grafted left internal thoracic artery (ITA); otherwise, there were no significant changes compared with previous imaging studies obtained after the CABG. After percutaneous embolization of the grafted left ITA side branch, the angina was resolved and myocardial SPECT showed improved perfusion. PMID:25346902
Kim, Eung Re; Oh, Se Jin; Kang, Hyun-Jae; Kim, Ki-Bong
Background: Staged hybrid revascularization integrated with minimally invasive coronary artery bypass grafting (CABG) and arrested heart totally endoscopic CABG has been reported. We report the first case of planned simultaneous hybrid coronary revascularization, integrating beating-heart TECAB, and percutaneous intervention (PCI) in the same operative setting. Methods: A 73-year-old woman with symptoms of angina and a history of diabetes was found
Sudhir Srivastava; Suresh Gadasalli; Orlando Tijerina; Reyna Barrera; Shaune Quismundo; Vishwa Srivastava
Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft
Objective To evaluate the outcome of off-pump coronary artery bypass grafting (OPCABG) using a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. Methods From October 2002 to December 2008, 208 patients (196 males and 12 females) underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 � 11.3 years, with an age range of 33�78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries (IMAs), and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery (LIMA) in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intra-operatively with the HT311 transit time flowmeter. Results A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5 � 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. Conclusions OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions. PMID:23097654
Gu, Cheng-Xiong; Yang, Jun-Feng; Zhang, Hong-Chao; Wei, Hua; Li, Ling-Ke
Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery
Patient: Male, 73 Final Diagnosis: Coronary artery thrombosis Symptoms: Angina pectoris � short of breath Medication: � Clinical Procedure: CABG Specialty: Cardiology Objective: Management of emergency care Background: Intra-operative formation of a thrombus in the right heart is rare and might be unrecognized. However, it can be associated with severe consequences, including pulmonary embolism and death. Case Report: We report the case of a 73-year-old man who presented to the cardiologist with angina pectoris and rare shortness of breath. Coronary artery bypass grafting (CABG) was performed due to multi-vessel disease. Because of hemodynamic insufficiency, an intra-operative transesophageal echocardiogram (TEE) was performed and a huge free-floating thrombus was detected. Multiple thrombi were removed from the right heart and pulmonary arteries. The patient died after cardiopulmonary bypass support and 12 hours of intensive care. Conclusions: In this case report, we emphasize the importance of the TEE during the preoperational period and during CABG, as well as in the preoperative evaluation of pulmonary hypertension. PMID:24116264
Senarslan, Omer; Zungur, Mustafa; Uyar, ?hsan Sami; Uyar, Samet; Tavli, Talat; Alayunt, Emin Alp
Coronary artery bypass grafting (CABG) was first used in the late 1960s. This revolutionary procedure created hope among ischemic heart disease patients. Multiple conduits are used and the golden standard is the left internal mammary artery to the left anterior descending artery. Although all approaches were advocated by doctors, the use of saphenous vein grafts became the leading approach used by the majority of cardiac surgeons in the 1970s. The radial artery graft was introduced at the same time but was not as prevalent due to complications. It was reintroduced into clinical practice in 1989. The procedure was not well received initially but it has since shown superiority in patency as well as long-term survival after CABG. This review provides a summary of characteristics, technical features and patency rates of the radial artery graft in comparison with venous conduits. Current studies and research into radial artery grafts and saphenous vein grafts for CABG are explored. However, more studies are required to verify the various findings of the positive effects of coronary artery bypass grafting with the help of radial arteries on mortality and long-lasting patency. PMID:24198449
Al-Sabti, Hilal Ali; Al Kindi, Adil; Al-Rasadi, Khalid; Banerjee, Yajnavalka; Al-Hashmi, Khamis; Al-Hinai, Ali
Subintimal tracking and re-entry (STAR) technique has been described as a bailout strategy for coronary total occlusion (CTO) recanalization. However, the length of the dissected segment represents a major concern. The aim of this study is, to evaluate whether "deferred" stent implantation may limit the total stent length following STAR recanalization of CTO. All consecutive patients with CTO in a native coronary artery treated by successful STAR technique in our institution were included. In the first period (March 2004-December 2009) all procedures were completed with stent implantation (Elective Stent Group; n?=?60). Thereafter (January 2010-June 2012) stent implantation was postponed until a scheduled (within 3 months) angiographic follow-up (Deferred Stent Group; n?=?69). The dissection length was 75?�?37 mm in the Elective Stent Group and 83?�?31 mm in the Deferred Stent Group (P?=?0.22). In the Deferred Stent Group, at the angiographic follow-up, the dissection length was significantly shorter than at the index procedure (40?�?35 mm versus 83?�?31 mm, P <0.001). The total stent length was significantly shorter in the Deferred Stent Group versus the Elective Stent Group (22?�?33 mm versus 56?�?28 mm; P?0.001). At six-month follow-up, rate of cardiac death and myocardial infarction (6.7% vs 0; P?=?0.049) and of stent thrombosis (5% vs 0%; P?=?0.10) were higher in the Elective Stent Group. The present study suggests that deferring stenting implantation following STAR recanalization (1) limits the stent length and (2) is associated with a lower rate of objective endpoints. � 2014 Wiley Periodicals, Inc. PMID:24740711
Visconti, Gabriella; Focaccio, Amelia; Donahue, Michael; Briguori, Carlo
Preoperative usages of levosimendan in patients undergoing coronary artery bypass grafting
Objectives: Levosimendan (LS) is a new inotropic drug which belongs to the group of drugs known as calcium sensitizers. It is different from other inotropic agents by its inotropic and vasodilatory actions without an increase in myocardial oxygen consumption and considered as a good choice in high-risk patients undergoing cardiac surgery. We aimed to investigate the proper time of the administration and the effect of prophylactic usage of LS in patients with low left ventricular ejection fraction (LVEF) undergoing coronary artery bypass grafting (CABG). Methods: Forty patients who underwent isolated CABG with LVEF) less than 30% were evaluated retrospectively. Patients were divided into 3 groups according to the induction time of LS during different phases of the operation and compared to a non-LS control group. LS infusion (0.2 ?g/kg/min) was applied 12 hours before the operation in Group 1 (G1) (n=10), after the induction of anaesthesia in Group 2 (G2) (n=10) and during the pump removal period in Group 3 (G3) (n=10) and non-LS control group 4 (G4) (n=10). Demographic data, operative characteristics, hemodynamic parameters and serum lactate, troponin, creatinine levels were compared between groups before and after LS treatment during pre and postoperative period. Data were evaluated by Fisher exact, Kruskal-Wallis, Mann-Whitney U, Chi-square and Wilcoxon rank tests. Results: We found that the duration of tracheal intubation, the intensive care unit stay and the hospital stay were significantly decreased in G1 and G2 when compared to the patients in G3 and G4. During postoperative period, in G1 and G2 one (10%) patient from each required intraaortic balloon pump (IABP), while in G3 two (20%) patients and in G4 five (50%) patients required IABP. Cardiac index (CI) was significantly increased in all groups from baseline to intensive care unit (ICU)1h and ICU24h. When groups compared each other significant increase was found in G1-G4 (p=0.001) and G2-G4 (p=0.007) at ICU1h. There was a significant increase in % EF especially in G1-G4 (p=0.011) and G2-G4 (p=0.007) at ICU1h. Systemic vascular resistance index significantly decreased in G1 and G2 in comparison to G3 and G4. However there was no significant decrease in pulmonary capillary wedge pressure of all 4 groups before and after LS. There was a significant decrease in mean pulmonary arterial pressure in G1 and G2 according to G4. Compared with the other groups preoperatively LS-treated patients (G1 and G2) had lower postoperative troponin I, serum lactate and creatinine concentrations. Conclusions: Our study shows that the elective preoperative initiation of LS especially 12 hours before the operation onset is associated with better improvement on cardiac functions as well as with lower mortality and complication rates, lower use of additional inotropic and vasopressor drugs, less need for intra-aortic balloon pump support and shorter length of stay in the ICU in patients with high perioperative risk or compromised left ventricular function. As a result, patients who received an infusion of LS 12 hours before surgery showed an evidence of less myocardial damage which suggested the preconditioning effect of the drug. PMID:24482709
Eris, Cuneyt; Yavuz, Senol; Toktas, Faruk; Turk, Tamer; Gucu, Arif; Erdolu, Burak; Goncu, M Tugrul
ABSTRACT Objectives: The present study evaluates our experience with aorto-coronary bypass grafting in patients with severe dysfunction of left ventricle (LV) and low ejection fraction-EF(<35%). Revascularization of myocardium in this settings remains contraversial because of concerns over morbidity, mortality and quality of life. Material and Methodes: Forty patients with severe coronary artery disease and dysfunction of LV (low ejection fraction <35%) underwent coronary artery bypass grafting in period of 3 years. Preoperative diagnostic of 40 patients was consisted of anamnesis, clinical exam, non-invasive methods EHO, MR and invasive diagnostic methods-cateterization. The major indication for surgery was severe anginal pain, heart failure symptoms and low ejection fraction. Internal mammary artery was used in all operated patients. Results: Average age of patients who have been operated was 59,8. In the present study, 81,3% were male and 18,8% female. We found one-vessel disease present in 2,5% (1/40) of patients, two -vessel disease in 40% (16/40), three-vessel disease in 42,5% (17/40) and four -vessel disease in 15% (6/40) of patients. One bypass grafting we implanted in 2,5% patients, two bypasses in 42,5%, three bypasses in 45 5%, and four bypasses in 10% of patients. Left ventricular ejection fraction assessed preoperativly was 18%-27% and postoperatively was improved to 31, 08% in period of 30 days. Conclusion: In patients with left ventricular dysfunction, coronary artery bypass grafting can be performed safely with improvement in quality of life and in left ventricular ejection fraction. PMID:25568566
Haxhibeqiri-Karabdic, Ilirijana; Hasanovic, Aida; Kabil, Emir; Straus, Slavenka
Study objectives: To examine how deep chest surgical site infections following coronary artery bypass graft (CABG) surgery impact hospital inpatient length of stay (LOS), costs, and mortality. Setting: A large, Midwestern community medical center. Design: All CABG patients who developed deep chest infection (n 5 41) were compared to a set of control subjects (n 5 160) systematically selected as
Christopher S. Hollenbeak; Denise M. Murphy; Stephanie Koenig; Robert S. Woodward; William C. Dunagan; Victoria J. Fraser
Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing. We have reviewed the short- and long-term outcome after aortic valve replacement with or without concomitant coronary artery bypass grafting in patients over 80 years of age. From 1 January 1995 until 30 June 1999, 114 patients (83 women and 31 men, 80-89
J�rgen Ennker; Amir Mortasawi; Stefan Gehle; Mehran Yaghmaie; Thomas Schr�der; Ulrich Rosendahl; Ina Carolin Ennker
Patency rates of saphenous vein grafts following coronary artery bypass grafting (CABG) depend on multiple factors. Information regarding the impact of biomechanical properties of vein grafts on patency rates is not available. The objective of the present study was to evaluate whether uncontrolled manual pressure distension during routine preparation of the saphenous vein in CABG-induced changes in the biomechanical properties
Jingbo Zhao; Jan Jesper Andreasen; Jian Yang; Bodil Steen Rasmussen; Donghua Liao; Hans Gregersen
The independent relationships of emotional support and marital status with posthospital adjustments following coronary artery bypass surgery (CABS) were examined longitudinally with an intake sample of 85 male patients. Follow-ups occurred at 1, 4, and 13 months after hospital release. Demographic characteristics (age, education) and cardiac status at the time of surgery (wall motion abnormalities) were controlled statistically. As anticipated,
James A. Kulik; Heike I. M. Mahler
ERIC Educational Resources Information Center
This study describes the influence of highly intense aerobic circuit training on the cardiorespiratory fitness of 31 coronary artery disease patients who had undergone bypass surgery. Results show improvement in heart rate and other measured responses and no abnormal responses related to cardiovascular or musculoskeletal complications. (Author/MT)
LaFontaine, Tom; Bruckerhoff, Diane
Objectives. The purpose of this consensus effort was of define and prioritize the importance of a set of clinical variables useful for monitoring and improving the short-term mortality of patients undergoing coronary artery bypass graft surgery (CABG).Background. Despite widespread use of data bases to monitor the outcome of patients undergoing CABG, no consistent set of clinical variables has been defined
Robert H. Jones; Edward L. Hannan; Karl E. Hammermeister; Elizabeth R. DeLong; Gerald T. O'Connor; Russell V. Luepker; Victor Parsonnet; David B. Pryor
Objective: To analyse the relation between perioperative myocardial injury (PMI) and the risk of subsequent heart failure after coronary artery bypass grafting (CABG).Design and setting: Clinical data were documented prospectively in all patients and stored in a computer. All hospital readmissions were identified and the registered primary diagnoses were analysed. Survival information on all patients was obtained by use of
J Steuer; F Granath; U de Faire; A Ekbom; E Sta?hle
Metabolic syndrome is associated with poor operative outcomes of coronary artery bypass grafting surgery (CABG). A healthy food pattern for metabolic syndrome patients is necessary not only in the initial stage to prevent cardiovascular disease but for those who experience cardiovascular problems and undergo heart surgery. Empirical studies that explore food pattern and quality of life metabolic syndrome patients who
Heng-Hsin Tung; Li-Hua Tseng; Jeng Wei; Cheng-Hsin Lin; Tsae-Jyy Wang; Shu-Yuan Liang
Objective: With the aim of performing a completely endoscopic coronary bypass anastomosis, we have undertaken an experimental and clinical study using robotic instrumentation and voice-controlled camera guidance. Methods: The ZEUS Robotic Surgical System (Computer Motion Inc, Goleta, Calif) consists of three interactive robotic arms and a control unit, allowing the surgeon to move the instrument arms in a scaled down
Hermann Reichenspurner; Ralph J. Damiano; Michael Mack; Dieter H. Boehm; Helmut Gulbins; Christian Detter; Bruno Meiser; Reinhard Ellgass; Bruno Reichart
Introduction To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery. Material and methods Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H2O (group 1) or 8 cm H2O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared. Results Low- and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 �37 ml vs. 69 �29 ml, p = 0.03) and pericardial fluid (17 �5 ml vs. 14 �6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 �1.21 days vs. 5.25 �0.91 days, p = 0.03). Conclusions Prophylactic administration of postoperative PEEP levels of 8 cm H2O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients. PMID:25395944
Salihoglu, Ece; Celik, Sezai; Ugurlucan, Murat; Caglar, Ilker Murat; Turhan-Caglar, Fatma Nihan; Isik, Omer
Background: Obstructive sleep apnea (OSA) is very frequent and often unrecognized in surgical patients. OSA is associated with perioperative complications. We evaluated the effects of OSA on postoperative complications and hospital outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: Candidates of elective CABG were evaluated by the Berlin questionnaire for OSA. After surgery, patients were assessed for postoperative complications, re-admission to the Intensive Care Unit (ICU), duration of intubation, re-intubation, days spent in the ICU and the hospital. Results: We studied 61 patients who underwent CABG from which 25 (40.9%) patients had OSA. Patients with OSA had higher body mass index (29.5 � 3.9 vs. 26.0 � 3.7 kg/m2, P = 0.003) and higher frequency of hypertension (68.0% vs. 30.5%, P = 0.003), dyslipidemia (36.0% vs. 5.5%, P = 0.004), and pulmonary disease (16.0 vs. 2.7%, P = 0.08). Regarding the surgical outcomes, OSA patients had longer intubation duration (0.75 � 0.60 vs. 0.41 � 0.56 days, P = 0.03). Conclusions: Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.
Amra, Babak; Niknam, Nasim; Sadeghi, Mohsen Mir Mohammad; Rabbani, Majid; Fietze, Ingo; Penzel, Thomas
Elective Cholecystectomy During Laparoscopic Roux-En-Y Gastric Bypass: Is it Worth the Wait?
Background: Combined gastric bypass and cholecystectomy have been advocated for open bariatric procedures. Our goal was to\\u000a evaluate the safety of this technique in laparoscopic bariatric surgery patients with gallstones diagnosed preoperatively.\\u000a Methods: 94 out of 556 consecutive morbidly obese patients (16.9%) underwent laparoscopic gastric bypass with simultaneous\\u000a cholecystectomy (LGBP\\/LC) for cholelithiasis. Results: 328 patients (59%) had a concomitant secondary
Giselle G. Hamad; Sayeed Ikramuddin; William F. Gourash; Philip R. Schauer
The effects of perioperative psychiatric intervention were studied in 33 patients undergoing coronary artery bypass graft (CABG) surgery. All patients were evaluated preoperatively using the Mini-Mental State Exam and the Psychological Adjustment to Illness Scale-Self-Report. Participants in the study group (N = 16) had a structured psychiatric interview prior to surgery and were followed daily with supportive psychotherapy throughout their hospitalization. The number of medical complications was higher in the control group. No significant differences were found in neurologic or psychologic complications. The study group used significantly more oxycodone-acetaminophen (Percocet), but less morphine-sulfate or benzodiazepine on postoperative days 3, 4, and 6. The mean length of stay was 3 days shorter for patients in the study group. In the current era of escalating health care costs and high technology, clinical protocols and research studies that evaluate the cost effectiveness and efficacy of psychiatric intervention in medically ill patients should be pursued. PMID:2792747
Schindler, B A; Shook, J; Schwartz, G M
Randomized trial of the effects of exercise training after coronary artery bypass surgery
Fifty-three male volunteers who had undergone coronary artery bypass surgery were randomized to a medically supervised exercise program (N = 28) or to usual community care (N = 25). They were tested initially and at one year with exercise tests for thallium scintigraphy, maximal oxygen uptake, and electrocardiography. Approximately one third of the patients had signs and/or symptoms of ischemia consistent with incomplete or unsuccessful revascularization. Over the year there were five dropouts, but no major complications occurred. The exercisers attended an average of 82% of the sessions (three times a week) and trained at 80% of their maximal heart rate. Both the exercisers with and those without angina had significant increases in estimated and measured oxygen uptake and significant declines in submaximal and resting heart rate. There was a trend toward improved thallium scans in the exercised patients with angina.
Froelicher, V.; Jensen, D.; Sullivan, M.
Conduits for Coronary Bypass: Arteries Other Than the Internal Thoracic Artery's
This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance. PMID:23772403
Endoscopic Harvesting Device Type and Outcomes in Patients Undergoing Coronary Artery Bypass Surgery
Objective To evaluate angiographic and clinical outcomes associated with open and closed tunnel dissection endoscopic vein harvesting (EVH) devices. Summary Background Data A previous PREVENT-IV analysis reported that EVH for coronary artery bypass graft (CABG) surgery was associated with worse outcomes compared with traditional vein harvesting; however, outcomes by EVH device type were not available. Methods Using data from the PREVENT-IV trial, we compared 1549 patients from 75 surgical sites who underwent EVH with open (n=390) or closed (n=1159) harvest tunnel devices. Outcomes included the incidence of vein graft failure at 12 to 18 months and a composite of death, myocardial infarction, or revascularization through 5 years. Results Among patients undergoing open and closed tunnel EVH, no difference in the per-patient incidence of vein graft failure (43.8% vs. 47.1%; adjusted odds ratio [OR], 0.91; 95% confidence interval [CI], 0.53 to 1.55; p=0.724) or per-graft incidence of vein graft failure (25.5% vs. 25.9%; adjusted OR, 0.96; 95% CI, 0.59 to 1.55; p=0.847) was observed. At 5 years, no difference was observed in the primary composite clinical outcome between open and closed system EVH patients (21.5% vs. 23.9%; adjusted hazard ratio, 0.85; 95% CI, 0.66 to 1.10; p=0.221). Conclusion No differences in angiographic or clinical outcomes were observed among patients who underwent open vs. closed tunnel endoscopic harvesting for coronary bypass surgery. These findings suggest that the risks associated with EVH that were reported in a previous PREVENT-IV analysis are not related to a specific EVH device. PMID:24368640
van Diepen, Sean; Brennan, J. Matthew; Hafley, Gail E.; Reyes, Eric M.; Allen, Keith B.; Ferguson, T. Bruce; Peterson, Eric D.; Williams, Judson B.; Gibson, C. Michael; Mack, Michael J.; Kouchoukos, Nicholas T.; Alexander, John H.; Lopes, Renato D.
Systematic review of robotic-assisted, totally endoscopic coronary artery bypass grafting
Background Advancements in surgical robotic technology over the last two decades have enabled coronary artery bypass grafting to be performed totally endoscopically, and have the potential to significantly change clinical practice in the future. Methods A systematic review of studies reporting clinical outcomes of total endoscopic coronary artery bypass grafting (TECABG) was performed. Results 14 appraised studies included 880 beating heart TECABGs, 360 arrested heart TECABGs, 633 one-vessel operations and 357 two-vessel operations. Patients were generally low-risk. There was a significant learning curve. The weighted means for short-term beating heart and arrested heart TECABG results respectively were: intraoperative exclusion rate of 5.7% and 1.9%, intraoperative conversion rate of 5.6% and 15.0%, all-cause mortality of 1.2% and 0.4%, stroke of 0.7% and 0.8%, myocardial infarction of 0.8% and 1.8%, new onset atrial fibrillation of 10.7% and 5.1% and post-operative reintervention rate of 2.6% and 2.3%. The overall rate of short term postoperative graft patency for beating heart and arrested heart TECABG was 98.3% and 96.4% respectively. Conclusions Appropriate patient selection was important in minimizing the risk of intraoperative and postoperative complications. Short-term outcomes of both beating and arrested heart TECABG were acceptable, but results so far have been heterogeneous. There were fewer studies reporting intermediate to long-term outcomes, but results were encouraging, and further investigation and development of the procedure is warranted. PMID:23977616
Edelman, J. James B.; Yan, Tristan D.; Wilson, Michael K.; Bannon, Paul G.; Vallely, Michael P.
Objectives: The aim of this study was to evaluate cost effectiveness of coronary artery bypass graft (CABG) versus percutaneous coronary intervention (PCI) with stenting from Iran society perspective. Methods: A retrospective study was carried out to estimate the annual cost and health related quality of life (HRQoL) of 109 patients who underwent coronary revascularization (PCI [n = 75] and CABG [n = 34]). A Markov model has been developed to determine the cost effectiveness of CABG compared with PCI. We used the model to calculate lifetime costs, life-years (LYs), and quality-adjusted life-years (QALYs) of each strategy. We also used probabilistic sensitivity analysis to test model robustness. Results: We found that discounted QALY lived per person in CABG versus PCI group in 5 years, 10 years, and lifetime time horizon were (3.8 � 0.13 versus 3.88 � 0.14), (6.4 � 0.23 versus 6.33 � 0.22), and (8.74 � 0.29 versus 8.33 � 0.27), respectively. The estimated medical cost of CABG and PCI per patient in 5 years, 10 years, and lifetime time horizon were (USD 6,819 � 765 versus 9,011 � 1,816), (USD 8,852 � 1,348 versus 12,034 � 2,375), and (USD 14,037� 4,201 versus 18,798 � 5,821), respectively. The incremental cost-effectiveness ratio results showed CABG is a dominate alternative in 10 years and lifetime time horizon. Conclusions: This study demonstrated that despite higher initial cost and lower HRQoL, CABG is a cost-effective revascularization strategy compared with PCI for patients with multivessel coronary artery disease in long-term. PMID:25401422
Javanbakht, Mehdi; Bakhsh, Razieh Yazdani; Mashayekhi, Atefeh; Ghaderi, Hossein; Sadeghi, Masoumeh
The aim of the study was to compare the mean and maximum flow and the flow pattern of coronary vein grafts (SVG) supplying target vessels of the inferior and lateral wall with internal mammary (IMA) grafts to the left anterior descending artery (LAD). In 21 patients 25 bypass grafts (13/25 SVG, 12/25 IMA) were investigated. Using the transit time ultrasound method, flow was measured every 5 ms and the flow data of 60 s were acquired. The flow pattern showed significant differences between both graft types during their cycle. IMA grafts showed only one peak occurring after 22.1+/-12.3% and the second after 63.4+/-15.5% of their cycle. The mean flow was not different in both graft types (IMA: 45.3+/-27.0 ml/min and SVG: 41.8+/-26.7 ml/min, p = n. s.) as it was the case for the maximum flow (IMS: 98. 4+/-45.2 ml/min and SVG: 75.7+/-55.4 ml/min, p = n. s.). In conclusion, there is a different flow pattern for both graft types concerning the number and the occurrence of flow-peaks in the bypass cycle. The mean and peak flow showed no significant difference. PMID:10552179
Voigtl�nder, T; Dahm, M; Kreitner, K F; Frick, C; Wittlinger, T; Nowak, B; Kalden, P; Hake, U; Mayer, E; Bickel, C; Meyer, J
Hypoxaemia and myocardial ischaemia on the night before coronary bypass surgery.
Using pulse oximetry and Holter ECG monitoring on the night before coronary bypass surgery, we studied 30 male patients with coronary artery disease to determine the relationship between nocturnal hypoxaemia and myocardial ischaemia. The patients received intensive anti-angina medication and were sedated with clorazepate. Ten patients developed a total of 42 ischaemic episodes, 24 of which occurred between 22:00 and 06:00. Mean heart rate was significantly higher in patients with ischaemia than in those without ischaemia. In 60% of all patients, heart rate increased > or = 20% at the onset of the ischaemic episode. The patients spent a median of 2 (range 0.02-40.6)% of the night with oxygen saturation (SpO2) < 90% (the minimum SpO2 value recorded was 84 (69-88) %). Only five ischaemic episodes were associated with respiratory events. These were not associated with either extraordinary oxygen desaturation or marked increases in heart rate. Comparing patients with and without ischaemia, there were no significant differences in the extent of nocturnal hypoxaemia or the pattern of desaturation episodes (cyclic variations in saturation characteristic of periodical breathing vs non-cyclic desaturation episodes). Despite marked nocturnal hypoxaemia, simultaneous occurrence of desaturation episodes and myocardial ischaemia was a rare event in our study. PMID:7917728
Keyl, C; Lemberger, P; R�dig, G; Dambacher, M; Frey, A
Summary Introduction There is controversy over the best approach for patients with concomitant carotid and coronary artery disease. In this study, we report on our experience with simultaneous carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) surgery in our clinic in the light of data in the literature. Methods Between January 1996 and January 2009, a total of 110 patients (86 males, 24 females; mean age 65.11 � 7.81 years; range 44�85 years), who were admitted to the cardiovascular surgery clinic at our hospital, were retrospectively analysed. All patients underwent simultaneous CEA and CABG. Demographic characteristics of the patients and a history of previous myocardial infarction (MI), hypertension, diabetes mellitus, hyperlipidaemia, peripheral arterial disease and smoking were recorded. Results One patient (0.9%) with major stroke died due to ventricular fibrillation. Peri-operative neurological complications were observed in seven patients (6%). Complications were persistent in two patients. Four patients (3%) had postoperative major stroke, whereas three patients (2%) had transient hemiparesis. No peri-operative myocardial infarction was observed. Conclusion Simultaneous CEA and CABG can be performed with low rates of mortality and morbidity. PMID:25000443
Aydin, Ebuzer; Ozen, Yucel; Sarikaya, Sabit; Yukseltan, Ismail
CASE REPORT Sternal Chondrosarcoma After Sternotomy for Coronary Artery Bypass Grafting
Objective: Primary bony tumors of the chest wall are usually benign and most commonly located in the ribs or sternum. Chondrosarcoma is regarded as one of the most frequent primary malignancies of the chest wall and its incidence after a sternotomy for a cardiac procedure is extremely rare. We present a case of sternal chondrosarcoma. Methods: The patient presented with a sternal mass 4 years after undergoing coronary artery bypass grafting for ischemic coronary artery disease. The mass originally emanated from the upper portion of the patients� sternum and then rapidly enlarged to include the anterior aspects of his neck. Radiologic imaging studies were undertaken: computed tomographic scan and magnetic resonance imaging, with surgical intervention for excision. Results: Computed tomographic scan and magnetic resonance imaging established an 8.4 � 6.2 � 8.6 cm3 complex solid tissue mass within the lower neck arising from the sternal manubrium, with extensive bone destruction. Computed tomography-guided biopsy showed cells of uncertain significance. Surgical excision was performed and the mass was diagnosed as a grade II chondrosarcoma. Discussion: Primary sarcomas of the sternum though uncommon are potentially curable with wide surgical excision. Success depends on tumor histologic type and grade, which dictate recurrence. PMID:23372861
Singh, Vijay�A.; Abreu, Juan; Bowman, Kimberly; Shariff, Masood�A.; McGinn, Joseph�T.
The development of intimal hyperplasia is the major cause of failure of both autologous saphenous vein and synthetic coronary artery bypass grafts. This is partially due to graft-host vessel compliance mismatch. Cellulose and chitosan (CELL:CHIT) are both biocompatible, nontoxic, and naturally occurring biopolymers that have been used extensively for biomedical applications. Elastic properties of membranes made of CELL:CHIT blends with different ratios between each polymer were determined using uniaxial tests and the ratio that yielded the less stiff membrane was chosen to prepare a small diameter hollow tube. The presence of chitosan had a favorable impact on the elasticity of the membranes, where the CELL:CHIT 5:5 ratio showed the lowest Young's modulus. Small diameter tubular constructs were fabricated using this optimal CELL:CHIT ratio and the compliance was determined on samples with different wall thickness and internal diameter. The compliance of the hollow tube with inner diameter of 4?mm and wall thickness of 1.2?mm was found to be 5.91%/mmHg�10(-2), which is higher than those of Dacron, expanded polytetrafluorethylene, and saphenous vein, but very close to that of human coronary artery. Burst strength tests revealed that the tubes can withstand at least 300?mmHg. Finally, the tubes showed satisfactory cell attachment property when myofibroblast cells adhered and proliferated on the lumen of the samples. PMID:23565645
Azevedo, Eduardo P; Retarekar, Rohini; Raghavan, Madhavan L; Kumar, Vijay
Can internal thoracic arteries be used for both coronary artery bypass and breast reconstruction?
OBJECTIVES Recently, the internal thoracic arteries have been preferentially used in autologous breast reconstruction at the levels of the third or fourth intercostal spaces. This may compromise future treatment of occult coronary disease. We hypothesized that internal thoracic artery length at the fourth intercostal space would allow both breast reconstruction and future coronary artery bypass grafting (CABG). METHODS Anatomic analysis of 20 female patients undergoing CABG was performed examining internal thoracic artery length from its origin to the third, fourth, fifth intercostal spaces and the left anterior descending (LAD) artery target. RESULTS The left internal thoracic artery was anastamosed to the LAD target at a mean length of 11.4���1.4�cm. The mean lengths of the pedicled left internal thoracic artery from its origin to the third, fourth and fifth intercostal space were 8.5���1.0, 10.9���1.2 and 13.0���1.4�cm, respectively. Therefore, the left internal thoracic artery length was adequate at the fourth intercostal space in 6 of 20 (30%) patients. CONCLUSIONS Dissection of the left internal thoracic artery to the fourth intercostal space would allow for concomitant use in CABG and breast reconstruction in one-third of cases. However, skeletonization of the internal thoracic artery at the level of the fourth intercostal space would be sufficient for CABG in all cases following autologous breast reconstruction. PMID:22899665
Currie, Maria E.; Fox, Stephanie A.; Greer-Bayramoglu, Rebecca J.; Fortin, Amanda J.; Chu, Michael W. A.
Background The clinical benefits of the left internal thoracic artery�to�left anterior descending coronary artery graft are well established in coronary artery bypass graft surgery (CABG). However, limited data are available regarding the long?term outcome of the radial artery (RA) as a secondary conduit over the established standard of the saphenous venous graft. Methods and Results We compared the 12?year survival outcome in a set of propensity?matched CABG patients who received either the RA or the saphenous vein as a secondary conduit. A multivariable logistic regression that included 18 baseline characteristics was used to define the propensity of receiving an RA graft. The propensity model resulted in 260 matched pairs who underwent first?time isolated CABG from 1996 to 2001 with similar preoperative characteristics (C statistic=0.86). The cumulative 12?year survival estimated by use of the Kaplan�Meier method was higher for the RA graft patients (hazard ratio 0.76; P=0.03). This survival advantage was especially significant in diabetics (P=0.005), in women (P=0.02), and in the elderly (P=0.04.) The protective effect appeared beginning at year 5 post surgical intervention. Conclusion The RA as a secondary conduit provided superior long?term survival after CABG, especially in diabetic patients, women, and the elderly. This effect was most pronounced >5 years after surgery. PMID:23969224
Lin, John; Cheng, Wen; Czer, Lawrence S.; De Robertis, Michele A.; Mirocha, James; Ruzza, Andrea; Kass, Robert M.; Khoynezhad, Ali; Ramzy, Danny; Esmailian, Fardad; Trento, Alfredo
[Health-related quality of life in the elderly after coronary artery bypass grafting].
Despite of higher operative risk in the elderly, coronary artery bypass grafting (CABG) is more often performed in this age group to achieve the remission of the disease and to improve the quality of life. The aim of the study was to assess some subjective and objective health indices in the elderly two years after CABG (I group) in comparison to analogous group of older patients just waiting for CABG (II group). 109 patients aged 65 years and older, consecutively discharged from the Cardiac Surgery Department 2 years ago, were analyzed as well as 60 patients currently waiting for such surgery. Both groups of patients did not differ with demographic features. The health related quality of life was measured with the EASYCare questionnaire and similar one of own construction supplemented with some items of the WHOQol-BREF scale. Two years after CABG, 100 patients were available for the study (six persons died and three persons refused). Response rate was 92%. Significant reduction of symptoms of the coronary artery disease were shown. The chest pain was declared in 18% in I group vs 70% in II group; palpitation in 23% in I group vs 38% in II group and effort angina in 38% in I group vs 65% in II group. The positive evaluation of the health status was declared significantly more often in the patients of I group in comparison to patients in II group. CABG caused positive change concerning health-related quality of life in the elderly two years after surgery. PMID:15850328
Lapi?ski, Tomasz; Bie?, Barbara; Wilma?ska, Jolanta
It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD. PMID:24855606
Kim, Sun Min; Cho, Jae Yeong; Kim, Ju Han; Park, Keun-Ho; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun
Objectives: It has been proved in human subjects and animals that atelectasis is a major cause of intrapulmonary shunting and hypoxemia after cardiopulmonary bypass. Animal studies suggest that shunting can be prevented entirely by a total vital capacity maneuver performed before termination of bypass. This study aimed to test this theory in human subjects and to evaluate possible advantages of
Edda M. Tschernko; Anton Bambazek; Wilfried Wisser; Bernhard Partik; Ursula Jantsch; Klaus Kubin; Marek Ehrlich; Walter Klimscha; Michael Grimm; Franz P. Keznickl
A 61-year-old male vasculopath presented for coronary revascularization and was found to have high-grade bilateral subclavian artery stenosis. The adequacy of the left internal mammary artery for bypass to the left anterior descending artery was in question. Rather than assessing the left internal mammary artery intraoperatively, we performed a preoperative cardiac computed tomography (CT) angiogram. This showed that the free left internal mammary artery was a suitable conduit and the procedure was performed expeditiously. Therefore, cardiac CT angiography is a noninvasive tool for preoperative planning in coronary revascularization. PMID:19267832
Moussa, Fuad; Kumar, Pawan; Pen, Visal
Off-pump coronary artery bypass technique or bypass graft surgery without the use of a heart-lung machine has been introduced in the last six years, and now comprises approximately 25 per cent of all coronary artery bypass surgery being done in the world. One of the goals of beating heart surgery is to eliminate the complications associated with the use of cardiopulmonary bypass. The use of all arterial conduits for coronary artery bypass graft has become more acceptable after experiences gained and reports of better long-term results. From January 2001 to December 21 2002 the authors performed 251 off-pump procedures. One hundred and nine of these cases were done utilizing all arterial conduits. The data was stratified using the US National Society of Thoracic Surgeons Cardiac Surgery Database pre-operative risk module and divided into 3 groups as suggested: Low risk group with a predicted mortality of 0-1 per cent (2 patients); Medium risk group with a predicted mortality of 2-9 per cent (87 patients), and High risk group with a predicted mortality of 10+ per cent (10 patients). The predicted mortality of the entire group was 4.5 per cent. There were 90 males and 19 females with a mean age of 60.2 +/- 10.7 years, with 15.6 per cent of them older than 70 years. Pre-operative co-morbidities included 1/4 of the patients who had ejection fraction (EF) of equal to or less than 0.4, 4.5 per cent had unstable angina, 1.6 per cent had urgent/emergent status, 26.6 per cent underwent re-operative procedure, 1 per cent had pre-operative serum creatinine more than 2 mg per cent, 4.8 per cent had a history of stroke, 20.2 per cent had a history of congestive heart failure, 45.2 per cent had a history of previous myocardial infarction, 10.7 per cent had a history of chronic obstructive pulmonary disease, 46.9 per cent had a history of diabetes, 62 per cent had hypertension, and 20 patients (18.3%) required intra aortic balloon pump. Intra-operative parameters revealed 3.7 +/- 1.3 grafts/patient. The left internal mammary artery (LIMA) was used to the left anterior descending (LAD) in 6.4 per cent, or sequential with the diagonals 93.6 per cent. The 30 days mortality was 3.6 per cent (4 cases). Further analysis revealed that pre-operatively, none of these 4 cases was in the low predicted (predicted mortality of 0-1%) risk group, 2 of them were in the medium (predicted mortality of 2-9%) and the other 2 were in the high predicted risk (predicted mortality of 10+%) group. The skin-to-skin time was 4.1 hours and there were two conversions to on-pump in this group. Post-operatively, the intubation time was 4.7 hours. There was no peri-operative myocardial infarction, one patient required dialysis, and no patient experienced stroke. There was no sternal wound or arm wound infection, 9.5 per cent experienced temporal sensation impairment at the site of the radial artery harvesting at one month. Re-operation for bleeding occurred in 3 cases, and thirteen patients (14.3%) developed new atrial fibrillation. The authors are no longer making a one-foot long incision and spread ten inches wide like in the old days'. With the less invasive approach lessened in the recent past, the authors have found the less invasive the incision the less the pain after surgery. Totally eliminating the leg incision has allowed the patient to get up and mobilize on the same afternoon, if the procedure was done in the morning. All of these approaches combined with the off-pump technique, as far as the authors are concerned, will provide those who need coronary arterial bypass graft the best operative procedure. PMID:12866764
Visudharom, Kitipan; Jotisakulratana, Vibul; Pitiguagool, Vitoon; Banyatpiyaphod, Sujit; Pamornsing, Piyapan; Cumpeeravut, Pranom
Objective: To describe hemodynamic alterations during coronary artery bypass grafting (CABG) without extracorporeal circulation using the Octopus Tissue Stabilizer, and to describe the two anesthetic management protocols based on either general anesthesia with opioids (34 patients) or general anesthesia with high thoracic epidural anesthesia (TEA; 66 patients).Design: A prospective observational report.Setting: An academic university heart center.Participants: First 100 patients undergoing
Arno P. Nierich; Jan Diephuis; Erik W. L. Jansen; Diederik van Dijk; Jaap R. Lahpor; Cornelius Borst; Johannes T. A. Knape
Aims To establish the influence of perioperative myocar- dial injury on short- and long-term survival after coronary artery bypass grafting (CABG). Methods and Results The correlation of postoperative serum aspartate aminotransferase and creatine kinase MB to early cardiac-related death and to late survival was evaluated in 4911 patients who underwent CABG consecu- tively during a 6-year period. There were 93
J. Steuer; L.-G. Horte; B. Lindahl; E. Sta
OBJECTIVES Haemodilution during cardiopulmonary bypass is associated with increased perioperative blood transfusions and is thought to reduce intraoperative oxygen delivery to the brain. We sought to evaluate our method of rapid antegrade prime displacement in the context of the perioperative blood transfusion rate, intraoperative cerebral saturations and postoperative hospital stay. METHODS Retrospective analysis of 160 propensity-matched patients undergoing elective coronary artery bypass grafting was performed comparing different perfusion strategies on perioperative blood transfusion and length of postoperative stay. Eighty patients who had rapid antegrade prime displacement and vacuum-assisted venous drainage (RAD-VAD) were compared with 80 patients who had conventional cardiopulmonary bypass with gravity drainage (CB). RAD-VAD involved displacing all or most of the prime in the circuit with the patient's own blood prior to the initiation of cardiopulmonary bypass within a 15�20 s window. Within each group, 10 patients had intraoperative cerebral saturation measurements. RESULTS There were no differences in the baseline characteristics between the groups. Both groups had a significant fall (P < 0.05) in haematocrit during cardiopulmonary bypass from preoperative values, however, the fall in haematocrit was significantly less in the RAD-VAD group (P < 0.05). There was significantly (P < 0.05) less intraoperative and postoperative homologous blood transfusions in the RAD-VAD group (47.892 ml � 8.14 and 76.58 ml � 21.58) compared with the CB group (229.06 ml � 105.03 and 199.91 ml � 47.13). There was a significant fall in cerebral saturations within both groups (P < 0.05) but it was not significant between the groups. The postoperative stay was significantly (P < 0.05) shorter in the RAD-VAD group compared with the conventional group (7.74 days � 0.51 vs 10.13 days � 0.95). CONCLUSIONS RAD-VAD is associated with a significantly lower blood transfusion rate perioperatively and shorter hospital stays compared with CB. PMID:23690433
Ariyaratnam, Priyadharshanan; Bennett, Robert T.; McLean, Lindsay A.; Jagannadham, Kishore K.; Turner, Edward; Griffin, Steven; Chaudhry, Mubarak A.; Loubani, Mahmoud
Dual antiplatelet therapy with both aspirin and clopidogrel is increasingly used after coronary artery bypass grafting (CABG); however, little is known about the safety or efficacy. We sought to determine the relationship between postoperative clopidogrel and clinical and angiographic outcomes following CABG. We evaluated 3,014 patients from PREVENT IV who underwent CABG at 107 US sites. Postoperative antiplatelet therapy was left to physician discretion. Risk-adjusted angiographic and clinical outcomes were compared in patients taking and not taking clopidogrel 30 days post-CABG. At 30 days, 633 (21 %) patients were taking clopidogrel. Clopidogrel users were more likely to have peripheral vascular (15 vs. 11 %) and cerebrovascular disease (17 vs. 11 %), prior myocardial infarction (MI) (46 vs. 41 %), and off-pump surgery (33 vs. 18 %). Clopidogrel use was associated with statistically insignificant higher graft failure (adjusted odds ratio 1.3; 95 % confidence interval [CI] [1.0, 1.7]; P = 0.05). At 5-year follow-up, clopidogrel use was associated with similar composite rates of death, MI, or revascularization (27 vs. 24 %; adjusted hazard ratio 1.1; 95 % CI [0.9, 1.4]; P = 0.38) compared with those not using clopidogrel. There was an interaction between use of cardiopulmonary bypass and clopidogrel with a trend toward lower 5-year clinical events with clopidogrel in patients undergoing off-pump CABG. In this observational analysis, clopidogrel use was not associated with better 5-year outcomes following CABG. There may be better outcomes with clopidogrel among patients having off-pump surgery. Adequately powered randomized clinical trials are needed to determine the role of dual antiplatelet therapy after CABG. PMID:23543398
Williams, Judson B.; Lopes, Renato D.; Hafley, Gail E.; Ferguson, T. Bruce; Mack, Michael J.; Gibson, C. Michael; Harrington, Robert A.; Peterson, Eric D.; Smith, Peter K.; Mehta, Rajendra H.
Summary Background To evaluate clinical and laboratorial parameters that predict decreased respiratory function in patients subjected to coronary artery bypass graft surgery (CABG). Material/Methods This was a prospective study evaluating 61 patients subjected to CABG with cardiopulmonary bypass, median sternotomy, and under mechanical ventilation for up to 24 h. One day before surgery, clinical information was recorded. Maximal inspiratory (MIP) and expiratory (MEP) pressures, and expiratory peak flow rate (EPFR) values were assessed 1 day before surgery and on the fifth postoperative day. Student�s t test, 2-way ANOVA, Pearson�s linear correlation, and logistic regression were used for statistical analysis. Results Patients were 63�10 years old, 67% males. Arterial hypertension was found in 75.4% of the patients, diabetes in 31.2%, dyslipidemia in 63.9%, tabagism in 25%, and chronic obstructive pulmonary disease (COPD) in 16.4%. Previous myocardial infarction was found in 67%. Preoperative hemoglobin levels were 12.8�1.71 g/dL. Older individuals had lower preoperative MEP and EPFR values. Preoperatively, positive association was found between hemoglobin levels and maximal respiratory pressures and EPFR values. Patients with both class III angina and COPD presented higher reductions in pulmonary pressures between the preoperative period and the 5th postoperative day. Conclusions Older age and low hemoglobin levels are associated with preoperative low maximal respiratory pressures and EPFR. The combination of severe angina and COPD results in higher postoperative reduction of maximal respiratory pressures for patients who underwent CABG. PMID:22936191
Gimenes, Camila; de Godoy, Irma; Padovani, Carlos Roberto; Gimenes, Rodrigo; Okoshi, Marina Politi; Okoshi, Katashi
Differential Effects of Natriuretic Peptides on Arterial and Venous Coronary Artery Bypass Conduits
Background Arterial grafts have patency rates superior to venous grafts in patients undergoing coronary bypass grafting surgery. Natriuretic peptides play a major role in vascular homeostasis. We hypothesized that natriuretic peptides might have different effects on arterial and venous conduits. Methods The relaxation responses and tissue levels of cyclic guanosine monophosphate (cGMP) after exposure to atrial natriuretic peptide, brain natriuretic peptide, and C-type natriuretic peptide were assessed in segments of internal mammary artery, radial artery, and saphenous vein obtained from the same patients at the time of bypass surgery (n = 12). Natriuretic peptide receptor (NPR) expression was assessed using immunohistochemistry and Western blotting. Results Relaxation of the internal mammary artery and radial artery to all the natriuretic peptides were similar, and greater than that of saphenous vein, correlating with increased tissue levels of cGMP in both arterial conduits. Relaxation responses to all three natriuretic peptides were nearly abolished in the presence of LY83583, an inhibitor of guanylyl cyclase. Exposure of the conduits to N(G)-Nitro-L-arginine methyl ester (nitric oxide synthase inhibitor) resulted in a modest but significant blunting of the relaxation responses. Expression of NPRA, NPRB and NPRC was strong in the endothelium and vascular smooth muscle layer of the internal mammary artery and radial artery, and was significantly less in saphenous vein. Conclusions Natriuretic peptides are potent vasodilators of the internal mammary artery and radial artery but not the saphenous vein. The relaxation response is mediated through guanylyl cyclase and nitric oxide synthase. These observations may provide additional insight into the mechanisms that account for superior patency of arterial conduits. PMID:19231384
Nguyen, Hao G.; Korach, Amit; Collura, Chey; Eskenazi, Benjamin R.; Vita, Joseph A.; Shapira, Oz M.
Objectives To assess the pattern of the adoption of internal mammary artery (IMA) grafting in the United States, test its association with clinical outcomes, and assess whether its effectiveness differs in key clinical subgroups. Background The effect of IMA grafting on major clinical outcomes has never been tested in a large randomized trial, yet it is now a quality standard for coronary artery bypass graft (CABG) surgery. Methods We identified Medicare beneficiaries aged ?66 years who underwent isolated multivessel CABG between 1988 and 2008, and documented patterns of IMA use over time. We used a multivariable propensity score to match patients with and without an IMA, and compared rates of death, myocardial infarction (MI), and repeat revascularization. We tested for variations in IMA effectiveness using treatment by covariate interaction tests. Results IMA use in CABG rose slowly from 31% in 1988 to 91% in 2008, with persistent wide geographic variations. Among 60,896 propensity score matched patients over a median 6.8 year follow-up, IMA use was associated with lower all-cause mortality (adjusted hazard ratio 0.77, p<0.001), lower death or MI (adjusted hazard ratio 0.77, p<0.001), and fewer repeat revascularization over five years (8% vs. 9%, p<0.001). The association between IMA use and lower mortality was significantly weaker (p?0.008) for older patients, women, and for patients with diabetes or peripheral arterial disease. Conclusions IMA grafting was adopted slowly and still shows substantial geographic variation. IMA use is associated with lower rates of death, MI and repeat coronary revascularization. PMID:24080110
Hlatky, Mark A; Boothroyd, Derek B; Reitz, Bruce A; Shilane, David A; Baker, Laurence C; Go, Alan S
Cardiac events after coronary artery bypass surgery (CABG) may be related to left ventricular (LV) function, residual coronary artery diseases (CAD), graft occlusion, and progression of CAD. This study examined the value of rest and exercise (EX) radionuclide ventriculography (RNV) done 3-6 mos after CABG in risk stratification in 212 pts. There were 185 men and 27 women, aged 57 +- 8 years (mean +- SD). During a followup period of up to 4 years, (15 +- 10 months), there were 23 cardiac events; 13 pts died of cardiac causes and 20 had non-fatal acute myocardial infarctions. The pts with and without events did not differ in: clinical presentation after CABG (most were asymptomatic), medications and ECG findings at rest and EX. The pts with events had lower EX systolic blood pressure (p < 0.01); resting LV ejection fraction (EF) (p = 0.002), and EX EF (40 +- 18% vs 54 +- 16%, p = 0.002). The change in EF (rest to EX) was not significantly different (l.6 +- 8.2%, vs 2.1 +- 9.2%). Survival analysis (Cox model) identified the EX EF as the best predictor of death and total events (X/sup 2/ = 4.3 and 2.4, p = 0.04 and 0.07 respectively). Actuarial life table analysis showed that the risk increased as the EX EF decreased when pts were grouped into EX EF greater than or equal to 50, 30-49, and <30%, (p < 0.001, Mantel-Cox). Thus, EX RNA is useful in risk stratification after CABG. The EX LVEF is an important descriptor that categorizes pts into different risks groups. The pts at high risk probably require more aggressive followup and continued medical therapy.
Iskandrian, A.S.; Hakki, A.H.; Goel, I.P.; Mundth, E.D.; Kane, S.; Schenk, C.
We have performed 12 cases of robotically assisted coronary artery bypass grafting (CABG) to accomplish less invasive revascularization. In this report, we describe a new method of robotically assisted internal thoracic artery (ITA) harvesting via subxiphoid approach, using the da Vinci surgical system. A 22-year-old man with three-vessel coronary artery disease due to Kawasaki disease was referred to our institution for coronary artery revascularization. A small subxiphoid incision was made, and the xiphoid process at the lower end of the sternum was excised. A U-shaped hook was inserted into the retrosternal space, and the lower sternum was lifted. A 30 degrees angle-up camera was inserted under the U-shaped hook, bilateral ITAs were harvested in a totally skeletonized fashion endoscopically. The required time for right ITA harvesting was 50 min, and that for the left was 20 min. After bilateral ITAs were harvested, composite grafts were made, and then the distal anastomoses were made. The patient was discharged six days after the operation. We performed a new robotically assisted bilateral ITA harvesting technique via sub-xiphoid safely and with excellent results. This method might be an evolutionary step of minimally invasive direct coronary artery bypass (MIDCAB) using the da Vinci surgical system. PMID:19720658
Takata, Munehisa; Watanabe, Go; Ushijima, Teruaki; Ishikawa, Norihiko
PURPOSE: Coronary artery bypass graft (CABG) surgery represents the standard treatment of advanced coronary artery disease. Two major types of anastomosis exist to connect the graft to the coronary artery, i.e., by using an end-to-side or a side-to-side anastomosis. There is still controversy because of the differences in the patency rates of the two types of anastomosis. The purpose of
Thomas Frauenfelder; Evangelos Boutsianis; Thomas Schertler; Lars Husmann; Sebastian Leschka; Dimos Poulikakos; Borut Marincek; Hatem Alkadhi
Minimally invasive direct coronary artery bypass has been widely employed as an approach for revascularization of the left anterior descending coronary artery. Recent advances in minimally invasive cardiac surgery enhanced with technological assistance have meant that these operations are now being performed through smaller incisions. We present 2 cases, both of which emphasize the beneficial role of the DaVinci robotic system in performing bloodless coronary surgery without blood transfusion and in reducing blood contact in instances in which there is a high risk for infection. In the first case, a Jehovah's Witness patient, blood transfusion was not an option; in the second case, a human immunodeficiency virus (HIV)-positive patient, blood contact would have put the staff at risk for HIV infection. PMID:15138099
Casula, Roberto; Athanasiou, Thanos
The increasing popularity of beating-heart coronary surgery has raised concerns and doubts about the quality of the coronary anastomoses performed. Intraoperative graft patency verification methods are not commonly used after coronary surgery and, most of the cardiac surgeons, rely on the simple clinical signs (electrocardiogram tracings and hemodynamic stability) to make a diagnosis of coronary graft occlusion. New transit time ultrasound based methods for graft-patency verification have been adopted in many centers during beating-heart and traditional bypass grafting. Although the results are very encouraging, correct interpretation of the flow findings may prove difficult if specific rules are not properly followed. Flow curves, pulsatility index, and flow values should always be considered simultaneously before revising a coronary graft. Measurements should also be always performed with and without a proximal coronary snare. This article summarizes the main features of flowmetry and provides some technical pitfalls and suggestions to achieve an adequate intraoperative flow measurement adopting the transit time method. PMID:10999613
D'Ancona, G; Karamanoukian, H L; Ricci, M; Bergsland, J; Salerno, T A
NASA Astrophysics Data System (ADS)
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.
Grajek, Magdalena; Krzyminiewski, Ryszard; Kalawski, Ryszard; Kulczak, Mariusz
Transit-time flowmetry enables immediate intraoperative assessment of blood flow parameters in coronary artery bypass grafts (CABG). The present study assesses the predictive value of measured graft flows on early and medium-term outcomes. All cardiac surgery patients with measured graft flows were included. The last intraoperative flow measurements recorded using the Medtronic Butterfly Flowmetry system were used for analysis. Patients were separated into two groups: patients with normal flow in all grafts or patients with abnormal flow > or =1 graft. Any pulsatility index (pulsatility index=min-max flow/mean flow) < or =5 was determined to be normal flow. The study population included 985 patients. Nineteen percent of patients had abnormal flow in > or =1 graft. Overall in-hospital mortality was 4.7% and not significant between the two groups. After adjusting for covariates, the in-hospital composite outcome for adverse cardiac events was more prevalent in the abnormal flow group (31% vs. 17%; P<0.0001) with an odds ratio of 1.7 (CI 1.1-2.7). Survivors to discharge had a mean follow-up of 1.8 years. However, abnormal flow was not an independent predictor of the medium-term mortality and readmission to hospital for cardiac reason following discharge. Our findings suggest that abnormal flows measured intraoperatively are independently associated with short-term in-hospital adverse outcome. PMID:18467427
Herman, Christine; Sullivan, John A; Buth, Karen; Legare, Jean-Francois
Microemboli are not associated with delirium after coronary artery bypass graft surgery.
Delirium is an acute change in cognition which occurs frequently after coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from plaque, air, or thrombus, have been hypothesized to contribute to delirium and cognitive decline after CABG. The purpose of this study was to determine if there was an association between cerebral microemboli and delirium after cardiac surgery. Non-delirious patients (n=68) were prospectively enrolled and underwent intraoperative monitoring of the middle cerebral arteries with transcranial Doppler (TCD). TCD signals were saved and analyzed postoperatively for microemboli manually, according to established criteria. Postoperatively, patients were assessed for delirium with a standardized battery. Thirty-three patients (48.5%) developed delirium after surgery. Microemboli counts (mean + or - SD) were not significantly different in those with and without delirium (303 + or - 449 vs. 299 + or - 350; p=0.97). While intraoperative microemboli were not associated with delirium after CABG, further investigation into the source and composition of microemboli can further elucidate the long-term clinical impact of microemboli. PMID:20093336
Rudolph, James L; Babikian, Viken L; Treanor, Patrick; Pochay, Val E; Wigginton, Jeremy B; Crittenden, Michael D; Marcantonio, Edward R
Microemboli are not associated with delirium after coronary artery bypass graft surgery
Delirium is an acute change in cognition which occurs frequently after coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from plaque, air, or thrombus, have been hypothesized to contribute to delirium and cognitive decline after CABG. The purpose of this study was to determine if there was an association between cerebral microemboli and delirium after cardiac surgery. Non-delirious patients (n=68) were prospectively enrolled and underwent intraoperative monitoring of the middle cerebral arteries with transcranial Doppler (TCD). TCD signals were saved and analyzed postoperatively for microemboli manually, according to established criteria. Postoperatively, patients were assessed for delirium with a standardized battery. Thirty-three patients (48.5%) developed delirium after surgery. Microemboli counts (mean � SD) were not significantly different in those with and without delirium (303 �449 vs. 299 �350; p=0.97). While intraoperative microemboli were not associated with delirium after CABG, further investigation into the source and composition of microemboli can further elucidate the long-term clinical impact of microemboli. PMID:20093336
Rudolph, James L.; Babikian, Viken L.; Treanor, Patrick; Pochay, Val E.; Wigginton, Jeremy B.; Crittenden, Michael D.; Marcantonio, Edward R.
Predictors of hospital readmission two years after coronary artery bypass grafting.
OBJECTIVE: To determine the clinical factors before, and in association with, coronary artery bypass grafting (CABG) that increase the risk of readmission to hospital in the first two years after surgery. PATIENTS: All patients in western Sweden who had CABG without simultaneous valve surgery between 1 June 1988 and 1 June 1991. METHODS: All patients who were readmitted to hospital were evaluated by postal inquiry and hospital records. RESULTS: A total of 2121 patients were operated on, of whom 2037 were discharged from hospital. Information regarding readmission was missing in four patients, leaving 2033 patients; 44% were readmitted to hospital. The most common reasons for readmission were angina pectoris and congestive heart failure. There were 12 independent significant predictors for readmission: clinical history (a previous history of either congestive heart failure or myocardial infarction, or CABG); acute operation; postoperative complications (time in intensive care unit greater than two days, neurological complications); clinical findings four to seven days after the operation (arrhythmia, systolic murmur equivalent to mitral regurgitation); medication four to seven days after the operation (antidiabetics, diuretics for heart failure, other antiarrhythmics (other than beta blockers, calcium antagonists, and digitalis), and lack of treatment with aspirin). CONCLUSION: 44% of patients were readmitted to hospital two years after CABG. The most common reasons for readmission were angina pectoris and congestive heart failure. Four clinical markers predicted readmission: clinical history; acute operation status; postoperative complications; and clinical findings and medication four to seven days after operation. PMID:9196414
Herlitz, J.; Albertsson, P.; Brandrup-Wognsen, G.; Emanuelsson, H.; Haglid, M.; Hartford, M.; Hjalmarson, A.; Karlson, B. W.; Karlsson, T.; Sand�n, W.
Nafamostat Mesilate: Can It Be Used as a Conduit Preserving Agent in Coronary Artery Bypass Surgery?
Background Graft vessel preservation solution in coronary artery bypass surgery is used to maintain the graft conduit in optimal condition during the perioperative period. Nafamostat mesilate (NM) has anticoagulation and anti-inflammatory properties. Therefore, we investigated NM as a conduit preservative agent and compared it to papaverine. Methods Sprague-Dawley (SD) rat thoracic aortas were examined for their contraction-relaxation ability using phenylephrine (PE) and acetylcholine (ACh) following preincubation with papaverine and NM in standard classical organ baths. Human umbilical vein endothelial cells (HUVECs) were cultured to check for the endothelial cell viability. Histopathological examination and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed on the thoracic aortas of SD rats. Results The anti-contraction effects of papaverine were superior to those of NM at PE (p<0.05). The relaxation effect of NM on ACh-induced vasodilatation was not statistically different from that of papaverine. Viability assays using HUVECs showed endothelial cell survival rates of >90% in various concentrations of both NM and papaverine. A histopathological study showed a protective effect against necrosis and apoptosis (p<0.05) in the NM group. Conclusion NM exhibited good vascular relaxation and a reasonable anti-vasocontraction effect with a better cell protecting effect than papaverine; therefore, we concluded that NM is a good potential conduit preserving agent. PMID:24368967
Yoon, Yoo Sang; Oh, Hyunkong; Kim, Yonghwan; Lim, Seung Pyung
A 55-year-old powerlifter in Tennessee learned about the sport-specific, high-intensity cardiac rehabilitation training available in Dallas, Texas, and contacted the staff by phone. He was recovering from quadruple coronary artery bypass grafting (CABG) and had completed several weeks of traditional cardiac rehabilitation in his hometown, but the exercise program no longer met his needs. He wanted help in returning both to his normal training regimen and to powerlifting competition but was unable to attend the Dallas program in person. An exercise physiologist with the program devised a virtual coaching model in which the patient was sent a wrist blood pressure cuff for self-monitoring and was advised about exercises that would not harm his healing sternum, even as the weight loads were gradually increased. After 17 weeks of symptom-limited, high-intensity training that was complemented by phone and e-mail support, the patient was lifting heavier loads than he had before CABG. At a powerlifting competition 10 months after CABG, he placed first in his age group. This case report exemplifies the need for alternative approaches to the delivery of cardiac rehabilitation services. PMID:25552808
Adams, Richard; Adams, Jenny; Qin, Huanying; Bilbrey, Tim; Schussler, Jeffrey M
Bleeding remains a serious complication of cardiac surgery. Studies indicate that preoperative fibrinogen concentration is an independent predictor of blood loss during coronary artery bypass graft (CABG) surgery. This study evaluates whether fibrinogen concentration is a better predictor of blood usage than the prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests. Patients not taking clopidogrel bisulfate who underwent CABG surgery during a 3-month period at a 350-bed community hospital were included in this prospective study. The parameters evaluated included patient�s age, preoperative coagulation test results (PT, international normalized ratio [INR], aPTT, fibrinogen), and number of blood components transfused. A probability value of less than 0.05 was deemed significant. Thirty-five patients were included in this study. Mean blood usage was 6 units. Patient�s age approached significance as a predictor of blood usage, and fibrinogen levels trended toward significance more than the other coagulation parameters. In this study, the increased age of the patient and low plasma concentrations of fibrinogen were associated with increased blood usage. Although no indicators clearly demonstrated statistical significance, the vast difference in the probability values for patients� ages and fibrinogen levels indicated that there was a trend toward significance in blood usage for CABG patients. Further studies with larger patient populations are indicated. PMID:22646071
Josefy, S; Briones, R; Bryant, B J
The New Zealand priority criteria project. Part 2: Coronary artery bypass graft surgery.
Priority criteria developed during a national project were used to conduct an audit of all 662 patients on waiting lists for coronary artery bypass surgery in New Zealand during spring 1996. Based on the observed distribution of priority scores, the cost of providing surgery to all patients down to various levels of priority was estimated. Descriptions incorporating life expectancy and quality of life implications of surgery were developed of the kinds of patients who would or would not receive surgery at each of several possible funding levels. Cardiologists and cardiac surgeons agreed that a threshold of 25 points was a reasonable clinical goal but to work with a threshold of 35, which can be sustained with current levels of funding. All agree that the gap between these clinically preferred and currently afforded thresholds is a subject for wider societal dialogue and decision. The ability to measure the size of the gap between clinical desirability and financial sustainability provides a new transparency to the problem of healthcare resource allocation. PMID:9006478
Hadorn, D. C.; Holmes, A. C.
A 55-year-old powerlifter in Tennessee learned about the sport-specific, high-intensity cardiac rehabilitation training available in Dallas, Texas, and contacted the staff by phone. He was recovering from quadruple coronary artery bypass grafting (CABG) and had completed several weeks of traditional cardiac rehabilitation in his hometown, but the exercise program no longer met his needs. He wanted help in returning both to his normal training regimen and to powerlifting competition but was unable to attend the Dallas program in person. An exercise physiologist with the program devised a virtual coaching model in which the patient was sent a wrist blood pressure cuff for self-monitoring and was advised about exercises that would not harm his healing sternum, even as the weight loads were gradually increased. After 17 weeks of symptom-limited, high-intensity training that was complemented by phone and e-mail support, the patient was lifting heavier loads than he had before CABG. At a powerlifting competition 10 months after CABG, he placed first in his age group. This case report exemplifies the need for alternative approaches to the delivery of cardiac rehabilitation services. PMID:25552808
Adams, Richard; Qin, Huanying; Bilbrey, Tim; Schussler, Jeffrey M.
Uncertainty surrounds the optimal revascularization strategy for patients with left main coronary artery disease presenting with acute coronary syndromes (ACSs), and adequately sized specific comparisons of percutaneous and surgical revascularization in this scenario are lacking. The aim of this study was to evaluate the incidence of 1-year major adverse cardiac events (MACEs) in patients with left main coronary artery disease and ACS treated with percutaneous coronary intervention (PCI) and drug-eluting stent implantation or coronary artery bypass grafting (CABG). A total of 583 patients were included. At 1 year, MACEs were significantly higher in patients treated with PCI (n = 222) compared to those treated with CABG (n = 361, 14.4% vs 5.3%, p <0.001), driven by a higher rate of target lesion revascularization (8.1% vs 1.7%, p = 0.001). This finding was consistent after statistical adjustment for MACEs (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.2 to 5.9, p = 0.01) and target lesion revascularization (adjusted HR 8.0, 95% CI 2.2 to 28.7, p = 0.001). No statistically significant differences between PCI and CABG were noted for death (adjusted HR 1.1, 95% CI 0.4 to 3.0, p = 0.81) and myocardial infarction (adjusted HR 4.8, 95% CI 0.3 to 68.6, p = 0.25). No interaction between clinical presentation (ST-segment elevation myocardial infarction or unstable angina/non-ST-segment elevation myocardial infarction) and treatment (PCI or CABG) was observed (p for interaction = 0.68). In conclusion, in patients with left main coronary artery disease and ACS, PCI is associated with similar safety compared to CABG but higher risk of MACEs driven by increased risk of repeat revascularization. PMID:21545992
Caggegi, Anna; Capodanno, Davide; Capranzano, Piera; Chisari, Alberto; Ministeri, Margherita; Mangiameli, Andrea; Ronsivalle, Giuseppe; Ricca, Giovanni; Barrano, Giombattista; Monaco, Sergio; Di Salvo, Maria Elena; Tamburino, Corrado
In selected patients undergoing cardiac surgery, our research group previously showed that optimized temporary biventricular pacing can increase cardiac output one hour after weaning from cardiopulmonary bypass. Whether pacing is effective after beating-heart surgery is unknown. Accordingly, in this study we examined the feasibility of temporary biventricular pacing after off-pump coronary artery bypass grafting. The effects of optimized pacing on cardiac output were measured with an electromagnetic aortic flow probe at the conclusion of surgery in 5 patients with a preoperative mean left ventricular ejection fraction of 0.26 (range, 0.15-0.35). Atrioventricular (7) and interventricular (9) delay settings were optimized in randomized order. Cardiac output with optimized biventricular pacing was 4.2 � 0.7 L/min; in sinus rhythm, it was 3.8 � 0.5 L/min. Atrial pacing at a matched heart rate resulted in cardiac output intermediate to that of sinus rhythm and biventricular pacing (4 � 0.6 L/min). Optimization of atrioventricular and interventricular delay, in comparison with nominal settings, trended toward increased flow. This study shows that temporary biventricular pacing is feasible in patients with preoperative left ventricular dysfunction who are undergoing off-pump coronary artery bypass grafting. Further study of the possible clinical benefits of this intervention is warranted. PMID:24082369
Wang, Daniel Y; Kelly, Lauren A; Richmond, Marc E; Quinn, T Alexander; Cheng, Bin; Spotnitz, Michelle D; Cabreriza, Santos E; Naka, Yoshifumi; Stewart, Allan S; Smith, Craig R; Spotnitz, Henry M
Background: Sedation after open heart surgery is important in preventing stress on the heart. The unique sedative features of propofol prompted us to evaluate its potential clinical role in the sedation of post-CABG patients. Objectives: To compare propofol-based sedation to midazolam-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). Patients and Methods: Fifty patients who were admitted to the ICU after CABG surgery was randomized into two groups to receive sedation with either midazolam or propofol infusions; and additional analgesia was administered if required. Inclusion criteria were as follows: patients 40-60 years old, hemodynamic stability, ejection fraction (EF) more than 40%; exclusion criteria included patients who required intra-aortic balloon pump or inotropic drugs post-bypass. The same protocol of anesthetic medications was used in both groups. Depth of sedation was monitored using the Ramsay sedation score (RSS). Invasive mean arterial pressure (MAP) and heart rate (HR), arterial blood gas (ABG) and ventilatory parameters were monitored continuously after the start of study drug and until the patients were extubated. Results: The depth of sedation was almost the same in the two groups (RSS=4.5 in midazolam group vs 4.7 in propofol group; P = 0.259) but the total dose of fentanyl in the midazolam group was significantly more than the propofol group (12.5 mg/hr vs 4 mg/hr) (P = 0.0039). No significant differences were found in MAP (P = 0.51) and HR (P = 0.41) between the groups. The mean extubation time in patients sedated with propofol was shorter than those sedated with midazolam (102 � 27 min vs 245 � 42 min, respectively; P < 0.05) but the ICU discharge time was not shorter (47.5 hr vs 36.3 hr, respectively; P = 0.24). Conclusions: Propofol provided a safe and acceptable sedation for post-CABG surgical patients, significantly reduced the requirement for analgesics, and allowed for more rapid tracheal extubation than midazolam but did not result in earlier ICU discharge. PMID:24660162
Aghdaii, Nahid; Yazdanian, Frouzan; Faritus, Seyedeh Zahra
Pain Location and Intensity During the First Week Following Coronary Artery Bypass Graft Surgery
Background Despite the advances in pain control following surgery, data on the location and distribution of pain following coronary artery bypass grafting (CABG) are lacking. Objectives This study was intended to investigate the location, distribution, and intensity of pain in patients undergoing CABG during their postoperative hospital stay from the operation to the end of the first postoperative week. Factors that could affect pain intensity and distribution were analyzed as well. Patients and Methods The present study was conducted on 138 patients who underwent CABG surgery at Rajaei cardiovascular, Medical and Research Center during May and July 2011. Location and intensity of pain were assessed using numeric rating scale (NRS) over time: every six hours after the operation on the first day (T1-T4, respectively), and on two (POD2), three (POD3), and seven days after the operation (POD7). Results Among 138 patients assessed in the study, the greatest severity of pain was reported on T2, with the mean severity of 3.4, followed by POD2 with the mean severity of 2.9 (P < 0.01). The location of the surgical incision had the most severity of pain in all patients (P < 0.01). On the site of surgical incision, a negative correlation was seen between the age and the severity of pain on T1 (P = 0.03, r = -0.180). Women experienced more severe pain compared to men at POD7. A significant correlation was seen between the severity of pain on POD7 and body mass index (BMI) (P < 0.01, r = 0.23). In patients who had the longer duration of cardiopulmonary bypass (CBD), the most pain intensity was reported on T1 (P < 0.01, r = 0.18). A significant correlation was seen on the pain intensity on T4 and chest tube drainage (P < 0.01, r = 0.24). The correlation between the pain severity pain and duration of admission in intensive care unit (ICU), was significant on T1 (P < 0.05, r = 0.18), T4 (P < 0.01, r = 0.29), POD2 (P < 0.01, r = 0.35) and POD7 (P < 0.05, r = 0.18). Conclusions Following CABG, the most severity of pain was reported at surgical incision on time T2. Pain began to decrease from the third day following the operation. Age, sex and BMI along with operation-related factors such as duration of CBP or chest tube drainage may affect the pain pattern following CABG surgery. PMID:24660142
Totonchi, Ziae; Seifi, Somayeh; Chitsazan, Mitra; Alizadeh Ghavidel, Alireza; Baazm, Farah; Faritus, Seyedeh Zahra
Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass Graft Surgery
IMPORTANCE In vitro and animal model data suggest that intraoperative preservation solutions may influence endothelial function and vein graft failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking. OBJECTIVE To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization. RESULTS Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P < .001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P = .001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P < .001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P = .08]) and blood (0.81 [0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions. PMID:25073921
Harskamp, Ralf E.; Alexander, John H.; Schulte, Phillip J.; Brophy, Colleen M.; Mack, Michael J.; Peterson, Eric D.; Williams, Judson B.; Gibson, C. Michael; Califf, Robert M.; Kouchoukos, Nicholas T.; Harrington, Robert A.; Ferguson, T. Bruce; Lopes, Renato D.
Carotid stenosis is a frequent coexisting condition in patients undergoing coronary artery bypass graft (CABG) surgery. The impact of carotid stenosis on cerebral perfusion is not fully understood. The purpose of this study was to determine the impact of carotid stenosis on cerebral blood flow velocity in patients undergoing CABG. Seventy-three patients undergoing CABG were prospectively recruited and underwent preoperative Duplex carotid ultrasound to evaluate the degree of carotid stenosis. Intraoperatively, transcranial Doppler ultrasound was used to record of the mean flow velocity within the bilateral middle cerebral arteries. Additionally, during the period of cardiopulmonary bypass, regulators of cerebral hemodynamics such as hematocrit, partial pressure of carbon dioxide, and temperature were recorded. The ipsilateral middle cerebral artery mean flow velocity was compared in arteries with and without carotid stenosis using a repeated measures analysis. Seventy-three patients underwent intraoperative monitoring during CABG and 30% (n=22) had carotid stenosis. Overall, MFV rose throughout the duration of CABG including when the patient was on cardiopulmonary bypass. However, there was no significant MFV difference between those arteries with and without stenosis (F=1.2, p=.21). Further analysis during cardiopulmonary bypass, demonstrated that hemodilution and partial pressure of carbon dioxide may play a role in cerebral autoregulation during CABG. Carotid stenosis did not impact mean cerebral blood flow velocity during CABG. The cerebrovascular regulatory process appears to be largely intact during CABG. PMID:19540657
Rudolph, James L.; Sorond, Farzaneh A.; Pochay, Val E.; Haime, Miguel; Treanor, Patrick; Crittenden, Michael D.; Babikian, Viken L.
Coronary artery bypass grafting in Canada: What is its rate of use? Which rate is right?
We reviewed recent reports from administrative databases and clinical registries addressing the utilization of coronary artery bypass grafting (CABG) in Canada. The Canadian CABG rate per 100,000 people increased from 31.1 to 43.2 between 1981-82 and 1986-87. Between 1981 and 1986 the rate in the United States increased from 69.9 to 95.3 per 100,000, consistently about two times the Canadian rate. Provincial data have shown particular growth in utilization among elderly people. However, in the United States the 1985 CABG rate was twice as high as the aggregated age-specific rates for Ontario and Manitoba among people 65 to 74 years of age and four times higher among those 75 years or more. Limited registry data suggest that the Canadian CABG case mix is similar to the case mix in major US centres and that, utilization growth notwithstanding, the procedure is largely applied to patients who should, in theory, benefit (i.e., those with severe angina, impaired left ventricular function and left main-stem or triple-vessel disease). However, chart audits and registry evaluations using explicit criteria are needed to compare the use of CABG in Canada and the United States. In addition, Canadian data show moderate regional and municipal variations, the 1986-87 rates per 100,000 population in major census metropolitan areas varying from 19.5 to 46.9. Areas with consistently low rates raise particular concerns about impaired access to CABG. Reasons for variations should therefore be a research priority. PMID:1544075
Naylor, C D; Ugnat, A M; Weinkauf, D; Anderson, G M; Wielgosz, A
Is single-unit blood transfusion bad post-coronary artery bypass surgery?�
OBJECTIVES Publications in the surgical literature are very consistent in their conclusions that blood is dangerous with regard to in-hospital mortality, morbidity and long-term survival. Blood is frequently used as a volume expander while simultaneously increasing the haematocrit. We investigated the effects of a single-unit blood transfusion on long-term survival post-cardiac surgery in isolated coronary artery bypass grafting patients. METHODS A prospective single-institution cardiac surgery database was analysed involving 4615 patients. Univariate, multivariate stepwise Cox regression analysis and propensity matching were performed to identify whether a single-unit blood transfusion was detrimental to long-term survival. RESULTS Univariate analysis revealed that blood was significantly associated with a reduced long-term survival even with a single-unit transfused, P = 0.0001. Cox multivariate regression analysis identified age, ejection fraction, preoperative dialysis, logistic EuroSCORE, postoperative CKMB, blood transfusion, urgent operative status and atrial fibrillation as significant factors determining long-term survival. When the Cox regression was repeated with patients who received no blood or only one unit of blood, transfusion was not a risk factor for long-term survival. An interaction analysis revealed that blood transfusion was significantly interacting with preoperative haemoglobin levels, P = 0.02. Propensity analysis demonstrated that a single-unit transfusion is not associated with a detrimental long-term survival, P = 0.3. CONCLUSIONS Cox regression and propensity matching both indicate that a single-unit transfusion is not a significant cause of reduced long-term survival. Preoperative anaemia is a significant confounding factor. Despite demonstrating the negligible risks of a single-unit blood transfusion, we are not advocating liberal transfusion and would recommend changing from a double-unit to a single-unit transfusion policy. We speculate that blood is not bad, but that the underlying reason that it is given might be. PMID:23449665
Warwick, Richard; Mediratta, Neeraj; Chalmers, John; Pullan, Mark; Shaw, Matthew; Mcshane, James; Poullis, Michael
Risk of atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is high, yet the effectiveness of guideline-recommended preoperative prophylaxis in clinical practice remains uncertain. We determined the utilization and variation of preoperative AF prevention and assessed the comparative effectiveness of alternative drugs using the Society of Thoracic Surgeons multicenter Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) registry. Among 2,177 patients who underwent high-risk CABG and/or valve surgery, the mean age was 71 � 9, 66% were men, 26% had chronic lung disease, and 21% had cerebrovascular disease. Overall use of AF prophylaxis was 84% and varied across sites (range 52% to 100%). The most common preventive agents were beta blockers (72%), followed by calcium antagonists (17%). Postoperatively, 30% (n�= 646) developed AF at a median of 2 (25th to 75th percentiles: 1 to 3) days after surgery. Increasing age, height, white race, body mass index >35, New York Heart Association class IV heart failure, preoperative dialysis, and concomitant aortic valve replacement were associated with greater odds of postoperative AF (p <0.05 for all). Preoperative amiodarone use was associated with a trend to reduction of postoperative AF (26%, adjusted odds ratio 0.72 [95% confidence interval 0.51 to 1.00], p�= 0.052). After adjustment, the odds of postoperative AF were not statistically different across agents. In conclusion, use of AF prophylaxis before surgery varied significantly. In this high-risk population, we were unable to demonstrate that any of the commonly used preventive agents were associated with lower rates of AF compared with alternatives or no treatment. PMID:23850476
Piccini, Jonathan P; Zhao, Yue; Steinberg, Benjamin A; He, Xia; Mathew, Joseph P; Fullerton, David A; Hegland, Donald D; Hernandez, Adrian F; Mills, Roger M; Klaskala, Winslow; Peterson, Eric D
Background The incidence of Post-CABG atrial fibrillation (AF) lies between 25% and 40%. It worsens morbidity and raises post-operative costs. Detection of incoming AF soon enough for prophylactic intervention would be helpful. The study is to investigate the electrophysiological changes preceding the onset of AF and their relationship to the preoperative risk. Methods and Results Patients were recorded continuously for the first four days after coronary artery bypass grafting surgery (CABG) with three unipolar electrodes sutured to the atria (AEG). The patients experiencing an AF lasting more than 10 minutes were selected and the two hours before the onset were analyzed. Four variables were found to show significant changes in the two hours prior to the first prolonged AF: increasing rate of premature atrial activation, increasing incidence of short transient arrhythmias, acceleration of heart rate, and rise of low frequency content of heart rate. The main contrast was between the first and last hour before AF onset. Preoperative risk was not predictive of the onset time of AF and did not correlate with the amplitude of changes prior to AF. Conclusions Post-CABG AF were preceded by electrophysiological changes occurring in the last hour before the onset of the arrhythmia, whereas none of these changes was found to occur in all AF patients. The risk was a weighted sum of factors related to the density of premature activations and the state of atrial substrate reflected by the sinus rhythm and its frequency content prior to AF. Preoperative risk score seems unhelpful in setting a detection threshold for the AF onset. PMID:25247814
Xiong, Feng; Yin, Yalin; Dub�, Bruno; Pag�, Pierre; Vinet, Alain
Labetalol is a competitive inhibitor of alpha- and beta-adrenergic receptors and has an antihypertensive action. To determine limb haemodynamic effects, we measured calf blood flow and venous capacitance by venous occlusion plethysmography before and after oral labetalol in 10 patients 3-7 days following coronary bypass surgery. Vascular resistance was calculated as the ratio of mean arterial pressure to arterial flow. The peak effect of labetalol was taken as the point of maximum blood pressure decline, and this interval was selected for evaluation of the limb haemodynamic response. Ninety to 120 min after administration of 100-200 mg of labetalol the mean blood pressure fell from 88 +/- 3 to 79 +/- 3 mm Hg; (P less than 0.005). The mean arterial blood flow registered 5.1 +/- 1.0 ml 100 ml-1 limb tissue min-1 which was not significantly different from the control value of 4.4 +/- 0.8 ml 100 ml-1 limb tissue min-1. The calculated index of limb vascular resistance was not affected by labetalol administration, averaging 37 +/- 12 mm Hg 100-1 ml limb tissue min-1 before labetalol and 30 +/- 11 mm Hg ml-1 100 ml limb tissue min-1 at the time of peak hypotensive effect. There was a slight but statistically significant increment in limb venous volume to 1.9 +/- 0.3 from 1.5 +/- 0.3 ml 100 ml-1 limb tissue (P less than 0.025). Placebo administration produced no consistent changes in blood pressure, arterial blood flow, vascular resistance or venous capacitance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2872908
Halperin, J L; Mindich, B P; Rothlauf, E B; Reder, R F; Litwak, R S; Kupersmith, J
Cognitive impairments are observed in numerous patients following coronary bypass surgery, and piracetam are nootropic compounds that modulate cerebral functions by directly enhancing cognitive processes. The present meta-analysis was conducted to evaluate the protective effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery. The relevant studies were identified by searching Medline, EMBASE, PubMed and the Cochrane Library up to June 2013 and the pertinent bibliographies from the retrieved studies were reviewed. Data were selected from the studies according to predefined criteria. The meta-analysis included two randomized control trials involving 184 patients and including the Syndrom-Kurz test (SKT). Findings of the meta-analysis showed that following treatment the change from baseline observed in five SKT subtest scores, conducted with piracetam patients, indicated a significant advantage over those patients that were in the placebo group. The subtests included immediate pictured object recall, weighted mean difference (WMD)=0.91, 95% confidence interval (CI) 0.51�1.31, P<0.00001; delayed pictured object recall, WMD=0.74, 95% CI 0.19�1.28, P=0.008; delayed picture recognition, WMD=0.82, 95% CI 0.31�1.31, P=0.001; immediate word recall, WMD=0.87, 95% CI 0.47�1.28, P<0.0001; and letter interference, WMD=3.46, 95% CI ?5.69 to ?1.23, P=0.002. These results indicated that piracetam may have been effective in improving the short-term cognitive performance of patients undergoing coronary bypass surgery. High quality, well-controlled and longer randomized trials are required to corroborate this result. PMID:24396419
Objective. To evaluate the effects of continuous positive airway pressure (CPAP) and bi- level positive airway pressure (Bi- PAP) on extravascular lung water during weaning from mechanical ventilation in patients following coronary artery bypass grafting. Design: Prospective, randomized clinical study. Setting: Intensive care unit at a uni- versity hospital. Patients: Seventy-five patients following coronary artery bypass grafting. Interventions: After extubation
R. Gust; H. Schmidt; B. W. B�ttiger; H. B�hrer; E. Martin; A. Gottcchalk
Surgeons should be aware of diaphragmatic hernia in obese patients who have undergone coronary artery bypass grafting (CABG) using a gastroepiploic artery graft (GEA), even if the antegastric route is utilized.We report a case of diaphragmatic hernia, which occurred 88 months after initial CABG. A 64-year-old obese man underwent surgical repair of a diaphragmatic hernia. At initial surgery, the diaphragm was incised vertically and re-sutured, leaving a route for GEA graft. Both the stomach and the lateral segment of the liver were dislocated in the pericardial space. The diaphragmatic defect was closed with a polytetrafluoroethylene patch. PMID:21881348
Takiuchi, Hiroki; Totsugawa, Toshinori; Tamaki, Takahiko; Kuinose, Masahiko; Yoshitaka, Hidenori; Tsusima, Yoshimasa
The generalizability of a prediction model from North America for incident nosocomial pneumonia following coronary artery bypass graft surgery was assessed for 23247 patients on the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registry. The performance of the North American model was evaluated using measures of calibration and discrimination. The model had reasonable discrimination (area under the receiver-operating characteristic curve, AUC=0�69), but unsatisfactory calibration (Hosmer-Lemeshow test, P<0�001) in the ANZSCTS patients. An update of the model coefficients yielded a model with AUC=0�71 and good calibration (P=0�46). PMID:23800544
Sanagou, M; Wolfe, R; Leder, K; Reid, C M
Background�Coronary bypass surgery (CABG) and angioplasty (PTCA) have been compared in several randomized trials, but data about long-term economic and quality-of-life outcomes are limited. Methods and Results�Cost and quality-of-life data were collected prospectively from 934 patients who were randomized in the Bypass Angioplasty Revascularization Investigation (BARI) and followed up for 10 to12 years. CABG had 53% higher costs initially, but
Mark A. Hlatky; Derek B. Boothroyd; Kathryn A. Melsop; Maria M. Brooks; Daniel B. Mark; Bertram Pitt; Guy S. Reeder; William J. Rogers; Thomas J. Ryan; Patrick L. Whitlow; Robert D. Wiens
The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods. PMID:24826267
Gardner, Jonathan D.; Maddox, William R.; Calkins, Joe B.
The impact of blood use on patients undergoing coronary artery bypass surgery: a prospective study
Summary Objectives This survey aimed at assessing the incidence of blood use and the impact of cardiopulmonary bypass (CBP), sex, age, number of grafts, combined cardiac interventions, and hematocrit level in patients who undergo coronary artery bypass graft (CABG) surgery. Patients and Methods A prospective study included patients in the department of cardiac surgery at the American Hospital, in Tirana, Albania. We studied 164 consecutive patients who underwent CABG surgery over a 2-year period (2011�2013). Results We analyzed 164 patients: 138 men and 26 women. The average age was 61.8 years (range, 34�82 years). Of these, 116 patients (101 men/15 women) and 48 patients (37 men/11 women) were operated on-pump and off-pump, respectively. Packed red blood cells (PRBC) were administered to 79.87% of patients (131/164). In total, 334 units were transfused. The average number of PRBC units per patient was 2.03 � 1.5 (range, 0�8 units). Blood transfusion was administered to 87.06% and 62.5% of on-pump and off-pump patients, respectively. On-pump and off-pump patients received 2.4 and 1 unit of PRBC, respectively (p < 0.001). Female and male patients received 2.2 and 2 units, respectively (p = 0.1). Patients aged ? 62.5 years received 2.3 units on average versus the average of 1.7 units received by patients aged < 62.5 years (p < 0.001). Interventions with 4�6 grafts (79/164) received an average 2.5 units, while those with 1�3 grafts (85/164) received 1.5 units (p < 0.001). Patients requiring other cardiac surgical interventions (35/164) received an average of 2.6 units, while those without other cardiac surgical interventions (129/164) received an average of 1.8 units (p < 0.001). Patients with preoperative hematocrit < 35% received an average 1.2 units of PRBC intraoperatively, and 2.8 units throughout the hospital stay, while patients with preoperative hematocrit ? 35% received an average of 0.75 units intraoperatively (p < 0.001) and 1.9 units throughout the hospital stay (p < 0.001). Conclusion Blood transfusion was required for 79.87% of patients. Five variables were important factors in the use of blood in patients undergoing CABG: using CBP, a higher number of grafts, age ? 62.5 years, combined heart interventions and preoperative hematocrit < 35%. Female patients required more PRBC than male patients, although it was not statistically significant. Knowledge of these risk factors enables better prediction of the probability of patients who might require more blood, better distribution of blood in CABG procedures, use by the blood bank, and evaluation of cost-effectiveness in the use of blood products. PMID:24690337
Perioperative monitoring of primary and secondary hemostasis in coronary artery bypass grafting.
On-pump cardiac surgery is accompanied by complex alterations of hemostasis. The excessive postoperative bleeding has been attributed to acquired platelet dysfunction, impaired plasmatic coagulation, and increased fibrinolysis. The characterization of the hemostatic defects responsible for bleeding is crucial for specific treatment and optimal clinical management of the patient. For rapid determination of platelet-dependent primary hemostatic capacity (PHC), the Platelet Function Analyzer PFA-100 system is available. To evaluate the PFA performance in perioperative monitoring, a study was performed in 49 patients selected for low bleeding risk undergoing selective primary coronary artery bypass grafting (CABG). We compared PHC with Simplate bleeding time (BT) and platelet aggregometry. Furthermore, we analyzed global hemostasis by thromboelastography (TEG) and plasmatic coagulation by standard clotting tests prothrombin time (PT, Quick), activated partial thromboplastin time (aPTT), thrombin time (TT) and clotting factors and fibrinolysis by batroxobin (reptilase) time (RT). In all patients BT was postoperatively increased by 1.5- to 2-fold irrespective of perioperative complications and decreased to mildly prolonged values on the first postoperative day (1st day). In patients without complications, PHC in both collagen-adenosine diphosphate closure time (CADP-CT: 83 seconds preop, 78 seconds postop, and 74 seconds 1st day) and collagen-epinephrine closure time (CEPI-CT: 98 seconds preop, 95 seconds postop, 85 seconds 1st day) remained nearly stable. Apart from a patient with postoperative moderate thrombocytopenia, in bleeding patients no other significant defect of postoperative platelet hemostatic capacity was observed. However, on 1st day, the PHC of those patients was significantly reduced compared with non-bleeding patients. In patients with postoperative myocardial ischemia, increased PHC was identified by significantly shorter postoperative CADP-CT (66 seconds vs. 83 seconds) than in uncomplicated patients. By aggregometry, partial platelet dysfunction was observed in some patients without correlation to bleeding complications. In seven of 9 patients the postoperative bleeding complication was attributed to prolonged heparin anticoagulation and/or mildly enhanced fibrinogenolysis/fibrinolysis by TEG and standard plasmatic coagulation tests (TEG: k time 18 minutes vs. 8 minutes; aPTT: 47 seconds vs. 32 seconds; TT: 18.0 seconds vs. 12.3 seconds) and (RT: 19.5 seconds vs. 17.7 seconds). The impairment of PHC, platelet aggregation, and clotting factors observed on the 1st day in bleeding and in intra-aortic balloon pump (IABP) patients are most likely secondary effects, for example, loss of active platelets and clotting factors, to the primary postoperative bleeding or implantation of the IABP. In conclusion, our data indicate that in standard CABG procedures highly variable alterations of the hemostatic system occur after cardiopulmonary bypass (CPB) even in patients with assumed low operative risks. For identification of post-CPB bleeding complications, thromboelastography, aPTT, and TT and heparin and batroxobin (reptilase) time as fibrinolysis-sensitive assays are useful. Platelet function appears to be rapidly restored in uncomplicated CABG. PHC determination by PFA-100 demonstrates a high specificity for adequate platelet function and, therefore, could be beneficial in improved transfusion of platelet concentrates. PHC testing by PFA-100 may help identify postoperative platelet hyper-reactivity associated with myocardial lesion. PMID:16149021
Hertfelder, Hans-J�rg; B�s, Monika; Weber, Dagmar; Winkler, Kai; Hanfland, Peter; Preusse, Claus J
Background While extracardiac vascular disease (ECVD), defined as a history of peripheral vascular disease (PVD) or cerebrovascular disease (CBVD), is common in patients undergoing coronary artery bypass graft (CABG) surgery, there are limited data available on the association between ECVD, vein graft failure (VGF), and clinical outcomes. Methods Using data from the Project of Ex-vivo Vein Graft Engineering via Transfection IV (PREVENTIV) trial (n = 3,014), 1-year angiographic follow-up and 5- year clinical outcomes (death, myocardial infarction, and revascularization) were determined in patients with and without ECVD. Logistic regression was used to assess risk of VGF. Generalized estimating equations methods were used to account for correlations in a graft level analysis. Kaplan-Meier estimates and Cox hazards regression were used to compare clinical outcomes. We similarly explored the association of the individual components CBVD and PVD with both VGF and clinical outcomes in an additive model. Results Patients with ECVD (n=634, 21%) were older, more commonly female, and had more comorbidities, lower use of internal thoracic artery grafting, and overall worse graft quality than patients without ECVD. VGF rates tended to be higher (patient-level: odds ratio [OR]: 1.23, 95% confidence interval [CI] 0.96 to 1.58, p = 0.099; graft-level: OR: 1.23, 95% CI: 1.00 to 1.53, p = 0.053) in patients with ECVD. VGF rates were significantly higher among CBVD patients (OR: 1.42, 95% CI: 1.03 to 1.97, p = 0.035; graft-level: OR: 1.40, 95% CI: 1.06 to 1.85, p = 0.019). Patients with ECVD had a higher risk of death, myocardial infarction, or revascularization 5 years after CABG surgery (hazard ratio [HR]: 2.96, 95% CI: 2.02 to 4.35, p < 0.001). This relationship was driven by the subset of patients with PVD (HR = 3.32, 95% CI: 2.16 to 5.09, p < 0.001) and not by those with CBVD (HR = 1.10, 95% CI: 0.88 to 1.37, p = 0.40). Conclusions ECVD is common among patients undergoing CABG surgery and is associated with similar short-term but increasingly worse long-term clinical outcomes. This higher risk may be partly, but not exclusively, due to higher rates of VGF among these patients. PMID:24360877
Harskamp, Ralf E.; Alexander, John H.; Schulte, Phillip J.; Jones, W. Schuyler; Williams, Judson B.; Mack, Michael J.; Peterson, Eric D.; Gibson, C. Michael; Califf, Robert M.; Kouchoukos, Nicholas T.; Ferguson, T. Bruce; de Winter, Robbert J.; Lopes, Renato D.
Copeptin can reflect individual's stress state and are correlated with poor outcome of critical illness. The occurrence of postoperative delirium (POD) and cognitive dysfunction (POCD) is associated with worse outcome after coronary artery bypass graft (CABG) surgery. The present study aimed to investigate the ability of postoperative plasma copeptin level to predict POD and POCD in patients undergoing CABG surgery. Postoperative plasma copeptin levels of 108 patients were measured by an enzyme-linked immunosorbent assay. It was demonstrated that plasma copeptin levels were substantially higher in patients with POD than without POD (1.8�0.6 ng/mL vs. 1.1�0.3 ng/mL; P<0.001) and in patients with POCD than without POCD (1.9�0.6 ng/mL vs. 1.1�0.4 ng/mL; P<0.001). Plasma copeptin level and age were identified as independent predictors for POD [odds ratio (OR), 67.386; 95% confidence interval (CI), 12.031-377.426; P<0.001 and OR, 1.202; 95% CI, 1.075-1.345; P=0.001] and POCD (OR, 28.814; 95% CI, 7.131-116.425; P<0.001 and OR, 1.151; 95% CI, 1.030-1.285; P=0.003) using a multivariate analysis. For prediction of POD, the area under receiver operating characteristic curve (AUC) of the copeptin concentration (AUC, 0.883; 95% CI, 0.807-0.937) was markedly higher than that of age (AUC, 0.746; 95% CI, 0.653-0.825; P=0.020). For prediction of POCD, the AUC of the copeptin concentration (AUC, 0.870; 95% CI, 0.792-0.927) was markedly higher than that of age (AUC, 0.735; 95% CI, 0.641-0.815; P=0.043). Thus, postoperative plasma copeptin level may be a useful, complementary tool to predict POD and POCD in patients undergoing CABG surgery. PMID:25073070
Dong, Sheng; Li, Chun-Lai; Liang, Wan-Dong; Chen, Mao-Hua; Bi, Yun-Tian; Li, Xing-Wang
Background Surgical site infections following coronary artery bypass graft (CABG) procedures pose substantial burden on patients and healthcare systems. This study aims to describe the incidence of surgical site infections and causative pathogens following CABG surgery over the period 2003�2012, and to identify risk factors for complex sternal site infections. Methods Routine computerised surveillance data were collected from three public hospitals in Queensland, Australia in which CABG surgery was performed between 2003 and 2012. Surgical site infection rates were calculated by types of infection (superficial/complex) and incision sites (sternal/harvest sites). Patient and procedural characteristics were evaluated as risk factors for complex sternal site infections using a logistic regression model. Results There were 1,702 surgical site infections (518 at sternal sites and 1,184 at harvest sites) following 14,546 CABG procedures performed. Among 732 pathogens isolated, Methicillin-sensitive Staphylococcus aureus accounted for 28.3% of the isolates, Pseudomonas aeruginosa 18.3%, methicillin-resistant Staphylococcus aureus 14.6%, and Enterobacter species 6.7%. Proportions of Gram-negative bacteria elevated from 37.8% in 2003 to 61.8% in 2009, followed by a reduction to 42.4% in 2012. Crude rates of complex sternal site infections increased over the reporting period, ranging from 0.7% in 2004 to 2.6% in 2011. Two factors associated with increased risk of complex sternal site infections were identified: patients with an ASA (American Society of Anaesthesiologists) score of 4 or 5 (reference score of 3, OR 1.83, 95% CI 1.36-2.47) and absence of documentation of antibiotic prophylaxis (OR 2.03, 95% CI 1.12-3.69). Conclusions Compared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease. PMID:24916690
Background Glycated hemoglobin (HbA1c) predicts clinical cardiovascular disease or cardiovascular mortality. However, the relationship between HbA1c and myocardial injury following elective percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (DM) has not been investigated. Objectives The study sought to assess the relationship between HbA1c and myocardial injury following elective PCI in patients with type 2 DM. Methods We studied a cohort of consecutive 994 diabetic patients with coronary artery disease (CAD) undergoing elective PCI. Periprocedural myocardial injury was evaluated by analysis of troponin I (cTnI). The association between preprocedural HbA1c levels and the peak values of cTnI within 24 hours after PCI was evaluated. Results Peak postprocedural cTnI >1�upper limit of normal (ULN), >3�ULN and >5�ULN were detected in 543 (54.6%), 337 (33.9%) and 245 (24.6%) respectively. In the multivariate model, higher HbA1c levels were associated with less risk of postprocedural cTnI >1�ULN (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.76�0.95; P?=?0.005). There was a trend that higher HbA1c levels were associated with less risk of postprocedural cTnI >3�ULN (OR, 0.90; 95% CI, 0.81�1.02; P?=?0.088). HbA1c was not associated with the risk of postprocedural cTnI elevation above 5�ULN (OR, 0.95; 95% CI, 0.84�1.08; P?=?0.411). Conclusions The present study provided the first line of evidence that higher preprocedural HbA1c levels were associated with less risk of myocardial injury following elective PCI in diabetic patients. PMID:24988213
Li, Xiao-Lin; Li, Jian-Jun; Guo, Yuan-Lin; Zhu, Cheng-Gang; Xu, Rui-Xia; Li, Sha; Qing, Ping; Wu, Na-Qiong; Jiang, Li-Xin; Xu, Bo; Gao, Run-Lin
We assessed the effects of aortic valve pathology type on the long-term outcomes of patients who underwent concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. We retrospectively reviewed 150 patients who underwent AVR- CABG at our institution between January 1997 and December 2006. We divided patients into aortic stenosis (AS), aortic regurgitation (AR), and mixed-type groups
Rafet Gunay; Yavuz Sensoz; Ilyas Kayacioglu; Abdullah Kemal Tuygun; Ahmet Yavuz Balci; Ugur Kisa; Mahmut Murat Demirtas; Ibrahim Yekeler
ERIC Educational Resources Information Center
Purpose: This paper examines gender as a moderating variable between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients. Methods: Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified.�
Dao, Tam K.; Voelkel, Emily; Presley, Sherine; Doss, Brendel; Huddleston, Cashuna; Gopaldas, Raja
OBJECTIVESTo evaluate whether coronary artery bypass graft (CABG) surgery is equally provided among different socioeconomic status (SES) groups in accordance with need. To estimate the association between SES and mortality occurring 30 days after CABG surgery.DESIGNIndividual socioeconomic index assigned with respect to the characteristics of the census tract of residence (level I = highest SES; level IV = lowest SES).
Carla Ancona; Nera Agabiti; Francesco Forastiere; Massimo Arc�; Danilo Fusco; Salvatore Ferro; Carlo A Perucci
Objective Growth differentiation factor-15 (GDF-15) has been identified as a strong marker of cardiovascular disease; however, no data are available concerning the role of GDF-15 in the occurrence of organ dysfunction during coronary artery bypass grafting (CABG) associated with cardiopulmonary bypass (CPB). Methods Five arterial blood samples were taken sequentially in 34 patients from anesthesia induction (IND) until 24 h after arrival at the intensive care unit (ICU). Plasma levels of GDF-15, follistatin-like 1 (FLST1), myeloperoxidases (MPO), hydroperoxides and plasma antioxidant status (PAS) were measured at each time-point. Markers of cardiac (cardiac-troponin I, cTnI) and renal dysfunction (neutrophil gelatinase-associated lipocalin, NGAL) and other classical biological factors and clinical data were measured. Results Plasma GDF-15 levels increased gradually during and after surgery, reaching nearly three times the IND levels in the ICU (3,075�284 ng/L vs. 1,061�90 ng/L, p<0.001). Plasma MPO levels increased dramatically during surgery, attaining their highest level after unclamping (UNCLAMP) (49�11 ng/mL vs. 1,679�153 ng/mL, p<0.001) while PAS significantly decreased between IND and UNCLAMP (p<0.05), confirming the high oxidative status induced by this surgical procedure. ICU levels of GDF-15 correlated positively with cTnI and NGAL (p?=?0.006 and p?=?0.036, respectively), and also with hemoglobin and estimated glomerular filtration rate (eGFR). Among all the post-operative biomarkers available, only eGFR, NGAL and GDF-15 measured at ICU arrival were significantly associated with the onset of acute kidney injury (AKI). Patients with a EuroSCORE >3 were shown to have higher GDF-15 levels. Conclusions During cardiac surgery associated with CPB, GDF-15 levels increased substantially and were associated with markers of cardiac injury and renal dysfunction. PMID:25171167
Kahli, Abdelkader; Guenancia, Charles; Zeller, Marianne; Grosjean, Sandrine; Stamboul, Karim; Rochette, Luc; Girard, Claude; Vergely, Catherine
Background: Cardiovascular diseases are the main cause of 40% of deaths in Iran annually. Many patients undergoing coronary artery bypass graft surgery have previous cardiovascular risk factors which could be prevented. Objectives: The present study aimed to assess the prevalence of cardiovascular risk factors in the patients undergoing coronary artery bypass graft surgery. Materials and Methods: In this cross-sectional (descriptive � analytical) study, a data collecting form was used. A total of 246 patients were selected from six hospitals of Shiraz using random stratification. Descriptive statistics were presented through figures and tables and t-test was used to analyze the continuous variables. All the statistical analyses were performed using the SPSS statistical software (version 15.0). Besides, P < 0.05 was considered as statistically significant. Results: Among the study patients, only 11.67% had no risk factors and 88.33% had one or more risk factors. The most common risk factors observed in the patients were hypertension, obesity and overweight, hyperlipidemia, and diabetes mellitus. The results showed a significant difference between males and females regarding the prevalence of hypertension (P = 0.001), diabetes (P = 0.028), hypercholesterolemia (P = 0.020), and cigarette smoking (P = 0.001). In addition, the patients' mean levels of cholesterol, LDL, triglyceride, and fasting blood sugar were higher than the acceptable level, while that of HDL was lower than the accepted level. Conclusions: These patients are recommended to be trained regarding lifestyle changes. Also, prevention strategies can play an important role in reducing patient morbidity and mortality.
Ostovan, Mohammad Ali; Darvish, Negar; Askarian, Mehrdad
Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery.
Background: Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ? 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ? 0.01). Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.Fundamento: A cirurgia de revasculariza��o mioc�rdica (CRM) � a op��o cir�rgica padr�o para pacientes com placas arteriais difusas e significativas. Tal procedimento, no entanto, n�o � desprovido de complica��es p�s-operat�rias, especialmente dist�rbios pulmonares e cognitivos. Objetivo: Comparar o impacto de duas abordagens fisioterap�uticas diferentes nas fun��es pulmonar e cognitiva de pacientes submetidos a CRM. M�todos: Testes de fun��o pulmonar e neuropsicol�gicos foram aplicados, antes e ap�s CRM, a 39 pacientes randomizados em dois grupos: Grupo 1 - 20 pacientes-controle submetidos a uma sess�o de fisioterapia por dia; Grupo 2 - 19 pacientes submetidos a tr�s sess�es de fisioterapia por dia durante recupera��o no hospital. Testes t de Student pareado e n�o pareado foram usados para comparar as vari�veis cont�nuas. Vari�veis sem distribui��o normal foram comparadas entre os grupos usando-se o teste de Mann-Whitney, e, dentro do mesmo grupo em momentos diferentes, usando-se o teste de Wilcoxon. O teste do qui-quadrado avaliou diferen�as das vari�veis categ�ricas. Testes estat�sticos com p valor ? 0,05 foram considerados significativos. Resultados: As altera��es da fun��o pulmonar n�o diferiram significativamente entre os grupos. Entretanto, o mesmo n�o ocorreu com a fun��o neurocognitiva, que apresentou decl�nio no Grupo 1, mas n�o no Grupo 2 (p ? 0,01). Conclus�o: Tais resultados refor�am a import�ncia da fisioterapia ap�s CRM e da realiza��o de m�ltiplas sess�es por dia, o que oferece aos pacientes melhores condi��es psicossociais e menos morbidade. PMID:25352459
Cavalcante, Elder Dos Santos; Magario, Rosmeiri; Conforti, C�sar Augusto; Cipriano J�nior, Gerson; Arena, Ross; Carvalho, Antonio Carlos C; Buffolo, Enio; Luna Filho, Br�ulio
XIENCE PRIME Everolimus Eluting Coronary Stent System (EECSS) China Single-Arm Study
Angioplasty; Cardiovascular Disease; Chronic Coronary Occlusion; Coronary Artery Bypass Graft (CABG); Coronary Artery Disease; Coronary Heart Disease; Coronary Restenosis; Myocardial Infarction; Myocardial Ischemia; Stent Thrombosis; Vascular Disease
Intraoperative assessment of graft anastomoses is commonly performed after off-pump coronary artery bypass grafting (OPCAB). The SPY imaging system allows intraoperative graft assessment. We document correlation between intraoperative SPY images and wall motion abnormality by transesophageal echocardiogram (TEE) during OPCAB. A 79-year-old female underwent OPCAB. Intraoperative graft patency assessment was performed with the SPY and left ventricular wall motion was assessed by TEE. SPY imaging demonstrated poor flow trough the distal vein graft anastomosis to the posterior descending artery, which correlated with a new posterior wall motion hypokinesis. After graft revision, SPY imaging demonstrated good distal flow and the TEE demonstrated normalization of the left ventricular posterior wall motion. SPY technology allows the surgeon to accurately assess graft patency intraoperatively and allows immediate correction of a technical problem. PMID:22436858
Anderson, Curtis A; Kypson, Alan P; Hudson, Wes; Ferguson, Bruce; Rodriguez, Evelio
A comparison of off-pump and on-pump coronary bypass surgery in patients with low EuroSCORE
Background The aim of the present study was to evaluate and compare postoperative short-term, mid-term and long-term outcomes of coronary artery bypass surgery performed with or without cardiopulmonary bypass in patients with a low European System for Cardiac Operative Risk Evaluation score. Methods A retrospective analysis of 478 consecutive low risk patients undergoing coronary bypass surgery between January 2002 and December 2007 was performed. Of these patients, 83 cases had undergone on-pump and 395 cases had undergone off-pump coronary bypass surgery. The patients were assessed in terms peri-operative complications, survival, mortality due to cardiac events, need for rehospitalization and repeated coronary revascularization. Results There was no significant difference between the two groups in terms of preoperative characteristics, except for chronic obstructive pulmonary disease. The number of distal anastomosis per patient was significantly lower in the off-pump group than in the on-pump group (2.66?�?0.74 vs. 3.21?�?0.85, p?0.001). Early mortality rates were similar in both groups (1.01% for the off-pump group and 1.2% for the on-pump group, p?=?0.687). Neurological complications were significantly lower in the off-pump group than in the on-pump group (1.1% vs. 6%, p?=?0.01). The mean follow-up period was 80?�?19.1�months (range, 3�112 months). The need for revascularization during long-term follow-up was 10.1% in the off-pump group and 7.2% in the on-pump group (p?=?0.416). The 5-year survival was 95.2?�?1.1% and 95.5?�?2.7% in the off-pump and on-pump groups, respectively (p?=?0.8), whereas the 7-year survival was 91.9?�?1.6% and 84.7?�?6.8% in the off-pump and on-pump groups, respectively (p?=?0.274). The 5-year revascularization-free period was 89.5?�?1.6% and 89.7?�?3.5% in the off-pump and on-pump groups, respectively (p?=?0.785). The 7-year revascularization-free period was 71.1?�?3.1% and 73.5?�?7.3% in the off-pump and on-pump groups, respectively (p?=?0.075). The 7-year event-free survival was 80.1?�?2.2% and 73.4?�?7.3% in the off-pump and on-pump groups, respectively (p?=?0.377). Conclusions The present study demonstrated that off-pump cardiac surgery had advantages over on-pump cardiac surgery in the short term; however, both interventions had similar mid-term and long-term outcomes, when performed in low-risk patient. PMID:24942178
Anomalous origin of the left coronary artery from the pulmonary artery is a very rare congenital malformation. Re-coronary artery bypass grafting was performed in a 18-year-old man who had received coronary artery reconstruction with a homologous saphenous vein (from his mother) at 7-months old. After the first operation, clinical course was uneventful, but the patient became symptomatic because of effort angina at age 15. The electrocardiogram showed abnormal ST segments in Lead V2-5 and abnormal T waves in Lead V5-6. Coronary arteriography revealed that saphenous vein graft was occluded. The left internal thoracic artery (LITA) was anastomosed to the left anterior descending artery and a two coronary system was established. Postoperative angiography revealed that LITA was patent, and relief of angina was obtained. PMID:7933746
Tobe, M; Kondo, J; Imoto, K; Hirano, K; Tanabe, H; Jin, Y; Matsumoto, A
The aim of study was to assess the effects of an intraoperative external head-cooling technique on cognitive dysfunction in the early postoperative period (at the 10th day) in patients after coronary artery bypass graft (CABG) surgery. Patients in Group H (n=25) were cooled with CPB and the intraoperative, external head-cooling technique, patients in Group C (n=25) were cooled only with cardiopulmonary bypass (CPB) to achieve mild hypothermia (33 - 34 �C). Cognitive function was analyzed before the operation and after the surgery using the Mini Mental State Examination (MMSE), the Modified Visual Reproduction Test from the Wechsler Memory Scale, Trail Making (A/B), WAIS--Digit Span (WDS) and WAIS Digit Symbol Substitution Test (WDSST). The incidence of cognitive impairment at the 10th day after the surgery was 36% (n=9) in Group H and 64% (n=16) in Group C (p=0.048). The temperature during the aortic cross-clamp period was associated with a lower rate of cognitive dysfunction (p=0.05, r(2)=0.09). The intraoperative, external head-cooling technique during the aortic cross-clamp period has a neuroprotective effect and leads to less short-term cognitive function impairment after CABG surgery. PMID:23878011
Sirvinskas, E; Usas, E; Mankute, A; Raliene, L; Jakuska, P; Lenkutis, T; Benetis, R
Contrast-induced nephropathy (CIN) is one of the major causes of hospital-acquired acute renal failure. The pathophysiological mechanism of CIN remains unknown. There has been little evidence regarding the effects of Traditional Chinese Medicine (TCM) on CIN. Cordyceps sinensis (CS), a traditional Chinese herb, has been widely used clinically for the prevention of the progression of renal failure. We performed a prospective, randomized controlled trial to investigate the role of CS in the prevention of CIN in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI). The 150 ACS patients were randomly assigned to three groups, basic treatment group (n=51), standard CS therapy group (n=49, corbrin capsule 2 g, 3 times/d were used 3 days before and after angiography), and intensive CS therapy group (n=50, corbrin capsule 3 g, 3 times/d were used 3 days before and after angiography). Renal function was assessed at the time of hospital admission and on days 1, 2, and 3 after PCI. CIN occurred in 13 of 150 patients (8.67%). The incidence of CIN was lower in the CS treatment groups than in the basic treatment group (P<0.05), and a significant decrease in the incidence of CIN in the intensive CS therapy group was shown (P<0.01). In conclusion, prophylactic treatment with CS during the peri-procedural stage in ACS patients undergoing elective PCI has a preventive role against CIN, and intensive CS therapy could be more effective. PMID:25664103
Zhao, Kai; Lin, Yu; Li, Yong-Jian; Gao, Sheng
Background We evaluated the surgical results and predictors of long-term survival in patients who underwent coronary artery bypass grafting (CABG) at the time of an aortic valve replacement (AVR) due to aortic stenosis. Materials and Methods Between January 1990 and December 2009, 183 consecutive patients underwent CABG and concomitant aortic valve replacement for aortic stenosis. The mean follow-up period was 59.8�3.3 months and follow-up was possible in 98.3% of cases. Predictors of mortality were determined by Cox regression analysis. Results There were 5 (2.7%) in-hospital deaths. Follow-up of the in-hospital survivors documented late survival rates of 91.5%, 74.8%, and 59.6% at 1, 5, and 10 postoperative years, respectively. Age (p<0.001), a glomerular filtration rate (GFR) less than 60 mL/min (p=0.006), and left ventricular (LV) mass (p<0.001) were significant predictors of mortality in the multivariate analysis. Conclusion The surgical results and long-term survival of aortic valve replacement with concomitant CABG in patients with aortic stenosis and coronary artery disease were acceptable. Age, a GFR less than 60 mL/min, and LV mass were significant predictors of mortality. PMID:22263139
Cho, Won-chul; Yoo, Dong-Gon; Kim, Joon-Bum; Choo, Suk-Jung; Jung, Sung-Ho; Chung, Cheol-Hyun
Objective: To examine the validity of central venous oxygen saturation (ScvO2) as a numerical substitution of mixed venous oxygen saturation (SvO2) in adult patients undergoing normothermic on pump beating coronary artery bypass grafting (CABG). Materials and Methods: Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter (PAC) as a part of our routine intraoperative monitoring. SvO2 and ScvO2 were simultaneously measured 15 minutes (T1) and 30 minutes (T2) after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass (T3 and T4), and 15 and 30 minutes after admission to intensive care unit (T5 and T6). Results: ScvO2 showed higher reading than SvO2 all through our study. Our results showed perfect positive statistically significant correlation between SvO2 and ScvO2 at all data points. Individual mean of difference (MOD) between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. Conclusions: In on pump beating CABG patients; ScvO2 and SvO2 are not interchangeable numerically. ScvO2 is useful in the meaning of trend; our data suggest that ScvO2 is equivalent to SvO2 , only in the course of clinical decisions as long as absolute values are not required. PMID:20927264
Alshaer, Ahmad; Abdel-Meguid, Mohamed Essam; Ibraheim, Osama; Fawzi, Khaled; AbdulSalam, Ibrahim; Sheta, Saad; Abdullah, Khaled M.; El-Demerdash, Ahmed; Al-Satli, Raed; AbdelAll, Mohamed; Bakir, Bakir M.; AlNahal, Nezar; Abdulrahman, Yasser; AlHamoud, Hanaa
Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA. Forty-six patients with single-vessel coronary artery disease were studied. Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB. In both groups sequential transesophageal echocardiograms were recorded during the entire procedure. Hemodynamic data and oxygenation variables were acquired simultaneously. In both groups, mild but obvious perioperative SWMA were identified and noted to increase during the course of the operation. These SWMA were more pronounced in the TECAB group. Independent of operating time, these changes disappeared completely after revascularization. No significant hemodynamic compromise was observed. We conclude that MIDCAB and TECAB techniques are associated with significant perioperative SWMA. The appearance of more profound SWMA in the TECAB group compared with the MIDCAB patients might have been the result of intrathoracic CO(2) insufflation, as SLV was used in both groups. No persistent SWMA or post-CPB SWMA were apparent in either group. More extensive intraoperative ventricular SWMA was detected in the TECAB group, suggesting that a more frequent risk for right ventricular dysfunction may exist during TECAB procedures. PMID:15673848
Mierdl, S; Byhahn, C; Lischke, V; Aybek, T; Wimmer-Greinecker, G; Dogan, S; Viehmeyer, S; Kessler, P; Westphal, Klaus
Recently, off-pump coronary artery bypass grafting (off-pump CABG: OPCAB) has been considered a safe alternative to conventional CABG (CCAB) for myocardial revascularization, because OPCAB improves operative mortality and morbidity from the view of reduction of multi-organ complications, duration of hospital stay, risks of blood transfusion and operative costs. This study was performed to estimate the benefit of OPCAB by examining the change of myocardial oxygen metabolism during OPCAB. Twenty five patients who had undergone OPCAB including the internal thoracic artery (LITA) on the segment 8 of the left anterior descending coronary artery (LAD) were studied in this series, and divided in 2 groups [17 angina pectoris (AP) cases, 8 old myocardial infarction (OMI) cases]. With 3-wave length near infrared spectroscopy (TOS-96: TOSTEC, Tokyo, Japan), the tissue hemoglobin (Hb) volume in the myocardium [Hb index (HbI) = 10 x calibrated absorption at 801 nm/clinical absorption intensity at 801 nm] and the myocardial tissue oxygen saturation (rSo2) on the surface of the left ventricle surrounded by LAD and the 2nd diagonal branch were measured at 5 minutes before and after OPCAB to LAD, and myocardial oxygen metabolism (OM) was calculated [OM = (20-1.34 x systemic Hb x rSo2/100) x HbI]. During OPCAB, several hemodynamic data, systemic Hb and arterial gas findings were not changed. In both groups, the HbI and the OM were significantly increased [HbI: AP group; 1.04 +/- 0.23 to 1.57 +/- 0.41 (p < 0.0001), OMI group; 0.99 +/- 0.28 to 1.55 +/- 0.39 (p = 0.0051), OM: AP group; 11.6 +/- 3.1 to 17.5 +/- 6.0 (p = 0.0010), OMI group; 10.6 +/- 2.3 to 16.1 +/- 2.8 (p = 0.0007)]. The rSo2 was not changed and remained within normal limit during OPCAB. These findings suggested that the regional myocardial oxygen metabolism would be improved immediately just after OPCAB and this finding might be one of the reasons why OPCAB shows the good mortality and morbidity compared with CCAB. PMID:12910955
Nakano, H; Daimon, M; Hayashi, K; Chikazawa, G
Despite the deleterious and sometimes catastrophic consequences of proximal left anterior descending (LAD) artery occlusion, there is a paucity of data to guide the treatment of patients with such disease. Our aim was to describe outcomes with medical therapy, angioplasty, or left internal mammary artery (LIMA) bypass grafting in patients with 1-vessel, proximal LAD disease. We retrospectively analyzed prospectively collected
Adam B Greenbaum; Robert M Califf; Robert H Jones; Laura H Gardner; Harry R Phillips; Michael H Sketch; Richard S Stack; Joseph A Puma
Objective To compare the outcomes between minimally invasive coronary artery bypass (MINI-CAB) and drug-eluting stent (DES) implantation for isolated left anterior descending artery disease. Methods Randomized and observational comparative publications were identified using MEDLINE and Google Scholar databases (January 2003 to December 2013). Studies without outcomes data, without DES use, or using conventional bypass surgery were excluded. The outcomes of interest were cardiac death, myocardial infarction, target vessel revascularization, and periprocedural stroke. Data were compared using the Mantel-Haenszel methods and are presented as odds ratios (ORs), 95%confidence intervals (CIs), and number needed to treat. Results From 230 publications, we identified 4 studies (2 randomized and 2 observational) with 941 patients (478 had undergone MINI-CAB and 463 DES implantation). The incidence of target vessel revascularization at maximum follow-up (range, 6�60 months) was significantly lower in the MINI-CAB group (OR, 0.16; 95%CI, 0.08�0.30; P < .0001; number needed to treat, 13). The incidence of cardiac mortality and MI was similar between the MINI-CAB and DES groups during follow-up (OR, 1.05; 95% CI, 0.44�2.47; and OR, 0.83; 95% CI, 0.43�1.58, respectively). In addition, a similar incidence of periprocedural death (OR, 0.85; 95% CI, 0.21�3.47; P = .82), myocardial infarction (OR, 0.98; 95% CI, 0.38�2.58; P = .97), and stroke (OR, 1.36; 95% CI, 0.28�6.70; P = .70) was observed between the 2 treatment modalities. Conclusions Given the available evidence, MINI-CAB will result in lower target vessel revascularization rates but otherwise similar clinical outcomes compared with DESs in patients with left anterior descending artery disease. PMID:24755335
Harskamp, Ralf E.; Williams, Judson B.; Halkos, Michael E.; Lopes, Renato D.; Tijssen, Jan G. P.; Ferguson, Bruce; de Winter, Robbert J.
A surgical fire is a serious complication not previously described in the literature with regard to the thoracic cavity. We report a case in which an intrathoracic fire developed following an air leak combined with high pressure oxygen ventilation in a patient with severe chronic obstructive pulmonary disease. The patient presented to our institution with diffuse coronary artery disease and
Martin Friedrich; Theodor Tirilomis; Jan D Schmitto; Aron F Popov; Suyog A Mokashi; Marc Hinterthaner; Gunnar G Hanekop; Paul Zwaka; Friedrich A Schoendube
There is no agreement on whether statins influence the incidence of atrial fibrillation after coronary artery bypass grafting. We performed a meta-analysis of 12 studies that compared statins with controls. Statin therapy significantly reduced the incidence of postoperative atrial fibrillation (POAF) (odds ratio, 0.50; 95% confidence interval, 0.35-0.73) and length of hospital stay (weighted mean difference, -0.72; 95% confidence interval, -0.99 to -0.45), an effect that survived detailed subgroup analysis. Meta-regression analysis revealed that patient characteristics did not influence the extent of improvement in the incidence of POAF attributable to statins. In conclusion, patients undergoing coronary artery bypass grafting benefit from perioperative treatment with statins, which significantly reduce the incidence of POAF and length of hospital stay. PMID:24705176
Zheng, Hui; Xue, Song; Hu, Zhen-Lei; Shan, Jiang-Gui; Yang, Wen-Gang
BACKGROUND: Provincial cardiac registries and the Canadian Institute for Health Information (CIHI) pan-Canadian administrative databases are invaluable tools for understanding Canadian cardiovascular health and health care. Both sources are used to enumerate cardiovascular procedures performed in Canada. OBJECTIVE: To examine the level of agreement between provincial cardiac registry data and CIHI data regarding procedural counts for coronary artery bypass grafts (CABGs) and percutaneous coronary interventions (PCIs). METHODS: CIHI staff obtained CABG and PCI counts from seven provinces that, in 2004, performed these procedures and had a cardiac registry (ie, British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, and Newfoundland and Labrador). Structured mail questionnaires, and e-mail and telephone follow-ups elicited information from a designated registry respondent. The CIHI derived its counts of CABG and PCI procedures by applying the geographical boundaries, procedural definitions and analytical case criteria used by the cardiac registries to CIHI inpatient and day procedure databases. Steps were taken to reduce double-counting procedures when combining results from the two CIHI databases. Two measures were calculated: the absolute difference between registry and CIHI estimates, and the per cent agreement between estimates from the two sources. RESULTS: All seven cardiac registries identified as eligible for the study participated. Agreement was high between the two sources for CABG (98.8%). For PCI, the level of agreement was high (97.9%) when CIHI sources were supplemented with day procedure data from Alberta. CONCLUSIONS: The high level of agreement between cardiac registry and CIHI administrative data should increase confidence in estimates of CABG and PCI counts derived from these sources. PMID:20847972
Gurevich, Yana; McFarlane, Anne; Morris, Kathleen; Jokovic, Aleksandra; Peterson, Gail M; Webster, Gregory K
BACKGROUND: Provincial cardiac registries and the Canadian Institute for Health Information (CIHI) pan-Canadian administrative databases are invaluable tools for understanding Canadian cardiovascular health and health care. Both sources are used to enumerate cardiovascular procedures performed in Canada. OBJECTIVE: To examine the level of agreement between provincial cardiac registry data and CIHI data regarding procedural counts for coronary artery bypass grafts (CABGs) and percutaneous coronary interventions (PCIs). METHODS: CIHI staff obtained CABG and PCI counts from seven provinces that, in 2004, performed these procedures and had a cardiac registry (ie, British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, and Newfoundland and Labrador). Structured mail questionnaires, and e-mail and telephone follow-ups elicited information from a designated registry respondent. The CIHI derived its counts of CABG and PCI procedures by applying the geographical boundaries, procedural definitions and analytical case criteria used by the cardiac registries to CIHI inpatient and day procedure databases. Steps were taken to reduce double-counting procedures when combining results from the two CIHI databases. Two measures were calculated: the absolute difference between registry and CIHI estimates, and the per cent agreement between estimates from the two sources. RESULTS: All seven cardiac registries identified as eligible for the study participated. Agreement was high between the two sources for CABG (98.8%). For PCI, the level of agreement was high (97.9%) when CIHI sources were supplemented with day procedure data from Alberta. CONCLUSIONS: The high level of agreement between cardiac registry and CIHI administrative data should increase confidence in estimates of CABG and PCI counts derived from these sources.
Gurevich, Yana; McFarlane, Anne; Morris, Kathleen; Jokovic, Aleksandra; Peterson, Gail M; Webster, Gregory K
Percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass (MIDCAB) grafting are both established therapeutic options for single-vessel disease of the left anterior descending artery (LAD). The present systematic review with meta-analysis aims to determine the current strength of evidence for or against PCI and MIDCAB for revascularization of the LAD. Therefore, we performed a meta-analysis of randomized, controlled trials (RCTs) and observational trials (OTs) that reported clinical outcome after isolated LAD revascularization. Analysed postoperative outcomes included major adverse cardiac and cerebrovascular events (MACCEs), all-cause mortality, myocardial infarction and stroke. Pooled treatment effects [odds ratio (OR) or weighted mean difference (WMD), 95% confidence intervals (95% CI)] were assessed using a fixed- or random-effects model. A total of 2885 patients from 12 studies (6 RCTs, 6 OTs) were identified after a literature search of major databases using a predefined list of keywords. PCI of the LAD was performed in 60.7% (n = 1751) and MIDCAB in 39.3% of patients (n = 1126). Pooled-effect estimates revealed an increased incidence for MACCEs after PCI (OR 1.98; 95% CI 1.45-2.69; P < 0.0001) 6 months after the procedure. Especially, PCI was particularly associated with an increased odds for target vessel revascularization (OR 2.11; 95% CI 1.00-4.47; P = 0.0295). No differences with regard to stroke, myocardial infarction and all-cause mortality were observed between both revascularization strategies. Patients after PCI had a shorter length of hospital stay (WMD -3.37 days; 95% CI (-)4.92 to (-)1.81; P < 0.0001). In conclusion, the present systematic review underscores the superiority of MIDCAB over PCI for treatment of single-vessel disease of the LAD. PMID:25100715
Deppe, Antje-Christin; Liakopoulos, Oliver J; Kuhn, Elmar W; Slottosch, Ingo; Scherner, Maximilian; Choi, Yeong-Hoon; Rahmanian, Parwis B; Wahlers, Thorsten
ABSTRACT Background: Hepatitis B virus (HBV) infection is a major global health problem in the worldwide that associated with significant morbidity and mortality in cardiac surgery. The available data on HBV distribution and genotyping of HBV are very heterogeneous. Therefore in this study, we tried to indicate the prevalence of HBV infections in cardiac catheterization patients referred to health centers in the north of Iran and identified the HBV genotypes using polymerase chain reaction (PCR). Methods: In this cross-sectional study, we studied 2650 patients who underwent selective coronary artery angiography and coronary artery bypass grafting in Mazandaran heart center, Sari, Iran from 2011 to 2013. All serum samples were examined to detect HBsAg by ELISA test. HBV-DNA was extracted from HBsAg positive samples using Mini Elute Kit from Qiagen and determined the genotypes of HBV by PCR using the Master Mix kit with Taq-DNA polymerase enzyme and with type of specific primers. All samples were examined in the virology laboratory of Sari Medical School. Results: The mean age of patients was 59.7�10.9 (range, 20 to 81) year that 1590 (60%) patients were male and 1060 (40%) were female. Seventeen cases (0.08 %) were found with hepatitis B virus infection, and the highest rates of infection were reported among those aged 40�60 years old in this study. We found genotype D the predominant type in this study. Conclusion: This study indicates that the prevalence of HBV endemicity in the north of Iran is low and genotype D is the only genotype in patients infected with HBV. PMID:25568563
Mousavi, Tahoora; Ziabakhsh-Tabary, Shervin; Ghaemiyan, Ali; Haghshenas, Mohammad Reza
Genetic research has elucidated molecular mechanisms of heart failure (HF). Peroxisome proliferator-activated receptors (PPARs) seem to be important in etiology of HF. The aim of study was to find the correlation between PPAR? expression during development of HF in patients and coronary artery disease (CAD) after coronary artery bypass-grafting (CABG). Methods and Results. We followed up 157 patients (mean age 63) with CAD without clinical, laboratory, or echo parameters of HF who underwent CABG. Clinical and laboratory status were assessed before CABG and at 1, 12, and 24 months. During CABG slices of aorta (Ao) and LV were collected for genetic research. HF was defined as LVEF <40% or NT-proBNP >400?pg/mL or 6MWT <400?m. Patients were divided into 2 groups: with and without HF. PPAR? expression in Ao and LV was not increased in both groups at 2-year follow-up. Sensitivity of PPAR? expression in Ao above 1.1075 in detection of HF was 20.5% (AUC 0.531, 95% CI 0.442�0.619). Positive predictive value (Ppv) was 85.7%. Sensitivity and specificity of PPAR? expression in the LV in detection of HF were 58% and 92.9%, respectively (AUC 0.540, 95% CI 0.452�0.626). Ppv was 73.2%. Conclusion. PPAR? expression in Ao and LV was comparable and should not be used as predictive factor for development of HF in patients with CAD after CABG. PMID:25371662
Wojtkowska, Izabela; Tysarowski, Andrzej; Seliga, Katarzyna; Siedlecki, Janusz A.; Juraszy?ski, Zbigniew; Marona, Milosz; Greszata, Lidia; Skrobisz, Anna; Kaminski, Karol; Sawicki, Robert; St?pi?ska, Janina
Atrial fibrillation after coronary bypass (CABG) sur- gery is an important cause of morbidity and increased resource utilization. Insulin-enhanced cardioplegia may reduce postoperative arrhythmias by improving aerobic myocardial metabolism and mitigating the del- eterious effects of ischemia. We performed a double- blinded, randomized, controlled clinical trial to deter- mine if insulin-enhanced cardioplegia decreases the risk of post-CABG atrial fibrillation in
Marja Hynninen; Michael A. Borger; Vivek Rao; Richard D. Weisel; George T. Christakis; Jo-Ann Carroll; Davy C. H. Cheng
OBJECTIVESThe purpose of this prospective, randomized, double-blind, placebo-controlled study was to assess the efficacy of preoperatively and postoperatively administered oral d,l sotalol in preventing the occurrence of postoperative atrial fibrillation (AF).BACKGROUNDAtrial fibrillation is the most common arrhythmia following coronary artery bypass surgery (CABG). Its etiology, prevention and treatment remain highly controversial. Furthermore, its associated morbidity results in a prolongation of
J. Anthony Gomes; John Ip; Francesco Santoni-Rugiu; Davendra Mehta; Arisan Ergin; Steven Lansman; Elena Pe; Teri Takle Newhouse; Sally Chao
Background. Coronary bypass surgery carries a higher operative mortality and less favorable long-term clinical benefits for women than men. The impact of arterial revascularization on long-term results, including quality of life (QOL) in women, compared with men, has not been clearly defined.Methods. A retrospective analysis was performed comparing 261 consecutive women patients from a single surgical practice receiving bilateral internal
Paul A Kurlansky; Ernest A Traad; David L Galbut; Samuel Singer; Melinda Zucker; George Ebra EdD
Background. Off-pump coronary artery bypass grafting (OPCAB) can be performed in several ways using a minimally invasive approach (MIDCAB). Using the left anterior small thoracotomy (LAST) approach, only the LAD can be grafted. To expand the indications for MIDCAB from single-vessel disease to double-vessel disease, we have used a partial sternotomy without a transverse cut, namely, the lower-end sternal splitting
Hiroshi Niinami; Yasuo Takeuchi; Seiichi Ichikawa; Yuji Suda
BACKGROUND: Heart surgery is associated with an occurrence of pulmonary complications. The aim of this study was to determine whether pre-surgery respiratory physiotherapy reduces the incidence of post-surgery pulmonary complications. METHODS: Observational study of 263 patients submitted to off-pump coronary artery bypass grafting (CABG) surgery at the A Coru�a University Hospital (Spain). 159 (60.5%) patients received preoperative physiotherapy. The fact
Isabel Y�nez-Brage; Salvador Pita-Fern�ndez; Alberto Juff�-Stein; Ursicino Mart�nez-Gonz�lez; Sonia P�rtega-D�az; �ngeles Maule�n-Garc�a
This paper will present some of the findings of a qualitative study that utilised grounded theory to discover nurses perceptions of quality and factors that affect quality nursing care provided to Percutaneous Transluminal Coronary Angioplasty (PTCA) patients in a large Queensland Metropolitan Hospital. The study used focus group interviews, participant observation, in-depth interviews and published literature to gather data. Fifteen
Sonja Cleary; Sansnee Jirojwong; Sandra Walker
Background: Simple and efficient way of pain management after Coronary Artery Bypass Graft (CABG) surgery is an important aspect of patients' care. Objectives: This study aimed to compare the effects of morphine and diclofenac suppositories on postoperative pain management. Patients and Methods: In this double-blinded clinical trial study, 120 patients aged 30-65 years old, undergone CABG, were equally divided into two groups of A (morphine) and B (diclofenac). All patients were anesthetized with intravenous fentanyl 10 ?g/kg, etomidate 0.2 mg/kg and cisatracurium 0.2 mg/kg. Anesthesia was maintained with oxygen 50% and air 50%, propofol 50 ?g/kg/min, fentanyl 1-2 ?g/kg/h and atracurium 0.6 mg/kg/h. Analgesics were administered after the operation at intensive care unit (ICU) and Visual Analogue Score (VAS) was evaluated in both groups in 4-hour intervals after extubation for 24 hours. After extubation in case of VAS > 3, morphine suppository 10 mg (group A) or diclofenac suppository 50 mg (group B) was administered for patients. Results: No significant statistical relationship was found between the two groups regarding gender, age, BMI, paracetamol consumption, length of operation time, cardiopulmonary bypass pump (CPB) time, and stay time at ICU (P Value ? 0.05). Total dosage of used morphine was 22 � 8.3 mg in each patient and total dosage of used diclofenac was 94 � 32.01 mg. Average variation of VAS at measured intervals was significant (P Value ? 0.0001), but these variations were not significantly different when comparing the two groups (P Value = 0.023). Conclusions: Both morphine and diclofenac suppositories reduced pain significantly and similarly after CABG surgery. PMID:25346897
Imantalab, Vali; Mirmansouri, Ali; Sedighinejad, Abbas; Naderi Nabi, Bahram; Farzi, Farnoush; Atamanesh, Hadi; Nassiri, Nassir
We report a combined carotid endarterectomy and coronary revascularization surgery with cardiopulmonary bypass using bivalirudin for systemic anticoagulation in a patient with a positive titer for the heparin-platelet factor 4 antibody. The patient experienced procedural success for both the carotid and coronary surgeries. Increased blood and blood product transfusion was required postoperatively. PMID:19299772
Avery, Edwin G; Hilgenberg, Alan D; Cambria, Richard P; Beckerly, Rena; Donnelly, Anne M; Laposata, Michael
Objectives To investigate the procedure characteristics and long term follow-up of percutaneous coronary intervention (PCI) for saphaneous vein graft (SVG) lesions in the elderly patients. Methods From December 2005 to December 2011, 84 graft lesions were treated percutaneously. Seventeen were located at proximal anastomosis, 48 were located at SVG body, 19 were located at distal anastomosis. Primary endpoint was defined as major adverse cardiovascular events (MACE, composite of cardiac death, target vessel revascularization, acute myocardial infarction). Results The graft age was 6.7 � 4.0 years. Most anastomosis lesions (80.0%) presented within one year post coronary artery bypass grafting (CABG). Proximal anastomosis lesion had the lowest successful rate for PCI compared with graft body and distal anastomosis lesions (70.6% vs. 91.7%, 79.0%, P < 0.05). The distal embolic protection device was used in 19.1% of patients, most frequently used in body graft PCI (29.2%, P < 0.01). The diameter of the stent was smallest in distal anastomosis group (2.9 � 0.4 mm, P < 0.05). The highest post dilatation pressure was required in the proximal anastomosis (17.8 � 2.7 atm, P < 0.05). The patients were followed up for 24.3 � 16.9 months. MACE occurred in 18.57% of patients. Incidence of MACE was highest among proximal anastomosis PCI (47.1% vs. body graft PCI 16.7%, distal anastomosis PCI 21.1%; P < 0.05). Old myocardial infarction was the predictive factor for the poor clinical outcomes (P = 0.04). Conclusions PCI of SVG lesions is feasible with lower success rate. PCI of ostial graft anastomosis lesions had the lowest procedure success rate and highest MACE rate compared with graft body and distal anastomosis lesions. Old myocardial infarction was a predictive factor of poor outcomes. PMID:24748878
Wang, Ji-Hong; Liu, Wei; Du, Xin; Ma, Chang-Sheng; Wu, Xue-Si
We describe successful anesthetic management during living-donor liver transplantation in a 63-year-old man with previous coronary artery bypass grafting (CABG) that employed an in situ right gastroepiploic artery (RGEA). Anesthesia was maintained with 1.5% isoflurane in air/oxygen and fentanyl. A five-lead electrocardiogram, transesophageal echocardiogram, and pacing pulmonary artery catheter evaluated cardiac function. A pacing wire was inserted through the catheter to prepare for intraoperative severe bradyarrhythmia. Olprinone and nicorandil were continuously infused to prevent decrease in coronary arterial blood flow and the collapse of cardiac function. Avoiding disruption of circulation to coronary arteries through injury or spasm of the RGEA graft and preparing for cardiac insufficiency during liver transplantation of a patient with previous CABG using an in situ RGEA is critical. PMID:20191293
Murata, Hiroaki; Inoue, Haruka; Sumikawa, Koji
Off-pump coronary artery bypass grafting (CABG) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on the operators' capability due to technical difficulties. The SPY system, based on the fluorescence of indocyanine green, is an innovative device that permits validation of graft patency intra-operatively. Real time images of grafts are obtained with no need for catheterization, X-rays or iodine contrast medium. High-quality images could be obtained in all 290 grafts of 72 off-pump CABG cases (mean 4.0 grafts per patient). Four anastomoses (1.4%), including two proximal and two distal, were revised because of defects detected by SPY images. In one case, the SPY system revealed no blood flow in a radial sequential graft, although transit-time flow meter measurements showed a diastolic dominant pattern. SPY images provide critical information to surgeons to detect non-patent grafts, allowing them to be revised while the patient is still on the operating table. Using the SPY system, technical failures could be completely resolved during surgery. The use of the SPY system for intra-operative graft validation during off-pump CABG may become the gold standard for surgical management in the near future. PMID:17670291
Takahashi, Masao; Ishikawa, Toshihiro; Higashidani, Koichi; Katoh, Hiroki
Intraoperative transesophageal echocardiography (TEE) assessment of coronary artery graft anastomosed to posterior descending artery (PDA) was evaluated. Twenty-one patients with a saphenous vein (SV) graft (n=17) or right gastroepiploic artery (RGEA) graft (n=4) anastomosed to the PDA were examined. In the transgastric mid short-axis view, the graft was depicted as an echo-free zone between the right ventricle and diaphragm. The depth, diameter, angle for Doppler measurement, and angle-corrected blood flow velocity were determined. The graft was visualized in 20 cases (95.2%). The diameter of the SV graft was 3.0-6.5 mm (mean 4.0 mm), while that of RGEA graft was 2.2-2.9 mm (mean 2.5 mm), at the depth of 1.2-4.4 cm (mean 2.4 mm) with incident angle of 14-57 degrees (mean 38.6 degrees ). Blood flow was detected in 17 cases but was difficult to detect in three cases (velocity <10 cm/s). Postoperative coronary angiography showed patent graft in 16 of former cases (one case of operative death excluded) but occluded graft in all of latter cases. Intraoperative TEE assessment was feasible nearly consistently. Diastolic blood flow velocity <10 cm/s suggests an early occlusion of the graft. PMID:19246496
Orihashi, Kazumasa; Okada, Kenji; Imai, Katsuhiko; Kurosaki, Tatsuya; Takasaki, Taiichi; Takahashi, Shinya; Morifuji, Kiyohiko; Sueda, Taijiro
Background Despite continuous improvements in materials and perfusion techniques, cardiac surgery still causes lung injury and a delay of pulmonary recovery. Currently, there is no gold standard for quantifying cardiac surgery induced lung injury and dysfunction. Adding objective measures, such as plasma biomarkers, could be of great use here. In this study the utility of lung epithelium specific proteins as biomarkers for lung dysfunction was evaluated. Methods Serial measurements of plasma concentrations of Clara cell 16 kD (CC16) protein, Surfactant protein D (SP-D), Elastase and Myeloperoxidase were performed on blood samples from 40 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass (CABG, n?=?20) or without cardiopulmonary bypass (OPCAB, n?=?20). Results The increase of SP-D and CC16 between pre-operative concentrations and concentrations at the end of cardiopulmonary bypass, correlated with the Aa-O2 gradient at 1?hour on the ICU (Rs?=?0.409, p?=?.016 and Rs?=?0.343, p?=?.043, respectively). Furthermore, SP-D and CC16 were higher in CABG than in OPCAB at the end of surgery [8.96 vs. 4.91?ng/mL, p?=?.042 and 92 vs. 113%, p?=?.007, respectively]. After 24?h both biomarkers returned to their baseline values. Conclusions Our results show that increases in plasma of SP-D and CC16 correlate with clinical lung injury after coronary artery bypass surgery. Therefore, lung epithelium specific proteins seem to be a useful biomarker for measuring lung injury in the setting of cardiac surgery. PMID:23302601
Clopidogrel is an oral antiplatelet pro-drug prescribed to 40 million patients worldwide who are at risk for thrombotic events or receiving percutaneous coronary intervention (PCI). However about a fifth of patients treated with clopidogrel do not respond adequately to the drug. From a cohort of 105 patients on whom we had functional data on clopidogrel response, we used ultra-high throughput sequencing to assay mutations in CYP2C19 and ABCB1, the two genes genetically linked to respond. Testing for mutations in CYP2C19, as recommended by the FDA, only correctly predicted if a patient would respond to clopidogrel 52.4% of the time. Similarly, testing of the ABCB1 gene only correctly foretold response in 51 (48.6%) patients. These results are clinically relevant and suggest that until additional genetic factors are discovered that predict response more completely, functional assays are more appropriate for clinical use. PMID:23462555
Correll, Mick; Johnson, Christopher K.; Ferrari, Giovanni; Brizzio, Mariano; Mak, Andrew W.C.; Quackenbush, John; Shaw, Richard E.; Zapolanski, Alex; Grau, Juan B.
The accepted value for reproducibility (true change) is two standard deviations (SD) of the differences between repeat measurements. It has been well established for coronary artery measurements using several different quantitative coronary angiography (QCA) systems, but it has not been well documented for saphenous vein grafts (SVG). The purpose of this study was to assess, using the Cardiovascular Measurement System (CMS), the measurement reproducibility of 24 vein grafts from 24 patients who had symptom-directed control angiography. Three equal graft segments were studied separately. Focal narrowings expressed in percent stenosis varied from 5 to 80% (mean 20.8 +/- 15.9%). The average minimum lumen diameter (MLD) was 3.07 +/- 0.81 mm and the average interpolated reference diameter (Ref. D) was 3.87 +/- 0.58 mm. We assessed the reproducibility of measurements obtained from two separate imagings of the graft in the same view but at least 20 minutes apart, near the beginning and at the end of the angiographic procedure (simulating baseline and end-trial examinations). The SD for differences in measurements (variability) was 0.183 mm for the MLD, 0.193 mm for the Ref.D, 0.184 mm for the mean diameter (Mean D) and 3.72% for the percent diameter stenosis (PDS). A reasonable true change cut-off for SVG measurements in our laboratory is > or = 0.4 mm for the minimum and mean lumen diameters, and > or = 10% for the PDS, when QCA is obtained with the QCA-CMS analytical software package. PMID:8993992
Lesp�rance, J; Campeau, L; Reiber, J H; Bois, M; Dyrda, I; Laurier, J; Hudon, G
Background For the last decade continuous efforts have been made to translate regenerative cell therapy protocols in the cardiovascular field from �bench to bedside�. Successful clinical introduction, supporting safety, and feasibility of this new therapeutic approach, led to the initiation of the German, Phase III, multicenter trial - termed the PERFECT trial (ClinicalTrials.gov Identifier: NCT00950274), in order to evaluate the efficacy of surgical cardiac cell therapy on left ventricular function. Methods/Design The PERFECT trial has been designed as a prospective, randomized, double-blind, placebo controlled, multicenter trial, analyzing the effect of intramyocardial CD 133+ bone marrow stem cell injection in combination with coronary artery bypass grafting on postoperative left ventricular function. The trial includes patients aged between 18 and 79?years presenting with a coronary disease with indication for surgical revascularization and reduced global left ventricular ejection fraction as assessed by cardiac magnet resonance imaging. The included patients are treated in the chronic phase of ischemic cardiomyopathy after previous myocardial infarction. Discussion Patients undergoing coronary artery bypass grafting in combination with intramyocardial CD133+ cell injection will have a higher LV ejection fraction than patient who undergo CABG alone, measured 6?months after the operation. Trial registration ClinicalTrials.gov Identifier: NCT00950274 PMID:22747980
Aims: The objective was to evaluate the prognostic value of exercise myocardial perfusion scintigraphy (MPS) in patients who underwent coronary artery bypass grafting (CABG). Subjects and Methods: A retrospective, one-center study of 361 patients with multivessel coronary artery disease was carried out. All the patients underwent MPS after CABG due to worsened health status. MPS was performed at 4.5 years standard deviation (SD: 0.2), based on symptoms. MPS was carried out using Tc-99m methoxy isobutyl isonitrile and following a 1-day protocol (stress-rest). The end points were analyzed at 6.5 years (SD: 3.3) after MPS, on the average. Statistical Analysis Used: SPSS software for Windows, version 13.0. The t-test or the ?2-test was used. Survival times were calculated. A multivariate Cox proportional hazards model was developed. Results: During the follow-up, death occurred in 54 patients, and 37 patients experienced major adverse cardiovascular events (MACE). In the multivariate analysis, advanced age hazard ratio (HR: 1.45; 95% confidence interval [CI]: 1.4�2.02; P = 0.027), previous myocardial infarction (HR: 3.17; 95% CI: 1.22�8.2; P = 0.018), left ventricular ejection fraction of <40% (HR: 2.16; 95% CI: 1.2�3.89; P = 0.01), and the summed stress score (SSS) of ?4 (HR: 1.87; 95% CI: 1.02�3.41; P = 0.04) were independent predictors of all-cause death. The summed difference score (SDS) was the only independent predictor of MACE (HR: 1.26; 95% CI: 1.06�1.48; P = 0.034). Conclusions: The parameters of MPS were found to have prognostic value in the long-term period after CABG. Advanced age, previous myocardial infarction, decreased left ventricular ejection fraction, and the abnormal SSS were associated with an increased risk of all-cause death. The SDS was found to be the only significant risk factor for MACE. PMID:25400360
Milvidaite, Irena; Kulakiene, Ilona; Vencloviene, Jone; Kinduris, Sarunas; Jurkiene, Nemira; Grizas, Vytautas; Navickas, Ramunas; Slapikas, Rimvydas
Heart rate variability (HRV) was used in the present study to evaluate a target-controlled approach compared with a constant-rate infusion for remifentanil anesthesia during off-pump coronary artery bypass grafting (OP-CABG) surgery. A total of 65 patients with American Society of Anesthesiologists (ASA) physical status II or III, who were aged 60�85 years and scheduled for OP-CABG, were selected for the study. All patients were administered an intramuscular premedication of 10 mg morphine and 0.3 mg scopolamine. In group I, remifentanil was infused using a target-controlled approach at 1.5�5.0 ng/ml, and in group II, remifentanil was infused at a constant-rate of 0.05�1.0 ?g/kg/min and at additional single increments of 1 ?g/kg when appropriate. The heart rate and other hemodynamic monitoring indices of the patients, including the mean arterial pressure, central venous pressure, pulmonary artery pressure and pulmonary capillary wedge pressure, were monitored at various time points, including prior to induction (T0), at extubation (performed intraoperatively; T7) and at 24 h post-surgery. The HRV indices, including total power (TP), low frequency (LF) and the LF/high frequency (HF) ratio of power (LF/HF), were reduced following induction at T0 and remained low at 24 h post-surgery. At T5 (right coronary or left circumflex artery anastomosis) and T7 (tracheal extubation), all the HRV indices, with the exception of the HF power, were significantly increased (P<0.05). Additionally, the TP, LF and LF/HF values in group II were higher at T5 compared with those in group I (P<0.05). Remifentanil target-controlled infusion is superior to constant-rate infusion in suppressing the stress response during OP-CABG, maintaining the balance of the cardiac autonomic nervous system and promoting the recovery of the autonomic function following surgery. PMID:23935756
Background Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG). Methods From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed. Results The baseline LVEF was 32.7�9.2%, which improved to 41.6�11.0% 6 months later and 32/52 patients improved LVEF by ?5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172�6.996, p?=?0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ?4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC?=?0.91, p<0.001). Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001). Conclusions Our findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization. PMID:24358136
Sun, Han-Song; Tang, Yue; Pan, Shi-Wei; Zhao, Shi-Hua
Acute kidney injury (AKI) is a frequent complication of cardiac surgery and usually occurs in patients with preexisting chronic kidney disease (CKD). Remote ischemic preconditioning (RIPC) may mitigate the renal ischemia-reperfusion injury associated with cardiac surgery and may be a preventive strategy for postsurgical AKI. We undertook a randomized controlled trial of RIPC to prevent AKI in 86 patients with CKD (estimated glomerular filtration rate under 60?ml/min per 1.73?m(2)) undergoing coronary artery bypass graft (CABG) surgery. Forty-three patients each were randomized to receive standard care with or without RIPC consisting of three 5-minute cycles of forearm ischemia followed by reperfusion. The primary end point was the development of AKI defined as an increase in serum creatinine concentration over 0.3?mg/dl within 48?h of surgery. Secondary end points included a comparison between the study and control groups of several serum biomarkers of renal injury including cystatin-C, neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 (IL-18), and urinary biomarkers including NGAL, IL-18, and kidney injury molecule-1 measured at 6, 12, and 24?h after CABG, and the 72-h serum troponin T concentration area under the curve as a marker of myocardial injury. Clinical and operative characteristics were similar between the preconditioned and control groups. AKI developed in 12 patients in both groups within 48?h of CABG. There were no significant differences between the two groups in the concentrations of any of the serum or urinary biomarkers of renal or cardiac injury after CABG. Thus, RIPC induced by forearm ischemia-reperfusion had no effect on the frequency of AKI after CABG in patients with CKD. PMID:25075773
Gallagher, Sean M; Jones, Dan A; Kapur, Akhil; Wragg, Andrew; Harwood, Steve M; Mathur, Rohini; Archbold, R Andrew; Uppal, Rakesh; Yaqoob, Muhammad M
Background This study was conducted to follow plasma concentrations of sFlt-1 and sKDR, two soluble forms of the vascular endothelial growth factor (VEGF) receptor in patients undergoing coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). Methods Plasma samples were obtained before, during and after surgery in 15 patients scheduled to undergo CABG. Levels of sFlt-1 and KDR levels were investigated using specific ELISA. Results A 75-fold increase of sFlt-1 was found during cardiac surgery, sFlt-1 levels returning to pre-operative values at the 6th post-operative hour. In contrast sKDR levels did not change during surgery. The ECC-derived sFlt-1 was functional as judge by its inhibitory effect on the VEGF mitogenic response in human umbilical vein endothelial cells (HUVECs). Kinetic experiments revealed sFlt-1 release immediately after the beginning of ECC suggesting a proteolysis of its membrane form (mFlt-1) rather than an elevated transcription/translation process. Flow cytometry analysis highlighted no effect of ECC on the shedding of mFlt-1 on platelets and leukocytes suggesting vascular endothelial cell as a putative cell source for the ECC-derived sFlt-1. Conclusion sFlt-1 is released during CABG with ECC. It might be suggested that sFlt-1 production, by neutralizing VEGF and/or by inactivating membrane-bound Flt-1 and KDR receptors, might play a role in the occurrence of post-CABG complication. PMID:17888151
Denizot, Yves; Leguyader, Alexandre; Cornu, Elisabeth; Laskar, Marc; Orsel, Isabelle; Vincent, Christelle; Nathan, Nathalie
Background?We hypothesized that patients treated with prasugrel compared with those treated with clopidogrel before coronary artery bypass graft (CABG) surgery are at increased risk of hemorrhagic complications needing transfusions and are more likely to need surgical reexploration. Patients and?Methods Preoperative and postoperative clinical data were collected prospectively on 143 consecutive patients treated preoperatively with prasugrel (n?=?59) or clopidogrel (n?=?84) before undergoing isolated CABG at our institution from January 2011 to October 2012. Results?Patients receiving prasugrel showed a slightly higher additive EuroSCORE I compared with those treated with clopidogrel (7 vs. 5, p?=?0.001), and more often underwent urgent/emergent CABG (47 vs. 27%, p?=?0.01). Patients treated with prasugrel were more likely than those treated with clopidogrel to need perioperative platelet transfusions (25 vs. 12%, p?=?0.04). The numbers of transfusions of red blood cells, fresh-frozen plasma, or fibrinogen were high in both groups but showed no statistical differences. Patients treated with prasugrel, however, more often needed surgical reexploration for bleeding complications (8 vs. 1%, p?=?0.03). Logistic regression revealed that preoperative therapy with prasugrel (RR 2.9, p?=?0.01) and urgent/emergent surgery (RR 2.2, p?=?0.04) were predictors for the composite endpoint "need for perioperative platelet transfusion and/or surgical reexploration." Conclusion?Pretreatment with prasugrel, compared with clopidogrel, in patients undergoing isolated CABG is associated with an increased need for platelet transfusions and a higher risk of surgical reexploration for bleeding complications. PMID:24838516
Drews, Susanne; Bolliger, Daniel; Kaiser, Christoph; Grapow, Martin; Reuthebuch, Oliver; Eckstein, Friedrich; Matt, Peter
The objective of this study was to assess the effect of lidocaine jelly application to chest tubes on the intensity and duration of overall pain, chest tube site pain and the required analgesics for postoperative pain relief in coronary artery bypass graft (CABG) patients. For patients in group L, we applied sterile 2% lidocaine jelly on the chest tubes just before insertion, and for patients in group C, we applied normal saline. Overall visual analogue scale (VAS), maximal pain area with their VAS were documented postoperatively, and the frequency that button of patient-controlled analgesia was pressed (FPB) and total fentanyl consumption were assessed. The number of patients who complained that tube site was the most painful site was significantly higher in group C than in group L (85% vs. 30% at extubation, P<0.001). The overall VAS score was significantly higher in group C than in group L (39.14�12.49 vs. 27.74�13.76 at extubation, P=0.006). After all of the tubes were removed, the VAS score decreased more in group C (5.74�4.77, P<0.001) than in group L (3.05�2.48, P<0.001). FPB and total fentanyl consumption were significantly higher in group C than in group L (73.00, 59.00-78.00 vs. 34.00, 31.00-39.25, P<0.001; 2,214.65�37.01 vs. 1,720.19�361.63, P<0.001, respectively). Lidocaine jelly application is a very simple way to reduce postoperative pain by reducing chest tube site pain after CABG. (Clinical Trials Registry No. ACTRN 12611001215910) PMID:25368494
Choe, Ju Won; Woo, Young Cheol; Kim, Sang Wook; Park, Soon J.
Background and Objective: Anxiety and depression are among the psychological disorders in heart surgeries. Establishing a simple communication is essential to reduce anxiety and depression. Hence, the objective of the present studywas to examine the impact of Peplau therapeutic communication model on anxiety and depression in patients, who were candidate for coronary artery bypass in Al-Zahra Heart Hospital, Shiraz during 2012-2013. Methods: This is a clinical trial in which 74 patients were randomly divided into intervention and control groups, each consisted of 37 patients. Anxiety and depression levels were assessed before, and two and four months after intervention using the Hospital Anxiety and Depression Scale (HADS). Seven therapeutic communication sessions were held in four stages. Data were analyzed with the SPSS (version 16) using analysis of covariance. Results: The mean anxiety and depression levels decreased in the intervention group after the therapeutic communication (p<0.01). Anxiety scores in the intervention group before and after intervention were 10.23 and 9.38, respectively. While the corresponding scores in the control group were 10.26 and 11.62, respectively. Depression scores in the intervention group before and after intervention were 11 and 9.13, respectively. The corresponding scores in the control group were 11.30 and 12.08, respectively. Conclusion: The results demonstrated the positive role of therapeutic communication in reducing anxiety and depression of the patients. Therefore, the therapeutic communication is recommended as a simple, cost effective and efficient method in this area. PMID:25505931
Zarea, Kourosh; Maghsoudi, Solmaz; Dashtebozorgi, Bahman; Hghighizadeh, Mohammad Hossin; Javadi, Mostafa
Background and objectives: Off-pump coronary artery bypass grafting (CABG) has been advocated to cause less inflammation, morbidity, and mortality than the more traditional on-pump technique. This meta-analysis compares these two surgical techniques with respect to causing acute kidney injury (AKI). Design, setting, participants, & measurements: This study searched for randomized controlled trials in MEDLINE and abstracts from the proceedings of scientific meetings through February 2010. Included were trials comparing off-pump to on-pump CABG that reported the incidence of AKI, as defined by a mixture of criteria including biochemical parameter/urine output/dialysis requirement. Mortality was evaluated among the studies that reported kidney-related outcomes. For primary and subgroup analyses, fixed-effect meta-analyses of odds ratios (OR) were performed. Results: In 22 identified trials (4819 patients), the weighted incidence of AKI in the on-pump CABG group was 4.0% (95% confidence interval [CI] 1.8%, 8.5%), dialysis requirement 2.4% (95% CI 1.6%, 3.7%), and mortality 2.6% (95% CI 1.6%, 4.0%). By meta-analysis, off-pump CABG was associated with a 40% lower odds of postoperative AKI (OR 0.60; 95% CI 0.43, 0.84; P = 0.003) and a nonsignificant 33% lower odds for dialysis requirement (OR 0.67; 95% CI 0.40, 1.12; P = 0.12). Within the selected trials, off-pump CABG was not associated with a significant decrease in mortality. Conclusions: Off-pump CABG may be associated with a lower incidence of postoperative AKI but may not affect dialysis requirement, a serious complication of cardiac surgery. However, the different definitions of AKI used in individual trials and methodological concerns preclude definitive conclusions. PMID:20671222
Seabra, Victor F.; Alobaidi, Sami; Balk, Ethan M.; Poon, Alan H.
Re-operation after coronary artery bypass grafting (CABG) is associated with increased risk for morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is an alternative for patients with aortic stenosis, but the outcomes of patients with a history of CABG are unknown. The aim of this study was to explore the association between previous CABG and the outcome of patients undergoing TAVI. Out of 372 consecutive patients who underwent TAVI from 2007 to 2013, 122 (32.8%) had previous CABG, whereas 250 (67.2%) did not. A comparison was made between groups. Subgroup analysis compared patients with and without previous CABG in 3 patient subsets: inoperable, operable, and those who underwent transapical TAVI. Patients with previous CABG were younger (81.99�6.78 vs 84.81�7.06 years, respectively, p<0.001). These patients also had more high-risk features (e.g., peripheral vascular disease, previous myocardial infarction, past cerebrovascular disease, and lower average left ventricular ejection fraction (p<0.05 for all). Procedural aspects were mostly similar between groups. No disparities in mortality rates at 1 year were noted (22.1% vs 21.6%, respectively, p=0.91). Subgroup analyses yielded similar outcomes for all 3 groups. In conclusion, although patients with previous CABG present with more high-risk features, they share similar short- and long-term outcomes with patients without previous CABG, irrespective of their surgical risk. This includes patients who underwent transapical access. TAVI in patients with previous CABG is safe and does not confer a significant risk for adverse outcome. PMID:24513466
Minha, Sa'ar; Magalhaes, Marco A; Barbash, Israel M; Ben-Dor, Itsik; Dvir, Danny; Okubagzi, Petros G; Chen, Fang; Torguson, Rebecca; Kent, Kenneth M; Suddath, William O; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron
Background The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries. Aims To compare the characteristics used to categorise patients receiving a coronary artery bypass graft (CABG) surgery into DRGs. Further, to compare the structure into which DRGs are placed and the relative price paid for patients across Europe. Method Patients with a procedure of CABG surgery are analysed from Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden. Diagrammatic algorithms of DRG structures are presented for each country. The price in Euros of seven typical case vignettes, each made up of a set of a hypothetical patient�s characteristics, is also analysed for each country. In order to enable comparisons across countries the simplest case (index vignette) is taken as baseline and relative price levels are calculated for the other six vignettes, each representing patients with different combinations of procedures and comorbidities. Results European DRG payment structures for CABG surgery vary in terms of the number of different DRGs used and the types of distinctions which define patient categorisation. Based on the payments given to hospitals in different countries, the most resource intensive patient, relative to the index vignette, ranges in magnitude from 1.37 in Poland to 2.82 in Ireland. There is also considerable variation in how much different systems pay for particular circumstances, such as the occurrence of catheterisation or presence of comorbidity. Conclusion Past experience of the construction of DRG systems for CABG patients demonstrates the variety of options available. It also highlights the importance of updating systems as frequently as possible, to incentivise best practice. PMID:24949279
Objective: The aim of this study was to evaluate the role of coronary artery bypass grafting (CABG) in patients with out-of-hospital cardiac arrest (OHCA). Methods: The immediate and 5-year outcome after CABG of a consecutive series of 48 patients who survived OHCA was compared with those of control patients having had a recent myocardial infarction without ventricular arrhythmias. Results: All OHCA patients were found to have suffered myocardial infarction-related cardiac arrest. The mean delay from OHCA to CABG was 10.3?�?13.0?days. Despite not statistically significant, the risk of 30-day postoperative mortality was higher among OHCA patients than control patients (6.3 vs. 0%, p?=?0.24, propensity score adjusted analysis: p?=?1.00). Cardioverter defibrillator was implanted in two patients who were alive 3.8 and 4.4?years after CABG, respectively. At 5-year, the overall survival rate was 80.7% in OHCA patients and 84.5% in control patients (p?=?0.98, propensity score adjusted analysis: p?=?0.87), and survival freedom from fatal cardiac event was 86.1% in OHCA patients and 86.5% in control patients (p?=?0.61; propensity score adjusted analysis: p?=?0.90). Conclusions: Early and 5-year survival rates after CABG in OHCA patients are excellent even when cardioverter defibrillator is very selectively implanted. The early and intermediate results CABG suggest a confident approach toward surgical revascularization in this critically ill patient population. PMID:25654081
Mosorin, Matti-Aleksi; Lantos, Mat�; Juvonen, Tatu; Biancari, Fausto
Background. The practice of minimally invasive coronary artery bypass grafting remains controversial. This study outlines the results of single and multiple vessel bypass performed using the Medtronic Octopus Tissue Stabilization System and beating heart techniques. Results are compared with those of a standard cardiopulmonary bypass group.Methods. The group included 89 patients having operations performed during a 10-month period with average
Ted H Spooner; Peter E Dyrud; Bjorn K Monson; Ginny E Dixon; Len D Robinson
Background: Hypothermic cardiopulmonary bypass is associated with low perfusion state causing a mismatch between demand and supply to various organs such as gut, kidneys and brain. The consequences are thought to be responsible for postoperative complications like systemic inflammatory response, renal failure, neurological injury, etc. Pharmacological agents like dopamine, dopexamine and dobutamine have been used in an attempt to reduce
Rajeshwara Krishna Prasad Adluri; Arvind V. Singh; Julian Skoyles; Adrian Robins; Anthony Hitch; Mya Baker; Ian Moore Mitchell
The internal mammary artery (IMA) is routinely used for grafting of the left anterior descending coronary artery (LAD), providing good flow to the anterior left ventricle (LV) wall. Impeded IMA-to-LAD flow may result in myocardial ischaemia and haemodynamic deterioration. From a study population, we describe two incidents where myocardial ischaemia was observed during off-pump coronary artery bypass surgery (CABG), with a confirmed reduction in the IMA-to-LAD flow in one patient. In patient no. 1, normal IMA flow was assessed by transit-time flow measurement after a complete IMA-to-LAD anastomosis. The anterior LV wall thickening was monitored continuously by epicardial ultrasonic transducers. Normal wall thickening was confirmed after IMA grafting. During a wide sternal opening for circumflex grafting the anterior wall motion displayed an ischaemic pattern, with reduced systolic and increased post-systolic wall thickening. IMA flow was reduced simultaneously. When easing the sternal opening, IMA flow normalized, as did the motion pattern in the anterior LV wall. In patient no. 2, similar changes in wall thickening occurred during a wide sternal opening after IMA-to-LAD grafting. When easing the retractor, the wall thickening normalized. It is important for the surgeon to be aware of this possible cause of myocardial ischaemia, with a risk of subsequent haemodynamic deterioration. This may not only be of great importance during off-pump CABG, but can also be significant for successful weaning from the cardiopulmonary bypass machine. PMID:22499803
Espinoza, Andreas; Bergsland, Jacob; Lundblad, Runar; Fosse, Erik
Background: Many previous studies have investigated the influence of gender on coronary artery bypass grafting surgery (CABG) outcomes. Despite the great volume of reports on this issue, it is still not clear whether it is the gender of the patient or pre-existing comorbid conditions that is the best predictor for the different outcomes seen between men and women. Multiple studies have shown that women are at higher risk of postoperative complications than men, particularly in the perioperative period. Objectives: The goal of this study was to determine whether sex differences exist in preoperative variables between men and women, and to evaluate the effect of gender on short-term mortality and morbidity after CABG in an Iranian population. Patients and Methods: Data were collected prospectively from 690 consecutive patients (495 men and 195 women) who underwent isolated CABG. Preoperative, intraoperative, and postoperative variables, major complications and death were compared between the male and female patients until hospital discharge using multivariate analysis. Results: Women were older (P = 0.020), had more diabetes (P = 0.0001), more obesity (P = 0.010), a higher New York Heart Association functional class (P = 0.030), and there was less use of arterial grafts (P = 0.016). Men had more tobacco smokers (P = 0.0001) and lower preoperative ejection fractions (EF) (P = 0.030). After surgery, women had a higher incidence of respiratory complications (P = 0.003), higher creatine kinase (CK) � MB levels (P = 0.0001), and higher inotropic support requirements (P = 0.030). They also had a higher incidence of decreased postoperative EF versus preoperative values (P = 0.020). The length of ICU stay, incidence of return to ICU and postoperative death, were similar between men and women. Nevertheless, after adjusting for age and diabetes, female gender was still independently associated with higher morbidity in patients over 50 years of age. Conclusions: Women had more risk factors, comorbidities, and postoperative complications. Women older than 50 years of age were at a higher risk of postoperative complications than men. This difference decreased with younger age. In-hospital mortality rates were not influenced by sex, as there was no difference found between the two groups (2.5% women vs. 2.2% men; P > 0.05). PMID:25478483
Yazdanian, Forouzan; Azarfarin, Rasoul; Aghdaii, Nahid; Jalali Motlagh, Soudabeh; Faritous, Zahra; Alavi, Mostafa; Hosseini, Saeid
Purpose: Although robot-assisted coronary artery bypass grafting (RA-CABG) has gained more acceptance worldwide, its success still depends on the surgeon's experience and expertise, and the conversion rate to full sternotomy is in the order of 15%-25%. One of the reasons for conversion is poor pre-operative planning, which is based solely on pre-operative computed tomography (CT) images. In this paper, the authors propose a technique to estimate the global peri-operative displacement of the heart and to predict the intra-operative target vessel location, validated via both an in vitro and a clinical study. Methods: As the peri-operative heart migration during RA-CABG has never been reported in the literatures, a simple in vitro validation study was conducted using a heart phantom. To mimic the clinical workflow, a pre-operative CT as well as peri-operative ultrasound images at three different stages in the procedure (Stage{sub 0}--following intubation; Stage{sub 1}--following lung deflation; and Stage{sub 2}--following thoracic insufflation) were acquired during the experiment. Following image acquisition, a rigid-body registration using iterative closest point algorithm with the robust estimator was employed to map the pre-operative stage to each of the peri-operative ones, to estimate the heart migration and predict the peri-operative target vessel location. Moreover, a clinical validation of this technique was conducted using offline patient data, where a Monte Carlo simulation was used to overcome the limitations arising due to the invisibility of the target vessel in the peri-operative ultrasound images. Results: For the in vitro study, the computed target registration error (TRE) at Stage{sub 0}, Stage{sub 1}, and Stage{sub 2} was 2.1, 3.3, and 2.6 mm, respectively. According to the offline clinical validation study, the maximum TRE at the left anterior descending (LAD) coronary artery was 4.1 mm at Stage{sub 0}, 5.1 mm at Stage{sub 1}, and 3.4 mm at Stage{sub 2}. Conclusions: The authors proposed a method to measure and validate peri-operative shifts of the heart during RA-CABG. In vitro and clinical validation studies were conducted and yielded a TRE in the order of 5 mm for all cases. As the desired clinical accuracy imposed by this procedure is on the order of one intercostal space (10-15 mm), our technique suits the clinical requirements. The authors therefore believe this technique has the potential to improve the pre-operative planning by updating peri-operative migration patterns of the heart and, consequently, will lead to reduced conversion to conventional open thoracic procedures.
Cho, Daniel S.; Linte, Cristian; Chen, Elvis C. S.; Bainbridge, Daniel; Wedlake, Chris; Moore, John; Barron, John; Patel, Rajni; Peters, Terry [Imaging Research Laboratories, Robarts Research Institute and Biomedical Engineering Graduate Program, University of Western Ontario, Ontario N6A 5K8 (Canada); Imaging Research Laboratories, Robarts Research Institute and Biomedical Imaging Resource, Mayo Clinic, Rochester, Minnesota 55905 (United States); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, Ontario N6A 5K8 (Canada); Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, Ontario N6A 5K8 (Canada); Department of Computer Science, University of Western Ontario, Ontario N6A 5B7 (Canada); Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada); Imaging Research Laboratories, Robarts Research Institute, Biomedical Engineering Graduate Program, University of Western Ontario N6A 5K8 (Canada); and Canadian Surgical Technologies and Advanced Robotics, London, Ontario N6A 5A5 (Canada)
Background Despite improved myocardial protection strategies, cardioplegic arrest and ischemia still result in reperfusion injury. We have previously published a study describing the effects of propofol (an anesthetic agent commonly used in cardiac surgery) on metabolic stress, cardiac function, and injury in a clinically relevant animal model. We concluded that cardioplegia supplementation with propofol at a concentration relevant to the human clinical setting resulted in improved hemodynamic function, reduced oxidative stress, and reduced reperfusion injury when compared to standard cardioplegia. Objective The Propofol cardioplegia for Myocardial Protection Trial (ProMPT) aims to translate the successful animal intervention to the human clinical setting. We aim to test the hypothesis that supplementation of the cardioplegic solution with propofol will be cardioprotective for patients undergoing isolated coronary artery bypass graft or aortic valve replacement surgery with cardiopulmonary bypass. Methods The trial is a single-center, placebo-controlled, randomized trial with blinding of participants, health care staff, and the research team. Patients aged between 18 and 80 years undergoing nonemergency isolated coronary artery bypass graft or aortic valve replacement surgery with cardiopulmonary bypass at the Bristol Heart Institute are being invited to participate. Participants are randomly assigned in a 1:1 ratio to either cardioplegia supplementation with propofol (intervention) or cardioplegia supplementation with intralipid (placebo) using a secure, concealed, Internet-based randomization system. Randomization is stratified by operation type and minimized by diabetes mellitus status. Biomarkers of cardiac injury and metabolism are being assessed to investigate any cardioprotection conferred. The primary outcome is myocardial injury, studied by measuring myocardial troponin T. The trial is designed to test hypotheses about the superiority of the intervention within each surgical stratum. The sample size of 96 participants has been chosen to achieve 80% power to detect standardized differences of 0.5 at a significance level of 5% (2-tailed) assuming equal numbers in each surgical stratum. Results A total of 96 patients have been successfully recruited over a 2-year period. Results are to be published in late 2014. Conclusions Designing a practicable method for delivering a potentially protective dose of propofol to the heart during cardiac surgery was challenging. If our approach confirms the potential of propofol to reduce damage during cardiac surgery, we plan to design a larger multicenter trial to detect differences in clinical outcomes. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 84968882; http://www.controlled-trials.com/ISRCTN84968882/ProMPT (Archived by WebCite at http://www.webcitation.org/6Qi8A51BS). PMID:25004932
Plummer, Zoe E; Baos, Sarah; Rogers, Chris A; Suleiman, M-Saadeh; Bryan, Alan J; Angelini, Gianni D; Hillier, James; Downes, Richard; Nicholson, Eamonn
Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) is associated with intense activation of hemostatic mechanisms. But the precise knowledge of the effects of eliminating CPB in patients undergoing off-pump coronary artery bypass grafting (CABG) are not well established. The present study was carried out to compare and document the changes in selected coagulation and fibrinolysis variables in patients undergoing on-pump and off-pump CABG (OPCAB). A total of 42 patients of on-pump and 31 patients of off-pump CABG were selected for the study. Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), Fibrinogen and D-dimer levels were measured immediately, 24�h and 7�days after operation and compared with the baseline preoperative values. Statistical analysis was done by mixed ANOVA for repeated measures and Post-hoc tests using the Bonferroni correction, Chi square and unpaired t test. All the parameters were significantly changed (P�<�0.05) with the time. Platelet counts, fibrinogen and D-dimer levels were significantly different between on-pump and off-pump CABG patients on immediate and 24�h postoperative period and attained almost same level after 7�days of operation. Fibrinogen level and platelet counts were increased after a sharp fall in the immediate post-operative period whereas D-dimer levels were persistently increased with a sharp peak of rise in the immediate post-operative period in on-pump group. On-pump surgery was associated with excessive fibrinolytic activity immediately after operation. The off-pump group demonstrated less activation of coagulation and fibrinolysis and delayed postoperative response that became almost equal to the on-pump group in the later postoperative period. PMID:25435738
Roy, Shreosee; Saha, Kaushik; Mukherjee, Krishnendu; Dutta, Santanu; Mukhopadhyay, Debasis; Das, Indranil; Raychaudhuri, Gargi
We investigated the association between the preoperative logistic clinical syntax score (log CSS), saphenous vein graft (SVG) patency, and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass surgery (CABG). Of 1875 patients undergoing isolated CABG between 2009 and 2011, 267 patients, who later underwent coronary angiography, were included in the study. The primary end point was at least 1 graft occlusion on the follow-up coronary angiogram. The secondary end point was a composite of MACCE. In multivariate analysis, log CSS was found as a strong predictor of SVG failure (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.46-0.94, P = .02; and OR: 2.21, 95% CI: 1.02-4.75, P = .04, respectively): log CSS was also associated with MACCE (P = .001 and P < .001, respectively). The addition of clinical parameters to the anatomical SYNTAX score, termed as "log CSS", augmented the accuracy and reliability of the prediction of SVG failure and MACCE in patients undergoing CABG. PMID:25385816
Ozturk, Derya; Cel?k, Omer; Cakmak, Huseyin Altug; Ak?n, Fatih; Aslan, Serkan; Enhos, As?m; Tasbulak, Omer; Ayca, Burak; Erkanl?, Korhan; Bak?r, Ihsan
MedlinePLUS Videos and Cool Tools
... for your specific condition. �1995-2012, The Patient Education Institute, Inc. www.X-Plain.com ct030109 Last ... for your specific condition. �1995-2012, The Patient Education Institute, Inc. www.X-Plain.com ct030109 Last ...
Objectives: We sought to investigate the effect of topical application of tranexamic acid into the pericardial cavity in reducing postoperative blood loss in coronary artery surgery. Methods: A prospective, randomized, double-blind investigation with parallel groups was performed. Forty consecutive patients undergoing primary coronary surgery were randomly assigned to group 1 (tranexamic acid group) or group 2 (placebo group). Tranexamic acid
Michele De Bonis; Franco Cavaliere; Francesco Alessandrini; Elisabetta Lapenna; Filippo Santarelli; Umberto Moscato; Rocco Schiavello; Gian Federico Possati
Background: Open heart surgery can cause high levels of anxiety in patients. Nowadays, lavender essential oil is widely used in medical research. This study was conducted with an aim to investigate the effects of lavender essential oil to reduce the anxiety of patients after coronary artery bypass surgery. Materials and Methods: This research is double-blinded randomized controlled trial on 60 patients who had undergone coronary artery bypass surgery in a 2-day intervention targeting reduction of anxiety. This study was conducted in Ekbatan Therapeutic and Educational Center, Hamadan city, Iran, in 2013. The patients in the inhalation aromatherapy group inhaled two drops of 2% lavender essential oil and those in the control group inhaled two drops of distilled water as placebo for 20 min on the 2nd and 3rd days after surgery. The level of anxiety was evaluated by Spielberger's State Anxiety questionnaire before and after intervention and the vital signs were documented as well. Data were analyzed using Stata 11 (Stata Corp., College Station, TX, USA) by independent t-test for continuous variables and Chi-square test for categorical variables. Results: The mean score of anxiety in the aromatherapy group was 48.73 � 5.08 and in the control group was 48 � 6.98 before the intervention (P = 0.64), which reduced after the intervention to 42.6 � 5.44 and 42.73 � 7.30, respectively. On the 3rd day after surgery, the mean score of anxiety in the aromatherapy group was 46.76 � 4.07 and in the control group was 46.53 � 7.05 before the intervention, which reduced to 41.33 � 3.65 and 41.56 � 6.18, respectively, after the intervention. However, there was no statistically significant difference in the mean scores of anxiety between the aromatherapy and control groups. Conclusions: Lavender essential oil has no significant effect on anxiety in patients after coronary artery bypass surgery, although it decreased the level of anxiety in the patients.
Seifi, Zahra; Beikmoradi, Ali; Oshvandi, Khodayar; Poorolajal, Jalal; Araghchian, Malihe; Safiaryan, Reza
Objective In this retrospective non-randomized cohort study, the image quality and radiation dose were compared between prospectively electrocardiogram (ECG)-gated axial (PGA) and retrospectively ECG-gated helical (RGH) techniques for the assessment of coronary artery bypass grafts using 256-slice CT. Methods We studied 124 grafts with 577 segments in 64 patients with a heart rate (HR) <85 bpm who underwent CT coronary angiography (CTCA); 34 patients with RGH-CTCA and 30 patients with PGA-CTCA. The image quality of the bypass grafts was assessed by a 5-point scale (1?=?excellent to 5?=?non-diagnostic) for each segment (proximal anastomosis, proximal, middle, distal course of graft body, and distal anastomosis). Other objective image quality indices such as noise, signal-to-noise ratio (SNR) and contrast-to-noise ratios (CNR) were assessed. Radiation doses were also compared. Results Patient characteristics of the two groups were well matched except HR. The HR of the PGA group was lower than that of the RGH group (62.0�5.0 vs. 65.7�7.4). For both groups, over 90% of segments received excellent or good image quality scores and none was non-evaluative. The image quality generally degraded as graft segment approached to distal anastomosis regardless of techniques and graft types. Image quality scores of the PGA group were better than those of the RGH group (1.51�0.53 vs. 1.73�0.62; p<0.001). There was no significantly difference of objective image quality between two techniques, and the effective radiation dose was significantly lower in the PGA group (7.0�1.2 mSv) than that of the RGH group (20.0�4.6 mSv) (p<0.001), with a 65.0% dose reduction. Conclusions Following bypass surgery, 256-slice PGA-CTCA is superior to RGH-CTCA in limiting the radiation dose and obtaining better image quality for bypass grafts. PMID:23145126
Lee, Yi-Wei; Yang, Ching-Ching; Mok, Greta S. P.; Law, Wei-Yip; Su, Cheng-Tau; Wu, Tung-Hsin
Peri-procedural myocardial damage (MD) is associated with increased risk of major in-hospital complications and adverse clinical events. The aim of this study was to evaluate the effects of on-clopidogrel platelet aggregation and CYP2C19-reduced-function gene variants on elective percutaneous coronary intervention (PCI)-related MD. We measured changes in serum high-sensitive troponin T (hs-TnT) levels, CYP2C19 genotype, and on-clopidogrel platelet aggregation (PA) using VerifyNow(�) P2Y12 system in 91 patients who received stent implantation (stent group). The control group comprised 30 patients who did not receive PCI. Blood samples were obtained before and 24�h after PCI or coronary angiography (CAG). Patients of the stent group were divided into high and low MD groups based on the median value of hs-TnT level at 24�h after PCI. Serum hs-TnT levels were significantly higher 24�h after PCI (86.8���121.5�pg/ml) compared with before PCI (9.4���5.3, p�<�0.001), whereas the levels were identical before and 24�h after CAG in the control group. Simple logistic regression analysis demonstrated that MD correlated with age (p�=�0.014), estimated GFR (p�=�0.003), hemoglobin A1c (p�=�0.015), baseline serum hs-TnT (p�=�0.049), and stent length (p�<�0.001). Multiple logistic regression analysis identified old age, high hemoglobin A1c level, and long stent, but not CYP2C19 reduced-function allele or high on-clopidogrel PA, as independent predictors of elective PCI-related MD. The present study demonstrated no significant relation between peri-procedural MD and high on-clopidgrel PA associated with CYP2C19 reduced-function allele in patients undergoing elective PCI. PMID:24781308
Yoshimura, Hiromi; Kaikita, Koichi; Ono, Takamichi; Iwashita, Satomi; Nakayama, Naoki; Sato, Koji; Horio, Eiji; Tsujita, Kenichi; Kojima, Sunao; Tayama, Shinji; Hokimoto, Seiji; Ogawa, Hisao
BACKGROUND: The number of patients with coronary artery disease and type 2 diabetes will increase dramatically over the next decade. Diabetes has been related to accelerated atherosclerosis and many patients with diabetes will require coronary artery bypass graft (CABG) surgery utilizing saphenous vein grafts. After CABG, accelerated atherosclerosis in saphenous vein grafts leads to graft failure in approximately 50% of cases over a 10-year period. Rosiglitazone, a peroxisome proliferator-activated receptor-gamma agonist, has been shown to improve multiple metabolic parameters in patients with type 2 diabetes. However, its role in the prevention of atherosclerosis progression is uncertain. STUDY DESIGN: VeIn-Coronary aTherOsclerosis and Rosiglitazone after bypass surgerY (VICTORY) is a cardiometabolic trial in which patients with type 2 diabetes, one to 10 years after CABG, will be randomly assigned to receive rosiglitazone (up to 8 mg/day) or a placebo after qualifying angiography and intravascular ultrasound of a segment of one vein graft with or without a native anastomosed coronary artery. A comprehensive set of athero-thrombo-inflammatory markers will be serially assessed during the 12-month follow-up period. Body fat distribution and body composition will be assessed by computed tomography and dual energy x-ray absorptiometry, respectively, at baseline, six months and 12 months follow-up. For atherosclerosis progression evaluation, repeat angiography and intravascular ultrasound will be performed after 12 months follow-up. The primary end point of the study will be the change in atherosclerotic plaque volume in a 40 mm or longer segment of one vein graft. CONCLUSIONS: The VICTORY trial is the first cardiometabolic study to evaluate the antiatherosclerotic and metabolic effects of rosiglitazone in post-CABG patients with type 2 diabetes. PMID:19746240
Bertrand, Olivier F; Poirier, Paul; Rod�s-Cabau, Josep; Rinfret, St�phane; Title, Lawrence; Dzavik, Vladimir; Natarajan, Madhu; Angel, Juan; Batalla, Nuria; Alm�ras, Natalie; Costerousse, Olivier; De Larochelli�re, Robert; Roy, Louis; Despr�s, Jean-Pierre
Hypercholesterolemia is well known as a risk factor which had been shown to affect the long-term prognosis after coronary artery bypass grafting (CABG). The data were collected from multi-institutions documenting the long-term results of CABG in 61 hypercholesterolemic patients who received LDL-apheresis. Mean post-CABG period was 50 +/- 34 (+/- SD) months. Mean period of therapy by LDL-apheresis using Liposorber system after CABG was 25 +/- 17 months with a frequency of once per 2.6 +/- 1.3 weeks. Before initiating LDL-apheresis mean serum cholesterol (TC) and LDL-cholesterol (LDL-C) were 327 mg/dl and 261 mg/dl, respectively. With combined LDL-apheresis and lipid-lowering drug therapy mean TC and LDL-C were reduced to 247 mg/dl and 177 mg/dl immediately pre-apheresis and 106 mg/dl and 60 mg/dl immediately post-apheresis, respectively. Two of 61 patients had PTCA post CABG. Percent free from cardiac event during the long-term period post CABG as calculated by the life-table method was 97% at 3 years and 94% at 4 years and thereafter. While number of the patients is still small, the aggressive cholesterol-lowering therapy by LDL-apheresis is suggested to improve the prognosis of hypercholesterolemic patients with bypass grafts. PMID:8492490
Kito, Y; Takahashi, J; Endo, M; Agishi, T; Kitamura, S; Matsuda, H; Fujiwara, T; Dohi, T; Ito, T; Kawashima, Y
To assess if recovery of regional myocardial function can be predicted by perioperative Doppler tissue echocariography, 20 patients undergoing coronary artery bypass graft surgery (mean 4.1 grafts) had serial transthoracic and transesophageal echocardiography. Systolic velocities were lower in basal posterior and anterior segments, and higher in the midanterior septum, at intraoperative transesophageal echocardiography compared with preoperative transthoracic echocardiography (-45%, -30%, +18%, respectively), but comparable elsewhere. After bypass, velocities were increased in midposterior, basal lateral, basal anterior, and midanterior septal segments (+41%, 25%, 27%, 44%, respectively, P <.05). Increased velocities in circumflex segments at 6 weeks (midposterior, basal lateral, and midlateral +54%, 45%, 39%, respectively, P <.05) were not predicted by perioperative changes or related to graft flow (transit-time flowmetry; R -0.09, -0.14, and -0.32, respectively, not significant). Myocardial velocities measured by transthoracic and transesophageal echocardiography are not comparable in segments with different angles of insonation. Perioperative changes in resting myocardial systolic velocity are highly variable and do not predict late recovery. PMID:12411906
Williams, R Ian; Haaverstad, Rune; Sianos, Georgios; Vourvouri, Eleni; Fraser, Alan G
Objectives: Levosimendan is a calcium sensitizer drug which has been used in cardiac surgery for the prevention of postoperative low cardiac output syndrome (LCOS) and in difficult weaning from cardiopulmonary bypass (CPB). This study aims to evaluate perioperative hemodynamic effects of levosimendan pretreatment in patients for off-pump coronary artery bypass graft (OPCABG) surgery with low left ventricular ejection fractions (LVEF < 30%). Materials and Methods: Fifty patients undergoing OPCABG surgery with low LVEF (<30%) were enrolled in the study. Patients were randomly divided in two groups: Levosimendan pretreatment (Group L) and placebo pretreatment (Group C) of 25 each. Group L, patients received levosimendan infusion 200 ?g/kg over 24 h and in Group C Patients received placebo. The clinical parameters measured before and after the drug administration up to 48 h were heart rate (HR; for the hour after drug infusion), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP). The requirement of inotropes, intraaortic balloon pump (IABP), CPB, intensive care unit (ICU) stay, and hospital stay were also measured. Results: The patients in group L exhibited higher CI and PCWP during operative in early postoperative period as compared to control group C. Group L also had a less requirement for inotropes, CPB support and IABP with shorter ICU stay as well as hospital stay. Conclusion: Levosimendan pretreatment (24 h infusion) in patient for OPCABG with poor LVEF shows better outcomes and hemodynamics in terms of inotropes, CPB and IABP requirements. It also reduces ICU stay. PMID:24550581
Shah, B.; Sharma, P.; Brahmbhatt, A.; Shah, R.; Rathod, B.; Shastri, Naman; Patel, J.; Malhotra, A.
ObjectiveDel Nido (DN) cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60�minutes, and the addition of lidocaine may limit intracellular calcium influx. Single-dose DN cardioplegia solution may offer an alternative myocardial protection strategy to multi-dose cold whole blood (WB) cardioplegia following acute myocardial infarction (AMI).MethodsWe retrospectively reviewed 88 consecutive patients with AMI undergoing coronary artery bypass (CABG) surgery with cardioplegic arrest between June 2010 to June 2012. Patients exclusively received WB (n�=�40, June 2010-July 2011) or DN (n�=�48, August 2011-June 2012) cardioplegia. Preoperative and postoperative data were retrospectively reviewed and compared using propensity scoring.ResultsNo significant difference in age, maximum preoperative serum troponin level, ejection fraction, and STS score was present between DN and WB. A single cardioplegia dose was given in 41 DN vs. 0 WB patients (p�<�0.001), and retrograde cardioplegia was used 10 DN vs. 31 WB patients (p�<�0.001). Mean cardiopulmonary bypass and cross clamp times were significantly shorter in the DN group versus WB group. Tranfusion rate, length of stay, intra-aortic balloon pump requirement, post-operative inotropic support, and 30-day mortality was no different between groups. One patient in the WB group required a mechanical support due to profound cardiogenic shock.ConclusionsDN cardioplegia may provide equivalent myocardial protection to existing cardioplegia without negative inotropic effects in the setting of acute myocardial infarction. PMID:25359427
Yerebakan, Halit; Sorabella, Robert A; Najjar, Marc; Castillero, Estibaliz; Mongero, Linda; Beck, James; Hossain, Maliha; Takayama, Hiroo; Williams, Mathew R; Naka, Yoshifumi; Argenziano, Michael; Bacha, Emile; Smith, Craig R; George, Isaac
There is a lack of knowledge on the interaction between age and left main coronary artery revascularization. The aim of this study was to investigate the comparative effectiveness of percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) in patients with left main coronary artery disease aged <75 versus ?75 years. Of a total of 894 patients included, 692 (77.4%) were aged <75 years and 202 (23.6%) ?75 years. PCI was found to be significantly different from CABG with respect to the composite of major adverse cardiac events at 1-year follow-up in patients aged <75 years (15.5% vs 8.5%, p = 0.01) but not in those aged ?75 years (16.4% vs 13.9%, p = 0.65). This finding was consistent after statistical adjustment for baseline confounders in the 2 groups (adjusted hazard ratio [AHR] 2.2, 95% confidence interval 1.2 to 4.1, p = 0.016 in younger patients; AHR 0.9, 95% confidence interval 0.3 to 3.0, p = 0.88 in older patients). In the 2 groups, PCI and CABG showed similar adjusted risks for all-cause death, cardiac death, and myocardial infarction. Target lesion revascularization occurred more frequently in patients aged <75 years treated with PCI compared to CABG (AHR 5.1, 95% confidence interval 1.9 to 13.6, p = 0.001) but not in those aged ?75 years. A significant interaction between age and treatment with regard to major adverse cardiac events was identified (adjusted p for interaction = 0.034). In conclusion, compared to younger patients, elderly patients with left main disease are likely to derive the maximal gain from a less invasive procedure such as PCI. PMID:22853983
Capodanno, Davide; Caggegi, Anna; Capranzano, Piera; Milino, Viviana; Chisari, Alberto; Mangiameli, Andrea; Monaco, Sergio; Barrano, Giombattista; Di Salvo, Maria Elena; Tamburino, Corrado
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), or off pump, has gained popularity by avoiding the postoperative morbidity related to the use of CPB. Previously, we have demonstrated that CABG done on pump using heparin-bonded cardiopulmonary bypass circuits (HBC) with a lower anti-coagulation protocol (LAP) attenuates these effects, reduces homologous blood product requirement, and improves clinical outcome when compared with conventional CPB circuits. Our purpose in this study was to compare off-pump CABG clinical outcomes to on-pump CABG using HBC with LAP. We retrospectively analysed preoperative and postoperative variables of all primary CABG (n=1214) performed at this institution from 1 January 1997 to 28 July 2000. These patients were divided into the on-pump (n=1152) and off-pump groups (n=62). HBC with LAP were used in all on-pump CABG cases. There was no statistical difference in preoperative comorbid risk factors except percentage of females (on pump, 30% vs. off pump, 44%; p=0.02) and body surface area (on pump, 1.94 +/- 0.25 ml vs. off pump, 1.85 +/- 0.22 ml; p=0.02). There was no difference in intraoperative and postoperative complications, risk-adjusted mortality, total blood product usage, or length of stay. The mean number of distal anastomoses performed was significantly different (on pump, 3.5 +/- 0.82 vs. off pump 1.8 +/- 0.82; p < 0.001). Despite similar preoperative risk factors, clinical outcomes and homologous blood requirements were not statistically different between the off-pump and on-pump groups. These endpoints should not be the only criteria to justify performing off-pump CABG. PMID:11958309
O'Gara, Paul J; Natarajan, Vijay; Lilly, Kevin; Husain, Ali; Shapira, Oz M; Shemin, Richard J
Objective: To analyze the frequency and severity of sub- clinical cerebral complications associated with coro- nary artery bypass grafting (CABG). Design: A prospective controlled study using preopera- tive and postoperative magnetic resonance imaging (MRI) of the brain, quantitative electroencephalography (QEEG), and detailed neuropsychological and neurologic exami- nations as potentially sensitive indicators of subclinical cerebral injury associated with CABG.
Ritva Vanninen; Marja Aikia; Mervi Kononen; Kaarina Partanen; Harri Tulla; Paivi Hartikainen; Juhani Partanen; Hannu Manninen; Pentti Enberg; Mikko Hippelainen
Objectives: Multislice (64 slice) computed tomography (MSCT) angiography has recently emerged as a potential technique that can evaluate the coronaries in an accurate yet non-invasive manner. It has still not been shown whether the accuracy of the anatomy shown is precise enough to operate on the basis of MSCT alone. The aim of this prospective clinical trial is to compare
Harinder Singh Bedi; Jeet Amol Singh Gill; Sandeep Singh Bakshi
Objectives: Multislice (64 slice) computed tomography (MSCT) angiography has recently emerged as a potential technique that can evaluate thecoronariesinan accurateyetnon-invasivemanner.It hasstillnotbeenshownwhethertheaccuracyof theanatomyshown ispreciseenoughto operate on the basis of MSCTalone. The aim of this prospective clinical trial is to compare MSCT to conventional coronary angiography (CCA), and to conclude whether MSCTalone is adequate for proceeding for CABG. Methods: 50 patients with
Harinder Singh Bedi; Jeet Amol Singh Gill; Sandeep Singh Bakshi
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In patients undergoing off-pump coronary artery bypass (OPCAB) surgery, does the off-pump to on-pump conversion rate have an impact on post-operative results? Altogether more than 420 papers were found using the reported search, of which 14 randomized controlled trials (RCTs) represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated and ordered according to the sample size. In the 14 RCTs reviewed, the off-pump to on-pump conversion rate incidence ranged from 0 to 13.3%. The most frequent causes of conversion were haemodynamic instability and intramyocardial-coronary target. A low conversion rate (<2%) was reported by five studies. Three of them did not show any difference in terms of mortality between the OPCAB and on-pump groups, one showed better survival of the OPCAB group at 5 years, and one reported better early survival of the OPCAB group. Three of these trials describe a high OPCAB experience and reported that patients undergoing OPCAB had a shorter post-operative stay and lower morbidity compared with patients undergoing on-pump coronary artery bypass grafting. Five RCTs showed a high conversion rate (>9%), and among them, one reported lower morbidity of the OPCAB patients, three were not able to show any benefit in terms of morbidity of the OPCAB, and one reported worse survival and patency graft rate of the OPCAB group. Four RCTs reported conversion rates ranging from 3.7 to 7.0%, describing a wide spectrum of results. We conclude that RCTs with a high off-pump to on-pump conversion rate were often associated with a lower experience in OPCAB of the surgeons participating in the trials. These studies were also mostly unable to show any benefit in terms of mortality or morbidity of OPCAB over the on-pump strategy. On the contrary, a low conversion rate is mostly reported by RCTs with a high structured experience in OPCAB. These trials were mostly able to show a benefit, in terms of morbidity and survival, of the OPCAB over the on-pump strategy. PMID:22159253
Urso, Stefano; Sadaba, Justo Rafael; Pettinari, Matteo
Background Results from randomized controlled trials (RCT) concerning cardiac and renal effect of remote ischemic preconditioning(RIPC) in patients with stable coronary artery disease(CAD) are inconsistent. The aim of this study was to explore whether RIPC reduce cardiac and renal events after elective percutaneous coronary intervention (PCI). Methods and Results RCTs with data on cardiac or renal effect of RIPC in PCI were searched from Pubmed, EMBase, and Cochrane library (up to July 2014). Meta-regression and subgroup analysis were performed to identify the potential sources of significant heterogeneity(I2?40%). Eleven RCTs enrolling a total of 1713 study subjects with stable CAD were selected. Compared with controls, RIPC significantly reduced perioperative incidence of myocardial infarction (MI) [odds ratio(OR) ?=?0.68; 95% CI, 0.51 to 0.91; P?=?0.01; I2?=?41.0%] and contrast-induced acute kidney injury(AKI) (OR?=?0.61; 95% CI, 0.38 to 0.98; P?=?0.04; I2?=?39.0%). Meta-regression and subgroup analyses confirmed that the major source of heterogeneity for the incidence of MI was male proportion (coefficient ?=??0.049; P?=?0.047; adjusted R2?=?0.988; P?=?0.02 for subgroup difference). Conclusions The present meta-analysis of RCTs suggests that RIPC may offer cardiorenal protection by reducing the incidence of MI and AKI in patients undergoing elective PCI. Moreover, this effect on MI is more pronounced in male subjects. Future high-quality, large-scale clinical trials should focus on the long-term clinical effect of RIPC. PMID:25551671
Pei, Hanjun; Wu, Yongjian; Wei, Yingjie; Yang, Yuejin; Teng, Siyong; Zhang, Haitao
The possibility of developing coronary steal in patients having coronary artery bypass graft (CABG) using internal thoracic artery (ITA) and ipsilateral upper extremity arteriovenous (AV) hemodialysis shunt has been reported. The impact of this phenomenon on clinical outcomes is uncertain. The aim of this study was to investigate an association between the AV dialysis shunt location regarding the side of the ITA CABG and clinical outcomes. This retrospective cohort study included chronic hemodialysis patients having ITA CABG and upper extremity AV shunt. The patients were divided into two groups: those with ipsilateral and those with contralateral location of ITA CABG and AV shunt. The outcomes were: death from any cause, cardiac death and a first cardiac event. In a group of 112 chronic hemodialysis patients having CABG, 32 had an ipsilateral and 25 had a contralateral location of ITA CABG and an upper extremity AV shunt. Significantly more cardiac events occurred in the group with an ipsilateral compared to a contralateral location of ITA CABGs and dialysis AV shunts (hazard ratio, 2.16 [95% CI, 1.11 to 4.19], P = 0.023). There was no difference between the groups in the all cause mortality risk (hazard ratio, 1.005 [95% CI, 0.43 to 2.37], P = 0.990) or the risk of cardiac death (hazard ratio, 2.43 [95% CI, 0.64 to 9.17], P = 0.191). The ipsilateral location of a CABG with the use of ITA and upper extremity AV hemodialysis shunt may be associated with increased risk of cardiac events. PMID:24417873
Feldman, Leonid; Tkacheva, Inna; Efrati, Shai; Rabin, Igor; Beberashvili, Ilia; Gorelik, Oleg; Averbukh, Zhan; Shani, Michal
Background/Aims There are controversial data about renal function following off-pump coronary artery bypass grafting (CABG). The present study aimed to evaluate renal function changes 24 h after on- and off-pump CABG, as well as renal function correlated with high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-? (TNF-?). Methods Ninety patients with coronary artery disease referred to our center for CABG from July 2006 to November 2007 were enrolled in the study. Patients were equally and randomly divided in two groups, on- and off-pump. Serum levels of creatinine (Cr), blood urea nitrogen, creatinine clearance (CrCl), hs-CRP, and TNF-? were determined immediately before and 24 h after surgery. Results Cr and CrCl changes after surgery were not significantly different between the two groups; however, blood urea nitrogen levels after surgery were significantly higher in the on-pump group (p = 0.035). No statistically significant difference was noted between the two groups in terms of changes in levels of hs-CRP and TNF-? (p = 0.350 and 0.805, respectively). The changes in CrCl levels had no significant correlation with hs-CRP and TNF-?. Conclusions The early Cr and CrCl levels after surgery are not significantly different in on- and off-pump groups. The early renal function after on- or off-pump CABG is not correlated with the levels of inflammatory markers including hs-CRP and TNF-?. PMID:22969775
Nezami, Nariman; Djavadzadegan, Hassan; Tabatabaie-Adl, Haleh; Hamdi, Amir; Ghobadi, Kazem; Ghorashi, Sona; Hajhosseini, Babak
OBJECTIVE--To assess the long-term (four to 10 years) prognostic significance of transient ST segment changes on ambulatory ST segment monitoring after coronary artery bypass grafting (CABG). PATIENTS AND METHODS--76 patients (67 men, nine women) underwent CABG between 1982 and 1984 (n = 31) and between 1987 and 1988 (n = 45) and at a mean age of 57. All underwent 48 hours of ambulatory ST segment monitoring at a mean of 19 weeks after surgery. The results were available for assessment. All general practitioners were contacted and patients' notes reviewed. Patients were contacted by telephone. Details were recorded of intervening events (acute myocardial infarction, unstable angina, need for further revascularisation, and deaths). Event free survival curves were produced for those with and without transient ST segment changes during routine postoperative ambulatory ST segment monitoring. RESULTS--During 3213 hours of monitoring after CABG, 21 (27.6%) of 76 patients had transient ST segment changes, of which 70% were silent. Over a mean 70 month follow up period, patients with such ischaemic changes were no more likely to have either an objective (myocardial infarction or cardiac death) or subjective (unstable angina or another revascularisation) event than those patients without ischaemic changes. This finding was the same in patients operated on between 1987 and 1988 and between 1982 and 1984. CONCLUSIONS--Although ambulatory ST segment monitoring is becoming increasingly popular in some countries as a routine investigation for ischaemia in various coronary subgroups, the findings of such an investigation, when performed after CABG, do not help to identify a subgroup more likely to have an adverse outcome during up to 10 years of follow up. There seems to be no reason to perform this investigation after surgery, and particularly to refer patients for reinvestigation because of the detection of predominantly silent ST segment changes of uncertain relevance. PMID:8217441
Patel, D; Mulcahy, D; Curzen, N; Sullivan, A; Cunningham, D; Sparrow, J; Wright, C; Quyyumi, A; Fox, K
Background Central nervous system complications are the most clinically important of those affecting mortality in patients undergoing coronary artery surgery. Newly developed sophisticated techniques and surgical interventions obviating the need for cardiopulmonary pumps have facilitated avoidance of these complications. In this study, we compared the impact of on-pump and off-pump coronary artery bypass surgery on cerebral oxygenation using near-infrared spectroscopy. Methods This study included 40 patients with no comorbidities who were scheduled for on-pump (n = 20) and off-pump (n = 20) cardiac surgery. Preoperative and postoperative Standardized Mini-Mental State Examination (SMMSE) scores, perioperative mean arterial blood pressure (MAP), hematocrit (Hct), peripheral oxygen saturation (SpO2), regional cerebral oximetry values (rSO2), body temperature, and partial pressure of carbon dioxide (PCO2) were recorded, for all patients. Intergroup and intragroup comparisons were then performed. Results The mean operative time was longer in the on-pump group. SMMSE scores were similar and relevant postoperative values were lower in both groups. Perioperative MAP, PCO2, and SpO2 were similar in both groups. SpO2 and PCO2 did not differ from baseline levels in either group, while the postextubation MAP at 2 h postoperatively remained low. Hct levels decreased during the perioperative and postoperative periods, while the body temperature declined perioperatively and to a greater degree in the on-pump group. The intraoperative and postoperative rSO2 decreased in both groups. In the on-pump group, the decrease in rSO2 was more prominent during the interval between the start and closure of the sternotomy. Conclusions Physiological alterations that occur during coronary artery surgery affect cerebral oxygenation during and after the operation irrespective of the application of a cardiopulmonary pump. Cerebral oxygenation decreases to a greater extent during on-pump surgery; however, probably because of the neuroprotective effects of hypothermia, the postoperative changes resemble those of off-pump surgery.
�ukurova, Zafer; Eren, G�lay; Herg�nsel, Oya
Background Plasma concentrations of sFlt-1, the soluble form of the vascular endothelial growth factor receptor (VEGF), markedly increase during coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). We investigated if plasma sFlt-1 values might be related to the occurrence of surgical complications after CABG. Methods Plasma samples were collected from the radial artery catheter before vascular cannulation and after opening the chest, at the end of ECC just before clamp release, after cross release, after weaning from ECC, at the 6th and 24th post-operative hour. Thirty one patients were investigated. The presence of cardiovascular, haematological and respiratory dysfunctions was prospectively assessed. Plasma sFlt-1 levels were measured with commercially ELISA kits. Results Among the 31 investigated patients, 15 had uneventful surgery. Patients with and without complications had similar pre-operative plasma sFlt-1 levels. Lowered plasma sFlt-1 levels were observed at the end of ECC in patients with haematological (p = 0.001, ANOVA) or cardiovascular (p = 0.006) impairments, but not with respiratory ones (p = 0.053), as compared to patients with uneventful surgery. Conclusion These results identify an association between specific post-CABG complication and the lower release of sFlt-1 during ECC. sFlt-1-induced VEGF neutralisation might, thus, be beneficial to reduce the development of post-operative adverse effects after CABG. PMID:18423019
Denizot, Yves; Leguyader, Alexandre; Cornu, Elisabeth; Laskar, Marc; Orsel, Isabelle; Vincent, Christelle; Nathan, Nathalie
Low baroreflex sensitivity (BRS) following coronary artery bypass graft (CABG) surgery increases the risk of sympathetically mediated cardiac arrhythmias. To reduce this risk, D,L-sotalol, a nonselective ?-adrenergic receptor antagonist (Class II) and an antiarrhythmic (Class III), is prescribed postoperatively. However, its effect on BRS has not been reported. The purpose of this study was to characterize the influence of D,L-sotalol on BRS measures in supine and standing postures 4 days following CABG surgery. BRS was measured in 27 men and 10 women receiving D,L-sotalol and compared with archival data for 21 men and 10 women obtained prior to the routine administration of D,L-sotalol. In the latter (control) group, 61% had BRS of less than 3 ms/mmHg in the supine posture and 74% in the standing posture compared to 42% with less than 3 ms/mmHg in the supine posture and 65% in the standing posture in the D,L-sotalol group. Men in the D,L-sotalol group showed higher R-R interval and BRS in both supine and standing postures compared with controls. Women in the D,L-sotalol group had higher R-R interval in the supine posture. The higher BRS in men not only reduces the risk of arrhythmias after CABG surgery but may also allow a more rapid circulatory response to the standing posture, thereby decreasing the risk of syncope. PMID:23539669
Brown, C Ann; Chenier-Hogan, Nicole; Hains, Sylvia M J; Parlow, Joel L
Background: During the on-pump coronary artery bypass grafts surgery, ischemia/reperfusion injury would happen. Ischemia preconditioning could increase the tolerance against subsequent ischemia and reduce the ischemia/reperfusion injury. However the clinical outcomes of the available trials were different. Methods : We searched the Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 3, 2013), the Medline/PubMed and CNKI in March 2013. RevMan 5.1.6 and GRADEprofiler 3.6 were used for statistical analysis and evidence quality assessment. Heterogeneity was evaluated with significance set at P?0.10. Results: Eighteen randomized controlled trials were included. There were no differences on in-hospital mortality, postoperative myocardial infarction morbidity between ischemia preconditioning and control groups. The heterogeneity of creatine kinase-MB level 24 hours after surgery was obvious. The differences of 72 hours area under the curve of cardiac troponin T (mean differences of -14.50, 95% confidence interval of -21.71 to -7.28) and troponin I (mean differences -181.79, 95% confidence interval of -270.07 to -93.52) after surgery were observed. Conclusion s : All the 18 trails, the positive and the negative results were equal. The meta-analysis results should be interpreted with caution due to limited effective data. Because of high cost-effectiveness, ischemia preconditioning could not be denied completely. Large-scale randomized studies are needed, with the operation procedures and included criteria being more specific. PMID:24948996
Chai, Qing; Liu, Jin
Effect of low-dose propofol infusion on total-body oxygen consumption after coronary artery surgery
Objective: To investigate the effect of low-dose propofol infusion on total-body oxygen consumption (V02) after coronary artery bypass grafting (CABG) surgery.Design: A prospective, randomized, placebo-controlled, double-blind study.Setting: Cardiovascular intensive care unit in a university hospital.Participants: Thirty patients after elective, uncomplicated CABG surgery.Intervention: Patients were administered a continuous infusion of propofol with a fixed rate of 1 mg\\/kg\\/h (n = 15)
Esa Hammar�n; Mika Scheinin; Markku Hynynen
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was if transit-time flow measurement (TTFM) can improve graft patency and clinical outcome in patients undergoing coronary surgery. Altogether 102 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The papers considered for the analysis focus attention on three major topics: intraoperative graft verification with the aim of improving immediate graft patency; predictive power of early- and mid-term graft patency and clinical outcome. Among TTFM parameters, according to different authors, mean graft flow is set at 10 or 15�ml/min; pulsatility index is set at three or five; insufficiency ratio is set by 3 or 4%. We conclude that TTFM is a reliable method to verify intraoperative graft patency. There is some evidence that checking graft patency intraoperatively may improve mid-term outcomes. PMID:20682631
Di Giammarco, Gabriele; Rabozzi, Roberto
Background Rosiglitazone improves glycemic control for patients with type 2 diabetes, but there remains controversy regarding an observed association with cardiovascular hazard. The cardiovascular effects of rosiglitazone for patients with coronary artery disease (CAD) remain unknown. Methods and Results To examine any association between rosiglitazone use and cardiovascular events among patients with diabetes and CAD, we analyzed events among 2368 patients with type 2 diabetes and CAD in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Total mortality, composite death, myocardial infarction (MI), and stroke, and individual incidence of death, MI, stroke, congestive heart failure (CHF) and fractures, were compared during 4.5 yrs of follow-up among patients treated with rosiglitazone vs. patients not receiving a thiazolidinedione using Cox proportional hazards and Kaplan-Meier analyses including propensity matching. After multivariable adjustment, among patients treated with rosiglitazone, mortality was similar (HR 0.83; 95% CI, 0.58 to 1.18) while there was a lower adjusted incidence of composite death, MI, and stroke (hazard ratio (HR) 0.72; 95% confidence interval (CI), 0.55 to 0.93) and stroke (HR 0.36, 95% CI 0.16 to 0.86), and a higher incidence of fractures (HR 1.62, 95% CI 1.05 to 2.51); the incidence of MI (HR 0.77; 95% CI, 0.54 to 1.10) and CHF (HR 1.22, 95%CI, 0.84 to 1.82) were not significantly different. Among propensity matched patients rates of major ischemic cardiovascular events and CHF were not significantly different. Conclusions Among patients with type 2 diabetes and CAD in the BARI 2D trial, neither on-treatment nor propensity matched analysis supported an association of rosiglitazone treatment with an increase in major ischemic cardiovascular events. PMID:23857320
Bach, Richard G.; Brooks, Maria Mori; Lombardero, Manuel; Genuth, Saul; Donner, Thomas W.; Garber, Alan; Kennedy, Laurence; Monrad, E. Scott; Pop-Busui, Rodica; Kelsey, Sheryl F.; Frye, Robert L.
Objective: One of the major complications of cardiac surgery is the presence of post-operative bleeding. The aim of the present study was to investigate the topical application of tranexamic acid in the pericardial cavity on post-operative bleeding in off-pump coronary artery bypass graft (CABG) surgery. Materials and Methods: This study was on 71 patients who underwent off-pump CABG. The anesthesia and surgery methods were the same for all patients. Patients were assigned to two equal groups. In the first group, 1 g of tranexamic acid in 100 mL of normal saline solution (NSS) was applied to pericardium and mediastinal cavity at the end of surgery. In the second group, only 100 mL of NSS was applied. Chest drainage of the patients after 24 h and the amounts of blood and blood products transfusion were also recorded during this time. Results: Patients were the same regarding demographic information and surgery. The average volume of blood loss after 24 h was 366 mL for the first group and 788 mL for the control group. There was a statistically significant difference between the two groups (P < 0.001). The amount of packed red blood cells transfusion in the first group was less than that of the control group, which was not statistically significant. There was no statistically significant difference between the amount of hemoglobin, hematocrit, platelets, prothrombin time and partial thromboplastin time in the post-operative stage in the two groups. Conclusion: The topical application of tranexamic acid in off-pump CABG patients leads to a decreased post-operative blood loss. PMID:24843337
Hosseini, Habibollah; Rahimianfar, Ali Akbar; Abdollahi, Mohammad Hassan; Moshtaghiyoon, Mohammad Hossein; Haddadzadeh, Mahdi; Fekri, Asefeh; Barzegar, Kazem; Rahimianfar, Fatemeh
Minimally invasive coronary artery bypass grafting (MICS CABG) is a nonrobotic, nonthoracoscopic operation that achieves complete anatomical graft similarity with conventional CABG, while avoiding sternotomy and cardiac anoxia. We describe the stepwise approach to perform proximal anastomoses directly off the ascending aorta and also early results of this operation. All myocardial territories are accessed via a 4- to 6-cm left fifth intercostal thoracotomy. After takedown of the left internal thoracic artery, the ascending aorta is progressively brought into view by the following maneuvers: (1) administration of cardiac inotropes to minimize right ventricle filling, (2) increase in right lung positive end-expiratory pressures and tidal volumes, (3) placement of multilevel pericardial retractions, (4) leftward displacement of the ascending aorta with a gauze anterior to the superior vena cava, and (5) left posteroinferior displacement of the right ventricular outflow tract with an epicardial stabilizer. Handsewn proximal anastomoses can then be performed on the ascending aorta with a side-biting clamp. In the first 100 patients who underwent multivessel MICS CABG with proximal anastomoses directly off the aorta, the mean age was 62.6 � 10.2 years, and median operative time was 3.5 hours. The mean number of grafts was 2.3 � 0.5, and there were 3 conversions to open sternotomy. There were no preoperative deaths, 2 reoperations for bleeding, and 2 superficial wound infections. The median length of hospital stay was 4 days. MICS CABG is a safe alternative to conventional CABG, with excellent short-term results. PMID:22643668
Chan, Vincent; Lapierre, Harry; Sohmer, Benjamin; Mesana, Thierry G; Ruel, Marc
Aims To evaluate the influence of achieving secondary prevention target treatment goals for cardiovascular (CV) risk factors on clinical outcomes in patients with prior coronary artery bypass surgery (CABG). Methods and results Accordingly, we analysed treatment to target goals in patients with prior CABG and atherothrombotic disease or known risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, obesity) enrolled in the global REduction in Atherothrombosis for Continued Health (REACH) Registry, and their association with 1 year outcomes. A total of 13 907 of 68 236 patients (20.4%) in REACH had a history of prior CABG, and 1 year outcomes data were available for 13 207 of these. At baseline <25, 25�<50, 50�<75, and ?75% risk factors were at goal in 3.7, 12.9, 31.7, and 51.7% of patients, respectively. One-year composite rates of CV death, non-fatal MI, non-fatal stroke were inversely related to the proportion of risk factors at goal at baseline (age, gender, and region adjusted rates 6.1, 5.6, 5.2, and 4.3% of patients with <25, 25�<50, 50�<75, and >75% risk factors at goal, respectively; P for trend 0.059). Conclusion Risk-factor control varied greatly in CABG patients. Although CABG patients are frequently treated with appropriate therapies, these treatments fail to achieve an adequate level of prevention in many. This failure was associated with a trend for worse age-, gender-, and region-adjusted clinical outcomes. Thus, perhaps secondary prevention after CABG needs to focus on more comprehensive modification of risk factors to target goals in the hope of preventing subsequent CV events, and represents an opportunity to improve CV health. PMID:18996953
Mehta, Rajendra H.; Bhatt, Deepak L.; Steg, Ph. Gabriel; Goto, Shinya; Hirsch, Alan T.; Liau, Chiau-Suong; R�ther, Joachim; Wilson, Peter W.F.; Richard, Alain-Jean; Eagle, Kim A.; Ohman, E. Magnus
Background The aim of this study was to describe positive and negative emotions in patients undergoing coronary artery bypass graft (CABG) surgeries with extracorporeal circulation and the correlations between emotions and basic indicators of the inflammatory condition: C-reactive protein (CRP) concentration, body temperature, and leukocyte count. Material/Methods Standardized tools were used to select 52 patients (aged 47�63 years, 6 women � 11.5% and 46 men � 88.5%) without dementia or depression. The Positive and Negative Affect Schedule (PANAS) was used to examine positive affect (PA) and negative affect (NA) and the State-Trait Anxiety Inventory (STAI X1 and X2) was used to examine the anxiety level. The patients underwent CABG surgery according to a common anesthesia protocol and for 5 consecutive days they were observed in the ward, where selected indicators of the inflammatory condition were monitored. Results A detailed description of the results of examinations of emotions was presented. The patients with low PA-trait level, high NA-trait level, and high anxiety-trait level (STAI X2) exhibited statistically significantly higher body temperatures than the other patients in the postoperative period. The patients with high NA-trait and anxiety-state levels (STAI X1) had statistically significantly lower CRP levels in the postoperative period than the patients with low NA-trait and anxiety-state levels (STAI X1). Conclusions Patients undergoing CABG operations express both positive and negative affects. The changes in the inflammatory markers are expressed mostly by CRP concentration. There exist relationships between the result of tests assessing emotions and the markers of the inflammatory condition. PMID:25573296
P?otek, W?odzimierz; Pielok, Joanna; Cybulski, Marcin; Samborska, Regina
Half-dose aprotinin previously has been shown to reduce bleeding and the need for blood transfusions, but the results of cost-reduction studies have been variable. The purpose of the present retrospective study was to compare, from the perspective of the acute care hospital as health care provider, the costs associated with first-time reoperative coronary artery bypass graft (CABG) surgery in patients who received half-dose aprotinin with the costs in those who did not. Medical records from 46 historical controls (first-time reoperative CABG patients receiving no aprotinin) and 51 half-dose aprotinin-treated patients were reviewed. A total of 36 variables were abstracted from the medical records for analysis. It was found that more aprotinin-treated patients did not require transfusion compared with nontreated patients (47% vs 26%). Twenty-one percent fewer aprotinin-treated patients received red blood cell transfusions, 21% fewer received plateletpheresis packs, and 19% fewer received fresh frozen plasma. Cost savings per patient receiving half-dose aprotinin compared with no aprotinin were approximately $878 in blood products and $1088 in total length of stay (including critical care), for total savings of $1966. When the cost of aprotinin ($450) was subtracted, the approximate net mean savings per patient were $1516. This did not include additional cost savings with aprotinin resulting from a median 19.5-minute shorter pump time. The authors conclude that the use of half-dose aprotinin results in reductions in surgical and associated hospitalization costs because of decreases in the length of hospital stay, including length of stay in critical care, and in the use of blood products. PMID:9663372
Able, M E; Tilly, D A
Summary Objectives The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients, 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores, patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery, and the control group (n = 73) received no topical treatment. Results Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73, p = 1.0). No superficial sternal wound infection was observed in the rifamycin group, however, it did occur in one patient in the control group (0/78 vs 1/73, p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. Conclusion Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant, locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI. PMID:24687038
Aygun, Fatih; Kuzgun, Ahmet; Ulucan, Seref; Keser, Ahmet; Akpek, Mahmut; Kaya, Mehmet G
Purpose The objective of this study is to assess the effect of heart rate, heart rate variability and z-axis location on coronary artery bypass graft (CABG) image quality using a 256-slice computed tomography (CT) scanner. Methods A total of 78 patients with 254 CABG (762 graft segments) were recruited to undergo CABG assessment with 256-slice CT and prospective ECG-gating. Two observers rated graft segments for image quality on a 5-point scale. Quantitative measurements were also made. Logistic and cumulative link mixed models were used to assess the predictors of graft image quality. Results Graft image quality was judged as diagnostic (scores 5 (excellent), 4 (good) and 3 (moderate)) in 96.6% of the 762 segments. Interobserver agreement was excellent (kappa ?0.90). Graft image quality was not affected by heart rate level. However, high heart rate variability was associated with an important and significant image quality deterioration (odds ratio 4.31; p ?=? 0.036). Distal graft segments had significantly lower image quality scores than proximal segments (p ? 0.02). Significantly higher noise was noted at the origin of the mammary grafts (p ?=? 0.001), owing to streak artifacts from the shoulders. Conclusion CABG imaging with 270-msec rotation 256-slice CT and prospective ECG-gating showed an adequate image quality in 96.6% of graft segments, and an excellent interobserver agreement. Graft image quality was not influenced by heart rate level. Image quality scores were however significantly decreased in patients with high heart rate variability, as well as in distal graft segments, which are closer to the heart. PMID:24637891
Gramer, Bettina M.; Diez Martinez, Patricia; Chin, Anne S.; Sylvestre, Marie-Pierre; Larriv�e, Sandra; Stevens, Louis-Mathieu; Noiseux, Nicolas; Soulez, Gilles; Rummeny, Ernst J.; Chartrand-Lefebvre, Carl
Background Currently, saphenous vein (SV) and radial artery (RA) are the most commonly used conduits in combination with the left internal mammary artery for conventional coronary artery bypass graft surgery (CABG). The present meta-analysis aimed to assess the existing evidence from randomized controlled trials (RCTs) to compare the angiographic outcomes of these two conduits at mid-term follow-up. Methods Four relevant and updated RCTs with follow-up beyond 3 years were identified using five electronic databases. Angiographic endpoints included complete occlusion, �string sign�, graft failure and complete patency. Results The incidence of complete occlusion was significantly lower after using RA compared to SV [6.7% vs. 17.2%; odd ratio (OR), 0.36; 95% confidence interval (CI), 0.23-0.58; P<0.0001]. The angiographic �string sign� was significantly more likely to be identified after using RA compared to SV (3.1% vs. 0%; OR, 5.65; 95% CI, 1.21-26.39; P=0.03). Graft failure was significantly lower after RA compared to SV (9.6% vs. 18.8%; OR, 0.47; 95% CI, 0.30-0.72; P=0.0005). Complete graft patency was found to be significantly higher after RA compared to SV (88.6% vs. 75.8%; OR, 3.19; 95% CI, 1.42-7.16; P=0.005). Conclusions Results of the present meta-analysis suggest that selected patients with severe, proximal stenosis may have superior angiographic outcomes at mid-term follow-up after using RA compared to SV for CABG. However, RA is associated with a significantly higher incidence of the �string sign�. Future studies should aim to collect additional data on symptomatic outcomes. PMID:23977615
Ang, Su C.; Wolak, Kevin; Peeceeyen, Sheen; Bannon, Paul; Yan, Tristan D.
Background The aim of this study was to describe positive and negative emotions in patients undergoing coronary artery bypass graft (CABG) surgeries with extracorporeal circulation and the correlations between emotions and basic indicators of the inflammatory condition: C-reactive protein (CRP) concentration, body temperature, and leukocyte count. Material and Methods Standardized tools were used to select 52 patients (aged 47-63 years, 6 women - 11.5% and 46 men - 88.5%) without dementia or depression. The Positive and Negative Affect Schedule (PANAS) was used to examine positive affect (PA) and negative affect (NA) and the State-Trait Anxiety Inventory (STAI X1 and X2) was used to examine the anxiety level. The patients underwent CABG surgery according to a common anesthesia protocol and for 5 consecutive days they were observed in the ward, where selected indicators of the inflammatory condition were monitored. Results A detailed description of the results of examinations of emotions was presented. The patients with low PA-trait level, high NA-trait level, and high anxiety-trait level (STAI X2) exhibited statistically significantly higher body temperatures than the other patients in the postoperative period. The patients with high NA-trait and anxiety-state levels (STAI X1) had statistically significantly lower CRP levels in the postoperative period than the patients with low NA-trait and anxiety-state levels (STAI X1). Conclusions Patients undergoing CABG operations express both positive and negative affects. The changes in the inflammatory markers are expressed mostly by CRP concentration. There exist relationships between the result of tests assessing emotions and the markers of the inflammatory condition. PMID:25573296
P?otek, W?odzimierz; Pielok, Joanna; Cybulski, Marcin; Samborska, Regina
Background: Previous studies have documented that obstructive sleep apnea (OSA) increases the incidence of hypertension, respiratory failure and unexpected post-operative deaths during night in coronary artery bypass grafting (CABG) patients. We hypothesized that continuous positive airway pressure (CPAP) reduces blood pressure in these patients. Methods: We conducted a prospective, controlled study in 51 patients. The subjects received CPAP treatment were defined as CPAP group, whereas those refused to use CPAP were served as controls. Blood pressure was measured by 24 h ambulatory blood pressure at baseline and at six months. Results: Fifty-one patients completed the study. CPAP group and controls had similar characteristics. Compared with the control group, the 24-h SBP and 24-h DBP in the CPAP group had a tendency towards lower levels, but the differences were not statistically significant. But the change of SBP in CPAP treatment was significantly higher than controls (CPAP: 10.0 � 13.5 mm Hg vs. Control: 2.9 � 10.5 mm Hg, P = 0.040). The rate of hypertension control was improved in the CPAP treatment, but had no statistical difference compared to the controls (CPAP, 76.0% vs. Control, 61.5%; P = 0.260). Compared with controls, the proportion of non-dipping hypertension had a markedly improvement in the CPAP group (Control, 46.2% vs. CPAP, 16.0%; P = 0.034). Conclusions: CPAP therapy decreased SBP and improved the status of non-dipping hypertension and alleviated daytime somnolence in hypertensive patients with CABG and OSA on standardized antihypertensive treatment. But DBP and hypertension control did not significantly change compared with the control group.
Dong, Yumei; Dai, Yingnan; Wei, Guoqian; Cha, Li; Li, Xueqi
Aim To evaluate the cardioprotective effect of sevoflurane on a beating heart in patients undergoing coronary artery bypass grafting with normal preoperative left ventricular function. Methods The randomized controlled study included 32 patients induced with sevoflurane and then randomized to receive either 1 minimal alveolar concentration (MAC) end-tidal concentration of sevoflurane (n?=?16) or propofol (n?=?16) 2 to 3 mg kg-1 hour-1. The acceleration of the aortic blood flow, cardiac index, heart rate, mean arterial pressure, and central venous pressure were measured 5 minutes after anesthesia induction, at the beginning of ischemia, 15 minutes after ischemia, and 15 minutes after sternum closure. Results There were no differences in heart rate, mean arterial pressure, and central venous pressure within each group and between groups during surgery. Acceleration increased in the sevoflurane group 15 minutes after ischemia (10.3?�?3.5 m/s2; P?=?0.004) and 15 minutes after sternum closure (10.7?�?3.9 m/s2; P<0.001). Acceleration in the propofol group decreased from the beginning of ischemia (P<0.001) and remained lower 15 minutes after sternum closure (P?=?0.001 and P?=?0.024, respectively). Acceleration was higher in the sevoflurane group at the beginning of ischemia and 15 minutes after sternum closure (P?=?0.017 and P?=?0.046, respectively). There were no significant differences in cardiac index values within the sevoflurane group. In the propofol group, significant decreases in cardiac index were seen at the beginning of ischemia (P<0.001). There were between-group differences in cardiac index values at the beginning of ischemia and 15 minutes after ischemia (P?=?0.002, and P?=?0.011, respectively). Conclusion Cardiac function was better preserved in the patients anesthetized with sevoflurane than in patients anesthetized with propofol. Trial Registration ClinicalTrials.gov Identifier NCT00477737 PMID:17589976
Hused�inovi?, Ino; Bari�in, Stjepan; Bradi?, Nikola; Milanovi?, Rudolf
Background Malnutrition is very common in patients undergoing cardiac surgery. Malnutrition can change myocardial substrate utilization which can induce adverse effects on myocardial metabolism and function. We aim to investigate the hypothesis that there is a disturbed amino acids profile in the cardiac surgical patient which can be normalized by (par)enteral nutrition before, during and after surgery, subsequently improving cardiomyocyte structure, cardiac perfusion and glucose metabolism. Methods/Design This randomized controlled intervention study investigates the effect of uninterrupted perioperative (par)enteral nutrition on cardiac function in 48 patients undergoing coronary artery bypass grafting. Patients are given enteral nutrition (n = 16) or parenteral nutrition (n = 16), at least two days before, during, and two days after coronary artery bypass grafting, or are treated according to the standard guidelines (control) (n = 16). We will illustrate the effect of (par)enteral nutrition on differences in concentrations of amino acids and asymmetric dimethylarginine and in activity of dimethylarginine dimethylaminohydrolase and arginase in cardiac tissue and blood plasma. In addition, cardiomyocyte structure by histological, immuno-histochemical and ultrastructural analysis will be compared between the (par)enteral and control group. Furthermore, differences in cardiac perfusion and global left ventricular function and glucose metabolism, and their changes after coronary artery bypass grafting are evaluated by electrocardiography-gated myocardial perfusion scintigraphy and 18F-fluorodeoxy-glucose positron emission tomography respectively. Finally, fat free mass is measured before and after intervention with bioelectrical impedance spectrometry in order to evaluate nutritional status. Trial registration Netherlands Trial Register (NTR): NTR2183 PMID:21439030
Objectives. We sought to determine whether there is a gender bias in the selection of patients for coronary revascularization once the severity of the underlying coronary artery disease has been established with angiography.Background. It has been suggested that women with coronary artery disease are less likely to be referred for coronary angiography and coronary artery bypass surgery than men. Whether
Malcolm R. Bell; Peter B. Berger; David R. Holmes; Charles J. Mullany; Kent R. Bailey; Bernard J. Gersh
A best evidence topic in interventional cardiac surgery was written according to a structured protocol. The question we addressed related to the elevation of markers of cardiac damage associated with percutaneous coronary intervention (PCI). We explored and compared the clinical and prognostic relevance of the elevation of creatinine kinase-myocardial band (CK-MB) and cardiac troponin (cTn) levels during the periprocedural period and the post-procedural period, respectively, following an emergency or elective PCI. We found in excess of 390 papers after a systematic literature search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. From the best evidence available it appears that the monitoring of cardiac biomarkers following a PCI can provide important clinical information about the health of the myocardium, as well as prognostic information on short to mid-term outcomes of mortality up to 3 years. The narrow evidence base advocates the use of periprocedural CK-MB monitoring, recommending that an elevation in CK-MB is a significant predictor of adverse events. Troponins remain a precise and reliable marker of cardiac damage; however, current evidence argues that cTn holds little prognostic relevance until the degree of elevation is almost five times the upper limit of normal (ULN). Thus, the best evidence recommends the use of periprocedural CK-MB routinely during PCI to provide clinical and prognostic information about the degree of myocardial injury and risk of post-procedural morbidity and mortality. PMID:23842761
Gollop, Nicholas D.; Dhullipala, Anumita; Nagrath, Nalin; Myint, Phyo K.
A best evidence topic in interventional cardiac surgery was written according to a structured protocol. The question we addressed related to the elevation of markers of cardiac damage associated with percutaneous coronary intervention (PCI). We explored and compared the clinical and prognostic relevance of the elevation of creatinine kinase-myocardial band (CK-MB) and cardiac troponin (cTn) levels during the periprocedural period and the post-procedural period, respectively, following an emergency or elective PCI. We found in excess of 390 papers after a systematic literature search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. From the best evidence available it appears that the monitoring of cardiac biomarkers following a PCI can provide important clinical information about the health of the myocardium, as well as prognostic information on short to mid-term outcomes of mortality up to 3 years. The narrow evidence base advocates the use of periprocedural CK-MB monitoring, recommending that an elevation in CK-MB is a significant predictor of adverse events. Troponins remain a precise and reliable marker of cardiac damage; however, current evidence argues that cTn holds little prognostic relevance until the degree of elevation is almost five times the upper limit of normal (ULN). Thus, the best evidence recommends the use of periprocedural CK-MB routinely during PCI to provide clinical and prognostic information about the degree of myocardial injury and risk of post-procedural morbidity and mortality. PMID:23842761
Gollop, Nicholas D; Dhullipala, Anumita; Nagrath, Nalin; Myint, Phyo K
Objective: Coronary artery bypass grafting on the beating heart through median sternotomy is a relatively new treatment, which allows multiple revascularization without the use of cardiopulmonary bypass. A prospective randomized study was designed to investigate the effect of coronary bypass with or without cardiopulmonary bypass on postoperative blood loss and transfusion requirement. Methods: Two hundred patients with coronary artery disease
Raimondo Ascione; Simon Williams; Clinton T. Lloyd; Thiagarajamirthy Sundaramoorthi; Antonis A. Pitsis; Gianni D. Angelini
Objective: To demonstrate that small intestinal mucosal ischemia occurs during cardiopulmonary bypass by measuring serum diamine oxidase activity, an index of small intestinal mucosal ischemia, in perioerative patients undergoing cardiovascular surgery with and without cardiopulmonary bypass. Methods: Twelve successive patients who underwent coronary artery bypass grafting with cardiopulmonary bypass (Group I) were compared to 10 patients who underwent off-pump coronary
Nobuo Tsunooka; Kazutaka Maeyama; Yoshihiro Hamada; Hiroshi Imagawa; Shinji Takano; Yuji Watanabe; Kanji Kawachi
Objective: To demonstrate that small intestinal mucosal ischemia occurs during cardiopulmonary bypass by measuring serum diamine oxidase activity, an index of small intestinal mucosal ischemia, in perioerative patients undergoing cardiovascular surgery with and without cardiopulmonary bypass. Methods: Twelve successive patients who underwent coronary artery bypass grafting with cardiopulmonary bypass (Group I) were compared to 10 patients who underwent off-pump coronary
Nobuo Tsunooka; Kazutaka Maeyama; Yoshihiro Hamada; Hiroshi Imagawa; Shinji Takano; Yuji Watanabe; Kanji Kawachi
Purpose: The purpose of this study is to compare the perioperative total prostate specific antigen (tPSA) levels among coronary artery bypass grafting (CABG) patients with and without extracorporeal circulation (ECC), to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels. Materials and Methods: A prospective study was conducted. Our sample was allocated to: (a) Seven patients who underwent off pump CABG (Group I) and (b) 16 CABG patients with ECC (Group II). The levels of tPSA were measured preoperatively (baseline), intra-operatively and at the 4th postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. Results: Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I (31�C vs. 36.9�C, P < 0.001). In each group separately, postoperative tPSA levels were increased significantly compared to the baseline values (2.55 ng/ml vs. 0.39 ng/ml for Group I, P = 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001). CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values (0.67 ng/ml vs. 0.77 ng/ml, P = 0.008). We did not observe significant differences of tPSA levels between the two groups. Conclusions: CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction.
Patris, Emmanuel; Giakoumidakis, Konstantinos; Patris, Vasileios; Kuduvalli, Manoj; Argiriou, Mihalis; Charitos, Christos; Kalaitzis, Christos; Touloupidis, Stavros
Many surgeons are concerned about the flow capacity of a skeletonized internal thoracic artery (ITA) in comparison with a pedicled ITA used during coronary artery bypass graft (CABG). This work aims to summarize the evidence comparing the flow capacity of a skeletonized versus pedicled ITA during CABG. We performed systematic review and meta-analysis according to the PRISMA statement based on a search in MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Studies included were original studies whose populations comprised patients undergoing CABG; compared outcomes between skeletonized versus pedicled ITA; the outcomes included data regarding intraoperative flow capacity of the grafts; the studies were prospective or retrospective or non-randomized or randomized controlled trials. In total, eight studies were identified and reviewed for eligibility and data were extracted. Forest plots and the summarized difference in means including 95% confidence intervals (CIs) were estimated and meta-regressions were performed. There was a statistically significant difference in favour of the skeletonized ITA compared with the pedicled ITA in terms of flow capacity (random-effect model: additional 20.8 ml/min, 95% CI 6.6-35.0, P = 0.004), being the summary measures under the influence of heterogeneity of the effects, but free from publication bias. We observed a difference with regard to the type of study, since non-randomized studies together demonstrated the superiority of a skeletonized ITA (random-effect model: additional 32.3 ml/min, 95% CI 21.0-43.6, P < 0.001), but the randomized studies together did not show it (random-effect model: additional 13.2 ml/min, 95% CI -1.1 to 27.6, P = 0.071). Meta-regression demonstrated some modulation influence by female gender, age and diabetes on the flow capacity of grafts. In summary, in terms of flow capacity, a skeletonized ITA appears to be superior in comparison with a pedicled ITA during CABG. PMID:25228742
S�, Michel Pompeu Barros Oliveira; Cavalcanti, Paulo Ernando Ferraz; Santos, Henrique Jos� de Andrade Costa; Soares, Artur Freire; Miranda, Rodrigo Gusm�o Albuquerque; Ara�jo, Mayara Lopes; Lima, Ricardo Carvalho
Background Our objective was to evaluate the effect of delays on adverse events while waiting for coronary artery bypass grafting (CABG). Methods An observational study that prospectively followed patients from registration on a wait list to removal for planned surgery, death while waiting, or unplanned emergency surgery. The population-based registry provided data on 12,030 patients with a record of registration on a wait list for first-time isolated CABG surgery between 1992 and 2005. Results In total, 104 patients died and 382 patients underwent an emergency surgery before planned CABG. The death rate was 0.5 per 1000 patient-weeks in the semiurgent group and 0.6 per 1000 patient-weeks the nonurgent group, adjusted OR?=?1.07 (95% confidence interval [CI] 0.69�1.65). The emergency surgery rate of 1.2 per 1000 patient-weeks in the nonurgent group was lower compared to 2.1 per 1000 patient-weeks in the semiurgent group (adjusted OR?=?0.72, 95% CI 0.54�0.97). However, the nonurgent group had a greater cumulative incidence of preoperative death than the semiurgent group for almost all weeks on the wait list, adjusted OR?=?1.92 (95% CI 1.25�2.95). The surgery rate was 1.2 per 1000 patient-weeks in the nonurgent group and 2.1 per 1000 patient-weeks in the semiurgent group, adjusted OR?=?0.72 (95% CI 0.54�0.97). The cumulative incidence of emergency surgery before planned CABG was similar in the semiurgent and nonurgent groups, adjusted OR?=?0.88, (95% CI 0.64�1.20). Conclusion Despite similar death rates in the semiurgent and nonurgent groups, the longer waiting times in the nonurgent group result in a greater cumulative incidence of death on the wait list compared to that in the semiurgent group. These longer waiting times also offset the lower rate of emergency surgery before planned admission in the nonurgent group so that the cumulative incidence of the emergency surgery was similar in both groups. PMID:23577641
Objective To compare the long term effects of yoga based cardiac rehabilitation program with only physiotherapy based program as an add-on to conventional rehabilitation after coronary artery bypass grafting (CABG) on risk factors. Methods In this single blind prospective randomized parallel two armed active control study, 1026 patients posted for CABG at Narayana Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were screened. Of these, 250 male participants (35�65 years) who satisfied the selection criteria and consented were randomized into two groups. Within and between group comparisons were done at three points of follow up (i.e. 6th week, 6th month, and 12th month) by using Wilcoxon's signed ranks test and Mann Whitney U test respectively. Results Yoga group had significantly (p�=�0.001, Mann Whitney) better improvement in LVEF than control group in those with abnormal baseline EF (<53%) after 1 year. There was a better reduction in BMI in the yoga group (p�=�0.038, between groups) in those with high baseline BMI (?23) after 12 months. Yoga group showed significant (p�=�0.008, Wilcoxon's) reduction in blood glucose at one year in those with high baseline FBS ?110�mg/dl. There was significantly better improvement in yoga than the control group in HDL (p�=�0.003), LDL (p�=�0.01) and VLDL (p�=�0.03) in those with abnormal baseline values. There was significantly better improvement (p�=�0.02, between groups) in positive affect in yoga group. Within Yoga group, there was significant decrease in perceived stress (p�=�0.001), anxiety (p�=�0.001), depression (p�=�0.001), and negative affect (p�=�0.03) while in the control group there was reduction (p�=�0.003) only in scores on anxiety. Conclusion Addition of yoga based relaxation to conventional post-CABG cardiac rehabilitation helps in better management of risk factors in those with abnormal baseline values and may help in preventing recurrence. PMID:25443601
Raghuram, Nagarathna; Parachuri, Venkateshwara Rao; Swarnagowri, M.V.; Babu, Suresh; Chaku, Ritu; Kulkarni, Ravi; Bhuyan, Bhagavan; Bhargav, Hemant; Nagendra, Hongasandra Ramarao
Postoperative hemorrhagic complications is still one of the major problems in cardiac surgeries. It may be caused by surgical issues, coagulopathy caused by the side effects of the intravenous fluids administered to produce plasma volume expansion such as hydroxyl ethyl starch (HES). In order to thwart this hemorrhagic issue, few agents are available. Fibrinolytic inhibitors like tranexamic acid (TA) may be effective modes to promote blood conservation; but the possible complications of thrombosis of coronary artery graft, precludes their generous use in coronary artery bypass graft surgery. The issue is a balance between agents that promote coagulation and those which oppose it. Therefore, in this study we have assessed the effects of concomitant use of HES and TA. Thromboelastogram (TEG) was used to assess the effect of the combination of HES and TA. With ethical committee approval and patient's consent, 100 consecutive patients were recruited for the study. Surgical and anesthetic techniques were standardized. Patients fulfilling our inclusion criteria were randomly allocated into 4 groups of 25 each. The patients in group A received 20 ml/kg of HES (130/0.4), 10 mg/kg of T.A over 30 minutes followed by infusion of 1 mg/kg/hr over the next 12 hrs. The patients in group B received Ringer's lactate + TA at same dose. The patients in the Group C received 20 ml/kg of HES. Group D patients received RL. Fluid therapy was goal directed. Total blood loss was assessed. Reaction time (r), ? angle, maximum amplitude (MA) values of TEG were assessed at baseline, 12, 36 hrs. The possible perioperative myocardial infraction (MI) was assessed by electrocardiogram (ECG) and troponin T values at the baseline, postoperative day 1. Duration on ventilator, length of stay (LOS) in the intensive care unit (ICU) were also assessed. The demographical profile was similar among the groups. Use of HES increased blood loss significantly (P < 0.05). Concomitant use of TA reduced blood loss when used along with HES. r value was prolonged at 12 hours in all the groups and ? angle was reduced at 12 hours in all the groups, where as MA value was reduced at 12 th hour in the HES group compared to the baseline and increased in TA + HES group. These findings were statistically significant. No significant change in Troponin T values/ECG, duration of ventilation and LOS ICU was observed. No adverse events was noticed in any of the four groups. HES (130/0.4) used at a dose of 20 ml/kg seems to produce coagulopathy causing increased blood loss perioperatively. Hemodilution produced by fluid therapy seems to produce Coagulopathy as observed by TEG parameters. Concomitant use of TA with HES appears to reverse these changes without causing any adverse effects in patients undergoing OPCAB surgery. PMID:22508200
Chakravarthy, Murali; Muniraj, Geetha; Patil, Swapnil; Suryaprakash, Sharadaprasad; Mitra, Sona; Shivalingappa, Benak
Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury
Background. Proinflammatory cytokines play a key role in the inflammatory cascade after cardiopulmonary bypass and may induce cardiac dysfunction. We compared the production of cytokines and the degree of postoperative myocardial injury in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting through median sternotomy with or without cardiopulmonary bypass.Methods. Forty-four consecutive patients were studied. Patients were selected
Song Wan; Mohammad Bashar Izzat; Tak Wai Lee; Innes Y. P Wan; Nelson L. S Tang; Anthony P. C Yim
Computer-assisted LAD bypass grafting at the open heart
Open heart bypass surgery is the standard treatment in advanced coronary heart diseases. For an effective revascularization procedure, optimal placement of the bypass is very important. To accelerate the intraoperative localization of the anastomosis site and to increase the precision of the procedure, a concept for computer assistance in open heart bypass surgery has been developed comprising the following steps:
Christine Hartung; Claudia Gnahm; Reinhard Friedl; Martin Hoffmann; Klaus Dietmayer
What Is Coronary Bypass Surgery?
... AHA-USA1 (1-800-242-8721), or visit heart.org to learn more about heart disease. For information ... disease or care for a loved one. Visit heart.org/answersbyheart to learn more. Knowledge is power, so ...
Different embolic protection devices have been introduced for endovascular interventions: filters or balloon occlusion and aspiration systems. Despite widening use in a variety of vascular beds and clinical syndromes, little is known about the particulate burden liberated from different vascular beds and caught by different protection devices. We performed histologic and morphometric analyses of particulate debris captured during stenting of degenerated saphenous vein bypass grafts and native coronary arteries during acute myocardial infarction or during elective intervention and carotid arteries to assess the relative performance of different protection devices. We analyzed 232 interventions (90 saphenous vein bypass grafts, 77 native coronary arteries, and 65 carotid arteries) with 4 different devices (65 FilterWires, 99 Interceptors, 41 GuardWires, and 27 Proxis catheters) using the RapidVue particle analyzer. No difference in embolic volume retrieved was demonstrated between devices in saphenous vein bypass grafts and carotid interventions. A smaller volume of particulate debris was retrieved by the GuardWire compared with the FilterWire and the Proxis catheter in native coronary artery interventions. The Interceptor and the GuardWire captured more smaller particles than did the FilterWire or Proxis catheter. During saphenous vein bypass graft or carotid intervention, different embolic protection strategies were performed similarly. In native coronary artery stenting, however, proximal embolic protection retrieved larger amounts of debris than did distal filters or occlusion devices. These data may allow greater tailoring of embolic protection device development and application in specific anatomic locales. PMID:15950562
Quan, Vu-Hung; Huynh, Rany; Seifert, Philip A; Kuchela, Arun; Chen, Wai-Hong; S�tsch, Gabor; Eisenhauer, Andrew C; Rogers, Campbell
NSDL National Science Digital Library
Election Day teaches how elections work in the United States. Players learn about political parties, public opinion, campaign financing, election law, political marketing, strategic planning, and the media. The game is well-suited for high-school and college students.
Washington, University O.
21 CFR 870.5100 - Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheter.
Code of Federal Regulations, 2013 CFR
...balloon dilatation of a hemodynamically significant coronary artery or bypass graft stenosis in patients evidencing coronary...intended for the treatment of hemodynamically significant coronary artery stenosis for the purpose of improving myocardial...
21 CFR 870.5100 - Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheter.
Code of Federal Regulations, 2012 CFR
...balloon dilatation of a hemodynamically significant coronary artery or bypass graft stenosis in patients evidencing coronary...intended for the treatment of hemodynamically significant coronary artery stenosis for the purpose of improving myocardial...
Graft occlusion after deployment of the Symmetry Bypass System.
Recently the Symmetry Bypass System (SJM, St. Paul, MN) became available. Now the system is frequently applied for vein-graft to aorta anastomoses in off-pump coronary artery bypass operations. This report describes a complication associated with the use of the Symmetry Bypass System (SJM) in a patient undergoing a standard off-pump coronary artery bypass procedure. A novel imaging system (SPY, Novadaq, Toronto, Canada) was applied for intraoperative assessment of graft function, and this system immediately diagnosed the occlusion of the proximal mechanical anastomosis caused by a mobile atheromatous aortic plaque. PMID:12735592
Reuthebuch, Oliver T; Kadner, Alexander; Lachat, Mario L; Turina, Marko I
The present substudy from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial assessed the outcomes and their relation to different antithrombotic regimens in patients with previous coronary artery bypass grafting (CABG) treated with primary percutaneous coronary intervention. Of 3,599 patients with information regarding a history of CABG, 105 (2.9%) had previously undergone CABG. Of these 105 patients, 46 were randomized to heparin plus a glycoprotein IIb/IIIa inhibitor and 59 to bivalirudin. The patients with versus without previous CABG were less frequently triaged to primary percutaneous coronary intervention (83.8% vs 93.2%, p�= 0.0002) and had a longer door-to-balloon time (median 1.9 vs 1.6 hours, p�= 0.047), lower rates of final Thrombolysis In Myocardial Infarction flow grade 2 to 3 in the intervened vessel (92.6% vs 97.8%, p�= 0.007), and less frequent rates of complete or partial ST-segment resolution (66.3% vs 77.6%, p�= 0.019). At 3 years, previous CABG was associated with a significantly greater incidence of major adverse cardiovascular events (36.4% vs 21.4%, p <0.001) owing to greater rates of mortality (11.2% vs 6.7%, p�= 0.08), reinfarction (11.6% vs 7.1%, p�= 0.09), stroke (5.1% vs 1.8%, p�= 0.013), and ischemic target vessel revascularization (23.6% vs 12.9%, p�= 0.005). The outcomes did not differ significantly as a function of the antithrombotic regimen. On multivariate analysis, previous CABG was an independent predictor of 3-year ischemic stroke (hazard ratio 3.57, 95% confidence interval 1.09 to 11.66). Intervention on the saphenous vein graft versus the native�vessel predicted 3-year major adverse cardiovascular events (hazard ratio 2.69, 95% confidence interval 1.17 to 6.19). In the HORIZONS-AMI trial, previous CABG was associated with a delay to mechanical reperfusion and lower rates of percutaneous coronary intervention and patency of the infarct related vessel along with worse clinical outcomes. PMID:23465098
Nikolsky, Eugenia; Mehran, Roxana; Yu, Jennifer; Witzenbichler, Bernhard; Brodie, Bruce R; Kornowski, Ran; Brener, Sorin; Xu, Ke; Dangas, George D; Stone, Gregg W
The ability of exercise-induced myocardial hypoperfusion on thallium scintigraphy to predict coronary events was assessed in 1,689 patients with symptoms suggestive of coronary artery disease but without prior myocardial infarction or coronary artery bypass surgery. A total of 74 patients had a coronary event in the year after testing (12 cardiac deaths, 20 nonfatal infarctions and 42 referrals for bypass
Marc L. Ladenheim; Brad H. Pollock; Alan Rozanski; Daniel S. Berman; Howard M. Staniloff; James S. Forrester; George A. Diamond
The radial artery is commonly used as a conduit in coronary artery bypass grafting. No data exist on the effects of radial sheath insertion on radial artery function. Because many patients considered for coronary artery bypass grafting have had previous radial procedures, it is important to understand any effects radial sheath insertion may have on radial artery function. Twenty-two patients who underwent elective coronary angiography or angioplasty with a 6Fr sheath through the right radial artery were studied. Radial artery function was assessed using ultrasound to measure flow-mediated dilation (FMD). Reactive hyperemia was produced by 5-minute cuff inflation on the arm to suprasystolic pressures. Radial artery diameter was measured at rest and 1 minute after cuff deflation. FMD was expressed as percent change in radial diameter compared with at rest. In all cases, the left radial artery was studied as a control. Patients were studied before sheath insertion, immediately after sheath insertion, and 6 weeks after sheath insertion. The FMD of the cannulated arm was 13.2% before sheath insertion versus 3.6% immediately after sheath insertion (p <0.01) and 0.2% (p <0.01) 9 weeks after sheath insertion. In contrast, there were no significant changes in the noncannulated arm at either time point. In conclusion, radial artery sheath insertion for coronary angiography or angioplasty results in immediate and persistent blunting of FMD, suggesting severe vasomotor dysfunction. Radial artery sheath insertion has important effects on radial artery function that must be considered when selecting radial conduits for coronary artery bypass grafting. PMID:17293183
Burstein, Jason M; Gidrewicz, Dominica; Hutchison, Stuart J; Holmes, Kate; Jolly, Sanjit; Cantor, Warren J
Background Despite the common practice of clopidogrel loading for coronary stenting, the time dependence and degree of platelet inhibition after this therapy are not well defined. We sought to establish an optimal clopidogrel dosing regimen for sustained platelet inhibition in stented patients. Methods and Results Platelets were assessed by conventional aggregation with 5 ?mol\\/L adenosine diphosphate (ADP), 1 ?g\\/mL collagen
Paul A. Gurbel; Charles C. Cummings; Christopher R. Bell; Amanda B. Alford; Andrew F. Meister; Victor L. Serebruany
Congenital coronary artery fistulae: a rare cause of heart failure in adults
Coronary artery fistulae are uncommon, reported in 0.25% of patients undergoing coronary angiography. Two patients with congenital coronary artery fistula and coronary artery disease who presented with symptoms of exacerbated congestive heart failure out of proportion to their atherosclerotic burden were successfully treated by epicardial fistula ligation and coronary artery bypass grafting with marked improvement in functional status. PMID:24886594
We developed a new color charge-coupled device (CCD) camera for the intraoperative indocyanine green (ICG) angiography. This device consists of a combination of custom-made optical filters and an ultra-high sensitive CCD image sensor, which can detect simultaneously color and near-infrared (NIR) rays from 380 to 1200 nm. We showed a comparison between our system and other devices for the preliminary experience. We routinely performed both transit-time flowmetry (TFM) and color images for intraoperative assessment, thallium-scintigraphy for the early postoperative assessment, and then angiography after 1-year surgery. We also obtained intraoperative graft flows and images in 116 grafts. Although TFM indicated a graft patency, the CCD camera suspected perfusion failures in four grafts. Also the analysis of the ICG fluorescence intensity showed the significant hypoperfusion at the perfusion territory distal to the anastomosis (graft vs. perfusion territory; 230+/-26 vs. 156+/-13 a.u, P=0.02). When the CCD camera suspected a graft failure, CCD camera and angiography showed a comparable graft failure. The unique device that visualized ICG-enhanced structures against a background of natural myocardial color improved the visibility of abnormality in flow and perfusion. Our findings show that this device may become a standard intraoperative graft and perfusion assessment tool in coronary artery bypass graft (CABG). PMID:19423513
Handa, Takemi; Katare, Rajesh G; Sasaguri, Shiro; Sato, Takayuki
NSDL National Science Digital Library
Understanding the Electoral College: Making predictions for 2012 With the election coming fast we better make sure we understand the Electoral College and how it works. After our classroom explanation of the Electoral College you will be assigned to argue for or against using the Electoral College for future elections. Use the following resources to form your argument. Pros and Cons of Electoral College More Pros and Cons Electoral Map ...
Background and Objectives Although prasugrel allows for rapid and potent platelet inhibition, the efficacy and safety of lower doses of prasugrel for patients of East Asian ethnicity has not yet been investigated. We compared the effect of a lower loading dose (LD) of prasugrel with conventional LDs of clopidogrel and prasugrel in Korean patients. Subjects and Methods Forty-three Korean patients undergoing coronary angiography were enrolled in the study. Participants were randomly administered LDs of clopidogrel 600 mg, prasugrel 30 mg or prasugrel 60 mg prior to coronary angiography. Platelet reactivity was assessed at baseline and at the time of peak platelet inhibition using light transmission aggregometry (LTA), the VerifyNow assay, and multiple electrode aggregometry. Results Although baseline platelet reactivity between the groups showed no significant differences, at the time of peak platelet inhibition, the prasugrel 30 mg (18.9�10.0%) and 60 mg groups (13.8�10.8%) showed significantly more potent platelet inhibition than the clopidogrel 600 mg group (52.9�15.8%; p<0.001) by LTA. However, there were no significant differences between the prasugrel 30 mg and 60 mg groups (p=0.549). Conclusion The loading effect of prasugrel 30 mg was more potent than clopidogrel 600 mg and was not significantly different from prasugrel 60 mg. PMID:25469140
Lee, Dong Hyun; Guo, Long Zhe; Park, Min Kyu; Yi, So Jeong
Deaths and delays in queues for coronary surgery in Canada have been highlighted by American interest groups opposed to "socialized medicine". Since 1991 all nine cardiac surgery centres in Ontario register and follow patients after acceptance for surgery. We examined the experience of 8517 consecutive patients leaving the registry from October 1991 to July 1993. Individual acuity scores were determined based on symptoms, angiographic findings, left ventricular function, and, where available, non-invasive tests of ischaemic jeopardy. Planned surgery was declined or deferred for 3.2% of registrants. While in the queue, 31 (0.4%) patients died and three had surgery indefinitely deferred after a non-fatal myocardial infarction. Among 8213 patients receiving surgery, the median wait was 17 days (inter-quartile range [IQR]: 4, 51), ranging from one day (IQR 0:4) for patients needing very urgent surgery (acuity score 2-3) to 42 days (IQR: 18, 77) for those rated low priority (acuity score 6-7). In a multivariate analysis, the most important determinant of waiting time was symptom status (p < 0.001), followed by anatomy (p < 0.001). Age did not alter waiting time; depending on statistical methods, female sex was either not significant or independently associated with approximately 11% relative delay (p = 0.001). Whether controlling for significant clinical factors or the multifactorial acuity scores, waiting times clearly varied (p < 0.001) among hospitals. We conclude that, during 1991-93, patients queuing for coronary surgery in Ontario rarely suffered critical events or extreme delays, and individual variation in waiting times primarily reflected clinical acuity. Nonetheless, symptoms provoked by very modest exertion were commonplace in the queue, and waiting times did vary inequitably among hospitals. PMID:7500756
Naylor, C D; Sykora, K; Jaglal, S B; Jefferson, S
Peripheral artery bypass - leg - discharge
Aortobifemoral bypass - discharge; Femoropopliteal - discharge; Femoral popliteal - discharge; Aorta-bifemoral bypass - discharge; Axillo-bifemoral bypass - discharge; Ilio-bifemoral bypass - discharge
Background: Erythropoietin (EPO) is known as a regulating hormone for the production of red blood cells, called erythropoiesis. Some studies have shown that EPO exerts some non-hematopoietic protective effects on ischemia-reperfusion injuries in myocytes. Using echocardiography, we evaluated the effect of EPO infusion on reducing ischemia-reperfusion injuries and improvement of the cardiac function shortly after coronary artery bypass graft surgery (CABG). Methods: Forty-three patients were recruited in this study and randomly divided into two groups: the EPO group, receiving standard medication and CABG surgery plus EPO (700 IU/kg), and the control group, receiving standard medication and CABG surgery plus normal saline (10 cc) as placebo. The cardiac function was assessed through echocardiography before as well as at 4 and 30 days after CABG. Results: Echocardiography indicated that the ejection fraction had no differences between the EPO and control groups at 4 days (47.05�6.29 vs. 45.90�4.97; P=0.334) and 30 days after surgery (47.27�28 vs. 46.62�5.7; P=0.69). There were no differences between the EPO and control groups in the wall motion score index at 4 (P=0.83) and 30 days after surgery (P=0.902). In the EPO group, there was a reduction in left ventricular end-systolic and end-diastolic diameters (LVESD and LVEDD, respectively), as compared to the control group. Conclusion: Our results indicated that perioperative exogenous EPO infusion could not improve the ventricular function and wall motion index in the immediate post-CABG weeks. Nevertheless, a reduction in LVEDD and LVESD at 4 days and 30 days after CABG in the EPO group, by comparison with the control group, suggested that EPO correlated with a reduction in the remodeling of myocytes and reperfusion injuries early after CABG. Trial Registration Number: 138809102799N1 PMID:24644377
Ziabakhsh-Tabary, Shervin; Jalalian, Rozita; Mokhtari-Esbuie, Farzad; Habibi, Mohammad Reza
Background: Pain on mid sternotomy incision site after Coronary Artery Bypass� Graft� Surgery (CABG) is a common problem that causes sleep disturbance, delayed wound healing, and increased use of analgesic drugs. Massage therapy which is mostly performed by healthcare providers is a non-pharmacological approach for managing this pain. The present study aimed to determine the effect of massage therapy by patient�s companion on the severity of pain in post CABG patients. Methods: In this randomized single-blind clinical trial, 70 post CABG patients were randomly divided into an intervention and a control group. The intervention group received massage by one of their relatives who was trained by an expert nurse. The control group, on the other hand, received routine care. The pain intensity was assessed by Visual Analogue Scale (VAS) before and immediately, 30, 60, and 120 minutes after the intervention. Then, the data were entered into the SPSS statistical software (version 16) and analyzed using repeated measures ANOVA and post-hoc test (Scheffe). Results: At the beginning of the study, no significant difference was found between the two groups regarding the pain severity. In the intervention group, the pain severity significantly decreased in all the four time points after the intervention (P=0.001). However, no significant difference was observed in this regard in the control group. Conclusion: Massage therapy by patient�s companion trained by a nurse was an effective strategy for pain management in post CABG patients. This could also promote the patient�s family participation in the process of care. Trial Registration Number: IRCT201208218505N3. PMID:25349854
Najafi, Sied Saeed; Rast, Fazlola; Momennasab, Marzieh; Ghazinoor, Mahmood; Dehghanrad, Fereshteh; Mousavizadeh, Sied Ali
ERIC Educational Resources Information Center
Every four years, the presidential election campaign unfolds, and the position of the candidates on education is predictable: They are in favor of it. Something else is easy to predict: In every presidential campaign, hot-button issues--some important and some infuriatingly not--suck up most of the oxygen, and the hoped-for focus on education�
Kennedy, Mike
NSDL National Science Digital Library
A fast, economical way to keep up with worldwide election news is Election Notes, a daily web service provided by Klipsan Press. The site provides concise summaries of election news by country, with hypertext connections to the news sources when available. Election returns (with sources) are provided when available.
NSDL National Science Digital Library
On June 10, 11, and 13, 1999, about 298 million voters in the 15 European Union (EU) Member States chose 626 Members of the European Parliament (MEPs) in the fifth direct elections to the European Parliament. Provided by the European Parliament, this site is aimed at EU voters; nevertheless, researchers, students, or any users interested in Europe-wide politics will want to pay a visit. The site includes electoral procedures by country, four essays on "The European Parliament and his [the] people," an overview of the outgoing Parliament, Important points 1994-1999, and a list of candidates for the upcoming election. The last section is available in French and English only, but the remainder of the site can be viewed in eleven languages.
NSDL National Science Digital Library
Every presidential election in the United States gives rise to greater legions of so-called "spin doctors," and a number of pundits offering their opinions on the chances of each candidate who has thrown their hat in the ring. Fortunately, the University of Michigan Documents Center has developed this helpful and informative website that culls together hundreds of useful websites about the upcoming presidential election of 2004. From the homepage visitors can look through a number of helpful sections devoted to listing sites dedicated to such topics as Policy Issues, Candidates, and Campaign. Within each of these broad thematic areas are contained more specific areas dedicated to links on important subtopics such as campaign finances, media coverage, terrorism, economics, and many others. Scholars will want to take a look at the Academic Research section, which contains links to online periodical databases and some links to sites with recent working papers on the subject.
NSDL National Science Digital Library
In late September (of an election year), one class session is devoted to developing a list of issues key to the class and likely to be discussed by the candidates. The list is converted into 3-5 questions all students will research and answer. Each student is assigned a candidate (President, Governor, congress, state legislature). An effort is made to assign each student a candidate who will appear on his/her ballot and to assign third party candidates. Student research candidates' positions using web resources, news papers, and campaign materials. Students are strongly encouraged to contact the campaign directly and question the candidate, if possible. Students report back to the class with a 3-5 minute presentation and a poster that may be displayed in a college commons area. Reports are presented a week prior to the election.
Phillips, Michael
Objective: Prognosis of severe coronary artery disease with no indication of percutaneous coronary intervention or coronary artery bypass grafting remains poor. We have recently demonstrated that shock wave therapy effectively induces neovascularization and improves myocardial ischemia in a porcine model in vivo. Methods: With permission from the Ethical Committee of our Institute, we treated nine patients with end-stage coronary artery
Yoshihiro Fukumoto; Akira Ito; Toyokazu Uwatoku; Tetsuya Matoba; Takuya Kishi; Haruki Tanaka; Akira Takeshita; Kenji Sunagawa; Hiroaki Shimokawa
A 66-year-old man was referred for treatment of critical limb ischemia arising with multiple organ dysfunction due to acute pneumonia. Angiographic examinations demonstrated total obstruction of the bilateral external iliac arteries and the bilateral superficial femoral arteries with collateral circulation to the distal vessels. Urgent percutaneous transluminal angioplasty dissolved the obstruction of the left external iliac artery, and subsequent low-density-lipoprotein apheresis ameliorated his progressive ischemia in the lower extremities. Femoro-femoral and bilateral femoro-popliteal bypasses were performed 31 days after the endovascular intervention, which achieved successful limb salvage with the relief of ischemic symptoms related to arteriosclerotic obliterans. PMID:24995063
... and animations for grades K-6. The Coronary Arteries | Share Coronary Circulation The heart muscle, like every ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...
We studied the pharmacokinetic and pharmacodynamic properties of integrelin, a novel platelet glycoprotein IIb/IIIa receptor inhibitor, in patients undergoing elective percutaneous coronary intervention. Patients were randomized to placebo (n = 19) or to 1 of 4 integrelin dosing regimens (total n = 54) that were studied sequentially. All patients received aspirin and heparin. Patients were followed until discharge for the occurrence of adverse clinical events: death, myocardial infarction, coronary artery bypass surgery, repeat intervention, or recurrent ischemia. Bleeding was the primary safety end point. Frequent blood sampling was performed for adenosine diphosphate-induced platelet aggregations. Simplate bleeding times were performed. Adverse clinical events occurred less often in the integrelin-treated patients, although the overall numbers were too small to make a definitive statement as to clinical efficacy. There was no significant increase in serious bleeding among integrelin-treated patients. The 2 highest integrelin boluses (180 and 135 micrograms/kg) immediately (15 minutes after the bolus) provided > 80% inhibition of adenosine diphosphate-induced platelet aggregation in > 75% of treated patients. A constant integrelin infusion of 0.75 micrograms/kg/min maintained this marked antiplatelet effect, whereas an infusion of 0.50 micrograms/kg/min allowed gradual recovery of platelet function. Elective coronary intervention was performed safely and with no significant increase in serious bleeding events using integrelin with aspirin and heparin as an antithrombotic regimen. Integrelin provided rapid, intense, and persistent ex vivo platelet inhibition during coronary intervention. This new antiplatelet agent may be beneficial in reducing platelet-mediated ischemic complications of percutaneous coronary intervention. PMID:7503000
Harrington, R A; Kleiman, N S; Kottke-Marchant, K; Lincoff, A M; Tcheng, J E; Sigmon, K N; Joseph, D; Rios, G; Trainor, K; Rose, D
Quality of Life After Bypass Surgery in Patients with Chest Pain and Heart Failure
... Bypass Surgery in Patients With Chest Pain and Heart Failure The full report is titled �Quality-of-Life ... in patients who have coronary artery disease plus heart failure, which can cause additional symptoms, such as shortness ...
21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.
Code of Federal Regulations, 2014 CFR
...vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to cannulate the vessels, perfuse the coronary arteries, and to interconnect the catheters and cannulas with an oxygenator. The device includes accessory bypass equipment....
... blood. This is called ischemic heart disease, or coronary artery disease (CAD). It can cause chest pain ( angina ). Coronary artery ... exercise and diet changes, or angioplasty with stenting. Coronary artery disease is different from person to person. The way ...
Silent meningioma � a rare cause of stroke in post-cardiopulmonary bypass patients
Stroke in cardiac patients undergoing surgery is usually attributed to the use of cardiopulmonary bypass. In this report, we present an unusual cause of cerebral dysfunction: a meningioma leading to stroke, following coronary artery bypass grafting in a 62-year-old patient. Diagnosis and treatment options of the pathology are discussed with the guidance of the literature. PMID:22371743
Chow, Hon K.; Yousafzai, Sajjad M.; Canver, Charles C.
Background Coronary artery calcification (CAC) is closely related to coronary atherosclerosis. However, less is known about the clinical significance of extensive CAC (ECAC) in regard to types of first coronary events (acute vs. chronic). Diabetes mellitus (DM) represents a strong risk factor for CAD although its association with CAC is controversial. Aiming to elucidate these controversies we investigated the long-term outcome of coronary artery disease (CAD) in relation to degree of CAC in patients with and without DM from our annual cheek-up outpatient clinic. Methods Coronary artery computed tomography (CT) was performed in 667 patients who were yearly evaluated during a mean follow-up period of 6.3 �3.4�year. The following 4 CAC categories were established: calcium absence; total calcium score (TCS): 1�100�AU; TCS: 101�600�AU and ECAC: TCS above 600�AU. Acute event was defined as first acute myocardial infarction (MI) or a new unstable angina. First chronic event was defined as a positive stress test with a consequent elective percutaneous coronary intervention or coronary artery bypass grafting. Results 628 subjects (94%) were free from any cardiac events, 39 (6%) experienced first cardiac event: 18 of them suffered acute and 21 chronic events. There were 67 patients with and 600 patients without DM: 78% of patients with DM presented CAC vs. 50% of patients without DM (p?0.001).The mean TCS was 17 times higher in the chronic than in the acute events group: 914 vs. 55�AU, p?0.001. In 95% of the patients with chronic events more than one calcified vessel was found, compared to 67% of the patients with acute events and only 30% of those without events (p?0.001). Incidence of CAD events (all types pooled together) rose consequently from 2% in subjects without CAC to 34% in subjects with ECAC (p?0.001). However, among the 32 subjects with ECAC, 11 (34%) developed chronic event while none of them had acute event. In contrast, none of subjects with TCS =0 or TCS 1�100�AU presented with chronic events. Subjects with TCS 101�600�AU presented 10 (9%) chronic and 5 (4.5%) acute events (p?0.001). Conclusions Asymptomatic subjects with ECAC are not firstly manifested as acute coronary events but presented a high level of chronic CAD-related events during the 6.3 �3.4�year follow-up. In contrast, first acute CAD-related events occurred mostly in subjects with mild and moderate CAC score. PMID:24188692
USCM Mayoral Elections Database
NSDL National Science Digital Library
The US Conference of Mayors (USCM) (see the January 1, 1999 Scout Report) provides the Mayoral Elections Database. The database allows citizens from all 50 states and the District of Columbia to locate information on mayoral elections held in 1999. Users may search the database by city, state, political party, or name of candidate. Searches yield city name, state, party and name of election winner, percentage of votes earned by winner, and month of election. [AO
NSDL National Science Digital Library
Canada's 36th federal general election takes place June 2, and Elections Canada, "the non-partisan agency responsible for the conduct of federal elections and referendums" provides complete riding and candidate information, information on voter registration for eligible voters who are away from their districts, and 1st Source 1997, current vote results that will be made available immediately after the polls close.
Coronary artery surgery: cardiotomy suction or cell salvage?
Coronary artery bypass grafting (CABG) today results in what may be regarded as acceptable levels of blood loss with many institutions avoiding allogeneic red cell transfusion in over 60% of their patients. The majority of cardiac surgeons employ cardiotomy suction to preserve autologous blood during on-pump coronary artery bypass surgery; however the use of cardiotomy suction is associated with a more pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. This leads to a tendency to increased blood loss, transfusion requirement and organ dysfunction. Conversely, the avoidance of cardiotomy suction in coronary artery bypass surgery is not associated with an increased transfusion requirement. There is therefore no indication for the routine use of cardiotomy suction in on-pump coronary artery surgery. PMID:17961227
Lau, Kelvin; Shah, Hetul; Kelleher, Andrea; Moat, Neil
Clogging the enrichment bypass
The issue that has come to be known as the bypass is the latest dispute in the continuing saga of uranium trade between the United States and the Commonwealth of Indepenent States. Bypass deals now being conducted by US utilities have drawn heavy criticism from the US Department of Commerce but are perfectly legal under the terms of the Suspension Agreements. Urged on by the United States Enrichment Corporation, the US DOC intends to stop, or at least severely restrict, bypass deals. Using a recent agreement with Kazakhstan as a case study, this article reviews the implications of such bypass deals.
MR angiography of the coronary arteries.
Magnetic resonance angiography (MRA) of the coronary arteries has recently become possible due to the development of a new group of ultrafast imaging sequences. Coronary arteries are small, tortuous vessels subjected to significant physiological motions (respiration and cardiac contractions). Most coronary MRA pulse sequences rely on a combination of segmental acquisition of data (in k-space) to minimize cardiac motion artifacts and patient breath-holding to minimize respiratory motion artifacts. MR is noninvasive, does not require any contrast agents or ionizing radiation, and thus offers the potential of becoming a very important cardiac screening tool. Coronary MRA can routinely depict the proximal and middle portion of most coronary arteries and some coronary artery branches. However, its clinical utility for detecting lesions has not yet been proven. As coronary MRA techniques improve they may become an integral part of the evaluation of patients with ischemic heart disease. Existing coronary MRA techniques can already play a significant clinical role in the evaluation of coronary artery anomalies, in the follow-up of proximal lesions after angioplasty, and in the noninvasive determination of patency of bypass grafts and coronary stents. PMID:8534497
Duerinckx, A J
We report a rare case of a 65-year-old woman who underwent an emergent lifesaving heart operation for an undiagnosed right coronary artery aneurysm with a coronary arteriovenous fistula complicated by active infective endocarditis, which affected the aortic valve, mitral valve, and coronary sinus. We performed direct closure of the coronary arteriovenous fistula, ligation of the right coronary artery aneurysm, double coronary artery bypass grafting, and double valvular replacement. Five years after the operation, she had no sign of congestive heart failure or infection, and was not receiving antibiotics. PMID:19830518
Umezu, Kentaro; Hanayama, Naoji; Toyama, Akihiko; Hobo, Kyoko; Takazawa, Arifumi
The case against coronary artery surgery
Coronary by-pass surgery has been performed in hundreds of thousands of patients in the last 15 years with a high standard of technical and surgical perfection. The indications for this kind of surgery, however, are still controversial because in spite of many retrospective and several prospective studies it cannot be proven convincingly that in a given patient this surgical procedure
Jochen Schaefer
We studied three groups of patients without previous renal impairment, undergoing elective coronary artery bypass surgery. Group H (n = 7) underwent open heart surgery using moderate hypothermia (28 degrees C); Groups N and M (n = 8, each) were managed at normothermia. The extracorporeal circuit was primed with Hartmann's solution 2.5 L with the addition of mannitol 0.5 g/kg in Group M. Serum concentrations of sodium and creatinine, and the urinary concentrations of microalbumin and N-acetyl-beta-D-glucosaminidase (NAG) were measured in each patient at six different time intervals: T0, 6 h prior to surgery; T1, between sternotomy and 45 min into cardiopulmonary bypass (CPB); T2, in the interval from 45 min into, to prior to weaning off CPB; T3, from coming off CPB to skin closure; T4, in the first 6 h in the intensive care unit; and T5, at 6 days postoperatively. Creatinine clearance (CCR) and fractional sodium excretion (FENA) were calculated at each time point. Urine output during CPB at Interval T2 was significantly higher in Group H compared to Group N (P = 0.03) but not Group M. We found no significant differences in CCR, FENA, microalbuminuria, and urinary NAG among the three groups at any time. However, there were overall significant changes in measured variables over time compared to baseline. We conclude that CPB is associated with a significant alteration in renal function as shown by increased FENA, microalbuminuria, and urinary NAG. The use of hypothermic or normothermic CPB and the use of prophylactic mannitol did not produce any significant modification of these changes. PMID:8160980
Ip-Yam, P C; Murphy, S; Baines, M; Fox, M A; Desmond, M J; Innes, P A
MedlinePLUS Videos and Cool Tools
Heart bypass surgery begins with an incision made in the chest, with the breastbone cut exposing the heart. Next, a portion of the saphenous vein is ... used to bypass the blocked arteries in the heart. The venous graft is sewn to the aorta ...
Long-term outcome of dialysis patients in the United States with coronary revascularization procedures.BackgroundThe optimal method of coronary revascularization in dialysis patients is controversial, as previous small retrospective studies have reported increased cardiac events after percutaneous transluminal coronary angioplasty (PTCA) compared with coronary artery bypass (CAB) surgery. The purpose of this study was to compare the long-term survival of chronic dialysis
Charles A. Herzog; Jennie Z. Ma; Allan J. Collins
Computer-assisted LAD bypass grafting at the open heart
NASA Astrophysics Data System (ADS)
Open heart bypass surgery is the standard treatment in advanced coronary heart diseases. For an effective revascularization procedure, optimal placement of the bypass is very important. To accelerate the intraoperative localization of the anastomosis site and to increase the precision of the procedure, a concept for computer assistance in open heart bypass surgery has been developed comprising the following steps: 1. Preprocedural planning: A patient-specific coronary map with information on vessel paths and wall plaque formations is extracted from a multi-slice computed tomography (MSCT). On this basis, the heart surgeon and the cardiac radiologist define the optimal anastomosis site prior to surgery. 2. Intraoperative navigation: During surgery, data are recorded at the beating heart using a stereo camera system. After registering the pre- and intraoperative data sets, preprocedural information can be transferred to the surgical site by overlaying the coronary map and the planned anastomosis site on the live video stream. With this visual guidance system, the surgeon can navigate to the planned anastomosis site. In this work, the proposed surgical assistance system has been validated for the left anterior descending coronary artery (LAD). The accuracy of the registration mechanism has been evaluated in retrospective on patient data sets and the effects of breathing motion were quantified. The promising results of the retrospective evaluation led to the in-vivo application of the computer assistance system during several bypass grafting procedures. Intraoperative navigation has been performed successfully and postoperative evaluation confirms that the bypass grafts were accurately positioned to the preoperatively planned anastomosis sites.
Hartung, Christine; Gnahm, Claudia; Friedl, Reinhard; Hoffmann, Martin; Dietmayer, Klaus
... OG-rah-fee) is a test that uses dye and special x rays to show the insides ... the coronary arteries. Overview During coronary angiography, special dye is released into the bloodstream. The dye makes ...
NSDL National Science Digital Library
A project of the Carnegie Endowment for International Peace (CEIP) and the Carnegie Moscow Center, this modest site offers several helpful resources for following and understanding the December 19 Russian Duma Elections. Among these are pre-election bulletins, an election calendar, issue briefs, op-ed pieces, links to political parties/ blocs contesting the 1999 Duma Elections, and a number of related English- and Russian-language links. Additional content includes links to polling data and a listing of books recently published by the Carnegie Endowment Project on Russian domestic politics.
Canadian Election Survey, 1997
NSDL National Science Digital Library
The Inter-university Consortium for Political and Social Research (ICPSR) at the University of Michigan has the election study, Canadian Election Survey, 1997, in its archive. The Canadian Election Survey, 1997 comprehensively surveyed the election behavior and political attitudes of Canadian voters. The ICPSR freely provides codebooks and documentation in compressed and uncompressed .pdf format for both studies. Data are supplied in compressed and uncompressed SPSS Export files, which may be downloaded by authorized member institutions and official representatives of the ICPSR Data Archive. Downloading specifications and instructions are provided.
Blais, Andre.; Gidengil, Elisabeth.; Nadeau, Richard.; Nevitte, Neil.
Cardiac CT: atherosclerosis to acute coronary syndrome
Coronary computed tomographic angiography (CCTA) is a robust non-invasive method to assess coronary artery disease (CAD). Qualitative and quantitative assessment of atherosclerotic coronary stenosis with CCTA has been favourably compared with invasive coronary angiography (ICA) and intravascular ultrasound (IVUS). Importantly, it allows the study of preclinical stages of atherosclerotic disease, may help improve risk stratification and monitor the progressive course of the disease. The diagnostic accuracy of CCTA in the assessment of coronary artery bypass grafts (CABG) is excellent and the constantly improving technology is making the evaluation of stents feasible. Novel techniques are being developed to assess the functional significance of coronary stenosis. The excellent negative predictive value of CCTA in ruling out disease enables early and safe discharge of patients with suspected acute coronary syndromes (ACS) in the Emergency Department (ED). In addition, CCTA is useful in predicting clinical outcomes based on the extent of coronary atherosclerosis and also based on individual plaque characteristics such as low attenuation plaque (LAP), positive remodelling and spotty calcification. In this article, we review the role of CCTA in the detection of coronary atherosclerosis in native vessels, stented vessels, calcified arteries and grafts; the assessment of plaque progression, evaluation of chest pain in the ED, assessment of functional significance of stenosis and the prognostic significance of CCTA. PMID:25610801
Munnur, Ravi Kiran; Cameron, James D.; Ko, Brian S.; Meredith, Ian T.
Barometer elections in comparative perspective
This paper develops a conceptual framework for studying the performance of the government in what we term �barometer elections�. Barometer elections are defined as elections that reflect changes in citizens' attitudes toward the government in response to changing political and economic conditions, absent the opportunity to install a new executive. We classify British by-elections and German Land elections as barometer
Daniel S Ward
Which is the best graft for the right coronary artery?
Bilateral internal mammary arteries directed to the left coronaries are gaining popularity; an increasing level of evidence nowadays supports this surgical strategy. On the other hand, composite right internal mammary artery, radial artery, and gastroepiploic artery targeting high-grade stenotic lesions in the right coronary artery system may confer improved mid- and long-term patency compared to long saphenous veins. This analysis looks into the evidence comparing data of the third best available conduit for grafting the right coronary artery, and by extrapolating this report, compares total arterial revascularization vs. conventional coronary artery bypass grafting. PMID:24585306
Parissis, Haralabos; Ramesh, Bandigowdanapalya Channaiah; Al-Alao, Bassel
We give a necessary and sufficient condition for the addition of a collection of disjoint bypasses to a convex surface to be universally tight -- namely the nonexistence of a polygonal region which we call a virtual pinwheel.
Ko Honda; William H. Kazez; Gordana Matic
Cardiopulmonary Bypass and Cardioplegia
\\u000a This chapter describes the history and techniques of cardiopulmonary bypass, a process that effectually excludes the heart\\u000a from the general circulation and leaves it empty so that it can accommodate open cardiac surgical intervention. Since its\\u000a first implementation, cardiopulmonary bypass has improved significantly to become a very highly sophisticated, but reliably\\u000a performed procedure. The near future promises even more improvements
J. Ernesto Molina
Do Indo-Asians have smaller coronary arteries?
There is a widespread belief that coronary arteries are smaller in Indo-Asians. The aim of the present study was to compare the size of atheroma-free proximal and distal epicardial coronary arteries of Indo-Asians and Caucasians. We analysed normal coronary angiograms from 77�Caucasians and 39�Indo-Asians. The two groups were comparable for dominance of the coronary arteries. Indo-Asian patients had generally smaller coronary arteries, with a statistically significant difference in the mean diameters of the left main coronary artery, proximal, mid and left anterior descending, and proximal and distal right coronary artery segments. There was a non-significant trend towards smaller coronary artery segment diameters for the distal left anterior descending, proximal and distal circumflex, and obtuse marginal artery segments. However, after correction for body surface area, none of these differences in size were statistically significant. Thus, the smaller coronary arteries in Indo-Asian patients were explained by body size alone and were not due to ethnic origin per se. This finding nevertheless has important therapeutic implications, since smaller coronary arteries may give rise to technical difficulties during bypass graft and intervention procedures such as percutaneous transluminal coronary angioplasty, stents and atherectomy. On smaller arteries, atheroma may also give an impression of more severe disease than on larger diameter arteries.???Keywords: Indo-Asians; coronary artery; body surface area PMID:10646023
Lip, G; Rathore, V; Katira, R; Watson, R; Singh, S
Elective induction: When? Ever?
The frequency of labor induction has increased significantly in recent years. Although medically indicated inductions comprise a portion of this increase, elective inductions have increased in frequency as well. Given that elective inductions, by definition, provide no benefit from a strictly medical standpoint, it is particularly important to evaluate whether women who undergo these inductions incur greater risks than those who labor spontaneously. This article will assess whether elective inductions are associated with changes in pregnancy outcomes, and evaluate how these associations are influenced by parity and cervical ripeness. PMID:17513939
Grobman, William A
Background Percutaneous coronary intervention (PCI) is sometimes performed with the intent to lower cardiovascular risk before high?risk noncardiac surgery (HRNCS). There are limited data on the frequency and outcome of PCIs performed in this setting. Methods and Results We assessed the frequency, characteristics, and in?hospital outcomes of patients undergoing PCI as part of the preoperative workup for HRNCS among all 61 145 elective PCIs performed between 2002 and 2009 at 14 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Propensity matching was performed to compare outcomes of patients undergoing PCI before HRNCS with all other elective PCI patients. The frequency of PCI before HRNCS was low (4.2%). Patients undergoing PCI before HRNCS were older (67.3 versus 64.9 years, P<0.0001) and had a greater burden of comorbidity. Patients undergoing PCI before HRNCS had an increase in unadjusted major adverse cardiovascular events, postprocedure transfusion, contrast?induced nephropathy, nephropathy requiring dialysis, and same?admission coronary artery bypass graft surgery, but there was no difference in mortality (0.27% versus 0.14%, P=0.11). However, in propensity score�matched samples, there was a significant difference only in nephropathy requiring dialysis. Conclusions The incidence of PCI performed in preparation for high?risk noncardiac surgery is low, and these procedures are currently being performed on a highly selected high?risk patient population. PMID:24820654
Muthappan, Palaniappan; Smith, Dean; Aronow, Herbert D.; Eagle, Kim; Wohns, David; Fox, James; Share, David; Gurm, Hitinder S.
Primary Election Systems and Representation
We examine how differences in the institutions that regulate candidate nomination procedures, specifically direct primary election laws, affect the types of candidates elected in nonpresidential American elections. We hypothesize that in more closed primary systems, control over candidate nominations by ideological extremists will translate into a higher likelihood that extreme candidates win in the general election. We hypothesize that in
Elisabeth R Gerber; Rebecca B Morton
NSDL National Science Digital Library
This interactive mathematics resource allows students to explore and interpret Alberta provincial election results from 1905 to 2004 using a pictograph, line graph, bar graph, circle graph, or data table. The resource includes print activities, solutions, and learning strategies.
Background. In beating heart coronary artery bypass graft operations, biventricular pump failure, as observed after exposure of the posterior circumflex branches by sternotomy, may originate from mechanical obstruction to coronary flow.Methods. Regional coronary blood flow was measured in 8 anesthetized, paced, ?-blocked pigs, and the beating heart was fully retracted.Results. Displacement decreased cardiac output from 4.8 � 1.1 L\\/min (mean
Paul F Gr�ndeman; Cornelius Borst; Joost A van Herwaarden; Cees W. J Verlaan; Erik W. L Jansen
Background. A retrospective study of 444 patients undergoing urgent and emergent coronary artery bypass grafting for acute coronary insufficiency was performed to identify the risk factors for hospital death specifically associated with the clinical severity of the acute coronary insufficiency syndrome.Methods. The patients were divided into three groups�urgent, emergent A, and emergent B�on the basis of the evolution of the
Biagio Tomasco; Antonino Cappiello; Rosario Fiorilli; Archimede Leccese; Raniero Lupino; Antonio Romiti; Ugo F Tesler
Cerebral emboli detected by transcranial Doppler imaging were recorded in 20 patients undergoing multiple-vessel coronary artery bypass surgery, either with or without cardiopulmonary bypass, in a prospective unblinded comparative study. Emboli were recorded continuously from the time of pericardial incision until 10 min after the last aortic instrumentation. The numbers of coronary grafts and of aortic clampings were also documented. Patients undergoing revascularization with cardiopulmonary bypass had more emboli (median 79, range 38-876) per case compared with patients having off-pump surgery (median 3, range 0-18). No clinically detectable neurological deficits were seen in either group. Beating heart surgery is associated with fewer emboli than coronary surgery with cardiopulmonary bypass. Further research is necessary to determine whether a smaller number of emboli alters the incidence of neurological deficit after cardiac surgery. PMID:10844840
Watters, M P; Cohen, A M; Monk, C R; Angelini, G D; Ryder, I G
... Breathing problems Heart attack or stroke during or after surgery Infection, including in the cut, lungs (pneumonia), bladder, or kidney There are a number of risks for any weight-loss surgery. ... also risks that are more likely after gastric bypass surgery.
Risk of massive upper gastrointestinal bleeding in gastric bypass patients taking clopidogrel
BackgroundThe antiplatelet drug clopidogrel (Plavix) is widely used in patients who have undergone coronary artery stenting or had a stroke. Because morbid obesity is associated with atherosclerosis, some of these patients are candidates for weight loss surgery. We chose to determine the risk of upper gastrointestinal bleeding after gastric bypass in patients taking clopidogrel.
Joseph A. Caruana; Marc N. McCabe; Audrey D. Smith; Vishnudas Pai Panemanglore; Daniel Sette Camara
[Coronary heart disease - what is of importance after coronary intervention?].
In the European Union Ticagrelor has recently been approved, as another P2Y12-receptor antagonist in addition to clopidogrel and prasugrel, in [corrected] the drug treatment after coronary intervention. [corrected] Dual antithrombotic treatment must be given for 4 weeks after elective implantation [corrected] of bare-metal stents, or for at least 6 months [corrected] with acetylsalicylic acid (ASA) plus clopidogrel after implantation of a drug-eluding stent. After an acute coronary syndrome ASA and clopidogrel (or prasugrel or ticagrelor) must be given for 12 months. In patients requiring urgent oral anticoagulation essential triple-drug treatment should be given over as short a [corrected] space of time if possible. [corrected] Prasugrel and ticagrelor may, to protect against gastroduodenal bleeding, be given without restriction together with a proton-pump inhibitor. Preoperative coagulation management is essential for patients who have been on dual platelet-aggregation inhibitors, but premature withdrawal of this medication should be avoided. PMID:21271479
Rassaf, T; Hamm, C W
NSDL National Science Digital Library
In this season of electoral uncertainty, both researchers and concerned citizens can find the extensive data available at the National Election Studies Website quite useful. "NES conducts national surveys of the American electorate in presidential and midterm election years and carries out research and development work through pilot studies in odd-numbered years. The NES time-series now encompasses 23 biennial election studies spanning five decades." The data from these studies, along with codebooks, cover public opinion and political participation themes such as "expectations about the election outcome; perceptions and evaluations of the major parties and their candidates; interest in the campaign; information about politics; partisanship; assessments of the relative importance of major problems facing the country; attention to campaign coverage in the mass media; feelings of political efficacy; political values; conservatism vs. liberalism; trust in government; political participation; vote choice; economic well-being; positions on social welfare, economic, social, and civil rights issues" and more. Pilot studies, whose data is also available on-site, are conducted in off-election years in order "to test new, or refine existing, instrumentation and study designs." A major feature of the site, useful to not only researchers but journalists and the general public, is The NES Guide to Public Opinion and Electoral Behavior, which offers easily digestible data on a whole range of issues drawn from the time-series studies.