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1

Endoscopic vein harvest in elective off-pump coronary artery bypass grafting  

Microsoft Academic Search

While traditional open vein harvest was related to postoperative wound complications, endoscopic vein harvest was developed\\u000a to minimize the morbidity in the greater saphenous vein harvest procedure. In this study, these two procedures were compared\\u000a for postoperative wound healing and long-term graft patency. We reviewed all consecutive patients undergoing elective off-pump\\u000a coronary artery bypass grafting from January 2004 to December

Nai-kuan Chou; Meng-lin Lee; Shoei-shen Wang

2009-01-01

2

Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass  

PubMed Central

Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male) underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8%) had significant (<50%) and 3 (1.1%) patients had critical (<70%) stenosis in internal carotid arteries. Plaque formation in common carotid was not significantly different between two genders but the stenosis of left internal carotid was more frequently seen among men. Patients with plaques in right or left internal carotid arteries were significantly older. Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

Tarzamni, Mohammad K; Afrasyabi, Abbas; Farhoodi, Mehdi; Karimi, Fatemeh; Farhang, Sara

2007-01-01

3

Initial report of the National Registry of Elective Cardiopulmonary Bypass Supported Coronary Angioplasty.  

PubMed

Relative contraindications to coronary angioplasty have been large amounts of jeopardized myocardium and poor left ventricular function. To prevent possible hemodynamic collapse after balloon occlusion or acute vessel closure in such high risk patients, a cardiopulmonary bypass system capable of providing up to 6 liters/min output was employed prophylactically. This technique, termed supported angioplasty, results in reductions of preload and afterload and allows prolonged balloon inflations in critical coronary vessels. A National Registry of 14 centers performing elective supported angioplasty was formed to collate the initial experience with high risk patients. Suggested indications were ejection fraction less than 25% or a target vessel supplying more than half the myocardium, or both. During 1988, the data from 105 patients (mean age 62 years) undergoing supported angioplasty were entered into the Registry. This group included 20 patients whose disease was deemed too severe to permit bypass surgery and 30 patients who had dilation of their only patent coronary vessel. Seventeen patients had stenosis of the left main coronary artery and 15 underwent dilation of that vessel. Chest pain and electrocardiographic changes occurred uncommonly despite prolonged balloon inflations. During the trial, there was a progressive change from cutdown insertion to percutaneous insertion of the circulatory support cannulas. The angioplasty success rate was 95% for the 105 patients, who underwent an average of 1.7 dilations per patient. Morbidity was frequent (41 patients), in most cases due to arterial, venous or nerve injury associated with cannula insertion or removal, or both.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2404047

Vogel, R A; Shawl, F; Tommaso, C; O'Neill, W; Overlie, P; O'Toole, J; Vandormael, M; Topol, E; Tabari, K K; Vogel, J

1990-01-01

4

Endoscopic vein harvest in elective off-pump coronary artery bypass grafting.  

PubMed

While traditional open vein harvest was related to postoperative wound complications, endoscopic vein harvest was developed to minimize the morbidity in the greater saphenous vein harvest procedure. In this study, these two procedures were compared for postoperative wound healing and long-term graft patency. We reviewed all consecutive patients undergoing elective off-pump coronary artery bypass grafting from January 2004 to December 2005 and collected data regarding wound complications and coronary events. Wound complications included dehiscence, excessive discharge, edema, altered sensation, cellulitis, hematoma, pain scale, and superficial and deep wound infection. Coronary events were defined as diagnosis of myocardial infarction during the first year's follow-up. A total of 392 patients were included in our series, among whom 44 were excluded from the study due to emergent operation, preoperative intra-aortic balloon pump support, or the greater saphenous vein varicose characteristic, 78 belonged to open vein harvest group, and 270 to endoscopic vein harvest group. Wound complications were significantly less in the endoscopic group (5.2%) compared to the open group (19.2%) (P=0.0002). There was no significant difference on preoperative risk factors, total operative time, or hospitalization days. During one-year follow-up, both the early and late graft patency rates were similar between the two groups. Endoscopic vein harvest is safe and effective, which carries less risk for wound complications and is associated with better satisfaction and cosmetic result than the traditional greater saphenous vein harvest procedure. The endoscopic vein harvest also demonstrates a great long-term patency. PMID:19816999

Chou, Nai-kuan; Lee, Meng-lin; Wang, Shoei-shen

2009-10-01

5

Unchanged Plasma Levels of the Soluble Urokinase Plasminogen Activator Receptor in Elective Coronary Artery Bypass Graft Surgery Patients and Cardiopulmonary Bypass Use  

PubMed Central

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.

Gozdzik, Waldemar; Adamik, Barbara; Gozdzik, Anna; Rachwalik, Maciej; Kustrzycki, Wojciech; Kubler, Andrzej

2014-01-01

6

Coronary Artery Bypass Surgery  

MedlinePLUS

... 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 ...

7

Elective Percutaneous Coronary Intervention  

PubMed Central

Regardless of the diabetic status of patients with coronary artery disease, hyperglycemia and hypoglycemia are adversely associated with cardiovascular events. The relationship between glucose levels and increased mortality risk in acute myocardial infarction has been shown through various glucose metrics; however, there is a dearth of multivariate analysis of the relationship between elective coronary angioplasty and preprocedural blood glucose levels. We evaluated the relationship between preprocedural blood glucose levels and myocardial injury in 1,012 consecutive patients who underwent elective percutaneous coronary angioplasty. The patients were classified into 4 glycemic groups on the basis of blood glucose levels measured immediately before the procedure: hypoglycemic, euglycemic, mildly hyperglycemic, and hyperglycemic. Samples for troponin I and creatine kinase–MB fraction were collected before each procedure and at 8, 16, and 24 hours after each procedure. Bivariate analysis revealed that postprocedural troponin I levels were significantly higher in the hyperglycemic group (P=0.027). Although postprocedural levels of creatine kinase–MB fraction rose insignificantly in the hypoglycemic patients, our results showed that these patients were more likely to have postprocedural levels 2 to 5 times the upper limit of normal (P=0.013). We tentatively conclude that abnormally low preprocedural plasma glucose levels—together with a recent history of smoking—are associated with an increased incidence of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention.

Madani, Mohsen; Alizadeh, Keivan; Ghazaee, Sepideh Parchami; Zavarehee, Abbas; Abdi, Seifollah; Shakerian, Farshad; Salehi, Negar; Firouzi, Ata

2013-01-01

8

Coronary Artery Bypass Grafting  

MedlinePLUS

... plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause ... coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle. Surgeons can bypass multiple ...

9

Prognostic factors of atrial fibrillation following elective coronary artery bypass grafting: the impact of quantified intraoperative myocardial ischemia  

PubMed Central

Background Atrial fibrillation (AF) occurs in 28-33% of the patients undergoing coronary artery revascularization (CABG). This study focuses on both pre- and peri-operative factors that may affect the occurrence of AF. The aim is to identify those patients at higher risk to develop AF after CABG. Patients and methods Two patient cohorts undergoing CABG were retrospectively studied. The first group (group A) consisted of 157 patients presenting AF after elective CABG. The second group (group B) consisted of 191 patients without AF postoperatively. Results Preoperative factors presenting significant correlation with the incidence of post-operative AF included: 1) age > 65 years (p = 0.029), 2) history of AF (p = 0.022), 3) chronic obstructive pulmonary disease (p = 0.008), 4) left ventricular dysfunction with ejection fraction < 40% (p = 0.015) and 5) proximal lesion of the right coronary artery (p = 0.023). The intraoperative factors that appeared to have significant correlation with the occurrence of postoperative AF were: 1) CPB-time > 120 minutes (p = 0.011), 2) myocardial ischemia index < 0.27 ml.m2/Kg.min (p = 0.011), 3) total positive fluid-balance during ICU-stay (p < 0.001), 4) FiO2/PO2 > 0, 4 after extubation and during the ICU-stay (p = 0.021), 5) inotropic support with doses 15-30 ?g/Kg/min (p = 0.016), 6) long ICU-stay recovery for any reason (p < 0.001) and perioperative myocardial infarction (p < 0.001). Conclusions Our results suggest that the incidence of post-CABG atrial fibrillation can be predicted by specific preoperative and intraoperative measures. The intraoperative myocardial ischemia can be sufficiently quantified by the myocardial ischemia index. For those patients at risk we would suggest an early postoperative precautionary anti-arrhythmic treatment.

2011-01-01

10

What Is Coronary Bypass Surgery?  

MedlinePLUS

... and the other end is attached to the coronary artery below the point where it’s blocked. Blood can ... the heart. You may have more than one coronary artery bypass done at a time, depending on how ...

11

Early exercise testing and elective coronary artery bypass surgery after uncomplicated myocardial infarction. Effect on morbidity and mortality  

Microsoft Academic Search

One hundred and nineteen consecutive patients were studied prospectively after uncomplicated myocardial infarction by maximal exercise electrocardiography at two weeks and coronary angiography at six weeks. At angiography 87 patients had a stenosis greater than 70% in one major coronary artery supplying residual viable myocardium outside the infarction zone. In 82 (94%) of these the 12 lead maximal exercise electrocardiogram

F Akhras; J Upward; J Keates; G Jackson

1984-01-01

12

POST CORONARY ARTERY BYPASS GRAFT STUDY (CABG)  

EPA Science Inventory

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 ...

13

Elective minimally invasive coronary artery bypass: Shunt or tournique occlusion? Assessment of a protective role of perioperative left anterior descending shunting on myocardial damage. A prospective randomized study  

PubMed Central

Background To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass. Methods 38 patients were randomly assigned to external tournique occlusion (n?=?19) or intraluminal-left anterior descending shunt group (n?=?19). Blood samples for cardiac troponin T were collected at 30 minutes prior to, 6 and 24 hours after surgery. Results One patient in external tournique occlusion and two patients in intraluminal-left anterior descending shunt group were excluded from futher analysis due to preoperative cardiac troponin T level above the 99th-percentile. Postoperatively, each six patients in external tournique occlusion (33.3%) and intraluminal-left anterior descending shunt (35.3%) group were above the 99th-percentile. Two patients from each group (external tournique occlusion group 11.1% vs. intraluminal-left anterior descending shunt group 11.8%) had peak values above 10-% coeficient of variation cutoff (p?=?1). There were no significant differences in between both groups at all studied timepoints. Conclusion There was no protective effect of intraluminal shunting on myocardial damage compared to short-term tournique occlusion. It is upon the surgeon's discretion which method may preferrably be used to achieve a bloodless field in grafting of the non-occluded left anterior descending in minimally invasive coronary artery bypass.

2012-01-01

14

Reoperation after coronary bypass grafting.  

PubMed Central

Coronary artery bypass grafting is one of the most commonly performed surgical procedures in the western world, and myocardial revascularization during the first operation is well established. But patients are now surviving beyond the patency of their primary grafts. Repeat myocardial revascularization can be performed successfully in patients who have adequate ventricular function and graftable distal vessels. Images Figures 1-2 Figure 3 Figure 5

Menkis, A. H.; Carley, S. D.; Clough, T. M.

1993-01-01

15

Types of Coronary Artery Bypass Grafting  

MedlinePLUS

... is called beating heart bypass grafting. Minimally Invasive Direct Coronary Artery Bypass Grafting This type of surgery ... they showed that excess signaling via the Transforming Growth Factor Beta (TGF-Beta) family causes the inner ...

16

Recovery After Coronary Artery Bypass Graft Surgery (Beyond the Basics)  

MedlinePLUS

... exertion Therapeutic lifestyle changes Patient information: Recovery after coronary artery bypass graft surgery (CABG) (Beyond the Basics) Author ... PI Rating of perceived exertion BYPASS SURGERY OVERVIEW Coronary artery bypass graft surgery, also known as CABG or ...

17

21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.  

Code of Federal Regulations, 2010 CFR

...4310 Cardiopulmonary bypass coronary pressure gauge. (a) Identification. A cardiopulmonary bypass coronary pressure gauge is a device used...pressure of the blood perfusing the coronary arteries. (b) Classification....

2010-04-01

18

21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.  

Code of Federal Regulations, 2010 CFR

...4310 Cardiopulmonary bypass coronary pressure gauge. (a) Identification. A cardiopulmonary bypass coronary pressure gauge is a device used...pressure of the blood perfusing the coronary arteries. (b) Classification....

2009-04-01

19

Coronary artery bypass grafting to a calcified right coronary artery  

Microsoft Academic Search

A severely calcified coronary artery demands a special technique in coronary artery bypass surgery. We have successfully developed\\u000a a “punch-out” technique for a calcified right coronary artery in a dialysis patient. After an incision into the target coronary\\u000a artery, the calcified arterial wall was resected using a punch to make an oval hole for anastomosis. Limited endarterectomy,\\u000a which consisted of

Masaru Yoshikai; Keiji Kamohara; Junji Yunoki

2002-01-01

20

Should Coronary Artery Bypass Grafting Be Regionalized?  

Microsoft Academic Search

everal studies have shown that cardiac care centers that provide a high volume of cardiac services, particularly coronary artery bypass grafting (CABG), have better outcomes than those with low volumes. Some analysts have used these data to suggest that patients in need of care for coronary artery disease would be best served if they were referred only to those centers

Brahmajee K. Nallamothu; Kim A. Eagle; Victor A. Ferraris; Robert M. Sade

2010-01-01

21

Perioperative Glucose-Insulin-Potassium Infusion in Elective Coronary Surgery: Minor Benefit in Connection with Blood Cardioplegia?  

Microsoft Academic Search

SummaryObjective: The goal of this study was to examine the metabolic and hemodynamic effects of a glucose-insulin-potassium infusion in elective coronary surgery, when blood cardioplegia was used for cardiac protection. Design and Patients: A prospective, randomized, open, clinical comparison was performed between 2 perioperative infusion regimens in 40 elective nondiabetic coronary artery bypass graft (CABG) surgery patients. Setting and Interventions:

J.-O. M. Wistbacka; L. S. Nuutinen; M. V. K. Lepojärvi; J. Nissinen; K. E. V. Karlqvist; A. Ruokonen

1994-01-01

22

Minimally invasive direct coronary artery bypass  

Microsoft Academic Search

From January 1996 to May 1997, minimally invasive direct coronary artery bypass (MIDCAB) through a small anterior thoracotomy without cardiopulmonary bypass was completed in 31 of 32 patients (Male: Female=1.9:1, mean age=64.6 years, 11 (34.4%)>70 years). Twenty, five, and seven patients had one, two, and three vessel disease respectively. Twelve patients presented with unstable angina, seven had prior myocardial infarction,

Hon Chi Suen; Robert G Johnson; Ronald M Weintraub; Andrew Maslow; Mark E Comunale; William E Cohn

1997-01-01

23

Coronary artery bypass graft degenerative disease  

Microsoft Academic Search

Opinion statement  The choice of conduit is the most important factor influencing long-term patency of coronary artery bypass grafts (CABGs);\\u000a arterial grafts are far superior to saphenous vein bypass grafts (SVGs) in this regard. Aspirin therapy should be started\\u000a early in the perioperative period and continued indefinitely. Warfarin (Coumadin; Dupont, Wilmington, DE) and other platelet\\u000a inhibitors offer no added value to

Fredarick L. Gobel; Michael R. Mooney; Kevin J. Graham

2001-01-01

24

Economics of coronary artery bypass grafting  

Microsoft Academic Search

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

1985-01-01

25

Pulmonary function after coronary artery bypass surgery  

Microsoft Academic Search

Coronary artery bypass graft surgery (CABG) adversely affects pulmonary function tests (PFTs). Although several previous studies have addressed these changes, none has measured the forced vital capacity (FVC) on a daily basis. The purpose of the present study was to assess serial changes in the FVC following CABG and to identify factors that may influence these changes. The FVC was

F. S. Vargas; M. Terra-Filho; W. Hueb; L. R. Teixeira; A. Cukier; R. W. Light

1997-01-01

26

Ultrasonic coronary angioplasty during coronary artery bypass grafting.  

PubMed

This preliminary study in 20 patients demonstrated that ultrasonic coronary angioplasty in the setting of bypass grafting is feasible, safe, and able to recanalize atherosclerotic vessels. Shorter monorail probes were superior to longer probes without guidewires in terms of success of vessel recanalization; >95% of particle debris was <25 microm in size. PMID:8914887

Eccleston, D S; Cumpston, G N; Hodge, A J; Pearne-Rowe, D; Don Michael, T A

1996-11-15

27

Repair of mycotic coronary aneurysm without cardiopulmonary bypass: case report.  

PubMed

Mycotic aneurysms of the coronary arteries are extremely rare, with 15 cases reported. We report the successful treatment of a mycotic aneurysm of the left anterior descending coronary artery by coronary artery bypass grafting with aneurysm ligation and resection without the use of cardiopulmonary bypass. PMID:15454373

Pratt, Jerry W; Kukielka, Gilbert; Brown, David A

2004-01-01

28

Silent Aspiration After Coronary Artery Bypass Grafting  

Microsoft Academic Search

Background. “Silent” aspiration was recognized to be a more frequent complication at this hospital in patients who have had coronary artery bypass grafting than in the general surgical population.Methods. A case-control retrospective study covering a 4.5-year period was conducted to determine risk factors for pharyngeal dysfunction resulting in silent aspiration.Results. Significant predictors of silent aspiration were age, history of cerebral

O. Brewster Harrington; John K Duckworth; Carey L Starnes; Patricia White; Lynn Fleming; Stephen B Kritchevsky; Rexann Pickering

1998-01-01

29

Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass  

Microsoft Academic Search

Objective: In coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) the inflammatory response is suggested to be minimized. Coronary anastomoses are performed during temporary coronary occlusion. Inflammatory response and myocardial ischaemia need to be studied in a randomized study comparing CABG in multivessel disease with versus without CPB. Methods: Following randomization 30 consecutive patients received CABG either with (n=16)

Martin Czerny; Harald Baumer; Juliane Kilo; Andrea Lassnigg; Ahmad Hamwi; Thomas Vukovich; Ernst Wolner; Michael Grimm

2000-01-01

30

Renal outcome following on- and off-pump coronary artery bypass graft surgery.  

PubMed

A prospective study was carried out to compare the outcomes of patients with preexisting non-dialysis-dependent renal dysfunction who underwent coronary artery bypass grafting with or without cardiopulmonary bypass. Elective off-pump coronary artery bypass was performed in 29 patients with renal dysfunction. Their results were compared with those of a similar group of 35 patients who underwent the conventional on-pump coronary artery grafting. There was a significant deterioration in creatinine clearance in the on-pump group on days 1, 2, and 4 after surgery, while creatinine clearance in the off-pump group remained close to the baseline level. Both groups had improved to the preoperative creatinine clearance values on follow-up at 4 weeks. It was concluded that off-pump surgery provided better renal protection than the conventional on-pump technique in patients with preexisting non-dialysis-dependent renal dysfunction. PMID:18984756

Ooi, Joanna S M; Abdul Rahman, Mohd R; Shah, Shamsul A; Dimon, Mohd Z

2008-12-01

31

Conduits for Coronary Bypass: Vein Grafts  

PubMed Central

The saphenous vein has been the principal conduit for coronary bypass grafting from the beginning, circa 1970. This report briefly traces this history and concomitantly presents one surgeons experience and personal views on use of the vein graft. As such it is not exhaustive but meant to be practical with a modest number of references. The focus is that of providing guidance and perspective which may be at variance with that of others and recognizing that there may be many ways to accomplish the task at hand. Hopefully the surgeon in training/early career may find this instructive on the journey to surgical maturity.

Farkas, Emily A

2012-01-01

32

Diltiazem provides anti-ischemic and anti-arrhythmic protection in patients undergoing coronary bypass grafting  

Microsoft Academic Search

In 91 patients undergoing elective coronary bypass grafting, the anti-ischemic and anti-arrhythmic efficacy of a 24-hour infusion of either the calcium antagonist diltiazem (0.1 mg\\/kg per h, n = 44) or nitroglycerin (1 pg\\/kg per min, n = 47) were compared. Myocardial ischemia was diagnosed by Halter monitoring and the repeated assessment of 12-lead ECG and serum enzyme levels and

W. Hannes; R FASOL; H. Zajonc; M. Schindler; B. Schumacher; V. Schlosser; C. H. Holuharsch; R. Seitelberger

1993-01-01

33

Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot study  

Microsoft Academic Search

ObjectiveNeurocognitive impairment can be a debilitating complication after cardiac surgery. The aim of this study was to assess the effect of minimal extracorporeal circulation (MECC) versus conventional extracorporeal circulation (CECC) on neurocognitive function after elective coronary artery bypass grafting (CABG) and whether this can be attributed to improved cerebral perfusion intraoperatively.Methods and results64 patients scheduled for elective CABG surgery were

Kyriakos Anastasiadis; Helena Argiriadou; Mary H Kosmidis; Kalliopi Megari; Polychronis Antonitsis; Evanthia Thomaidou; Eleni Aretouli; Christos Papakonstantinou

2011-01-01

34

Off-pump coronary artery bypass surgery.  

PubMed

Off-pump coronary artery bypass surgery has been adopted enthusiastically worldwide. However, despite more than 6 years' experience and refinement, many surgeons use it only sporadically and some hardly at all. This reluctance persists despite support for the procedure because of the lack of properly designed risk models and/or randomized studies. Although it has not been overwhelmingly shown that off-pump surgery is superior to the conventional on-pump procedure, the technique has its place in our specialty. It has been shown to be better for noncritical end points in selected patients in the hands of selected surgeons. That there are differences in surgical skill among surgeons is something we all know but rarely discuss in public. Until now, disparities in skill have been most salient with uncommon and extraordinarily challenging operations. Perhaps the off-pump procedure should be regarded as the "challenging" aspect of coronary artery bypass surgery, and self-restraint may need to remain in force if we are to continue to achieve the highest level of clinical excellence. PMID:15585716

Black, Edward A; Ghosh, Sudip; Sin, Kenny; Spyt, Tom; Pillai, Ravi

2004-12-01

35

Robotic computer-assisted telemanipulation enhances coronary artery bypass  

Microsoft Academic Search

Objectives: Totally endoscopic coronary artery bypass grafting depends greatly on perfecting the anastomosis. We tested a new computer-assisted telemanipulation robot (Intuitive Surgical Inc, Mountain View, Calif) in performing endoscopic coronary bypass. Methods: On-bench anastomoses of the porcine arterial graft to the left anterior descending coronary artery were performed with both direct visualization and conventional surgical instruments (group I), endoscopic 3-dimensional

Hani Shennib; Amr Bastawisy; Joan McLoughlin; Frederic Moll

1999-01-01

36

Awake coronary artery bypass grafting: utopia or reality?  

Microsoft Academic Search

BackgroundOff-pump coronary artery bypass grafting (OPCAB) was implemented to reduce trauma during surgical coronary revascularization. High thoracic epidural anesthesia further reduced intraoperative stress and postoperative pain. This technique also supports awake coronary artery bypass (ACAB), completely avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients. We compared our first results of the ACAB procedure with the conventional

Tayfun Aybek; Paul Kessler; Selami Dogan; Gerd Neidhart; Mohammad Fawad Khan; Gerhard Wimmer-Greinecker; Anton Moritz

2003-01-01

37

Dipyridamole thallium scanning in the evaluation of coronary artery disease in elective abdominal aortic surgery  

SciTech Connect

Dipyridamole thallium scanning was routinely performed on 68 consecutive patients who presented for elective aortic surgery. All 68 patients were judged by clinical assessment to be at low risk for perioperative cardiac complications. In addition, 42 of 68 patients had a history of myocardial infarction, stable angina, or abnormal echocardiographic findings (group 1). Twenty-six of 68 patients did not have a history of myocardial infarction, angina, or abnormal echocardiographic findings (group 2). In group 1, 34 of 4 patients had positive results on dipyridamole thallium scanning, and 15 of these patients were found to have critical coronary artery disease on subsequent cardiac catheterization; nine underwent immediate coronary artery bypass grafting, and six had their coronary artery disease treated medically and their vascular operations cancelled. The remaining 27 patients in group 1 underwent elective operations, with six (22%) of 27 sustaining postoperative cardiac complications. None of the group 2 patients was found to have critical coronary artery disease. All patients in group 2 underwent aortic operation without cardiac complication. Routine dipyridamole thallium scanning detected a 22% (15 of 68) incidence of critical coronary artery disease overall. There was a 36% (15 of 42) incidence of critical coronary artery disease in group 1 patients vs 0% in group 2 patients (95% confidence interval, 21% to 50%). The authors conclude that the use of dipyridamole thallium scanning in low-risk patients for cardiac screening prior to elective aortic operations is beneficial in selected patients who have a history of myocardial infarction, angina, or abnormal echocardiographic findings, but is not necessary in patients with no history of coronary artery disease.

Strawn, D.J.; Guernsey, J.M. (Department of Surgery, Veterans Affairs Medical Center, Martinez, CA (USA))

1991-07-01

38

Outcomes of coronary artery bypass graft surgery  

PubMed Central

This review article summarizes the major studies that have investigated the outcomes of coronary artery bypass graft surgery (CABG). The article includes a review of the literature in the areas of: history of CABG; indications for CABG; and measurement of quality of life following CABG, including prolongation of life, physical functioning (ie, relief from angina and dyspnea, physical activity, as well as complications of surgery and re-hospitalization), psychological functioning, and social functioning. Overall, the literature demonstrates that the outcomes of CABG have historically been measured in terms of mortality and morbidity; however, it has now been well recognized that adjustment to CABG is a multidimensional phenomenon that is not fully explained by medical factors. Therefore, in addition to studying mortality and morbidity outcomes following CABG, many recent studies have identified that it is important to investigate various physical, psychological, and social variables that have a significant impact on post-operative adjustment to CABG.

Hawkes, Anna Louise; Nowak, Madeleine; Bidstrup, Benjamin; Speare, Richard

2006-01-01

39

[Concomitant surgery--coronary artery bypass and pulmonary lobectomy].  

PubMed

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

2000-05-15

40

Scintigraphic documentation of hemorrhage from coronary artery bypass graft  

SciTech Connect

Tc-99m labeled RBC imaging was used to conclusively demonstrate continuing intrathoracic hemorrhage from the anastomotic site of a coronary artery bypass graft. Demonstration of continuing hemorrhage and localization of the most likely site of bleeding resulted in timely and appropriate surgical intervention, which resulted in hemostasis and eventual patient recovery. Tc-99m RBC imaging may be an ideal noninvasive technique to investigate the site and activity of intrathoracic hemorrhage after coronary bypass surgery and other thoracic procedures.

Orzel, J.A.; Baisden, C.E.

1986-11-01

41

Inflammatory response after coronary revascularization with or without cardiopulmonary bypass  

Microsoft Academic Search

Background. We sought to investigate the effect of multiple coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) on the perioperative inflammatory response.Methods. Sixty patients undergoing CABG were randomly assigned to one of two groups: (A) on pump with conventional CPB and cardioplegic arrest, and (B) off pump on the beating heart. Serum samples were collected for estimation

Raimondo Ascione; Clinton T Lloyd; Malcolm J Underwood; Attilio A Lotto; Antonis A Pitsis; Gianni D Angelini

2000-01-01

42

The cerebral complications of coronary artery bypass surgery.  

PubMed Central

A prospective study of 79 coronary artery bypass surgery patients has been undertaken to determine the cerebral consequences of this form of surgery. Thirty comparative major vascular and thoracic non-cardiopulmonary bypass patients have also been studied. Detailed neurological, neuropsychological and cerebral blood flow investigations were undertaken preoperatively and at 8 days and 8 weeks postoperatively. Whilst stroke was rare following coronary artery bypass surgery, only one case in 76 being found (less than 1%), moderate or severe neuropsychological deficit was common, occurring in 49 of 67 patients (73%) 8 days after surgery and in 25 of 67 patients (37%) 8 weeks after surgery. However, the non-cardiopulmonary bypass patients also showed comparative levels of neuropsychological deficit. Cerebral blood flow was significantly reduced 8 days following coronary artery bypass surgery but not at 8 weeks and not in the comparative group. Significant cerebral blood flow reduction 8 days after coronary artery bypass graft surgery was not related to neuropsychological deficit found at a similar time. A greater neuropsychological deficit was found with longer cardiopulmonary bypass times but increased length of cardiopulmonary bypass appeared not to be related to an increased cerebral blood flow reduction.

Smith, P. L.

1988-01-01

43

Metabolic Profiles Predict Adverse Events Following Coronary Artery Bypass Grafting  

PubMed Central

Objectives Clinical models incompletely predict outcomes following coronary artery bypass grafting. Novel molecular technologies may identify biomarkers to improve risk stratification. We examined whether metabolic profiles can predict adverse events in patients undergoing coronary artery bypass grafting. Methods The study population comprised 478 subjects from the CATHGEN biorepository of patients referred for cardiac catheterization who underwent coronary artery bypass grafting after enrollment. Targeted mass spectrometry-based profiling of 69 metabolites was performed in frozen, fasting plasma samples collected prior to surgery. Principal-components analysis and Cox proportional hazards regression modeling were used to assess the relation between metabolite factor levels and a composite outcome of post-coronary artery bypass grafting myocardial infarction, need for percutaneous coronary intervention, repeat coronary artery bypass grafting, or death. Results Over a mean follow-up of 4.3 ± 2.4 years, 126 subjects (26.4%) suffered an adverse event. Three principal-components analysis-derived factors were significantly associated with adverse outcome in univariable analysis: short-chain dicarboxylacylcarnitines (factor 2, P=0.001); ketone-related metabolites (factor 5, P=0.02); and short-chain acylcarnitines (factor 6, P=0.004). These three factors remained independently predictive of adverse outcome after multivariable adjustment: factor 2 (adjusted hazard ratio 1.23; 95% confidence interval [1.10-1.38]; P<0.001), factor 5 (1.17 [1.01-1.37], P=0.04), and factor 6 (1.14 [1.02-1.27], P=0.03). Conclusions Metabolic profiles are independently associated with adverse outcomes following coronary artery bypass grafting. These profiles may represent novel biomarkers of risk that augment existing tools for risk stratification of coronary artery bypass grafting patients and may elucidate novel biochemical pathways that mediate risk.

Shah, Asad A.; Craig, Damian M.; Sebek, Jacqueline K.; Haynes, Carol; Stevens, Robert C.; Muehlbauer, Michael J.; Granger, Christopher B.; Hauser, Elizabeth R.; Newby, L. Kristin; Newgard, Christopher B.; Kraus, William E.; Hughes, G. Chad; Shah, Svati H.

2012-01-01

44

Hyperhomocysteinemia and Mortality after Coronary Artery Bypass Grafting  

PubMed Central

Background The independent prognostic impact, as well as the possible causal role, of hyperhomocysteinemia (HHcy) in coronary artery disease (CAD) is controversial. No previous study specifically has addressed the relationship between HHcy and mortality after coronary artery bypass grafting (CABG) surgery. The aim of this study is to evaluate the prognostic impact of HHcy after CABG surgery. Methodology and Principal Findings We prospectively followed 350 patients who underwent elective CABG between May 1996 and May 1999. At baseline, fasting total homocysteine (tHcy) levels were measured in all participants, and a post-methionine loading (PML) test was performed in 77.7% of them (n?=?272). After a median follow-up of 58 months, 33 patients (9.4%) had died, 25 because of cardiovascular events. HHcy, defined by levels higher than the 90th percentile (25.2 µmol/L) of the population's distribution, was significantly associated to total and cardiovascular mortality (P?=?0.018 [log-rank test 5.57]; P?=?0.002 [log-rank test 9.76], respectively). The PML test had no prognostic value. After multiple adjustment for other univariate predictors by Cox regression, including statin therapy (the most powerful predictor in uni-/multivariate analyses), high-sensitivity C Reactive Protein (hs-CRP) levels, and all known major genetic (MTHFR 677C?T polymorphism) and non-genetic (B-group vitamin status and renal function) tHcy determinants, HHcy remained an independent prognostic factor for mortality (HRs: 5.02, 95% CIs 1.88 to 13.42, P?=?0.001). Conclusions HHcy is an important prognostic marker after CABG, independent of modern drug therapy and biomarkers.

Girelli, Domenico; Martinelli, Nicola; Olivieri, Oliviero; Pizzolo, Francesca; Friso, Simonetta; Faccini, Giovanni; Bozzini, Claudia; Tenuti, Ilaria; Lotto, Valentina; Villa, Giuliano; Guarini, Patrizia; Trabetti, Elisabetta; Pignatti, Pier Franco; Mazzucco, Alessandro; Corrocher, Roberto

2006-01-01

45

A comparison of coronary angioplasty and coronary artery bypass grafting outcomes in chronic dialysis patients  

Microsoft Academic Search

The objective of this study was to compare the outcomes of angina, myocardial infarction (MI), cardiac death, and all-cause death following percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). The study design was based on retrospective, nonrandomized analysis and was set in referral teaching hospitals and community hospitals. Eighty-four chronic dialysis patients with symptomatic coronary artery disease

Ann L. Rinehart; Charles A. Herzog; Allan J. Collins; John M. Flack; Jennie Z. Ma; John A. Opsahl

1995-01-01

46

Real-time patency control with thermal coronary angiography in 1401 coronary artery bypass grafting patients  

Microsoft Academic Search

Objective: Intraoperative coronary angiography has always been favoured by cardiac surgeons. Thermal coronary angiography (TCA) is a useful method for intraoperative control of graft patency. It detects heat differences between tissues, provides easy-to-interpret angiographic images and even measures the flow of the grafts quantitatively. Methods: Between January 2000 and January 2002, TCA has been used in scheduled coronary bypass operations.

Bingür Sönmez; Harun Arbatli; Selim Tansal; Naci Ya?an; Mehmet Ünal; Ergun Demirsoy; Faruk Tükenmez; O?uz Yilmaz

2003-01-01

47

Development of Circulating Antiheart Antibodies as a Result of Coronary Bypass Surgery.  

National Technical Information Service (NTIS)

Antiheart antibodies have been implicated as a marker of postcardiotomy syndrome in patients undergoing coronary artery bypass. To assess the frequency of and contributory factors in the development of antiheart antibodies after coronary bypass procedures...

J. R. Baker D. J. Cohen H. D. Head J. L. DeShong G. M. Graeber

1986-01-01

48

Racial Disparities in Outcomes Following Coronary Artery Bypass Grafting  

PubMed Central

More than 12 million people in the United States have coronary heart disease, the second leading cause of hospitalization in the United States. It is known that persons within racial minorities, specifically African Americans, have a higher prevalence of coronary heart disease, yet are much less likely to undergo invasive cardiac treatment interventions. An invasive intervention commonly used to treat coronary heart disease is coronary artery bypass grafting, with over 140,000 operations performed annually in the United States. However, blacks are known to experience higher post–coronary artery bypass graft morbidity and mortality. The causes for racial disparities in post–coronary artery bypass graft outcomes are not well known but may include factors related to the individual, provider, system, and society/environment, either alone or in combination. The purpose of this article is to provide an overview of the literature regarding disparities in the health and healthcare of black patients with coronary heart disease with respect to CABG, and examine potential hypotheses for variant outcomes after surgery.

Hravnak, Marilyn; Ibrahim, Said; Kaufer, Abigail; Sonel, Ali; Conigliaro, Joseph

2013-01-01

49

Two generations of the St. Jude Medical ATG coronary connector systems for coronary artery anastomoses in coronary artery bypass grafting  

Microsoft Academic Search

BackgroundIn the past, coronary anastomoses have been performed using running and, occasionally, interrupted non-resorbable sutures. Recently, special interest has developed in mechanical anastomotic devices to facilitate minimal invasive techniques or limited access surgery. The experience with two series of patients undergoing coronary artery bypass grafting (CABG) using the St. Jude Medical ATG coronary connector systems (investigational stainless steel device, not

Friedrich S Eckstein; Luis F Bonilla; Hartzell Schaff; Lars Englberger; Stephan Windecker; Paul Hindrichs; Thierry P Carrel

2002-01-01

50

Coronary Artery Bypass Grafting Nine Months after Pneumonectomy  

PubMed Central

We performed coronary artery bypass grafting on a 58-year-old man who only 9 months earlier had undergone right pneumonectomy for bronchial carcinoma. Although his preoperative pulmonary function had been poor, coronary artery bypass surgery was successful, and the patient was discharged on the 9th postoperative day. Two years after surgery, he remained in New York Heart Association functional class I. We attribute this success to special management before, during, and after the operation. On the 32nd postoperative month, this patient died of multiple tumor metastases.

Golbasi, Ilhan; Turkay, Cengiz; Sahin, Nursel; Oz, Nejdet; Akbulut, Ercan; Gulmez, Harun; Bayezid, Omer

2001-01-01

51

Disease progression and adverse events in patients listed for elective percutaneous coronary intervention  

PubMed Central

Objective: To record disease progression and the timing of adverse events in patients on a waiting list for elective percutaneous coronary intervention (PCI). Design: Observational prospective study. Settings: A UK tertiary cardiothoracic centre, at a time when waiting lists for PCI were up to 18 months. Patients: 145 patients (116 men, median age 59.5 years) placed on an elective waiting list for PCI between October 1998 and September 1999. Main outcome measures: Adverse events recorded were death, myocardial infarction, need for urgent hospital admission because of unstable angina, and need for emergency revascularisation while waiting for PCI. Results: During a median follow up of 10 months (range 1–18 months), nine (6.2%) patients experienced an adverse event. Eight (5.52%) patients were admitted with unstable angina as emergencies. One was admitted with a myocardial infarction. Twenty nine (20.0%) patients had significant disease progression at the time of the repeat angiogram before PCI. In 10 (7%), disease had progressed so that PCI was no longer feasible and patients were referred for coronary artery bypass graft. Sixteen (11%) were removed from the PCI waiting list because of almost complete resolution of their anginal symptoms. Conclusion: Adverse coronary events and clinically significant disease progression occur commonly in patients waiting for PCI. Despite the presence of severe coronary lesions, myocardial infarction was rare and no patients died while on the waiting list. Resolution of anginal symptoms was also comparatively common. The pathophysiology of disease progression frequently necessitates a change in the treatment of patients waiting for PCI.

Talwar, S; Karpha, M; Thomas, R; Vurwerk, C; Cox, I; Burrell, C; Motwani, J; Gilbert, T; Haywood, G

2005-01-01

52

Revascularization therapy for coronary artery disease. Coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty.  

PubMed Central

Coronary artery bypass surgery relieves the symptoms of myocardial ischemia and prolongs survival of patients with more severe coronary artery disease. Randomized trials of surgical therapy have consistently shown that the benefits of surgical revascularization are proportional to the amount of myocardium affected by, or at risk for, ischemic injury. This risk is inferred from angiographically delineated coronary anatomy, estimates of left ventricular function, and physiologic testing. The population that may see a survival benefit from surgical revascularization has probably been expanded beyond that reported in the VA, CASS, and ECSS trials, due to improved perioperative care, longer graft survival, and the use of internal mammary artery grafts. Percutaneous transluminal coronary angioplasty revascularizes myocardium by dilating a stenotic segment of coronary artery. While successful in relieving the symptoms of myocardial ischemia, PTCA is hindered by the occurrence of abrupt vessel closure and the frequent development of restenosis. Furthermore, firm proof of a survival benefit, outside of emergency therapy for acute myocardial infarction, is not yet available. However, because the risk of procedure-related death or serious complication is lower than that seen with bypass surgery, PTCA provides a useful alternative revascularization method for patients with less extensive disease, in whom the risk of surgery may equal or exceed any beneficial effect. New technology and growing experience are widening the scope of percutaneous revascularization by extending the hope of symptomatic relief and survival benefit even to patients with extensive, severe coronary artery disease. Comparisons between surgical therapy and PTCA in select populations with single- and multivessel coronary artery disease have shown that PTCA is not as effective as surgery for long-term symptomatic control, and that it often requires repeat PTCA or cross-over to bypass surgery; however, long-term outcomes (i.e., death and myocardial infarction) are similar. The cost of treatment beginning with PTCA may be lower than that of initial surgery, even when the increased need for repeat revascularization is taken into account. Despite this, surgical bypass remains the mainstay of therapy for patients with severe coronary artery disease and a poor prognosis for survival, and will remain the fallback procedure for patients who repeatedly undergo failed PTCA. At the present time, revascularization should be offered on the basis of symptom severity (in the presence of medical therapy) and in accordance with the prognosis for survival as judged by the extent and severity of disease (Table VI). Percutaneous transluminal coronary angioplasty is preferred in patients who require revascularization but can obtain no proven benefit from bypass surgery. Coronary artery bypass surgery, using the internal mammary artery when possible, remains the revascularization method of choice for patients with more severe disease or whose disease is not amenable to treatment using percutaneous methods (Table VII).

Wilson, J M; Ferguson, J J

1995-01-01

53

Unprotected left main coronary artery stenting: immediate and medium- term outcomes of 140 elective procedures  

Microsoft Academic Search

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; Joël Sainsous; Gilles Bayet; Jean-Baptiste Simeoni; Pierre-Olivier Roquebert; Gilles Macaluso; Jean-Louis Bouvier; Bertrand Comet

2000-01-01

54

A pilot study of cerebral tissue oxygenation and postoperative cognitive dysfunction among patients undergoing coronary artery bypass grafting randomised to surgery with or without cardiopulmonary bypass*.  

PubMed

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

2014-06-01

55

Predictors of low cardiac output syndrome after coronary artery bypass  

Microsoft Academic Search

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

1996-01-01

56

Psychological Adjustment Following Coronary Artery Bypass Graft Surgery.  

ERIC Educational Resources Information Center

Identified patterns of psychological adjustment following coronary bypass surgery in 100 individuals, 1 to 2 years postsurgery. Profiles were clustered into three groups based on level of distress (low, moderate, high). Findings revealed that over one-half of participants reported levels of psychological distress following surgery that were one or…

Hagen, Janet W.

1991-01-01

57

Thermal-coronary-angiography (TCA) for intraoperative evaluation of graft patency in coronary artery bypass surgery  

Microsoft Academic Search

Despite the evolution of surgical techniques, coronary artery bypass graft surgery is complicated by early and late graft failure. While late graft failure is usually due to progression of the underlying disease, early graft failure can be caused by technical mistakes at the level of anastomoses. Thermal Coronary Angiography (TCA) has been developed to detect intraoperative graft failures. The method

V. Falk; H. Kitzinger; T. Walther; T. Rauch; A. Diegeler; F. W. Mohr

2000-01-01

58

Relationshi?p between atrial fibrillation and coronary bypass surgery  

PubMed Central

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.

Ozcan, Sedat

2014-01-01

59

Inhibition of neutrophil apoptosis after coronary bypass operation with cardiopulmonary bypass  

Microsoft Academic Search

Background. Granulocyte apoptosis is a key control process in the clearance of neutrophils from inflammatory sites, and its rate is modulated both in vitro and in vivo by a number of inflammatory mediators. In this study, we investigated the influence of cardiopulmonary bypass (CPB) on neutrophil apoptosis.Methods. Twenty patients undergoing coronary operation with CPB were studied. Patients undergoing off-pump (OP)

Massimo Chello; Pasquale Mastroroberto; Angela Quirino; Giovanni Cuda; Francesco Perticone; Francesco Cirillo; Elvio Covino

2002-01-01

60

Coronary Artery Bypass Surgery: Proceedings from Conference Held at Washington, DC on April 21-23, 1981.  

National Technical Information Service (NTIS)

Contents: The financing of CABs; The non-invasive evaluation of the coronary artery disease patient; Strategies for improving the work status of patients after coronary artery bypass surgery; Epidemiology of candidates for coronary bypass surgery; The cli...

1981-01-01

61

Surgical intervention utilizing cardiopulmonary bypass for coronary unroofing of anomalous coronary artery.  

PubMed

Coronary arteries originating from the opposite coronary cusp and crossing the path between the aorta and the pulmonary artery are associated with ischemia and sudden cardiac death. An increased prevalence of these cases may be attributed to diagnostic advances in computed tomographic angiography (CTA). We report a retrospective review of ten patients referred for surgical intervention from March 2008 to present. Nine patients were diagnosed with right coronary arteries arising from the left coronary cusp and one patient with a left coronary artery arising from the right coronary cusp. Seven patients were male and the median age was 40 years (range, 21 to 51). Symptoms included atypical chest pain, tachy-arrythmias, diaphoresis, and dyspnea on exertion. CTA demonstrated anomalous coronary arteries arising from the opposite coronary cusp and traveling between the aorta and the pulmonary artery. Surgical intervention was performed on all ten patients with no mortality and only one re-operation requiring bypass grafting. The sixth patient in the series had concomitant atherosclerotic disease, requiring left internal mammary artery grafting to the left anterior descending coronary artery. Cardiopulmonary bypass (CPB) was utilized with moderate hypothermia in all ten patients, with retrograde and/or coronary ostial cardioplegia administration. At routine surgical follow-up, all patients were without original presenting symptoms. Patients with anomalous coronary arteries arising from the opposite coronary cusp are at risk of acute myocardial infarction and sudden cardiac death. Surgical unroofing is a viable option for this patient population and avoids coronary artery bypass grafting. Since March 2008, we have operated on ten patients presenting with this anomaly and have had excellent short-term results. Further long-term follow-up is necessary. PMID:20515983

Resley, Justin; Burke, Ryan; Isbell, David; Tribble, Reid; Martin, Jeffery; Petit, Scott

2010-07-01

62

Cephalic veins in coronary artery bypass surgery  

Microsoft Academic Search

Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 43 distal anastomoses. When calculating patency by number of patent distal anastomoses, this was

P. E. Andersen; E. Jacobsen; G. Lerbjerg

1996-01-01

63

In vitro effects of L-carnitine on coronary artery bypass grafts  

PubMed Central

BACKGROUND: The gold standard treatment for multivessel coronary revascularization is coronary artery bypass grafting. The internal mammary artery and saphenous vein grafts are the conduits most frequently used for these operations. Spasm of arterial and venous grafts is a significant problem during the operation. OBJECTIVES: To evaluate the acute in vitro effects of L-carnitine on internal mammary artery and saphenous vein grafts using a tissue bath. METHODS: Ten consecutive patients who underwent elective coronary artery bypass grafting were enrolled in the present study (nine men, one woman; mean [± SD] age 62±9.1 years). Samples from left internal mammary artery and saphenous vein grafts were collected from each patient. Submaximal smooth muscle contraction was achieved by adding 1 ?M phenylephrine, and L-carnitine was then added to the solution. The concentration-response curves of the vasodilation response were obtained. RESULTS: In the internal mammary graft samples, the vasodilation response to L-carnitine was 64.3±11.1% at a concentration of 5 mM. In the saphenous vein graft samples, the vasodilation response to L-carnitine was 41.5±11.4% at a concentration of 5 mM. There was a statistically significant difference (P<0.001) between the response of the internal mammary artery and saphenous vein grafts in the in vitro tissue bath system. CONCLUSIONS: These results indicate that L-carnitine is a potential vasodilatory drug for internal mammary artery and saphenous vein grafts.

Guclu, Orkut; Yuksel, Volkan; Huseyin, Serhat; Ege, Turan; Canbaz, Suat; Sungun, Mutasim

2013-01-01

64

A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel  

Microsoft Academic Search

background Whether the glycoprotein IIb\\/IIIa inhibitor abciximab is beneficial in patients undergo- ing elective percutaneous coronary intervention after pretreatment with clopidogrel is unknown. methods We enrolled 2159 patients with coronary artery disease who underwent a percutaneous coronary intervention: 1079 patients were randomly assigned in a double-blind manner to receive abciximab and 1080 patients to receive placebo. All patients were pretreated

Adnan Kastrati; Julinda Mehilli; Helmut Schühlen

2004-01-01

65

Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting  

Microsoft Academic Search

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

1996-01-01

66

Computer-assisted telemanipulation: an enabling technology for endoscopic coronary artery bypass  

Microsoft Academic Search

Background. The ultimate objective of minimally invasive coronary artery bypass grafting is to perform the anastomosis totally endoscopically. In this feasibility study, we examined the potential of performing coronary artery bypass grafting with the use of computer-assisted telemanipulation technology.Methods. Intuitive Telemanipulation Technology (Intuitive Surgical, Mountain View, CA) was used to perform an arterial graft to left anterior descending coronary artery

Hani Shennib; Amr Bastawisy; Michael J Mack; Frederic H Moll

1998-01-01

67

Morphologic and functional evaluation of coronary artery bypass conduits.  

PubMed

There is clear evidence in the literature that conventional spin-echo and gradient-echo magnetic resonance imaging (MRI) is capable of assessing patency of coronary artery vein grafts. With more recently introduced breath-hold two-dimensional (2D) and contrast-enhanced 3D techniques, the predictive accuracy has further improved, with sensitivities and specificities in the 90% range. Limitations arise with regard to assessing obstructive disease and evaluating distal segments of sequential grafts, due to insufficient spatial resolution, low signal-to-noise ratio, and cardiac motion. Imaging of arterial grafts is complicated by the metallic clip artifacts. Adding information on graft flow patterns and flow reserve using velocity-encoded cine MRI may help to reduce some of the problems. Clinically, these functional measurements may become of use in non-invasive monitoring of gradually increasing graft narrowing. However, apart from a few exceptions, most patients undergo evaluation of their grafts because they are considered for a re-intervention by angioplasty or coronary artery bypass graft surgery. In these cases information on the status of the native coronary arteries is required. A broader clinical use of MRI in the evaluation of patients with coronary artery bypass grafts may therefore only be expected with further improvement in MR techniques for coronary angiography. J. Magn. Reson. Imaging 1999;10:734-740. PMID:10548783

van Rossum, A C; Bedaux, W L; Hofman, M B

1999-11-01

68

Endoscopic vein harvesting in coronary artery bypass surgery  

Microsoft Academic Search

Summary  BACKGROUND: Leg wound complications and infections after harvesting of the greater saphenous vein (GSV) in coronary artery\\u000a bypass surgery (CABG) represent a serious source of patient morbidity. Especially, in patients with obesity, diabetes and\\u000a peripheral vascular disease, severe wound complications with increased pain occur more often. METHODS: Our aim was to evaluate\\u000a the feasibility and the results of the endoscopic

S. Huber; P. Bergmann; S. Schweiger; H. Mächler; P. Oberwalder; B. Rigler

2007-01-01

69

Off-pump coronary artery bypass grafting in India  

PubMed Central

Off-pump Coronary Artery Bypass Grafting (OPCAB) is the latest innovation in cardiac surgery. However OPCAB is not adopted universally. Even there have been suggestions of abandoning OPCAB in a special report. In India, OPCAB has been successfully adopted across the board. There are various evidences which favor OPCAB and are discussed in this review. The purpose of this review is to put forward the perspective of the OPCAB surgeons of our country and critically look at the suggestion of abandoning OPCAB.

Saha, Kamales Kumar

2014-01-01

70

Validation of a Novel Clinical Prediction Score for Severe Coronary Artery Diseases before Elective Coronary Angiography  

PubMed Central

Objectives Coronary artery disease (CAD) severity is associated with patient prognosis. However, few efficient scoring systems have been developed to screen severe CAD in patients with stable angina and suspected CAD before coronary angiography. Here, we present a novel scoring system for CAD severity before elective coronary angiography. Methods Five hundred fifty-one patients with stable angina who were admitted for coronary angiography were enrolled in this study. Patients were divided into training (n?=?347) and validation (n?=?204) cohorts. Severe CAD was defined as having a Gensini score of 20 or more. All patients underwent echocardiography (ECG) to detect ejection fraction and aortic valve calcification (AVC). Multivariable analysis was applied to determine independent risk factors and develop the scoring system. Results In the training cohort, age, male sex, AVC, abnormal ECG, diabetes, hyperlipidemia, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were identified as independent factors for severe CAD by multivariable analysis, and the Severe Prediction Scoring (SPS) system was developed. C-indices of receiver operating characteristic (ROC) curves for severe CAD were 0.744 and 0.710 in the training and validation groups, respectively. The SPS system also performed well during calibration, as demonstrated by Hosmer-Lemeshow analysis in the validation group. Compared with the Diamond-Forrester score, the SPS system performed better for severe CAD prediction before elective coronary angiography. Conclusions Severe CAD prediction was achieved by analyzing age, sex, AVC, ECG, diabetes status, and lipid levels. Angina patients who achieve high scores using this predicting system should undergo early coronary angiography.

Qian, Ju-Ying; Ma, Jian-Ying; Ge, Jun-Bo

2014-01-01

71

Off-pump coronary artery bypass grafting: the Zurich experience.  

PubMed

Coronary artery bypass grafting (CABG) is the surgical procedure of choice for treatment of multi-vessel coronary artery disease. The rising risk profile of the patients requiring isolated CABG and the economic pressure have prompted us to devise new operative strategies to treat these patients. Elimination of the cardiopulmonary bypass is one possible answer to the dilemma of maintaining the quality of care and reducing the exploding costs of our health system. Therefore, we developed the off-pump coronary artery bypass grafting (OPCAB) for patients requiring isolated CABG. In our experience the key to successful OPCAB relies on the order of revascularization of the myocardial walls (anterior, inferior, lateral), use of intracoronary shunt, no-touch technique for the proximal aortic anastomosis with heart string â (Guidant, IN, USA), close collaboration with the anesthesiologists, early and aggressive administration of anti-platelet therapy, endoscopic vein harvest by perfusionists, and improved body temperature control. Following these concepts, we have been able to offer the OPCAB procedure to over 90% of our patients and to reduce perioperative morbidity and global costs. PMID:16112937

Tavakoli, R; Reuthebuch, O; Hofer, C; Grünenfelder, J; Genoni, M

2005-01-01

72

Outcomes and predictors of prolonged ventilation in patients undergoing elective coronary surgery†  

PubMed Central

OBJECTIVES Despite the seriousness of prolonged mechanical ventilation (PMV) as a postoperative complication, previously proposed risk prediction models were met with limited success. The purpose of this study was to identify perioperative variables associated with PMV in elective primary coronary bypass surgery. PMV was defined as the need for intubation and mechanical ventilation for >72 h, after completion of the operation. METHODS Between April 1997 and September 2010, 10 977 consecutive patients were retrospectively reviewed. A series of two multivariate logistic regression analyses were carried out to identify preoperative predictors of prolonged ventilation and the impact of operative variables. RESULTS PMV occurred in 215 (1.96%) patients; 119 (55.3%) of these underwent tracheostomy. At multivariate analysis, predictors included NYHA higher than class II (odds ratio [OR], 1.77; 95% confidence intervals [CI], 1.34–2.34), renal dialysis (OR, 5.5; 95% CI, 2.08–14.65), age at operation (OR, 1.04; 95% CI, 1.02–1.06), reduced FEV1 (OR, 0.99; 95% CI, 0.98–0.99), body mass index >35 kg/m2 (OR, 1.73; 95% CI, 1.14–2.63). On serial logistic regression analyses, operative variables added little to the discriminatory power of the model. Kaplan–Meier survival curves showed reduced survival among PMV patients (P < 0.001) with an improved survival in the tracheostomy subgroup. CONCLUSIONS PMV after coronary bypass is associated with a reduction in early and mid-term survival. Risk modelling for PMV remains problematic even when examining a more homogenous lower risk group.

Saleh, Hesham Z.; Shaw, Matthew; Al-Rawi, Omar; Yates, Jonathan; Pullan, D. Mark; Chalmers, John A.C.; Fabri, Brian M.

2012-01-01

73

Coronary-artery spasm after coronary artery bypass graft surgery without extracorporeal circulation: diagnostic and management.  

PubMed

Coronary artery spasm in perioperative of coronary artery bypass graft surgery is a serious complication, with high rate mortality. Patient 51 years-old submitted to coronary artery bypass graft surgery without Extracorporeal Circulation. The patient evolved in 1st post operative (PO) day with enzymatic alteration and ST-elevation, developing soon afterwards in ventricular fibrillation, defibrillation with success. Cardiac catheterization showed important spasm of all coronary arteries and anastomosis between the left internal thoracic artery and the left anterior interventricular artery. Intracoronary Vasodilators and intra-graft, with re-establishment of their usual and immediate calibers to improve clinic and Hemodynamic stability was used. Satisfactory evolution, discharged at 13rd PO day. PMID:21103752

Carneiro Neto, Joaquim David; Lima Neto, José Antonio de; Simões, Rosa Maria da Costa; Stolf, Noedir Antonio Groppo

2010-01-01

74

Pylorus-preserving pancreaticoduodenectomy after coronary artery bypass grafting using right gastroepiploic artery.  

PubMed

Coronary artery bypass grafting using right gastroepiploic artery and pylorus-preserving pancreaticoduodenectomy are both well known and commonly performed procedures independently. However, pylorus-preserving pancreaticoduodenectomy after coronary artery bypass grafting using right gastroepiploic artery has not been reported in the literature. We report the first case with operative demonstration of pylorus-preserving pancreaticoduodenectomy in a patient who had undergone coronary artery bypass grafting using an in situ right gastroepiploic artery graft. PMID:24694430

Fukuhara, Shinichi; Montgomery, Marissa; Ikoma, Naruhiko; Miyata, Ryohei

2014-04-01

75

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis  

PubMed Central

Objectives: Atherosclerosis has been identified as a risk factor for both morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG). To investigate outcomes following CABG for severe atherosclerosis, and to determine whether different surgical techniques can reduce the risk of neurologic events in these patients. Methods: We studied 225 consecutive patients who underwent elective isolated CABG. Routine preoperative and intraoperative examinations identified patients with severe atherosclerosis. We compared the outcomes between patients with (group A; 42 ceses) and those without (group N; 183 cases) severe atherosclerosis. Results: 36 patients (85.7%) in group A and 176 (96.2%) in group N underwent off-pump coronary artery bypass (OPCAB); 6 (14.3%) in group A and 7 (3.8%) in group N underwent on-pump beating CABG. Three patients in group A suffered deep sternal infection (7.1%), and one suffered stroke (2.4%) compared with none in group N. No cerebral infarction or neurologic events occurred in patients who underwent OPCAB (n = 212, 94.2%). Conclusions: Prevalence of complications was significantly greater among patients with severe atherosclerotic disease who underwent OPCAB than in those without atherosclerotic disease. Careful selection of surgical strategies can prevent perioperative stroke and reduce mortality.

Kanemitsu, Shinji; Tanabe, Sawaka; Ohue, Kensuke; Miyagawa, Hiroyuki; Miyake, Yoichiro; Okabe, Manabu

2011-01-01

76

Predictors of Atrial Arrhythmias for Patients Undergoing Coronary Artery Bypass Grafting.  

National Technical Information Service (NTIS)

Coronary artery bypass grafting (CABG) is a commonly used and effective procedure to treat coronary artery disease. Atrial arrhythmias are common after CABG. The purpose of this descriptive study was to identify demographic, preoperative, intraoperative, ...

M. J. DeJong

1996-01-01

77

Coronary artery bypass grafting supported with intracardiac microaxial pumps versus normothermic cardiopulmonary bypass: a prospective randomized trial  

Microsoft Academic Search

Objective: To analyze the difference in coronary artery bypass grafting (CABG) performed with normothermic cardiopulmonary bypass (CPB) and CABG supported with the intracardiac microaxial pump (ICP, Impella, Aachen, Germany). Methods: A prospective randomized study was conducted in seven centers. The study population consists of 199 patients undergoing isolated primary CABG (CPB group 94 patients, ICP group 105 patients). Both groups

B Meyns; R Autschbach; A Böning; W Konertz; K Matschke; F Schöndube; K Wiebe; E Fischer

2002-01-01

78

Value of tomographic thallium-201 imaging in patients with chest pain following coronary artery bypass grafting  

SciTech Connect

To determine whether thallium-201 washout profile analysis can detect regional myocardial ischemia caused by coronary artery bypass graft occlusion or progression of disease in nonbypassed coronary arteries, 19 consecutive patients with chest pain following bypass grafting were evaluated with coronary arteriography and thallium-201 scintigraphy. Twenty of the 55 coronary artery regions were perfused by an occluded bypass graft or a significantly stenosed (greater than or equal to 70% diameter narrowing) nonbypassed coronary artery, while 35 coronary regions were perfused by patent bypass grafts or insignificantly diseased coronary arteries. The tomographic thallium-201 washout profile results correlated with the bypass graft and coronary arteriographic findings. The sensitivity of tomographic thallium-201 washout profile abnormalities for arteriographic abnormalities was 75%, while the specificity was 86%. The authors conclude that tomographic thallium-201 washout profile analysis may be very useful in the evaluation of patients with chest pain following coronary artery bypass grafting by detecting regional myocardial ischemia caused by occlusion of specific bypass grafts or progression of disease in nonbypassed coronary arteries.

Starling, M.R.; Walsh, R.A.; Dehmer, G.J.; Lasher, J.C.; Blumhardt, R.

1987-02-01

79

Factor XI deficiency: incidental diagnosis post coronary artery bypass graft.  

PubMed

Severe Factor XI (FXI) deficiency is defined when the activated partial thromboplastin time is prolonged and its activation is <1-15 UdL(-1) in plasma. It is inherited as an autosomal recessive trait but can be acquired. In severe deficiency the bleeding diathesis is normally injury related. This particularly occurs during surgical procedures and trauma involving tissues rich in fibrinolytic activators. Cardiopulmonary bypass induces transient abnormalities in haemostasis which can cause a postoperative bleeding diathesis. Once treated, it does not appear to be a contraindication to cardiac procedures. Conversely, acquired deficiencies are more insidious being incidentally diagnosed during routine laboratory investigations and might be triggered by an inhibitory agent. We present a case of an uncomplicated 12-month delayed diagnosis of Factor XI deficiency following coronary artery bypass grafting and sternal rewiring. The potential risks if undiagnosed and the uncharacteristic clinical history of our case are discussed. PMID:24419230

Lammy, Simon; Pessotto, Renzo

2014-02-01

80

Suppression of renin production in patients undergoing coronary artery bypass.  

PubMed

Twenty patients undergoing elective myocardial revascularization for coronary insufficiency were divided into two equal groups. In 10 patients, propranolol was discontinued 24 hours before operation while the remaining patients received propranolol until the day of operation. Plasma renin was elevated in the intensive care unit in the control group (p < 0.05) whereas patients receiving propranolol did not demonstrate significant elevation of plasma renin. Systemic vascular resistance was elevated in both groups in the intensive care unit (p < 0.05) and was associated with hypertension as defined by a blood pressure of greater than or equal to 160/100 mm Hg in 80% of the control patients and 70% of patients receiving propranolol. We conclude from this study that renin metabolism does not contribute significantly to the production of hypertension following coronary artery operation. PMID:7008725

Landymore, R W; Murphy, D A; Kinley, E; Parrott, J; Sai, O; Quirbi, A A

1980-12-01

81

[Percutaneous coronary intervention versus bypass surgery in patients with diabetes and multivessel coronary disease : Coronary revascularization after FREEDOM].  

PubMed

Is coronary revascularization required in a patient with chronic stable coronary artery disease or can optimized medical therapy (OMT) alone be a sufficient alternative? This question has been controversially discussed for non-diabetics as well as for diabetics since the COURAGE and BARI 2D trials. According to our present knowledge, a patient will benefit from coronary revascularization only when either a non-invasive test method, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial scintigraphy, stress echocardiography or stress nuclear magnetic resonance imaging, can detect relevant, objective evidence of ischemia >10% of the left ventricular myocardium or when a pathological fractional flow reserve (FFR) <0.80 can be measured in an invasive procedure for an angiographically detectable coronary stenosis. If similar relevant ischemia can be non-invasively or invasively objectified in a patient with chronic stable multivessel coronary artery disease, the often controversially discussed question arises particularly in diabetics whether a percutaneous coronary intervention (PCI) with implantation of drug-eluting stents or coronary artery bypass surgery should be favored. The FREEDOM study (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease), published in November 2012, was the first prospective randomized study to examine this issue in diabetic patients with multivessel coronary artery disease. Despite a higher rate of stroke in the surgical cohort, after an average follow-up time of 3.8 years a significant prognostic advantage in favor of bypass surgery was detected for a combined primary endpoint of all-cause mortality, nonfatal myocardial infarction and nonfatal stroke. Thus, in the new ESC guidelines on diabetes, pre-diabetes and cardiovascular diseases developed with the EASD of the European Society of Cardiology and published in 2013, coronary bypass surgery has a class I, level of evidence A recommendation for patients with diabetes mellitus, chronic stable multivessel coronary disease and a synergy between PCI with taxus and cardiac surgery (SYNTAX) score >22. The decision for or against a PCI/stent implantation or coronary bypass surgery in a diabetic patient with chronic stable multivessel coronary artery disease should therefore be made with the patient only after a detailed informed consent discussion and comprehensive explanation of both treatment options. In controversial cases, particularly with an equivocal SYNTAX score around 22, relevant comorbidities or anticipated method-specific complications, a one-stage ad hoc intervention during the diagnostic coronary angiography should be rejected in favor of a two-stage procedure with prior discussion of both treatment options in the heart team comprising noninvasive cardiologists, interventional cardiologists and cardiac surgeons. PMID:24740094

Dörr, R; Stumpf, J; Dalibor, J; Simonis, G; Spitzer, S G

2014-05-01

82

Endoscopic radial artery harvesting procedure for coronary artery bypass grafting  

PubMed Central

Development and adoption of endoscopic minimally invasive saphenous vein harvesting prompted its application to the radial artery in an effort to minimize surgical trauma. Recently, we reported that endoscopic radial artery harvesting was associated with better wound appearance and it proved to be safe and effective, with less pain and fewer wound complications than the open surgical technique. Based on this positive experience, our institution adopted endoscopic radial artery harvesting, hence the aim of this manuscript is to describe the minimally invasive endoscopic radial artery harvesting for coronary artery bypass grafting.

Olivares, Gabriel; Ehasz, Paul; Gillinov, A. Marc; Svensson, Lars G.; Brozzi, Nicolas; Lytle, Bruce

2013-01-01

83

Off-pump coronary artery bypass grafting in India.  

PubMed

Off-pump Coronary Artery Bypass Grafting (OPCAB) is the latest innovation in cardiac surgery. However OPCAB is not adopted universally. Even there have been suggestions of abandoning OPCAB in a special report. In India, OPCAB has been successfully adopted across the board. There are various evidences which favor OPCAB and are discussed in this review. The purpose of this review is to put forward the perspective of the OPCAB surgeons of our country and critically look at the suggestion of abandoning OPCAB. PMID:24814116

Saha, Kamales Kumar

2014-01-01

84

Glycemic Control during Coronary Artery Bypass Graft Surgery  

PubMed Central

Hyperglycemia, which occurs in the perioperative period during cardiac surgery, has been shown to be associated with increased morbidity and mortality. The management of perioperative hyperglycemia during coronary artery bypass graft surgery and all cardiac surgical procedures has been the focus of intensive study in recent years. This report will paper the pathophysiology responsible for the detrimental effects of perioperative hyperglycemia during cardiac surgery, show how continuous insulin infusions in the perioperative period have improved outcomes, and discuss the results of trials designed to determine what level of a glycemic control is necessary to achieve optimal clinical outcomes.

Lazar, Harold L.

2012-01-01

85

Coronary artery bypass grafting in female patients on Thyroxine replacement  

Microsoft Academic Search

Background  Female gender and hypothyroidism are considered independent risk factors for mortality following CABG. The dysfunctional thyroid\\u000a gland has profound impact on the cardiovascular system.\\u000a \\u000a \\u000a \\u000a Method  We investigated the thirty day mortality of female patients undergoing CABG between 1999–2003 to identify if thyroxin replacement\\u000a therapy amongst other variables affected outcome. A total of 1545 patients underwent coronary artery bypass grafting of which

Abdul Karim Rafeeq; Sadasivan Rajagopal; Joshua Suresh Kumar; Bafana Mahendra; Suresh Ganngadharan Nair; Shiv Kumar Nair

2005-01-01

86

Endoscopic lesser saphenous vein harvesting for coronary artery bypass grafting: first reported case.  

PubMed

Endoscopic vessel harvesting has become a widely used modality for harvesting venous and arterial conduits for coronary artery bypass grafting. Specifically, it has been used to harvest the greater saphenous vein, internal thoracic artery, and the radial artery. A case of endoscopic lesser saphenous vein harvesting for coronary artery bypass grafting is reported. PMID:22436552

Nickum, Christopher W; Dullum, Mercedes Kc; Boyd, W Douglas; Gray, Dana R

2005-01-01

87

Modified Brown-Séquard syndrome following coronary artery bypass graft: case report  

Microsoft Academic Search

A 75 year old man underwent a triple coronary artery bypass graft performed with intra-aortic balloon pump assistance. Left leg weakness developed on the first postoperative day, progressive worsening occurred over the next 2½ weeks, finally culminating in a modified Brown-Séquard pattern of deficit. No etiology was found. Previous reports of spinal cord injury following coronary artery bypass graft are

M H Gottesman; Ibrahim Saraya; Franesco Tenti

1992-01-01

88

C-Type Natriuretic Peptide Relaxes Human Coronary Artery Bypass Grafts Preconstricted by Endothelin1  

Microsoft Academic Search

Background. Endothelin is implicated in graft spasm after coronary artery bypass grafting. We assessed rever- sal by the endothelium-derived vasodilator C-type natri- uretic peptide of prior contraction of radial artery and other vessels commonly used for coronary artery bypass surgery. Methods. Segments of human radial artery, saphenous vein, and internal mammary artery were mounted in organ baths after removal from

Christopher J. Kelsall; Adrian H. Chester; Mohammed Amrani; Donald R. J. Singer

2005-01-01

89

Quality of Life Improvement after Robotically Assisted Coronary Artery Bypass Grafting  

Microsoft Academic Search

Objectives: Coronary artery bypass grafting (CABG) is associated with long rehabilitation periods and slow quality of life (QOL) improvement. Totally endoscopic coronary artery bypass grafting (TECAB) can be performed using robotic technology and remote access perfusion. The aim of this study was to evaluate whether TECAB leads to accelerated QOL improvement as compared to standard CABG. Methods: We included 120

Nikolaos Bonaros; Thomas Schachner; Dominik Wiedemann; Armin Oehlinger; Elisabeth Ruetzler; Gudrun Feuchtner; Christian Kolbitsch; Corinna Velik-Salchner; Guy Friedrich; Othmar Pachinger; Guenther Laufer; Johannes Bonatti

2009-01-01

90

Extended resection of a chest wall desmoid tumour with concomitant coronary artery bypass grafting  

Microsoft Academic Search

We report on the resection of a large desmoid tumour of the anterior chest wall in a 65-year-old male patient. The patient had a coronary artery bypass operation 2 years prior to the first detection of a tumour. Because the left internal mammary artery bypass to the left anterior descending coronary artery (LAD) was embedded in the tumour mass, it

Martin Kostolny; Heinz Präuer; Norbert Augustin; Rüdiger Lange

2001-01-01

91

Extended resection of a chest wall desmoid tumour with concomitant coronary artery bypass grafting  

Microsoft Academic Search

We report on the resection of a large desmoid tumour of the anterior chest wall in a 65-year-old male patient. The patient had a coronary artery bypass operation 2 years prior to the first detection of a tumour. Because the left internal mammary artery bypass to the left anterior descending coronary artery (LAD) was embedded in the tumour mass, it

Martin Kostolny Jr; Heinz Prauer; Norbert Augustin

92

Current status of arterial grafts for coronary artery bypass grafting  

PubMed Central

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.

2013-01-01

93

Current status of arterial grafts for coronary artery bypass grafting.  

PubMed

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

Taggart, David P

2013-07-01

94

Coronary artery bypass grafting without cardiopulmonary bypass and without interruption of native coronary flow using a novel anastomosis site restraining device (“Octopus”)  

Microsoft Academic Search

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. Bredée

1996-01-01

95

Carotid stenosis and peripheral artery disease in Japanese patients with coronary artery disease undergoing coronary artery bypass grafting.  

PubMed

The combination of a change in lifestyle toward Western habits and an aging society, has led to a steady increase in the incidence of atherosclerotic diseases in the Japanese population. Coronary artery disease (CAD), carotid stenosis (CS), and peripheral artery disease (PAD) are major manifestations of generalized atherosclerosis and increase the risk of cardiovascular events. However, the incidence of CS and PAD in Japanese patients with CAD is not well known, so the present study investigated this in 380 consecutive patients with CAD undergoing elective coronary aorta bypass grafting (CABG) at Kishiwada Tokushukai Hospital between October 1999 and October 2001. The coexistence of CS and PAD in all patients was preoperatively evaluated by duplex ultrasonography and the ankle - brachial index (ABI). The average age of the study population was 66.09.1 years (range, 42-87). The number of male patients was 293 (77.1%). The incidence of CS was 13.7% and 15.3% for PAD. Multivariate logistic regression analysis demonstrated that no particular traditional atherosclerotic risk factor, such as hypertension, hyperlipidemia, diabetes mellitus, and smoking, was able to predict either CS or PAD, but CS and PAD were independent predictors of each other. The results of the study suggest that CS and PAD were not only highly prevalent but also strongly associated with each other in this cohort of CAD patients. Accordingly, extracoronary atherosclerotic disease should be assessed in Japanese CAD patients. PMID:14639014

Kawarada, Osami; Yokoi, Yoshiaki; Morioka, Nobuyuki; Nakata, Shinji; Higashiue, Shinichi; Mori, Toshifumi; Iwahashi, Masahiro; Hatada, Atsutoshi

2003-12-01

96

Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery  

Microsoft Academic Search

Objective: Obese patients are usually thought to have an increased risk for complications in coronary artery bypass surgery. Methods: Therefore, the data of 500 consecutive patients undergoing coronary artery bypass grafting at our department in 1998 by use of cardiopulmonary bypass were analyzed. Severe obesity was defined as body mass index (BMI) ?30.0 kg\\/m2. Obese patients (n=100; group O) were

Michael Brandt; Kristina Harder; Knut P. Walluscheck; Jan Schöttler; Aziz Rahimi; Frank Möller; Jochen Cremer

2001-01-01

97

Gastroepiploic artery graft in coronary artery bypass grafting  

PubMed Central

The right gastroepiploic artery (GEA) has been recognized as a suitable and reliable conduit for coronary bypass surgery. From a sizable number of experiences, we know the use of this artery does not increase surgical risk, and no gastric ischemia nor abdominal complications occur with takedown of the GEA. This artery undergoes less significant arteriosclerosis and demonstrates physiological adaptability as seen in the internal thoracic artery (ITA). From our experience with over 1,500 GEA grafts, the operative mortality was 1.26%, and 5-, 10-, and 15-year survival rates were 91.7%, 81.4%, and 71.3% respectively, while the cardiac death-free survival rates were 95.8%, 91.7%, and 88.6%, respectively. The cumulative patency rate of the GEA graft was 98.5% at 1 month, 93.7% at 1 year, 86.2% at 5 years, and 70.2% at 10 years. The GEA graft is a safe and effective arterial conduit for coronary artery bypass grafting (CABG).

2013-01-01

98

The enabler right ventricular circulatory support system for beating heart coronary artery bypass graft surgery  

Microsoft Academic Search

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; André L Dekker; Frederik H van der Veen; Audrey A Cramers; Jos G Maessen; David Shoshani; Kees B Prenger

1999-01-01

99

Off-Pump Coronary Bypass Grafting Causing Stunned Myocardium  

PubMed Central

The term “stunned myocardium” refers to abnormalities in the myocardial function following reperfusion and is common in on-pump coronary artery bypass grafting (CABG) and is exceedingly rare in off- pump CABG. A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery (LAD) and the obtuse marginal. Laboratory findings and Chest X-ray revealed nothing abnormal. The intraoperative course was uneventful. The patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output. At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. Cardiac enzymes were normal. High-dose adrenalin and Dobutamine were administrated and an intra-aortic balloon pump was used. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, coronary angiography showed patent grafts and correct anastomotic sites. On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally after hospital discharge on the thirtieth postoperative day, an echocardiogram showed normal left ventricular function without regional wall motion abnormalities.

Sabzi, Feridoun; Hemati, Naser; Zokaei, Abdoul Hamid; Moradi, Gholamreza; Dabiri, Samsam

2012-01-01

100

Cardiac Compression of Lung Lower Lobes after Coronary Artery Bypass Graft with Cardiopulmonary Bypass  

PubMed Central

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.

Neves, Flavio H.; Carmona, Maria J.; Auler, Jose O. C.; Rodrigues, Roseny R.; Rouby, Jean Jacques; Malbouisson, Luiz M. S.

2013-01-01

101

Perioperative ischemic injury after coronary bypass graft surgery  

SciTech Connect

Two hundred twelve patients who underwent isolated coronary bypass graft surgery were prospectively evaluated for perioperative ischemic injury. All patients underwent preoperative and postoperative testing with technetium 99m pyrophosphate first-pass ventriculography combined with myocardial uptake scans, 12-lead electrocardiography, and serial creatinine phosphokinase MB determination. Fifteen percent of the patients had ischemic injury with at least two test results positive, but only 4 percent had positive results of all three tests. No single test proved adequate. Enzyme levels were highly sensitive and had value as a screening test. The electrocardiogram was specific but only moderately sensitive. The single best test was the radionuclide scan with good sensitivity and no false-positive results. All three tests are required to rigorously diagnose ischemic injury.

Li, W.; Hanelin, L.G.; Riggins, R.C.; Agnew, R.C.; Annest, L.S.; Anderson, R.P.

1985-07-01

102

Effects of Cardiopulmonary Bypass on Propofol Pharmacokinetics and Bispectral Index During Coronary Surgery  

PubMed Central

PURPOSE Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass. METHODS Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10) or off-pump coronary artery bypass graft (group, n=10) coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 ?g/mL). Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p<0.05 as significant. RESULTS After cardiopulmonary bypass, despite similar plasma propofol concentrations in both groups, bispectral index values were lower in the on-pump coronary artery bypass graft group. Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 ± 117 vs. 216 ± 85 min, p = 0.04). Patients undergoing cardiopulmonary bypass had shorter biological (1.82 ± 0.5 vs. 3.67 ± 1.15h, p < 0.01) and terminal elimination (6.27 ± 1.29 vs. 10.5h ± 2.18, p < 0.01) half-life values, as well as higher total plasma clearance (28.36 ± 11.40 vs.18.29 ± 7.67 mL/kg/min, p = 0.03), compared to patients in the off-pump coronary artery bypass graft group. CONCLUSION Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

Barbosa, Ricardo Antonio G.; Jorge Santos, Silvia Regina C.; White, Paul F.; Pereira, Valeria A.; Silva Filho, Carlos R.; Malbouisson, Luiz M. S.; Carmona, Maria Jose C.

2009-01-01

103

The influence of general health status and social support on symptomatic outcome following coronary artery bypass grafting  

PubMed Central

OBJECTIVES—To assess health status, level of social support, and presence of coronary artery disease risk factors before and after coronary artery bypass grafting (CABG); to assess symptomatic relief approximately 12 months postoperatively; and to examine the association between preoperative health status and recurrence of symptoms.?DESIGN—Observational study.?SETTING—Preoperatively, in hospital outpatient department (1995-1996); postoperatively, at home (1996-97).?SUBJECTS AND METHODS—Patients awaiting elective CABG were recruited one month before the expected date of operation. Preoperative assessment included severity of symptoms, coronary artery disease risk factors, short form 36 (SF-36) questionnaire, and social activities questionnaire. The presence and severity of angina and breathlessness were reported postoperatively (mean 16.4 months). Multiple regression analysis was used to identify factors associated with improved outcome following CABG.?MAIN OUTCOME MEASURE—Patient reported presence and severity of angina and breathlessness.?RESULTS—183 patients were followed for a mean of 16.4 months after CABG. Angina and breathlessness were completely relieved in 55% and 36% of patients, respectively. In patients with residual symptoms, the severity was significantly reduced (angina p < 0.001; breathlessness, p = 0.02). Patients with low SF-36 scores and low social network scores preoperatively were less likely to be relieved of symptoms (p < 0.001). Health status and social support levels preoperatively were lower than in other reported coronary artery disease patients groups. Preoperatively, coronary artery disease risk factors were higher than recommended in current guidelines: 67.4% had raised plasma cholesterol, 39.0% were hypertensive, 80% were moderately obese, and 22.9% were smokers.?CONCLUSIONS—Recurrence of symptoms exceeded other published studies. Patients' perception of general health, symptoms, and social support influences outcome.???Keywords: health status indicator; coronary artery bypass; social support; risk factors

Lindsay, G; Smith, L; Hanlon, P; Wheatley, D

2001-01-01

104

Laser Doppler imaging of myocardial perfusion during coronary bypass surgery  

NASA Astrophysics Data System (ADS)

Laser Doppler perfusion imaging has been used to assess the myocardium perfusion on the arrested heart during bypass surgery. Twenty-two patients undergoing coronary artery bypass grafting, including usage of the left internal thoracic artery, were included in the study. The anticipated perfusion increase following declamping of the internal thoracic artery was investigated by mapping areas at the size of 10 cm X 11 cm, (n equals 11) and 7 cm X 5 cm (n equals 11). The larger images allowed quantification of blood flow in different regions of the myocardium. The size of the affected area was 32.2 +/- 12.9 cm2 with a total increase of 3.17 +/- 0.75 a.u. (range 0 - 10 a.u.). Corresponding values for areas surrounding the vessels and areas defined as the larger vessels in the myocardium were 29.0 +/- 10.9 cm2 (2.85 +/- 0.57 a.u.) and 3.5 +/- 2.8 cm2 (6.78 +/- 0.18 a.u.). All subjects but two showed a substantial blood flow increase (> 2 a.u.) after release of the clamp. Six subjects had a total increase of at least 4 a.u. Correlation analysis between areas including various number of sites showed an r equals 0.91 (p < 0,0001) or better. In conclusion, laser Doppler perfusion imaging can easily be used intraoperatively in conjunction with bypass surgery. It enables immediate assessment of both the increase and spatial distribution of myocardial perfusion following declamping of an arterial graft.

Wardell, Karin; Hermansson, Ulf; Nilsson, Gert E.; Casimir-Ahn, Henrik

2000-05-01

105

Value of Magnetic Resonance Imaging for the Noninvasive Detection of Stenosis in Coronary Artery Bypass Grafts and Recipient Coronary Arteries  

Microsoft Academic Search

Background—Magnetic resonance imaging (MRI) is a potential noninvasive diagnostic tool to detect coronary artery bypass graft stenosis, but its value in clinical practice remains to be established. We investigated the value of MRI in detecting stenotic grafts, including recipient vessels. Methods and Results—We screened for inclusion 173 consecutive patients who were scheduled for coronary angiography because of recurrent chest pain

Susan E. Langerak; Hubert W. Vliegen; J. Wouter Jukema; Patrik Kunz; Aeilko H. Zwinderman; Hildo J. Lamb; Ernst E. van der Wall; Albert de Roos

2010-01-01

106

Does isoflurane optimize myocardial protection during cardiopulmonary bypass?  

Microsoft Academic Search

Objective: To investigate the possible myocardial protective effect of isoflurane during aortic cross-clamp and cardioplegic cardiac arrest in patients undergoing conventional coronary artery bypass graft surgery. Design: Prospective, randomized. Setting: University medical center. Participants: Forty-nine patients undergoing elective coronary artery bypass graft surgery divided into 2 groups: control group (n = 21) and isoflurane group (n = 28). Intervention: Isoflurane

Sania Haroun-Bizri; Samar S. Khoury; Imad Rachid Chehab; Chadi M. Kassas; Anis Baraka

2001-01-01

107

Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention  

Microsoft Academic Search

Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used.

Jurriën M ten Berg; HW Thijs Plokker; Freek WA Verheugt

2001-01-01

108

Is totally endoscopic coronary artery bypass safe, feasible and effective?  

PubMed Central

A best evidence topic was written according to a structured protocol. The question addressed was whether totally endoscopic coronary artery bypass (TECAB) is safe, effective and feasible. A total of 171 papers were found, of which eight represented the best evidence. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The da Vinci robotic system was utilized in seven retrospective studies and one multicentre prospective trial, comprising 724 patients undergoing TECAB. Patient-related outcomes, including the incidence of major adverse cardiac events, graft patency and survival, were investigated. From the studies evaluated, TECAB appears to be safe operation with low complication rates and excellent early- and mid-term graft patencies. The incidence of internal thoracic artery injury was documented in four studies and ranged from 0 to10%. Re-exploration for bleeding was necessary in 1–15% of patients. Conversion to open techniques was performed in 0–24% of cases. There was no in-hospital mortality in the majority of studies, but this reached 2.1% in a large series of 228 patients. Target-vessel reintervention rates varied between 0 and 12.1% according to the institutional experience. Pre- and post-discharge graft patencies were excellent at 93–100 and 92–100%, respectively. Intraoperative variables, such as time taken for internal thoracic artery harvest, anastomosis, cross-clamp, cardiopulmonary bypass (CPB) and the overall operation were as follows: internal thoracic artery harvest time (range 5–187 min), anastomosis time (range 6–82 min), cross-clamp time (range 30–223 min), CPB time (range 41–268 min) and operative time (range 84–600 min). TECAB is a technically demanding and time-consuming procedure associated with a significant learning curve. Proctoring and structured training programmes are currently supported by European and international societies to encourage wider uptake of the procedure. In conclusion, TECAB represents a feasible alternative to conventional coronary artery bypass in selected patients. It is associated with low morbidity and excellent mid-term graft patency. Larger, prospective and multicentre trials are required to assess the long-term and patient-reported outcomes of TECAB.

Acharya, Metesh Nalin; Ashrafian, Hutan; Athanasiou, Thanos; Casula, Roberto

2012-01-01

109

Carbon dioxide embolism during endoscopic saphenous vein harvesting in coronary artery bypass surgery  

Microsoft Academic Search

ObjectivesOur objectives were to determine the incidence and severity and the time course of the CO2 embolism during endoscopic saphenous vein harvesting with CO2 insufflation in coronary artery bypass surgery with transesophageal echocardiography monitoring.

Tzu-Yu Lin; Kuan-Ming Chiu; Ming-Jiuh Wang; Shu-Hsun Chu

2003-01-01

110

Learning by Doing: Productivity Gains for Surgeons Performing CABGs (Coronary Artery Bypass Graft).  

National Technical Information Service (NTIS)

Technological improvements and other factors are believed to have reduced the time and effort required by surgeons to perform certain surgical procedures such as coronary artery bypass graft (CABG) surgery. However, there have been no time-series regressi...

J. B. Mitchell J. Cromwell W. B. Stason J. Posner

1988-01-01

111

Alterations in Sympathetic Nervous System Activity with Intraoperative Hypothermia during Coronary Artery Bypass Surgery.  

National Technical Information Service (NTIS)

To determine how intraoperative hypothermia associated with coronary artery bypass surgery (CABS) alters sympathetic nervous system (SNS) activity, we prospectively studied 21 adult CABS patients and measured preoperative, intraoperative, and postoperativ...

H. L. Reed B. Chernow C. R. Lake G. P. Zaloga M. A. Stoiko

1989-01-01

112

78 First year experience of a dedicated “radial lounge” for patients undergoing elective percutaneous coronary procedures  

Microsoft Academic Search

IntroductionThe potential to achieve safe early mobilisation and same day discharge on a consistent basis after radial artery access has provided us with the opportunity to make a step change in the way we deliver elective care to patients undergoing percutaneous coronary procedures. We designed a dedicated “radial lounge” to accommodate patients before and after their procedure with the aim

S Brewster; R Weerackody; K Khimdas; A Little; N Cleary; A Penswick; M Rothman; A Archbold

2011-01-01

113

Technical aspects of total revascularization in off-pump coronary bypass via sternotomy approach  

Microsoft Academic Search

Background. Cardiopulmonary bypass and cardioplegic arrest result in known physiologic inflammatory, coagulopathic, and embolic states that may result in end-organ damage. Interest in off-pump complete coronary revascularization using sternotomy exposure is therefore increasing.Methods. Using specific surgical and anesthetic techniques, we have been able to achieve total revascularization using off-pump coronary artery bypass grafting procedures (OP-CAB) through a sternotomy approach. Exposure

Fritz J. Baumgartner; Ali Gheissari; Eli R. Capouya; George P. Panagiotides; Alireza Katouzian; Taro Yokoyama

1999-01-01

114

Safety and efficacy of off-pump coronary artery bypass grafting  

Microsoft Academic Search

Background. We evaluated the application of the off-pump coronary artery bypass (OPCAB) procedure relative to safety and efficiency as measured by operative mortality postoperative complications and longitudinal outcome.Methods. Three hundred and fifty OPCAB patients were compared to 3,171 on-pump or conventional coronary artery bypass (CCAB) patients between January 1, 1997 and December 31, 1998. The groups were divided into three

Kit V Arom; Thomas F Flavin; Robert W Emery; Vibhu R Kshettry; Patricia A Janey; Rebecca J Petersen

2000-01-01

115

Renin–angiotensin system and haemostasis gene polymorphisms and outcome after coronary artery bypass graft surgery  

Microsoft Academic Search

BackgroundCoronary artery bypass graft surgery is associated with a considerable 2-year mortality rate. Gene polymorphisms of the renin–angiotensin system may be associated with the risk of hypertension and cardiovascular disease. The angiotensin I-converting enzyme DD genotype has recently been identified as independent predictor of the outcome after coronary artery bypass graft surgery. Genetic factors of the clotting system may be

Henry Völzke; Volker Kleine; Daniel M. Robinson; Rita Grimm; Sabine Hertwig; Christian Schwahn; Lothar Eckel; Rainer Rettig

2005-01-01

116

The Efficacy of Supplemental Magnesium in Reducing Atrial Fibrillation After Coronary Artery Bypass Grafting  

Microsoft Academic Search

Background. Atrial fibrillation after coronary artery bypass is reported from 17% to 53%. Hypomagnesemia after this surgery is considered a contributing factor. Methods. Two hundred-two coronary bypass patients were randomized to magnesium (n 105) or placebo (n 97). The experimental group received 80-mg magne- sium sulfate per kilogram ideal weight in 100 mL dex- trose 5% water 30 minutes preoperatively.

Stephen R. Hazelrigg; Theresa M. Boley; Ibrahim B. Cetindag; Kreigh P. Moulton; Gary L. Trammell; Joan E. Polancic; Tilitha S. Shawgo; Jacquelyn A. Quin; Stephen Verhulst

117

Phlegmasia Cerulea Dolens after Coronary Artery Bypass Surgery: What Should We Know  

PubMed Central

Phlegmasia cerulea dolens (PCD) is one of the most critical disorders of acute deep vein thrombosis in that it can cause permanent disability secondary to the compartment syndrome. Although several etiological factors have been proposed, PCD after coronary artery bypass surgery is extremely rare and its definitive pathophysiology is still under debate. We herein present a case of PCD that resulted in the compartment syndrome after coronary artery bypass surgery. Early recognition and decompression of PCD are crucial for saving the affected limbs.

Lee, Kang-Hoon; Park, Hyun-Suk

2014-01-01

118

Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency  

Microsoft Academic Search

Background. Preoperative renal insufficiency is a predictor of acute renal failure in patients undergoing conventional coronary artery bypass grafting. Off-pump coronary artery bypass operations have been shown to reduce renal dysfunction in patients with normal renal function, but the effect of this technique in patients with preoperative nondialysis-dependent renal insufficiency is unknown.Methods. From June 1996 to December 1999, data of

Raimondo Ascione; Guy Nason; Sharif Al-Ruzzeh; Chung Ko; Franco Ciulli; Gianni D Angelini

2001-01-01

119

Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery  

Microsoft Academic Search

Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery.BackgroundMore than 600,000 coronary artery bypass graft (CABG) procedures are done annually in the United States. Some data indicate that 10 to 20% of patients who are undergoing a CABG procedure have a serum creatinine of more than 1.5 mg\\/dl. There are few data on the impact of a

ROBERT J. ANDERSON; MAUREEN O'BRIEN; SAMANTHA MAWHINNEY; CATHERINE B. VILLANUEVA; THOMAS E. MORITZ; GULSHAN K. SETHI; WILLIAM G. HENDERSON; KARL E. HAMMERMEISTER; FREDERICK L. GROVER; A. LAURIE SHROYER

1999-01-01

120

Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting  

Microsoft Academic Search

Background. The aim of the present study was to evaluate potential myocardial protection by trimetazidine by measurement of the cardiac marker protein troponin T (TnT) during coronary bypass operations.Methods. We conducted a double-blind, placebo-controlled study on 30 randomized patients who had aorta-coronary artery bypass operations. The TMZ group was composed of 15 patients and the placebo group of 15 patients

Bülent Tünerir; Ömer Çolak; Özkan Alata?; Yavuz Be?o?ul; Tu?rul Kural; Recep Aslan

1999-01-01

121

Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation  

Microsoft Academic Search

Objective: Cardiopulmonary bypass (CPB) is known to cause part of the systemic inflammatory reaction after cardiac surgery that can be responsible for organ failure. A novel technique based on a minimal extracorporeal circulation (MECC®) system has been evaluated with regard to the inflammatory response in a prospective study involving patients undergoing coronary artery bypass grafting. Methods: Sixty consecutive patients were

Yves Fromes; Didier Gaillard; Olivier Ponzio; Maryline Chauffert; Marie-Françoise Gerhardt; Philippe Deleuze; Olivier M Bical

2002-01-01

122

Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease  

Microsoft Academic Search

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

2001-01-01

123

The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery  

Microsoft Academic Search

BACKGROUND: Intensive insulin therapy to maintain normoglycemia after cardiac surgery reduces morbidity and mortality. We investigated the magnitude and duration of hyperglycemia caused by dexamethasone administered after cardiopulmonary bypass. METHODS: A single-center before-after cohort study was performed. All consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass during a 6-month period were included. Insulin administration was guided by a

Mathijs Vogelzang; Miriam Hoekstra; José T. Drost; Marcel Janse; Piet W. Boonstra; Felix Zijlstra; Bert G. Loef; Maarten W. N. Nijsten

2007-01-01

124

Outcomes of patients with prior coronary artery bypass graft who present with acute coronary syndrome.  

PubMed

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

2014-06-01

125

Should we consider off-pump coronary artery bypass grafting in patients undergoing coronary endarterectomy?  

PubMed

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass grafting with coronary endarterectomy (OPCAB-CE) is a safe and feasible method of myocardial revascularization in patients presenting with diffuse coronary artery disease. Seventy-one papers were identified by a systematic search, of which nine were judged to best answer the clinical question. All were observational studies. Of these, two were comparative and the remaining seven were case series. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and results were tabulated. In total, these 9 studies included 341 patients (225 OPCAB-CE, 116 ONCAB-CE) undergoing coronary endarterectomy in combination with coronary artery bypass grafting. CE was performed either by an open method whereby the atheroma is removed through an arteriotomy made along the length of the stenosis or by a closed method whereby the atheroma is removed by gentle traction through a small arteriotomy made over a proximal area of the plaque. Overall, OPCAB-CE was associated with a low perioperative mortality ranging from zero in smaller case series to 2.8% in the largest study (n = 70). Two comparative studies demonstrate at least equivalent 30-day mortality between OPCAB-CE and ONCAB-CE, although the sample sizes are small. The overall incidence of postoperative myocardial infarction (MI) was 6.1% (11/180) and seems comparable between OPCAB-CE and ONCAB-CE. Notably, both postoperative MI and mortality appeared higher in patients undergoing multiple endarterectomies performed using a closed technique and CE to the right coronary artery was associated with increased postoperative MI. In summary, OPCAB-CE in the setting of diffuse coronary artery disease appears both safe and feasible, yielding comparable results to ONCAB-CE. Where possible, open arteriotomy with on-lay patch angioplasty may improve postoperative outcomes. Large, prospective database studies are now required with explicit sub-group criteria and stratification to number, territory and technique of endarterectomy in order to isolate the patients in whom OPCAB-CE may confer the greatest benefit. PMID:24791957

Soylu, Erdinc; Harling, Leanne; Ashrafian, Hutan; Athanasiou, Thanos

2014-08-01

126

Early percutaneous transluminal coronary angioplasty or coronary bypass surgery following thrombolytic treatment of acute myocardial infarction.  

PubMed

Coronary reocclusion rates following intracoronary streptokinase (IC-SK) infusion remain significantly high despite anticoagulation. Early intervention by coronary angioplasty (PTCA) or coronary bypass surgery (CABG) was advocated to minimize such risk and/or maintain coronary reperfusion. Of 71 consecutive patients (60 men, 11 women; mean age, 54.9 years) who underwent IC-SK infusion for acute myocardial infarction (MI) 50 had early CABG, 18 had PTCA, and three had both procedures. Sixty-four of the 71 had successful thrombolysis. Thirty-six patients had either CABG or PTCA within three days, 22 patients within seven days, and 13 patients within two weeks. There was no immediate or in-hospital mortality, and all patients remained alive through the follow-up period of three to 36 months. Functional class (FC) 1 was achieved in 45 patients, FC 2 in 22 patients, FC 3 in three patients, and FC 4 in one patient. Sixty-seven patients (94 percent) were free of chest pain through the follow-up period. These data suggest that early intervention by CABG and/or PTCA in suitable candidates could be achieved with reduced risk and expected to yield favorable results. This favorable trend could be related to maintenance of myocardial perfusion by these procedures, initially induced by thrombolysis. Long-term, large-scale studies are needed to confirm the role of optimal timing of such procedures, but we believe that such results indicate that early revascularization yields promising results. PMID:2952466

Salem, B I; Gowda, S; Haikal, M; Leidenfrost, R; Cox, J L; Ferguson, T

1987-05-01

127

Endoscopic greater saphenous vein harvesting reduces the morbidity of coronary artery bypass surgery  

Microsoft Academic Search

Background: Most coronary artery bypass grafting (CABG) operations still involve the use of greater saphenous vein (GSV) for one or more grafts, even with the increasing use of arterial conduits for coronary revascularization. Wound complications from GSV harvesting are common, and sometimes severe. In order to reduce the morbidity of this procedure, we adopted a technique of endoscopic vein harvesting

Chance D. Felisky; Daniel L. Paull; Mark E. Hill; R. Alan Hall; Mary Ditkoff; William G. Campbell; Steven W. Guyton

2002-01-01

128

Revascularization Options for Ischemic Cardiomyopathy: On-Pump and Off-Pump Coronary Artery Bypass Surgery  

Microsoft Academic Search

Patients with ischemic cardiomyopathy and markedly reduced left ventricular (LV) function should be evaluated for coronary artery bypass surgery (CABG) before other surgical options are considered. The success of surgery depends on the presence of viable myocardium and target coronary arteries of acceptable quality. Long-term survival in this setting may be comparable to that with cardiac transplantation. Off-pump CABG can

Kamal R. Khabbaz; David DeNofrio; Marwan Kazimi; Philip A. Carpino

2004-01-01

129

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.

1983-01-01

130

Techniques and Results of Off-Pump Coronary Artery Bypass Grafting Using Homemade Intracoronary Shunt  

Microsoft Academic Search

Background: The outcome of the off-pump coronary artery bypass grafting (CABG) is highly dependent on surgical techniques. To overcome problems of intraoperative hemodynamic instability and avoid potential injury to coronary artery arising from occlusive technique, the authors have modified the strategy of performing distal anastomosis by using the authors' homemade intracoronary artery shunt. Objective: To document the results of off-pump

Suchart Chaiyaroj; Somchai Viengteeravat; Wipapon Bhumarangura RN; Siam Khajarern; Parinya Leelayana; Boontiva Purintrapiban RN

2006-01-01

131

Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery  

Microsoft Academic Search

Coronary artery bypass grafting has been utilized as a beneficial treatment for myocardial ischemic disease for over three decades. Failure of coronary artery venous grafts occurs at a substantial rate and has a large impact on two main endpoints, survival and quality of life. An exhaustive amount of basic research has been generated to delineate possible mechanisms responsible for graft

Jeffrey H Shuhaiber; Alexander N Evans; Malek G Massad; Alexander S Geha

2002-01-01

132

Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery  

Microsoft Academic Search

Summary Coronary artery bypass grafting has been utilized as a beneficial treatment for myocardial ischemic disease for over three decades. Failure of coronary artery venous grafts occurs at a substantial rate and has a large impact on two main endpoints, survival and quality of life. An exhaustive amount of basic research has been generated to delineate possible mechanisms responsible for

Jeffrey H. Shuhaiber; Alexander N. Evans; Malek G. Massad; Alexander S. Geha

2010-01-01

133

Isotropic Half-Millimeter Angiography of Coronary Artery Bypass Grafts With 16Slice  

Microsoft Academic Search

Background. Computed tomography (CT) with four detector rows and magnetic resonance imaging (MRI) are still of limited value for the assessment of coronary artery bypass grafts (CABG). We investigated the abili- ties of 16-slice CT in these patients. Methods. A retrospective analysis of all noninvasive coronary angiographies with multislice computed to- mography (MSCT; Aquilion, Toshiba) on patients with CABG referred

Computed Tomography; Marc Dewey; Alexander Lembcke; Christian Enzweiler; Bernd Hamm; Patrik Rogalla

134

Positron emission tomography using fluorine-18 deoxyglucose in evaluation of coronary artery bypass grafting  

Microsoft Academic Search

To assess the clinical value of positron emission tomography (PET) in the evaluation of coronary artery bypass grafting (CABG), PET perfusion and metabolic imaging using nitrogen-13 ammonia and fluorine-18 deoxyglucose (FDG) was performed before and 5 to 7 weeks after CABG in 22 patients with coronary artery disease. Postoperative improvement in hypoperfusion was observed more often in the metabolically active

Nagara Tamaki; Yoshiharu Yonekura; Keiji Yamashita; Hideo Saji; Yasuhiro Magata; Michio Senda; Yutaka Konishi; Kazuo Hirata; Toshihiko Ban; Junji Konishi

1989-01-01

135

Neurocognitive Outcomes of Off-Pump Versus On-Pump Coronary Artery Bypass: A Prospective Randomized Controlled Trial  

Microsoft Academic Search

Background. Preliminary reports have documented the safety of off-pump coronary artery bypass graft compared with conventional coronary artery bypass graft surgery. Whereas off-pump coronary artery bypass graft surgery may be associated with improvement in some short-term outcomes, longer-term outcomes and influence on neuro- cognitive function have not been fully assessed. We examined short-term and intermediate-term neurocogni- tive and index admission

Felix Hernandez; Jeremiah R. Brown; Donald S. Likosky; Robert A. Clough; Anne L. Hess; Robert M. Roth; Cathy S. Ross; Cindy M. Whited; Gerald T. O'Connor; John D. Klemperer

136

A syndromal analysis of neuropsychological outcome following coronary artery bypass graft surgery  

PubMed Central

Background: Studies of neuropsychological outcome following coronary artery bypass graft surgery (CABG) have traditionally dichotomised patients as "impaired" or "unimpaired". This conceals the potential heterogeneity of deficits due to different mechanisms and sites of brain injury. Objectives: To explore neuropsychological outcome following CABG and determine to what extent it conforms to prototypic cortical and/or subcortical neurobehavioral syndromes and whether different intraoperative physiologic measures are associated with different subtypes of neuropsychological outcome. Methods: Neuropsychological tests were administered to 85 patients before and after elective CABG and to 50 matched normal control subjects. Pre- to postoperative change scores were computed using standardised regression based norms. Change scores on selected memory measures were subjected to cluster analysis to identify qualitatively distinct subtypes of memory outcome. Emergent clusters were compared on non-memory measures, intraoperative physiologic measures, and demographic variables. Results: Three subtypes of memory outcome were identified: memory spared (48% of patients), retrieval deficit (35%), and encoding/storage deficit (17%). Contrary to expectation, the subgroups were indistinguishable on measures of confrontation naming and manual dexterity and on intraoperative cardiac surgical physiologic measures and demographic variables. The encoding/storage deficit subgroup exhibited executive dysfunction. Conclusions: Heterogeneous profiles of neuropsychological dysfunction were found following CABG although they did not tightly conform to prototypic cortical and subcortical neurobehavioral syndromes. This challenges the value and appropriateness of the common practice of collapsing individual test scores to arrive at a single figure to define "impairment". Whether different subtypes of neuropsychological outcome are caused by different pathophysiologic mechanisms remains unknown.

Kneebone, A; Luszcz, M; Baker, R; Knight, J

2005-01-01

137

Antimicrobial prophylaxis in coronary bypass surgery: a critical appraisal.  

PubMed

The literature has been examined to assess the optimal prophylactic antimicrobial regimen for patients undergoing coronary bypass surgery. Antimicrobial surgical prophylaxis should be based on the two main potential pathogens, Staphylococcus epidermidis and S. aureus. It is unclear whether the prophylactic use of antimicrobials can or should be guided by in vitro antimicrobial susceptibility testing; data from well-performed clinical trials should be evaluated. The data fail to demonstrate consistently a significant difference within the cephalosporin class of antimicrobials with regard to prevention of infectious complications. Although it does not reach statistical difference, the trend with respect to efficacy appears to be cefuroxime, then cefamandole, and then cefazolin. The lack of significant difference among antimicrobials suggests an institution-individualized approach to the selection of the optimal antimicrobial for prophylaxis. For our facilities we recommend the following regimen: cefazolin sodium 1-2 g iv q8h for two days. There are not enough data at this time to recommend less than two days of antimicrobial prophylaxis for this type of surgery. In addition, aminoglycosides provide no added benefit when added to cephalosporins. PMID:2068834

Ariano, R E; Zhanel, G G

1991-05-01

138

[Use of inferior epigastric artery for coronary artery bypass grafting].  

PubMed

Between 3/91 and 3/93 twenty-nine patients (pts.) with a mean age of 55 years (30-68) underwent CABG (including 3 reoperation) using inferior epigastric artery (IEA) in addition to internal thoracic artery and saphenous vein graft. IEAs were harvested as pedicles with a mean length of 12.2 cm (7.5-17). Overall distal anastomoses were performed 3.2 per patients. And a mean of 2.3 anastomoses were completed as an arterial graft. IEA grafts were applied to left anterior descending artery in 10, diagonal branch in 15, in marginal branches in 2 and right coronary artery in 2. Mean cardiopulmonary bypass time amounted to 103 minutes and operation procedures were completed in 258 minutes (mean). Aortic cross clamp time of 48 minutes were required. One patient was died of cerebral accident 23 days postoperatively. Except for two abdominal wall infection no wound healing problems occurred. One reexploration for bleeding were necessary. Postoperative angiography revealed patent IEA grafts in 12 of 13 patients (92%). We concluded that the application of IEAs for CABG is available as a third arterial graft and with respect to intraoperative management and perioperative complications use of IEA combined with ITAs appears suited or superior to the use of the right gastroepiploic artery. PMID:8301913

Watanabe, G; Misaki, T; Yamamoto, K; Cremer, J; Haverich, A; Borst, H G; Watanabe, Y

1994-02-01

139

Revascularization for coronary artery disease in diabetes mellitus: Angioplasty, stents and coronary artery bypass grafting  

PubMed Central

Patients with diabetes mellitus (DM) are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases their likelihood of requiring revascularization. However, the unique pathophysiology of atherosclerosis in patients with DM modifies the response to arterial injury, with profound clinical consequences for patients undergoing percutaneous coronary intervention (PCI). Multiple studies have shown that DM is a strong risk factor for restenosis following successful balloon angioplasty or coronary stenting, with greater need for repeat revascularization and inferior clinical outcomes. Early data suggest that drug eluting stents reduce restenosis rates and the need for repeat revascularization irrespective of the diabetic state and with no significant reduction in hard clinical endpoints such as myocardial infarction and mortality. For many patients with 1- or 2-vessel coronary artery disease, there is little prognostic benefit from any intervention over optimal medical therapy. PCI with drug-eluting or bare metal stents is appropriate for patients who remain symptomatic with medical therapy. However, selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial. Randomized trials comparing multivessel PCI with balloon angioplasty or bare metal stents to coronary artery bypass grafting (CABG) consistently demonstrated the superiority of CABG in patients with treated DM. In the setting of diabetes CABG had greater survival, fewer recurrent infarctions or need for re-intervention. Limited data suggests that CABG is superior to multivessel PCI even when drug-eluting stents are used. Several ongoing randomized trials are evaluating the long-term comparative efficacy of PCI with drug-eluting stents and CABG in patients with DM. Only further study will continue to unravel the mechanisms at play and optimal therapy in the face of the profoundly virulent atherosclerotic potential that accompanies diabetes mellitus.

Aronson, Doron

2010-01-01

140

Hybrid Coronary Revascularization Using Limited Incisional Full Sternotomy Coronary Artery Bypass Surgery in Multivessel Disease: Early Results  

PubMed Central

Background There are several modalities of coronary artery revascularization for multivessel coronary artery disease. Hybrid coronary revascularization (HCR) with minimally invasive direct coronary artery bypass grafting was introduced for high-risk patients, and recently, many centers have been using it. Limited incisional full sternotomy coronary artery bypass (LIFCAB) involves left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis through a sternotomy with a minimal skin incision; it could be considered another technique for minimally invasive LITA-to-LAD anastomosis. Our center has performed HCR using LIFCAB, and in this paper, we report our short-term results, obtained in the past 3 years. Methods The medical records of 38 patients from May 2010 to June 2013 were analyzed retrospectively. The observation period after HCR was 1 to 37 months (average, 18.3±10.3 months). The patency of revascularization was confirmed with postoperative coronary angio-computerized tomography or coronary angiography. Results There were 3 superficial wound complications, but no mortalities. All the LITA-to-LAD anastomoses were patent in the immediate postoperative and follow-up studies, but stenosis was detected in 3 cases of percutaneous coronary intervention. Conclusion HCR using LIFCAB is safe and yields satisfactory results from the viewpoint of revascularization for multivessel disease.

Kang, Joonkyu; Lee, Seok In; Moon, Mi Hyung; Kim, Hwan Wook; Jo, Gyun Hyun

2014-01-01

141

Ventricular Septal Defect in an Octogenarian: A Case Report of VSD Surgical Repair Concomitant with Coronary Artery Bypass and Valvular Surgery  

PubMed Central

Finding an untreated or asymptomatic large ventricular septal defect (VSD) in an elderly patient is uncommon. The present case was an 81-year-old man who suffered from acute myocardial infarction due to three-vessel coronary disease, mitral and tricuspid valve insufficiency, and high-flow perimembranous VSD (Qp/Qs 2.3). Although the patient was elderly and the VSD had been asymptomatic for a long time, we considered that high-flow VSD and valve diseases should be repaired simultaneously with coronary disease. Then, he underwent elective surgery, namely, VSD patch repair concomitant with coronary artery bypass grafting, and mitral and tricuspid annuloplasty. His postoperative course was uneventful. We conclude that, even for an octogenarian, surgical repair of VSD is recommendable, if surgical indications are appropriate.

Tayama, Eiki; Fujita, Satoshi; Ueda, Tomohiro; Imasaka, Ken-ich; Enomoto, Naofumi; Onitsuka, Hirofumi; Tomita, Yukihiro

2012-01-01

142

Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation  

PubMed Central

There is no established strategy of how and when to treat coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). Simultaneous, single-stage treatment of both pathologies is a possible solution. We report our initial results of simultaneously performed transapical TAVI and elective percutaneous coronary interventions (PCI) in high-risk patients with severe aortic valve stenosis. Between April 2008 and July 2011, a total of 419 patients underwent transapical TAVI. Combined elective PCI and TAVI were performed in 46 (11%) patients. Only the most significant coronary lesion or lesions were treated. Technical success of the combined approach was 100%. The mean count of implanted stents per patient was 1.6 ± 1.0 (range, 1–5 stents). The 30-day mortality rates in the PCI and TAVI group was 4.3%. Survival at 12, 24 and 36 months of the PCI and TAVI group 87.1 ± 5.5, 69.7 ± 10.3 and 69.7 ± 10.3%, respectively. The results showed that the single-stage approach with combined elective PCI and TAVI is feasible and safe. It has become our primary choice for treatment of high-risk patients with severe aortic valve stenosis and CAD.

Pasic, Miralem; Dreysse, Stephan; Unbehaun, Axel; Buz, Semih; Drews, Thorsten; Klein, Christoph; D'Ancona, Giuseppe; Hetzer, Roland

2012-01-01

143

A Randomized Trial of the Topical Effect of Antifibrinolytic Epsilon Aminocaproic Acid on Coronary Artery Bypass Surgery Without Cardiopulmonary Bypass.  

PubMed

We assessed the effect of the topical application of epsilon-aminocaproic antifibrinolytic acid (EACA) on the pericardium of patients submitted to coronary artery bypass graft (CABG) without the use of cardiopulmonary bypass (CPB). This is a prospective, randomized, and double-blind study. We evaluated 26 patients with chronic coronary heart disease indicated for CABG without CPB (EACA and placebo groups). The analysis of the postoperative hematological results showed no difference between groups in hemoglobin and hematocrit. There was no difference between the groups regarding the postoperative bleeding through the drains in the first 24 hours, 48 hours, and accumulated loss until removal of drains. The use of EACA in patients undergoing CABG without CPB presented no difference in the reduction of the amount of bleeding and the need for blood transfusions. PMID:23434921

Gurian, Danilo Bortolotto; Meneghini, Adriano; de Abreu, Luiz Carlos; Murad, Neif; de Matos, Leandro Luongo; Pires, Adilson Casemiro; Valenti, Vitor E; Breda, João Roberto

2013-03-17

144

Contrast-enhanced cardiac MRI before coronary artery bypass surgery: impact of myocardial scar extent on bypass flow.  

PubMed

The aim of the study was to relate the extent of myocardial late gadolinium enhancement (LGE) in cardiac MRI to intraoperative graft flow in patients undergoing coronary artery bypass graft (CABG) surgery. Thirty-three CAD patients underwent LGE MRI before surgery using an inversion-recovery GRE sequence (turboFLASH). Intraoperative graft flow in Doppler ultrasonography was compared with the scar extent in each coronary vessel territory. One hundred and fourteen grafts were established supplying 86 of the 99 vessel territories. A significant negative correlation was found between scar extent and graft flow (r = -0.4, p < 0.0001). Flow in grafts to territories with no or small subendocardial scar was significantly higher than in grafts to territories with broad nontransmural or transmural scar (75 +/- 39 vs. 38 +/- 26 cc min(-1); p < 0.0001). In summary, the extent of myocardial scar as defined by contrast-enhanced MRI predicts coronary bypass graft flow. Beyond the probability of functional recovery, preoperative MRI might add value to surgery planning by predicting midterm bypass graft patency. PMID:18581115

Hunold, Peter; Massoudy, Parwis; Boehm, Claudia; Schlosser, Thomas; Nassenstein, Kai; Knipp, Stephan; Eggebrecht, Holger; Thielmann, Matthias; Erbel, Raimund; Jakob, Heinz; Barkhausen, Jörg

2008-12-01

145

Totally endoscopic quadruple coronary artery bypass grafting is feasible using robotic technology.  

PubMed

Multivessel robotic totally endoscopic coronary artery bypass grafting is currently under development. Quadruple totally endoscopic coronary artery bypass has so far not been reported. A 75-year-old patient with multivessel coronary artery disease underwent daVinci Si-assisted completely endoscopic placement of a left internal mammary artery bypass to the left anterior descending artery and construction of a right internal mammary artery Y-graft off the left internal mammary artery to the posterior descending artery. The left internal mammary artery was also connected to a diagonal branch as a sequential graft. The obtuse marginal branch was revascularized using an endoscopically harvested vein graft originating from the left axillary artery. PMID:22541230

Bonatti, Johannes; Wehman, Brody; de Biasi, Andreas R; Jeudy, Jean; Griffith, Bartley; Lehr, Eric J

2012-05-01

146

Clinical benefits of endoscopic vein harvesting in patients with risk factors for saphenectomy wound infections undergoing coronary artery bypass grafting  

Microsoft Academic Search

Objective: The influence of endoscopic harvesting techniques on the prevalence of leg-wound complications after coronary artery bypass grafting remains to be defined for patients at high risk for the development of wound infections. Methods: Among 1473 patients undergoing coronary artery bypass grafting who had the saphenous vein harvested by either a continuous incision or skip incisions leaving intact skin bridges,

Phillip A. Carpino; Kamal R. Khabbaz; Robert M. Bojar; Hassan Rastegar; Kenneth G. Warner; Richard E. Murphy; Douglas D. Payne

2000-01-01

147

Off-pump versus on-pump coronary bypass in high-risk subgroups  

Microsoft Academic Search

Background. Cardiopulmonary bypass (CPB) has pathophysiologic sequelae that may be more severe in high-risk subsets. We wanted to determine whether off-pump coronary bypass (OPCAB) could optimize outcomes.Methods. Our database of 242 OPCAB patients undergoing complete revascularization was compared to a base of 483 CABG patients undergoing CPB. Results were compared for the overall series and in the following high-risk subsets:

Taro Yokoyama; Fritz J Baumgartner; Ali Gheissari; Eli R Capouya; George P Panagiotides; Richard J Declusin

2000-01-01

148

Comparison of the effects of desflurane and propofol anesthesia on the inflammatory response and s100? protein during coronary artery bypass grafting.  

PubMed

Cardiopulmonary bypass (CPB) contributes to the secretion of anti-inflammatory cytokines that mediate the inflammatory response observed during open heart surgery. In addition to many factors, type of anesthesia management affects immune response and central nervous system in cardiac surgery. The aim of this study was to assess the effect of propofol versus desflurane anesthesia on systemic immune modulation and central nervous system on patients undergoing coronary artery bypass grafting. Forty patients undergoing elective coronary artery bypass graft surgery with CPB were included in this prospective randomized study. Patients were allocated to receive propofol (n = 20) or desflurane (n = 20) for maintenance of anesthesia. The blood samples for IL-6, IL-8, TNF-?, and S100? were drawn just prior to the operation before the induction of anesthesia, second before cardiopulmonary bypass, third after CPB, fourth 4 h postoperatively at the ICU. Major finding in our study is that S100? levels were lower in propofol group when compared to desflurane anesthesia. And also immune reaction was less in patients exposed to desflurane anesthesia when compared to propofol anesthesia as indicated by lower plasma concentrations of IL-8 and IL-6. Propofol is more preferable in terms of S100? for anesthetic management for CABG. PMID:23775574

Baki, Elif Do?an; Aldemir, Mustafa; Kokulu, Serdar; Koca, Halit Bu?ra; Ela, Yüksel; S?vac?, Remziye Gül; Öztürk, Nilgün Kavrut; Emmiler, Mustafa; Adal?, Fahri; Uzel, Hanife

2013-12-01

149

Compartment syndrome after endoscopic harvest of the great saphenous vein during coronary artery bypass grafting.  

PubMed

Compartment syndrome is a limb-threatening condition often associated with traumatic, crush, burn, and reperfusion injuries. It is characterized by the development of disproportionately severe pain, paresthesias, decreased range of motion, loss of pulse, and a tense, edematous limb. In addition, measured compartment pressures and creatine phosphokinase values are often elevated. The definitive treatment is a decompressive fasciotomy. Compartment syndrome after coronary artery bypass grafting, however, is rare. The few reported cases all occurred in the vein donor leg after open harvest. We present a patient with compartment syndrome after endoscopic harvest of the saphenous vein for coronary artery bypass grafting. PMID:20103252

Kolli, Aparna; Au, Joyce T; Lee, Daniel C; Klinoff, Natalie; Ko, Wilson

2010-01-01

150

Endovascular Treatment of a Coronary Artery Bypass Graft to Pulmonary Artery Fistula with Coil Embolization  

SciTech Connect

Fistula formation between a coronary artery bypass graft (CABG)and the pulmonary arterial circulation represents a rare cause of recurrent angina in patients following bypass grafting. Therapy has traditionally involved surgical ligation by open thoracotomy. We describe a case of left internal mammary artery-left upper lobe pulmonary artery fistula presenting as early recurrent angina following CABG. The fistula was embolized using platinum coils, resulting in symptomatic relief and improvement in myocardial perfusion on cardiac perfusion scintigraphy. Coil embolization should be considered a therapeutic option in patients with coronary-pulmonary steal syndrome.

Nielson, Jeffery L., E-mail: nielson@uhrad.com; Kang, Preet S. [University Hospitals of Cleveland and Veterans Administration Medical Center-Cleveland, Case Western Reserve University, Departments of Radiology (United States)

2006-04-15

151

Thoracoscopic lobectomy for lung cancer after coronary artery bypass grafting using internal thoracic artery.  

PubMed

Video-assisted thoracic surgery is useful during a typical lobectomy procedure, though challenging in complicated cases. We report successful video-assisted thoracic surgery lobectomy procedures performed after coronary artery bypass grafting in two lung cancer patients, with severe adhesion of lung parenchyma to grafts of the internal thoracic artery. We avoided dissection of the lung from the grafts and divided the lung parenchyma. No intrathoracic infection or local recurrence was found 5 years after surgery in either patient. The present 'non-dissection technique' is a feasible and safe optional procedure during a lobectomy after coronary artery bypass grafting using internal thoracic artery grafts. PMID:22914803

Funaki, Soichiro; Inoue, Masayoshi; Shigemura, Norihisa; Okumura, Meinoshin

2012-11-01

152

Bilateral anterior compartment syndrome after routine coronary artery bypass surgery and severe hypothyroidism.  

PubMed

Compartment syndrome is a very rare complication of coronary artery bypass grafting and previously it has only been described unilaterally. We describe the development of compartment syndrome in bilateral anterior compartments of the lower leg after vein harvest for coronary artery bypass grafting. We describe a series of predisposing factors contributing to this condition and its delayed diagnosis, including severe undiagnosed hypothyroidism. We advise a high index of suspicion in patients postvein harvest and recommend thyroid function testing for all patients who have compartment syndrome develop. PMID:20868840

Mills, Jane; Pretorius, Victor; Lording, Tim; Hardikar, Ashutosh; Murton, Mark

2010-10-01

153

Patient preferences for coronary artery bypass graft surgery or percutaneous intervention in multivessel coronary artery disease.  

PubMed

Objectives: Determine if patients prefer multivessel percutaneous coronary intervention (mv-PCI) over coronary artery bypass graft surgery (CABG) for treatment of symptomatic multivessel coronary artery disease (mv-CAD) despite high 1-year risk. Background: Patient risk perception and preference for CABG or mv-PCI to treat medically refractory mv-CAD are poorly understood. We hypothesize that patients prefer mv-PCI instead of CABG even when quoted high mv-PCI risk. Methods: 585 patients and 31 physicians were presented standardized questionnaires with a hypothetical scenario describing chest pain and medically refractory mv-CAD. CABG or mv-PCI was presented as treatment options. Risk scenarios included variable 1-year risks of death, stroke, and repeat procedures for mv-PCI and fixed risks for CABG. Participants indicated their preference of revascularization method based on the presented risks. We calculated the odds that patients or physicians would favor mv-PCI over CABG across a range of quoted risks of death, stroke, and repeat procedures. Results: For nearly all quoted risks, patients preferred mv-PCI over CABG, even when the risk of death was double the risk with CABG or the risk of repeat procedures was more than three times that for CABG (P < 0.0001). Compared to patients, physicians chose mv-PCI less often than CABG as the risk of death and repeat procedures increased (P < 0.001 and P = 0.004, respectively). Conclusion: Patients favor mv-PCI over CABG to treat mv-CAD, even if 1-year risks of death and repeat procedures far exceed risk with CABG. Physicians are more influenced by actual risk and prefer mv-PCI less than patients despite similarly quoted 1-year risks. PMID:22517566

Kipp, Ryan; Lehman, James; Israel, Jacqueline; Edwards, Niloo; Becker, Tara; Raval, Amish N

2013-08-01

154

Re-birth after coronary bypass graft surgery: a hermeneutic-phenomenological study.  

PubMed

Although coronary artery bypass graft surgery has significant effects on reducing the symptoms of coronary artery disease, there is not enough knowledge and understanding of lived experience of patients after surgery. Understanding lived experience of this group of patients would be helpful for healthcare staff to provide better services to the patients. The aim of this study was to describe with a deeper understanding, the lived experiences of patients after Coronary Artery Bypass Graft Surgery. Using a hermeneutic phenomenological approach and a Van-Manen analysis method, in-depth semi-structured interviews were conducted with eleven participants who had lived experienced of at least six months post - coronary artery bypass graft surgery. Re-birth was the main theme that emerged in the process of data analysis. This theme was derived from four sub-themes including "feels younger", ''vigorous heart'', ''intrepid life'' and ''oriented to be healthy''. Life after a coronary artery bypass graft surgery is often appreciated as a re-birth by persons with these experiences as surgery did not only provide a feeling of wellness, but also added a sensation of youthfulness and improvement in the quality of life for these participants. In addition, they would actively participate in health promotional activities such as; adherence to medication and diet regimes, changes in lifestyle to maintain their health. PMID:24762368

Abbasi, Mohammad; Mohammadi, Nooredin; Nasrabadi, Alireza Nikbakht; Fuh, Suh Boudouin; Sadeghi, Tahereh

2014-05-01

155

Symptoms and angiographic findings of patients undergoing elective coronary angiography without prior stress testing.  

PubMed

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

2014-08-01

156

Temporary Diabetes Insipidus in 2 Men after On-Pump Coronary Artery Bypass Grafting  

PubMed Central

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.

Uyar, Ihsan Sami; Sahin, Veysel; Akpinar, Besir; Yurtman, Volkan; Abacilar, Feyzi; Okur, Faik Fevzi; Ates, Mehmet

2013-01-01

157

Successful percutaneous stenting of a right gastroepiploic coronary bypass graft using monorail delivery system: a case report.  

PubMed

The right gastroepiploic artery (RGEA) is being successfully used as an arterial conduit in a selected group of patients undergoing coronary artery bypass graft surgery. However, myocardial ischemia may result due to spasm, occlusion, and stenosis of this graft. The anastamosis site at distal right coronary artery (RCA) or posterior descending artery (PDA) is the most common location for stenosis of an in situ gastroepiploic coronary bypass graft. Balloon angioplasty of such stenoses has been reported with optimal short-term results. Stent deployment would decrease the restenosis rate, so that repeat procedures could be minimized for these technically challenging lesions. We describe a case of successful deployment of a stent with monorail delivery system at the anastamotic site stenosis of an in situ gastroepiploic right coronary artery bypass graft. This percutaneous coronary intervention could prevent redo coronary artery bypass graft surgery. Cathet. Cardiovasc. Intervent. 49:197-199, 2000. PMID:10642773

Alam, M; Safi, A M; Mandawat, M K; Anderson, J E; Kwan, T; Feit, A; Clark, L T

2000-02-01

158

Atrial fibrillation and minimally invasive coronary artery bypass grafting: Risk factor analysis  

Microsoft Academic Search

Atrial fibrillation (AF) is a frequent arrhythmia after conventional coronary artery bypass grafting. With the advent of minimally\\u000a invasive technique for left internal mammary artery-left anterior descending coronary artery (LIMA-LAD) grafting, we analyzed\\u000a the incidence and the risk factors of postoperative AF in this patient population. This prospective study involves all patients\\u000a undergoing isolated LIMA-LAD grafting with minimally invasive technique

Xavier M. Mueller; Hendrik T. Tevaearai; Patrick Ruchat; Frank Stumpe; Ludwig K. von Segesser

2002-01-01

159

Right infarction response to coronary artery bypass and the Abiomed BVS 5000.  

PubMed

A 57-year-old man presented with acute right ventricular infarction. A percutaneous coronary intervention was undertaken, but he developed shock and required extracorporeal membrane oxygenator support. Coronary artery bypass was performed, and a Abiomed BVS 5000 was implanted as a right ventricular assist device. Circulation gradually stabilized, and the device was removed after 5 days. There no sign of heart failure or infection at 9 months post-surgery. PMID:24585910

Hisata, Yoichi; Hashizume, Koji; Tanigawa, Kazuyoshi; Miura, Takashi; Odate, Tomohiro; Eishi, Kiyoyuki

2014-03-01

160

Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting.  

PubMed

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 artery blood flow velocity (transcranial Doppler sonography), and cerebral oxygen metabolism (cerebral metabolic rate and cerebral extraction ratio) were measured during four phases of the operation: before bypass, during bypass (at hypothermia and at normothermia), and after bypass. A battery, of neuropsychologic tests were also conducted before and 6 weeks after the operation. During hypothermic (28 degrees C) bypass, cerebral blood flow was significantly (p < 0.001) greater in the pH-stat group (41 mlx100 gm(-1)xmin(-1); 95% confidence interval 39 to 43 mlx100 gm(-1)xmin(-1)) than in the alpha-stat group (24 mlx100 gm(-1)xmin(-1); confidence interval 22 to 26 mlx100 gm(-1)xmin(-1)) at constant pressure and How. Arterial carbon dioxide tensions were 41 mm Hg (40 to 41 mm Hg) and 26 mm Hg (25 to 27 mm Hg), respectively; pH was 7.36 (7.34 to 7.38) and 7.53 (7.51 to 7.55), respectively. Middle cerebral artery flow velocity was significantly (p < 0.05) reduced in the alpha-stat group to 87% (77% to 96%) of the prebypass value, whereas it was significantly (p < 0.05) increased (152%; 141% to 162%) in the pH-stat group. Cerebral extraction ratio for oxygen demonstrated relative cerebral hyperemia during hypothermic (28 degrees C) bypass in both the pH-stat and alpha-stat groups (0.12 [0.11 to 0.14] and 0.25 [0.22 to 0.28], respectively); however, hyperemia was significantly more pronounced in the pH-stat group, indicating greater disruption in cerebral autoregulation. Neuropsychologic impairment criteria of deterioration in results of three or more tests revealed that a significantly (Fisher's exact test, p = 0.02) higher proportion of patients in the pH-stat group fared poorly than in the alpha-stat group at 6 weeks (17/35, 48.6% [32% to 65.1%], and 7/35, 20% [6.7% to 33.2.2%], respectively). In conclusion, patients receiving alpha-stat management had less disruption of cerebral autoregulation during cardiopulmonary bypass, accompanied by a reduced incidence of postoperative cerebral dysfunction. PMID:8642829

Patel, R L; Turtle, M R; Chambers, D J; James, D N; Newman, S; Venn, G E

1996-06-01

161

Prophylactic fibrinogen infusion reduces bleeding after coronary artery bypass surgery. A prospective randomised pilot study.  

PubMed

It has been suggested that preoperative fibrinogen plasma concentration is independently associated to postoperative blood loss after cardiac surgery. Theoretically, prophylactic infusion of fibrinogen concentrate may thus reduce postoperative bleeding, but this has not previously been investigated. Twenty elective coronary artery bypass graft (CABG) patients with preoperative plasma fibrinogen levels <3.8 g/l were included in a prospective randomised pilot study. Patients were randomised to receive an infusion of 2 g fibrinogen concentrate (FIB group) or no infusion before surgery (control group). Primary endpoint was safety with clinical adverse events and graft occlusion assessed by multi-slice computed tomography. Predefined secondary endpoints were postoperative blood loss, blood transfusions, haemoglobin levels 24 hours (h) after surgery, and global haemostasis assessed with thromboelastometry, 2 and 24 hours after surgery. Infusion of 2 g fibrinogen concentrate increased plasma levels of fibrinogen by 0.6 +/- 0.2 g/l. There were no clinically detectable adverse events of fibrinogen infusion. Computed tomography revealed one subclinical vein graft occlusion in the FIB group. Fibrinogen concentrate infusion reduced postoperative blood loss by 32% (565 +/- 150 vs. 830 +/- 268 ml/12 h, p=0.010). Haemoglobin concentration was significantly higher 24 h after surgery in the FIB group (110 +/- 12 vs. 98 +/- 8 g/l, p=0.018). Prophylactic fibrinogen concentrate infusion did not influence global postoperative haemostasis as assessed by thromboelastometry. In conclusion, in this pilot study preoperative fibrinogen concentrate infusion reduced bleeding after CABG without evidence of postoperative hypercoagulability. Larger studies are necessary to ensure safety and confirm efficacy of prophylactic fibrinogen treatment in cardiac surgery. PMID:19572078

Karlsson, Martin; Ternström, Lisa; Hyllner, Monica; Baghaei, Fariba; Flinck, Agneta; Skrtic, Stanko; Jeppsson, Anders

2009-07-01

162

Influence of colloid infusion on coagulation during off-pump coronary artery bypass grafting  

PubMed Central

This study was conducted to determine the influence of colloid infusion on coagulation in patients undergoing off-pump coronary artery bypass grafting (OP-CABG). Thirty patients undergoing elective OP-CABG received medium molecular weight hydroxyethyl starch group I (MMW-HES 200/0.5), low molecular weight hydroxyethyl starch group II (LMW-HES 130/0.4) or gelatin group III (GEL) in a prospective randomized trial. Blood samples were assessed for hemoglobin (Hb), activated coagulation time (ACT), prothrombin time (PT), activated partial thromboplastin time (aPPT), platelet count, fibrinogen and von Willebrand factor (vWF) at specified intervals. Total volume of the colloid infused and postoperative chest-time drainage was also measured. There was a significant decrease in Hb, platelet count, fibrinogen levels in all these groups, which did not warrant blood transfusion. After the colloid infusion, vWF decreased significantly to 67% from baseline in group I as compared to 85 and 79% in group II and group III, respectively. vWF levels remained lower than the baseline value in the first 24 hours in group I, whereas this factor level increased above the baseline values in groups II and III, 6 hours postoperatively. Postoperative chest tube drainage in 24 hours was significantly higher in group I (856 ± 131 ml) as compared to group II (550 ± 124 ml) and group III (582 ± 159 ml). LMW-HES 130/0.4 was superior to MMW-HES 200/0.5 and gelatin in patients undergoing OP-CABG, in terms of better preservation of coagulation associated with enhanced volume effect.

Muralidhar, K; Garg, Rajnish; Mohanty, SK; Banakal, Sanjay

2010-01-01

163

Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention and Medical Therapy for Multivessel Disease with and without Left Ventricular Dysfunction  

Microsoft Academic Search

Multiple randomized trials support the treatment of patients with multivessel coronary artery disease (CAD) and relatively normal left ventricular (LV) ejection fraction (EF) by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). However, there has been a paucity of trials in the recent literature that have compared the outcomes of patients with multivessel CAD and low EF

Amitra E. B. Caines; Malek G. Massad; Jacques Kpodonu; Abdallah G. Rebeiz; Alexander Evans; Alexander S. Geha

2004-01-01

164

Relationship Between Vein Graft Failure and Subsequent Clinical Outcomes After Coronary Artery Bypass Surgery  

PubMed Central

Background Vein graft failure (VGF) is common after coronary artery bypass graft surgery, but its relationship with long-term clinical outcomes is unknown. In this retrospective analysis, we examined the relationship between VGF, assessed by coronary angiography 12 to 18 months after coronary artery bypass graft surgery, and subsequent clinical outcomes. Methods and Results Using the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial database, we studied data from 1829 patients who underwent coronary artery bypass graft surgery and had an angiogram performed up to 18 months after surgery. The main outcome measure was death, myocardial infarction, and repeat revascularization through 4 years after angiography. VGF occurred in 787 of 1829 patients (43%). Clinical follow-up was completed in 97% of patients with angiographic follow-up. The composite of death, myocardial infarction, or revascularization occurred more frequently among patients who had any VGF compared with those who had none (adjusted hazard ratio, 1.58; 95% confidence interval, 1.21–2.06; P=0.008). This was due mainly to more frequent revascularization with no differences in death (adjusted hazard ratio, 1.04; 95% confidence interval, 0.71–1.52; P=0.85) or death or myocardial infarction (adjusted hazard ratio, 1.08; 95% confidence interval, 0.77–1.53; P=0.65). Conclusions VGF is common after coronary artery bypass graft surgery and is associated with repeat revascularization but not with death and/or myocardial infarction. Further investigations are needed to evaluate therapies and strategies for decreasing VGF to improve outcomes in patients undergoing coronary artery bypass graft surgery.

Lopes, Renato D.; Mehta, Rajendra H.; Hafley, Gail E.; Williams, Judson B.; Mack, Michael J.; Peterson, Eric D.; Allen, Keith B.; Harrington, Robert A.; Gibson, C. Michael; Califf, Robert M.; Kouchoukos, Nicholas T.; Ferguson, T. Bruce; Alexander, John H.

2013-01-01

165

What to Expect during Coronary Artery Bypass Grafting  

MedlinePLUS

... lung bypass machine is used during this procedure. Robot-assisted technique. This type of procedure allows for ... trials are research studies that explore whether a medical strategy, treatment, or device is safe and effective ...

166

Thirty-year patency of a coronary sequential venous bypass graft.  

PubMed

The optimal conduit of second choice in surgical coronary revascularization  remains a matter of debate. Radial artery grafts are believed to have a better patency rate than the saphenous vein grafts, although no conclusive results have been reported. This report describes the late result of a coronary revascularization with sequential venous bypass performed 30 years earlier.MethodsAn 80-year-old woman was admitted for dyspnoea on exertion and recent-onset angina due to severe aortic valve stenosis. Thirty years earlier, the patient had undergone revascularization with coronary bypass grafting performed using a sequential saphenous vein graft anastomosed on first diagonal branch and on left anterior descending coronary artery. Coronary angiography showed the occlusion of the native left anterior descending artery and the good patency of the previous described sequential vein graft.ResultsSurgical inspection confirmed the patency and the soft pliability of the venous graft and the surgeon decided to do not replace the previous graft with a pedicled LIMA (Left Internal Mammary Artery) graft.   The patient underwent 21-mm biological Edwards Perimount Magna Ease prosthesis implantation. Postoperative course was uneventful and the patient was discharged on the seventh day after surgery.ConclusionsThis case report demonstrated the potential extreme long-term patency of a sequential saphenous vein graft in coronary bypass surgery, raising the question if vein grafts should be really considered the conduits of last resort for coronary artery bypass surgery. Long-term follow-up of randomized trials comparing radial artery versus saphenous vein grafts are warranted in order to give conclusive  answers to this ongoing debate. PMID:24897971

Molardi, Alberto; Nicolini, Francesco; Benassi, Filippo; Gallingani, Alan; Gherli, Tiziano; Spaggiari, Igino

2014-01-01

167

Utility of Stress Single-Photon Emission Computed Tomography (SPECT) Perfusion Imaging in Predicting Outcome After Coronary Artery Bypass Grafting  

Microsoft Academic Search

Previous studies have examined the predictors of outcome in medically treated patients with coronary artery disease (CAD). There is limited information on predictors of outcome after coronary artery bypass grafting (CABG). This study examined the predictors of outcome of 255 patients with CAD, at a mean time of 5 years after CABG for angina pectoris. The 255 patients underwent coronary

Nasaraiah Nallamothu; Jeffrey H. Johnson; Bruce Bagheri; Jaekyeong Heo; Ami E. Iskandrian

1997-01-01

168

A Randomized Trial of Endoscopic Versus Open Saphenous Vein Harvest in Coronary Bypass Surgery  

Microsoft Academic Search

Background. The purpose of this study was to deter- mine whether or not endoscopic vein harvest is a reliable, beneficial, and cost-effective method for saphenous vein harvest in coronary bypass surgery (CABG). Methods. A total of 100 patients having primary CABG were prospectively randomized to either endoscopic (EVH; n 5 47) or open saphenous vein harvest (OVH; n 5 50).

John D. Puskas; Carolyn E. Wright; Philip K. Miller; Thomas E. Anderson; John Parker Gott; W. Morris Brown III; Robert A. Guyton

2010-01-01

169

A randomized trial of endoscopic versus open saphenous vein harvest in coronary bypass surgery  

Microsoft Academic Search

Background. The purpose of this study was to determine whether or not endoscopic vein harvest is a reliable, beneficial, and cost-effective method for saphenous vein harvest in coronary bypass surgery (CABG).Methods. A total of 100 patients having primary CABG were prospectively randomized to either endoscopic (EVH; n = 47) or open saphenous vein harvest (OVH; n = 50). Three patients

John D Puskas; Carolyn E Wright; Philip K Miller; Thomas E Anderson; John Parker Gott; W. Morris Brown; Robert A Guyton

1999-01-01

170

Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: a prospective randomized trial  

Microsoft Academic Search

Objective: Endoscopic saphenous vein harvesting (EVH) for coronary artery bypass grafting (CABG) has been developed to reduce leg wound morbidity and improve patient satisfaction. Choosing between EVH of a short vein segment from the thigh and open venous harvesting (OVH) of a short segment from the calf represents a clinical dilemma as EVH is easiest to perform from the thigh

Jan Jesper Andreasen; Vytautas Nekrasas; Claus Dethlefsen

2008-01-01

171

CLINICAL PREDICTORS OF IN-HOSPITAL SUSTAINED VENTRICULAR TACHYARRHYTHMIAS FOLLOWING CORONARY ARTERY BYPASS GRAFTING  

Microsoft Academic Search

Background Sustained ventricular tachyarrhythmias (VT) such as monomorphic or polymorphic ventricular tachycardia and ventricular fibrillation represent the most dreadful arrhythmic events that can complicate the postoperative course of coronary artery bypass grafting (CABG). The perioperative factors that are potentially associated with the onset of post-CABG sustained VT have not been deeply investigated. Hence, the aim of our paper was to

Valentino Ducceschi; Antonello D' Andrea; Biagio Liccardo; Alfonso Alfieri

172

Nitroglycerin is preferable to diltiazem for prevention of coronary bypass conduit spasm  

Microsoft Academic Search

Background. Diltiazem is widely used to prevent radial artery spasm after coronary bypass grafting (CABG). However, recent in vitro and in vivo studies have shown that nitroglycerin is a superior conduit vasodilator compared to diltiazem. A clinical comparison of these agents in patients undergoing CABG has not been previously performed.Methods. One hundred sixty-one consecutive patients undergoing isolated CABG with the

Oz M Shapira; Joseph D Alkon; Donald S. F Macron; John F Keaney; Joseph A Vita; Gabriel S Aldea; Richard J Shemin

2000-01-01

173

Endoscopic coronary artery bypass grafting with the aid of robotic assisted instruments  

Microsoft Academic Search

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 Aupècle; John Y. M. Relland

1999-01-01

174

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

2010-01-01

175

Ventilation by external high-frequency oscillations improves cardiac function after coronary artery bypass grafting1  

Microsoft Academic Search

Objecti6e: To compare the effects of ventilation with intermittent positive pressure and external high frequency oscillation by the Hayek Oscillator during the first 5 h after coronary artery bypass grafting. Methods: Eleven patients were randomized to intermittent positive pressure ventilation throughout the observation period (5 h), while 13 patients were initially ventilated with intermittent positive pressure ventilation, then by external

Borje Sideno; Jarle Vaage

176

Long-term patency of cephalic vein in coronary bypass surgery.  

PubMed

In the situation where the saphenous veins were unavailable, cephalic vein was the second choice in the beginning of 1980s. The routine use of saphenous vein and recent enthusiasm for arterial surgical myocardial revascularization lead to less attention on this conduit. We reported a patient undergoing redo coronary bypass surgery after 18 years of having cephalic vein grafts. PMID:18598332

Tjang, Yanto Sandy; Hornik, Lech; Seifert, Dirk; Körfer, Reiner

2008-01-01

177

Antiarrhythmic Effect of Ischemic Preconditioning in Recent Unstable Angina Patients Undergoing Coronary Artery Bypass Grafting  

Microsoft Academic Search

Coronary artery bypass grafting (CABG) for unstable angina pectoris patients results in a higher incidence of arrhythmia and higher arrhythmic cardiac mortality. Ischemic preconditioning (IP) has proved effective in suppressing ischemia reperfusion arrhythmias in animals and in humans. The purpose of the present study was to investigate whether IP protects against postoperative arrhythmias in recent unstable angina patients undergoing urgent

Zhong-Kai Wu; Tiina Iivainen; Erkki Pehkonen; Jari Laurikka; Matti R. Tarkka

2004-01-01

178

A ?-blocker, not magnesium, is effective prophylaxis for atrial tachyarrhythmias after coronary artery bypass graft surgery  

Microsoft Academic Search

Objective: To evaluate magnesium as a sole or adjuvant agent with currently used prophylactic drugs in suppressing postoperative atrial tachyarrhythmias (POAT) after coronary artery bypass graft (CABG) surgery. Design: Single-center prospective, randomized clinical trial. Setting: University hospital. Participants: Patients (n = 400) undergoing CABG surgery. Interventions: Patients were randomized among 6 prophylaxis regimens: (1) control (no antiarrhythmics), (2) magnesium only,

Arthur A Bert; Steven E Reinert; Arun K Singh

2001-01-01

179

Effect of single dose magnesium on arrhythmias in patients undergoing coronary artery bypass surgery  

Microsoft Academic Search

Objective: To evaluate the safety and role of prophylactic administration of magnesium in preventing arrhythmias. Method: This double blind randomized placebo controlled clinical trial was conducted at Aga Khan University Hospital on coronary artery bypass surgery patients. All patients were connected to holter monitor before induction of anaesthesia and this monitoring continued for 24 hours. Study drug containing either 2-grams

Mohammad Hamid; Rehana Shafi Kamal; Shahid Ahmed Sami; Farouk Atiq; Azam Shafquat; Hamid Iqil Naqvi; Fazal Hameed Khan

180

Impaired Exercise Capacity in Diabetic Patients after Coronary Bypass Surgery: Effects of Diastolic and Endothelial Function  

Microsoft Academic Search

Objectives: The aims of this study were to clarify the influence of cardiac diastolic and peripheral vascular function on the exercise capacity of patients with coronary bypass surgery (CABG) and diabetes mellitus (DM) by tissue Doppler imaging (TDI) and flow-mediated vasodilatation (FMD), and to investigate interrelations between exercise capacity and LV diastolic function, endothelial function and biochemical parameters. Methods: We

Yen-Wen Wu; Ching-Ling Hsu; Shoei-Shen Wang; Mei-Wun Tsai; Shu-Hsiun Chu; Yih-Sharng Chen; Wei-Shiung Yang; Ying-Tai Wu

2008-01-01

181

Preoperative intra-aortic balloon pump in high-risk coronary bypass grafting.  

PubMed

Prophylactic intra-aortic balloon pumping prior to coronary artery bypass grafting is employed variably despite some evidence to support its use. The aim of this study was to describe the characteristics, preoperative balloon pump utilization, and outcomes of high-risk patients undergoing coronary artery bypass. The study cohort included all patients in the Australian National Cardiac Surgery Database over an 8 year period. The primary outcome was 30-day mortality adjusted for preoperative illness severity. Coronary artery bypass was performed in 18,662 patients including 2,348 (12.6%) identified as high-risk. Of these high-risk patients, 359 (15.3%) received a balloon pump preoperatively. For high-risk patients, 30-day mortality was significantly higher in those with a preoperative balloon pump than in those who did not receive a preoperative balloon pump (15.3% vs. 4.9%). After adjusting for preoperative illness severity, there was no significant association between preoperative balloon pumping and 30-day mortality. High-risk patients represent a significant proportion of those undergoing coronary artery bypass grafting. Despite their increased risk of postoperative mortality, only a small minority currently receive a preoperative balloon pump. After adjusting for illness severity, there was no significant association between preoperative balloon pumping and 30-day mortality, although we could not rule out a 20% reduction in mortality. PMID:22499961

Litton, Edward; Delaney, Anthony

2012-04-01

182

Using Automated Health Plan Data to Assess Infection Risk from Coronary Artery Bypass Surgery  

Microsoft Academic Search

We determined if infection indicators were sufficiently consistent across health plans to allow comparison of hospitals' risks of infection after coronary artery bypass surgery. Three managed care organizations accounted for 90% of managed care in eastern Massachusetts, from October 1996 through March 1999. We searched their automated inpatient and outpatient claims and outpatient pharmacy dispensing files for indicator codes suggestive

Richard Platt; Ken Kleinman; Kristin Thompson; Rachel S. Dokholyan; James M. Livingston; Andrew Bergman; John H. Mason; Teresa C. Horan; Robert P. Gaynes; Steven L. Solomon; Kenneth E. Sands

183

Influence of median sternotomy on the psychosomatic outcome in coronary artery single-vessel bypass grafting  

Microsoft Academic Search

Objectives: New less invasive surgical techniques for the treatment of coronary artery single-vessel disease have been developed by either avoiding median sternotomy or cardiopulmonary bypass or both, however, until now no prospective randomized trial has been carried out to compare these techniques to the conventional approach with special respect to the psychosomatical effects. Methods: In a prospective randomized trial four

Vassilios Gulielmos; Markus Eller; Sebastian Thiele; Hans-Martin Dill; Thorsten Jost; Sems Malte Tugtekin; Stephan Schueler

1999-01-01

184

Perioperative management of a renal transplanted patient for coronary artery bypass grafting.  

PubMed

Following renal transplantation, patients for coronary artery bypass grafting are subjected to high morbidity and mortality during the perioperative period because of the risk of major infections, renal impairment or rejection, and myocardial infarction. We describe the perioperative management of one such high-risk patient. PMID:12462672

Juneja, Rajiv; Singh, Sarab Mohan; Mehta, Yatin; Mishra, Yugal; Trehan, Naresh

2002-01-01

185

Coronary artery bypass graft: why is the saphenous vein prone to intimal hyperplasia?  

PubMed

Proliferation and migration of smooth muscle cells and the resultant intimal hyperplasia cause coronary artery bypass graft failure. Both internal mammary artery and saphenous vein are the most commonly used bypass conduits. Although an internal mammary artery graft is immune to restenosis, a saphenous vein graft is prone to develop restenosis. We found significantly higher activity of phosphatase and tensin homolog (PTEN) in the smooth muscle cells of the internal mammary artery than in the saphenous vein. In this article, we critically review the pathophysiology of vein-graft failure with detailed discussion of the involvement of various factors, including PTEN, matrix metalloproteinases, and tissue inhibitor of metalloproteinases, in uncontrolled proliferation and migration of smooth muscle cells towards the lumen, and invasion of the graft conduit. We identified potential target sites that could be useful in preventing and (or) reversing unwanted consequences following coronary artery bypass graft using saphenous vein. PMID:24933515

Sur, Swastika; Sugimoto, Jeffrey T; Agrawal, Devendra K

2014-07-01

186

Should we consider off-pump coronary artery bypass grafting in patients with acute coronary syndrome?  

PubMed Central

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.

Moscarelli, Marco; Harling, Leanne; Ashrafian, Hutan; Athanasiou, Thanos

2013-01-01

187

Myocardial Revascularization for the Elderly: Current Options, Role of Off-pump Coronary Artery Bypass Grafting and Outcomes  

PubMed Central

The increase in life expectancy has confronted cardiac surgery with a rapidly growing population of elderly patients requiring surgical myocardial revascularization. Recent advances in surgical and anesthetic techniques and improvements in postoperative care have made coronary artery bypass grafting an established therapeutic option for the treatment of coronary artery disease in this group of patients. However, conventional coronary artery bypass grafting on cardiopulmonary bypass is associated with significant risk and related morbidity and mortality in the elderly. In recent years off-pump coronary artery bypass grafting has emerged as a safe and less invasive strategy for surgical myocardial revascularization. Off-pump coronary artery bypass grafting by avoiding the deleterious effects of cardiopulmonary bypass can offer potential benefits to elderly patients requiring surgical myocardial revascularization. This review article provides an overview of the age-related cardiovascular changes, epidemiology of coronary artery disease in the elderly and focuses on outcomes of surgical myocardial revascularization with special emphasis on the impact of off-pump coro-nary artery bypass surgery in the elderly.

Raja, Shahzad G

2012-01-01

188

Coronary-subclavian steal phenomenon late after coronary artery bypass grafting: an underappreciated cause of myocardial ischemia?  

PubMed

Coronary-subclavian steal (CSS) is an increasingly reported phenomenon after coronary artery bypass graft (CABG) operation and it is caused by proximal subclavian artery stenosis in patients with internal thoracic artery grafts. We discuss briefly the diagnostic strategies to rule out significant subclavian stenosis before CABG and, in the follow-up, the importance of subclinical detection of coronary-subclavian steal before the potential onset of myocardial ischemia. Although the most appropriate management of concomitant brachiocephalic and coronary artery disease remains a matter of debate, patients developing CSS syndrome after CABG can be treated successfully by both surgical and percutaneous techniques. Retrospective analysis of surgical databases will help to identify the predictors, if any, of subclavian artery disease progression in candidates for internal thoracic artery grafting, in order to choose a tailored surgical approach. PMID:19412120

Migliorato, Alessandro; Andò, Giuseppe; Micari, Antonio; Baldari, Sergio; Arrigo, Francesco

2009-07-01

189

On-pump versus off-pump coronary artery bypass surgery: what is the status after ROOBY, DOORS, CORONARY and GOPCABE?  

PubMed

Off-pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized, controlled trials. Conversely, it has been suggested that revascularization after off-pump surgery is associated with fewer grafts and lower graft patency, potentially leading to a higher risk of cardiovascular morbidity and need for repeated coronary interventions. Since 2009, four major randomized controlled trials have been published, increasing the level of evidence significantly. PMID:23834696

Houlind, Kim

2013-07-01

190

Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients ?65 years with multivessel coronary artery disease.  

PubMed

Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery-to-left anterior descending coronary artery grafting with percutaneous coronary intervention of non-left anterior descending coronary arteries. The safety and efficacy of HCR in patients ?65 years of age is unknown. In this study, patients aged ?65 years were included who underwent HCR at an academic center from October 2003 to September 2013. These patients were matched 1:4 to similar patients treated with coronary artery bypass grafting (CABG) using a propensity-score matching algorithm. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between HCR and CABG, and 30-day major adverse cardiovascular and cerebrovascular events (a composite of mortality, myocardial infarction, and stroke), periprocedural complications, and 3-year all-cause mortality. Of 715 patients (143 of whom underwent HCR and 572 CABG) in the propensity score-matched cohort, rates of 30-day major adverse cardiovascular and cerebrovascular events were comparable after HCR and CABG (5.6% vs 3.8%, odds ratio 1.46, 95% confidence interval 0.65 to 3.27, p = 0.36). Compared with CABG, HCR resulted in fewer procedural complications (9.1% vs 18.2%, p = 0.018), fewer blood transfusions (28.0% vs 53.3%, p <0.0001), less chest tube drainage (838 ± 484 vs 1,100 ± 579 cm(3), p <0.001), and shorter lengths of stay (<5 days: 45.5% vs 27.4%, p = 0.001). Over a 3-year follow-up period, mortality rates were similar after HCR and CABG (13.2% vs 16.6%, hazard ratio 0.81, 95% confidence interval 0.46 to 1.43, p = 0.47). Subgroup analyses in high-risk patients (Charlson index ?6, age ?75 years) rendered similar results. In conclusion, although the present data are limited, we found that in older patients, the use of HCR is safe, has fewer procedural complications, entails less blood product use, and results in faster recovery with similar longitudinal outcomes relative to conventional CABG. PMID:24878119

Harskamp, Ralf E; Puskas, John D; Tijssen, Jan G; Walker, Patrick F; Liberman, Henry A; Lopes, Renato D; Vassiliades, Thomas A; Peterson, Eric D; Halkos, Michael E

2014-07-15

191

Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65  

PubMed Central

BACKGROUND: Over the past 20 years, there have been marked increases in rates of coronary artery bypass grafting (CABG) among older people in Canada. The objectives of this study were to accurately estimate the direct medical costs of CABG in older patients (age 65 years or more) and to compare CABG costs for this age group with those for patients less than 65 years of age. METHODS: Direct medical costs were estimated from a sample of 205 older and 202 younger patients with triple-vessel or left main coronary artery disease who underwent isolated CABG at The Toronto Hospital, a tertiary care university-affiliated hospital, between Apr. 1, 1991, and Mar. 31, 1992. Costs are expressed in 1992 Canadian dollars from a third-party payer perspective. RESULTS: The mean costs of CABG in older and younger patients respectively were $16,500 and $15,600 for elective, uncomplicated cases, $23,200 and $19,200 for nonelective, uncomplicated cases, $29,200 and $20,300 for elective, complicated cases, and $33,600 and $23,700 for nonelective, complicated cases. Age remained a significant determinant of costs after adjustment for severity of heart disease and for comorbidity. Between 59% and 91% of the cost difference between older and younger patients was accounted for by higher intensive care unit and ward costs. INTERPRETATION: CABG was more costly in older people, especially in complicated cases, even after an attempt to adjust for severity of disease and comorbidity. Future studies should attempt to identify modifiable factors that contribute to longer intensive care and ward stays for older patients.

Naglie, G; Tansey, C; Krahn, M D; O'Rourke, K; Detsky, A S; Bolley, H

1999-01-01

192

Coronary flow reserve early and late after minimally invasive coronary artery bypass grafting in patients with totally occluded left anterior descending coronary artery  

Microsoft Academic Search

Background: The impairment of flow reserve of the left anterior descending coronary artery in the early postoperative period in patients receiving a left internal thoracic artery graft has been related to the effects of cardiopulmonary bypass. Indeed, the late improvement in flow has been attributed to a late increase in left internal thoracic artery diameter. Methods: We evaluated 12 patients

Ruggero De Paulis; Fabrizio Tomai; Achille Gaspardone; Luisa Colagrande; Paolo Nardi; Anna Ghini; Francesco Versaci; Alfonso Penta de Peppo; Pier Agostino Gioffrè; Luigi Chiariello

1999-01-01

193

Comparison of multidetector 64-slice computed tomographic angiography to coronary angiography to assess the patency of coronary artery bypass grafts.  

PubMed

This study prospectively evaluated the diagnostic accuracy of 64-slice computed tomographic angiography (CTA) in assessing the patency of coronary artery bypass grafts compared with invasive coronary angiography. In total 147 bypass grafts (100 venous grafts and 47 mammary artery grafts) were evaluated in 50 consecutive patients. Contrast-enhanced 64-slice CTA was performed and compared with invasive angiography. The computed tomographic angiographic scan protocol used 64- x 0.5-mm slice collimation and 0.33-second gantry rotation time during simultaneous electrocardiographic gating. Patients with a heart rate >65 beats/min received beta blockers. Overall 145 of 147 bypass grafts (98.6%) were detected by CTA; 2 nonvisualized grafts were occluded at the time of invasive angiography. Of the grafts visualized, 28 were totally occluded, 103 were patent, and 14 had significant stenoses that were confirmed by invasive angiography. Ninety-five percent (111 of 117) of patent grafts demonstrated good run-off distal to anastomoses but without an ability to accurately evaluate the presence of retrograde flow; 83% (97 of 117) of distal anastomoses were adequately evaluated, whereas the remaining 17% (20 of 117) were not well visualized due to vascular clips and/or calcification artifacts. Two grafts were not demonstrated by invasive angiography but were detected by CTA and found to be widely patent. In conclusion, multidetector 64-slice CTA is a valuable tool for direct visualization of coronary bypass grafts and assessment of their patency. Dysfunctional bypass grafts can be detected with high diagnostic accuracy. PMID:17531575

Jabara, Refat; Chronos, Nicolas; Klein, Larry; Eisenberg, Steven; Allen, Rebecca; Bradford, Shannon; Frohwein, Stephen

2007-06-01

194

Minimally invasive direct coronary artery bypass--a surgical approach for anomalous right coronary artery from left aortic sinus of Valsalva.  

PubMed

Anomalous origin of the right coronary artery from the left aortic sinus of Valsalva, although rare, has been associated with myocardial ischemia and sudden death. Methods of surgical correction include ostial reconstruction, excision and translocation of the vessel origin, and coronary artery bypass grafting. We describe a 39-year-old man with symptoms of myocardial ischemia and an anomalous right coronary artery in whom we performed the new, minimally invasive direct coronary artery bypass procedure with use of the right internal mammary artery. PMID:9663197

Izhar, U; Lerman, A; Olney, B A; Schaff, H V

1998-07-01

195

Minimally invasive thoracoscopically assisted coronary artery bypass surgery  

Microsoft Academic Search

Objective: Minimally invasive techniques have been widely used in other surgical fields including video-assisted thoracic surgery (VATS) in thoracic surgery. These concepts are now being applied to cardiac surgery. The opportunities to make cardiac surgery less invasive include elimination of the median sternotomy incision, elimination of cardiopulmonary bypass and no manipulation of the aorta. Materials and methods: From January 1992

Michael Mack; Tea Acuff; Peter Yong; G. Kimble Jett; David Carter

1997-01-01

196

Lowest Hematocrit on Cardiopulmonary Bypass Impairs the Outcome in Coronary Surgery  

PubMed Central

Severe hemodilutional anemia on cardiopulmonary bypass increases morbidity and mortality after coronary surgery. The present study focuses on the lowest hematocrit values during extracorporeal circulation and on allogenic blood transfusions as mortality and morbidity risk factors. The records of 1,766 consecutive adult patients undergoing isolated coronary artery bypass graft surgery at 3 institutions have been analyzed retrospectively for in-hospital mortality and adverse outcomes. Clinical data were from the Italian National Cardioanesthesia Database. Multivariate analysis and analysis of receiver operating characteristic curves were applied. The lowest hematocrit value on cardiopulmonary bypass was an independent risk factor for postoperative low-output syndrome and renal failure. The hematocrit cutoff values were similar for renal failure (23%) and low-output syndrome (24%). Blood transfusions were significantly associated with both renal failure and low-output syndrome. The risk of renal failure doubled when the nadir-on-cardiopulmonary-bypass hematocrit occurred in transfused patients. Anemia upon cardiopulmonary bypass was not associated with death. Our findings confirm that both severe anemia and blood transfusions were significantly associated with renal failure and low-output syndrome.

Ranucci, Marco; Biagioli, Bonizella; Scolletta, Sabino; Grillone, Giovanni; Cazzaniga, Anna; Cattabriga, Iolter; Isgro, Giuseppe; Giomarelli, Pierpaolo

2006-01-01

197

Early and mid-term results of minimally invasive coronary artery bypass grafting  

PubMed Central

Introduction Minimally invasive coronary artery bypass grafting (MICABG) is a less invasive method of performing surgical revascularization. This technique coupled with use of off pump technique of surgical revascularization makes it truly less invasive. This method is highly effective even in high-risk patients. Results of this procedure are comparable to standard off pump technique and are better than percutaneous coronary intervention utilizing drug-eluting stent. We present an early and mid-term result of the use of this technique. Method We enrolled 33 patients for analysis operated between 2008 and 2012. Operation was performed utilizing off-pump technique of coronary artery bypass grafting through a minimal invasive incision. Left internal mammary artery graft was done for single vessel disease and radial artery was utilized for other grafts if required. Median follow up of 2.5 years (6 months–4 years) is available. Results Median age was 58.5 years (41–77) and all were male. Single vessel disease was present in 7, double vessel in 14 and triple vessel disease in 12 patients. All the patients had normal left ventricular size and function. There was no operative and 30-day mortality. Conversion to median sternotomy to complete the operation was done in 6.6% (2 out of 33 patients). One patient had acute myocardial infarction and there were no deaths during follow up. Conclusion MICABG is a safe and effective method of revascularization in low risk candidates for coronary artery bypass grafting.

Pande, Shantanu; Agarwal, Surendra K.; Gupta, Devendra; Mohanty, Satayapriya; Kapoor, Aditya; Tewari, Satyendra; Bansal, Anubhav; Ambesh, Sushil P.

2014-01-01

198

Off-pump coronary artery bypass surgery in patients with coronary artery disease and malign neoplasia: results of ten patients and review of the literature  

Microsoft Academic Search

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 Özsöyler; Levent Yilik; ?ahin Bozok; Bilgin Emrecan; Mert Kestell?; Nagihan Karahan; Ali Gürbüz

2006-01-01

199

[Iliac aneurysm rupture during preconditioning with levosimendan for coronary artery bypass graft].  

PubMed

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

Román Fernández, A; López Álvarez, A; Corujeira Rivera, M C; Vilanova Vázquez, V; Carregal Rañó, A; Pereira Loureiro, M Á

2014-03-01

200

Analysis of Micro-Costs of Coronary Artery ByPass Grafting. Abstract, Executive Summary and Final Report.  

National Technical Information Service (NTIS)

Coronary artery bypass grafting (CABG) is one of the most common and costly surgical procedures. To control rising costs, Health Care Financing Administration began a demonstration in 1991 to pay hospitals and physicians a single negotiated global price f...

C. F. Liu S. Subramanian J. Cromwell

1999-01-01

201

The impact of ethnicity on outcomes following coronary artery bypass graft surgery in the Veterans Health Administration  

Microsoft Academic Search

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

2002-01-01

202

Comparative Effectiveness of Multivessel Coronary Bypass Surgery and Multivessel Percutaneous Coronary Intervention  

PubMed Central

Background Randomized trials of coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) suggest that patient characteristics modify the effect of treatment on mortality. Objective To assess whether clinical characteristics modify the comparative effectiveness of CABG versus PCI in an unselected, general patient population. Design Observational treatment comparison using propensity score matching and Cox proportional hazards models. Setting United States, 1992 to 2008. Patients Medicare beneficiaries aged 66 years or older. Intervention Multivessel CABG or multivessel PCI. Measurements The CABG–PCI hazard ratio (HR) for all-cause mortality, with prespecified treatment-by-covariate interaction tests, and the absolute difference in life-years of survival in clinical subgroups after CABG or PCI, both over 5 years of follow-up. Results Among 105 156 propensity score–matched patients, CABG was associated with lower mortality than PCI (HR, 0.92 [95% CI, 0.90 to 0.95]; P < 0.001). Association of CABG with lower mortality was significantly greater (interaction P ? 0.002 for each) among patients with diabetes (HR, 0.88), a history of tobacco use (HR, 0.82), heart failure (HR, 0.84), and peripheral arterial disease (HR, 0.85). The overall predicted difference in survival between CABG and PCI treatment over 5 years was 0.053 life-years (range, ?0.017 to 0.579 life-years). Patients with diabetes, heart failure, peripheral arterial disease, or tobacco use had the largest predicted differences in survival after CABG, whereas those with none of these factors had slightly better survival after PCI. Limitation Treatments were chosen by patients and physicians rather than being randomly assigned. Conclusion Multivessel CABG is associated with lower long-term mortality than multivessel PCI in the community setting. This association is substantially modified by patient characteristics, with improvement in survival concentrated among patients with diabetes, tobacco use, heart failure, or peripheral arterial disease. Primary Funding Source National Heart, Lung, and Blood Institute.

Hlatky, Mark A.; Boothroyd, Derek B.; Baker, Laurence; Kazi, Dhruv S.; Solomon, Matthew D.; Chang, Tara I.; Shilane, David; Go, Alan S.

2014-01-01

203

Axillary artery to left anterior descending coronary artery bypass with an externally stented graft: a technical report  

PubMed Central

With the proliferation of minimally invasive cardiac surgery a number of alternative inflow sites for coronary artery bypass grafting have been utilized, especially in higher risk patients. The use of axillary-coronary artery bypass is a safe and effective alternative especially in the case of patients requiring redo coronary revascularization. However, the length and convoluted course of the axillary-coronary vein graft makes is susceptible to twisting, trauma and neointimal hyperplasia. We therefore report a case of an axillary-coronary artery bypass in a high risk patient in which a Dacron conduit was used to externally support and protect the vein graft to the left anterior descending artery. Surgical technique and considerations are presented and discussed.

Athanasiou, Thanos; Kapetanakis, Emmanouil I; Rao, Christopher; Salvador, Loris; Darzi, Ara

2008-01-01

204

SIMULTANEOUS ENDOSCOPIC RADIAL ARTERY AND GREAT SAPHENOUS VEIN HARVESTING FOR REDO CORONARY ARTERY BYPASS GRAFTING. A REPORT OF TWO CASES  

Microsoft Academic Search

Aim: An ageing population and increase in patient co-morbidities are forcing cardiac surgeons to meticulously consider the benefi ts and risks of respective conduits and their harvesting techniques. Case reports: Two cases of simultaneous endoscopic radial artery and great saphenous vein harvesting, for redo coronary artery bypass grafting, are presented. A shortage of venous conduits after previous bypass grafting, as

M. Simek; P. Nemec; P. Marcian; M. Gwozdziewicz; I. Fluger; Petr Nemec

205

High Thoracic Epidural Anesthesia for Coronary Artery Bypass Grafting Using Two Different Surgical Approaches in Conscious Patients  

Microsoft Academic Search

Recent developments in coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass made the sole use of high thoracic epidural anesthe- sia (TEA) in conscious patients feasible. Previously, TEA has been reported only for single-vessel CABG via lateral thoracotomy. We investigated the feasibil- ity and complications of sole TEA in 20 patients un- dergoing beating-heart arterial revascularization via partial lower

Paul Kessler; Gerd Neidhart; Dorothee H. Bremerich; Tayfun Aybek; Selami Dogan; Volker Lischke; Christian Byhahn

2002-01-01

206

Impact of gender on coronary bypass operative mortality  

Microsoft Academic Search

Background. In spite of many reports investigating the influence of gender on coronary artery operations, it is still uncertain whether gender is an independent risk factor for operative mortality. A major problem of previous reports has centered around the fact that men and women constitute quite different populations, thereby making direct comparisons difficult.Methods. The Society of Thoracic Surgeons National Cardiac

Fred H. Edwards; Joseph S. Carey; Frederick L. Grover; Joseph W. Bero; Renee S. Hartz

1998-01-01

207

Minimally invasive coronary artery bypass grafting decreases hospital stay and cost.  

PubMed Central

OBJECTIVE: The authors performed a retrospective cost analysis for patients undergoing revascularization of their left anterior descending (LAD) coronary artery either by standard coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), or minimally invasive coronary artery bypass grafting (MICABG). SUMMARY BACKGROUND DATA: Minimally invasive CABG has become a safe and effective alternative treatment for single-vessel coronary artery disease. However, the acceptance of this procedure as a routine alternative for the treatment of coronary artery disease will depend on both long-term graft patency rates as well as a competitive market cost. METHODS: The authors conducted a retrospective analysis of three patient groups undergoing LAD coronary revascularization from January 1995 to July 1996. Ten patients were selected randomly from this period after PTCA of an LAD lesion with or without stenting. Nine patients underwent standard CABG on cardiopulmonary bypass with a left internal mammary artery. Nine patients received MICABG via a limited left anterior thoracotomy and left internal mammary artery to LAD grafting without the use of cardiopulmonary bypass. RESULTS: Percutaneous transluminal coronary angioplasty (n = 10) was unsuccessful in two patients. One patient in the MICABG group (n = 9) was converted successfully to conventional CABG because of an intramyocardial LAD and dilated left ventricle. There was no operative morbidity or mortality in any group. Average length of stay postprocedure was decreased significantly for both the MICABG and PTCA groups when compared with that of conventional CABG (n = 9) (2.7 + 0.26, p = 0.009, and 2.6 + 0.54, p = 0.006, vs. 4.8 + 0.46, respectively). Total hospital costs for the MICABG and PTCA groups were significantly less when compared with those of standard CABG ($10,129 + 1104, p = 0.0028, and $9113 + 3,039, p = 0.0001, vs. $17,816 + 1043, respectively). There were no statistically significant differences between the MICABG and PTCA groups. CONCLUSIONS: The final role of minimally invasive CABG is unclear. This procedure is clearly cost effective when compared with that of PTCA and conventional CABG. The long-term patency rates for MICABG will determine its overall efficacy.

King, R C; Reece, T B; Hurst, J L; Shockey, K S; Tribble, C G; Spotnitz, W D; Kron, I L

1997-01-01

208

Giant coronary pseudoaneurysm. Five-year follow-up after bypass grafting.  

PubMed

A roentgenogram of the shoulder in a 25-year-old man with an athletic injury revealed a large mass along the left heart border. Evaluation with coronary arteriography established the diagnosis of a massive aneurysm of the left anterior descending coronary artery. The aneurysm was excised and a saphenous vein bypass graft was placed into the distal artery. Histologic examination revealed that the excised segment was a false aneurysm. Five years postoperatively, the patient is asymptomatic and the graft remains widely patent. PMID:6969827

Chun, P K; Davia, J E; Cheitlin, M D; Green, D C; Bowen, T E; Brott, W H

1981-01-01

209

Coronary artery bypass grafting and/or valvular surgery in patients with previous pneumonectomy.  

PubMed

There is a lack of data regarding heart surgery on patients who have been previously pneumectomized. These patients pose unique challenges and surgical management may necessitate deviations from standard methods in the perioperative course. To summarize the available knowledge and to assess the optimal methods, we reviewed all reported patients with prior pneumonectomy who were subjected to coronary artery bypass grafting and/or valve surgery.In a Medline search from 1966 to May 2011 carefully undertaken, we identified 22 articles, including 29 patients who underwent 30 operations: CABG 70%, valvular surgery 23%, and combination 7%. Severe morbidity was 37% and 30-day mortality 13%.Although postoperative morbidity and mortality remain higher in previously pneumectomized patients undergoing coronary artery bypass grafting and valvular surgery, the gathered experience up to date suggests that a carefully planned surgical strategy, along with the use of advanced modern techniques may reduce morbidity and improve final outcome. PMID:23050830

Fragkidis, Alexander; Dimitriou, Alexander; Dougenis, Dimitrios

2012-01-01

210

Risk-Adjusted Survival after Coronary Artery Bypass Grafting: Implications for Quality Improvement  

PubMed Central

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.

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.

2014-01-01

211

Coronary Artery bypass grafting and/or valvular surgery in patients with previous pneumonectomy  

PubMed Central

There is a lack of data regarding heart surgery on patients who have been previously pneumectomized. These patients pose unique challenges and surgical management may necessitate deviations from standard methods in the perioperative course. To summarize the available knowledge and to assess the optimal methods, we reviewed all reported patients with prior pneumonectomy who were subjected to coronary artery bypass grafting and/or valve surgery. In a Medline search from 1966 to May 2011 carefully undertaken, we identified 22 articles, including 29 patients who underwent 30 operations: CABG 70%, valvular surgery 23%, and combination 7%. Severe morbidity was 37% and 30-day mortality 13%. Although postoperative morbidity and mortality remain higher in previously pneumectomized patients undergoing coronary artery bypass grafting and valvular surgery, the gathered experience up to date suggests that a carefully planned surgical strategy, along with the use of advanced modern techniques may reduce morbidity and improve final outcome.

2012-01-01

212

Aortocoronary bypass for critical stenosis of the left main coronary artery.  

PubMed

Over a 2-year period 33 patients with symptomatic stenosis (greater than 75%) of the left main coronary artery underwent aortocoronary bypass. Intra-aortic balloon counterpulsation was used preoperatively in only two patients as a therapeutic measure for medically unstable angina. There were no operative deaths. Follow-up study 3 to 27 months (mean 13.3 months) after operation revealed one death. Twenty-two patients were free of pain. The authors conclude that aortocoronary bypass surgery for severe stenosis of the left main coronary artery can be safely accomplished, without prophylactic use of intra-aortic balloon counterpulsation in the majority of cases, with an acceptable operative mortality and morbidity. PMID:312689

Dajee, H; Murphy, D A; Moffitt, E A; Kinley, C E; Parrott, J A; Chandler, B M

1979-03-01

213

Health related quality of life trajectories and predictors following coronary artery bypass surgery  

PubMed Central

Background Many studies have demonstrated that health related quality of life (HRQoL) improves, on average, after coronary artery bypass graft surgery (CABGS). However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. Methods 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36), Profile of Mood States (POMS) and the Everyday Functioning Questionnaire (EFQ). These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. Results For both the physical component summary scale (PCS) and the mental component summary scale (MCS) of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers). A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. Conclusion It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of each patient, and those post-operative symptoms that could be possible targets for intervention to improve HRQoL outcomes.

Le Grande, Michael R; Elliott, Peter C; Murphy, Barbara M; Worcester, Marian UC; Higgins, Rosemary O; Ernest, Christine S; Goble, Alan J

2006-01-01

214

Intermittent antegrade hyperkalaemic warm blood cardioplegia supplemented with magnesium prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery  

Microsoft Academic Search

Objective: The influence of the addition of magnesium on myocardial protection with intermittent antegrade warm blood hyperkalaemic cardioplegia in patients undergoing coronary artery surgery was investigated and compared with intermittent antegrade warm blood hyperkalaemic cardioplegia only. Methods: Twenty-three patients undergoing primary elective coronary revascularization were rando- mized to one of two different techniques of myocardial protection. In the first group,

M. Caputoa; A. J. Bryan; A. M. Calafioreb; M.-S. Suleiman; G. D. Angelini

215

Intermittent antegrade hyperkalaemic warm blood cardioplegia supplemented with magnesium prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery  

Microsoft Academic Search

Objective: The influence of the addition of magnesium on myocardial protection with intermittent antegrade warm blood hyperkalaemic cardioplegia in patients undergoing coronary artery surgery was investigated and compared with intermittent antegrade warm blood hyperkalaemic cardioplegia only. Methods: Twenty-three patients undergoing primary elective coronary revascularization were randomized to one of two different techniques of myocardial protection. In the first group, myocardial

M Caputo; A. J Bryan; A. M Calafiore; M.-S Suleiman; G. D Angelini

1998-01-01

216

Projected long-term costs of coronary stenting in multivessel coronary disease based on the experience of the Bypass Angioplasty Revascularization Investigation (BARI)  

Microsoft Academic Search

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

2000-01-01

217

Improvement of Post-Operative Coronary Artery Bypass Graft Surgery Wound Infection Rates  

Microsoft Academic Search

ISSUE: A devastating complication of coronary artery bypass graft (CABG) surgery is post-operative surgical site wound infections. In 2001, Baptist Medical Center (BMC) experienced a post-operative CABG surgical wound infection rate that was above the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance System (NISS) rate.PROJECT: A multidisciplinary performance improvement team, consisting of the chiefs of Cardiovascular

J. Kilts; K. S. Meyer; R. J. Still; K. Walsh

2004-01-01

218

Medico-legal autopsy in postoperative hemodynamic collapse following coronary artery bypass surgery  

Microsoft Academic Search

Sudden unexpected postoperative hemodynamic collapse with a high mortality develops in 1–3% of patients undergoing coronary\\u000a artery bypass surgery (CABG). The contribution of surgical graft complications to this serious condition is poorly known and\\u000a their demonstration at autopsy is a challenging task. Isolated CABG was performed in 8,807 patients during 1988–1999. Of the\\u000a patients, 76 (0.9%) developed sudden postoperative hemodynamic

Janne P. KarhunenPekka; Pekka J. Karhunen; Peter M. Raivio; Eero I. T. Sihvo; Tiina L. S. Vainikka; Ulla-Stina Salminen

2011-01-01

219

Endoscopic vs open saphenous vein harvest for coronary artery bypass grafting: a prospective randomized trial  

Microsoft Academic Search

Objective: Endoscopic saphenous vein harvesting (EVH) for coronary artery bypass grafting (CABG) has been developed to reduce leg wound morbidityandimprovepatientsatisfaction.ChoosingbetweenEVHofashortveinsegmentfromthethighandopenvenousharvesting(OVH)ofashort segment from the calf represents a clinical dilemma as EVH is easiest to perform from the thigh and OVH is easiest to perform from the calf. The purpose of this study was to investigate whether leg wound morbidity was reduced

Jan Jesper Andreasen; Vytautas Nekrasas; Claus Dethlefsen

220

Rapid recovery protocol applied to 5,658 consecutive “on-pump” coronary bypass patients  

Microsoft Academic Search

Background. Increasing hospital costs, restricted resources, and new surgical strategies have stimulated effectiveness of all routines in cardiac surgery. Over a 10-year period, 5,658 consecutive patients undergoing coronary artery bypass grafting followed a protocol aiming at short postoperative intubation times and rapid physical rehabilitation.Methods. The patients were prepared for rapid recovery, emphasizing (1) preoperative education and respiratory training, (2) low-dose

Eivind Øvrum; Geir Tangen; Carla Schiøtt; Stein Dragsund

2000-01-01

221

Coronary artery bypass grafting in non–dialysis-dependent mild-to-moderate renal dysfunction  

Microsoft Academic Search

Objectives: The effect of mild-to-moderate elevation of preoperative serum creatinine levels on morbidity and mortality from coronary artery bypass grafting has not been investigated in a large multivariable model incorporating preoperative and intraoperative variables. Our first objective was to ascertain the effect of a mild-to-moderate elevation in the preoperative serum creatinine level on the need for mechanical renal support; the

Arjuna Weerasinghe; Philip Hornick; Peter Smith; Kenneth Taylor; Chandana Ratnatunga

2001-01-01

222

Coagulation and fibrinolytic markers in a two-month follow-up of coronary bypass surgery  

Microsoft Academic Search

Objectives: The alterations of the coagulation-fibrinolytic profile immediately and up to few days after cardiac surgery have been widely documented. However, less information is available on whether these alterations persist for prolonged periods of time after the operation. In this study we have evaluated the coagulation-fibrinolytic profile of patients who underwent coronary artery surgery with cardiopulmonary bypass during a 2-month

Alessandro Parolari; Susanna Colli; Luciana Mussoni; Sonia Eligini; Moreno Naliato; Xin Wang; Sara Gandini; Elena Tremoli; Paolo Biglioli; Francesco Alamanni

2003-01-01

223

Early hemodynamic effects of olprinone hydrochloride after coronary artery bypass grafting  

Microsoft Academic Search

Our purpose was to evaluate the hemodynamic effects of olprinone hydrochloride early after coronary artery bypass grafting\\u000a (CABG). Fifteen patients undergoing CABG were administered a constant infusion of 0.1 ?g\\/kg\\/min of olprinone and continued\\u000a for 4 hours. No bolus infusion of olprinone was administered before continuous infusion. Systolic systemic arterial pressure,\\u000a systolic pulmonary arterial pressure, systemic vascular resistance and pulmonary

Akira Marui; Takaaki Mochizuki; Norimasa Mitsui; Tadaaki Koyama; Mayumi Horibe

1998-01-01

224

Mechanical properties of cellulose: chitosan blends for potential use as a coronary artery bypass graft  

Microsoft Academic Search

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

Eduardo P. Azevedo; Rohini Retarekar; Madhavan L. Raghavan; Vijay Kumar

2012-01-01

225

Localization of bypass-induced changes in flow in coronary artery models.  

PubMed

Right coronary artery bypass restores blood flow through heart tissues. This also induces changes in flow leading to its failure. By this work the sites which are prone to such changes are localized. The bypass models are developed from transparent silicon rubber of elastic properties similar to arterial tissues. Flow visualization is carried out by photoelasticity technique by using dilute solution of vanadium pentoxide. This analysis carried out under pulsatile flow conditions shows that the proximal stenotic region continues to contribute to the alteration in flow in the hood region of the bypass. Thus making its proximal and distal regions prone to flow-induced changes, which may lead to its blockage over the long duration. PMID:15332491

Singh, M; Liepsch, D

2003-11-01

226

Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation  

PubMed Central

Atrial fibrillation (AF) occurs in one quarter to one third of patients after coronary artery bypass graft surgery (CABG). Conventional CABG uses cardiopulmonary bypass, a process that is itself associated with a systemic vascular inflammatory response that contributes to postoperative morbidity. The avoidance of cardiopulmonary bypass is associated with a significant reduction in the inflammatory response and in the release of markers of myocardial necrosis when compared with conventional CABG. There is speculation that off-pump CABG may reduce the incidence of postoperative AF through reduced trauma, ischaemia, and inflammation. Current data, however, do not emphatically answer the question of whether the incidence of post-CABG AF is reduced by off-pump surgery. The evidence from both observational and randomised studies is conflicting and many studies have weaknesses in design, conduct, or interpretation. It remains an attractive hypothesis that postoperative AF is reduced by off-pump CABG but more robust data are required.

Archbold, R A; Curzen, N P

2003-01-01

227

Short term follow-up of prediabetics undergoing elective percutaneous coronary intervention  

PubMed Central

Background Epidemiologic evidence suggests that the complications of diabetes begin early in the progression from normal glucose tolerance to frank diabetes. Prediabetes is defined as people with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), some of whom in fact already have the characteristic microvascular changes resulting from diabetes itself. Methods and results This study was conducted on 108 patients presenting to Ain Shams University Catheterization Laboratory for elective percutaneous coronary intervention using bare metal stents (48 diabetic patients, 30 pre-diabetic patients and 30 non-diabetic patients). All patients underwent bare metal stent deployment either preceded by balloon dilatation or not. Follow-up was done at three and six months for major adverse cardiac & cerebral events (cardiovascular death, acute coronary syndrome, cerebrovascular stroke, target vessel revascularization). Results Our findings demonstrate that there was no statistically significant difference between patients of the three different study groups regarding composite end point of death, stroke, acute coronary syndrome and target vessel revascularization at three months follow-up (diabetics = 18.8%, pre-diabetics = 13.3%, non diabetics = 3.3%, p-value = 0.1), but there was a highly statistical difference between them regarding acute coronary syndrome (diabetics = 43%, pre-diabetics = 26%, non diabetics = 10%, p-value = 0.006) at six months follow-up. Conclusion Prediabetes, though not a disease entity by itself is associated with of risk for both macrovascular and increasingly, microvascular pathology. It is important to identify these conditions to prevent incident diabetes and to take measures to stop the vascular complications. Our study findings revealed that complications of diabetes may begin early as patients are suffering impaired glucose homeostasis, which warrants further evaluation in larger studies.

El-Hammady, W.; Shawky, A.; El-Annany, A.

2013-01-01

228

Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass  

PubMed Central

OBJECTIVE—To compare cardiac troponin T release and lactate metabolism in coronary sinus and arterial blood during uncomplicated coronary grafting on the beating heart with conventional coronary grafting using cardiopulmonary bypass.?DESIGN—A prospective observational study with simultaneous sampling of coronary sinus and arterial blood: before and 1, 4, 10, and 20 minutes after reperfusion for analysis of cardiac troponin T and lactate. Cardiac troponin T was also analysed in venous samples taken 3, 6, 24, 48, and 72 hours after surgery.?SETTING—Cardiac surgical unit in a tertiary referral centre.?PATIENTS—18 patients undergoing coronary grafting on the beating heart (10 single vessel and eight two-vessel grafting) and eight undergoing two-vessel grafting with cardiopulmonary bypass.?RESULTS—Cardiac troponin T was detected in coronary sinus blood in all patients by 20 minutes after beating heart coronary artery surgery before arterial concentrations were consistently increased. Peak arterial and coronary sinus cardiac troponin T values on the beating heart during single (0.03 (0 to 0.05) and 0.09 (0.07 to 0.16 µg/l, respectively) and two-vessel grafting (0.1 (0.07 to 0.11) and 0.19 (0.14 to 0.25) µg/l) were lower than the values obtained during cardiopulmonary bypass (0.64 (0.52 to 0.72) and 1.4 (0.9 to 2.0) µg/l) (p < 0.05). The area under the curve of venous cardiac troponin T over 72 hours for two-vessel grafting on the beating heart was less than with cardiopulmonary bypass (13 (10 to 16) v 68 (26 to 102) µg.h/l) (p < 0.001). Lactate extraction began within one minute of snare release during beating heart coronary surgery while lactate was still being produced 20 minutes after cross clamp release following cardiopulmonary bypass.?CONCLUSIONS—Lower intraoperative and serial venous cardiac troponin T concentrations suggest a lesser degree of myocyte injury during beating heart coronary artery surgery than during cardiopulmonary bypass. Oxidative metabolism also recovers more rapidly with beating heart coronary artery surgery than with conventional coronary grafting. Coronary sinus cardiac troponin T concentrations increased earlier and were greater than arterial concentrations during beating heart surgery, suggesting that this may be a more sensitive method of intraoperative assessment of myocardial injury.???Keywords: beating heart coronary artery surgery; troponin T; cardiopulmonary bypass; intraoperative assessment; myocardial injury

Koh, T; Carr-White, G; DeSouza, A; Ferdinand, F; Hooper, J; Kemp, M; Gibson, D; Pepper, J

1999-01-01

229

Duloxetine for treatment of male sphincteric incontinence following partial conus medullaris infarction after coronary bypass surgery  

PubMed Central

Introduction Vascular spinal cord injury following coronary bypass grafting surgery is very rare and this is probably one of few reports of a presumptive partial conus medullaris lesion leading to sudden onset bladder and bowel incontinence which was managed using duloxetine, a selective serotonin and norepinephrine reuptake inhibitor. Duloxetine has been used in selected patients with post-prostatectomy sphincteric incontinence but not, to our knowledge, for spinal vascular lesions. Case presentation A 63-year-old Indian man developed bladder and bowel incontinence immediately following coronary bypass grafting surgery. Findings were suggestive of microcirculatory partial conus medullaris infarction. Based on his urodynamics findings he was managed with duloxetine, tolterodine and clean intermittent catheterization. The clinical presentation, serial urodynamic findings and implications are discussed. Conclusion Spinal injury following coronary bypass grafting is rare and devastating. It is important to be able to recognize the problem even when paraplegia is not noted, counsel the patient and manage the patient with the help of urodynamics. In patients with sphincteric incontinence, duloxetine may have a role in management.

2009-01-01

230

The effect of reflexotherapy on patients' vital signs before coronary artery bypass graft surgery  

PubMed Central

BACKGROUND: Medical operation is an anxious factor that causes physiological reactions in body which consequently increases respiratory rate, heart rate and blood pressure. The aim of this study is assessing the effect of reflexotherapy on vital signs of patients before coronary artery bypass surgery in Shahid Chamran hospital of Isfahan. METHODS: Fifty volunteer patients candidated for coronary artery bypass surgery were enrolled in this clinical trial. They were divided in two (control and treatment) groups. Vital signs were measured pre and post 30 minutes reflexotherapy in treatment group. Vital signs were also measured in patients in control group at the same condition of the treatment group, but reflexotherapy was not performed. RESULTS: The mean differences of vital signs was not significant in control and treatment groups at the baseline. But post reflexotherapy intervention, systolic and diastolic blood pressure lowered significantly in the treatment group in comparison with control group (p < 0.05). No significant changes were observed for other vital sign. CONCLUSIONS: The findings of the study shows that reflexotherapy is a safe, effective, cheep nursing intervention in reducing systolic and diastolic blood pressure of patients before coronary artery bypass surgery.

Moeini, Mahin; Kahangi, Leila Sadat; Valiani, Mahboobeh; Heshmat, Reza

2011-01-01

231

Early and long term results of coronary artery bypass grafts in patients with dialysis dependant renal failure  

Microsoft Academic Search

Objective: Coronary artery disease is the main cause of mortality and morbidity in patients on renal therapy replacement. The aim of this study was to define peri-operative risk and long term results of coronary artery bypass grafts (CABG) in dialysis patients. Methods: this retrospective study included 82 patients in chronic dialysis who underwent CABG between 1978 and 1997. The mean

L. Labrousse; C. de Vincentiis; F. Madonna; C. Deville; X. Roques; E. Baudet

1999-01-01

232

Endothelial cell dysfunction after coronary artery bypass grafting with extracorporeal circulation in patients with type 2 diabetes mellitus  

Microsoft Academic Search

Objective: Type 2 diabetes mellitus is a well-known risk factor in patients with severe coronary artery disease undergoing coronary artery bypass grafting (CABG). The aim of the study was to analyze the endothelial dysfunction in these patients by evaluating postoperative soluble inflammatory cytokines. Methods: Patients undergoing CABG without (n=15, group A) and with (n=14, group B) diabetes mellitus were analyzed

Karla Lehle; Jürgen G. Preuner; Anja Vogt; Leopold Rupprecht; Andreas Keyser; Reinhard Kobuch; Christof Schmid; Dietrich E. Birnbaum

2007-01-01

233

Endothelial cell dysfunction after coronary artery bypass grafting with extracorporeal circulation in patients with type 2 diabetes mellitus  

Microsoft Academic Search

Objective: Type 2 diabetes mellitus is a well-known risk factor in patients with severe coronary artery disease undergoing coronary artery bypass grafting (CABG). The aim of the study was to analyze the endothelial dysfunction in these patients by evaluating postoperative soluble inflammatory cytokines. Methods:PatientsundergoingCABG without (n = 15, group A) and with (n = 14, group B) diabetes mellitus were

Karla Lehle; J urgen G. Preuner; Anja Vogt; Leopold Rupprecht; Andreas Keyser; Reinhard Kobuch; Christof Schmid; Dietrich E. Birnbaum

2010-01-01

234

Should the radial artery be used as a bypass graft following radial access coronary angiography.  

PubMed

The radial artery (RA) is often selected as the next conduit of choice following the internal thoracic artery for coronary artery bypass grafting operations (CABG). Radial access coronary angiography (RA-CA) has grown in popularity among cardiologists and has been advocated as the access route of choice for coronary angiography and intervention by many groups. However, sheath insertion and instrumentation may lead to structural and functional damage to the RA, which may preclude its use as a bypass conduit. The increasing use of RA-CA may therefore have an adverse effect on the ability to use the RA as a bypass conduit at subsequent CABG. To review this, a best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: 'should the radial artery be used as a bypass conduit following radial access coronary angiography'? Altogether, 167 papers were found using the reported search; 11 papers were identified that provided 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 studies were tabulated. Acute RA occlusion occurs in 2.3-30.5% of patients undergoing RA-CA. While a significant number of occluded RA's show recanalization on early follow-up, markers of endothelial function such as intima-media thickening (IMT) and flow-mediated dilatation remain impaired. RA-CA causes structural injury to the RA with evidence of histological injury (including intimal hyperplasia, periarterial tissue/fat necrosis and adventitial inflammation) along with intimal tears and medial dissections evident along the entire length of the vessel. Only one paper directly assesses patency rates of RA's used as bypass grafts following RA-CA finding a significant adverse effect on graft patency (77% patency in RA-CA, compared with 98% in the control group). We recommend avoiding the RA as a bypass conduit if it has previously been used for RA-CA. In situations where conduit options are limited, if possible, the RA should be avoided for at least 3 months following RA-CA and it may be beneficial to assess the RA's patency and flow characteristics with Doppler ultrasound preoperatively. PMID:24254539

Lim, Lisa M; Galvin, Sean D; Javid, Mohamed; Matalanis, George

2014-02-01

235

[Coronary bypass surgery on the beating heart and surgery of an abdominal aortic aneurysm. Immediately sequential surgical treatments].  

PubMed

The authors report sequential association during the same general anaesthetic of coronary bypass surgery on the beating heart and surgery of an abdominal aortic aneurysm. Two aorto-coronary bypass grafts were carried out without cardiopulmonary bypass using the two pediculated internal mammary arteries (without manipulation of the ascending aorta), followed, after closure of the chest and monitoring in the operating theatre for one hour, by reinstallation of the patient for treatment of an infra-renal abdominal aortic aneurysm by classical prosthetic implantation. The postoperative course was uncomplicated. Sequential management of coronary revascularisation without cardiopulmonary bypass and aortic aneurysmal lesions during the same anaesthetic provides an alternative to classical two-stage surgery in selected patients. PMID:11387936

Braunberger, E; Combes, M A; Meimoun, P; Loeb, T; Julia, P; Thebault, B; Bellorini, M; Cheysson, E; Funck, F; Deloche, A

2001-04-01

236

Off-pump axillo-coronary artery bypass: a simple approach for high-risk myocardial revascularization.  

PubMed

We report the case of a 66-year-old male with increasing angina occurring after two previous coronary artery surgery procedures. The second operation had been complicated by severe mediastinitis necessitating surgical drainage, and sternal stabilization. Angiography revealed an occlusion of the LAD bypass with a patent LAD associated with a stenotic circumflex coronary artery. The ascending aorta was severely calcified. An off-pump axillo-LAD coronary artery bypass was safely performed in conjunction with stenting of the circumflex artery. This approach dramatically simplified the procedure and reduced the operative risk. At the 52-month follow-up, the patient is free of any angina symptoms. PMID:23594154

Grandmougin, Daniel; Maureira, Juan-Pablo; Fiore, Antonio; Vanhuyse, Fabrice; Elfarra, Mazen; Roudmane, Nezha; Portocarrero, Eric; Delolme, Maria-Christina; Folliguet, Thierry; Villemot, Jean-Pierre

2013-07-01

237

Diagnostic accuracy of 64-slice CT in evaluating coronary artery bypass grafts and of the native coronary arteries  

Microsoft Academic Search

Purpose  Our aim was to evaluate the accuracy, sensitivity and specificity of 64-slice multidetector computed tomography (MDCT) in\\u000a the assessment of occlusions and stenoses of arterial and venous bypass grafts and disease progression in the native vessels\\u000a distal to the graft, and to compare the results with those of conventional coronary angiography.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  We enrolled 78 individuals (45 men, 33

A. Romagnoli; A. Patrei; A. Mancini; C. Arganini; S. Vanni; M. Sperandio; G. Simonetti

2010-01-01

238

Quality of life in elderly patients following coronary artery bypass grafting  

PubMed Central

Background Surgical revascularization of the coronary arteries leads to changes in quality of life (QoL) for patients with coronary heart disease. The aim of this work was to monitor QoL, considering cognitive function, depression, and activities of daily living in elderly patients after coronary artery bypass grafting (CABG). Methods This study included 65 patients (29 women and 36 men) aged 61–74 years with stable coronary heart disease who underwent CABG. The control group included 29 women and 36 men aged 61–74 years who were not suffering from coronary heart disease. The questionnaires used in the study canvassed QoL (Nottingham Health Profile), cognitive function, depression, and basic and instrumental activities of daily living. The research was conducted before surgery and repeated 6 and 12 months after surgery. Results QoL was comparable between women and men and was lower than in the control group (P<0.05). After CABG, the values for particular domains of QoL improved more in men than in women. There was a reduction in the severity of depression 6 months after surgery in men and 12 months after surgery in women. Conclusion Elderly patients with coronary heart disease have decreased QoL, which normalizes in men and improves in women after CABG.

Bak, Ewelina; Marcisz, Czeslaw

2014-01-01

239

Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in patients undergoing coronary artery bypass grafting  

PubMed Central

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.

Demirtas, Sinan; Caliskan, Ahmet; Karahan, Oguz; Yavuz, Celal; Guclu, Orkut; Cayir, Mustafa Cagdas; Toktas, Faruk; Tiryakioglu, Osman

2013-01-01

240

Intraoperative insulin therapy does not reduce the need for inotropic or antiarrhythmic therapy after cardiopulmonary bypass  

Microsoft Academic Search

Objective: To determine whether attempted glucose control through intraoperative insulin therapy reduces the need for inotropic or antiarrhythmic therapy after cardiopulmonary bypass (CPB). Design:Post hoc analysis of a randomized, masked clinical trial of insulin therapy for prevention of neurobehavioral deficits. Setting: Single university hospital. Participants: Nondiabetic patients undergoing elective coronary artery bypass graft surgery (n = 381). Interventions: Patients received

Leanne Groban; John Butterworth; Claudine Legault; Anne T. Rogers; Neal D. Kon; John W. Hammon

2002-01-01

241

Autotransfusion management during and after cardiopulmonary bypass alters fibrin degradation and transfusion requirements  

Microsoft Academic Search

The coagulation-fibrinolytic profile during cardiopulmonary bypass (CPB) has been widely documented. However, less information is available on the possible persistence of these alterations when autotransfusion is used in management of perioperative blood loss. This study was designed to explore the influence of autotransfusion management on intravascular fibrin degradation and postoperative transfusions. Thirty patients, undergoing elective primary isolated coronary bypass grafting,

A. Wiefferink; P. W. Weerwind; W. L. van Heerde; S. Teerenstra; L. Noyez; B. E. de Pauw; R. M. H. J. Brouwer

2007-01-01

242

Screening of Carotid Artery Stenosis in Coronary Artery Bypass Grafting Patients  

PubMed Central

Background: We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting. Methods: A total of 2179 consecutive patients who underwent coronary artery bypass grafting alone or with other cardiac surgery at Tehran Heart Center, Tehran-Iran, between January 2005 and January 2006 were included in this retrospective study. Carotid Doppler was performed for 1604 (81.48%) of these patients. Results: The patients’ age ranged between 20 and 84 years (mean: 58.33, SD: 10.08 years). Of the 1604 patients studied, 1186 (73.9%) were men, 592 (36.9%) had diabetes, 598 (37.3%) were smokers, and 194 (12.1%) cases had significant left main stenosis. Twenty-one (1.3%) patients had significant carotid stenosis (> 60% stenosis), which constituted 0.9% of all the bypass surgery candidates. Post-operative cerebrovascular accident was not detected in any of the patients with significant carotid stenosis, but cerebrovascular accident occurred in 22 (1.4%) of the patients without carotid stenosis. Magnetic resonance angiography (MRA) was conducted in 15 patients. In our univariate analysis, female gender (p value = 0.023), hypertension (p value = 0.055), peripheral vascular disease (p value < 0.001), and age (p value = 0.001) were significant in the development of carotid stenosis. Conclusion: Pre-operative duplex carotid screening seems to be necessary in patients when there is hypertension, peripheral vascular disease, female gender, and advanced age.

Salehiomran, Abbas; Shirani, Shapour; Karimi, Abbasali; Ahmadi, Hossein; Marzban, Mehrab; Movahedi, Namvar; Moshtaghi, Naghmeh; Abbasi, Seyed Hesameddin

2010-01-01

243

Prevalence Pattern of Risk Factors for Coronary Artery Disease among Patients Presenting for Coronary Artery Bypass Grafting in Oman  

PubMed Central

Objectives To identify the pattern of prevalence of risk factors in patients presenting for coronary artery bypass grafting at a single center in Oman. Methods All patients who had coronary artery bypass grafting between March 2008 to March 2010 were included and data were obtained from history and laboratory investigations. The prevalence rates of eight conventional risk factors are presented as a retrospective single center observational study. Results Out of 146 total patients, 107 (73.29%) were male. The age ranged from 31 to 87 years old. The mean age was 58.18 ± 10.08 years (males = 56.81 ± 10.42, females = 61.95 ± 7.97). Hypertension was present in 119 patients (81.51%), 115 patients (78.77%) had dyslipidemia, 107 patients (73.29%) were male, 79 patients (54.11%) had diabetes mellitus, 70 patients (47.95%) were over the age of 60 years, 41 patients (28.08%) gave a history of smoking, 31 patients (21.23%) were obese, and 19 patients (13.01%) gave a positive family history. Conclusions The most common risk factor was hypertension, followed by dyslipidemia, male gender, diabetes mellitus, old age, smoking, obesity and positive family history; 87.7% had three or more risk factors. The females in this study were older than the males and had more risk factors at presentation. The most common combination of factors seen together was diabetes, hypertension, dyslipidemia and male gender.

Pieris, Rajeeva Rivikath; Al-Sabti, Hilal Ali; Al-Abri, Qasim Saleh Abdullah; Rizvi, Syed Gauhar Alam

2014-01-01

244

Meta-analysis of effect of single versus dual antiplatelet therapy on early patency of bypass conduits after coronary artery bypass grafting.  

PubMed

Aspirin monotherapy represents a standard therapy for preserving patency after coronary artery bypass grafting. Randomized trials addressing whether dual antiplatelet therapy is superior to single antiplatelet therapy to achieve graft patency early after coronary surgery have shown inconsistent results. We performed a meta-analysis of randomized controlled trials comparing single versus dual antiplatelet therapy after coronary artery bypass grafting. In a systematic published works search, 5 randomized controlled trials meeting inclusion criteria were identified. Pooled efficacy and safety data were abstracted and analyzed using a fixed-effects model. The 5 trials included 958 patients and a total of 2,919 grafts with treatment up to 1 year after coronary bypass surgery. Early occlusion was identified in 165 (6.5%) of 2,526 bypass grafts. Early occlusion occurred in a greater proportion of grafts among patients treated with single therapy (105 of 1,369; 7.7%) compared with dual antiplatelet therapy (69 of 1,386; 5.0%; p = 0.005). The odds ratio for graft occlusion with single versus dual therapy was 1.59 (95% confidence interval 1.16 to 2.17). For vein grafts, single antiplatelet therapy was associated with a significantly increased graft loss rate (91 of 846; 10.8%) versus dual antiplatelet therapy (57 of 860; 6.6%; odds ratio 1.70 [1.20 to 2.40]; p = 0.003). There was no effect on arterial graft patency. Bleeding was noted in 3.3% and 4.9% of single and dual therapy treated patients, respectively, with only 3 trials reporting bleeding outcomes. In conclusion, among 958 patients randomly assigned to either single or dual antiplatelet therapy for up to 1 year after coronary bypass surgery, single antiplatelet therapy significantly increased the risk for graft occlusion, an effect isolated to vein grafts, not arterial grafts. PMID:24035160

Nocerino, Angelica G; Achenbach, Stephan; Taylor, Allen J

2013-11-15

245

Surgical pitfalls of minimally invasive direct coronary artery bypass procedure from the viewpoint of a surgeon in the learning curve  

PubMed Central

Introduction Minimally invasive direct coronary artery bypass grafting (MIDCAB) offers arterial revascularization of the left anterior descending (LAD) coronary artery especially in lesions unsuitable for percutaneous coronary interventions. By avoidance of sternotomy and cardiopulmonary bypass its invasiveness is less than that of conventional bypass surgery. Aim We in this study discuss our surgical experience in the MIDCAB procedure. Material and methods Thirteen patients were operated on with the MIDCAB procedure. The inclusion criteria for MIDCAB were pure LAD disease totally occluded or severely stenotic. Patient demographics and preoperative and postoperative data were analyzed. Results Mean age of the patients was 60.0 ±8.6 years. Patients’ preoperative and postoperative levels of cardiac CK-MB (creatine kinase MB) were not significantly different (p = 0.993). However, cardiac troponin I (p < 0.001), hemoglobin (p < 0.001) and hematocrit (p < 0.001) were significantly different. No perioperative myocardial infarctions or cerebrovascular accidents were seen. The patients were discharged at a mean day of 4.77 with oral antiaggregant therapy. No mortality was seen in the study population. Conclusions Minimally invasive direct coronary artery bypass is associated with few perioperative complications. Minimally invasive direct coronary artery bypass in our experience is a very good option for single vessel LAD disease.

Ozdemir, Ahmet Coskun

2012-01-01

246

Endoscopic Saphenous harvesting with an Open CO2 System (ESOS) trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial  

PubMed Central

Background In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction. However, to date the short and the long-term benefits of the endoscopic technique remain controversial. This study provides an interesting opportunity to address this gap in the literature. Methods/Design Endoscopic Saphenous harvesting with an Open CO2 System trial includes two parallel vein harvesting arms in coronary artery bypass grafting surgery. It is an interventional, single centre, prospective, randomized, safety/efficacy, cost/effectiveness study, in adult patients with elective planned and first isolated coronary artery disease. A simple size of 100 patients for each arm will be required to achieve 80% statistical power, with a significant level of 0.05, for detecting most of the formulated hypotheses. A six-weeks leg wound complications rate was assumed to be 20% in the conventional arm and less of 4% in the endoscopic arm. Previously quoted studies suggest a first-year vein-graft failure rate of about 20% with an annual occlusion rate of 1% to 2% in the first six years, with practically no difference between the endoscopic and conventional approaches. Similarly, the results on event-free survival rates for the two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to enrol 230 patients from a single Italian cardiac surgery centre. Discussion The goal of this prospective randomized trial is to compare and to test improvement in wound healing, quality of life, safety/efficacy, cost-effectiveness, short and long-term outcomes and vein-graft patency after endoscopic open CO2 harvesting system versus conventional vein harvesting. The expected results are of high clinical relevance and will show the safety/efficacy or non-inferiority of one treatment approach in terms of vein harvesting for coronary artery bypass grafting surgery. Trial registration www.clinicalTrials.gov NCT01121341.

2011-01-01

247

Multiscale modeling and simulation of blood flow in coronary artery bypass graft surgeries  

NASA Astrophysics Data System (ADS)

We present a computational framework for modeling and simulation of blood flow in patients who undergo coronary artery bypass graft (CABG) surgeries. We evaluate the influence of shape on the homeostatic state, cardiac output, and other quantities of interest. We present a case study on a patient with multiple CABG. We build a patient-specific model of the blood vessels comprised of the aorta, vessels branching from the top of the aorta (brachiocephalic artery and carotids) and the coronary arteries, in addition to bypass grafts. The rest of the circulatory system is modeled using lumped parameter 0D models comprised of resistances, compliances, inertances and elastance. An algorithm is presented that computes these parameters automatically given constraints on the flow. A Finite element framework is used to compute blood flow and pressure in the 3D model to which the 0D code is coupled at the model inlets and outlets. An adaptive closed loop BC is used to capture the coupling of the various outlets of the model with inlets, and is compared with a model with fixed inlet BC. We compare and contrast the pressure, flowrate, coronary perfusion, and PV curves obtained in the different cases. Further, we compare and contrast quantities of interest such as wall shear stress, wall shear stress gradients and oscillatory shear index for different surgical geometries and discuss implications of patient-specific optimization.

Sankaran, Sethuraman; Esmaily Moghadam, Mahdi; Kahn, Andy; Marsden, Alison

2011-11-01

248

Influence of triflusal on platelet activation after coronary artery bypass graft.  

PubMed

The aim of the study was to investigate the effects of the antiplatelet agent triflusal on the changes in platelet function in patients who underwent a cardiopulmonary bypass for coronary arteries (CABG). In 20 surgical patients, blood was sampled before and at the conclusion of surgery, 48 h later (in the intensive care unit), and after 10 days of treatment with 600 mg/day triflusal (triflusal was administered from the first day after surgery). Adenosine diphosphate (ADP) and collagen-induced platelet aggregation in whole blood, granular release of beta-thromboglobulin and platelet release of thromboxane B2 were measured. Basal values were compared with results in a group of ten healthy volunteers. All platelet determinations of activation were higher in coronary patients than in healthy volunteers. Immediately after CABG, the platelet reactivity to ADP and collagen were significantly lower, and release of beta-thromboglobulin and thromboxane B2 were higher, than in the pre-CABG samples. During the patient's stay in the intensive care unit, all values tend to return to pre-CABG values. Triflusal inhibits both platelet beta-thromboglobulin (63% with respect to the post-CABG value) and thromboxane B2 (91% with respect to the post-CABG value) release. Platelet aggregation after 10 days of triflusal treatment tended to return to the pre-CABG values. In conclusion, Triflusal reduces platelet activation caused by the coronary artery bypass graft surgery. PMID:10759013

Prieto, M A; De La Cruz, J P; Del Prado, M F; Sánchez de la Cuesta, F

2000-03-01

249

Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review  

PubMed Central

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.

2013-01-01

250

Beating-heart totally endoscopic coronary artery bypass grafting: report of a case.  

PubMed

This case report presents beating-heart totally endoscopic coronary artery bypass grafting (TECAB) for single-vessel coronary artery disease. A 72-year-old man with isolated left anterior descending (LAD) coronary artery disease was considered eligible for TECAB. Left internal thoracic artery (LITA) mobilization and subsequent off-pump revascularization applying the LITA to the LAD in a closed chest environment was performed using the da Vinci surgical system (Intuitive Surgical, Mountain View, CA, USA). The LITA was first harvested completely in a totally skeletonized fashion through three incisions 1-2 cm long in the left thoracic wall. The LAD was immobilized with the aid of a heart stabilizer. The LITA was then anastomosed to the LAD with 10 interrupted sutures of a Nitinol self-closing S15 U-clip device (Medtronic, Minneapolis, MN, USA) on the beating heart without the use of cardiopulmonary bypass. The time acquired to perform anastomosis was 20 min, and the total operative time was 5 h 34 min. The postoperative course was uneventful and the patient was discharged 5 days after the operation. Beating-heart TECAB was successfully performed for this patient with single-vessel LAD disease. This approach may be an evolutionary step toward beating-heart multivessel TECAB. PMID:20037841

Nishida, Satoru; Watanabe, Go; Ishikawa, Norihiko; Kikuchi, Yujiro; Takata, Munehisa; Ushijima, Teruaki

2010-01-01

251

[Atrial fibrillation after coronary artery bypass surgery: possibilities of prevention].  

PubMed

Atrial fibrillation occurs as a frequent complication after cardiac interventions. It can be found in 5% of all surgical patients, and it is far more common in cardiac (10% - 65% of patients) than in non-cardiac procedures. In a number of patients it remains asymptomatic, but may be accompanied by very severe symptoms of hypotension, heart failure, syncope, systemic or pulmonary embolism, perioperative myocardial infarction, cerebrovascular insult and increased operative mortality. Patients whose postoperative course is complicated by atrial fibrillation require longer hospitalization. Possible predisposing factors of this arrhythmia are numerous and are associated with surgery, extensive coronary heart disease and revascularization, and preoperative diseases. According to the recommendations of the European Society of Cardiology orally applied beta-blocker, amiodarone and sotalol can be used for prophylaxis of atrial fibrillation. Following the recommendations, treatment of postoperative atrial fibrillation should include beta-blockers, amiodarone, and in patients with heart failure and left ventricular dysfunction, digoxin. Due to the increased risk of stroke, an anticoagulant protection is necessary. Many studies have been conducted with results supporting the prophylactic use of amiodarone and beta-blockers, while the treatment with new agents such as magnesium, statins, omega-3 fatty acids and inhibitors of the renin-angiotensin-aldosterone system is still being investigated. PMID:23092042

Obrenovi?-Kir?anski, Biljana; Orbovi?, Bojana; Vraneš, Mile; Parapid, Biljana; Kova?evi?-Kosti?, Nataša; Velinovi?, Miloš; Risti?, Stana

2012-01-01

252

Coronary artery bypass grafting in a patient with protein S deficiency: Perioperative implications.  

PubMed

Protein S (PS) along with activated protein C plays an important role in the down-regulation of in vivo thrombin generation. Its deficiency can cause abnormal and inappropriate clot formation within the circulation necessitating chronic anticoagulation therapy. The risk of developing thrombotic complications is heightened in the perioperative period in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Heparin resistance is very rare in these patients, especially when antithrombin levels are near normal. Management of CPB in this scenario is quite challenging. We report the perioperative management, particularly the CPB management, of a patient with type I PS deficiency and incidentally detected heparin resistance, who underwent coronary artery bypass grafting with CPB. PMID:24994735

Balan, Baskaran; Chengode, Suresh; Al Sabti, Hilal; Rao, Ram Narayan

2014-01-01

253

Coronary aspirate TNF? reflects saphenous vein bypass graft restenosis risk in diabetic patients  

PubMed Central

Background Patients with diabetes mellitus (DM) have an increased risk for periprocedural complications and adverse cardiac events after percutaneous coronary intervention. We addressed the potential for coronary microvascular obstruction and restenosis in patients with and without DM undergoing stenting for saphenous vein bypass graft (SVG) stenosis under protection with a distal occlusion/aspiration device. Methods SVG plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Percent diameter stenosis was determined from quantitative coronary angiography before, immediately after and 6?months after stent implantation. Coronary aspirate was retrieved during stent implantation and divided into particulate debris and plasma. Total calcium, several vasoconstrictors, and tumor necrosis factor (TNF)? in particulate debris and coronary aspirate plasma were determined. Results Patients with and without DM had similar plaque volume, but larger necrotic core and greater particulate debris release in patients with than without DM (20.3±2.7 vs. 12.7±2.6% and 143.9±19.3 vs. 75.1±10.4?mg, P<0.05). The TNF? concentration in particulate debris and coronary aspirate plasma was higher in patients with than without DM (15.9±6.6 vs. 5.1±2.4 pmol/mg and 2.2±0.7 vs. 1.1±0.2 pmol/L, P<0.05), whereas total calcium and vasoconstrictors were not different. Patients with DM had a greater percent diameter stenosis 6?months after stent implantation than those without DM (22.17±5.22 vs. 6.34±1.11%, P<0.05). The increase in TNF? immediately after stent implantation correlated with restenosis 6?months later (r=0.69, P<0.05). Conclusion In diabetics, particulate debris and coronary aspirate plasma contained more TNF?, which might reflect the activity of the underlying atherosclerotic process. Trial registration URL: http://www.clinicaltrials.gov/ct2/results?term=NCT01430884; unique identifier: NCT01430884

2013-01-01

254

On-pump versus off-pump coronary-artery bypass surgery: a meta-analysis.  

PubMed

There are controversies about the possible benefits of off pump coronary artery bypass grafting (OPCABG) compared to on-pump coronary artery bypass grafting (ONCABG). For a better perspective on this important issue, we performed a meta-analysis of randomized controlled trials, comparing the two techniques. The objective of this study was to verify which technique applied in Coronary Artery Bypass Surgery, OPCABG or ONCABG, provides better results through a meta-analysis of published randomized trials comparing the two techniques. We carried out a computer-based literature search in PubMed, Embase, B-on and Science Direct from March 2009 to January 2010. The studies covered were recovered according to predetermined criteria. A systematic review of randomized clinical trials was performed in order to evaluate the differences between the two revascularization techniques (OPCABG versus ONCABG) regarding mortality and morbidity. Selected studies did not include patients at high risk and long-term longitudinal evaluations. The meta-analysis focused on nine randomized clinical trials, corresponding to a total of 75,086 patients, and compared OPCABG to ONCABG. Regarding mortality, a reduction of 18% in the risk of cardiovascular mortality (OR: 0.82, 95%CI: 0.70 to 0.98, p = 0.03) and 27% in the risk of stroke postoperatively (OR: 0.73, 95%CI: 0.63 to 0.85, p = 0.0001) were observed, both in favor of OPCABG. Concerning the occurrence of complications associated with the procedure, no significant differences were found between the two surgical techniques, particularly with regard to the occurrence of kidney complications (OR: 0.97, 95%CI: 0.84-1.14, p = 0, 74) and sepsis (OR 0.98, 95%CI: 0.64-1.51, p = 0.93, respectively). Off-pump CABG significantly reduces the occurrence of major cardiovascular events (mortality and CVA) compared to on-pump CABG surgery. PMID:22323324

Godinho, Ana Sofia; Alves, Ana Sofia; Pereira, Alexandre José; Pereira, Telmo Santos

2012-01-01

255

Beating heart mitral valve repair for a patient with previous coronary bypass: a case report and review of the literature.  

PubMed

Mitral valve reoperation, through a median sternotomy, for a patient with patent coronary bypass grafts is technically challenging and carries higher postoperative morbidity and mortality than a primary operation. We present a case of mitral valve repair using a beating heart technique under normothermic cardiopulmonary bypass that was performed 3 years after a coronary artery bypass operation. A limited (10 cm) right thoracotomy was made and cardiopulmonary bypass was conducted using the ascending aortic and femoral venous cannulation. The left atrium was opened while beating was maintained. Triangular resection of the prolapsed portion of the posterior leaflet and ring annuloplasty were performed. Completeness of the repair was verified by direct visualization under beating condition and transesophageal echocardiogram. This technique is a safe and feasible option for a mitral valve reoperation that excludes re-sternotomy, extensive pericardial dissection and aortic clamping, thereby minimizes risks of bleeding, graft injury and myocardial damage. PMID:24128131

Nakamura, Teruya; Izutani, Hironori; Sekiya, Naosumi; Nakazato, Taro; Sawa, Yoshiki

2013-01-01

256

Upgrading redo coronary artery bypass graft by recycling in situ arterial graft.  

PubMed

We present a case of redo coronary artery bypass grafting (CABG) in which a single internal thoracic artery (ITA) graft was upgraded to a bilateral ITA graft by recycling a left ITA graft, anastomosed to the left anterior descending artery in primary CABG performed 17 years previously. During redo CABG, we dissected the left ITA, reused it in situ for the circumflex artery, and used the right ITA to the left anterior descending artery for a bilateral ITA graft. All grafts remained patent 2 years after redo CABG. Recycling ITA grafts may enable upgrading to bilateral ITA grafting during redo CABG. PMID:24996709

Dohi, Masahiro; Doi, Kiyoshi; Okawa, Kazunari; Yaku, Hitoshi

2014-07-01

257

High Postoperative Interleukin8 Levels Related to Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Surgery  

Microsoft Academic Search

Background  Atrial fibrillation (AF) is the most frequently encountered postoperative arrhythmic complication after coronary artery bypass\\u000a graft (CABG). There is increasing evidence to support the influence of inflammation in the pathogenesis of AF. The aim of\\u000a the present study was to investigate the relation of postoperative new AF and systemic inflammatory changes after CABG.\\u000a \\u000a \\u000a \\u000a Methods  A total of 113 CABG patients were

Zhong-Kai Wu; Jari Laurikka; Saila Vikman; Riina Nieminen; Eeva Moilanen; Matti R. Tarkka

2008-01-01

258

Biomechanics of coronary artery and bypass graft disease: potential new approaches.  

PubMed

The contribution of biomechanical factors to the incidence and distribution of coronary artery and bypass graft disease is underrecognized. This review examined the literature to determine which factors were relevant and the evidence for their importance. It identified two primary biomechanical factors that predispose to disease: (1) low-wall shear stress and (2) high-wall mechanical stress or strain. A range of secondary biomechanical factors have also been identified and include: vessel geometry; vessel movement; vessel wall characteristics and the presence of reflection waves. Potential surgical approaches for minimizing these effects are discussed. PMID:19101335

John, Lindsay C H

2009-01-01

259

Pregnancy after myocardial infarction and coronary artery bypass grafting - is it safe?  

PubMed Central

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.

Janion-Sadowska, Agnieszka; Sadowski, Marcin; Kurzawski, Jacek; Polewczyk, Anna; Janion, Marianna

2014-01-01

260

Off-pump coronary artery bypass grafting in a patient with Werner's syndrome.  

PubMed

Werner's syndrome is a rare hereditary disorder that is characterized by premature aging. We report a case of off-pump coronary artery bypass grafting (OPCAB) in a 56-year-old man with Werner's syndrome. We used an endoscopic vessel-harvesting system to harvest great saphenous vein grafts (SVGs) because this system helps minimize surgical wounds. This is important because poor wound healing is a prominent feature of Werner's syndrome. Revascularization of the coronary arteries in this case was thought to improve his prognosis, although he had already outlived the average life-span of Werner's syndrome. A detailed examination of the cardiovascular system should be performed in patients with this disorder. PMID:19085052

Tanaka, Satona; Miyairi, Takeshi; Shimada, Shogo; Miura, Sumio; Kigawa, Ikutaro; Fukuda, Sachito

2008-12-01

261

Release of S100B during coronary artery bypass grafting is reduced by off-pump surgery  

Microsoft Academic Search

Background. S100B, a plasma marker of brain injury, was compared after coronary artery bypass grafting with and without cardiopulmonary bypass (CPB).Methods. Fourteen patients with off-pump operations and 18 patients with CPB were compared. Seven patients in the off-pump group underwent a minithoracotomy and received only an arterial graft, whereas 7 patients underwent sternotomy and received both an arterial and one

Russell E Anderson; Lars-Olof Hansson; Jarle Vaage

1999-01-01

262

Release of S100B During Coronary Artery Bypass Grafting Is Reduced by Off-Pump Surgery  

Microsoft Academic Search

Background. S100B, a plasma marker of brain injury, was compared after coronary artery bypass grafting with and without cardiopulmonary bypass (CPB). Methods. Fourteen patients with off-pump operations and 18 patients with CPB were compared. Seven patients in the off-pump group underwent a minithoracotomy and received only an arterial graft, whereas 7 patients underwent sternotomy and received both an arterial and

Russell E. Anderson; Lars-Olof Hansson; Jarle Vaage

263

Prognostication in 3Vessel Coronary Artery Disease Based on Left Ventricular Ejection Fraction During Exercise Influence of Coronary Artery Bypass Grafting  

Microsoft Academic Search

Background—Previous data indicate that left ventricular ejection fraction (LVEF) provides prognostic information among patients with coronary artery disease (CAD), but the value of such testing specifically for defining benefits of coronary artery bypass grafting (CABG) may relate to severity of exercise-inducible ischemia measured noninvasively before surgery. Methods and Results—To determine the independent prognostic importance of preoperative ischemia severity for predicting

Phyllis G. Supino; Jeffrey S. Borer; Edmund M. Herrold; Clare Hochreiter

264

Off-pump coronary artery bypass grafting in elderly and high-risk patients--a review.  

PubMed

Elderly and high-risk patients are increasingly being considered for myocardial revascularisation. Most trials comparing the various options for revascularisation exclude elderly and 'high-risk' patients. We have reviewed the options for myocardial revascularisation for elderly patients, and for patients with a number of common 'high-risk' co-morbidities--diabetes mellitus, renal insufficiency, poor left ventricular ejection fraction, peripheral vascular disease, left main coronary artery disease and chronic obstructive pulmonary disease--with a focus on coronary artery bypass grafting without the use of cardiopulmonary bypass and aortic manipulation. PMID:21862405

Cooper, Edward A; Edelman, J James B; Wilson, Michael K; Bannon, Paul G; Vallely, Michael P

2011-11-01

265

Determinants of left ventricular function following aorto-coronary bypass surgery.  

PubMed

Ventricular function was evaluated by the development of ventricular function curves from the vulumes stress of angiographic contrast media in 30 patients before and an average of 5 months after coronary bypass surgery. Patients were grouped according to preoperative operative indications, perioperative events, and postoperative status to determine the most important factors affecting postoperative ventricular function. Progression of lesions in the native coronary circulation correlated most significantly with a decrease in postoperative ventricular function. In 18 of 19 patients the changes in native coronary circulation were progression to complete occlusion. Seventy-three per cent of these changes were associated with a patent graft distal to the change. Patients with very ischemic ventricles as evidenced by a markedly positive stress test (greater than 2 mm. ST depression) and/or main left coronary obstruction maintained or improved postoperatively ventricular function. Increase in postoperative ejection fraction was often associated with decrease in aortic mean pressure, making it difficult to use this parameter to evaluate postoperative ventricular function. PMID:300983

Brundage, B H; Anderson, W T; Davia, J E; Cheitlin, M D; DeCastro, C M

1977-06-01

266

Radionuclide methods of identifying patients who may require coronary artery bypass surgery  

SciTech Connect

Myocardial thallium-201 (/sup 201/Tl) scintigraphy or radionuclide angiography performed in conjunction with exercise stress testing can provide clinically useful information regarding the functional significance of underlying coronary artery stenoses in patients with known or suspected coronary artery disease. Knowledge of type, location, and extent of myocardial /sup 201/Tl perfusion abnormalities or the severity of exercise-induced global and regional dysfunction has prognostic value. Risk stratification can be undertaken with either radionuclide technique by consideration of the magnitude of the ischemic response and may assist in the selection of patients for coronary artery bypass graft surgery (CABG). In patients with coronary artery disease, delayed /sup 201/Tl redistribution observed on exercise or dipyridamole /sup 201/Tl scintigraphy, particularly when present in multiple vascular regions and associated with increased lung /sup 201/Tl uptake, has been shown to be predictive of an adverse outcome, whereas patients with chest pain and a normal exercise /sup 201/Tl scintigram have a good prognosis with medical treatment. Similarly, a marked fall in the radionuclide ejection fraction from rest to exercise has been found to correlate with high-risk anatomic disease. Another important application of radionuclide imaging in patients being considered for CABG (particularly those with a depressed resting left ventricular ejection fraction) is the determination of myocardial viability and potential for improved blood flow and enhanced regional function after revascularization. 69 references.

Beller, G.A.; Gibson, R.S.; Watson, D.D.

1985-12-01

267

Coronary Artery Bypass Grafting in the Elderly: Pros and Cons after Three-year Follow-up  

Microsoft Academic Search

Aim. The elderly represent an ever-growing proportion of the candidates for coronary artery bypass grafting (CABG) surgery. We analyzed the effect of anticipated risks on the early and mid-term outcome of coronary surgery in septua- genarians compared with younger patients. Method. We analyzed 1,475 consecutive isolated CABG procedures performed at the Charles University Hospital during the 1995-1997 period and assessed

Pavel Zacek; Jan Dominik

2002-01-01

268

Determinants of an impaired quality of life five years after coronary artery bypass surgery  

PubMed Central

OBJECTIVE—To identify determinants of an inferior quality of life (QoL) five years after coronary artery bypass grafting (CABG).?SETTING—University hospital.?PARTICIPANTS—Patients from western Sweden who underwent CABG between 1988 and 1991.?MAIN OUTCOME MEASURES—Questionnaires for evaluating QoL before CABG and five years after operation. Three different instruments were used: the Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the physical activity score (PAS).?RESULTS—2121 patients underwent CABG, of whom 310 died during five years' follow up. Information on QoL after five years was available in 1431 survivors (79%). There were three independent predictors for an inferior QoL with all three instruments: female sex, a history of diabetes mellitus, and a history of chronic obstructive pulmonary disease. Multivariate analysis showed that a poor preoperative QoL was a strong independent predictor for an impaired QoL five years after CABG. An impaired QoL was also predicted by previous disease.?CONCLUSIONS—Female sex, an impaired QoL before surgery, and other diseases such as diabetes mellitus are independent predictors for an impaired QoL after CABG in survivors five years after operation.?? Keywords: coronary artery bypass surgery; predictors; quality of life

Herlitz, J; Wiklund, I; Caidahl, K; Karlson, B; Sjoland, H; Hartford, M; Haglid, M; Karlsson, T

1999-01-01

269

Cognitive deficits following coronary artery bypass grafting: prevalence, prognosis, and therapeutic strategies.  

PubMed

There is increasing recognition that coronary artery bypass grafting (CABG) may be a risk factor for subtle cognitive decline although the presence and pattern of such decline has varied across studies. Cognitive deficits may present as short-term memory loss, executive dysfunction and psychomotor slowing. Although they are usually are not severe enough to meet criteria for mild cognitive impairment or vascular dementia, they lower quality of life and add to hospitalization and out-of-hospital costs. Proposed mechanisms include surgical-related trauma, genetic susceptibility (eg, apolipoprotein E4 allele), microembolization, other vascular or ischemic changes, and temperature during surgery. Depression and anxiety levels predict subjective perception of these deficits more than objective cognitive performance. Both nonpharmacologic (eg, emboli reduction, temperature, or glucose management) and pharmacologic (eg, dexanabinol, glypromate, nootropics) strategies to prevent post-CABG cognitive deficits are under investigation. Given the large numbers of subjects who may already have CABG associated cognitive deficits, clinical trials of agents being tested for Alzheimer's disease (eg, donepezil, rivastigmine, memantine, neramexane, ginkgo) may also be informative. The results of multicenter long-term outcome studies (with matched control groups) as well as ongoing treatment trials will more conclusively address some of these issues. These data emphasize the need for clinicians to monitor cognitive function before and after coronary bypass surgery, and to educate patients. PMID:15448586

Raja, Pushpa V; Blumenthal, James A; Doraiswamy, P Murali

2004-10-01

270

Saphenous vein graft vs. radial artery graft searching for the best second coronary artery bypass graft  

PubMed Central

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.

Al-Sabti, Hilal Ali; Al Kindi, Adil; Al-Rasadi, Khalid; Banerjee, Yajnavalka; Al-Hashmi, Khamis; Al-Hinai, Ali

2013-01-01

271

Effects of therapeutic touch on the vital signs of patients before coronary artery bypass graft surgery  

PubMed Central

BACKGROUND: Currently healthy heart word considered to be the objective of community health applications in many countries of the world because cardiovascular diseases are the most important factor in mortality of humans, worldwide. Coronary artery bypass graft surgery is one of the most common surgery procedures for these patients. The purpose of this study is to assess the impact of therapeutic touch on medical vital signs of patients before coronary artery bypass graft surgery. METHODS: The present study is a clinical trial with 44 samples that were selected by easy sampling method and based on two separate lists of random numbers for both men and women; they were divided into two groups. In the therapeutic touch group, intervention therapy was applied on patents for 20 minutes. Data was analyzed using descriptive and inferential statistics. RESULTS: Test results showed that there was a significant difference between the mean pulse rate before and after intervention in both groups (p < 0.001). Results also showed that there was a significant difference between the average number of breathing before and after intervention in both groups (p < 0.001). CONCLUSIONS: Considering the effects of therapeutic touch therapy as a safe and effective intervention on the patients which were revealed in this study, this technique can be used as a simple, cheap and applicable technique in all health care centers to help these patients.

Zare, Zahra; Shahsavari, Hooman; Moeini, Mahin

2010-01-01

272

Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery  

PubMed Central

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.

Senarslan, Omer; Zungur, Mustafa; Uyar, Ihsan Sami; Uyar, Samet; Tavli, Talat; Alayunt, Emin Alp

2013-01-01

273

Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft  

PubMed Central

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.

Gu, Cheng-Xiong; Yang, Jun-Feng; Zhang, Hong-Chao; Wei, Hua; Li, Ling-Ke

2012-01-01

274

Uncalibrated pulse power analysis fails to reliably measure cardiac output in patients undergoing coronary artery bypass surgery  

PubMed Central

Introduction Uncalibrated arterial pulse power analysis has been recently introduced for continuous monitoring of cardiac index (CI). The aim of the present study was to compare the accuracy of arterial pulse power analysis with intermittent transpulmonary thermodilution (TPTD) before and after cardiopulmonary bypass (CPB). Methods Forty-two patients scheduled for elective coronary surgery were studied after induction of anaesthesia, before and after CPB respectively. Each patient was monitored with the pulse contour cardiac output (PiCCO) system, a central venous line and the recently introduced LiDCO monitoring system. Haemodynamic variables included measurement of CI derived by transpulmonary thermodilution (CITPTD) or CI derived by pulse power analysis (CIPP), before and after calibration (CIPPnon-cal., CIPPcal.). Percentage changes of CI (?CITPTD, ?CIPPnon-cal./PPcal.) were calculated to analyse directional changes. Results Before CPB there was no significant correlation between CIPPnon-cal. and CITPTD (r2 = 0.04, P = 0.08) with a percentage error (PE) of 86%. Higher mean arterial pressure (MAP) values were significantly correlated with higher CIPPnon-cal. (r2 = 0.26, P < 0.0001). After CPB, CIPPcal. revealed a significant correlation compared with CITPTD (r2 = 0.77, P < 0.0001) with PE of 28%. Changes in CIPPcal. (?CIPPcal.) showed a correlation with changes in CITPTD (?CITPTD) only after CPB (r2 = 0.52, P = 0.005). Conclusions Uncalibrated pulse power analysis was significantly influenced by MAP and was not able to reliably measure CI compared with TPTD. Calibration improved accuracy, but pulse power analysis was still not consistently interchangeable with TPTD. Only calibrated pulse power analysis was able to reliably track haemodynamic changes and trends.

2011-01-01

275

Early Troponin T and Prediction of Potentially Correctable In-Hospital Complications after Coronary Artery Bypass Grafting Surgery  

PubMed Central

Background Peak levels of troponin T (TnT) reliably predict morbidity and mortality after cardiac surgery. However, the therapeutic window to manage CABG-related in-hospital complications may close before the peak is reached. We investigated whether early TnT levels correlate as well with complications after coronary artery bypass grafting (CABG) surgery. Methods A 12 month consecutive series of patients undergoing elective isolated CABG procedures (mini-extra-corporeal circuit, Cardioplegic arrest) was analyzed. Logistic regression modeling was used to investigate whether TnT levels 6 to 8 hours after surgery were independently associated with in-hospital complications (either post-operative myocardial infarction, stroke, new-onset renal insufficiency, intensive care unit (ICU) readmission, prolonged ICU stay (>48 hours), prolonged need for vasopressors (>24 hours), resuscitation or death). Results A total of 290 patients, including 36 patients with complications, was analyzed. Early TnT levels (odds ratio (OR): 6.8, 95% confidence interval (CI): 2.2-21.4, P=.001), logistic EuroSCORE (OR: 1.2, 95%CI: 1.0-1.3, P=.007) and the need for vasopressors during the first 6 postoperative hours (OR: 2.7, 95%CI: 1.0-7.1, P=.05) were independently associated with the risk of complications. With consideration of vasopressor use during the first 6 postoperative hours, the sum of specificity (0.958) and sensitivity (0.417) of TnT for subsequent complications was highest at a TnT cut-off value of 0.8 ng/mL. Conclusion Early TnT levels may be useful to guide ICU management of CABG patients. They predict clinically relevant complications within a potential therapeutic window, particularly in patients requiring vasopressors during the first postoperative hours, although with only moderate sensitivity.

Gober, Volkhard; Hohl, Andreas; Gahl, Brigitta; Dick, Florian; Eigenmann, Verena; Carrel, Thierry P.; Tevaearai, Hendrik T.

2013-01-01

276

Effects of topical hypothermia on postoperative inflammatory markers in patients undergoing coronary artery bypass surgery  

PubMed Central

Summary Background We aimed to examine the effects of topical hypothermia on inflammatory markers in patients undergoing coronary artery bypass surgery. Methods Fifty patients undergoing isolated coronary artery bypass surgery were included the study. They were randomised to two groups. Mild hypothermic cardiopulmonary bypass (28–32°C) was performed on both groups using standardised anaesthesiology and surgical techniques. Furthermore, topical cooling with 4°C saline was performed on patients in group I. We recorded peri-operative and intra-operative results of blood samples, pre-operative and postoperative outcomes of electrocardiography and echocardiography, diaphragm levels on X-ray, and the necessity of positive inotropic medication and intra-aortic balloon pump (IABP). Results Time-dependent changes in blood samples were compared between the two groups. The changes on complement 3 (C3) and TNF-? levels were more significant in group I than group II (p < 0.05 and p < 0.001, respectively). Spontaneous restoration rate of sinus rhythm was higher in group II than group I (80 vs 32%, p < 0.01). Atrial fibrillation was seen in six patients in group I and one patient in group II (p < 0.05). IABP was performed on four patients (16%) in group I (p < 0.05). Diaphragmatic paralysis was seen in seven patients in group I but not in group II (p < 0.01). Partial pericardiotomy rates were compared within the groups but there was no statistically significant difference (p > 0.05). One patient in group I died on the 18th postoperative day, but operative mortality rate was not statistically significant between the two groups (p > 0.05). Conclusions Topical hypothermia had a negative impact on inflammatory markers and postoperative morbidities.

Kadan, Murat; Erol, Gokhan; Savas Oz, Bilgehan; Arslan, Mehmet

2014-01-01

277

Early and mid term mortality after coronary artery bypass grafting in women depends on the surgical protocol: retrospective analysis of 3441 on- and off-pump coronary artery bypass grafting procedures  

Microsoft Academic Search

BACKGROUND: Since 2002 MI and stroke, not cancer, are leading causes of death in women. We studied 30-days and 1 year mortality of 3441 patients undergoing coronary artery bypass grafting (CABG) operations in our institution performed either conventionally or off pump (OPCAB). Our objective was to investigate the gender-related mortality in both groups. PATIENTS AND METHODS: Between 2004 and 2008,

Sandra Eifert; Eckehard Kilian; Andres Beiras-Fernandez; Gerd Juchem; Bruno Reichart; Peter Lamm

2010-01-01

278

Coronary bypass before simultaneous pancreas-kidney transplants for type 1 diabetics in renal failure.  

PubMed

Our study examined the results of coronary artery bypass (CAB) before simultaneous pancreas-kidney (SPK) transplant in type 1 diabetics in renal failure. Of 588 pancreas transplant patients from 1992 to 2002, 77 (24 females, 53 males) were candidates for SPK transplant. All 77 had coronary evaluation and were referred for pretransplant CAB. Among the 77 CAB patients, the mean age was 42 years (range: 30- 63 years), and the duration of diabetes was 28.52 years (range: 9-51 years). All had neuropathy, retinopathy, and nephropathy; 12.9% (n = 10) had angina; and 76% (n = 59) were on dialysis at the time of CAB. The creatinine level of the 18 nondialysis patients was 3.7 mg%; 42.8% (n = 33) had suffered myocardial infarction. The left ventricular ejection fraction (LVEF) was 49% (30-65%). At CAB surgery, 88% (n = 68) triple, 9% (n = 7) double, and 2.5% (n = 2) single arterial grafts were implanted. All 77 CAB patients had severe coronary artery disease (CAD); some vessels could not be bypassed in 9.8%. At surgery, 3.4 grafts/patient were implanted (range: 1-6 grafts). All 59 dialysis patients continued dialysis after CAB; 6 nondialysis patients required dialysis after CAB. The intensive care stay averaged 1.86 days (range: 1-10 days); the hospital stay averaged 10.5 days (range 6-28 days). There was no operative mortality. Eventually, 68 patients underwent SPK transplant; 9 await organs. The waiting period for 68 CAB patients who had SPK was 2 years, 5 months (range: 2 months to 10 years). The SPK operative mortality was 3.9% (n = 3). Significant CAD exists in patients > 30 years of age with type 1 diabetes and renal failure. Pretransplant CAB can be done safely and may reduce posttransplant mortality associated with cardiac events. PMID:15573261

Molina, J Ernesto; Sutherland, David E R; Wang, Yang; Gruessner, Angelika C; Bland, Barbara J

2004-10-01

279

Revascularization for coronary artery disease in diabetes mellitus: Angioplasty, stents and coronary artery bypass grafting  

Microsoft Academic Search

Patients with diabetes mellitus (DM) are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases\\u000a their likelihood of requiring revascularization. However, the unique pathophysiology of atherosclerosis in patients with DM\\u000a modifies the response to arterial injury, with profound clinical consequences for patients undergoing percutaneous coronary\\u000a intervention (PCI). Multiple studies have shown that DM is a strong risk

Doron Aronson; Elazer R. Edelman

2010-01-01

280

Randomized trial comparing intermittent antegrade warm blood cardioplegia with multidose cold blood cardioplegia for coronary artery bypass  

Microsoft Academic Search

Forty patients were randomized to receive antegrade multidose warm (WBC) or cold blood cardioplegia (CBC) during coronary artery bypass. Cardioplegia was infused at a predetermined dose every 10 min during cardioplegia arrest and core temperature was maintained at 37°C inboth groups during extracorporeal circulation. Patient profiles were similar in the two groups. Cardiac index, left ventricular stroke work index, and

M. Islam; J. T. Murphy; R. Hall

1996-01-01

281

Myocardial Protective Effect of Warm Blood, Tepid Blood, and Cold Crystalloid Cardioplegia in Coronary Artery Bypass Grafting Surgery  

Microsoft Academic Search

To compare the myocardial effects of cardioplegia by warm blood, tepid blood, and cold crystalloid during coronary artery bypass grafting (CABG). Methods Patients undergoing CABG surgery at Kaunas University Hospital between 2000 and 2004 were ran- domized into three groups (n=156), receiving a different method of cardioplegia. Intermittent antegrade warm blood cardioplegia was used in 51 patients, tepid blood cardioplegia

Edmundas Sirvinskas; Linas Nasvytis; Laima Raliene; Jolanta Vaskelyte; Adolfas Toleikis; Sonata Trumbeckaite

282

The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting  

Microsoft Academic Search

INTRODUCTION: Myocardial dysfunction necessitating inotropic support is a typical complication after on-pump cardiac surgery. This prospective, randomized pilot study analyzes the metabolic and renal effects of the inotropes adrenaline and milrinone in patients needing inotropic support after coronary artery bypass grafting (CABG). METHODS: During an 18-month period, 251 patients were screened for low cardiac output upon intensive care unit (ICU)

Matthias Heringlake; Marit Wernerus; Julia Grünefeld; Stephan Klaus; Hermann Heinze; Matthias Bechtel; Ludger Bahlmann; Jochen Poeling; Julika Schön

2007-01-01

283

Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65  

Microsoft Academic Search

Background: Over the past 20 years, there have been marked increases in rates of coronary artery bypass grafting (CABG) among older people in Canada. The ob- jectives of this study were to accurately estimate the direct medical costs of CABG in older patients (age 65 years or more) and to compare CABG costs for this age group with those for

Gary Naglie; Catherine Tansey; Murray D. Krahn; Keith O'Rourke; Allan S. Detsky; Hildo Bolley

1999-01-01

284

Epiaortic Scanning Modifies Planned Intraoperative Surgical Management But Not Cerebral Embolic Load During Coronary Artery Bypass Surgery  

Microsoft Academic Search

BACKGROUND: Patients with aortic atheroma are at increased risk for neurological injury after coronary artery bypass graft (CABG) surgery. We sought to determine the role of epiaortic ultrasound scanning for reducing cerebral embolic load, and whether its use leads to changes of planned intraoperative surgical management in patients undergoing CABG surgery. METHODS: Patients 70-yr-of-age scheduled for CABG surgery were prospectively

George Djaiani; Mohamed Ali; Michael A. Borger; Anna Woo; Jo Carroll; Christopher Feindel; Ludwik Fedorko; Jacek Karski; Harry Rakowski

2008-01-01

285

Clinical complications of limb undergone harvesting of great saphenous vein for coronary artery bypass grafting using bridge technique  

Microsoft Academic Search

Objective: The aim of this study was to assess clinical complications of limbs undergone harvesting of the great saphenous vein for venous coronary artery bypass graft surgery using bridge technique. Methods: Fourty-four patients who had undergone CABG using the great saphenous vein harvested by the bridge technique over more than 3 months ago were randomly selected. The exclusion criteria were

Cleusa Ema; Quilici BELCZAK; André Luiz TYSZKA; Jose Maria Pereira de GODOY; Rubiana Neves RAMOS; Sergio Quilici BELCZAK; Roberto Augusto

286

Efficacy and safety of the cyclooxygenase 2 inhibitors parecoxib and valdecoxib in patients undergoing coronary artery bypass surgery  

Microsoft Academic Search

Objective: Inhibition of cyclooxygenase 2 provides analgesia in ambulatory patients. We prospectively evaluated the safety and efficacy of a newly introduced cyclooxygenase 2 inhibitor in patients undergoing coronary artery bypass grafting surgery through a median sternotomy in a randomized clinical trial.Methods: A total of 462 patients with New York Heart Association classes I to III who were less than 77

Elisabeth Ott; Nancy A. Nussmeier; Peter C. Duke; Robert O. Feneck; R. Peter Alston; Michael C. Snabes; Richard C. Hubbard; Ping H. Hsu; Lawrence J. Saidman; Dennis T. Mangano

2003-01-01

287

Occult infiltrating bi-ventricular papillary renal cell carcinoma metastasis found during coronary artery bypass graft surgery  

PubMed Central

Metastatic papillary renal cell carcinoma (RCC) to the heart has never been reported. We report the case of a 73-year-old patient with papillary RCC metastatic to the left and right ventricles, found during a triple vessel coronary artery bypass graft surgery.

Mollberg, Nathan M.; Johnson, Nicholas B.; Ying, Shan-Chinga; Abdelhady, Khaled; Massad, Malek G.; Chung, Doreen E.

2012-01-01

288

The Efficacy and Risk of Intense Aerobic Circuit Training in Coronary Artery Disease Patients Following Bypass Surgery.  

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

1987-01-01

289

Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery  

Microsoft Academic Search

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

1996-01-01

290

SPY™: an innovative intra-operative imaging system to evaluate graft patency during off-pump coronary artery bypass grafting  

Microsoft Academic Search

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

Masao Takahashi; Toshihiro Ishikawa; Koichi Higashidani; Hiroki Katoh

2004-01-01

291

Atrial fibrillation after coronary artery bypass grafting: a comparison of cardioplegia versus intermittent aortic cross-clamping  

Microsoft Academic Search

Supraventricular tachyarrhythmias following coronary artery bypass grafting are a common cause of postoper- ative morbidity, with a reported incidence of lo-40%. Two techniques of myocardial protection were assessed to determine their influence on the occurrence of postoperative supraventricular tachyarrhythmias. Group I (n = 82) received cold potassium cardioplegia combined with topical hypothermia and systemic cooling to 28 'C. Group II

J. Butler; J. L. Chong; G. M. Rocker; R. Pillai; S. Westahy

1993-01-01

292

Technique for use of the inferior epigastric artery as a coronary bypass graft.  

PubMed

A search for a coronary bypass conduit with increased longevity has resulted in harvest of the inferior epigastric artery. The artery is dissected through a paramedian incision with retraction of the rectus muscle to the lateral side. As the inferior epigastric artery courses superiorly, it may lie in one of three positions in relation to the rectus muscle. Distal coronary anastomoses using this conduit are conventional, and the proximal anastomosis may be made to the aorta or end-to-side to an internal mammary artery or venous conduit. After preparation with dilute papaverine-Plasmalyte solution proximal sizes have ranged from 2.5 to 3.25 mm (internal diameter), and distal inferior epigastric artery sizes measured 1.5 to 2.5 mm (internal diameter). The lengths of the conduit ranged from 11.5 to 17.0 cm. Eighteen patients aged 41 to 74 years had inferior epigastric artery grafts to 19 coronary arteries. The indications for use were absent or poor-quality vein, young age with an attempt to limit vein graft, and avoidance of use of bilateral internal mammary artery grafts in insulin-dependent diabetic patients. There was one sterile wound hematoma and one late wound infection. There were no other infections and no deaths. Three patients studied postoperatively revealed widely patent inferior epigastric artery grafts. PMID:1989533

Mills, N L; Everson, C T

1991-02-01

293

Efficacy of coronary artery bypass surgery with gastroepiploic artery. Assessment with thallium 201 myocardial scintigraphy  

SciTech Connect

This study describes the efficacy of the right gastroepiploic artery (GEA) as graft material for coronary artery bypass grafting (CABG) as assessed by exercise thallium 201 myocardial scintigraphy in eight patients (age, 59.4 {plus minus} 9.35 years (mean {plus minus} SD)) who underwent CABG with the GEA graft in the past 2 years. Planar and single-photon-emission computed tomographic (SPECT) images were obtained during and 3 hours after exercise. Planar images were evaluated quantitatively with the percentile-washout method, and SPECT images were evaluated qualitatively with a bull's-eye, polar-coordinate map. All patients had triple-vessel disease, and in situ GEAs were anastomosed to the right coronary artery in seven patients and to the left anterior descending coronary artery in one. The internal mammary artery graft was concomitantly used in all patients. The mean number of grafts per patient was 3.0 (range, 2-4). Preoperative exercise testing could not be performed in two patients because of emergency operation. By qualitative assessment with the polar-coordinate map, four patients showed improvement, one did not show any change, and one became worse due to perioperative myocardial infarction.

Kusukawa, J.; Hirota, Y.; Kawamura, K.; Suma, H.; Takeuchi, A.; Adachi, I.; Akagi, H. (Osaka Medical College, Takatsuki (Japan))

1989-09-01

294

Impact of surgical shape on blood flow pattern for patient specific coronary artery bypass graft (CABG) surgery  

NASA Astrophysics Data System (ADS)

We present a numerical framework for studying blood flow patterns in patients who have undergone coronary artery bypass surgeries. We use a stabilized finite element framework for performing blood flow simulations. Specialized lumped parameter boundary conditions for the coronary arteries, aorta and its branches are utilized. Computational models of CABG patients are constructed from CT scan images. A comprehensive study of how surgical shape affects hemodynamics in patient-specific CABG surgery has not been performed till date. The objective of this work is to study the effect of surgical geometry on blood flow pattern, especially downstream and in the proximity of the suture locations of the bypass graft. Quantities such as energy efficiency, wall shear stresses and its gradients and oscillatory shear index are extracted and compared for different surgical shapes in a systematic fashion. A framework and results for robust optimization of bypass graft anastomoses in unsteady flow will be presented. Implications of surgical geometry on graft patency will be discussed.

Sankaran, Sethuraman; Marsden, Alison

2010-11-01

295

Effect of Cardiopulmonary Bypass Under Tepid Temperature on Inflammatory Reactions  

Microsoft Academic Search

Background. Cardiopulmonary bypass (CPB) causes inflammatory reactions and abnormal responses of vascular resistance. Theoretically, the difference in the blood temperature during CPB may influence the degree of CPB-induced inflammatory reactions.Methods. To elucidate the effect of the perfusate temperature during CPB, serum levels of inflammatory cytokines, neutrophil elastase, complements, and vasoactive substances were measured in 18 patients undergoing elective coronary artery

Toshihiro Ohata; Yoshiki Sawa; Keishi Kadoba; Takafumi Masai; Hajime Ichikawa; Hikaru Matsuda

1997-01-01

296

Prompt institution of percutaneous cardiopulmonary support managed perioperative refractory vascular spasm after isolated coronary artery bypass grafting surgery.  

PubMed

A 51-year-old Japanese male underwent on-pump coronary artery bypass grafting surgery. After weaning from cardiopulmonary bypass (348 min), sudden bradycardia and hypotension occurred, followed by ventricular fibrillation. Although defibrillation and infusion of catecholamine restored sinus rhythm, transesophageal echocardiography demonstrated severely reduced contraction of both ventricles, and perioperative vascular spasm was suspected. As vascular spasm was refractory to medications, percutaneous cardiopulmonary support (PCPS) system was quickly instituted under cardiac massage. Coronary angiography revealed vascular spasm of not only the native coronary arteries but also the implanted left internal thoracic artery. After 3 days of full hemodynamic assist, PCPS was withdrawn with no obvious abnormalities in regional wall motion by transesophageal echocardiography. The patient was extubated on postoperative day 6 with no impaired brain function. In this case, the immediate diagnosis of refractory vascular spasm by transesophageal echocardiography and full cardiocirculatory assistance by PCPS helped to save the life of the patient. PMID:23315203

Nakazawa, Harumasa; Moriyama, Kiyoshi; Motoyasu, Akira; Endo, Hidehito; Kubota, Hiroshi; Yorozu, Tomoko

2013-12-01

297

Vivostat system autologous fibrin sealant: preliminary study in elective coronary bypass grafting  

Microsoft Academic Search

Background. The Vivostat System is a medical device for the preparation of an autologous fibrin sealant from 120 mL of the patient’s blood in the operating room. The system is fully automated and microprocessor controlled and is made up of three components: an automated processor unit, an automated applicator unit, and a disposable, single-patient–use unit, which includes a preparation set

Henrik K. Kjaergard; Horace R. Trumbull

1998-01-01

298

Relationship of Glycated Hemoglobin Levels with Myocardial Injury following Elective Percutaneous Coronary Intervention in Patients with Type 2 Diabetes Mellitus  

PubMed Central

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.

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

2014-01-01

299

SinoSCORE: a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population.  

PubMed

This study aims to construct a logistically derived additive score for predicting in-hospital mortality risk in Chinese patients undergoing coronary artery bypass surgery (CABG). Data from 9839 consecutive CABG patients in 43 Chinese centers were collected between 2007 and 2008 from the Chinese Coronary Artery Bypass Grafting Registry. This database was randomly divided into developmental and validation subsets (9:1). The data in the developmental dataset were used to develop the model using logistic regression. Calibration and discrimination characteristics were assessed using the validation dataset. Thresholds were defined for each model to distinguish different risk groups. After excluding 275 patients with incomplete information, the overall mortality rate of the remaining 9564 patients was 2.5%. The SinoSCORE model was constructed based on 11 variables: age, preoperative NYHA stage III or IV, chronic renal failure, extracardiac arteriopathy, chronic obstructive pulmonary disease, preoperative atrial fibrillation or flutter (within 2 weeks), left ventricular ejection fraction, other elective surgery, combined valve procedures, preoperative critical state, and BMI. In the developmental dataset, calibration using a Hosmer-Lemeshow (HL) test was at P = 0.44 and discrimination based on the area under the receiver operating characteristic curve (ROC) was 0.80. In the validation dataset, the HL test was at P = 0.34 and the area under the ROC (AUC) was 0.78. A logistically derived additive model for predicting in-hospital mortality among Chinese patients undergoing CABG was developed based on the most up-to-date multi-center data from China. PMID:24048813

Zheng, Zhe; Zhang, Lu; Li, Xi; Hu, Shengshou

2013-12-01

300

Is coronary artery bypass grafting an acceptable alternative to myotomy for the treatment of myocardial bridging?  

PubMed Central

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was ‘Is CABG an effective alternative for the treatment of myocardial bridging?’ Altogether, only six papers were identified using the reported search that 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; these studies reported the outcome of myotomy and coronary artery bypass grafting (CABG) for myocardial bridging. All of these studies were retrospective reports of the results of surgical intervention in patients with myocardial bridging. They showed that the incidence of myocardial bridging was less than 1–1.5% in patients with angina requiring angiography, and 7–9% of these patients had refractory angina despite medical treatment and required surgery. The evidence on the treatment of this congenital condition that mainly affects the middle segment of left anterior descending artery is limited, and there are no treatment guidelines currently available. Stenting of the tunnelled segment has shown high failure rates in approximately half of the cases. Current evidence in the literature suggests that surgery is the mainstay treatment for myocardial bridging. Surgery is performed either as supra-arterial myotomy and de-roofing of the muscle bands on- or off-pump, or as coronary artery bypass grafting of the affected coronary artery beyond the tunnelled segment. Although no mortality was reported with either of these operations, surgical myotomy on deep and extensive myocardial bridges carries the risk of entering the right ventricle, bleeding and aneurysm formation. In addition, in a small percentage of the patients undergoing myotomy, angina recurred. Despite the possibility of competitive flow in the native coronary artery after CABG for myocardial bridging, we did not identify any evidence demonstrating graft occlusion after CABG for myocardial bridging. In conclusion, in extensive and deep myocardial bridgings, CABG may be the treatment of choice that carries low risk, limited complications and excellent symptomatic relief.

Attaran, Saina; Moscarelli, Marco; Athanasiou, Thanos; Anderson, Jon

2013-01-01

301

The effect of cyclosporin-A on peri-operative myocardial injury in adult patients undergoing coronary artery bypass graft surgery: a randomised controlled clinical trial  

PubMed Central

Objective Cyclosporin-A (CsA) has been reported to reduce myocardial infarct size in both the experimental and clinical settings. This protective effect is dependent on its ability to prevent the opening of the mitochondrial permeability transition pore, a critical determinant of cell death in the setting of acute ischaemia-reperfusion injury. Whether CsA can reduce the extent of peri-operative myocardial injury (PMI) in patients undergoing coronary artery bypass graft (CABG) surgery is unknown, and is investigated in this randomised controlled clinical trial. Methods 78 adult patients undergoing elective CABG surgery were randomised to receive either an intravenous bolus of CsA (2.5?mg/kg) or placebo administered after induction of anaesthesia and prior to sternotomy. PMI was assessed by measuring serum cardiac enzymes, troponin T (cTnT) and CK-MB at 0, 6, 12, 24, 48 and 72?h after surgery. Results There was no significant difference in mean peak cTnT levels between control (n=43) and CsA treatment (n=40) patients (0.56±0.06?ng/mL with control vs 0.35±0.05?ng/mL with CsA; p=0.07). However, in higher-risk patients with longer cardiopulmonary bypass times, there was a significant reduction in PMI with CsA therapy (p=0.049), with a reduced postoperative cTnT rise by 0.03?ng/mL for every 10?min, when compared with control. Conclusions In patients with longer cardiopulmonary bypass times, a single intravenous bolus of CsA administered prior to CABG surgery reduced the extent of PMI.

Hausenloy, DJ; Kunst, G; Boston-Griffiths, E; Kolvekar, S; Chaubey, S; John, L; Desai, J; Yellon, DM

2014-01-01

302

Preoperative chlorhexidine anaphylaxis in a patient scheduled for coronary artery bypass graft: a case report.  

PubMed

Chlorhexidine is a synthetic antiseptic and disinfectant that has been widely used in the healthcare setting and in everyday household products. In addition to oral rinses and skin preparations, manufacturers have incorporated chlorhexidine coatings into medical devices such as urinary catheters, endotracheal tubes, and central venous catheters in an effort to reduce infection rates. Despite the ubiquitous use of chlorhexidine, severe reactions, such as anaphylaxis, are relatively rare. This case report describes a 65-year-old patient scheduled for coronary artery bypass graft surgery who preoperatively experienced anaphylaxis to chlorhexidine delivered through multiple routes of administration. To our knowledge, this is the first reported perioperative anaphylactic reaction to chlorhexidine in the United States. A review of the anaphylaxis cascade, the prevalence of hospital-acquired infections, and the risks of using chlorhexidine are thoroughly discussed. It must be appreciated that life-threatening reactions to this commonly used agent are more than just a theoretical possibility. PMID:23923672

Toomey, Matthew

2013-06-01

303

Conduits for Coronary Bypass: Arteries Other Than the Internal Thoracic Artery's.  

PubMed

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

Barner, Hendrick B

2013-06-01

304

Pharmacological and nonpharmacological prevention of atrial fibrillation after coronary artery bypass surgery.  

PubMed

Atrial fibrillation (AF) is the most common complication of coronary artery bypass graft surgery (CABG). The reported incidence of AF after CABG varies from 20% to 40%. Postoperative AF (POAF) is associated with increased incidence of hemodynamic instability, thromboembolic events, longer hospital stays, and increased health care costs. A variety of pharmacological and nonpharmacological strategies have been employed to prevent AF after CABG. Preoperative and postoperative beta blockers are recommended in all cardiac surgery patients as the first-line medication to prevent POAF. Sotalol and amiodarone are also effective and can be regarded as appropriate alternatives in high-risk patients. Corticosteroids and biatrial pacing may be considered in selected CABG patients but are associated with risk. Magnesium supplementation should be considered in patients with hypomagnesemia. There are no definitive data to support the treatment with nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, procainamide, and propafenone, or anterior fat pad preservation to reduce POAF. PMID:23074627

Haghjoo, Majid

2012-01-01

305

Randomized trial of the effects of exercise training after coronary artery bypass surgery  

SciTech Connect

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.

1985-04-01

306

Pharmacological and Nonpharmacological Prevention of Atrial Fibrillation after Coronary Artery Bypass Surgery  

PubMed Central

Atrial fibrillation (AF) is the most common complication of coronary artery bypass graft surgery (CABG). The reported incidence of AF after CABG varies from 20% to 40%. Postoperative AF (POAF) is associated with increased incidence of hemodynamic instability, thromboembolic events, longer hospital stays, and increased health care costs. A variety of pharmacological and nonpharmacological strategies have been employed to prevent AF after CABG. Preoperative and postoperative beta blockers are recommended in all cardiac surgery patients as the first-line medication to prevent POAF. Sotalol and amiodarone are also effective and can be regarded as appropriate alternatives in high-risk patients. Corticosteroids and biatrial pacing may be considered in selected CABG patients but are associated with risk. Magnesium supplementation should be considered in patients with hypomagnesemia. There are no definitive data to support the treatment with nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, procainamide, and propafenone, or anterior fat pad preservation to reduce POAF.

Haghjoo, Majid

2012-01-01

307

Caregiving demand and difficulty in older adult spousal caregivers after coronary artery bypass surgery.  

PubMed

The purpose of this study was to describe the caregiving demands and difficulties for older adult spousal caregivers of coronary artery bypass (CAB) surgery patients. Caregiving demands and difficulties were measured by the Caregiving Burden Scale. The sample size was 35 caregivers of CAB surgery patients who were, on average, 60 years old and 19 days since hospital discharge. Descriptive analysis revealed that the top four most demanding caregiving activities perceived by spousal caregivers were providing transportation, additional household tasks, providing emotional support, and two tied for fourth: monitoring symptoms and additional tasks outside the home. The top four most difficult caregiving tasks were additional household tasks, providing transportation, and two tied for third: additional tasks outside home and managing behavior problems. Also, caregivers reported experiencing more demands than difficulties. Examining the demanding and difficult caregiving tasks provides information from which to develop and test tailored interventions for caregivers of this population. PMID:23764365

Park, Esther O; Yates, Bernice C; Schumacher, Karen L; Meza, Jane; Kosloski, Karl; Pullen, Carol

2013-01-01

308

Conduits for Coronary Bypass: Arteries Other Than the Internal Thoracic Artery's  

PubMed Central

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.

2013-01-01

309

Primary Payer Status is Associated with Mortality and Resource Utilization for Coronary Artery Bypass Grafting  

PubMed Central

Background Medicaid and Uninsured populations are a significant focus of current healthcare reform. We hypothesized that outcomes following coronary artery bypass grafting (CABG) in the United States is dependent upon primary payer status. Methods From 2003–2007, 1,250,619 isolated CABG operations were evaluated using the Nationwide Inpatient Sample (NIS) database. Patients were stratified by primary payer status: Medicare, Medicaid, Uninsured, and Private Insurance. Hierarchical multiple regression models were applied to assess the effect of primary payer status on postoperative outcomes. Results Unadjusted mortality for Medicare (3.3%), Medicaid (2.4%) and Uninsured (1.9%) patients were higher compared to Private Insurance patients (1.1%, p<0.001). Unadjusted length of stay was longest for Medicaid patients (10.9±0.04 days) and shortest for Private Insurance patients (8.0±0.01 days, p<0.001). Medicaid patients accrued the highest unadjusted total costs ($113,380±386, p<0.001). Importantly, after controlling for patient risk factors, income, hospital features, and operative volume, Medicaid (OR=1.82, p<0.001) and Uninsured (OR=1.62, p<0.001) payer status independently conferred the highest adjusted odds of in-hospital mortality. In addition, Medicaid payer status was associated with the longest adjusted length of stay and highest adjusted total costs (p<0.001). Conclusions Medicaid and Uninsured payer status confers increased risk adjusted in-hospital mortality for patients undergoing coronary artery bypass grafting operations. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors. Possible explanations include delays in access to care or disparate differences in health maintenance.

LaPar, Damien J.; Stukenborg, George J.; Guyer, Richard A.; Stone, Matthew L.; Bhamidipati, Castigliano M.; Lau, Christine L.; Kron, Irving L.; Ailawadi, Gorav

2012-01-01

310

Systematic review of robotic-assisted, totally endoscopic coronary artery bypass grafting  

PubMed Central

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.

Edelman, J. James B.; Yan, Tristan D.; Wilson, Michael K.; Bannon, Paul G.; Vallely, Michael P.

2013-01-01

311

Patients' satisfaction and wound-site complications after radial artery harvesting for coronary artery bypass  

PubMed Central

The aim of the study was to establish patients' satisfaction and the incidence of wound-site complications after radial artery (RA) harvesting for bypass surgery. A telephonic quality of life questionnaire was performed in 306 consecutive patients who had undergone coronary artery bypass grafting with the use of RA with the open technique. A psychometric Likert scale was used to define the degree of patients' satisfaction. The questionnaire concerned arm pain, cosmesis and mobility, sensory and neurological complications, and patients' general health state. The median values and the modal scores achieved the maximal value of satisfaction for all site-related complications and the mean scores were >4 out of 5. The median patients' general health state was 4. Cosmetic result of the wound was considered at least acceptable by 98% of patients. The incidence of impairing peripheral neurological complications was 16.7%. The degree of patients' satisfaction after RA harvesting was more than satisfactory and the incidence of wound-site complications was acceptable. The incidence of neurological injuries was lower than previously described.

Arrigoni, Sara C.; Halbersma, Wouter B.; Grandjean, Jan G.; Mariani, Massimo A.

2012-01-01

312

Predictors of Blood Transfusion in Patients Undergoing Coronary Artery Bypass Grafting Surgery  

PubMed Central

Objectives The aim of this retrospective study is to identify intraoperative patient’s characteristics predicting the need for blood transfusion during CABG in our local cardiac surgical service. Methods This study included 1835 consecutive patients, 1311 males and 524 females with mean age 58.8±9.9 years, undergoing coronary artery bypass grafting. Risk factors detected by univariate study were entered in a multivariate logistic regression model of the relationship between preoperative variables and blood transfusion. Results Blood transfusion was used in 435 patients (29.9%). Univariate analysis identified hemoglobin, smoking, hypertension, sex, diabetes, BMI and use of cardiopulmonary bypass (CPB) as significant predictors. Multivariate analysis revealed hemoglobin (OR: 0.8; CI: 0.74-0.86; P<0.001), CPB use (OR: 12.2; CI: 8.2-18.1; P<0.001) and female gender (OR: 2.29; CI:1.72-3.04; P<0.001) as independent risk factors for blood transfusion. Conclusions The predictors of RBC transfusion after isolated CABG were performing CPB, preoperative hemoglobin and female gender. These factors can be used as a clinical tool to preserve blood bank resources without increasing patient’s risk.

Sandoughdaran, Saleh; Sarzaeem, Mahmood Reza; Bagheri, Jamshid; Jebelli, Mohammad; Mandegar, Mohammad Hossein

2013-01-01

313

Optimal intraoperative anticoagulation strategy in patients undergoing off-pump coronary artery bypass  

PubMed Central

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was what the optimal intraoperative anticoagulation strategy should be in patients undergoing off-pump coronary artery bypass graft (CABG) surgery. A total of 157 papers were identified using the reported search, of which 8 were judged to represent the best evidence. The authors, journal, date, country of publication, study type, patient group studied, relevant outcomes and results were tabulated. The quality of clinical trials was assessed. Off-pump CABG is currently considered as a safe and effective alternative to CABG with the use of cardiopulmonary bypass, especially in the presence of off-pump expertise and certain pathologies. Although most technical steps in off-pump revascularization are standardized, it appears that there is inconsistency in intraoperative anticoagulation practice. Surveys conducted in the USA and Europe confirm the lack of uniform policy, with heparin dose ranging between 70 and 500 U/kg and from full-dose protamine to no reversal of anticoagulation. Although the quality of evidence is low, there is a trend for utilization of heparin at 150 U/kg, followed by half-dose protamine reversal, which appears to provide adequate anticoagulation for the safe conduct of anastomoses and thromboprophylaxis without significantly increasing the risk of postoperative bleeding. However, more research is necessary before firm recommendations can be made.

Rasoli, Sonia; Zeinah, Mohamed; Athanasiou, Thanos; Kourliouros, Antonios

2012-01-01

314

Evaluation of factors influencing liver function test in on-pump coronary artery bypass graft surgery.  

PubMed

Background: Liver dysfunction during on-pump coronary artery bypass graft surgery (CABG) is a rare complication but is associated with significant morbidity and mortality. The ability to identify high-risk patients may be helpful in planning appropriate management strategies. We aimed to evaluate the factors influencing liver function tests during on-pump CABG. Methods: In 146 patients scheduled for on-pump CABG, the liver function test was done preoperatively and on the first postoperative day. Some preoperative and intraoperative risk factors were checked and then the postoperative liver function tests were compared with the preoperative ones. Probable relationships between these changes and the preoperative and intraoperative risk factors were studied. Results: A medical history of diabetes had a significant relationship with the changes in direct bilirubin. Preoperative central venous pressure had a significant relationship with the changes in aspartate aminotransferase and alanine aminotransferase. Use of intra-aortic balloon pump and duration of aortic cross-clamp were significantly related to the changes in the liver function tests except for alanine aminotransferase and alkaline phosphatase. Conclusion: It seems that the techniques for the reduction of cardiopulmonary bypass and aortic cross-clamp duration may be useful to protect liver function. We recommend that a larger population of patients be studied to confirm these findings. PMID:24293784

Shahbazi, Shahrbano; Panah, Ashkan; Sahmeddini, Mohammad Ali

2013-12-01

315

Respiratory pressures and expiratory peak flow rate of patients undergoing coronary artery bypass graft surgery  

PubMed Central

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.

Gimenes, Camila; de Godoy, Irma; Padovani, Carlos Roberto; Gimenes, Rodrigo; Okoshi, Marina Politi; Okoshi, Katashi

2012-01-01

316

Detection of Gender Differences in Incomplete Revascularization after Coronary Artery Bypass Surgery Varies with Classification Technique  

PubMed Central

Background. Incomplete revascularization negatively affects survival after coronary artery bypass surgery (CABG). Since gender and classification technique might impact outcome and reporting, we investigated their effect on revascularization patterns and mortality. Methods. A cohort of bypass patients (N = 1545, 23% women) was enrolled prospectively. The degree of revascularization was determined as mathematical difference between affected vessels upon diagnosis and number of grafts or the surgeon's rating on the case file. Results. Although men displayed more triple-vessel disease, they obtained complete revascularization more frequently than women (85% versus 77%, P < 0.001). The two calculation methods identified analogous percentages of incompletely revascularized patients, yet there was only a 50% overlap between the two groups. Mathematically, more women, older patients, and patients with NYHA class III/IV appeared incompletely revascularized, while the surgeons identified more patients undergoing technically challenging procedures. Regardless of the definition, incompleteness was a significant risk factor for mortality in both genders (mathematical calculation: HR 2.62, 95% CI 1.76–3.89, P < 0.001; surgeon: HR 2.04, 95% CI 1.35–3.89, P = 0.001). Conclusions. Given the differences in identification patterns, we advise that the mathematical calculation be performed after-procedure in all patients regardless of the surgeons' rating to uncover additional subjects at increased risk.

Oertelt-Prigione, Sabine; Kaltenbach, Martin; Hetzer, Roland; Regitz-Zagrosek, Vera; Baretti, Rufus

2013-01-01

317

Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial  

PubMed Central

Background In severe coronary artery disease, coronary artery bypass grafting (CABG) surgery is indicated to re-establish an adequate blood supply to the ischemic myocardium. Effectiveness of CABG surgery for symptom relief and mortality decrease should therefore depend on bypass graft patency. As bypass using a left internal mammary artery (LIMA)-to-left anterior descending coronary artery (LAD) anastomosis allows the best results in terms of graft patency, we designed a new surgical technique using a saphenous vein graft as a venous bridge to distribute the LIMA flow to the cardiac anterolateral territory. This novel strategy could extend the patency benefits associated to the LIMA. Other potential benefits of this technique include easier surgical technique, possibility to use saphenous vein grafts as vein patch angioplasty, shorter saphenous vein grafts requirement and reduced or eliminated manipulations of the ascendant aorta (and associated stroke risk). Methods/Design Between July 2012 and 2016, 200 patients undergoing a primary isolated CABG surgery using cardiopulmonary bypass with a LAD bypass graft and at least another target on the anterolateral territory will be randomized (1:1) according to 1) the new composite strategy and 2) the conventional strategy with a LIMA-to-LAD anastomosis and revascularization of the other anterolateral target(s) with a separated aorto-coronary saphenous vein graft. The primary objective of the trial is to assess whether the composite strategy allows non-inferior anterolateral graft patency index (proportion of non-occluded CABGs out of the total number of CABGs) compared to the conventional technique. The primary outcome is the anterolateral graft patency index, evaluated at one year by 256-slice computed tomography angiography. Ten years of clinical follow-up is planned to assess clinical outcomes including death, myocardial infarction and need for revascularization. Discussion This non-inferiority trial has the potential to advance the adult cardiac surgery field, given the potential benefits associated with the composite grafting strategy. Trial registration ClinicalTrials.gov: NCT01585285.

2013-01-01

318

Lowest hematocrit on cardiopulmonary bypass impairs the outcome in coronary surgery: An Italian Multicenter Study from the National Cardioanesthesia Database.  

PubMed

Severe hemodilutional anemia on cardiopulmonary bypass increases morbidity and mortality after coronary surgery. The present study focuses on the lowest hematocrit values during extracorporeal circulation and on allogenic blood transfusions as mortality and morbidity risk factors. The records of 1,766 consecutive adult patients undergoing isolated coronary artery bypass graft surgery at 3 institutions have been analyzed retrospectively for in-hospital mortality and adverse outcomes. Clinical data were from the Italian National Cardioanesthesia Database. Multivariate analysis and analysis of receiver operating characteristic curves were applied. The lowest hematocrit value on cardiopulmonary bypass was an independent risk factor for postoperative low-output syndrome and renal failure. The hematocrit cutoff values were similar for renal failure (23%) and low-output syndrome (24%). Blood transfusions were significantly associated with both renal failure and low-output syndrome. The risk of renal failure doubled when the nadir-on-cardiopulmonary-bypass hematocrit occurred in transfused patients. Anemia upon cardiopulmonary bypass was not associated with death. Our findings confirm that both severe anemia and blood transfusions were significantly associated with renal failure and low-output syndrome. PMID:17041685

Ranucci, Marco; Biagioli, Bonizella; Scolletta, Sabino; Grillone, Giovanni; Cazzaniga, Anna; Cattabriga, Iolter; Isgrò, Giuseppe; Giomarelli, Pierpaolo

2006-01-01

319

Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting  

PubMed Central

Objective Although an extensive number of studies have attempted to identify predictors of new-onset atrial fibrillation (AFIB) after coronary artery bypass grafting (CABG), a strong predictive model does not exist. Prior studies have included patients recruited from multiple centers with variant AFIB prevalence rates and those who underwent CABG in combination with other surgical procedures. Also, most studies have focused on pre- and perioperative characteristics, with less attention given to the initial postoperative period. The purpose of this study was to comprehensively examine pre-, peri-, and postoperative characteristics that might predict new-onset AFIB in a large sample of patients undergoing isolated CABG in a single medical center, utilizing data readily available to clinicians in electronic data repositories. In addition, length of stay and selected postoperative complications and disposition were compared in patients with AFIB and no AFIB. Design Retrospective, comparative survey. Setting University-affiliated tertiary care hospital. Patients Patients with new-onset AFIB who underwent isolated standard CABG or minimally invasive direct vision coronary artery bypass were identified from an electronic clinical data repository. Interventions None. Measurements and Main Results The prevalence of AFIB in the total sample (n = 814) was 31.9%. Predictors of AFIB included age (p = .0004), number of vessels bypassed (p = .013), vessel location (diagonal [p < .003] or posterior descending artery [p < .001]), and net fluid balance on the operative day (p = .015). Forward stepwise regression analysis produced a model that correctly predicted AFIB in only 24% of cases, with age (14%) and body surface area (9%) providing the most prediction. The incidence of embolic stroke was higher in AFIB (n = 8) vs. no AFIB (n = 4) patients, but stroke preceded AFIB onset in seven of eight cases. Subjects with AFIB had a longer stay (p = .0004), more intensive care unit readmissions (p = .0004), and required more assistance at hospital discharge (p = .017). Conclusions Despite attempts to examine comprehensively predictors of new-onset AFIB, we were unable to identify a robust predictive model. Our findings, in combination with prior work, imply that it may not be feasible to predict the development of new-onset AFIB after CABG using data readily available to the bedside clinician. In this sample, stroke was uncommon and, when it occurred, preceded AFIB in all but one case. As anticipated, AFIB increased length of stay, and patients with this complication required more assistance at discharge.

Hravnak, Marilyn; Hoffman, Leslie A.; Saul, Melissa I.; Zullo, Thomas G.; Whitman, Gayle R.; Griffith, Bartley P.

2013-01-01

320

Coronary Artery Bypass Graft Surgery Using the Radial Artery as a Secondary Conduit Improves Patient Survival  

PubMed Central

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.

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

2013-01-01

321

Type A behavior and coronary artery bypass surgery: intraoperative blood pressure and perioperative complications.  

PubMed

Previous research has suggested that Type A, compared to Type B patients undergoing coronary artery bypass surgery evidence greater intraoperative increases over hospital admission systolic blood pressure, even though patients are under general anesthesia. The present study sought to examine whether such blood pressure increases are accounted for by elevations occurring entirely during surgery (with conscious mediation minimized), or by increases occurring prior to surgery. A second purpose of the study was to examine the relationship between Type A behavior and complications occurring during and after surgery. Twenty-seven male patients given a structured interview to measure Type A behavior in advance of surgery comprised the present sample. Results indicated that interview Type A intensity was reliably related to magnitude of systolic, but not diastolic blood pressure increases during, but not prior to surgery. The 12 patients with complications (largely arrhythmias), were reliably higher in rated intensity of Type A behavior (p less than 0.01) than those without complications (n = 14). None of the Type B or Type X patients showed evidence of complications during or after surgery. Results of this study support a body of data linking Type A behavior to cardiovascular reactivity and clinical complications of coronary disease. Since this reactivity is evident under general anesthesia, these data further suggest that conscious mediation may not always be necessary in order to elicit these responses. PMID:6982484

Krantz, D S; Arabian, J M; Davia, J E; Parker, J S

1982-07-01

322

A comparison of albumin, polygeline and crystalloid priming solutions for cardiopulmonary bypass in patients having coronary artery bypass graft surgery.  

PubMed

This study was designed to assess the effect of different prime solution compositions on a patient's fluid balance, transfusion requirements, renal function and haemodynamic stability over the first 24 hours postbypass. Ninety-three patients presenting for first-time coronary artery bypass graft (CABG) surgery were randomly allocated to receive one of three prime solutions for the CPB pump: albumin (4.6%) + Plasmalyte (Group A, n = 32), polygeline (Hemaccel) + Plasmalyte (Group P, n = 29), or crystalloid (Plasmalyte) alone (Group C, n = 32). Patients, anaesthetists, surgeons and intensive care unit (ICU) staff were all blinded as to the solution type. The groups were demographically and haemodynamically similar. There were no differences between the groups with respect to white cell or platelet counts during the study. There was a significant difference in haemoglobin levels between the groups on weaning from CPB and on arrival in the ICU (Group C > Groups P and A, p < 0.001 for both times). There was no difference in blood transfusion requirements between any of the groups. During CPB, Group C required significantly more crystalloid than the other groups (p < 0.001). Urine output was significantly higher in Group C compared with Groups P and A at all time periods up to and including ICU 12 hours (p < 0.05). The use of frusemide was significantly higher in the ICU in Groups P and A (p < 0.01). There was a net gain of 3132 +/- 412 ml in Group C in 24 hour fluid balance, which was significantly higher than Group A (2166 +/- 223 ml, p = 0.04). Our results show that, in this patient population, there is no advantage in using a colloid-based prime solution over a purely crystalloid solution from a haemotologic or haemodynamic point of view for the first 24 hours after CPB. There appears to be an increase in extracellular fluid (ECF) retention in Group C, but this caused no related problems in the study period. On the other hand, diuretics (frusemide) needed to be given significantly less often in these patients to offset oliguria. PMID:8747898

Scott, D A; Hore, P J; Cannata, J; Masson, K; Treagus, B; Mullaly, J

1995-11-01

323

Early failure of coronary artery bypass grafts: an albumin cross-linked glutaraldehyde (BioGlue) related complication.  

PubMed

Bioglue which constitutes albumin cross linked with glutaraldehyde (ACLG) produced by Cryolife, Inc, Kennesaw, GA was introduced as a better alternative to GRF glue with less tissue necrosis. We report a case of a 69-year-old male who developed stenosis of his saphenous vein and internal thoracic artery bypass grafts, requiring re-do coronary artery bypass grafting. Both fibrotic narrowing were in close proximity to the site of Bioglue application and appears to be a reaction to the glue. The advent of ACLG has facilitated surgery; however, this case highlights a potential side effect, emphasizing the judicious use of this hemostatic agent in patients.? PMID:21342262

Khan, Habib; Chaubey, Sanjay; Desai, Jatin

2011-05-01

324

Successful endovascular aneurysm repair for abdominal aortic aneurysm in a patient with severe coronary artery disease undergoing off-pump coronary artery bypass grafting.  

PubMed

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; Jeong, Myung Ho

2014-04-01

325

Successful Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm in a Patient with Severe Coronary Artery Disease Undergoing Off-Pump Coronary Artery Bypass Grafting  

PubMed Central

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.

Kim, Sun Min; Cho, Jae Yeong; Kim, Ju Han; Park, Keun-Ho; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun

2014-01-01

326

Immediate Results and Six-Month Clinical Outcome after Percutaneous Coronary Intervention in Patients with Prior Coronary Artery Bypass Surgery  

PubMed Central

Background Redo coronary artery bypass grafting surgery (CABG) is associated with a higher risk of mortality than the first operation. However, the impact of percutaneous coronary intervention (PCI) on the outcome in such patients is currently unclear. We evaluated the in-hospital and six-month clinical outcomes of post-CABG patients who underwent PCI in our center. Methods Between April 2008 and July 2009, 71 post-CABG patients (16 women and 55 men) underwent 110 stent implantations (74% drug-eluting stents) for 89 lesions. Sixty percent of the PCI procedures were performed on the native coronary arteries, 32% on graft arteries, and 8% on both types of vessels. Major adverse cardiac events (MACE) were recorded in hospital and at six months’ follow-up. Results The procedural success rate was 93%, and the in-hospital MACE rate was 5.6 % (1 death, 3 myocardial infarctions). At 6 months, the incidence of MACE was 5.6% (no death or myocardial infarction, but 4 target lesion revascularizations) and 4 (5.6 %) in-stent restenoses. There was no statistically significant difference in the comparison of MACE between the patients treated in either native arteries or in the grafts (15% vs.12%, p value = 0.8). According to the univariate analysis, hypertension and the use of the bare metal stent vs. the drug-eluting stent were the significant predictors of MACE, whereas the multivariate analysis showed that only hypertension (OR = 3.7, 95% CI 3.4–4, p value < 0.048) was the independent predictor of MACE. The mean of the left ventricular ejection fraction had no effect on the incidence of MACE (p value = 0.9). The multivariate analysis showed hypertension (p value < 0.048) and the use of the bare metal stent (p value < 0.018) were the independent predictors of MACE. The chronic total occlusion (CTO) (p value < 0.01) was the independent predictor of the success rate. The prevalence of diabetes had no impact on the incidence of MACE according to the univariate analysis (p value = 0.9). Our multivariate analysis showed that hypertension and the use of the bare metal stent were the independent predictors of MACE and that chronic total occlusion was the independent predictor of the procedural failure rate. Conclusion PCI is preferable to redo CABG for post-CABG patients. The independent predictors of MACE were hypertension and bare metal stents.

Behboudi, Fatemeh; Vakili, Hossein; Hashemi, Seyed Reza; Hekmat, Manouchehr; Safi, Morteza; Namazi, Mohammad Hasan

2011-01-01

327

Drug-eluting stent implantation for coronary artery disease: current stents and a comparison with bypass surgery.  

PubMed

Percutaneous coronary intervention (PCI) with bare-metal stents (BMS) has been performed increasingly ever since its introduction in the late 1970s. BMS have been replaced by drug-eluting stents (DES), and many interventional cardiologists consider this as a breakthrough therapy that might compete with coronary artery bypass grafting (CABG) as the standard treatment for coronary artery disease. Several DES are currently used and elute different agents. This review described what these agents are and provides an overview regarding the outcomes and associated adverse events. More importantly, this review compares outcomes of PCI with DES to CABG for patients with left anterior descending coronary artery involvement, left main involvement, or multivessel disease. PMID:22285216

Head, Stuart J; Bogers, Ad J J C; Kappetein, A Pieter

2012-04-01

328

Current status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery.  

PubMed

Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. This report describes a computer-assisted totally closed-chest coronary bypass operation, and preliminary results are discussed. The internal thoracic artery (ITA) was harvested through three 5-mm access ports and prepared and controlled endoscopically. A prototype sternal elevator was used to increase intrathoracic working space. A 10-mm endoscopic stabilizer was placed through the second intercostal space, and the left anterior descending coronary artery was controlled with silastic snares. Telerobotic anastomoses were completed end-to-side using custom-made, double-armed 8-0 polytetrafluroethylene sutures. To date, 84 patients have undergone successful myocardial revascularization with robotic assistance with a 0% surgical mortality rate. ITA harvest, anastomotic, and operating times for the entire group have been longer than for conventional surgery at 61.3 +/- 17.9 minutes, 28.5 +/- 28.2 minutes, and 368 +/- 129 minutes, respectively. Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology. PMID:11977023

Boyd, W Douglas; Kodera, Kojiro; Stahl, Kenneth D; Rayman, Reiza

2002-01-01

329

Effect of an Aggressive Lipid-Lowering Strategy on Progression of Atherosclerosis in the Left Main Coronary Artery From Patients in the Post Coronary Artery Bypass Graft Trial  

Microsoft Academic Search

Background—The Post Coronary Artery Bypass Graft Trial, designed to compare the effects of two lipid-lowering regimens and low-dose anticoagulation versus placebo on progression of atherosclerosis in saphenous vein grafts of patients who had had CABG surgery, demonstrated that aggressive lowering of LDL cholesterol levels to a mean yearly cholesterol level from 93 to 97 mg\\/dL compared with a moderate reduction

Carl W. White; Fredarick L. Gobel; Lucien Campeau; Genell L. Knatterud; Sandra A. Forman; James S. Forrester; Nancy L. Geller; J. Alan Herd; Ann Hickey; Byron J. Hoogwerf; Donald B. Hunninghake; Yves Rosenberg; Michael L. Terrin; Bypass Graft

2010-01-01

330

Randomized, Controlled Trial of Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease Six-Year Follow-Up From the Stent or Surgery Trial (SoS)  

Microsoft Academic Search

Background—The Stent or Surgery Trial is a randomized, controlled trial comparing percutaneous coronary intervention with coronary artery bypass grafting (CABG) for patients with multivessel disease. Initial results at a median follow-up of 2 years showed a survival advantage for patients randomized to CABG. This article reports survival outcome at a median follow-up of 6 years. Methods and Results—A total of

Jean Booth; Tim Clayton; John Pepper; Fiona Nugara; Marcus Flather; Ulrich Sigwart; Rodney H. Stables

331

SYNTAX score effect on electroencephalography power dynamics in patients undergoing on-pump coronary artery bypass grafting  

PubMed Central

Background The severity of angiographically assessed coronary artery disease may be the factor that influences the degree of brain damage during on-pump surgery. Modern technology such as computed electroencephalography (EEG) that is used to detect signs of brain damage could also be used to determine the advantages and disadvantages of various surgical myocardial revascularization methods in certain categories of patients. The present study investigated EEG power dynamics for 1 postoperative month in patients undergoing on-pump coronary artery bypass grafting (CABG) who were divided into two groups: those with moderate coronary lesions (SYNTAX score???22, n?=?12) and those with severe coronary lesions (SYNTAX score???23, n?=?18). Results At 7–10 days after CABG, all patients showed theta type 1 rhythm power higher than that seen preoperatively, possibly indicating that brain damage occurred during bypass. At 1 month after CABG, the theta type 1 rhythm power had decreased to the baseline level in patients with SYNTAX scores of ?22, whereas it had increased in patients with SYNTAX scores ?23. Conclusions SYNTAX scores???23 are associated with EEG markers of perioperative brain damage during CABG. Careful preoperative assessment, preparation, and more effective intraoperative brain protection are essential for this category of coronary heart disease (CHD) patients.

2013-01-01

332

[Anesthetic management of coronary artery bypass grafting for unstable angina pectoris in a patient undergoing home oxygen therapy].  

PubMed

A 70-year-old man with pneumoconiosis receiving home oxygen therapy presented with chest pain. Coronary angiogram showed severe stenosis of his left main trunks and required emergency off-pump coronary artery bypass grafting. Anesthesia was induced and maintained with propofol, fentanyl and vecuronium. The trachea was intubated and the lungs were ventilated with oxygen and air maintaining the PaO2 between 80-100 mmHg and the PaCO2 between 55-65 mmHg. The operation was performed uneventfully. In the intensive care unit, the trachea was extubated after ensuring adequate respiratory function. The postoperative course was satisfactory. PMID:18416197

Arai, Takero; Enomoto, Yoshiro; Kuno, Yuichiro; Inoue, Hisashi; Okuda, Yasuhisa

2008-04-01

333

Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting.  

PubMed

A systematic review and meta-analysis was performed to evaluate the effects of carvedilol versus metoprolol on the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting in randomized controlled trials. Ovid MEDLINE, PubMed, CENTRAL, and Excepta Medica (EMBASE) were searched up to March 2013 for suitable randomized controlled trials. Data were pooled using random-effects model for pairwise analyses. A total of 4 trials with 601 patients were included in this analysis. Pairwise analyses showed that compared with metoprolol, carvedilol significantly reduced the incidence of postoperative atrial fibrillation (odds ratio 0.50, 95% confidence interval 0.32 to 0.80). In conclusion, compared with metoprolol, carvedilol significantly reduces the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. PMID:24332247

DiNicolantonio, James J; Beavers, Craig J; Menezes, Arthur R; Lavie, Carl J; O'Keefe, James H; Meier, Pascal; Vorobcsuk, András; Aradi, Dániel; Komócsi, András; Chatterjee, Saurav; D'Ascenzo, Fabrizio; Gasparini, Mauro; Brugts, Jasper; Biondi-Zoccai, Giuseppe

2014-02-01

334

Care bundle to prevent methicillin-resistant Staphylococcus aureus sternal wound infection after off-pump coronary artery bypass.  

PubMed

Methicillin-resistant Staphylococcus aureus (MRSA) sternal wound infection (SWI) after cardiac surgery is endemic in our hospital. An infection control care bundle with preoperative chlorhexidine showering and povidone iodine paint before bathing was introduced in 2006. From 2001 to 2012, 23 (2.3%) of 1,010 patients undergoing off-pump coronary artery bypass had SWIs. SWI significantly decreased after 2006 (1.4% vs 3.4%, respectively; P = .03). Care bundle was more protective against MRSA infection (2.3% vs 0.5%, respectively; P = .021). SWI remained a common complication after off-pump coronary artery bypass. MRSA infection was most common, and the mortality was high. Care bundle can effectively decrease the incidence of SWI, especially infection caused by MRSA. PMID:24773797

Chien, Chen-Yen; Lin, Cheng-Hsin; Hsu, Ron-Bin

2014-05-01

335

Effect of remote ischemic conditioning on atrial fibrillation and outcome after coronary artery bypass grafting (RICO-trial)  

PubMed Central

Background Pre- and postconditioning describe mechanisms whereby short ischemic periods protect an organ against a longer period of ischemia. Interestingly, short ischemic periods of a limb, in itself harmless, may increase the ischemia tolerance of remote organs, e.g. the heart (remote conditioning, RC). Although several studies have shown reduced biomarker release by RC, a reduction of complications and improvement of patient outcome still has to be demonstrated. Atrial fibrillation (AF) is one of the most common complications after coronary artery bypass graft surgery (CABG), affecting 27-46% of patients. It is associated with increased mortality, adverse cardiovascular events, and prolonged in-hospital stay. We hypothesize that remote ischemic pre- and/or post-conditioning reduce the incidence of AF following CABG, and improve patient outcome. Methods/design This study is a randomized, controlled, patient and investigator blinded multicenter trial. Elective CABG patients are randomized to one of the following four groups: 1) control, 2) remote ischemic preconditioning, 3) remote ischemic postconditioning, or 4) remote ischemic pre- and postconditioning. Remote conditioning is applied at the arm by 3 cycles of 5 minutes of ischemia and reperfusion. Primary endpoint is the incidence AF in the first 72 hours after surgery, detected using a Holter-monitor. Secondary endpoints include length-of-stay on the intensive care unit and in-hospital, and the occurrence of major adverse cardiovascular events at 30 days, 3 months and 1 year. Based on an expected incidence in the control group of 27%, 195 patients per group are needed to detect with 80% power a reduction by 45% following either pre- or postconditioning, while allowing for a 10% dropout and at an alpha of 0.05. With the combined intervention expected to be stronger, we need 75 patients in this group to detect a reduction in incidence of AF of 60%. Discussion The RICO-trial (the effect of Remote Ischemic Conditioning on atrial fibrillation and Outcome) is a randomized controlled multicenter trial, designed to investigate whether remote ischemic pre- and/or post-conditioning of the arm reduce the incidence of AF following CABG surgery. Trial registration ClinicalTrials.gov under NCT01107184.

2011-01-01

336

Is there a surgeon or hospital volume-outcome relationship in off-pump coronary artery bypass surgery?  

PubMed Central

A best evidence topic was written according to a structured protocol. The question addressed was whether there is a surgeon or hospital volume–outcome relationship in patients undergoing off-pump coronary artery bypass surgery. A total of 281 papers were found using the reported searches, of which six represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the outcomes of off-pump coronary artery bypass surgery in relation to surgeon or hospital volume and evaluated the presence of a volume–outcome relationship. Reported measures included mortality and major adverse cardiovascular and cerebrovascular events. The methodological quality and strength of each study for exploring volume–outcome relationships were quantitatively assessed using a predefined scoring system. Three studies analysed surgeon volume and three studies analysed hospital volume. The two largest and most recent studies presented a significant volume–outcome relationship in mortality and postoperative complications. Perhaps owing to the smaller sample size, this significant relationship in mortality was not observed in the four smaller studies; however, one of these studies demonstrated a significantly positive relationship for postoperative complications and another study demonstrated a similar significant relationship for the number of grafts and the degree of completeness of revascularization. While the volume–outcome relationship in coronary artery bypass graft surgery is very well-documented, the technically challenging nature of off-pump surgery, the length of the learning curve associated with the operation and the higher risk profile of patients undergoing off-pump surgery in comparison with routine on-pump surgery render these results difficult to interpret. Although our review does support the idea of a volume–outcome relationship in off-pump coronary artery bypass surgery, this relationship may not be so clearly defined and requires further analysis by higher-quality studies.

Sepehripour, Amir H.; Athanasiou, Thanos

2013-01-01

337

Evaluation of right atrial and biatrial temporary pacing for the prevention of atrial fibrillation after coronary artery bypass surgery  

Microsoft Academic Search

OBJECTIVESThe purpose of this study was to determine if atrial pacing is effective in reducing postoperative atrial fibrillation (AF).BACKGROUNDAtrial fibrillation after coronary artery bypass grafting (CABG) is a common problem for which medical management has been disappointing. Atrial-based pacing has become an attractive nonpharmacologic therapy for the prevention of AF.METHODSSixty-one post-CABG patients (mean age = 65 years) were randomized to

Edward P Gerstenfeld; Michael R. S Hill; Steven N French; Rahul Mehra; Karen Rofino; Thomas J Vander Salm; Robert S Mittleman

1999-01-01

338

Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur  

Microsoft Academic Search

A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. Cardiac catheterization then performed and revealed patent

Umit Guray; Yesim Guray; Cemal Ozbakir; M. Birhan Yilmaz; Hatice Sasmaz; Sule Korkmaz

2004-01-01

339

Transit-time flow predicts outcomes in coronary artery bypass graft patients: a series of 1000 consecutive arterial grafts  

Microsoft Academic Search

Objective: This study was undertaken to evaluate transit-time flow (TTF) as a tool to detect technical errors in arterial bypass grafts intra-operatively and predict outcomes. Methods: TTF's three parameters, pulsatility index (PI, index of resistance), flow (ccmin?1) and diastolic filling (DF, proportion of diastole with coronary flow), were measured in 990\\/1000 (99%) of arterial grafts in 336 consecutive patients, prospectively

Teresa Mary Kieser; Sarah Rose; Ryszard Kowalewski; Israel Belenkie

2010-01-01

340

Value of thallium-201 reinjection after delayed SPECT imaging for predicting reversible ischemia after coronary artery bypass grafting  

Microsoft Academic Search

The reinjection of a small dose (40 MBq) of thallium-201 after stress and delayed imaging often shows new redistribution in the regions with persistent defect. To assess whether these segments may represent reversible ischemia, reinjection thallium-201 single-photon emission computed tomography (SPECT) was performed after stress and 3-hour delayed imaging in 24 patients before coronary artery bypass grafting (CABG). The left

H. Ohtani; N. Tamaki; Y. Yonekura; I. H. Mohiuddin; K. Hirata; T. Ban; J. Konishi

1990-01-01

341

A meta-analysis of minimally invasive versus traditional open vein harvest technique for coronary artery bypass graft surgery.  

PubMed

The long saphenous vein remains the most commonly used conduit in coronary artery bypass surgery. Vein harvest is a critical component of this operation with significant morbidity associated with large leg wounds from open techniques. Here, we analyse the available literature comparing minimally invasive techniques vs. the traditional open method for vein harvest. A systematic literature search of Medline, Embase and Cochrane databases was performed using the following terms; 'saphenous vein', 'coronary artery bypass', 'tissue and organ harvesting' and 'endoscopic'. Relevant papers were then analysed using Statsdirect software. There was significantly reduced leg wound infection, leg wound haematoma and postoperative pain in the minimally invasive group. There was no statistical difference between the groups for vein harvest time, length of hospital stay and incidence of vein injury. There was a significantly reduced long-term graft patency in veins harvested by a minimally invasive technique. The results of this meta-analysis demonstrate the operative advantages of minimally invasive techniques for the purposes of vein harvest in coronary artery bypass surgery. However, further studies are required to look at long-term graft patency following minimally invasive vein harvest as this remains a major concern. PMID:19942633

Markar, Sheraz R; Kutty, Ramesh; Edmonds, Lyn; Sadat, Umar; Nair, Sukumaran

2010-02-01

342

Predicting hospital costs for first-time coronary artery bypass grafting from preoperative and postoperative variables.  

PubMed

To predict hospital costs after coronary artery bypass grafting (CABG) from preoperative characteristics and postoperative complications, 4 analyses of the data were used: (1) a univariate analysis of each preoperative and postoperative variable, (2) a multivariate analysis of the preoperative variables (model 1), (3) a multivariate analysis of the postoperative variables (model 2), and (4) a multivariate analysis of pre- and postoperative variables (model 3). Eight-hundred seven patients who underwent a first-time CABG at Emory University during 1990 were analyzed in this study. Using model 1, the determinants of costs were higher angina grade (p = 0.0006), previous myocardial infarction (p = 0.0133), older age (p = 0.0001), congestive heart failure (p = 0.0001), and a higher number of diseased vessels (p = 0.0001). For model 2, the determinants of costs were adult respiratory distress syndrome (p = 0.0073), intraaortic balloon pumping (p < 0.0001), pneumonia (p < 0.0001), septicemia p < 0.0001), major arrhythmia (p < 0.0001), reexploration for bleeding (p < 0.0001), wound infection (p = 0.0632), neurologic event (p = 0.0013), fluid overload (p = 0.0516), and absence of pericarditis (p = 0.0588). For univariate analysis, the determinants of increased costs were similar to those from models 1 and 2. Although there is considerable variance in hospital costs for any number of complications, utilized resources (costs) increase inexorably as patients have more complications after coronary surgery. The mean cost to the hospital for the 382 patients who underwent CABG and experienced no complications was $16,776.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7942547

Mauldin, P D; Weintraub, W S; Becker, E R

1994-10-15

343

The value of exercise radionuclide ventriculography in risk stratification after coronary arterial bypass grafting  

SciTech Connect

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.

1985-05-01

344

Thrombotic gene polymorphisms and postoperative outcome after coronary artery bypass graft surgery  

PubMed Central

Background Emerging perioperative genomics may influence the direction of risk assessment and surgical strategies in cardiac surgery. The aim of this study was to investigate whether single nucleotide polymorphisms (SNP) affect the clinical presentation and predispose to increased risk for postoperative adverse events in patients undergoing coronary artery bypass grafting surgery (CABG). Methods A total of 220 patients undergoing first-time CABG between January 2005 and May 2008 were screened for factor V gene G1691A (FVL), prothrombin/factor II G20210A (PT G20210A), angiotensin I-converting enzyme insertion/deletion (ACE-ins/del) polymorphisms by PCR and Real Time PCR. End points were defined as death, myocardial infarction, stroke, postoperative bleeding, respiratory and renal insufficiency and event-free survival. Patients were compared to assess for any independent association between genotypes for thrombosis and postoperative phenotypes. Results Among 220 patients, the prevalence of the heterozygous FVL mutation was 10.9% (n = 24), and 3.6% (n = 8) were heterozygous carriers of the PT G20210A mutation. Genotype distribution of ACE-ins/del was 16.6%, 51.9%, and 31.5% in genotypes I/I, I/D, and D/D, respectively. FVL and PT G20210A mutations were associated with higher prevalence of totally occluded coronary arteries (p < 0.001). Furthermore the risk of left ventricular aneurysm formation was significantly higher in FVL heterozygote group compared to FVL G1691G (p = 0.002). ACE D/D genotype was associated with hypertension (p = 0.004), peripheral vascular disease (p = 0.006), and previous myocardial infarction (p = 0.007). Conclusions FVL and PT G20210A genotypes had a higher prevalence of totally occluded vessels potentially as a result of atherothrombotic events. However, none of the genotypes investigated were independently associated with mortality.

2011-01-01

345

Effects of Seasonal Variations on the Outcome of Coronary Artery Bypass Graft Surgery  

PubMed Central

Background: For all the reports on the association between seasons and coronary artery disease, there is a paucity of information on the possible effects of seasonal variations on the outcome of patients after coronary artery bypass grafting surgery (CABG). The aim of this study was to assess the short-term outcome of post-CABG patients in the four different seasons to find any correlation between seasonal variations and the outcome of such patients. Methods: Data on patients who underwent cardiac surgery between 2007 and 2009 were analyzed. In-hospital mortality, length of Intensive Care Unit (ICU) stay, and length of hospital stay in the four different seasons were considered as outcome measures. The EuroSCORE was calculated for all the patients, and the Kruskal-Wallis, Mann-Whitney, Student t, and chi square tests were used as appropriate. Results: Of a total of 402 patients, who underwent CABG during the mentioned period, 292 patients were male (M/F ratio=2.65). There were no differences in terms of mean age, sex ratio, and mean EuroSCORE of the patients between the seasons. The mean length of ICU stay was significantly more in the spring than that of the other seasons (P<0.001), while the difference between the four seasons regarding the mean length of hospital stay did not constitute statistical significance (P=0.22). No effect of seasonal variations was found for the lengths of ICU and hospital stay in the presence of the EuroSCORE after multiple logistic regression analysis (P=0.278, 0.431). Conclusion: Psychological mood changes caused by regional cultural differences rather than environmental factors should be considered in the optimal management of patients after CABG.

Nemati, Mohammad Hassan

2013-01-01

346

Does Off-pump Coronary Artery Bypass Reduce the Prevalence ofAtrial Fibrillation?  

PubMed Central

Introduction: To examine whether or not off-pump CABG (Coronary Artery Bypass Reduce) reduces the incidence of AF after cardiac surgery. Methods: The study was carried out in 939 consecutive coronary artery disease patients with sinus rhythm from which 383 patients underwent off-pump CABG, and 556 patients were operated through on-pump CABG. All patients were monitored postoperatively during intensive care unit (ICU) stay. Then, the incidence and predictive risk factors of post operative AF (POAF) in two groups were determined and compared with each other. Results: Overall, the mean age of the patients was 56.0±12.8 years with 234 patients (24.9%) being older than 65 years. POAF developed in 38 patients (9.9%) of the off-pump and in 93 patients (16.7%) of the on-pump CABG. There was significant difference between two groups when considering the incidence of POAF (P=0.002). Among preoperative risk factors, age>65 years had a significant association with the incidence of AF in both groups. This study also showed that most of the POAF cases converted to sinus rhythm after treatment. Moreover, these finding demonstrated that conversion to sinus rhythm is significantly more probable in off-pump group (P=0.006). Conclusion: A reduced prevalence of POAF could be observed in patients with off-pump as compared with on-pump techniques. Furthermore, conversion to sinus rhythm in off-pump group was significantly more probable than on-pump group.

Hashemzadeh, Khosrow; Dehdilani, Marjan; Dehdilani, Mahnaz

2013-01-01

347

[Body structure and ABO and Rh blood groups in patients with advanced coronary heart disease after aorto-coronary by-pass surgery].  

PubMed

A clinical analysis of the anthropometric traits related to body structure, ABO and rhesus blood groups was performed in 200 male individuals coming mainly from Warsaw and its territorial district. All patients were aged from thirty-one to sixty-eight years (X = 42.3) and total duration of coronary heart disease was from 1 to 12 years. The number of 54 patients (21%) was subjected to surgery because of coronary insufficiency, but without myocardial infarction (M.I.). One or three single cases of M.I. were reported in the remaining number of 146 patients (73%). A degree of extension of arteriosclerotic lesions either in two or three coronary arteries was larger determined upon coronarography. The control group for blood--groups in 200 patients was made of 11,820 healthy male--blood from District Blood Donor Station in Warsaw, but for the anthropometric tracts (height, body weight and Rohrer's index) the control group was made of 283 men aged 35-80 years (average 43.2) coming mainly from Warsaw and its district. Patients after aorto-coronary by-pas surgery with highly advanced arteriosclerosis of the coronary arteries featured indicated significantly higher number of cases with group AB (p < 0.01) due to deficiency in group O (p < 0.05). It has also been found that the occurrence of rhesus blood group lack in patients having undergone by-pass surgery is significantly common (p < 0.01). No significant difference in anthropological traits between the patients after aorto-coronary by-pass surgery and the control group from the same geographical region was reported.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8190657

Slipko, Z; Latuchowska, B; Wojtkowska, E

1994-01-01

348

A randomized study of coronary artery bypass surgery performed with the Resting Heart(TM) System utilizing a low vs a standard dosage of heparin  

PubMed Central

OBJECTIVES Allogeneic blood transfusion and reoperation for postoperative bleeding after the coronary artery bypass grafting have a negative impact on the patient outcome. This study aimed at evaluating the effects of reduced doses of heparin and protamine on the patient outcome, using a heparin-coated mini-cardiopulmonary bypass (CPB) system. METHODS Sixty patients undergoing elective first-time CPB were prospectively randomized either to have a reduced systemic heparinization [activated clotting time (ACT) = 250 s] or to a control group perfused with a full heparin dose (ACT = 420 s). Blood transfusions, ventilation time, early postoperative bleeding, ICU stay, reoperations for bleeding, postoperative cognitive status and the level of mobilization were registered. RESULTS Twenty-nine patients were randomized to the control group, 27 patients to the low-dose group and 4 patients were excluded because of protocol violations. Four patients in the control group received a total of 10 units of packed red blood cells, and in the low-dose group, no transfusions were given, P = 0.046. No patient was reoperated because of bleeding. The ICU stay was significantly shorter in the low-dose group (8.4 vs 13.7 h, P = 0.020), less dependent on oxygen on the first postoperative day (78 vs 97%, P = 0.034), better mobilized (89 vs 59%, P = 0.006) and had less pain (visual analogue scale 2.0 vs 3.5, P = 0.019) compared with the control group. CONCLUSIONS The use of a mini-CPB system combined with a low dose of heparin reduced the need for blood transfusions and may facilitate the faster mobilization of the patients.

Nilsson, Johan; Scicluna, Sara; Malmkvist, Gunnar; Pierre, Leif; Algotsson, Lars; Paulsson, Per; Bjursten, Henrik; Johnsson, Per

2012-01-01

349

Effect of different dosages of nitroglycerin infusion on arterial blood gas tensions in patients undergoing on- pump coronary artery bypass graft surgery  

PubMed Central

Background: On-pump coronary artery bypass graft (CABG) surgery impairs gas exchange in the early postoperative period. The main object on this study was evaluation of changes in arterial blood gas values in patients underwent on pump CABG surgery receiving different dose of intravenous nitroglycerin (NTG). Materials and Methods: sixty-seven consecutive patients undergoing elective on-pump CABG randomly enrolled into three groups receiving NTG 50 ?g/min (Group N1, n =67), 100 ?g/min (Group N2, n = 67), and 150 ?g/min (Group N3, n = 67). Arterial blood gas (ABG) tensions were evaluated just before induction of anesthesia, during anesthesia, at the end of warming up period, and 6 h after admission to the intensive care unit. Results: Pao2 and PH had the highest value during surgery in Group N1, Group N2, and Group N3. No significant difference was noted in mean values of Pao2 and PH during surgery between three groups (P > 0.05). There was no significant difference in HCO3 values in different time intervals among three groups (P > 0.05). Conclusion: our results showed that infusing three different dosage of NTG (50, 100, and 150 ?g/min) had no significant effect on ABG tensions in patients underwent on-pump CABG surgery.

Masoumi, Gholamreza; Pour, Evaz Hidar; Sadeghpour, Ali; Ziayeefard, Mohsen; Alavi, Mostapha; Anbardan, Sanam Javid; Shirani, Shahin

2012-01-01

350

Short-term outcome of attention and executive functions from aorta no-touch and traditional off-pump coronary artery bypass surgery.  

PubMed

Abstract Objectives. Postoperative cognitive dysfunction (POCD) is an important neuropsychiatric complication of coronary artery bypass grafting (CABG). It is most likely caused by microembolic brain damage and affects domains of attention, memory, executive functions and dexterity. In order to achieve better neuroprotection, surgeons introduced some advantageous operating procedures. Noteworthy among them is a state-of-the-art off-pump CABG aorta no-touch technique ("no touch" OPCABG). The aim of this study was to investigate the short-term effect of "no touch" OPCABG on patients' attention and executive functions. Methods. In this prospective, observational, single-surgeon trial, 74 patients scheduled for elective CABG were studied. Thirty-five patients underwent "no-touch" OPCABG and were compared to 39 patients who underwent "traditional" OPCABG. Subjects underwent neurological and neuropsychological evaluation at the time of admission (7 ± 2 days preoperatively) and discharge (7 days postoperatively). Results. Patients who underwent "traditional" OPCABG showed a significant decline in postoperative performance on 4 neuropsychological tests, while patients treated with "no touch" OPCABG showed a significant decline on 1 test. Twenty patients from "traditional" OPCABG group and ten patients from "no touch" OPCABG group were diagnosed with POCD. Conclusions. Use of "no touch" OPCABG was associated with better attention and executive functions 1 week after surgery compared with "traditional" OPCABG. PMID:23984711

Szwed, Krzysztof; Pawliszak, Wojciech; Anisimowicz, Lech; Buci?ski, Adam; Borkowska, Alina

2014-07-01

351

Two Cases of Percutaneous Intervention for Coronary Artery Bypass Graft Anastomoses With Paclitaxel-Eluting Balloon Catheters  

PubMed Central

Coronary artery bypass graft (CABG) intervention, particularly anastomosis site intervention, is challenging for interventional cardiologists. A paclitaxel-eluting balloon catheter (SeQuent Please) is a recently-introduced device capable of delivering paclitaxel homogeneously into the targeted vessel wall. We herein report our experience with two cases. In the first case, coronary angiography showed significant stenosis at the site of anastomosis between the saphenous vein graft and the left anterior descending artery (LAD). In the second case, coronary angiography showed significant stenosis at the site of anastomosis between the left internal mammary artery and the LAD. We performed percutaneous intervention of these CABG anastomoses using paclitaxel-eluting balloon catheters, and obtained favorable angiographic and clinical outcomes.

Uhm, Jae-Sun; Lee, Seok Jong; Shin, Ah Young; Jung, Soo-Yeon; Kim, Chan-Joon; Seo, Suk-Min; Park, Hun-Jun; Kim, Pum-Joon; Chang, Kiyuk; Seung, Ki-Bae

2011-01-01

352

Triclosan-coated sutures do not reduce leg wound infections after coronary artery bypass grafting  

PubMed Central

OBJECTIVES Leg wound infection is a common complication after coronary artery bypass grafting (CABG). Suture contamination has been suggested as a mechanism of surgical site infections. Vicryl Plus® is a polyglacitin suture coated with the antiseptic chemical substance Triclosan, which has been shown to inhibit the growth of Staphylococcus aureus in vitro. The first aim of the present study was to compare Vicryl Plus with conventional Vicryl® sutures with regard to leg wound infections following CABG. The second aim was to examine patient- and operative characteristics, which are assumed to predict leg wound infections. METHODS After statistical calculations a priori, 328 CABG patients were prospectively randomized to leg wound closure with Vicryl Plus (164 patients) or conventional Vicryl sutures (164 patients). Incidences of leg wound infection and predictors of infection related to patient- and operative characteristics were examined. RESULTS The incidence of leg wound infections was 10.4% (17/163) in the Vicryl group, and 10.0% (16/160) in the Vicryl Plus group (P = 1.00). Patients with leg wound infections had increased body mass index and prolonged extracorporeal circulation and aortic clamping time compared with patients without infections. CONCLUSIONS In the present study, we report for the first time that Vicryl Plus did not reduce the incidence of leg wound infections in patients undergoing CABG. Obesity and prolonged time of extracorporeal circulation were both associated with the increased risk of infections. Currently, the clinical role and indication for the use of Vicryl Plus have yet to be defined.

Seim, Bj?rn Edvard; T?nnessen, Theis; Woldbaek, Per Reidar

2012-01-01

353

Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting.  

PubMed

Recent advances in catheter-based optical coherence tomography (OCT) have provided the necessary resolution and acquisition speed for high-quality intravascular imaging. Complications associated with clearing blood from the vessel of a living patient have prevented its wider acceptance. We identify a surgical application that takes advantage of the vascular imaging powers of OCT but that circumvents the difficulties. Coronary artery bypass grafting (CABG) is the most commonly performed major surgery in America. A critical determinant of its outcome has been postulated to be injury to the conduit vessel incurred during the harvesting procedure or pathology preexistent in the harvested vessel. As a test of feasibility, intravascular OCT imaging is obtained from the radial arteries (RAs) and/or saphenous veins (SVs) of 35 patients scheduled for CABG. Pathologies detected by OCT are compared to registered histological sections obtained from discarded segments of each graft. OCT reliably detects atherosclerotic lesions in the RAs and discerns plaque morphology as fibrous, fibrocalcific, or fibroatheromatous. OCT is also used to assess intimal trauma and residual thrombi related to endoscopic harvest and the quality of the distal anastomosis. We demonstrate the feasibility of OCT imaging as an intraoperative tool to select conduit vessels for CABG. PMID:17994877

Brown, Emile N; Burris, Nicholas S; Gu, Junyan; Kon, Zachary N; Laird, Patrick; Kallam, Seeta; Tang, Cha-Min; Schmitt, Joseph M; Poston, Robert S

2007-01-01

354

Employment changes among patients following coronary bypass surgery: social, medical, and psychological correlates.  

PubMed Central

The relations of socioeconomic and psychological factors to resumption of employment following coronary artery bypass surgery were studied using a questionnaire returned by a sample of 426 men and 70 women. The sample was drawn from the membership of Mended Hearts, Inc., a nationwide voluntary organization of persons who have had heart surgery. Preoperatively, more men (92 percent) than women (59 percent) were employed. Return to work rates were high for men (81 percent) and much lower for women (58 percent). The 395 men tended to return to work an average of 3.7 months after surgery whereas the 41 women took an average of 4.8 months. Return to work following surgery was most clearly related to socioeconomic level for both sexes. In addition, for men, those most likely to return had less postoperative morbidity and held jobs requiring little physical exertion. Patients who reported that they were forced into an early retirement represent a particularly vulnerable group in that they were more likely to experience the most postoperative morbidity. As a group, they believed that their physicians had least prepared them to return to work, and they experienced the poorest emotional adjustment. Thus, women and those forced into early retirement represent two potentially high-risk groups of patients who would seem to require additional clinical and psychological management following surgery.

Zyzanski, S J; Rouse, B A; Stanton, B A; Jenkins, C D

1982-01-01

355

Missed case of sinus venosus atrial septal defect post coronary artery bypass grafting.  

PubMed

We report a case of a 41-year-old Indian man who initially underwent an emergency coronary artery bypass grafting surgery (CABG) after presenting with an anterolateral myocardial infarction.Post-operatively he developed progressively worsening symptoms of right heart failure with increasing abdominal distension and lower limb swelling. Clinically, the patient was in NYHA class 4 heart failure.He was admitted multiple times for the treatment of his heart failure, which was recalcitrant to diuretic therapy.He subsequently underwent an MRI scan, which revealed near transmural myocardial infarction involving mainly the left side of the heart. The right atrium and ventricle were grossly dilated, with moderate to severe right ventricular systolic dysfunction. A sinus venosus atrial septal defect with right-sided partial anomalous pulmonary venous drainange (PAPVD) was noted. He subsequently underwent surgery to repair the sinus venosus atrial septal defect (ASD) as well as re-route the PAPVD to the left atrium (LA). He was discharged on post-operative day 19 with oral diuretics.On follow-up at 1 month, the patient's symptoms had resolved and his clinical status corresponded to NYHA class 1-2. PMID:24884712

De, Sudeep Das; Maung Maung Aye, Winn; Shankar, Sriram

2014-01-01

356

Epidemiology and ethics of coronary artery bypass surgery in an eastern county.  

PubMed

Despite an extensive literature on coronary artery bypass grafting (CABG) surgery in the last decade, relatively little has been written on the demographic or socioeconomic characteristics of patients who receive this limited medical resource. In the present study data were collected on all patients (N = 539) who received this procedure over a one-year period (July 1977 to June 1978) within Erie County in western New York. Using available census tract data, age-sex adjusted surgery rates by socioeconomic status are developed for defined geographic areas. Patients residing in the city of Buffalo and those from census tracts in the lowest quartile of median family income have dramatically lower surgery rates than do others in the county (P less than .001). Although these discrepancies in CABG surgery rates may be partially explained by differing incidence rates of the medical indications for CABG surgery, problems of access to the service may be operative. Three different principles of distributive justice (equality, liberty, and utility) are discussed in an attempt to see how they might be applicable to the pattern documented. PMID:6977014

Dickman, R L; Bukowski, S

1982-02-01

357

Prevalence of claustrophobia and magnetic resonance imaging after coronary artery bypass graft surgery  

PubMed Central

Background The purpose of this study was to determine the prevalence of claustrophobia in patients undergoing magnetic resonance imaging (MRI) after coronary artery bypass graft (CABG) surgery. Methods After IRB approval, we conducted a substudy of a prospective randomized controlled clinical trial of 311 patients evaluating administration of tranexamic acid and early saphenous vein graft patency with MRI after conventional CABG surgery. Chest tube drainage was measured at 6, 12, and 24 hours after surgery. The rate of transfusion and the amount of red blood cells (RBC), fresh frozen plasma (FFP), and platelets transfused were recorded. Results A total of 237(76%) patients underwent MRI after surgery. 39 (14%, [95% CI, 10.2 to 18.0]) patients experienced severe anxiety caused by a fear of enclosed space in the MRI coil necessitating termination of the procedure. Patients with claustrophobia were on average 5 years younger. They were more likely to have diabetes mellitus and hypertension. Patients with claustrophobia had increased chest tube drainage during the postoperative period. The rate of blood product transfusion was similar between the two groups but patients with claustrophobia who were transfused received significantly more RBC and FFP than patients without claustrophobia. Conclusions Postoperative claustrophobia and anxiety, leading to inability to undergo MRI, may be more common than previously described.

Katznelson, Rita; Djaiani, George N; Minkovich, Leonid; Fedorko, Ludwik; Carroll, Jo; Borger, Michael A; Cusimano, Robert J; Karski, Jacek

2008-01-01

358

Missed case of sinus venosus atrial septal defect post coronary artery bypass grafting  

PubMed Central

We report a case of a 41-year-old Indian man who initially underwent an emergency coronary artery bypass grafting surgery (CABG) after presenting with an anterolateral myocardial infarction. Post-operatively he developed progressively worsening symptoms of right heart failure with increasing abdominal distension and lower limb swelling. Clinically, the patient was in NYHA class 4 heart failure. He was admitted multiple times for the treatment of his heart failure, which was recalcitrant to diuretic therapy. He subsequently underwent an MRI scan, which revealed near transmural myocardial infarction involving mainly the left side of the heart. The right atrium and ventricle were grossly dilated, with moderate to severe right ventricular systolic dysfunction. A sinus venosus atrial septal defect with right-sided partial anomalous pulmonary venous drainange (PAPVD) was noted. He subsequently underwent surgery to repair the sinus venosus atrial septal defect (ASD) as well as re-route the PAPVD to the left atrium (LA). He was discharged on post-operative day 19 with oral diuretics. On follow-up at 1 month, the patient's symptoms had resolved and his clinical status corresponded to NYHA class 1–2.

2014-01-01

359

Prediction of clinical conditions after coronary bypass surgery using dynamic data analysis.  

PubMed

This work studies the impact of using dynamic information as features in a machine learning algorithm for the prediction task of classifying critically ill patients in two classes according to the time they need to reach a stable state after coronary bypass surgery: less or more than 9 h. On the basis of five physiological variables (heart rate, systolic arterial blood pressure, systolic pulmonary pressure, blood temperature and oxygen saturation), different dynamic features were extracted, namely the means and standard deviations at different moments in time, coefficients of multivariate autoregressive models and cepstral coefficients. These sets of features served subsequently as inputs for a Gaussian process and the prediction results were compared with the case where only admission data was used for the classification. The dynamic features, especially the cepstral coefficients (aROC: 0.749, Brier score: 0.206), resulted in higher performances when compared to static admission data (aROC: 0.547, Brier score: 0.247). The differences in performance are shown to be significant. In all cases, the Gaussian process classifier outperformed to logistic regression. PMID:20503607

Van Loon, K; Guiza, F; Meyfroidt, G; Aerts, J-M; Ramon, J; Blockeel, H; Bruynooghe, M; Van den Berghe, G; Berckmans, D

2010-06-01

360

Bone marrow stem cell transplantation and coronary artery bypass grafting surgery for chronic ischemic myocardiopathy.  

PubMed

We studied 12 consecutive patients with chronic ischemic myocardiopathy treated with bone marrow adult stem cell (ASC) transplantation and coronary artery bypass grafting (CABG). The aim of the study was to evaluate functional class (New York Heart Association), wall motion score index (WMSI), and ejection fraction by echocardiography and to evaluate myocardial perfusion by single-photon emission computed tomography (SPECT). Follow-up evaluations were performed at 3, 6, and 12 months. The results revealed functional class improvement until 12 months, a progressive increase in the ejection fraction of 15% to 20% in the first 6 months, and a progressive increase in the WMSI by 35% to 45% in 12 months. Evaluation of the WMSI in the stem cell and CABG areas separately revealed a similar improvement in the first 3 months and a better progression in the CABG area. SPECT images revealed perfusion improvements in ischemic areas and no difference in fibrous tissue areas. These preliminary results show the safety of the method and its reproducibility. When performed concomitantly with CABG, bone marrow ASC transplantation may improve functional class, ejection fraction, WMSI, and myocardial perfusion. This study will be completed with all patients followed up for 12 months and compared with a control group. PMID:20534416

da Rocha Loures, Danton Richlin; de Souza, Juliano Mendes; Sermann, Oaidia Adelina Nocetti; Farah, Noemi; Rodriguez, Maria Felicitas Niedfeld; Malvezzi, Mariester; Borgonovo, Tamara; Westphal, Ricardo João; Ervilha, Lauro; da Cunha, Claudio Pereira

2010-06-01

361

Albumin Is A Better Predictor of Outcomes Than Body Mass Index Following Coronary Artery Bypass Grafting  

PubMed Central

Objective Body Mass Index (BMI) influences risk in coronary artery bypass grafting (CABG) patients, while albumin, is not collected by the Society of Thoracic Surgeons database. We postulate that preoperative albumin is a better predictor of mortality than BMI following CABG. Methods BMI from patients with serum albumin level within 6 months of isolated CABG between 1995–2010 from our institutional databases were identified. Patients were stratified by National Heart, Lung and Blood Institute (NHLBI) BMI class, and by preoperative albumin. Regression models were used to assess predictors of morbidity and mortality. Results We analyzed 2,794 isolated CABG patients at our institution. Unadjusted mortality was highest with lowest BMI (P?.05), and in patients with 2–3g/dL albumin (P=.02). Ejection fraction (EF) and intra-aortic balloon pump (IABP) use were similar despite BMI; however, EF was lowest and IABP use highest in the 2–3g/dL albumin group (P<.001, respectively). Unlike BMI groups, increasing albumin was associated with lower major complication rates (P=.001). Similarly, adjusted mortality was not influenced by BMI (AOR 0.97, 95%CI 0.93–1.02), but increasing albumin levels reduced the adjusted odds of death (AOR 0.61, 95%CI 0.42–0.90). Conclusions Albumin, more than body mass index, is associated with mortality and morbidity in isolated CABG recipients and may be a better indicator for outcomes.

Bhamidipati, Castigliano M; LaPar, Damien J; Mehta, Gaurav S; Kern, John A; Upchurch, Gilbert R; Kron, Irving L; Ailawadi, Gorav

2011-01-01

362

The New Zealand priority criteria project. Part 2: Coronary artery bypass graft surgery.  

PubMed Central

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.

Hadorn, D. C.; Holmes, A. C.

1997-01-01

363

Emergency coronary bypass grafting for evolving myocardial infarction. Effects on infarct size and left ventricular function  

SciTech Connect

Emergency aorta-coronary bypass grafting was performed early in the course of evolving myocardial infarction in 48 patients. The time interval between the onset of symptoms and reperfusion was 169 +/- 80 minutes. Quantitative assessment of postoperative thallium 201 myocardial scans in 19 patients revealed a significant salvage of myocardium after surgical reperfusion: The size of the residual infarction was less than 50% of that in a matched, medically treated, prospective control group (n = 39) (p less than 0.05). Postoperative equilibrium-gated radionuclide blood pool studies (technetium 99m) showed an enhanced recovery of regional and global ejection fraction after operation as compared to after medical treatment (p less than 0.05). Ultrastructural evaluation of biopsy specimens obtained during the operation delineated subendocardial necrosis in the majority of cases (72%), but subepicardial necrosis was found in only 6% of instances. Q-wave abnormalities were observed on the postoperative electrocardiogram in 50% of cases. Operative mortality was 0% in low-risk patients (i.e., hemodynamically stable condition, n = 26) and 18% in high-risk patients (i.e., cardiogenic shock including total electromechanical dysfunction, n = 22). Survival rate at 18 months was 92% +/- 4%, and 95% +/- 4% of the survivors were event free. It is concluded that early surgical reperfusion of evolving myocardial infarction limits infarct size significantly, enhances functional recovery, and may be a lifesaving operation in patients having cardiogenic shock associated with unsuccessful resuscitation.

Flameng, W.; Sergeant, P.; Vanhaecke, J.; Suy, R.

1987-07-01

364

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

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

2008-01-01

365

Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction  

PubMed Central

BACKGROUND The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established. METHODS Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. RESULTS The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P = 0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P = 0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG. CONCLUSIONS In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. (Funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories; STICH ClinicalTrials.gov number, NCT00023595.)

Velazquez, Eric J.; Lee, Kerry L.; Deja, Marek A.; Jain, Anil; Sopko, George; Marchenko, Andrey; Ali, Imtiaz S.; Pohost, Gerald; Gradinac, Sinisa; Abraham, William T.; Yii, Michael; Prabhakaran, Dorairaj; Szwed, Hanna; Ferrazzi, Paolo; Petrie, Mark C.; O'Connor, Christopher M.; Panchavinnin, Pradit; She, Lilin; Bonow, Robert O.; Rankin, Gena Roush; Jones, Robert H.; Rouleau, Jean-Lucien

2012-01-01

366

The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery  

Microsoft Academic Search

BackgroundAcute renal injury is a common serious complication of cardiac surgery. Moderate hemodilution is thought to reduce the risk of kidney injury but the current practice of extreme hemodilution (target hematocrit 22% to 24%) during cardiopulmonary bypass (CPB) has been linked to adverse outcomes after cardiac surgery. Therefore we tested the hypothesis that lowest hematocrit during CPB is independently associated

Madhav Swaminathan; Barbara G Phillips-Bute; Peter J Conlon; Peter K Smith; Mark F Newman; Mark Stafford-Smith

2003-01-01

367

The Association of Lowest Hematocrit During Cardiopulmonary Bypass With Acute Renal Injury After Coronary Artery Bypass Surgery  

Microsoft Academic Search

Background. Acute renal injury is a common serious complication of cardiac surgery. Moderate hemodilution is thought to reduce the risk of kidney injury but the current practice of extreme hemodilution (target hemat- ocrit 22% to 24%) during cardiopulmonary bypass (CPB) has been linked to adverse outcomes after cardiac sur- gery. Therefore we tested the hypothesis that lowest hematocrit during CPB

Madhav Swaminathan; Barbara G. Phillips-Bute; Peter J. Conlon

2010-01-01

368

Impact of the severity of coronary artery calcification on clinical events in patients undergoing coronary artery bypass grafting (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial).  

PubMed

The treatment of calcified coronary lesions by percutaneous coronary intervention has been shown to be associated with poor outcomes and an increased rate of complications. However, the impact of coronary calcification in patients undergoing coronary artery bypass grafting (CABG) is unknown. A total of 755 patients presenting with acute coronary syndrome in the Acute Catheterization and Urgent Intervention Triage Strategy trial underwent CABG. Patients were divided into 3 groups according to the presence and extent of coronary calcifications (lesion level: severe, moderate, none to mild) as assessed by an independent angiographic core laboratory. Major ischemic and bleeding outcomes were assessed at 30 days and 1 year. Severe calcification was found in 103 patients (13.6%), moderate calcification in 249 patients (33.0%), and none-to-mild calcification in 403 patients (53.4%). The presence of severe calcification compared with moderate or none to mild was associated with a significantly higher unadjusted rate of death (11.8% vs 3.7% vs 4.5%, p = 0.006), death or myocardial infarction (MI; 31.1% vs 19.7% vs 16.4%, p = 0.006), and major adverse cardiac event (MACE; 32.0% vs 22.6% vs 20.8%, p = 0.059) at 1 year. By multivariate analysis, severe calcification (vs nonsevere calcification) was identified as an independent predictor of 1-year MACE (hazard ratio 1.49, 95% confidence interval 1.01 to 2.21, p = 0.04) and death or MI (hazard ratio 1.77, 95% confidence interval 1.18 to 2.66, p = 0.006). In conclusion, the presence of severe coronary calcification was associated with worse outcomes after CABG, including an increased risk of death. The presence of severe coronary calcification was identified as an independent predictor of MACE and death or MI 1 year after CABG. PMID:24012035

Ertelt, Konstanze; Généreux, Philippe; Mintz, Gary S; Reiss, George R; Kirtane, Ajay J; Madhavan, Mahesh V; Fahy, Martin; Williams, Mathew R; Brener, Sorin J; Mehran, Roxana; Stone, Gregg W

2013-12-01

369

Metoprolol treatment for two years after coronary bypass grafting: effects on exercise capacity and signs of myocardial ischaemia.  

PubMed Central

OBJECTIVE--To evaluate whether prophylactic treatment with metoprolol for two years after coronary artery bypass grafting improves working capacity and reduces the occurrence of myocardial ischaemia in patients with coronary artery disease. METHODS--After coronary artery bypass grafting, patients were randomised to treatment with metoprolol or placebo for two years. Two years after randomisation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise test in 618 patients (64% of all those randomised). RESULTS--The median exercise capacity was 140 W in the metoprolol group (n = 307) and 130 W in the placebo group (n = 311) (P > 0.20). An ST depression of > or = 1 mm at maximum exercise was present in 34% of the patients in the metoprolol group and 38% in the placebo group (P > 0.20) and an ST depression of > or = 2 mm at maximum exercise was present in 11% in the metoprolol group and 16% in the placebo group (P = 0.09). The median values for maximum systolic blood pressure were 200 mm Hg in the metoprolol group and 210 mm Hg in the placebo group (P < 0.0001), while the median values for maximum heart rate were 126 beats/min in the metoprolol group and 143 beats/min in the placebo group (P < 0.0001). The occurrence of cardiac and neurological clinical events two years postoperatively among exercised patients was comparable in the treatment groups. CONCLUSIONS--Treatment with metoprolol for two years after coronary artery bypass grafting did not significantly change exercise capacity or electrocardiographic signs of myocardial ischaemia.

Sjoland, H.; Caidahl, K.; Lurje, L.; Hjalmarson, A.; Herlitz, J.

1995-01-01

370

Effect of antegrade graft cardioplegia combined with passive graft perfusion in on-pump coronary artery bypass grafting.  

PubMed

Patients undergoing on-pump coronary artery bypass graft (CABG) with proximal graft anastomosis were randomly divided into groups that received antegrade cardioplegic infusion only via the aortic root (group A) or antegrade cardioplegic infusion via the aortic root and additional cardioplegia via vein or free arterial grafts after completion of each distal anastomosis (group B). The group B patients also received bypass graft perfusion with warm arterial blood just after removal of the cross-clamp until the proximal graft anastomosis was completed. The need for defibrillation and inotropic support during separation from cardiopulmonary bypass (CPB), and total CPB time were significantly lower in group B than in group A. Group B also had significantly lower peak cardiac troponin I levels 12 h after operation compared with group A and this was more pronounced in subgroups with severe right coronary artery stenosis and poor left ventricular ejection fraction than in the whole population. It is concluded that antegrade graft cardioplegia and graft perfusion with warm blood during proximal graft anastomosis may improve myocardial protection. PMID:20926006

Goncu, M T; Sezen, M; Toktas, F; Ari, H; Gunes, M; Tiryakioglu, O; Yavuz, S

2010-01-01

371

Pain Location and Intensity During the First Week Following Coronary Artery Bypass Graft Surgery  

PubMed Central

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.

Totonchi, Ziae; Seifi, Somayeh; Chitsazan, Mitra; Alizadeh Ghavidel, Alireza; Baazm, Farah; Faritus, Seyedeh Zahra

2013-01-01

372

Sedative Efficacy of Propofol in Patients Intubated/Ventilated after Coronary Artery Bypass Graft Surgery  

PubMed Central

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.

Aghdaii, Nahid; Yazdanian, Frouzan; Faritus, Seyedeh Zahra

2014-01-01

373

Does off-pump coronary artery bypass surgery have a beneficial effect on mortality in patients with left ventricular dysfunction?  

PubMed Central

A best evidence topic was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass surgery (OPCAB) offered any beneficial effect on mortality when compared with on-pump coronary artery bypass surgery (ONCAB) in patients with left ventricular dysfunction (LVD). A total of 491 papers were found using the reported searches of which 17 represented the best evidence. The authors, date, journal, study type, outcome measures and results are tabulated. The 17 studies (only containing patients with LVD) comprised of one prospective randomized trial, one meta-analysis and 15 retrospective studies. The prospective trial associated the OPCAB technique with significantly lower in-hospital mortality. By comprising of seven studies and 1512 patients, the meta-analysis showed no significant difference in terms of operative mortality. Of the retrospective studies, all 15 compared short-term mortality (<30-day) of which four showed significantly lower mortality in the OPCAB group. Nine of the studies compared mid-term mortality (30 days to 5 years) with no significant difference detected and three of the studies compared long-term mortality (>5 years) with no significant difference detected. We conclude that there is limited evidence to associate the OPCAB technique with improved short-term mortality. The majority of the studies suffered from significant limitations such as containing data from operations carried out prior to the year 2000, a period when off-pump surgery was in its infancy. They frequently contained major differences in baseline characteristics with no specific inclusion/exclusion criteria, description of handling of patients converted from off-pump to bypass or reporting of myocardial viability and concomitant mitral regurgitation. Nine studies reported completeness of revascularization of which eight associated the OPCAB group with a poorer degree of revascularization making comparisons less valid. The lack of high-quality data indicates that prospective randomized trials are needed. The CRISP Trial (‘Coronary artery grafting in high-risk patients randomized to off-pump or on-pump surgery’) has recently been halted due to recruitment difficulties. The CORONARY (‘Coronary artery bypass surgery off- or on-pump revascularization study’) trial is a large international multicentre randomized study that is recruiting well and is likely to provide valuable information in the near future.

Jarral, Omar A.; Saso, Srdjan; Athanasiou, Thanos

2012-01-01

374

Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-  

PubMed Central

Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage.

Lee, Choon Soo; Yoon, Yeo Sam; Shim, Jae-Kwang

2013-01-01

375

Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-.  

PubMed

Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage. PMID:24427464

Lee, Choon Soo; Yoon, Yeo Sam; Shim, Jae-Kwang; Lim, Hyun Kyoung

2013-12-01

376

Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Coronary Artery Disease. Executive Summary. Effective Health Care Program Research Report No. 9.  

National Technical Information Service (NTIS)

Atherosclerosis develops in a patchy, discontinuous fashion within coronary arteries. Therefore, it is possible to treat the discrete areas of obstruction that most impede coronary blood flow to the myocardium. The mechanical approaches to coronary revasc...

2007-01-01

377

NURSES' PERCEPTIONS OF QUALITY NURSING CARE PROVIDED TO POST PROCEDURE ELECTIVE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY PATIENTS  

Microsoft Academic Search

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

378

Intraoperative administration of clevidipine to prevent vasospasm after radial and internal mammary artery grafts during coronary artery bypass grafting.  

PubMed

During coronary artery bypass graft surgery, various arterial and venous conduits have been used to carry blood flow from the aorta to the coronary vasculature. Arterial conduits provide certain advantages over the saphenous vein, including superior long-term patency, relative resistance to the development of atherosclerosis, and greater endothelium-dependent relaxation. However, the perioperative release of catecholamines and thromboxane A, mechanical manipulation, and underlying endothelial cell dysfunction may result in vasoconstriction or vasospasm of the arterial conduit and a compromise of myocardial perfusion. Given these issues, pharmacologic therapy is frequently initiated intraoperatively to prevent vasospasm. Clevidipine is a rapidly acting calcium channel antagonist. Like nicardipine, it is a member of the dihydropyridine subgroup. Its rapid metabolism by tissue and plasma esterases results in an effective half-life of 1 to 3 minutes. We report, for the first time, the perioperative use of clevidipine to prevent vasospasm after coronary artery bypass graft surgery with the use of internal mammary artery and bilateral radial artery conduits. Its potential application in this scenario and advantages when compared with other commonly used agents is discussed. PMID:20634670

Patel, Mitesh; Meyer, Thomas; Tharakan, Ajit; Tobias, Joseph D

2012-05-01

379

Edifoligide and Long-Term Outcomes After Coronary Artery Bypass Grafting: PREVENT IV 5-Year Results  

PubMed Central

Background Edifoligide, an E2F transcription factor decoy, does not prevent vein graft failure or adverse clinical outcomes at 1-year in patients undergoing coronary artery bypass grafting (CABG). We compared the 5-year clinical outcomes of patients in PREVENT IV treated with edifoligide and placebo and to identify predictors of long-term clinical outcomes. Methods A total of 3014 patients undergoing CABG with at least 2 planned vein grafts were enrolled. Kaplan-Meier curves were generated to compare the long-term effects of edifoligide and placebo. A Cox proportional hazards model was constructed to identify factors associated with 5-year post-CABG outcomes. The main outcome measure was death, myocardial infarction (MI), repeat revascularization, and rehospitalization through 5 years. Results Five-year follow-up was complete in 2865 (95.1%) patients. At 5 years, patients randomized to edifoligide and placebo had similar rates of death (11.7% and 10.7%), MI (2.3% and 3.2%), revascularization (14.1% and 13.9%), and rehospitalization (61.6% and 62.5%). The 5-year composite outcome of death, MI, or revascularization occurred at similar frequency in patients assigned to edifoligide and placebo (26.3% and 25.5%; hazard ratio 1.03 [95% confidence interval 0.89–1.18]; P=0.721). Factors associated with death, MI, or revascularization at 5 years included diabetes, sex, worst graft quality, peri-index CABG MI, and ejection fraction. Conclusions Up to a quarter of patients undergoing CABG will have a major cardiac event or repeat revascularization procedure within 5 years of surgery. Edifoligide does not affect outcomes following CABG; however, common identifiable baseline and procedural risk factors are associated with long-term outcomes following CABG.

Lopes, Renato D.; Williams, Judson B.; Mehta, Rajendra H.; Reyes, Eric M.; Hafley, Gail E.; Allen, Keith B.; Mack, Michael J.; Peterson, Eric D.; Harrington, Robert A.; Gibson, C. Michael; Califf, Robert M.; Kouchoukos, Nicholas T.; Ferguson, T. Bruce; Lorenz, Todd J.; Alexander, John H.

2013-01-01

380

Preoperative statin is associated with decreased operative mortality in high risk coronary artery bypass patients  

PubMed Central

Background Statins are widely prescribed to patients with atherosclerosis. A retrospective database analysis was used to examine the role of preoperative statin use in hospital mortality, for patients undergoing isolated coronary artery bypass grafting (CABG.) Methods The study population comprised 2377 patients who had isolated CABG at Allegheny General Hospital between 2000 and 2004. Mean age of the patients was 65 ± 11 years (range 27 to 92 years). 1594 (67%) were male, 5% had previous open heart procedures, and 4% had emergency surgery. 1004 patients (42%) were being treated with a statin at the time of admission. Univariate, bivariate (Chi2, Fisher's Exact and Student's t-tests) and multivariate (stepwise linear regression) analyses were used to evaluate the association of statin use with mortality following CABG. Results Annual prevalence of preoperative statin use was similar over the study period and averaged 40%. Preoperative clinical risk assessment demonstrated a 2% risk of mortality in both the statin and non-statin groups. Operative mortality was 2.4% for all patients, 1.7% for statin users and 2.8% for non-statin users (p < 0.07). Using multivariate analysis, lack of statin use was found to be an independent predictor of mortality in high-risk patients (n = 245, 12.9% vs. 5.6%, p < 0.05). Conclusions Between 2000 and 2004 less than 50% of patients at this institution were receiving statins before admission for isolated CABG. A retrospective analysis of this cohort provides evidence that preoperative statin use is associated with lower operative mortality in high-risk patients.

2010-01-01

381

Risk Factors of Red Blood Cell Transfusion in Isolate off Pump Coronary Artery Bypass Surgery  

PubMed Central

Background Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly. Materials and Methods One hundred and thirteen patients (male:female=35:78, mean age=66.7±9.9 years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery. Results Sixty-five patients (47.5%) received the RBC transfusion (mean 2.2±3.2 units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p<0.05). In multivariate analysis, patients risk factors for RBC transfusion were preoperative low hematocrit (<37.5%) and clopidogrel medication. Surgical risk factors were longer graft harvesting time (>75 minutes) and total operation time (>5.5 hours, p<0.05). Conclusion We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.

Chung, Eui Suk; Lim, Cheong; Choi, Jinho

2012-01-01

382

Use of blood products and risk of stroke after coronary artery bypass surgery  

PubMed Central

Background The impact of blood transfusion on the development of post-operative stroke after coronary artery bypass grafting (CABG) is not well established. We, therefore, investigated this issue. Materials and methods. Complete data on peri-operative blood transfusion were available for 2,226 patients who underwent CABG in three Finnish hospitals. Results Stroke occurred post-operatively in 53 patients (2.4%). Logistic regression showed that pre-operative creatinine (OR 1.003, 95% CI 1.000–1.006), extracardiac arteriopathy (OR 2.344, 95% CI 1.133–4.847), pre-operative atrial fibrillation (OR 2.409, 95% CI 1.149–5.052), and the number of packed red blood cell units transfused (OR 1.121, 95% CI 1.065–1.180) were significantly associated with post-operative stroke. When the various blood product transfusions instead of transfused units were included in the multivariable analysis, solvent/detergent treated plasma (Octaplas®) transfusion (OR 2.149, 95% CI 1.141–4.047), but not red blood cell transfusion, was significantly associated with postoperative stroke. Use of blood products ranging from no transfusion (stroke rate 1.6%) to combined transfusion of red blood cells, platelets and Octaplas® was associated with a significant increase in post-operative stroke incidence (6.6%, adjusted analysis: OR 1.727, 95% 1.350–2.209). Patients who received >2 units of red blood cells, >4 units of Octaplas® units and >8 units of platelets had the highest stroke rate of 21%. CART analysis showed that increasing amount of transfused Octaplas®, platelets and history of extracardiac arteriopathy were significantly associated with post-operative stroke. Conclusions Transfusion of blood products after CABG has a strong, dose-dependent association with the risk of stroke. The use of Octaplas® and platelet transfusions seem to have an even larger impact on the development of stroke than red blood cell transfusions.

Mikkola, Reija; Gunn, Jarmo; Heikkinen, Jouni; Wistbacka, Jan-Ola; Teittinen, Kari; Kuttila, Kari; Lahtinen, Jarmo; Juvonen, Tatu; Airaksinen, Juhani KE; Biancari, Fausto

2012-01-01

383

Coronary artery bypass grafting in Canada: What is its rate of use? Which rate is right?  

PubMed Central

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.

Naylor, C D; Ugnat, A M; Weinkauf, D; Anderson, G M; Wielgosz, A

1992-01-01

384

Perioperative outcomes after on- and off-pump coronary artery bypass grafting.  

PubMed

Although numerous reports describe the results of off-pump coronary artery bypass grafting (CABG) at specialized centers and in select patient populations, it remains unclear how off-pump CABG affects real-world patient outcomes. We conducted a large, multicenter observational cohort study of perioperative death and morbidity in on-pump (ON) versus off-pump (OFF) CABG. We reviewed Veterans Affairs Surgical Quality Improvement Program data for all patients (N=65,097) who underwent isolated CABG from October 1997 through April 2011 (intention-to-treat data were available from 2005 onward). The primary outcome was perioperative (30-day or in-hospital) death; the secondary outcomes were perioperative stroke, dialysis dependence, reoperation for bleeding, mechanical circulatory support, myocardial infarction, ventilator support ?48 hr, and mediastinitis. Propensity scores calculated from age, 17 preoperative risk factors, and year of surgery were used to match 8,911 OFF with 26,733 ON patients. In the complete cohort, compared with the ON patients (n=53,468), the OFF patients (n=11,629) had less perioperative death (2.02% vs 2.53%, P=0.0012) and lower incidences of all morbidities except perioperative myocardial infarction. In the matched cohort, perioperative death did not differ significantly between OFF and ON patients (1.94% vs 2.28%, P=0.06), but the OFF group had lower incidences of all morbidities except for perioperative myocardial infarction and mediastinitis. A subgroup intention-to-treat analysis yielded similar but smaller outcome differences between the ON and OFF groups. Off-pump CABG might be associated with decreased operative morbidity but did not affect operative death, compared with on-pump CABG. Future studies should examine the effect of off-pump CABG on long-term outcomes. PMID:24808773

Bakaeen, Faisal G; Chu, Danny; Kelly, Rosemary F; Holman, William L; Jessen, Michael E; Ward, Herbert B

2014-04-01

385

Effect of Obesity on Mortality and Morbidity After Coronary Artery Bypass Grafting Surgery in Iranian Patients  

PubMed Central

Background: Recent years have witnessed the emergence of obesity as a major public health concern. The drastic rise in obesity and its concomitant co-morbidities is a reflection of the recent changes in dietary habits in Iran and many other developing countries. A recent large population study in Tehran reported that 58% and 75% of middle-aged Iranian men and women, respectively, were either overweight or obese. Objectives: Considering the impact of obesity on mortality and morbidity after coronary artery bypass graft surgery (CABG), we sought to investigate the association between central obesity and the body mass index (BMI) and the post-CABG mortality and morbidity in Iranian patients. Patients and Methods: This prospective study was on 235 adult patients scheduled for isolated CABG in a university hospital. The patients were divided in two groups according to BMI ? 30 (obese; n = 60) and BMI < 30 (non-obese; n = 175). In-hospital and late (after 3 months) morbidity and mortality rates were compared between obese and non-obese patients. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.2 years (range = 29 to 79 years), mean BMI of 27.3 ± 4.2 (range = 17 to 40), and mean waist circumference of 101.2 ± 14.7 cm (range = 55 to 145 cm) were included. By the third postoperative month, wound infection had significantly increased in patients with BMI ? 30 (P = 0.022). In-hospital and late morbidity and mortality rates were comparable between the two groups (P > 0.05). Conclusions: In our patients obesity was a risk factor for wound infection but not atelectasis or the need for intra-aortic balloon pump or re-exploration. Obesity was not associated with increased in-hospital or 3 months mortality rates after CABG.

Ardeshiri, Maryam; Faritous, Zahra; Ojaghi Haghighi, Zahra; Hosseini, Shirin; Baghaei, Ramin

2014-01-01

386

Sustained supraventricular tachyarrhythmias following coronary artery bypass surgery comparing mammary versus saphenous vein grafts.  

PubMed

This retrospective study was designed to determine the incidence of sustained supraventricular tachyarrhythmias (SVTs) in patients undergoing coronary artery bypass grafting (CABG) with internal mammary artery (IMA) grafts, Group A, compared with those with saphenous vein grafts (SVG), Group B. Among 569 consecutive patients who underwent CABG surgery in the same institution, a total of 80 cases from Group A and 80 cases from Group B were selected for this study after application of exclusion criteria. Excluded from this study were the following: patients with preexisting or prior history of SVTs, significant left ventricular dysfunction (ejection fraction less than 40%), postoperative myocardial infarction, drug toxicity or electrolyte imbalance, and advanced chronic obstructive lung disease. Group A consisted of 63 men and 17 women and Group B consisted of 52 men and 28 women. All patients were monitored either in ICU or by telemetry for a period of three to six days after surgery and all had a predischarge 12-lead electrocardiogram. Both groups were fairly comparable in most of their clinical profile and number of grafts. The incidence of SVTs in Group A was 31% (25 of 80 patients) and in Group B was 24% (19 of 80 patients). Furthermore, the incidence of postoperative pericarditis was noted in 35% (28 of 80 patients) of Group A and in 19% (15 of 80 patients) in Group B. The authors conclude that male tobacco smokers of Group A tended to have a significantly higher incidence of postoperative pericarditis with a higher trend for postoperative SVTs than patients from Group B. PMID:2042791

Salem, B I; Chaudhry, A; Haikal, M; Gowda, S; Campbell, A; Coordes, C; Leidenfrost, R

1991-06-01

387

Perioperative Outcomes after On- and Off-Pump Coronary Artery Bypass Grafting  

PubMed Central

Although numerous reports describe the results of off-pump coronary artery bypass grafting (CABG) at specialized centers and in select patient populations, it remains unclear how off-pump CABG affects real-world patient outcomes. We conducted a large, multicenter observational cohort study of perioperative death and morbidity in on-pump (ON) versus off-pump (OFF) CABG. We reviewed Veterans Affairs Surgical Quality Improvement Program data for all patients (N=65,097) who underwent isolated CABG from October 1997 through April 2011 (intention-to-treat data were available from 2005 onward). The primary outcome was perioperative (30-day or in-hospital) death; the secondary outcomes were perioperative stroke, dialysis dependence, reoperation for bleeding, mechanical circulatory support, myocardial infarction, ventilator support ?48 hr, and mediastinitis. Propensity scores calculated from age, 17 preoperative risk factors, and year of surgery were used to match 8,911 OFF with 26,733 ON patients. In the complete cohort, compared with the ON patients (n=53,468), the OFF patients (n=11,629) had less perioperative death (2.02% vs 2.53%, P=0.0012) and lower incidences of all morbidities except perioperative myocardial infarction. In the matched cohort, perioperative death did not differ significantly between OFF and ON patients (1.94% vs 2.28%, P=0.06), but the OFF group had lower incidences of all morbidities except for perioperative myocardial infarction and mediastinitis. A subgroup intention-to-treat analysis yielded similar but smaller outcome differences between the ON and OFF groups. Off-pump CABG might be associated with decreased operative morbidity but did not affect operative death, compared with on-pump CABG. Future studies should examine the effect of off-pump CABG on long-term outcomes.

Bakaeen, Faisal G.; Chu, Danny; Kelly, Rosemary F.; Holman, William L.; Jessen, Michael E.; Ward, Herbert B.

2014-01-01

388

Screening preoperative Peptide biomarkers for predicting postoperative myocardial infarction after coronary artery bypass grafting.  

PubMed

Postoperative myocardial infarction (PMI) is one of the most serious complications of cardiac surgeries. No preoperative biomarker is currently available for predicting PMI after cardiac surgeries. In the present study, we used a phage display peptide library to screen potential preoperative peptide biomarkers for predicting PMI after coronary artery bypass grafting (CABG) surgery. Twenty patients who developed PMI after CABG and 20 age-, sex-, and body mass index-matched patients without PMI after CABG were enrolled as a discovery cohort. Another 50 patients who developed PMI after CABG and 50 randomly selected patients without PMI after CABG were enrolled as a validation cohort to validate the potential peptide biomarkers identified in the discovery cohort. Fifty randomly selected healthy volunteers were also enrolled in the validation phase as a healthy control group. In the discovery/screening phase, 17 out of 20 randomly selected phage clones exhibited specific reaction with purified sera IgG from the PMI group, among which 11 came from the same phage clone with inserted peptide sequence GVIMVIAVSCVF (named PMI-1). In the validation phase, phage ELISA showed that serum IgG from 90% of patients in the PMI group had a positive reaction with PMI-1; in contrast, only 14% and 6% of patients in the non-PMI group and the healthy control group had a positive reaction with PMI-1, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the PMI-1 phage clone to preoperatively identify patients who would develop PMI after CABG were 90.0%, 86.0%, 86.5, 89.5% and 88.0%, respectively. The absorbance value of the PMI-1 phage clone showed statistically significant correlation with the peak postoperative serum cardiac troponin I level (r?=?0.349, p?=?0.012) in the PMI group. In conclusion, we for the first time identified a mimic peptide (PMI-1) with high validity in preoperative prediction of PMI after CABG. PMID:24979051

Jiang, Zhibin; Hu, Ping; Liu, Jianxin; Wang, Dianjun; Jin, Longyu; Hong, Chao

2014-01-01

389

Cryopreservation of veins as an alternative to autografts in coronary by-pass grafting.  

PubMed

Cryopreserved venous segments could be used as allografts in coronary by-pass surgery in patients with limited availability of venous or arterial conduits for autologous grafting. After primarily disappointing clinical results it was the aim of these experiments to improve freezing procedure and incubation media in order to maintain most of the functional integrity of the biological material after cryopreservation, and thus to contribute to the essential prerequisites for a successful implantation. Freshly prepared segments of human saphenous vein were cryopreserved: 1) using various computer-assisted freezing programs with definite cooling rates and seeding temperatures; 2) after incubation in media consisting of RPMI 1640 and cryoprotective agents in different combinations and concentrations. The veins were stored at -196 degrees C, thawed quickly and analyzed in an in vitro perfusion system. The degree of vitality of the vein segments was assessed by measuring vasoconstriction after application of Norepinephrine and Serotonine and vasodilatation following release of endothelium-derived relaxing factor (EDRF) after perfusion with Acetylcholine. Our results show that the preservation of vascular smooth muscle can be maintained only by: 1) equilibrating the vein in RPMI 1640 with 2.2 M Glycerol and 1.6 M Ethylene-Glycol and 2) preventing an increase of temperature during the crystallization in the cooling process. The results clearly demonstrate the maintainance of vitality in vein segments after an appropriate freezing and equilibration process with specific cryoprotective agents. The data obtained in the study could serve as the basis for a better longterm prognosis of transplanted cryopreserved venous allografts. PMID:7775546

Korb, H; Borowski, A; Esbati, A; Schlesinger, U; Dhein, S

1994-12-01

390

Screening Preoperative Peptide Biomarkers for Predicting Postoperative Myocardial Infarction after Coronary Artery Bypass Grafting  

PubMed Central

Postoperative myocardial infarction (PMI) is one of the most serious complications of cardiac surgeries. No preoperative biomarker is currently available for predicting PMI after cardiac surgeries. In the present study, we used a phage display peptide library to screen potential preoperative peptide biomarkers for predicting PMI after coronary artery bypass grafting (CABG) surgery. Twenty patients who developed PMI after CABG and 20 age-, sex-, and body mass index-matched patients without PMI after CABG were enrolled as a discovery cohort. Another 50 patients who developed PMI after CABG and 50 randomly selected patients without PMI after CABG were enrolled as a validation cohort to validate the potential peptide biomarkers identified in the discovery cohort. Fifty randomly selected healthy volunteers were also enrolled in the validation phase as a healthy control group. In the discovery/screening phase, 17 out of 20 randomly selected phage clones exhibited specific reaction with purified sera IgG from the PMI group, among which 11 came from the same phage clone with inserted peptide sequence GVIMVIAVSCVF (named PMI-1). In the validation phase, phage ELISA showed that serum IgG from 90% of patients in the PMI group had a positive reaction with PMI-1; in contrast, only 14% and 6% of patients in the non-PMI group and the healthy control group had a positive reaction with PMI-1, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the PMI-1 phage clone to preoperatively identify patients who would develop PMI after CABG were 90.0%, 86.0%, 86.5, 89.5% and 88.0%, respectively. The absorbance value of the PMI-1 phage clone showed statistically significant correlation with the peak postoperative serum cardiac troponin I level (r?=?0.349, p?=?0.012) in the PMI group. In conclusion, we for the first time identified a mimic peptide (PMI-1) with high validity in preoperative prediction of PMI after CABG.

Jiang, Zhibin; Hu, Ping; Liu, Jianxin; Wang, Dianjun; Jin, Longyu; Hong, Chao

2014-01-01

391

Evaluating the relative frequency and predicting factors of acute renal failure following coronary artery bypass grafting  

PubMed Central

BACKGROUND Renal dysfunction or acute renal failure in patients undergoing coronary artery bypass grafting (CABG) is an important cause of morbidity and mortality. The great impact of acute renal failure (ARF) in the outcomes of cardiac surgery demands its study in our population, encouraging to the elaboration of this study, which aimed to identify the incidence and risk factors of ARF after CABG. METHODS Since March 2010 to 2011, 589 patients were studied who underwent CABG in Sina Hospital (Isfahan, Iran). In this cross-sectional study, patients were divided into two groups based on the occurrence of ARF after CABG and measured variables were compared between the two groups was also statistically significant. P value less than 0.05 was set as a significant level. RESULTS A total of 434 men and 155 women were enrolled in the study. The mean age of the study subjects was 57.6 years. ARF was seen in about 22% of patients after CABG. The mean age of ARF group was more than 3 years higher than that in the other group and the difference was significant between the two groups. Serum creatinine level after the surgery was different between the two groups. Moreover, the history of diabetes mellitus was significantly different between the two groups. Pump time comparison also showed was also statistically significant. CONCLUSION Our data showed older patients were more prone to affected by ARF. In addition, diabetic patients should be considered as high risk patients and are more likely to deteriorate by ARF. Despite increased prevalence of renal insufficiency in CABG patients, studies show that in most cases, this is not a serious problem and it is easily treatable. A lower proportion of patients (1.0 to 1.7% in different large series) develop ARF severe enough to require dialysis.

Mirmohammad-Sadeghi, Mohsen; Naghiloo, Ali; Najarzadegan, Mohammad Reza

2013-01-01

392

Is single-unit blood transfusion bad post-coronary artery bypass surgery?†  

PubMed Central

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.

Warwick, Richard; Mediratta, Neeraj; Chalmers, John; Pullan, Mark; Shaw, Matthew; Mcshane, James; Poullis, Michael

2013-01-01

393

Effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery: A meta-analysis  

PubMed Central

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.

FANG, YU; QIU, ZHANDONG; HU, WENTAO; YANG, JIA; YI, XIYAN; HUANG, LIANGJIANG; ZHANG, SUMING

2014-01-01

394

The Short Saphenous Vein: A Viable Alternative Conduit for Coronary Artery Bypass Grafts Harvested Using a Novel Technical Approach  

PubMed Central

A multitude of vascular conduits are available to the Cardiac Surgeon performing Coronary Artery Bypass Graft operations. The Internal Mammary Artery, Radial Artery (RA), and the Long Saphenous Vein (LSV) have proven to be excellent conduits, especially in the current era of statin usage. However, previous stripping or varicosities of the LSV and calcification of the RA, coupled with the need for multiple vessel grafting, requires an alternative candidate. We describe a novel harvesting technique for bilateral simultaneous Short Saphenous Vein harvest and propose this, often forgotten vein, as a viable alternative conduit.

Sarwar, Umran; Chetty, Govind; Sarkar, Pradip

2012-01-01

395

Monitoring cardiac output trends with end-tidal carbon dioxide pressures in off-pump coronary bypass.  

PubMed

The optimum method of intraoperative monitoring in patients undergoing off-pump coronary bypass remains debatable. Using capnography and end-tidal carbon dioxide pressure may be a helpful method of monitoring cardiac output trends, especially when grafting posterior and lateral vessels. After repositioning the heart, End-tidal carbon dioxide pressures that continue to trend down usually indicate decreased cardiac output and precede hemodynamic and electrical instability. The advantages of this method include simplicity, universal availability, and a short response time to changes in cardiac output. PMID:21524440

Saleh, Hesham Z; Pullan, D Mark

2011-05-01

396

Coronary vascular resistance increases under full bypass support of centrifugal pumps--relation between myocardial perfusion and ventricular workload during pump support.  

PubMed

Coronary circulation is closely linked to myocardial oxygen consumption (MVO(2)), and previous reports have suggested decreased coronary flow (CoF) under left ventricular assist device support. Decreased CoF itself under support is not unfavorable because the native heart can be well unloaded and myocardial oxygen demand is also decreased. There should be an autoregulatory system that would maintain optimal CoF according to oxygen demand; however, the detailed mechanism is still unclear. The aim of the current study is to evaluate the effect of centrifugal pumps on CoF under varied bypass rates in relation to left ventricle workload. A centrifugal pump, EVAHEART (Sun Medical Technology Research Corporation, Nagano, Japan), was installed in an adult goat (n = 10, 61.3 ± 6.5 kg). We set up the following conditions, including Circuit-Clamp (i.e., no pump support), 50% bypass, and 100% bypass. In these settings, CoF, MVO(2), pressure-volume area (PVA), and coronary vascular resistance (CVR) were measured. In 100% bypass, CoF, MVO(2), and PVA were all decreased significantly from clamp. While in 50% bypass, CoF and MVO(2) decreased from clamp, but not PVA. There was a significant 40% increase in CVR in 100% bypass from clamp. This CVR increase in 100% bypass was possibly due to mechanical collapse of coronary vascular bed itself by pump support or increased vascular tone through autoregulatory system. In clinical settings, we should adjust optimal pump speed so as not to cause this vascular collapse. However, to clarify autoregulatory system of the coronary perfusion, further investigation is ongoing in ischemic and heart failure models. PMID:21848933

Ando, Masahiko; Takewa, Yoshiaki; Nishimura, Takashi; Yamazaki, Kenji; Kyo, Shunei; Ono, Minoru; Tsukiya, Tomonori; Mizuno, Toshihide; Taenaka, Yoshiyuki; Tatsumi, Eisuke

2012-01-01

397

Evaluation of the Effect of Elective Percutaneous Coronary Intervention as a Treatment Method on the Left Ventricular Diastolic Dysfunction in Patients with Coronary Artery Disease  

PubMed Central

Background Although percutaneous coronary intervention (PCI) is an excellent therapy for coronary artery disease, there is a paucity of information on the efficacy of PCI in improving diastolic function, especially in Iran. Because of the high prevalence of left diastolic dysfunction in coronary artery disease patients and its probable progression to heart failure, an evaluation of the role of PCI in improving diastolic function is required. Methods Thirty patients scheduled for elective PCI were enrolled in this study providing that their systolic ejection fraction was > 40%. Before PCI and 48 hours and 3 months after PCI, echocardiography was done to evaluate some diastolic values in these patients. Results The mean age of all the patients was 54 ± 10 year, and 20 patients were male. All the patients had a low degree of left ventricular diastolic dysfunction. Isovolumic relaxation time (115 ± 10 before treatment versus 120 ± 1 and 119 ± 3 respectively 48 hours and 3 months after treatment), mitral E wave velocity in septal (0.70 ± 0.05 before treatment vs. 0.71 ± 0.15 and 0.72 ± 0.12 respectively 48 hours and 3 months after treatment), and the peak velocity of late filling due to atrial contraction (mitral A wave velocity) in septal (0.74 ± 0.02 before treatment vs. 0.73 ± 0.01 and 0.68 ± 0.16 respectively 48 hours and 3 months after treatment) showed improvement after PCI. It is notable that early diastolic mitral annulus velocity (E?) wave velocity in the septal part of the mitral annulus improved significantly 48 hours and 3 months after PCI (p value < 0.05). The early-to-late diastolic tissue velocity ratio of the mitral annulus (E/A) ratio of the mitral inflow improved 48 hours after PCI; it was statistically significant (p value = 0.05). Also, mitral A wave velocity in septal and the E/A ratio of the mitral inflow improved significantly 3 months after PCI (p value < 0.05). Conclusion Improvement in some of values related to left ventricular diastolic function followed by PCI shows that this method can be used to improve cardiac diastolic function in patients with symptomatic coronary artery disease.

Hashemi, Seyed Reza; Motamedi, Mohammadreza; Khani, Mohammad; Hekmat, Manouchehr; Gachkar, Latif; Rezaeefar, Atieh

2010-01-01

398

Impact of dual antiplatelet therapy on outcomes among aspirin-resistant patients following coronary artery bypass grafting.  

PubMed

Coronary artery bypass grafting is pivotal in the contemporary management of complex coronary artery disease. Interpatient variability to antiplatelet agents, however, harbors the potential to compromise the revascularization benefit by increasing the incidence of adverse events. This study was designed to define the impact of dual antiplatelet therapy (dAPT) on clinical outcomes among aspirin-resistant patients who underwent coronary artery surgery. We randomly assigned 219 aspirin-resistant patients according to multiple electrode aggregometry to receive clopidogrel (75 mg) plus aspirin (300 mg) or aspirin-monotherapy (300 mg). The primary end point was a composite outcome of all-cause death, nonfatal myocardial infarction, stroke, or cardiovascular hospitalization assessed at 6 months postoperatively. The primary end point occurred in 6% of patients assigned to dAPT and 10% of patients randomized to aspirin-monotherapy (relative risk 0.61, 95% confidence interval 0.25 to 1.51, p = 0.33). No significant treatment effect was noted in the occurrence of the safety end point. The total incidence of bleeding events was 25% and 19% in the dAPT and aspirin-monotherapy groups, respectively (relative risk 1.34, 95% confidence interval 0.80 to 2.23, p = 0.33). In the subgroup analysis, dAPT led to lower rates of adverse events in patients with a body mass index >30 kg/m(2) (0% vs 18%, p <0.01) and those <65 years (0% vs 10%, p = 0.02). In conclusion, the addition of clopidogrel in patients found to be aspirin resistant after coronary artery bypass grafting did not reduce the incidence of adverse events, nor did it increase the number of recorded bleeding events. dAPT did, however, lower the incidence of the primary end point in obese patients and those <65 years. PMID:24666617

Gasparovic, Hrvoje; Petricevic, Mate; Kopjar, Tomislav; Djuric, Zeljko; Svetina, Lucija; Biocina, Bojan

2014-05-15

399

Increase in serum cardiac myosin light chain I associated with elective percutaneous transluminal coronary angioplasty in patients with ischemic heart disease  

Microsoft Academic Search

Changes in serum myosin light chain I (MLCI) due to elective percutaneous transluminal coronary angioplasty (PTCA) were studied\\u000a after PTCA (0, 8 and 48 hours) in 57 patients with old myocardial infarction (MI group) and 20 patients with angina pectoris\\u000a (AP group). The AP group showed no increase after PTCA. In contrast, in the MI group there were 16 patients

Haruhito Tanaka; Kohshi Gotoh; Yasuo Yagi; Tsutomu Tanaka; Kazuya Yamashita; Takahiko Suzuki; Senri Hirakawa

1992-01-01

400

Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature  

PubMed Central

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.

Gardner, Jonathan D.; Maddox, William R.; Calkins, Joe B.

2012-01-01

401

Variability in cost of coronary bypass surgery in New York State: Potential for cost savings  

Microsoft Academic Search

Objective Previous analyses of variability in bypass resource use have not focused on hospital-level variation or adequately explored the influence of patient risk. We combined a clinical database with claims data to fully characterize patient level and hospital level variability in bypass surgery cost and length of stay in New York State and explored the extent to which lower cost

Patricia A. Cowper; Elizabeth R. DeLong; Eric D. Peterson; Edward L. Hannan; Kevin T. Ray; Michael Racz; Daniel B. Mark

2002-01-01

402

The impact of blood use on patients undergoing coronary artery bypass surgery: a prospective study.  

PubMed

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

Lako, A; Bilali, S; Memishaj, S; Daka, A; Dedej, T; Nurka, T; Bilali, V; Gjylameti, V

2014-01-01

403

Evaluation of Revascularization Subtypes in Octogenarians Undergoing Coronary Artery Bypass Grafting  

PubMed Central

Background Recent data suggest that octogenarians’ long-term survival after complete CABG revascularization is superior to incomplete revascularization. Discriminating between variable definitions of “complete” complicates interpretation of survival data. We aimed to clarify octogenarian long-term survival rates by stratifying revascularization subtypes. Methods and Results From 1986 to 2007, 580 patients 80 to 94 years of age underwent CABG. Functional complete revascularization was defined as at least one graft to all diseased coronary vessels with greater than 50% stenosis. Traditional complete revascularization was defined as one graft to each major arterial system with at least 50% stenosis. Incomplete revascularization was defined as leaving diseased, ungrafted regions. Revascularization was functional in 279 (48%), traditional in 181 (31%), and incomplete in 120 (21%). Long-term survival was evaluated by Kaplan-Meier analysis. Of 537 operative survivors, there were 402 late deaths. Cumulative long-term survival totaled 2,890 patient-years. Late survival (Kaplan-Meier) was similar between functional (6.8 years, mean) and traditional (6.7 years) groups (p=0.51), but diminished with incomplete (4.2 years) revascularization (p=0.007). Survival by group at 5 years was: 59±3% functional, 57±4% traditional, and 45±5% incomplete. Survival at 8 years was: 40±3% functional, 37±4% traditional, and 26±5% incomplete. To minimize selection bias in patients with limited life expectancy, Kaplan-Meier analysis was repeated including only patients with survival greater than 12 months. Survival was again impaired with incomplete revascularization (p=0.04), and there was no difference between functional and traditional complete revascularization (p=0.73). Conclusions Bypassing all diseased arterial vessels after revascularization does not afford significant long-term survival advantage compared to a traditional approach. Incomplete revascularization, related to more extensive disease, is associated with an 18% decline in survival. These data suggest that it is important to avoid incomplete revascularization in octogenarians, but the supplementary endeavor required to perform functional complete revascularization does not improve survival.

Aziz, Abdulhameed; Lee, Anson M.; Pasque, Michael K.; Lawton, Jennifer S.; Moazami, Nader; Damiano, Ralph J.; Moon, Marc R.

2009-01-01

404

Risk factors for endotracheal re-intubation following coronary artery bypass grafting  

PubMed Central

Background Endotracheal re-intubation following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for re-intubation following CABG. This study aimed to evaluate the independent risk factors for re-intubation following CABG. Methods The pre-, intra-, and post-operative materials in patients who had selective and isolated CABG performed on them from January 2004 to July 2012 in our hospital were analyzed retrospectively. Unvariate analysis and logistic regression were used to analyze the risk factor of postoperative re-intubation following CABG. Results Among the 1,244 patients investigated, 97 cases suffered from postoperative re-intubation, and the incidence rate of postoperative re-intubation was 7.8%. The in-hospital mortality in the re-intubation group was significantly higher than that in the non-re-intubation group (9.3% versus 1.4%, P?=?0.004). Re-intubation also correlated with many negative outcomes such as pneumonia, tracheotomy, acute renal failure, infection of incision, prolonged mechanical ventilation time, prolonged intensive care unit (ICU) stay and prolonged hospital stay. The most commonly cause of re-intubation after CABG was hypoxemia due to cardiogenic and noncardiogenic disease, which accounted for 72.2%. The relative factors of postoperative re-intubation were tested through unvariate analysis and logistic regression, and the associated factors were obtained. The associated factors for re-intubation following CABG included preoperative chronic obstructive pulmonary disease (COPD) (OR?=?2.134, 95% CI?=?1.472-2.967), preoperative congestive heart failure (CHF) (OR?=?2.325, 95% CI?=?1.512-3.121), postoperative relative hypoxemia (OR?=?2.743, 95% CI?=?1.657-3.326), postoperative acute kidney injury (AKI) (OR?=?2.976, 95% CI?=?2.127-4.023), postoperative total mechanical ventilation time (OR?=?1.976, 95% CI?=?1.347-2.645). Conclusion Preoperative COPD, preoperative CHF, postoperative relative hypoxemia, postoperative AKI and postoperative total mechanical ventilation time were five independent risk factors for re-intubation following CABG.

2013-01-01

405

Surgical site infections following coronary artery bypass graft procedures: 10 years of surveillance data  

PubMed Central

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.

2014-01-01

406

[Immunocytochemical and ultrastructural study of saphenous vein, internal thoracic artery, and right gastroepiploic artery in coronary artery bypass grafting].  

PubMed

The arterial conduits such as internal thoracic artery (ITA) and right gastroepiploic artery (GEA) are widely used in coronary artery bypass surgery because of their resistance to atherosclerosis. In this study, immunophenotypes of smooth muscle cells (SMCs) in intima and media of ITA, GEA and saphenous vein (SV) were studied using monoclonal antibodies specific to cytoskeletal pr